Self-directed affiliation and autonomy across acute and continuation phase cognitive therapy for recurrent depression

Abstract

Using Benjamin's (2000) Structural Analysis of Social Behavior, we evaluated change in "self-directed" affiliation and autonomy and prediction of treatment response and relapse/recurrence among adult outpatients with recurrent major depressive disorder consenting to acute phase cognitive therapy (A-CT; Beck, Rush, Shaw, & Emery, 1979; N=156); A-CT responders randomized (N=84) to 8 months of continuation phase cognitive therapy (C-CT; Jarrett, 1989; Jarrett et al., 1998; Jarrett & Kraft, 1997) or assessment-only control; and C-CT and control patients entering a 16-month, assessment-only follow-up (N=74). Self-directed affiliation and autonomy increased after A-CT, and C-CT further increased affiliation and autonomy. Affiliation and autonomy did not predict A-CT response, but lower affiliation and higher autonomy pre-A-CT predicted relapse/recurrence post-A-CT. We discuss potential clinical implications of these results and present case examples to illustrate patterns of change.

FIGURE 1

Theoretical circumplex structure of the self-directed domain of the Structural Analysis of Social Behavior. Eight "cluster" scales (in italics) mark equal increments (i.e., every 45°) around a two-dimensional circular space. The arrangement of clusters reflects their correlations with underlying affiliation and autonomy dimensions (in bold).

FIGURE 2

Design of randomized controlled trial and assessments used in these statistical analyses. A–CT = acute phase cognitive therapy; C–CT = continuation phase cognitive therapy. Assessment a = pre-A–CT (first therapy session); b = 0 months post-A–CT (average of 5 days after the 20th A–CT session); c = 8 months post-A–CT (end of experimental phase); d = 24 months post-A–CT (end of follow-up phase). SASB = Structural Analysis of Social Behavior.

FIGURE 3

Mean self-directed affiliation and autonomy scores from the Structural Analysis of Social Behavior changed from preacute phase cognitive therapy to 0 months postacute phase cognitive therapy. Best = ratings at one’s best; worst = ratings at one’s worst.

FIGURE 4

Mean self-directed affiliation and autonomy scores from the Structural Analysis of Social Behavior after 8 months of continuation phase cognitive therapy (C–CT) or assessment only (Control). Worst ratings pooled because C–CT and control groups did not differ significantly. Best = ratings at one’s best; worst = ratings at one’s worst.

FIGURE 5

Pre-A–CT ratings of self-directed affiliation (AFF) and autonomy (AUT) from the Structural Analysis of Social Behavior (SASB) predicted relapse/recurrence of major depressive disorder 24 months post-A–CT. Median splits of pre-A–CT AFF and AUT defined high-risk groups, which are not mutually exclusive. A–CT = acute phase cognitive therapy; best = ratings at one’s best; worst = ratings at one’s worst.