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Dysfunctional Attitudes in Cognitive–Behavioral Therapy and Antidepressant Pharmacotherapy for Adult Depression: A Systematic Review and Meta-Analysis of Individual Participant Data.

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Title: Dysfunctional Attitudes in Cognitive–Behavioral Therapy and Antidepressant Pharmacotherapy for Adult Depression: A Systematic Review and Meta-Analysis of Individual Participant Data.
Authors: Don, Frank J.1 (AUTHOR), Boschloo, Lynn2 (AUTHOR), Wienicke, Frederik J.3 (AUTHOR), Weitz, Erica S.4 (AUTHOR), Hollon, Steven D.5 (AUTHOR), Cohen, Zachary D.6 (AUTHOR), Segal, Zindel V.7 (AUTHOR), Kennedy, Sidney H.8 (AUTHOR), DeRubeis, Robert J.4 (AUTHOR), Bagby, R. Michael7,8 (AUTHOR), Quilty, Lena C.8,9 (AUTHOR), Simons, Anne D.10 (AUTHOR), Twisk, Jos W. R.11 (AUTHOR), Cristea, Ioana A.12,13 (AUTHOR), Furukawa, Toshiaki A.14 (AUTHOR), Cuijpers, Pim15 (AUTHOR), Driessen, Ellen1,3 (AUTHOR) ellen.driessen@ru.nl
Source: Journal of Consulting & Clinical Psychology. May2026, Vol. 94 Issue 5, p281-292. 12p.
Subject Terms: *Cognitive therapy, *Evidence synthesis, *Mental depression, Antidepressants, Depressed persons, Treatment effectiveness
Abstract: Objectives: Dysfunctional attitudes (DA) constitute a vulnerability factor for depression that might be most effectively targeted with cognitive–behavioral therapy (CBT), but evidence is inconclusive. This individual participant data meta-analysis examined DA change during CBT and antidepressant medication, potential pathways of change by exploring how DA were related to depressive symptoms at posttreatment, and whether baseline DA moderated CBT versus antidepressants' efficacy on depression outcomes. Method: We conducted systematic literature searches up to May 1, 2024. We included randomized comparisons of CBT and antidepressants in the acute-phase treatment of adult depression, assessing the Dysfunctional Attitude Scale at baseline and posttreatment. Individual participant data were requested and analyzed with mixed-effects models and network estimation techniques. Results: Five studies totaling 734 participants met inclusion criteria. DA decreased significantly after CBT and antidepressants, with no significant difference between treatments. Regardless of treatment, posttreatment DA were positively associated with posttreatment depressive symptomatology, particularly with guilt and suicidal thoughts. Baseline DA moderated the efficacy of CBT versus antidepressants on observer-rated outcomes, with CBT more effective for participants with higher DA and antidepressants more effective for those with lower DA, but this was not replicated across individual studies nor with self-reported outcomes. Conclusions: Change in DA and its associations with changes in depressive symptomatology do not appear specific to CBT. We found inconsistent evidence for the notion that CBT is more efficacious than antidepressants for individuals with high levels of DA. Repeated DA assessment during treatment would allow for more nuanced analysis in future studies. What is the public health significance of this article?: Cognitive–behavioral therapy and antidepressant medication result in lower levels of dysfunctional attitudes after treatment. Patients having less dysfunctional attitudes after treatment may also experience fewer feelings of guilt and a gain in interest in work and activities. Cognitive–behavioral therapy may be more efficacious for individuals with high levels of dysfunctional attitudes, whereas antidepressant medication may be more effective for those with low levels of dysfunctional attitudes, but evidence is inconclusive. [ABSTRACT FROM AUTHOR]
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Database: Education Research Complete
Description
Abstract:Objectives: Dysfunctional attitudes (DA) constitute a vulnerability factor for depression that might be most effectively targeted with cognitive–behavioral therapy (CBT), but evidence is inconclusive. This individual participant data meta-analysis examined DA change during CBT and antidepressant medication, potential pathways of change by exploring how DA were related to depressive symptoms at posttreatment, and whether baseline DA moderated CBT versus antidepressants' efficacy on depression outcomes. Method: We conducted systematic literature searches up to May 1, 2024. We included randomized comparisons of CBT and antidepressants in the acute-phase treatment of adult depression, assessing the Dysfunctional Attitude Scale at baseline and posttreatment. Individual participant data were requested and analyzed with mixed-effects models and network estimation techniques. Results: Five studies totaling 734 participants met inclusion criteria. DA decreased significantly after CBT and antidepressants, with no significant difference between treatments. Regardless of treatment, posttreatment DA were positively associated with posttreatment depressive symptomatology, particularly with guilt and suicidal thoughts. Baseline DA moderated the efficacy of CBT versus antidepressants on observer-rated outcomes, with CBT more effective for participants with higher DA and antidepressants more effective for those with lower DA, but this was not replicated across individual studies nor with self-reported outcomes. Conclusions: Change in DA and its associations with changes in depressive symptomatology do not appear specific to CBT. We found inconsistent evidence for the notion that CBT is more efficacious than antidepressants for individuals with high levels of DA. Repeated DA assessment during treatment would allow for more nuanced analysis in future studies. What is the public health significance of this article?: Cognitive–behavioral therapy and antidepressant medication result in lower levels of dysfunctional attitudes after treatment. Patients having less dysfunctional attitudes after treatment may also experience fewer feelings of guilt and a gain in interest in work and activities. Cognitive–behavioral therapy may be more efficacious for individuals with high levels of dysfunctional attitudes, whereas antidepressant medication may be more effective for those with low levels of dysfunctional attitudes, but evidence is inconclusive. [ABSTRACT FROM AUTHOR]
ISSN:0022006X
DOI:10.1037/ccp0001001