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Behav Ther. 2014 May;45(3):300-13. doi: 10.1016/j.beth.2013.12.005. Epub 2013 Dec 23.

Extreme nonresponse to acute phase cognitive therapy for depression: an attempt to replicate and extend.

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  • 1Perelman School of Medicine at the University of Pennsylvania, University of Pittsburgh Medical Center. Electronic address:
  • 2The University of Texas Southwestern Medical Center at Dallas.
  • 3Perelman School of Medicine at the University of Pennsylvania, West Chester University.
  • 4Perelman School of Medicine at the University of Pennsylvania.
  • 5Perelman School of Medicine at the University of Pennsylvania, University of Pittsburgh Medical Center.


As with other interventions for major depressive disorder (MDD), cognitive therapy (CT) results in treatment failure for about half of all participants. In 2007, Coffman and colleagues in Seattle studied this topic by identifying a group of patients who demonstrated an extremely poor response to CT (i.e., posttreatment BDI score≥31). They called these patients "extreme nonresponders" (ENR) and described the pretreatment characteristics that predicted response status. In the current study, we attempt a replication of the Seattle study with a larger sample of adults with recurrent MDD (N=473) who received a 16-20 session (12-14week) course of CT. The rate of ENR in this large sample was only 6.3% (30/473), compared to 22.2% (10/45) in the Seattle sample. Four pretreatment measures of symptom severity and functioning differed significantly among ENR and non-ENR participants. In each case, higher symptoms or poorer functioning were associated with ENR status. However, the combination of these factors in a regression model did not predict actual ENR status with the high degree of sensitivity or specificity observed in the Seattle study. These findings suggest that extreme nonresponse to CT is not as common as previously described and, although poor outcomes are associated with pretreatment clinical status, it is difficult to predict posttreatment symptom severity with a high degree of accuracy across different research samples.

Copyright © 2014. Published by Elsevier Ltd.


cognitive therapy (CT); major depressive disorder (MDD); nonresponse; predictors of response

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