This request for an Independent Scientist Award (KO2) fosters the candidate's research proficiency in personality disorders and treatment development within the context of three randomized clinical trials (RCTs) on the efficacy of cognitive therapy (CT) in reducing the likelihood of mood disorders in high risk or refractory outpatients. Project 1 (an ongoing R01) compares continuation phase CT (C-CT) to evaluation only (control) in reducing the risk of relapse during the first eight months following response to acute phase CT in outpatients with recurrent major depressive disorder (MDD). Approximately 156 male and female outpatients, aged 18-65, have entered 20 sessions of acute phase CT. Approximately 84 responders were randomized to either 8 months of: (a) 10 C-CT sessions, or (b) 10 evaluation only (control sessions); subjects are followed for an additional 16 months CT free. Relapse/recurrence (DSM IF MDD) is assessed by a blind evaluator using the LIFE at 4, 8, 12, and 24 months post-acute phase CT and at suspected relapse/recurrence, or exit. Project 2 is a proposed, multi-site collaboration with University of Pittsburgh (Western Psychiatric Institute and Clinic; WPIC). This blinded, controlled RCT will evaluate the efficacy of and indications for eight months of C-CT, pharmacotherapy (the standard of care) (FLX: fluoxetine), and pill placebo (PBO: the control) in outpatients with recurrent MDD who are at higher risk for relapse/recurrence. """"""""Higher risk"""""""" is a score >6 on the Hamilton Rating Scale for Depression (HRS-D) during the last six weeks of acute phase CT, while """"""""lower risk"""""""" is defined as a score of 6 or less. The primary hypotheses is that higher risk patients who receive either C-CT or FLX have a longer time until relapse than higher risk patients who receive acute phase CT only plus PBO. The lower risk patients will be followed for 24 months without CT and are predicted to have a 20% relapse/recurrence rate in the first 8 months after acute phase CT. Project 3 is a proposed, multi-site collaboration with WPIC comparing the differential efficacy of a trial of: (a) FLX and (b) FLX plus CT in out- patients with recurrent MDD who were refractory to 20 sessions of acute phase CT. Blind evaluation of outcome will aid in testing the prediction that combination therapy is more efficacious for refractory depression than FLX alone. The KO2 focuses the candidate on (a) identifying the residual symptoms and social impairment remaining after CT and (b) designing treatment sequences to restore full functioning. These RCTs have great public health significance because they will help identify (a) when CT reduces the risk of relapse-recurrence for patients suffering from recurrent MDD, an illness with high morbidity and mortality, and (b) if refractory MDD is best treated with combination therapy.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Scientist Development Award - Research (K02)
Project #
5K02MH001571-05
Application #
6625357
Study Section
Special Emphasis Panel (ZMH1-CRB-B (02))
Program Officer
Street, Linda L
Project Start
1998-12-01
Project End
2004-11-30
Budget Start
2002-12-01
Budget End
2004-11-30
Support Year
5
Fiscal Year
2003
Total Cost
$124,632
Indirect Cost
Name
University of Texas Sw Medical Center Dallas
Department
Psychiatry
Type
Schools of Medicine
DUNS #
800771545
City
Dallas
State
TX
Country
United States
Zip Code
75390
Callan, Judith A; Dunbar-Jacob, Jacqueline; Sereika, Susan M et al. (2012) ""Barriers to Cognitive Behavioral Therapy Homework Completion Scale- Depression Version"": Development and Psychometric Evaluation. Int J Cogn Ther 5:219-235
Taylor, Daniel J; Walters, Heather M; Vittengl, Jeffrey R et al. (2010) Which depressive symptoms remain after response to cognitive therapy of depression and predict relapse and recurrence? J Affect Disord 123:181-7
Vittengl, Jeffrey R; Clark, Lee Anna; Jarrett, Robin B (2010) Moderators of continuation phase cognitive therapy's effects on relapse, recurrence, remission, and recovery from depression. Behav Res Ther 48:449-58
Vittengl, Jeffrey R; Clark, Lee Anna; Jarrett, Robin B (2009) Deterioration in psychosocial functioning predicts relapse/recurrence after cognitive therapy for depression. J Affect Disord 112:135-43
Smits, Jasper A J; Minhajuddin, Abu; Jarrett, Robin B (2009) Cognitive therapy for depressed adults with comorbid social phobia. J Affect Disord 114:271-8
Vittengl, Jeffrey R; Clark, Lee Anna; Jarrett, Robin B (2009) Continuation-phase cognitive therapy's effects on remission and recovery from depression. J Consult Clin Psychol 77:367-71
Jarrett, Robin B; Vittengl, Jeffrey R; Clark, Lee Anna (2008) How much cognitive therapy, for which patients, will prevent depressive relapse? J Affect Disord 111:185-92
Vittengl, Jeffrey R; Clark, Lee Anna; Jarrett, Robin B (2004) Self-directed affiliation and autonomy across acute and continuation phase cognitive therapy for recurrent depression. J Pers Assess 83:235-47
Vittengl, J R; Clark, L A; Jarrett, R B (2004) Improvement in social-interpersonal functioning after cognitive therapy for recurrent depression. Psychol Med 34:643-58
Clark, Lee Anna; Vittengl, Jeffrey R; Kraft, Dolores et al. (2003) Shared, not unique, components of personality and psychosocial functioning predict depression severity after acute-phase cognitive therapy. J Pers Disord 17:406-30

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