Significance of prior episodes of depression in two patient populations

PERSONAL VULNERABILITIES AND ASSORTATIVE MATE SELECTION AMONG NEWLYWED SPOUSES

Assortative-mating theories propose that individuals select romantic relationship partners who are similar to them on positive and negative qualities. Furthermore, stress-generation and intergenerational transmission of divorce models argue that one's depression history or family-of-origin relationship problems predict qualities of a marital partner that predispose them to relationship distress. We analyzed data from 172 newlywed couples to examine predictors and mediators of a marital partner's risk index. First, an index of one's own and one's partner risk was created through factor analysis and was comprised of measures that indicate insecurity about oneself. This index was significantly correlated with baseline marital satisfaction and, among men, steps toward divorce at follow-up. Then, structural equation modeling tested direct and indirect pathways predicting partner's risk index, analyzing prior depression history and family-of-origin relational impairment as predictors and one's own risk index as the mediator. Results demonstrated that own risk index reliably predicted partner's risk, while own risk index also mediated the relationship between own family-of-origin relational dysfunction/depression history and partner's risk index. These results support assortative mating theories and suggest that the association between adverse family-of-origin relationships or depression history and the risk profile in one's marital partner is explained by one's own risk profile.

Specificity of effects of cognitive behavior therapy on coping, acceptance, and distress tolerance in a randomized controlled trial for smoking cessation

OBJECTIVE

Although there is extensive evidence of the efficacy of cognitive-behavioral therapy (CBT), it is less certain what potential mechanisms of change are specifically affected by CBT interventions. This study was intended to test the specific effects of CBT on compensatory coping skills, acceptance, and distress tolerance or persistence.

METHOD

Using data from a randomized controlled trial of 8-session group CBT and a time-matched comparison condition for cigarette smokers, we evaluated CBT effects on compensatory coping skills, self-rated acceptance and behavioral markers of persistence and distress tolerance. Because depression proneness had moderated treatment response in the parent clinical trial (Kapson & Haaga, 2010), we tested not only main effects (CBT vs. comparison condition) but also moderated effects (treatment condition X depression proneness).

RESULTS

CBT significantly improved compensatory coping skills only among the less depression-prone participants, who were the subset of smokers who did not benefit from CBT in terms of smoking cessation outcomes. There were no specific effects of CBT on acceptance or behavioral persistence.

CONCLUSIONS

To the extent that CBT had specific effects on compensatory coping skills, it was for the participants who did not benefit clinically from the intervention. Much more theory-driven research on multiple candidate change mechanisms is needed to clarify how effective and specific treatments have their effects, for either patients in general or subsets of patients as in moderated effects.