DOI: 10.14704/nq.2018.16.12.1860

Differential Change in Depressive Symptoms during Psychotherapy and Medication in Clinical Care

Jian Li, Jie Zhang, Hua Yang, Ning Zhang, YaLin Zhang, Kathi L Heffner, Chun Wang


The study aimed to compare potential differences in trajectory of depressive symptoms improvement between patients receiving attribution retraining group therapy (ARGT) and those undergoing first-line depression medication in clinical care. Participants were randomly assigned to ARGT (n = 63) and medication (n = 66) group. Patients in ARGT group received group therapy one session a week for 8 weeks, while patients in medication group took medication normally. Hamilton Depression Scale was measured for all participants at 5 sequential time points during the process. A mixed-effects linear model over 5 time points showed no significant differences between two treatments in the total depression scores. Both medication and ARGT had effectively reduced depressive symptoms. However, the pattern of symptoms improvement differed. In detail, ARGT preferentially targeted cognitive disturbance, retardation and hopelessness, while medication preferentially targeted factors related to diurnal variation, moreover, for ARGT, the pattern was weight and diurnal variation (week 2), sleep disturbance (week 4), anxiety, cognition disturbance, retardation and hopelessness (week 6), for medication, was sleep disturbance, anxiety, weight, and diurnal variation (week 2) cognition disturbance, retardation, hopelessness (week 8). The current finding showed ARGT reduced the depressive symptom and improved well-being in a different way, which may further benefit the advancement of precise treatment.


Attribution retraining group therapy, Selective serotonin reuptake inhibitors Depression, Hamilton depression scale, Processes of depressive symptoms improvement

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American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder, third edition. Arlington, VA: American Psychiatric Association, 2010.

American Psychiatric Association. Guideline watch: Practice guideline for the treatment of patients with obsessive-compulsive disorder. Arlington, VA: American Psychiatric Association, 2013.

Ballenger JC. Anxiety and Depression: Optimizing Treatments. Prim Care Companion J Clin Psychiatry, 2000; 2(3): 71-9.

Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev, 2006; 26(1): 17-31.

Clark DA, Beck AT. Cognitive theory and therapy of anxiety and depression: convergence with neurobiological findings. Trends in Cognitive Sciences, 2010; 14(9): 418-424.

Conrad A, Roth WT. Muscle relaxation therapy for anxiety disorders: It works but how? Journal of Anxiety Disorders, 2007; 21(3): 243-264

Dieser RB, Edward R. Effects of attribution retraining during therapeutic recreation on attributions and explanatory styles of adolescents with depression. Therapeutic Recreation Journal, 2002; 36(1): 35-47.

Försterling F. Attributional retraining: A review. Psychological Bulletin, 1985; 98(3): 495-12.

Ganellen RJ. Specificity of attributions and overgeneralization in depression and anxiety. Journal of Abnormal Psychology, 1988; 97(1): 83-6

Gläscher J, Adolphs R, Damasio H, Bechara A, Rudrauf D, Calamia M, Paul LK, Tranel D. Lesion mapping of cognitive control and value-based decision making in the prefrontal cortex. Proceedings of the National Academy of Sciences of USA, 2012; 109 (36): 14681-14686.

Goldapple K, Segal Z, Garson C, Lau M, Bieling P, Kennedy S, Mayberg, H. Modulation of cortical-limbic pathways in major depression: treatment-specific effects of cognitive behavior therapy. Arch Gen Psychiatry, 2004; 61(1): 34-41.

Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischmann RL, Hill CL, Heninger GR, Charney DS. The Yale-Brown obsessive compulsive scale: I. development, use, and reliability. Archives of General Psychiatry, 1989; 46(11): 1006-1011.

Green-Emrich A, Altmaier EM. Attributional Retraining as a structured Group Counseling Intervention. Journal of counseling and development, 1991; 69(4): 351-355.

Hamilton M. The assessment of anxiety states by rating. British Journal of Medical Psychology, 1959; 32(1): 50-5.

Hamilton M. A rating scale for depression. Journal of Neurology Neurosurgery and Psychiatry, 1960; 23(1): 56-62.

Haugen R, Lund T. Self-concept, attributional style and depression. Educational Psychology, 2002; 22(3): 305-15.

Luten AG, Ralph JA, Mineka S. Pessimistic attributional style: is it specific to depression versus anxiety versus negative affect? Behaviour Research and Therapy, 1997; 35(8): 703-19.

Mayberg HS, Brannan SK, Tekell JL, Silva JA, Mahurin RK, McGinnis S, Jerabek PA. Regional metabolic effects of fluoxetine in major depression: Serial changes and relationship to clinical response. Biological Psychiatry, 2000; 48(8): 830-43.

Metalsky GI, Joiner TE, Hardin TS, Abramson LY. Depressive reactions to failure in a naturalistic setting: a test of the hopelessness and self-esteem theories of depression. Journal of Abnormal Psychology, 1993; 102(1): 101-109.

Nutt DJ, Forshall S, Bell C, Rich A, Sandford J, Nash J, Argyropoulos S. Mechanisms of action of selective serotonin reuptake inhibitors in the treatment of psychiatric disorders. European Neuropsychopharmacology, 1999; 9 (Suppl. 3): 81-6.

Parker KJ, Schatzberg AF, Lyons DM. Neuroendocrine aspects of hypercortisolism in major depression. Hormones and Behavior, 2003; 43(1): 60-6.

Tan YR, Wang Y, Wang C,Zhang N, Xiao CY, Cao RX, Gao S, Yang J, Li HL. Brain activation before and after cognitive-behavior therapy in first-episode patients with mild-to-moderate major depressive disorder. Chinese Journal of Psychiatry [In Chinese], 2014; 47(3): 132-36.

The Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 2014; 14 (Suppl. 1).

Waikar SV, Craske MG. Cognitive correlates of anxious and depressive symptomatology: an examination of the Helplessness/ Hopelessness Model. Journal of Anxiety Disorders, 1997; 11(1): 1-16

Wang C, Zhang J, Li JJ, Zhang N, Zhang YL. Attribution retraining group therapy for outpatients with major depression disorder, generalized anxiety disorder, and obsessive-compulsive disorder: A pilot study. Journal of Biomedical Research, 2011; 25(5): 348-355.

Wang C, Zhang J, Zhang N, Zhang J, Yang H, Timothy TC. Comparison of the neurobiological effects of attribution retraining group therapy with those of selective serotonin reuptake inhibitors. Brazilian Journal of Medical and Biological Research, 2013; 46(3): 318-26.

Wang C, Zhang N. Get back the peace of mind. Wang W, Editor. Case analysis: counselling and psychotherapy. Beijing: People's Medical Publishing House, 2008; 227-50.

Zhang J, Wang C, Zhang N, Wu X, Guo SW, Ou HX. Curative effects of the attribution rertraining on major depression disorder, anxiety disorder and obsessive-compulsive disorder [In Chinese]. Journal of Clinical Psychiatry, 2010; 6: 371-373.

Supporting Agencies

National Natural Science Foundation of China (81571344,81201064);Natural Science Foundation of Jiangsu Province (BK 20161109);Nanjing Medical Science and Technique Development Foundation, Outstanding Youth Project (JQX14008);Nanjing Science and Technique

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