Feasibility and Impact of a Guided Symptom Exposure Augmented Cognitive Behavior Therapy Protocol to Prevent Symptoms of Pharmacologically Induced Depression: A Pilot Study

  • Lata K. McGinnEmail author
  • Anna Van Meter
  • Ian Kronish
  • Jessica Gashin
  • Karen Burns
  • Natalie Kil
  • Thomas G. McGinn
Original Article


Depression is the leading cause of disability and a major cause of morbidity worldwide, with societal costs now upwards of 1 trillion dollars across the globe. Hence, extending current efforts to augment prevention outcomes is consistent with global public health interests. Although many prevention programs have been developed and have demonstrated efficacy, studies have yet to demonstrate that CBT is effective in preventing symptoms in populations at risk for developing depression induced by pharmacological substances. Using a randomized, controlled design, this pilot study reports on the feasibility and preliminary effects of a novel, guided symptom exposure augmented cognitive behavioral prevention intervention (GSE-CBT) in a sample diagnosed with Hepatitis C at risk for developing medication induced depression. Results demonstrated that the guided symptom exposure augmented CBT (GSE-CBT) was feasible in this population and was delivered with high integrity. Although not statistically different, we observed a pattern of lower depression levels in the GSE-CBT group versus those in the control group throughout. This pilot study demonstrates that a psychosocial prevention intervention is feasible for use in patients at risk for developing pharmacologically induced depression and that a guided symptom exposure augmented CBT protocol has the potential to prevent symptoms of depression that develop as a side effect to taking these medications. Results are preliminary and future studies should use larger samples and test the intervention in other populations.


Depression Prevention Adulthood CBT Exposure Interoceptive exposure Mood induction Hepatitis Interferon 



This study was funded by the National Institute of Health. R23- DA021531-01 NIDA (NIH).

Compliance with Ethical Standards

Conflict of interest

Lata K. McGinn, Anna Van Meter, Ian Kronish, Jessica Gashin, Karen Burns, Natalie Kil and Thomas G. McGinn declare that they have no competing interests to report.

Informed consent and Animal Rights

All procedures performed in the study involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. No animal studies were carried out by the authors for this paper.


  1. Allartvan Dam, E., Hosman, C. M. H., Hoogduin, C. A. L., & Schaap, C. P. D. R. (2007). Prevention of depression in subclinically depressed adults: Follow-Up effects on the ‘coping with depression’ course. Journal of Affective Disorders, 97(1–3), 219–228. Scholar
  2. Allen, L. B., McHugh, R. K., & Barlow, D. H. (2008). Emotional disorders: A unified protocol. In D. H. Barlow (Ed.), Clinical handbook of psychological disorders: A step-by-step treatment manual (4th ed.), pp. 216–249). New York: Guilford Press.Google Scholar
  3. Barlow, D. B. (Ed.). (2014). Clinical handbook of psychological disorders: A step-by-step treatment manual (4th ed.). New York: Guilford Press.Google Scholar
  4. Beardslee, W. R., Brent, D. A., Weersing, V. R., Clarke, G. N., Porta, G., Hollon, S. D., & Garber, J. (2013). Prevention of depression in at-risk adolescents: Longer-term effects. JAMA Psychiatry, 70(11), 1161–1170. Scholar
  5. Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996). Comparison of beck depression Inventories IA and II in psychiatric outpatients. Journal of Personality Assessment, 67(3), 588–597. Scholar
  6. Beltman, M. W., Voshaar, O., R. C., & Speckens, A. E. (2010). Cognitive-behavioural therapy for depression in people with a somatic disease: Meta-analysis of randomized controlled trials. The British Journal of Psychiatry, 197(1), 11–19. Scholar
  7. Blackburn, I. M., James, I. A., Milne, D. L., Baker, C., Standart, S., Garland, A., & Reichelt, F. K. (2001). The Revised Cognitive Therapy Scale (CTS-R): Psychometric properties. Behavioural and Cognitive Psychotherapy, 29(4), 431–446. Scholar
  8. Calear, A. L., & Christensen, H. (2010). Systematic review of school-based prevention and early intervention programs for depression. Journal of Adolescence, 33(3), 429–438. Scholar
  9. Challen, A. R., Machin, S. J., & Gillham, J. E. (2014). The UK resilience programme: A school- based universal nonrandomized pragmatic controlled trial. Journal of Consulting and Clinical Psychology, 82(1), 75. Scholar
  10. Church, J. (1998). The application of cognitive-behavioural therapy for depression to people with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). Psycho-Oncology. 7(2), 78–88.;2-R Google Scholar
  11. Clark, D. A., & Beck, A. T. (2010). Cognitive therapy of anxiety disorders: Science and practice. New York: Guilford Press.Google Scholar
  12. Clarke, G. N., Hawkins, W., Murphy, M., Sheeber, L. B., Lewinson, P. M., & Seeley, J. R. (1995). Targeted prevention of unipolar depressive disorder in an at-risk sample of high school adolescents: A randomized trial of group cognitive intervention. Journal of the American Academy of Child & Adolescent Psychiatry, 34(3), 312–321. Scholar
  13. Clarke, G. N., Hornbrook, M., Lynch, F., Polen, M., Gale, J., Beardslee, W., & Seeley, J. (2001). A randomized trial of a group cognitive intervention for preventing depression in adolescent offspring of depressed parents. Archives of General Psychiatry, 58(12), 1127–1134. Scholar
  14. Cuijpers, P. (2017). Four decades of outcome research on psychotherapies for adult depression: An overview of a series of meta-analyses. Canadian Psychology, 58(1), 7–19. Scholar
  15. Cuijpers, P., Andersson, G., Donker, T., & van Straten, A. (2011). Psychological treatment of depression: Results of a series of meta-analyses. Nordic Journal of Psychiatry, 65(6), 354–364. Scholar
  16. Cuijpers, P., Beekman, A. T. F., & Reynolds, C. F. (2012). Preventing depression: A global priority. Journal of the American Medical Association, 307(10), 1033–1034. Scholar
  17. Cuijpers, P., Smit, F., Bohlmeijer, E., Hollon, S. D., & Andersson, G. (2010). Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depress: Meta-analytic study of publication bias. The British Journal of Psychiatry, 196(3), 173–178. Scholar
  18. Cuijpers, P., Turner, E. H., Mohr, D. C., Hofmann, S. G., Andersson, G., Berking, M., & Coyne, J. (2014). Comparison of psychotherapies for adult depression to pill placebo control groups: A meta-analysis. Psychological Medicine, 44(4), 685–695. Scholar
  19. Cuijpers, P., van Straten, A., Smit, F., Mihalopoulos, C., & Beekman, A. (2008). Preventing the onset of depressive disorders: A meta-analytic review of psychological intervention. American Journal of Psychiatry. 165. 12721280.
  20. Cujpers, P. (2011). Prevention of depressive disorders: Towards a further reduction of the disease of the disease burden of mental disorders. Early Intervention in Psychiatry. 5.3., 179–180.
  21. Di Giulio, G., Therapist, client factors, and efficacy in cognitive behavioural therapy: A meta- analytic exploration of factors that contribute to positive outcome. Ottawa: University of Ottawa; 2010. Retrieved from
  22. Dieperink, E., Willenbring, M., & Ho, S. B. (2000). Neuropsychiatric symptoms associated with hepatitis C and in interferon alpha: A review. American Journal of Psychiatry, 157(6), 867–876. Scholar
  23. Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R.J., Addis M. E., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658–670. Scholar
  24. Edelman, S., Bell, D. R., & Kidman, A. D. (1999). A group cognitive behaviour therapy programme with metastatic breast cancer patients. Psycho-Oncology. 8(4), 295–305.;2-Y Google Scholar
  25. Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Thompson-Hollands, J., Carl, J. R., et al. (2012). Unified protocol for transdiagnostic treatment of emotional disorders: A randomized control trial. Behavior Therapy, 43(3), 666–678. Scholar
  26. Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83(6), 1108–1122. Scholar
  27. Garber, J., Webb, C. A., & Horowitz, J. L. (2009). Prevention of depression in adolescents: A review of selective and indicated programs. In Nolen-Hoeksema, Susan (Ed.); L. M. Hilt (Ed.), Handbook of depression in adolescents (pp. 619–659). New York: Routledge/Taylor & Francis Group.Google Scholar
  28. Gillham, J. E., Reivich, K. J., Jaycox, L. H., & Seligman, M. E. P. (1995). Prevention of depressive symptoms in schoolchildren: Two-year follow-up. Psychological Science, 6(6), 343–351. Scholar
  29. Gotlib, I. H., & Joormann, J. (2010). Cognition and depression: Current status and future directions. Annual Review of Clinical Psychology, 6, 285–312. Scholar
  30. Greden, J. F. (2001). The burden of disease for treatment-resistant depression. The Journal of Clinical Psychiatry, 62(16), 26–31. Retrieved from
  31. Hasin, D. S., Goodwin, R. D., Stinson, F. S., & Grant, B. F. (2005). Epidemiology of major depressive disorder results from the national epidemiologic survey on alcoholism and related conditions. Archives of General Psychiatry, 62(10), 1097–1106. Scholar
  32. Hasin, D. S., Sarvet, A. L., Meyers, J. L., et al. (2018). Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA Psychiatry, 75(4), 336–346. Scholar
  33. Hayes, S. C., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L. F. (2004). DBT, FAP, and ACT: How empirically oriented are the new behavior therapy technologies? Behavior Therapy, 35(1), 35–54. Scholar
  34. Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152. Scholar
  35. Hey, S. P., & Kimmelman, J. (2014). The questionable use of unequal allocation in confirmatory trials. Neurology, 82(1), 77–79. Scholar
  36. Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427–440. Scholar
  37. Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O’Reardon, J. P., Lovett, M. L., Young, P. R., Haman, K. L., Gallop, F. B. B., R (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of General Psychiatry, 62(4), 417–422. Scholar
  38. Hopko, D. R., Bell, J. L., Armento, M., Robertson, S., Mullane, C., Wolf, N., & Lejuez, C. W. (2008). Cognitive-behavior therapy for depressed cancer patients in a medical care setting. Behavior Therapy, 39(2), 126–136. Scholar
  39. Horikawa, N., Yamazaki, T., Izumi, N., & Uchihara, M. (2003). Incidence and clinical course of major depression in patients with chronic hepatitis type C undergoing interferon-alpha therapy: A prospective study. General Hospital Psychiatry, 25(1), 34–38. Scholar
  40. Horowitz, J. L., Garber, J., Ciesla, J. A., Young, J. F., & Mufson, L. (2007). Prevention of depressive symptoms in adolescents: A randomized trial of cognitive-behavioral and interpersonal prevention programs. Journal of Consulting and Clinical Psychology, 75(5), 693–706. Scholar
  41. Ingram, R. E., & Ritter, J. (2000). Vulnerability to depression: Cognitive reactivity and parental bonding in high-risk individuals. Journal of Abnormal Psychology, 109(4), 588–596. Scholar
  42. Jane-Llopis, E., Hosman, C., Jenkins, R., & Anderson, P. (2003). Predictors of efficacy in depression prevention programmes. The British Journal of Psychiatry, 183(5), 384–397. Scholar
  43. Jorm, A. F., Morgan, A. J., & Hetrick, S. E. (2008). Relaxation for depression. Cochrane Database of Systematic Reviews, 4, CD007142.Google Scholar
  44. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of general psychiatry, 62(6), 593–602. Scholar
  45. Kessler, R. C., Heeringa, S., Lakoma, M. D., Petukhova, M., Rupp, A. E., Schoenbaum, M., et al. (2008). Individual and societal effects of mental disorders on earnings in the United States: results from the national comorbidity survey replication. American Journal of Psychiatry, 165(6), 703–711. Scholar
  46. Kessler, R. C., Merikangas, K. R., & Wang, P. S. (2007). Prevalence, comorbidity, and service utilization for mood disorders in the United States at the beginning of the twenty-first century. Annual Review of Clinical Psychology, 3, 137–158. Scholar
  47. Kohn, C. S., Petrucci, R. J., Baessler, C., Soto, D. M., & Movsowitz, C. (2000). The effect of psychological intervention on patients’ long-term adjustment to the ICD: A prospective study. Pacing and Clinical Electrophysiology. 23. 450–456. Scholar
  48. Krauskopf, K., McGinn, T. G., Federman, A. E., Halm, E. A., Leventhal, H., McGinn, L. K., et al. (2010). HIV and HCV health beliefs in an inner-city community. Journal of Viral Hepatitis, 18(11), 1–7. Scholar
  49. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. Scholar
  50. Li, C., Xu, D., Hu, M., Tan, Y., Zhang, P., Li, G., & Chen, L. (2017). A systematic review and meta- analysis of randomized controlled trials of cognitive behavior therapy for patients with diabetes and depression. Journal of Psychosomatic Research, 95, 44–54. Scholar
  51. Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press.Google Scholar
  52. Lucaciu, L. A., & Dumitrascu, D. L. (2015). Depression and suicide ideation in chronic hepatitis C patients untreated and treated with interferon: prevalence, prevention, and treatment. Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology, 28(4), 440–447. Retrieved from
  53. McGinn, L. K. (2016, April). Adapting CBT for Ethnically Diverse Populations: A Depression Prevention Initiative. In J. M. Smoller (Chair of the Conference), Integrating Practice Research and Community. Anxiety and Depression Association of America. Philadelphia, PA.Google Scholar
  54. McGinn, T. G., Gardenier, D., McGinn, L. K., Alfandre, D., O’Connor-Moore, N., Sturm, T. M., Schiano, T. D., & Reichman, S. (2005). Treating chronic Hepatitis C in the primary care setting. Seminars in Liver Disease, 25(1), 65–71.Google Scholar
  55. McGinn, L. K., Kyrimis, M., & Taitz, J. (2008). Guided Symptom Exposure Augmented Cognitive Behavior Therapy Program (GSE-CBT) for depression (Therapist and Client Manual). Unpublished manuscript.Google Scholar
  56. Merry, S., McDowell, H., Wild, C. J., Bir, J., & Cunliffe, R. (2004). A randomized placebo- controlled trial of a school-based depression prevention program. Journal of the American Academy of Child & Adolescent Psychiatry, 43(5), 538–547. Scholar
  57. Mohr, D. C., Goodkin, D. E., Likosky, W., Gatto, N., Baumann, K. A., & Rudick, R. A. (1997). Treatment of depression improves adherence to interferon beta-1b therapy for multiple sclerosis. Archives of Neurobiology, 54(5), 531–533. Scholar
  58. Mowbray, C. T., Holter, M. C., Teague, G. B., & Bybee, D. (2003). Fidelity criteria: Development, measurement, and validation. American Journal of Evaluation, 24(3), 315–340. Scholar
  59. Munoz, R. F., Cuijpers, P., Smit, F., Barrera, & Leykin, Y. (2010). Prevention of major depression. Annual Review of Clinical Psychology, 6, 181–212.Google Scholar
  60. Munoz, R. F., Ying, Y., Bernal, G., & Perez Stable, E. J. (1995). Prevention of depression with primary care patients: A randomized controlled trial. American Journal of Community Psychology, 23(2), 199–222. Scholar
  61. Newman, K. R., & Sears, C. R. (2015). Eye gaze tracking reveals different effects of a sad mood induction on the attention of previously depressed and never depressed women. Cognitive Therapy and Research, 39(3), 292–306. Scholar
  62. Orsmond, G. I., & Cohn, E. S. (2015). The distinctive features of a feasibility study: Objectives and guiding questions. OJTR: Occupation, Participation and Health, 35(5), 169–177. Scholar
  63. Pariante, C. M., Germana, M. O., Baita, A., Farci, M. G., & Carpiniello, B. (1999). Treatment with interferon alpha in patients with chronic hepatitis and mood or anxiety disorders. The Lancet, 354, 131–132. Scholar
  64. Pitceathly, C., Maguire, P., Fletcher, I., Parle, M., Tomenson, B., & Creed, F. (2009). Can a brief psychological intervention prevent anxiety or depressive disorders in cancer patients? A randomized controlled trial. Annals of Oncology, 20(5), 928–934. Scholar
  65. Pössel, P., Adelson, J. L., & Hautzinger, M. (2011). A randomized trial to evaluate the course of effects of a program to prevent adolescent depressive symptoms over 12 months. Behaviour Research and Therapy, 49(12), 838–851. Scholar
  66. Robaeys, G., De Bie, J., Wichers, M. C., Bruckers, L., Nevens, F., Michielsen, P., & Buntinx, F. (2007). Early prediction of major depression in chronic hepatitis C patients during peg- interferon alpha-2b treatment by assessment of vegetative-depressive symptoms after four weeks. World Journal of Gastroenterology, 13(43), 5736–5740. Scholar
  67. Robinson, L. A., Berman, J. S., & Neimeyer, R. A. (1990). Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research. Psychological Bulletin, 108(1), 30–49. Scholar
  68. Safren, S. A., O’Cleirigh, C., Tan, J., Raminani, S., Reilly, L. C., Otto, M. W., & Mayer, K. H. (2009). A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected Individuals. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association, 28(1), 1–10. Scholar
  69. Safren, S. A., O’Cleirigh, C. M., Bullis, J. R., Otto, M. W., Stein, M. D., & Pollack, M. H. (2012). Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV- infected injection drug users: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 80(3), 404–415. Scholar
  70. Schäfer, A., Wittchen, H. U., Seufert, J., & Kraus, M. R. (2007). Methodological approaches in the assessment of interferon-alfa-induced depression in patients with chronic hepatitis C– a critical review. International Journal of Methods in Psychiatric Research, 16(4), 186–201. Scholar
  71. Seligman, M. E. P., Schulman, P., DeRubeis, R. J., & Hollon, S. D. (1999). The prevention of depression and anxiety. Prevention & Treatment. 2(8).
  72. Seligman, M. E. P., Schulman, P., & Tryon, A. M. (2007). Group prevention of depression and anxiety symptoms. Behaviour Research and Therapy, 45(6), 1111–1126. Scholar
  73. Sharpe, L., Sensky, T., Timberlake, N., Ryan, B., Brewin, C. R., & Allard, S. (2001). A blind, randomized, controlled trial of cognitive behavioural intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity. Pain, 89(2–3), 275–283. Scholar
  74. Shochet, I. M., Dadds, M. R., Holland, D., Whitefield, K., Harnett, P. H., & Osgarby, S. M. (2001). The efficacy of a universal school-based program to prevent adolescent depression. Journal of Clinical Child Psychology, 30(3), 303–315. Scholar
  75. Silberbogen, A. K., Ulloa, E., DeAnna, L. M., & Brown, K. (2012). Telehealth intervention for veterans on antiviral treatment for the hepatitis C virus. Psychological Services, 9(2), 163–173. Scholar
  76. Sockalingam, S., Links, P. S., & Abbey, S. E. (2011). Suicide risk in hepatitis C and during interferon-alpha therapy: a review and clinical update. Journal of Viral Hepatitis, 18(3), 153–160. Scholar
  77. Soroudi, N., Perez, G. K., Gonzalez, J. S., Greer, J. A., Pollack, M. H., Otto, M. W., et al. (2008). CBT for medication adherence and depression (CBT-AD) in HIV-infected Patients receiving methadone maintenance therapy. Cognitive and Behavioral Practice, 15(1), 93–106. Scholar
  78. Spence, S. H., Sheffield, J. K., & Donovan, C. L. (2005). Long-term outcome of a school-based, universal approach to prevention of depression in adolescents. Journal of Consulting and Clinical Psychology, 73(1), 160. Scholar
  79. Stice, E., Rohde, P., Gau, J. M., & Wade, E. (2010). Efficacy trial of a brief cognitive– behavioral depression prevention program for high-risk adolescents: Effects at 1- and 2- year follow-up. Journal of Consulting and Clinical Psychology, 78(6), 856–867. Scholar
  80. Tak, Y. R., Lichtwarck-Aschoff, A., Gillham, J. E., Zundert, R. M. P., & Engels, R. C. M. E. (2016). Universal school-based depression prevention ‘Op Volle Kracht’: A longitudinal cluster randomized controlled trial. Journal of Abnormal Child Psychology, 44(5), 949–961. Scholar
  81. Tolin, D. F. (2010). Is cognitive-behavioral therapy more effective than other therapies? A meta- analytic review. Clinical Psychology Review, 30(6), 710–720. Scholar
  82. Tovote, K. A., Schroevers, M. J., Snippe, E., Emmelkamp, P. M. G., Links, T. P., Sanderman, R., & Fleer, J. (2017). What works best for whom? Cognitive Behavior Therapy and Mindfulness- Based Cognitive Therapy for depressive symptoms in patients with diabetes. PLoS ONE. 12(6). Article ID e0179941.
  83. van Straten, A., Geraedts, A., Verdonck-de Leeuw, I., Andersson, G., & Cuijpers, P. (2010). Psychological treatment of depressive symptoms in patients with medical disorders: a meta-analysis. Journal of Psychosomatic Research, 69(1), 23–32. Scholar
  84. Vázquez, F. L., Torres, Á, Blanco, V., Otero, P., Díaz, O., & Ferraces, M. J. (2016). Long-term follow-up of a randomized clinical trial assessing the efficacy of a brief cognitive- behavioral depression prevention intervention for caregivers with elevated depressive symptoms. The American Journal of Geriatric Psychiatry, 24(6), 421–432. Scholar
  85. Wahl, M. S., Patak, M. A., Pössel, P., & Hautzinger, M. (2011). A school-based universal programme to prevent depression and to build up life skills. Journal of Public Health, 19(4), 349–356. Scholar
  86. Waltz, J., Addis, M. E., Koerner, K., & Jacobson, N. S. (1993). Testing the integrity of a psychotherapy protocol: Assessment of adherence and competence. Journal of Consulting and Clinical Psychology, 61(4), 620–630. Scholar
  87. Weissman, M. M., Wickramaratne, P., Nomura, Y., Warner, V., Pilowsky, D., & Verdeli, H. (2006). Offspring of depressed parents: 20 years later. The American Journal of Psychiatry, 163 (6), 1001–1008.
  88. Welton, R. S. (2007). The management of suicidality: assessment and intervention. Psychiatry Edgmont, 4(5), 24–34. Scholar
  89. Williams, J. W., Pignone, M., Ramirez, G., & Stellato, C. P. (2002). Identifying depression in primary care: A literature synthesis of case-finding instruments. General Hospital Psychiatry, 24(4), 225–237. Scholar
  90. Wittkampf, K., van Ravesteijn, H., Baas, K., van de Hoogen, H., Schene, A., Bindels, P., & van Weert, H. (2009). The accuracy of patient health questionnaire-9 in detecting depression and measuring depression severity in high-risk groups in primary care. General Hospital Psychiatry, 31(5), 451–459. Scholar
  91. World Health Organization. (2017). Depression and other common mental disorders: global health estimates. World Health Organization. Retrieved from
  92. Ye, M., Du, K., Zhou, J., et al. (2018). A meta-analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients. Psycho-Oncology, 27(7), 1695–1703. Scholar
  93. Young, J. E., & Beck, A. T. (1980). Cognitive Therapy Scale: Rating manual. Center for Cognitive Therapy, University of Pennsylvania, Philadelphia: Unpublished manuscript.Google Scholar

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Authors and Affiliations

  1. 1.Ferkauf Graduate School of PsychologyYeshiva UniversityBronxUSA
  2. 2.Mount Sinai Medical CenterNew YorkUSA
  3. 3.The Feinstein Institute for Medical Research, The Zucker Hillside Hospital, Psychiatry ResearchGlen OaksUSA
  4. 4.Division of General MedicineColumbia Presbyterian HospitalNew YorkUSA
  5. 5.Department of MedicineHofstra Northwell School of MedicineManhassetUSA

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