The role of nonspecific factors in cognitive-behavior therapy for depression.

This article reviews the role of nonspecific treatment factors in cognitive-behavior therapy (CBT) for depression. An analysis of relevant studies reveals that the majority of symptomatic improvement in CBT occurs prior to the formal introduction of cognitive restructuring techniques. This suggests that other, likely nonspecific, treatment factors play a large role in mediating clinical improvement. Nonspecific factors are hypothesized to ameliorate patients’ feelings of hopelessness at the beginning of treatment, a process that catalyzes improvement across other depressive symptoms. Reviewed evidence supports a mediation role for the hopelessness construct in CBT. Two nonspecific factors, the treatment rationale and the assignment of homework, appear integral to early symptomatic improvement. The role of cognitive techniques is discussed in light of these findings.