{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T09:28:52Z","timestamp":1759483732591},"reference-count":62,"publisher":"Cambridge University Press (CUP)","issue":"15","license":[{"start":{"date-parts":[[2015,6,22]],"date-time":"2015-06-22T00:00:00Z","timestamp":1434931200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:sec id=\"S0033291715001191_sec_a1\"><jats:title>Background.<\/jats:title><jats:p>The cognitive model of depression suggests that cognitive therapy (CT) improves major depressive disorder (MDD) in part by changing depressive cognitive content (e.g. dysfunctional attitudes, hopelessness). The current analyses clarified: (1) the durability of improvements in cognitive content made by acute-phase CT responders; (2) whether continuation-phase CT (C-CT) or fluoxetine (FLX) further improves cognitive content; and (3) the extent to which cognitive content mediates continuation treatments\u2019 effects on depressive symptoms and major depressive relapse\/recurrence.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291715001191_sec_a2\" sec-type=\"methods\"><jats:title>Method.<\/jats:title><jats:p>Out-patients with recurrent MDD who responded to acute-phase CT (<jats:italic>n<\/jats:italic> = 241) were randomized to 8 months of C-CT, FLX or pill placebo (PBO) and followed for an 24 additional months. Cognitive content was assessed approximately every 4 months using five standard patient-report measures.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291715001191_sec_a3\" sec-type=\"results\"><jats:title>Results.<\/jats:title><jats:p>Large improvements in cognitive content made during acute-phase CT were maintained for 32 months, with 78\u201390% of patients scoring in normal ranges, on average. Cognitive content varied little between C-CT, FLX and PBO arms, overall. Small, transient improvements in cognitive content in C-CT or FLX compared with PBO patients did not clearly mediate the treatments\u2019 effects on depressive symptoms or on major depressive relapse\/recurrence.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291715001191_sec_a4\" sec-type=\"conclusion\"><jats:title>Conclusions.<\/jats:title><jats:p>Outpatients with recurrent MDD who respond to acute-phase CT show durable improvements in cognitive content. C-CT or FLX may not continue to improve patient-reported cognitive content substantively, and thus may treat recurrent MDD by other paths.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291715001191","type":"journal-article","created":{"date-parts":[[2015,6,22]],"date-time":"2015-06-22T14:25:49Z","timestamp":1434983149000},"page":"3191-3204","source":"Crossref","is-referenced-by-count":4,"title":["Improved cognitive content endures for 2 years among unstable responders to acute-phase cognitive therapy for recurrent major depressive disorder"],"prefix":"10.1017","volume":"45","author":[{"given":"J. R.","family":"Vittengl","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. A.","family":"Clark","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M. E.","family":"Thase","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. 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