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. 2017 Oct;41(5):712-719.
doi: 10.1007/s10608-017-9839-8. Epub 2017 Mar 1.

The relationship between automatic thoughts and depression in a cognitive-behavioral treatment for people living with HIV/AIDS: Exploring temporality and causality

Kristen E Riley  1 , Jasper S Lee  2 , Steven A Safren  2   3
Affiliations

The relationship between automatic thoughts and depression in a cognitive-behavioral treatment for people living with HIV/AIDS: Exploring temporality and causality

Kristen E Riley et al. Cognit Ther Res. 2017 Oct.

Abstract

Depression in people living with HIV/AIDS (PLWHA) is highly prevalent and related to worse adherence to antiretroviral therapy, but is amenable to change via CBT. Cognitive-behavioral therapy for adherence and depression (CBT-AD) specifically addresses negative automatic thoughts (ATs) as one component of the treatment. There is little research on the temporal nature of the relation between ATs and depression. HIV-positive adults with depression (N=240) were randomized to CBT-AD, information/supportive psychotherapy for adherence and depression (ISP-AD), or one session of adherence counseling alone (ETAU). ATs were self-reported (Automatic Thoughts Questionnaire; ATQ) and depression was assessed by blinded interview (Montgomery-Asberg Depression Rating Scale; MADRS) at baseline, and 4-, 8-, and 12-months. We performed autoregressive cross-lagged panel models. Broadly, decreases in ATs were followed by decreases in depression, but decreases in depression were not followed by decreases in ATs. In CBT-AD, decreases in ATs were followed by decreases in depression, and vice versa. However, in the ISP group, while depression and ATs both significantly influenced each other, not all relations were in the direction expected. This study adds to the evidence base for cognitive interventions to decrease depression in individuals with a chronic medical condition, HIV/AIDS.

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Conflict of interest statement

Compliance with Ethical Standards Related Potential Conflicts of Interest Dr. Kristen E. Riley and Jasper S. Lee have no conflicts of interest. Dr. Steven A. Safren receives royalties from Oxford University Press for books/treatment manuals on treating depression in the context of chronic illness. Human and Animal Rights Statement All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed Consent Informed consent was obtained from all individual participants included in the study.

Figures

Figure 1
Figure 1. Conceptual cross-lagged panel analysis model for all three study arms: hypothesized paths between depression (Dep) and automatic thoughts (AT)
Note. Bolded black pathways indicate hypothesized significant relationships, and dashed gray pathways indicate hypothesized non-significant relationships.
Figure 2
Figure 2. Overall cross-lagged panel analysis model with estimates across all three study arms, describing depression (Dep) and automatic thoughts (AT; N =240)
Note. Bolded black pathways indicate observed significant relationships, and dashed gray pathways indicate observed non-significant relationships Standardized betas (β) are presented. †Statistical trend; 05 ≤ p ≤ .1 * p < .05 ** p < .01 *** p < .001
Figure 3
Figure 3. CBT-AD cross-lagged panel analysis model with estimates for CBT-AD arm only, describing depression (Dep) and automatic thoughts (AT; N=94)
Note. Bolded black pathways indicate observed significant relationships, and dashed gray pathways indicate observed non-significant relationships. Standardized betas (β) are presented. †Statistical trend; 05 ≤ p ≤ .1 * p < .05 ** p < .01 *** p < .001
Figure 4
Figure 4. ISP-AD cross-lagged panel analysis model with estimates for ISP-AD arm only, describing depression (Dep) and automatic thoughts (AT; N=97)
Note. Bolded black pathways indicate observed significant relationships, and dashed gray pathways indicate observed non-significant relationships Standardized betas (β) are presented. †Statistical trend; 05 ≤ p ≤ .1 ** p < .01 *** p < .001
See this image and copyright information in PMC

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