The effects of cognitive behavior therapy on depression in older patients with cardiovascular risk

This study examined the effect of a cognitive behavior therapy (CBT) therapy intervention designed to reduce depression in older patients with elevated cardiovascular disease (CVD) risk. Forty-eight depressed patients with elevated CVD were randomized to a 16-week individual CBT intervention (n = 23) or a wait-list control (WLC) group (n = 25). Pre- and post-treatment measures of depression were obtained during office visits, and measures of positive and negative affect were obtained during laboratory psychological stress testing and at five points during the day. At post-treatment, the CBT subjects were significantly less depressed than WLC subjects on the Hamilton Depression Inventory (F = 52.8, P<.001, ES = 1.85) and the Beck Depression Inventory (F = 17.1, P = <.001, ES = 0.85). Fifty-seven percent (13/23) of subjects in the CBT treatment were considered to be in remission (on the basis of a clinical interview) at post compared to only 4% (1/25) in the WLC (chi(2) = 9.0, P =.003). Treatment subjects reported significantly less stress on the Perceived Stress Scale (F = 23.2, P<.001). CBT significantly improved mean positive affect during the day (F = 12.7, P =.0001) but there were no significant differences in mean negative affect (F = 1.8, P =.19). CBT significantly reduced negative affect (F = 7.1, P =.01) during psychological stress testing but did not affect positive affect. CBT is an effective treatment for reducing depression and increasing positive affect in patients at risk for CVD, but the results vary by time of measurement and measurement setting.