Positive cognitive behavior therapy in the treatment of depression: A randomized order within-subject comparison with traditional cognitive behavior therapy

• Published in: Behaviour research and therapy Vol. 116; pp. 119 - 130
• Main Authors: Geschwind, Nicole, Arntz, Arnoud, Bannink, Fredrike, Peeters, Frenk
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.05.2019; Elsevier Science Ltd
• Subjects: Adult; Behavior modification; Behavior therapy; Clinical outcomes; Clinical significance; Cognition; Cognition & reasoning; Cognitive ability; Cognitive behavior therapy; Cognitive behavioral therapy; Cognitive Behavioral Therapy - methods; Cross-Over Studies; Depressive Disorder, Major - therapy; Depressive personality disorders; Efficacy; Emotional disorders; Emotions; Female; Happiness; Health behavior; Humans; Major depression; Male; Mental depression; Mental disorders; Mental health; Mental health care; Mental health services; Middle Aged; Mood; Negative emotions; Optimism; Positive affect; Positive emotions; Positive psychology; Psychotherapeutic interventions; Psychotherapy; Solution focused brief therapy; Symptoms; Young Adult; P-CBT; Major depression; Positive psychology; Solution focused brief therapy; T-CBT; Psychotherapeutic interventions; Positive affect; Cognitive behavior therapy
• ISSN: 0005-7967; 1873-622X; 1873-622X
• DOI: 10.1016/j.brat.2019.03.005

Previous research suggests that a stronger focus on positive emotions and positive mental health may improve efficacy of Cognitive Behavior Therapy (CBT). Objectives were to compare differential improvement of depressive symptoms (primary outcome), positive affect, and positive mental health indices during positive CBT (P-CBT; CBT in a solution-focused framework, amplified with optional positive psychology exercises) versus traditional, problem-focused CBT (T-CBT). Forty-nine patients with major depressive disorder (recruited in an outpatient mental health care facility specialized in mood disorders) received two treatment blocks of eight sessions each (cross-over design, order randomized). Intention-To-Treat mixed regression modelling indicated that depressive symptoms improved similarly during the first, but significantly more in P-CBT compared to T-CBT during the second treatment block. Rate of improvement on the less-frequently measured secondary outcomes was not significantly different. However, P-CBT was associated with significantly higher rates of clinically significant or reliable change for depression, negative affect, and happiness. Effect sizes for the combined treatment were large (pre-post Cohen's d = 2.71 for participants ending with P-CBT, and 1.85 for participants ending with T-CBT). Positive affect, optimism, subjective happiness and mental health reached normative population averages after treatment. Overall, findings suggest that explicitly focusing on positive emotions efficiently counters depressive symptoms. •Positive CBT (P-CBT) has a solution focus and uses positive psychology exercises.•P-CBT resulted in stronger reduction of depression during 2nd phase of treatment.•P-CBT was associated with more clinically significant change than traditional CBT.•Dropout was significantly lower when starting with positive (cf. traditional) CBT.•The relative impact of solution focus and positive psychology is still unclear.