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Early Intervention for Adults at High Risk of Recurrent/Chronic Depression: Cognitive Model and Clinical Case Series

  • Stephen Barton (a1), Peter Armstrong (a2), Mark Freeston (a1) and Vivien Twaddle (a2)
  • DOI:
  • Published online: 01 May 2008

This paper describes a cognitive model for first/second onset depression that has been precipitated by major life stress, entrenched for several months and is unresponsive to pharmacotherapy. These conditions create high risks for recurrent/chronic depression and early intervention is proposed to identify, treat and protect against relapse/recurrence. Severe life stress interacts with an individual's core self-representations and personal values, identity is disrupted and depression is maintained by dysfunctional goal engagement and disengagement. Treatment aims to restore functional self-regulation by increasing self-diversification and creating balanced goal investments. Outcome and follow-up data are reported in a case series of five consecutive patients. There was good therapist adherence to the prescribed targets and pre-post effect sizes were comparable or larger than published outcome studies. At the 12 month follow-up, three of the four treatment completers (75%) had made reliable and clinically significant changes and were in full remission. This provides encouraging preliminary evidence for the model's validity and the therapy's efficacy.

Corresponding author
Reprint requests to Stephen Barton, Consultant Clinical Psychologist, Transitions Service, Chester le Street Health Centre, Newcastle Road, Chester le Street, Co Durham DH3 3UR, UK. E-mail:
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