Toward an integration of psychologic, social, and biologic factors in depression: effects on outcome and course of cognitive therapy.

The present study attempted to integrate key variables from 3 major domains of theory in depression (cognition, stress, and psychobiology) that are typically studied separately in analyses of course and response to cognitive therapy. Dysfunctional attitudes, negative life events, or sleep electroencephalogram were assessed in 53 outpatients before treatment with cognitive therapy. High levels of dysfunctional attitudes were found to be associated with poorer response to treatment but not for those patients who had experienced a severe negative life event. Examination of the length of time required to achieve remission revealed an effect for rapid eye movement (REM) latency as well as the interaction between REM latency and life events. These results are discussed in terms of the promise of integrative research in the study of depression and its treatment.