Positive Cognitive Behavior Therapy in the Treatment of Depression: A Randomized Order Within-subject Comparison With Traditional Cognitive Behavior Therapy

Geschwind, N., Arntz, A., Bannink, F., & Peeters, F. (2019). Positive Cognitive Behavior Therapy in the Treatment of Depression: A Randomized Order Within-subject Comparison With Traditional Cognitive Behavior Therapy. Behaviour Research and Therapy, 116, 119–130. https://doi.org/10.1016/j.brat.2019.03.005

Summary by: Wies van der Leest

Positive Cognitive Behavioral Therapy: A Comparative Experimental Evaluation

Recently, interest has arisen in placing elements of positive psychology into traditional cognitive behavioral therapy (CBT) for depression treatment. The study by Geschwind, Arntz, Bannink, and Peeters (2019) shows an empirical investigation into the effectiveness of Positive Cognitive Behavioral Therapy (P-CBT). P-CBT is a variant of CBT that emphasizes well being, positive emotions, and solution-focused strategies. The main objective of the study was to determine whether P-CBT results in bigger improvements of depressive symptoms and positive mental health indices compared to Traditional CBT (T-CBT).

The Experimental Design

The study was conducted using a within-subjects crossover design. It involved 49 patients diagnosed with Major Depressive Disorder (MDD). Each participant received both treatment modalities. The treatment consisted of eight sessions of P-CBT and eight sessions of T-CBT, administered in a randomized order. The design was chosen to improve statistical power and control for individual differences, mostly because of the complications in recruiting participants from a clinical population, that suffer from a moderate to severe depression.

The T-CBT followed the usual protocols that include identifying and restructuring dysfunctional thoughts and behaviors. P-CBT included solution-focused brief therapy and positive psychology exercises, for example, gratitude practices and visualizing the best possible self.

 

The Measures and Methodology

The Quick Inventory of Depressive Symptoms (QIDS-SR-16) was used as the primary outcome measure. It was completed by the participants on a weekly basis. The secondary outcomes, subjective happiness (SHS), including positive and negative affect (PANAS), optimism (LOT-R), and overall mental health (MHC-SF), were assessed every four sessions. For intention-to-treat analysis, mixed regression modeling was used accounting for time, treatment order, and phase.

 

The Key Findings

The most remarkable result was that the participants experienced a significantly greater decrease in symptoms during the P-CBT phase, particularly when following T-CBT first. The results indicate that P-CBT may be a helpful follow-up or extension to T-CBT. Participants who began with T-CBT and afterwards followed the P-CBT showed the largest pre-post effect size (Cohen’s d = 2.71), in comparison to the participants starting with P-CBT (d = 1.85).

Moreover, P-CBT was associated with increased rates of clinically significant and reliable changes in depression, negative affect, and happiness. Furthermore, more participants accomplished normative levels of optimism and positive affect after the P-CBT phase. Additionally, the perceived dropout rates were lower for those who started with P-CBT, demonstrating greater acceptability.

 

Implications and Considerations

The findings imply that emphasizing strengths and positive emotions may decrease depressive symptoms with a larger effectivity than problem-focused methods, specifically in later treatment stages. Remarkably, participants transitioned more effortlessly from T-CBT to P-CBT, possibly due to P-CBT’s future-oriented, uplifting nature. Nevertheless, limitations include potential carry-over effects from the crossover design, lack of treatment fidelity checks, infrequent outcome measures and limited experience with P-CBT of the therapists.

 

Conclusion

Geschwind et al.’s (2019) study offers strong preliminary evidence supporting the effectiveness of Positive Cognitive Behavioral Therapy as standalone treatment and as an addition to traditional CBT. Even though further research is necessary, predominantly randomized controlled trials, this study shows significant improvement in validating approaches that highlight well-being and resilience combined with symptom reduction in treating depression.