Fattori prognostici relativi all’esito della terapia cognitiva e comportamentale della depressione

Cognitive-behavioral therapy has undoubtedly shown its efficacy in several areas of psychopathology. The next step, proving the qualitative and quantitative growth of cognitive-behavioral approach, deals with finding out prognostic factors. Therefore we display the results of a review about cognitive and behavioral therapy of depression which covered the period from 1980 to 1993. We report, beyond the numerous clinical observations, a series of data about controlled research such as criteria for establishing the clinical improvement of patients, prognostic factors studied, instruments for measuring prognostic factors, short and long term prognostic factors or drop out prognostic factors. Among the others, higher level of pre-therapy depression, number of suicide attempts, lack of social support, marital distress, personality disorders, helplessness or hopelessness, high expectancy of improvement, older age, poor global health, psychiatric problems in family, anger proneness and population different from Caucasian ones seem to be relevant elements for a negative therapy outcome. On the contrary, moderate depression, active coping, patient’s high autonomy, high self-efficacy, good compliance, shared conceptualization according a cognitive or behavioral stance, fast reduction of symptomatology, good therapeutic relationship, experience of therapist and adherence to treatment protocol are linked to a good outcome. In sum, it is possible to outline some prognostic factors and clinical suggestions concerning with depression treatment outcomes but that is also necessary to do further inquiries, by studying a combination of factors rather than factors individually.