Rapid early response, cognitive modification, and nonspecific factors in cognitive behavior therapy for depression: A reply to Tang and DeRubeis.

Tang and DeRubeis (this issue) challenge the Ilardi and Craighead (1994) hypothesis that nonspecific factors mediate a large proportion of clinical improvement In cognitive behavior therapy (CUT) for depression, and argue that Beck's cognitive hypothesis is not contradicted by the phenomenon of rapid early treatment response. They propose (a) that cognitive modification techniques are introduced in CBT as early as Session 2, (b) that dose-response analyses are inconsistent with the rapid early response pattern, and (c) that observed heterogeneity of patient temporal response curves is problematic for the nonspecific factors hypothesis. In response, we note that (a) there is no compelling evidence that cognitive modification techniques are routinely implemented prior to Week 3 of CBT, (b) disproportionately rapid improvement In depressive symptoms typically occurs over the first six sessions (3 weeks) of CBT, and (c) the two newly reported heterogeneous temporal response patterns are each consistent with the hypothesis of nonspecific mediation of clinical improvement.