A study has revealed that moderate to severely depressed clients showed greater improvement in cognitive therapy when therapists emphasized changing how they thought rather than how they behaved.
The results suggest use of cognitive techniques to break out of negative thought patterns and to see events in their lives more realistically.
An attempt to change behaviour, such as getting the patient to get out of the house, and tracking how they spent their time was not very helpful.
"There has been a lot of attention recently on behavioural approaches to treating severe depression, and that may lead some people to suspect that cognitive techniques are not important for more severely depressed patients," said Daniel Strunk, co-author of the study and assistant professor of psychology at Ohio State University.
"But our results suggest that it was the cognitive strategies that actually helped patients improve the most during the first critical weeks of cognitive-behavioural therapy."
The study involved 60 patients who were diagnosed with major depression and who were being treated at two university clinics.
All the patients were being treated by one of six cognitive therapists and agreed to have their therapy sessions videotaped for study.
The tapes showed that that depression scores improved significantly when their therapists focused on cognitive techniques, but didn't change when their therapists focused on behavioural techniques.
Patients improved more when they collaborated with their therapists about a plan for treatment and followed that plan.
"We're trying to understand if cognitive therapy leads people to a profound change in their basic self view, or if it teaches them a set of skills that they have to continually practice over time," Strunk said.
Their results appear online in the journal Behaviour Research and Therapy and will appear in a later print edition.