Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jul:95:102172.
doi: 10.1016/j.cpr.2022.102172. Epub 2022 May 23.

Stage models for major depression: Cognitive behavior therapy, mechanistic treatment targets, and the prevention of stage transition

Michael W Otto  1 , Jeffrey L Birk  2 , Hayley E Fitzgerald  3 , Gregory V Chauvin  3 , Alexandra K Gold  3 , Jenna R Carl  4
Affiliations
Review

Stage models for major depression: Cognitive behavior therapy, mechanistic treatment targets, and the prevention of stage transition

Michael W Otto et al. Clin Psychol Rev. 2022 Jul.

Abstract

Stage models encourage a longitudinal perspective on the care of those with major depression: supporting vigilance to the risk for stage progression and the selection of interventions to address that risk. A central goal for this article is to evaluate the role of cognitive-behavior therapy (CBT) in addressing stage progression in the treatment of major depression. We summarize the evidence supporting depression-focused CBT for: (1) preventing depression onset, (2) treating syndromal depression, (3) treating residual symptoms, (4) preventing relapse, and (5) addressing pharmacologic treatment resistance. In addition, consistent with the goal of aiding prevention and intervention development by refining mechanistic treatment targets, we evaluate the role of two specific risk-factors for stage progression: insomnia and rumination. These risk factors have a feed-forward relationship with stress, both being amplified by stress and amplifying the negative consequences of stress. Moreover, each of these risk factors predict depression stage transmissions across multiple stages, and both are modifiable with treatment. Accordingly, insomnia and rumination appear to serve as excellent mechanistic targets for the prevention of depression stage progression. These findings are discussed in relation to current limitations and future research directions for targeting these risk factors and furthering the effective treatment of depression.

Keywords: Depression; Insomnia; Mechanistic target; Relapse; Rumination; Sleep; Stage model.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Abela JRZ, & Hankin BL (2011). Rumination as a vulnerability factor to depression during the transition from early to middle adolescence: A multiwave longitudinal study. Journal of Abnormal Psychology, 120(2), 259–271. 10.1037/a0022796 - DOI - PubMed
    1. Ahn S, Lobo JM, Logan JG, Kang H, Kwon Y, & Sohn MW (2021). A scoping review of racial/ethnic disparities in sleep. Sleep Medicine, 81, 169–179. 10.1016/j.sleep.2021.02.027 - DOI - PubMed
    1. Amaral AP, Soares MJ, Pinto AM, Pereira AT, Madeira N, Bos SC, Marques M, Roque C, Macedo A (2018). Sleep difficulties in college students: The role of stress, affect and cognitive processes. Psychiatry Research, 260, 331–337. doi: 10.1016/j.psychres.2017.11.072. - DOI - PubMed
    1. Baglioni C, Battagliese G, Feige B, Spiegelhalder K, Nissen C, Voderholzer U, Lombardo C, & Riemann D (2011). Insomnia as a predictor of depression: A meta-analytic evaluation of longitudinal epidemiological studies. Journal of Affective Disorders, 135, 10–19. 10.1016/j.jad.2011.01.011 - DOI - PubMed
    1. Baglioni C, Lombardo C, Bux E, Hansen S, Salveta C, Biello S, Violani C, & Espie CA (2010). Psychophysiological reactivity to sleep-related emotional stimuli in primary insomnia. Behaviour Research and Therapy, 48(6), 467–475. 10.1016/j.brat.2010.01.008 - DOI - PubMed

Publication types

MeSH terms