Reasons for depression and the process and outcome of cognitive-behavioral psychotherapies

This study examined the relationships between clients' reasons for depression and the process and outcome of a cognitive therapy (CT) and a behavioral activation (BA) treatment for major depression. Reason giving was conceptualized as the tendency to offer multiple explanations for a problem. Different reasons for depression were also thought to match or mismatch the theoretical model underlying each treatment. Reasons for depression were assessed pretreatment with a previously developed questionnaire. Process variables including homework compliance and perceived treatment helpfulness were measured early in treatment. Results demonstrated that perceived helpfulness of the treatment was associated with positive outcomes in BA. Reason giving was associated with worse outcomes in BA. Specific reasons also predicted differential outcome in the 2 treatments. Clients who endorsed existential reasons for depression had better outcomes in CT and worse outcomes in BA. Relationship-oriented reasons were consistently associated with negative process and outcome in CT. Results are discussed in terms of the function of reason giving and the role of specific explanations for depression in treatment process and outcome.