Demoralization and Response to Psychotherapy: A Pilot Study Comparing the Sequential Combination of Cognitive-Behavioral Therapy and Well-Being Therapy with Clinical Management in Cyclothymic Disorder

Patients with cyclothymic disorder were assessed for presence of psychosomatic syndromes in a recent treatment trial comparing clinical management (CM) to sequential combination of cognitive-behavioral therapy and well-being therapy (CBT/WBT) in which demoralization was found to be the most common syndrome. Demoralization is a psychological state characterized by helplessness, hopelessness, sense of failure and a feeling of inability to cope and may represent a heightened suggestibility to encouragement. Hypothesizing that comorbid demoralization in such patients may prove to be a predictor of increased treatment response, secondary analyses, specifically analyses of variance for repeated measures and contrast analyses, were performed separately for the two treatment groups to compare the mean scores of outcome measures in different assessment times with comorbid demoralization as the between-subjects factor and assessment times as within-subject factors. Among patients in the CM group, a significant time by comorbid demoralization interaction was found at the 2-year follow-up, where demoralized cyclothymic patients showed a significantly greater reduction in mood symptomatology than nondemoralized ones (p < 0.05). Jerome Frank had proposed that common psychotherapeutic elements such as providing a healing setting and encouragement, and instilling hopes and expectations of improvement into the patient, acted positively on demoralized patients. Such nonspecific ingredients provide lessening of isolation and the basis for therapeutic alliance, both considered by some as mechanisms of change. Evaluating the presence of demoralization may help identify those patients with a heightened suggestibility to nonspecific elements of treatment.