Psychophysiological responses to group cognitive-behavioral therapy in depressive patients

Cognitive-Behavioral Therapy (CBT) has a significant adjunctive effect in the treatment of Major Depressive Disorder (MDD), however its use as monotherapy in group-based approaches is less explored. We assessed the responses of distinct psychophysiological domains after a group-based CBT (gCBT, 16 weeks) intervention in drug-free patients with mild-moderate MDD (n = 20; women = 11) and compared them with a healthy control group (n = 25, women = 13). The treatment resulted in 65% of response and 55% of remission rates. Significant reductions in depressive and anxiety symptoms and increase in self-esteem and sleep quality were observed as gCBT responses. Moreover, after treatment, patients regulated their previously deregulated salivary cortisol awakening response and sleep quality toward healthy parameters. These improvements were correlated among themselves and dependent of remission outcome. Remitted patients showed larger improvements than non-remitted for all psychophysiological domains, except for serum cortisol that significantly changed only for no-remitted patients after gCBT but did not reached controls levels. Further, better baseline sleep quality was predictor of remission. The psychophysiological changes found support the use of gCBT as monotherapy treatment for mild-moderate MDD, corroborate the importance of the observation of the patients in theirs whole sociopsychophysiological condition since they are related to remission outcome and then stimulate further studies of validation of clinical protocols that work on all of these psychophysiological domains studied.

Trial Registration U1111–1215-4472. Registered 21 August 2018,

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Data Availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.


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The authors are thankful to all volunteers for this study and to Federal University of Rio Grande do Norte, Brazil, for institutional support.

Author Agreement Statement

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us.


This study was funded by National Science and Technology Institute for Translational Medicine (INCT-TM Fapesp 2014/50891–1; CNPq 465458/2014–9). NLGC is supported by CAPES Foundation from Brazilian Ministry of Education (Research Fellowship 88887.466701/2019–00) National Science and Technology Institute for Translational Medicine (INCT-TM Fapesp 2014/50891–1; CNPq 465458/2014–9). The funder did not have any role in the design of the study, collection, analysis, and interpretation of data and in drafting the manuscript.

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NLGC, YMV and NGS planned the clinical trial; ACLL did volunteers screening; YMV conducted treatment; ACMG and GMSJ carried out statistical analysis; all authors contributed to the manuscript.

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Correspondence to Nicole Leite Galvão-Coelho.

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Varela, Y.M., de Almeida, R.N., Galvão, A.d. et al. Psychophysiological responses to group cognitive-behavioral therapy in depressive patients. Curr Psychol (2021).

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  • Cortisol
  • Sleep
  • Anxiety
  • Self-esteem
  • Open-label trial