Psychoeducational treatment and prevention of depression: The “coping with depression” course thirty years later
Introduction
Depressive disorders are highly prevalent (Kessler et al., 1994, ESEMED, 2004), have a high incidence (Waraich, Goldner, Somers, & Hsu, 2004), are associated with a substantial loss of quality of life in patients and their relatives (Ustun et al., 2004, Saarni et al., 2007), with increased mortality rates (Cuijpers & Smit, 2002), with high levels of service use, and with considerable economic costs (Berto et al., 2000, Greenberg and Birnbaum, 2005, Smit et al., 2006). Major depression is currently the fourth disorder worldwide in terms of disease burden, and it is expected to be the disorder with the highest disease burden in high-income countries by the year 2030 (Mathers & Loncar, 2006).
In the past decades, several effective treatments have become available for the treatment of depressive disorders, including pharmacological treatments (Anderson, 2001), electroconvulsive therapies (Pagnin, de Queiroz, Pini, & Cassano, 2004), and bright light therapy (Golden et al., 2005). A large body of research has shown that several types of psychotherapy are also effective in the treatment of depression, including cognitive behavior therapy (Gloaguen et al., 1998, Churchill et al., 2001), behavioral activation treatments (Cuijpers, van Straten, Warmerdam, 2007a), marital therapy (Barbato & D'Avanzo, 2006), problem-solving treatments (Cuijpers, van Straten, Warmerdam, 2007b), psychodynamic therapy (Leichsenring, 2001) and interpersonal psychotherapy (De Mello, De Jesus Mari, Bacaltchuk, Verdeli, & Neugebauer, 2005).
One of the most important types of psychological treatment for depression is the “Coping with Depression” course (CWD). The first version of this treatment was developed in the late 1970s by the last author of this paper (prof. Lewinsohn) and his associates. Since the publication of the manual (Lewinsohn, Antonuccio, Breckenridge, & Teri, 1984; Table 1), many other researchers and practitioners have used this course in the treatment, prevention and relapse prevention of depression in many target groups. The course materials have been translated into several languages, and the course is actively used in many countries, including the United States, Canada, Germany, Finland, Mexico, The Netherlands and Perú. The CWD is now one of the most widely available psychological treatments for depression worldwide and is one of the best studied psychological treatments of depression in general.
In this paper we will give an overview of this treatment method and the results of research examining the efficacy and effectiveness. First we will describe the characteristics of the CWD, and the possible uses of the course in research and practice. Then we will present a meta-analytic overview of the randomized controlled studies that have examined the effects of the CWD.
Section snippets
Characteristics of the CWD
The CWD is a cognitive behavioral intervention for depression with several specific characteristics. One important characteristic of the CWD is the psychoeducational approach. In a psychoeducational treatment the “patient” works through a standardized psychological treatment protocol more or less independently. The standardized psychological treatment protocol can be written down in book form, but it can also be available through other media, such as a personal computer, CD-ROM, or television.
Selection and inclusion of studies
We used several methods to identify studies examining the effects of the CWD. First, because the authors of the current paper were involved in many of the relevant studies, we collected the data of our own studies and the references of studies by colleagues which were known by us. Second, we used a large database of studies on the psychological treatment of depression in general to identify studies on the CWD we were not aware of. This database, how it was developed and the methods used, have
Description of included studies
A total of 25 studies met all inclusion criteria. Selected characteristics of these studies are presented in Table 2.
Six studies were aimed at preventing the onset of depressive disorders, while the other 19 studies were aimed at the treatment of existing depressive disorders or symptoms. Eight studies were aimed at adolescents, seven on adults in general, three on older adults, five on minority groups, and three on other target groups (alcoholics, women with postpartum depression, and young
Discussion
In this review we discussed the basic characteristics, and the many different versions of the CWD that have been developed and tested in randomized trials in the past thirty years. We saw that the CWD is a flexible, highly structured, cognitive-behavioral intervention, based on the social learning theory, which can be adapted for prevention, treatment, and relapse prevention of prevention and has been used in group and individual format, but also as guided self-help and Internet-based
References (77)
- et al.
Prevention of depression in subclinically depressed adults: follow-up effects on the ‘Coping with Depression’ course
Journal of Affective Disorders
(2007) - et al.
Cognitive-behavioral depression treatment for mothers of children with attention-deficit/hyperactivity disorder
Behavior Therapy
(2006) - et al.
Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: a randomised trial of a group cognitive intervention
Journal of American Academy Child and Adolescent Psychiatry
(1995) - et al.
Group cognitive-behavioral treatment for depressed adolescent offspring of depressed parents in a health maintenance organization
Journal of the American Academy of Child and Adolescent Psychiatry
(2002) - et al.
Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions
Journal of the American Academy of Child and Adolescent Psychiatry
(1999) - et al.
Excess mortality in depression: a meta-analysis of community studies
Journal of Affective Disorders
(2002) - et al.
Behavioral treatment of depression: a meta-analysis of activity scheduling
Clinical Psychology Review
(2007) - et al.
Problem solving therapies for depression: a meta-analysis
European Psychiatry
(2007) - et al.
A meta-analysis of the effects of cognitive therapy in depressed patients
Journal of Affective Disorders
(1998) Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: a meta-analytic approach
Clinical Psychology Review
(2001)
Cognitive-behavioral treatment for depressed adolescents
Behavior Therapy
Psychoeducational interventions for family caregivers: preliminary efficacy data
Behavior Therapy
Prevention of postpartum depression in low-income women: development of the Mamas y Bebes/Mothers and Babies course
Cognitive and Behavioral Practice
An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder
Journal of the American Academy Child and Adolescent Psychiatry
Individual and group treatment of unipolar depression: comparison of treatment outcome and identification of predictors of successful treatment outcome
Behavior therapy
Meta-analytic studies on new antidepressants
British Medical Bulletin
Social learning theory
Marital therapy for depression
Cochrane Database of Systematic Reviews
Cognitive therapy of depression
Depression: cost-of-illness studies in the international literature, a review
Journal of Mental Health Policy and Economics
Cognitive-behavioral treatment for depression in alcoholism
Journal of Consulting and Clinical Psychology
Cognitive-behavioral treatment for depression in smoking cessation
Journal of Consulting and Clinical Psycholology
A psychoeducational approach to the treatment of depression: comparison of group, individual and minimal contact procedures
Journal of Consulting and Clinical Psychology
A systematic review of controlled trials of the effectiveness and cost-effectiveness of brief psychological treatments for depression
Health Technology Assessment
Randomized effectiveness trial of an internet, pure self-help, cognitive behavioral intervention for depressive symptoms in young adults
Behavior Therapy
Overcoming depression on the Internet (ODIN) (2): a randomized trial of a self-help depression skills program with reminders
Journal of Medical Internet Research
A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents
Archives of General Psychiatry
Overcoming depression on the Internet (ODIN): a randomised controlled trial of an Internet depression skills intervention program
Journal of Medical Internet Research
Psychological treatment of postpartum depression: a meta-analysis
Journal of Clinical Psychology
Preventing the onset of depressive disorders: A meta-analytic review of psychological interventions
American Journal of Psychiatry
Psychological treatment of depression: a meta-analytic database of randomized studies
BMC Psychiatry
Characteristics of effective psychological treatments of depression; a meta-regression analysis
Psychotherapy Research
A systematic review of research findings on the efficacy of interpersonal therapy for depressive disorders
European Archives of Psychiatry and Clinical Neuroscience
Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression
Journal of Consulting and Clinical Psychology
Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial. Outcomes of Depression International Network (ODIN) Group
British Medical Journal
A new guide to rational living
Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project
Acta Psychiatrica Scandinavica
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