Change in Psychosocial Functioning During Cognitive Therapy for Depression
Dunn, Todd Wilson
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Major Depressive Disorder (MDD) is a highly prevalent and recurrent disorder that impairs peoples' work, relationships, and leisure activities. Cognitive Therapy (CT) improves this impairment in psychosocial functioning in adults with MDD, but questions remain as to how improvements occur both independently and in relation to depressive symptoms. To address this issue, the current study developed a theoretical framework based on social cognitive theory to conceptualize change in psychosocial functioning during CT and tested it with structural equation modeling. Using data from 470 patients undergoing acute-phase CT (A-CT) for MDD, results showed that: a) change in psychosocial functioning and depressive symptom severity occurred independently of each other, b) change in psychosocial functioning during the first month of A-CT partially mediated change in depressive symptom severity from treatment baseline to week seven of A-CT, and c) psychosocial functioning at week seven of A-CT significantly predicted subsequent depressive symptom severity. In terms of the theoretical framework, results suggested that when people with MDD were exposed to an environmental stimuli (i.e., acute-phase CT), change in their behavior (i.e., psychosocial functioning) partially mediated change in personal factors (i.e., depressive symptom severity) and not vice versa. By disentangling the sequence of change in psychosocial functioning and depressive symptom severity, this study pushed the field one step closer to understanding how A-CT treats the impairment in psychosocial functioning associated with MDD.