Cognitive behavior therapy and interpersonal therapy have both shown efficacy in treating major depressive disorder among adolescents and emerging adults. Cognitive behavior therapy focuses on identifying and changing maladaptive thoughts and behaviors, while interpersonal therapy examines interpersonal relationships and communication styles. Research has found that both therapies effectively reduce depressive symptoms, though cognitive behavior therapy may be more effective for severe depression. Overall, cognitive behavior therapy and interpersonal therapy provide clients with skills to aid them post-treatment.

1. Running head: COGNITIVE BEHAVIOR AND INTERPERSONAL EFFICACY
Cognitive Behavior Therapy and Interpersonal Therapy Efficacy:
Major Depressive Disorder in Adolescent and Emerging Adults
Brennan Perreault
Introduction to Counseling 3406 - 002
Douglas Murdoch, Ph. D.
November 21, 2013

2. COGNITIVE BEHAVIOR AND INTERPERSONAL EFFICACY
Abstract
Major depression is a mental illness which significantly impacts the personal lives of millions of
individuals. Adolescents and emerging adults are one such population which has been prone to
mental illness, such as major depressive disorder. Treatments such as cognitive behavior therapy
or interpersonal therapy are effective methods in reducing major depressive disorder symptoms.
While efficacy for the aforementioned is high, researchers are interested in examining and
comparing treatment methods to gain a deeper understanding of these practices. Results show a
similarly in effectiveness for both cognitive behavior therapy and interpersonal therapy.
Additional findings suggest differences in effectiveness in favor of cognitive behavior therapy
with respect to more severe depressive symptoms. Ultimately both therapies provide clients' not
only with effaceable treatments but also practical skills which will aid them post-treatment,
helping to ensure enduring therapeutic effects.
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3. COGNITIVE BEHAVIOR AND INTERPERSONAL EFFICACY
In 2006 statistics Canada recorded over 1 million individuals who possessed the
symptoms of Major Depressive Disorder (MDD) (Mental illness in Canada, 2006). Researchers
have been working tirelessly to understand the how's and why's of MDD in the hope of finding
effective treatments and coping strategies. In addition to various antidepressants such as Prozac
or Cipralex, practitioners within psychology also prescribe the use of therapeutic interventions.
Often used in tandem with pharmaceuticals, therapies provide a wide range of benefits and
options to clients. Schools of thought tend to focus on either behavior, psychodynamic or
humanistic approaches. It is important to note that combinations of the previously mentioned are
also used. Techniques such as Cognitive Behavior Therapy (CBT) or Interpersonal
Psychotherapy (IPT) help clients cope and learn through various problems or stressors in their
personal lives. The ultimate goal is to assist clients in improving their wellbeing and
interpersonal relations. Researchers have worked tirelessly to determine the efficacy of the
aforementioned therapy styles with regards to MDD (Brakemeier, E., & Frase, L., 2012; Butler,
A. C., Chapman, J. E., Forman, E. M., & Beck, A. T., 2006; Cuijpers, P., et al., 2011; Hamdan-
Mansour, A., Puskar, K., & Bandak, A. G., 2009). In the following paragraphs I will explore the
use and efficacy of CBT and IPT in relation to treating MDD. These techniques will be
compared and contrasted to facilitate a deeper understanding of both their strengths and
limitations.
Major Depressive Disorder is a mood disorder that is typically known for its impacts on
emotional affect. Suicide is considered a major component of the mortality associated with it.
According to the DSM-V 5 or more symptoms, such as depressed mood, diminished pleasure or
recurrent thoughts of death (among others) must be present in order for an individual to be
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4. COGNITIVE BEHAVIOR AND INTERPERSONAL EFFICACY
diagnosed with MDD (DSM-5, 2013, pp. 160-168). Adolescents and emerging adults are
vulnerable to this disorder as they develop and mature into adults. Studies that have conducted
surveys of depressive symptoms in adolescent and emerging adults using self-report measures
have found varying degrees of information. These numbers often range between 5% - 25% but in
a small number of cases have exceeded 25% (Lee, C. L., 2005, p. 24; Sheets, et al., 2013, p.
425).
J.S. Beck's Cognitive behavior therapy: basics and beyond (2011) covers all aspects of
Aaron Beck's theory. A cognitive behavior therapy approach assumes that changes to a client's
thought processes should result in behavioral and emotional changes. Therefore, therapy will
focus on a client's maladaptive thoughts and behaviors (p. 3). The initial meet of the therapist
would include an introduction of their background and expectations address any concerns of the
client and establish a foundation for successful treatment. The client is given a consent from
which describes in further detail the therapist’s guidelines. Cognitive behavior therapists trained
in this style search for recurrent thought and behavior patterns as they interact with their client
(pp. 11-14). Awareness of thoughts is a skill that the therapist will develop with the client.
Because sessions are limited, this skill is not only critical for future sessions but will also aid the
client post-treatment (p. 9). Destructive patterns can include absolutist or automatic thinking,
negative comparison, and irrational thoughts (p. 7). Through homework – such as goal setting –
and structured sessions, the therapist assists the client in understanding how their thoughts
influence how they feel and act, resulting in cessation of the behavior (p.8). Throughout the
process, the client is strongly encouraged to take notes and reflect on knowledge gained through
therapist and client insight. This ensures therapeutic effects will endure past resolution of
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5. COGNITIVE BEHAVIOR AND INTERPERSONAL EFFICACY
treatment (p. 9). In contrast, the foci of interpersonal psychotherapy are to examine and improve
interpersonal relations. Treatment would include developing an interpersonal inventory,
complete with problem areas and expectations, as well as a collaborative effort towards
developing communication skills (Robertson, M., Rushton, P., & Wurm, C., 2008, p. 47).
Similar to cognitive behavior therapy, an introduction between therapist and client takes
place, however, this method differs in its use of "five distinct phases in the IPT approach",
examined by M. Robertson et al. (2008) in their article Interpersonal Psychotherapy: An
overview. These phases include: "assessment, initial sessions, middle sessions, termination
sessions or conclusion of acute treatment and maintenance sessions" (p. 47). During phase 1 the
therapist assesses characteristics of the client such as their desire to change and ego strength. An
important factor that must be considered is the client's personal view of the treatment style. If the
client believes the treatment aligns with their problem, informed consent is given and a time-
limited treatment may proceed (p. 47). The initial sessions (phase 2) foci is placed on specific
areas of interpersonal difficulty and existing social support networks. Key features that the
therapist is interested in are the client's communication and attachment styles. The therapist and
client will then compile an interpersonal inventory which organizes factors such as relationship
type, problems and expectations in the client's life (pp. 47-48). Phase 3 focuses on one or more
of four IPT problem areas – "grief, interpersonal disputes, role transitions and interpersonal
sensitivity"(p. 49) – to help the client understand. Based on the client's developing
understanding, a collaborative effort is made to learn, develop and refine the client's skills within
their interpersonal relations and communication style. The client is expected to implement the
solution(s) between sessions, with subsequent sessions focusing on refining the solution(s) (p.
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6. COGNITIVE BEHAVIOR AND INTERPERSONAL EFFICACY
48). Phase 4 and 5 mark the conclusion of acute treatment but not the end of the therapeutic
relationship. It is common for a new contract to be instituted to continue treatment. At this point
in therapy, clients have learned and developed new skills through their own effort which they can
call upon in the future. Revisiting the client's progression in therapy is encouraged in addition to
positive support. This highlights the personal effort on behalf of the client and reaffirming the
power to change and cope is within their control (pp. 48-49). Some of the major symptoms of
major depressive disorder challenge more basic feelings of self adding additional barriers within
treatment. Thus, researchers are interested in understanding these barriers in greater detail to
enrich the greater societal knowledge of effective and reliable treatments.
Studies show that both CBT and IPT are effective brief therapies. Research on these
approaches in respect to MDD in adolescent and emerging adult populations has been extensive
showing high levels of efficacy for both treatments (Brakemeier, E., & Frase, L., 2012; Butler,
A. C., et al., 2006; Cuijpers, P., et al., 2011; Hamdan-Mansour, A., et al., 2009; Luty, S. E., et al.,
2007; Power, M. J., & Freeman, C., 2012). some researchers attribute CBT success to its highly
structured approach (Rosselló, J., Bernal, G., & Rivera-Medina, C., 2012, p. 241). IPT is seen as
less structured but its focus on interpersonal functioning provides notable improvements to
"overall and specific domains of social functioning" (Mufson, L., Weissman, M. M., Moreau, D.,
& Garfinkel, R., 1999, p. 583). Additionally, researchers have tested these approaches against
one another in order to determine if one approach is more effective than the other. During these
comparisons, a control group – known as treatment as usual (TAU) – is often present as a
baseline but not necessarily required. Power and Freeman (2012) study comparing CBT, IPT and
TAU found some support that IPT produced its effects faster than CBT. By the end, all
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7. COGNITIVE BEHAVIOR AND INTERPERSONAL EFFICACY
treatments averaged similar levels of reduction in MDD symptoms (p. 167). Similar reduction
findings are echoed by Luty et al. (2007), although results showed CBT as being more effective
than IPT in treating severe depression symptoms (p. 500). In contrast, other research findings
suggests CBT produces "significantly greater decreases than IPT in Depressive symptoms"
(Rosselló, J., et al., 2012, p. 241) although It was noted that all treatments effectively reduced
symptoms of MDD (Rosselló, J., et al., 2012, p. 241).
In summation, the scientific community has shown strong support for the efficacy of both
cognitive behavior therapy and interpersonal psychotherapy (Brakemeier, E., & Frase, L., 2012;
Butler, A. C., et al., 2006; Cuijpers, P., et al., 2011; Hamdan-Mansour, A., et al., 2009). While
the overall effects at least coincide with that of treatment as usual, there is evidence to suggest
that CBT and IPT approaches offer quicker relief of symptoms of major depressive disorder
(Power, M. J., & Freeman, C., 2012, p. 167). In some cases CBT is a more effective form of
therapy, particularly with symptoms of severe depression. This finding is important because it
highlights the differences between CBT and IPT in their initial phases (early behavioral
activation and exploration respectively), suggesting that a client's circumstance could be
important when determining the right therapy (Luty, S. E., et al., 2007, p. 500). In later stages of
treatment, both styles provide clients with skills that will aid them post-treatment in the event of
a potential relapse strengthening the likelihood of enduring therapeutic effects.
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References
Beck, J. S. (2011). Cognitive behavior therapy: basics and beyond (2nd ed.). New York:
Guilford Press
Brakemeier, E., & Frase, L. (2012). Interpersonal psychotherapy (IPT) in major depressive
disorder. European Archives of Psychiatry and Clinical Neuroscience, 262, 117-121.
http://dx.doi.org/10.1007/s00406-012-0357-0
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of
cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review,
26(1), 17-31. http://dx.doi.org/10.1016/j.cpr.2005.07.003
Cuijpers, P., Geraedts, A. S., van Oppen, P., Andersson, G., Markowitz, J. C., & van Straten, A.
(2011). Interpersonal psychotherapy for depression: A meta-analysis. The American Journal
of Psychiatry, 168(6), 581-592. http://dx.doi.org/10.1176/appi.ajp.2010.10101411
Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington,
D.C.: American Psychiatric Association
Hamdan-Mansour, A., Puskar, K., & Bandak, A. G. (2009). Effectiveness of cognitive-
behavioral therapy on depressive symptomatology, stress and coping strategies among
jordanian university students. Issues in Mental Health Nursing, 30(3), 188-196.
http://dx.doi.org/10.1080/01612840802694577
The human face of mental health and mental illness in Canada, 2006. (2006). Ottawa: Public
Health Agency of Canada
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9. COGNITIVE BEHAVIOR AND INTERPERSONAL EFFICACY
Lee, C. L. (2005). Evidenced-based treatment of depression in the college population. Journal of
College Student Psychotherapy, 20(1), 23-31. http://dx.doi.org/10.1300/J035v20n01_03
Luty, S. E., Carter, J. D., McKenzie, J. M., Rae, A. M., Frampton, C. M. A., Mulder, R. T., &
Joyce, P. R. (2007). Randomised controlled trial of interpersonal psychotherapy and
cognitive-behavioural therapy for depression. The British Journal of Psychiatry, 190, 496-
502. http://dx.doi.org/10.1192/bjp.bp.106.024729
Mufson, L., Dorta, K. P., Wickramaratne, P., Nomura, Y., Olfson, M., & Weissman, M. M.
(2004). A randomized effectiveness trial of interpersonal psychotherapy for depressed
adolescents. Archives of General Psychiatry, 61(6), 577-584.
http://dx.doi.org/10.1001/archpsyc.61.6.577
Mufson, L., Weissman, M. M., Moreau, D., & Garfinkel, R. (1999). Efficacy of interpersonal
psychotherapy for depressed adolescents. Archives of General Psychiatry, 56(6), 573-579.
http://dx.doi.org/10.1001/archpsyc.56.6.573
Power, M. J., & Freeman, C. (2012). A randomized controlled trial of IPT versus CBT in
primary care: With some cautionary notes about handling missing values in clinical trials.
Clinical Psychology & Psychotherapy, 19(2), 159-169. http://dx.doi.org/10.1002/cpp.1781
Robertson, M., Rushton, P., & Wurm, C. (2008). Interpersonal psychotherapy: an overview.
Psychotherapy in Australia, 14(3), 46-54.
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10. COGNITIVE BEHAVIOR AND INTERPERSONAL EFFICACY
Rosselló, J., Bernal, G., & Rivera-Medina, C. (2012). Individual and group CBT and IPT for
puerto rican adolescents with depressive symptoms. Journal of Latina/o Psychology, 1, 36-
51. http://dx.doi.org/10.1037/2168-1678.1.S.36
Sheets, E. S., Craighead, L. W., Brosse, A. L., Hauser, M., Madsen, J. W., & Craighead, W. E.
(2013). Prevention of recurrence of major depression among emerging adults by a group
cognitive-behavioral/interpersonal intervention. Journal of Affective Disorders, 147(1-3),
425-430. http://dx.doi.org/10.1016/j.jad.2012.08.036
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