Improvement after evaluation in psychotherapy of depression: evidence of a placebo effect?

Thirty-two patients were seen by psychiatry residents, psychology interns, and social work fellows who were learning cognitive therapy of depression. Of these, 23 patients attended sufficient sessions for early response to be categorized as responding or not responding. Rapid response was not associated with positive perception of the therapist by the patient, self-control scores, or patient collaboration as viewed by the therapist. The BDI score at intake was moderately predictive of the BDI score at session 6, but it did not predict percent improvement. However, depressive severity at the beginning of session one was strongly predictive of the sixth session BDI, and it also predicted percent improvement. Another predictor of response was improvement in mood in the first therapy session, as measured by the VAS. However, outcome variance explained by the VAS did not significantly add to outcome variance explained by the first session BDI. Results are interpreted as indicating that improvement may be due to (1) a powerful beneficial effect that originates within the patient-therapist matrix and independent of therapist techniques; or (2) a continuing improvement process that began prior to entering treatment.