Motivational deficits differentially predict improvement in a randomized trial of self-system therapy for depression.

OBJECTIVE

A randomized trial compared the time course and differential predictors of symptom improvement in 2 treatments for depression.

METHOD

Forty-nine adults (84% female) who were not taking antidepressant medications and met diagnostic criteria for major depressive disorder or dysthymia were randomly assigned either to cognitive-behavioral therapy (CBT) or self-system therapy (SST), a treatment that targets problems in self-regulation, the ongoing process of evaluating progress toward personal goals. Self-regulatory variables (promotion and prevention focus and goal disengagement and reengagement) were assessed as potential moderators of efficacy. At intake, most participants reported depression in the moderate to severe range and had histories of recurrent episodes and previous treatment attempts. Self-reported symptoms of depression and anxiety were assessed at each therapy session. Multilevel modeling was used to examine (a) differences in change associated with the treatment conditions and (b) moderation of treatment efficacy by pretreatment measures of self-regulatory deficits.

RESULTS

Both treatments were effective and did not show differences in the magnitude or rate of symptom change or in dropout rates, suggesting that CBT and SST were equally effective in improving depression and anxiety. Patients with self-regulatory deficits, however, showed greater improvement in depressive symptoms with SST. Specifically, patients with low promotion focus and low goal reengagement responded better to SST, whereas patients with high prevention focus responded better to CBT.

CONCLUSIONS

Overall, the results corroborate previous research suggesting that SST is a viable short-term treatment for depression that is particularly effective in helping patients compensate for self-regulatory deficits.