Psychological Reports, 1987,61, 939-953.

@ Psychological Reports 1987

C O M P O N E N T AND PROCESS ANALYSIS

O F COGNITIVE THERAPY1

ROBERT D. ZETTLE AND STEVEN C. HAYES

Wichita Stats University University of Nevada-Reno

Summary.-A component and process analysis of cognitive therapy was

conducted. Three components, distancing, cognitive restructuring, and be-
havioral homework, were presented in various sequential combinations during
12 wk. of treatment to 12 women between 22 and 64 yr. of age ( M = 41.5
yr.). Time-series analyses of individual improvement suggested that corn-
ponents combined i n an additive rather than interactive manner. The mechan-
isms through which components initiated therapeutic change were evaluated by
measures assessing both cognitive and behavioral processes specific to depres-
sion. The results of the component and process analysis differed from predic-
tions derived from cognitive theory. Replication with a larger sample is needed.
Implications for the practice of and further research in cognitive therapy are
discussed.

Cognitive therapy (Beck, Rush, Shaw, & Emery, 1979) is recognized as

an effective treatment for depression (Rush, Beck, Kovacs, & Hollon, 1977;
Rush, Beck, Kovacs, Weissenburger, & Hollon, 1 9 8 2 ) ; however, it is unclear
which components contribute t o its efficacy o r the mechanisms through which
depression is affected. This study undertook a component and process analysis
t o begin t o address these unanswered questions.
Cognitive therapy may be viewed as a "treatment package" containing
several components. Three components, distancing, cognitive restructuring,
and behavioral homework, were evaluated i n the present study. Distancing has
been described as a "first, critical step" in cognitive therapy (Hollon & Beck,
1979, p. 189). T h e goal is to enable clients to recognize that depressogenic be-
liefs are hypotheses rather than facts. This is accomplished through strategies
such as similes, reattribution techniques, and "alternative conceptualizations"
(Beck, et al., 1979).
Distancing procedures are always in the service of other cognitive tech-
niques such as identifying and evaluating automatic thoughts, which have been
referred to as "cognitive restructuring." Once clients are able to approach
their beliefs as hypotheses-to-be-evaluated, an attempt is made to review logi-
cally both past and present evidence for and against the validity of such beliefs.

lPortions of this paper were presented at the meeting of the American Psychological Asso-
ciation, Toronto, August 1984. This arricle is a condensed version of the doctoral dis-
sertation conducted by the first author under the supervision of the second author. Ap-
preciation is expressed to Sally Carr and Jeff West, who served as interviewers, and to
Suzanne Brannon, Joe Haas, James Herbert, and Irwin Rosenfarb for their assistance in
data collection. Request reprints from Robert D. Zettle, Department of Psychology,
Wichita State University, Wichita, Kansas 67208.
940 R. D. ZETTLE & S. C HAYES

Beck has outlined several behavioral techniques within cognitive therapy.

Of primary importance for the current analysis are homework assignments in
which clients "test out" specific hypotheses formulated from their depressogenic
beliefs.
The few investigations which have evaluated the effects of distancing
(Blackburn & Bonham, 1980), cognitive restructuring (Teasdale & Fennel,
1982), and behavioral homework (Harmon, Nelson, & Hayes, 1980) suggest
that all exert some effect in reducing state depression and dysphoric mood.
The impact of each over longer durations or how they interact within the
context of cognitive therapy, however, has not been assessed. Also the extent
to which distancing is necessary for successful treatment and the role of be-
havioral homework have not been evaluated empirically. These issues were
addressed by closely monitoring individual improvement during a treatment
phase in which the three components were presented in various sequential
combinations.
METHOD
Subjects
Volunteer subjects were recruited through publicity services and com-
munity referral sources. A total of 49 women presented themselves as potential
subjects.
Selection Criteria
Participants were screened through a sequential, multicriterial selection
procedure to ensure they were experiencing a clinical level of pretreatment de-
pression. ( a ) Subjects were required to report moderate to severe levels of
depression, defined as a score of 20 or above on the Beck Depression Inventory
(Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). ( b ) Subjects meeting
criterion on Beck's inventory next were administered the MMPI (Hathaway &
McKinley, 1942). Subjects were required to obtain a T-score of 70 or greater
on the Depression scale. ( c ) Subjects finally were interviewed by an inde-
pendent evaluator. After the interview, the evaluator completed the Hamilton
Rating Scale for Depression (Hamilton, 1960). All interviews were audio-
taped to assess independent interrater reliability with a second assistant. Sub-
jects were required to score 14 or above on the 21-item version of the rating
scale.
A total of 18 women met all criteria and were invited to participate in the
study; six declined to do so. The remaining 12 subjects ranged in age from
22 to 64 yr., with a mean of 41.5 yr. All subjects were required to verify that
they were not taking antidepressant and/or tranquilizing medications.
Procedure
Subjects were assigned randomly to one of four treatment cells (lz =3
 ANALYSIS OF COGNITIVETHERAPY 941

in each cell) within a 2 (cognicive factor: cognitive restructuring vs distancing

plus cognitive restrucmring) X 2 (behavioral factor: absence vs presence of
behavioral homework) factorial design. Treatment conditions comprising the
four cells are described in detail below.
Prior to treatment, subjects collected 3, 4, or 5 weeks of baseline data, with
the phase length determined randomly. Subjects completed a Beck inventory
daily during the study. Accordingly, it was possible to evaluate the 1rnp3ct of
treatment introduction via a multiple baseline across subjects within each treat-
ment cell and to monitor closely the progress of each subject throughout
treatment
Dependent Meariwes
Outcome measwes.-To evaluate global improvement Beck's and Hamil-
ton's scales were readministered 1 wk. posttreatment and agdn at 2 mo. follow-
up. On both occasions subjects were interviewed by the same assistant em-
ployed at pretreatment. All interviews were audiotaped and rated subsequently
on Hamilton's scale by another assistant. Across the entire sample of inter-
views, interrater agreement was both statistically significant and adequate for
research purpose ( s = .89, p < .001).
Process measares.-At pretreatment, posttreatment, and follow-up, subjects
also were administered two questionnaires to assess both cognitive and be-
havioral processes specific to depression.
The Dysfunctional Attitude Scale consists of attitudes identified by ex-
perienced clinicians as most characteristic of depression. Accordingly, reduc-
tions in scores following treatment may be viewed as reflecting a restructuring
of core beliefs thought to underlie depression (Weissman, 1979).
The Pleasant Events Schedule lists 320 events rated as pleasurable by a
sample of subjects' (MacPhillarny & Lewinsohn, 1972). Subjects rate the
evenrs for their frequency of occurrence and associated pleasantness. T h e e
scores are derivable from the two sets of ratings: ( a ) Activity Level, defined as
the sum of frequency ratings, ( b ) Reinforcement Potential, defined as the sum
of pleasantness ratings, and ( c ) Obtained Reinforcement, defined as the sum of
the product of frequency and pleasantness ratings for each event.
Assessment of Nonspecific Treatment Effects
The first author served as therapist in all treatment conditions. To assess
the presence of any potential bias or ocher nonspecific effects, a postsession
questionnaire was administered at the end of each treatment session.
Treatment Conditiom
Each subject received 1 2 weekly sessions of individual treatment. All
9. J. MacPhillamy & P. M. Lewinsohn, A scale for the measurement of positive rein-
forcement. (Unpublished manuscript, Univer. of Oregon, 1971)
942 R. D. ZETTLE & S. C. HAYES

sessions were conducted according - to treatment manuals, with a random third

of them audiotaped for subsequent review as a manipulation check.3 Subjects
within each condition were exposed to varying phase lengths of the specific
treatment components involved ( Hayes, 1981) . There were three types of
components as described below.
Distancing.-Distancing procedures consisted of strategies such as similes,
reattribution techniques, and "alternative conceptualizations" outlined by Beck,
et al. (1979). For example, subjects were encouraged to view problematic
issues as an optimist and to consider external-situational factors in making
attributions of self-blame. Self-monitoring homework was used to identify
specific depressive thoughts for further discussion.
Cognitive restrzlctarin.g.-This treatment component closely followed
guidelines by Beck, et al. (1979). A Socratic style of dialogue was used to
review both past and present evidence relevant to the validity of depressive
thoughts.
Behavioral homework.-During this component the Pleasant Events Sched-
ule was used to identify low-frequency, highly pleasurable activities. Silbjects
were asked to verbalize particular thoughts which interfered with their en-
gagement in such activities (e.g., "I wouldn't have a good time anyway," "It
wouldn't turn out: right," etc.). Subjects then were guided in designing tests
of such thoughts, and for homework were asked to carry them out.
Combination. and sequelzcing of conditions.-Treatment components were

TABLE 1
OF COMPONENTS
SEQUENCING WITHINTREATMENT
CELLS:
NUMBEROF WEEKS IMPLEMENTED
Subject Baseline Distancing Restructuring Homework
Cognitive Restructuring
4 3 12
2 4 12
12 5 12
Cognitive Restructuring with Behavioral Homework
9 3 5 7
10 4 4 8
1 5 3 9
Distancing Plus Cognitive Restructuring
3 3 5 7
G 4 4 8
11 5 3 9
Distancing Plus Cognitive Restructuring with Behavioral Homework
5 3 5 3 4
8 4 4 4 4
7 5 3 5 4

'Copies of the treatment manuals may be obtained from R. D. Zettle.

 ANALYSIS OF COGNITIVE THERAPY 943

combined to form four different cells within a 2 X 2 factorial design. These

consisted of cognitive restructuring with and without distancing, and these two
groups with and without behavioral homework. As is shown in Table 1, the
phase lengths of each component and baseline were varied systematically to
meet requirements of a sequential multiple baseline design ( Hayes, 1981) .

RESULTS
Check of Treatment Integrity
To evaluate treatmenc integrity (Yeaton & Sechrest, 1981) audiotapes of
sessions were reviewed by a panel of judges familiar with treatment manuals
but blind to each subject's treaunent condition. The panel classified correctly
40 of 45 tapes, a proportion which greatly exceeds that expected by chance
( Z = 4.48, p < .001).
Nonspecific Treatment Effects
Responses on the postsession questionnaire from each treatment session
may be viewed as a gross measure of any possible nonspecific treatment effects.
N o significant main effects or interactions mere found on any of the items
at any of the measurement occasions.
Viszul-Gra9hic Analysis
A mean score using the daily measures on Beck's inventory was calculated
for each subject at each week of baseline and treatment. Figs. 1 and 2 display
these scores in a multiple-baseline fashion for subjects in the cognitive re-
structuring and distancing plus cognitive restructuring conditions, re~pectively.~
Cognitive restractaring condition.-A visual analysis of Fig. 1 showed
decelerating trends in Beck scores for subjects within the cell for cognitive
restructuring without behavioral homework. A mixed pattern of results was
obtained for subjects receiving cognitive restructuring with behavioral home-
work. Subject 9 showed an accelerating trend in scores during both cognitive
restructuring and homework components, with higher scores at posttreatment
and follow-up than during baseline. Subjects 1 and 10 showed a variable pat-
tern of scores during treatment with reduced levels of depression at follow-up.
Distancing plas cognitive-re~tractzlPing condition.-A visual analysis in
Fig. 2 indicated inconsistent trends for subjects within the cell for distancing
plus cognitive restructuring without behavioral homework. Subject 3 showed
an iatrogenic trend towards increasing depression and higher Beck scores at
posttreatment and follow-up than during baseline. Subjects 6 and 11 showed

'For ease of discussion, columns or rows within the factorial design will be referred to
as "conditions." Separate groups within a given condition (e.g., the cognitive restruc-
turing without behavioral homework group within the cognitive restructuring condition)
will be referred to as "cells."
944 R. D. ZETTLE & S. C. HAYES

ral Homework Behavioral Homework

50 4 Bsln I S9 4.

L
35 -
I
I S12 35 - L~
I S'
30 -
I
I 30 -

fi/\7
I
- .i\.\.-.,I----.--\. 25 -

,
25
20-
I
.... --.._. 20 - .-.
15 - I A 15- I n\.
0
I 10- I
10-
I I
5 - I 5- I A
I I
I 1 I I 1 I I I
5 10 15 F-U 5 10 15 F-U
Weeks
FIG.1. Weekly mean Beck scores for subjects in cognitive restructuring condition.
(Ordinates are in unequal units. = Sessions in which behavioral homework was
added to treatment. A = Follow-up Beck score.)

over-all decelerating trends, with lower depression at posttreatment and follow-

up than during baseline.
A more consistent pattern was evident for subjects within the cell for
distancing plus cognitive restructuring with behavioral homework. All re-
ported reduced depression at follow-up, with lower Beck scores at posttreatment
noted for Subjects 5 and 8.
 ANALYSIS OF COGNITIVE THERAPY 945

35 -IBsln I No Behavioral Homework Bsln

Behavioral Homework

55

50- I S11
35 - I S7
45 - I 30 I
40-
35-

30-
25
20
-
-
,.JY
--' Ii

I
.,. 0.0
~-o.-"%o,
A 15 -
20-
251
I

.P \ /I : [ \ . ~ ~ \ ~ ~ /
I I 0
0.0
15- I 10 - I A
10-
5 - 1 5 - I
I I
I I I I I 1 I 1
5 10 15 FU 5 10 15 FU
Weeks
FIG.2. Weekly mean Beck scores for subjects in distancing plus cognitive resctuc-
curing condition. (Ordinates are i n unequal units. 0 = Sessions in which cognitive
restrucruring was added to treatment. = Sessions i n which behavioral homework was
added to treatment. = Follow-up Beck score.)

Trends suggested by visual analyses were evaluated further by the C

statistic (Tryon, 1982). The C statistic is a method of time-series analysis
which evaluates variance among successive data points within a treatment
phase relative to their variability about the mean of that phase.
946 R. D. ZETTLE & S. C. HAYES

Baseline trends initially were evaluated for each subject. In the absence
of a trend, data points from the first treatment component were appended to
those from baseline, with the C statistic used to evaluate the entire aggregate.
If a trend was detected in baseline, the split-middle technique was used to pro-
ject celeration line over the time period in which the first component was im-
plemented (Kazdin, 1976). Beck scores associated with the first component
were then subtracted from those predicted by the celeration line (Hayes, 1981),
with the C statistic conducted on the difference scores. In the same manner,
the C statistic also was used to detect trends resulting from adding new com-
ponents to any already in effect.
Trends in cognitive components.-Table 2 summarizes trends within the
cognitive components, when each was added to baseline and when cognitive re-
structuring was added to distancing and to baseline plus distancing. N o sig-
nificant difference was noted in the proportion of therapeutic trends associated
with the two cognitive components. Similarly, no significant difference was
detected between the two components in evaluating the impact of adding each
to baseline.

TABLE 2
SUMMARYOF TRENDSIN COGNITIVECOMPONENTS:
NUMBER
OF SUBJECTS SHOWINGCHANGE

Type of Trend Cognitive Distancing

Restructurin~
Alone
Improvement
No Improvement
Added to Baseline
Improvernenc
N o Improvement
Added to Distancing
Improvement
N o Improvement
Added to Baseline Plus Distancing
Improvement
No Improvement

Because cognitive restructuring for subjects in the distancing plus cognitive-

restructuring condition was introduced after distancing, it was possible to deter-
mine whether cognitive restructuring significantly accelerated any trends to-
wards improvement already established by distancing. As can be seen in Table
2, this was the case for only one of six subjects. This finding suggests that
cognitive restructuring at best only maintained therapeutic trends initiated by
distancing, rather than facilitating a shift towards more accelerated improvement.
Trends in behavioral component.-Table 3 summarizes trends associated
 ANALYSIS OF COGNITIVE THERAPY

TABLE 3
NWER OF SUBJECTS AND TRENDSIN BEHAVIORALCOMPONENT

Trend Comwnenrs Evaluated

Homework
Alone
+Cognitive
Restructuring
+
Distancing
Improvement 3 1 (1)" 1 (1)
N o Improvement 3 5 (2j 2 (2j
*Values i n parentheses represent number of subjects showing trends toward improvement
vs no improvement when baseline phase is included.

with behavioral homework when analyzed in isolation and when added to the
cognitive components. Equivocal trends were noted in evaluating homework
in isolation. The introduction of homework also was associated with few trend
shifts towards more accelerated improvement when added to the cognitive
components.
Analyses of Dependent Measures
All dependent measures initially were evaluated to determine whether the
assumption of homogeneity of error variance required by the analysis of variance
was met. This assumption was violated for the Hamilton rating and for Pleasant
Events Schedule, Obtained Reinforcement. Data from these measures subse-
quently were evaluated with nonparametric rests. The remaining measures
were evaluated with analyses of variance or covariance using pretreatment scores
as covariates.
Ozltcome measures.-A 2 (cognitive factor) X 2 (behavioral factor) X
2 (assessment occasion) analysis of covariance with repeated measures on the
last factor indicated main effects on Beck scores for the cognitive (F1.7 = 7.19,
p = .03, behavioral factors (F1.7 = 8.21, p = .03), and their interacrion (PI,?
= 6.22, p = .04). As can be seen in Table 4, lower scores were obtained for
the distancing plus cognitive-restructuring condition (adjusted M = 12.06)
than for the cognitive-restructuring condition (adjusted M = 19.70). Also,
subjects receiving behavioral homework reported lower depression (adjusted
M = 11.59) than those who did not (adjusted M = 20.17). The lowest de-
pression (adjusted M .=2.48) was reported by subjects in the distancing plus
cognitive-restructuring condition who also received behavioral homework.

TABLE 4
BECK INVENTORY SCORESFOR CELLS OF THE FACTORIAL
DESIGN
Cognitive Conditions Behavioral Conditions
- - - .- - ~

N o Homework Homework
M~el. M SD Mt.al. M SD
Cognitive Restructuring 18.70 9.83 6.41 20.70 21.00 16.32
Distancing Plus
Cognitive Restructuring 21.64 20.33 13.56 2.48 12.33 15.35
948 R. D. ZETTLE & S. C. HAYES

A Man-Whitney test on pretreatment Hamilton ratings detected a differ-

ence for the behavioral factor ( U = 7, p = .05), with subjects who subse-
quently received homework showing higher depression. This main effect was
not maintained at posttreatment or follow-up. The results are consistent with
those on Beck's inventory in suggesting greater improvement among subjects
given homework. Unlike the Beck findings, however, no significant differ-
ences between the two cognitive conditions were obtained at either assessment
occasion.
Process measwes.-On the Dysfunctional Attitude Scale a 2 X 2 X 2
analysis of covariance indicated a significant interaction of assessment occasion
X behavioral factor (F1,7 = 5.55, p = .05). The individual means involved
are contained in Table 5 . Dysfunctional attitudes were endorsed at a higher
level at both assessment occasions by subjects who received behavioral home-
work, with the relative difference between the two behavioral conditions greater
at posttreatment.

TABLE 5
DYSPUNC~IONAL
ATTITUDE SCORESFOR BEHAVIORAL CONDITIONS
Assessment Behavioral Conditions
Occasion No Homework Homework
Mda,. M SD M~aj. M SD
Posttreatment 94.35 78.60 22.50 136.57 150.67 33.17
Follow-up 91.34 86.80 35.21 125.84 125.83 23.46

N o significant main effects or interactions were obtained on Activity Level

of the Pleasant Events Schedule.
On Reinforcement Potential repeated measures analysis of variance indi-
cated a main effect for assessment occasion (Fg,10= 8.85, p = .003). Post
hoc tests indicated greater reinforcement potential associated with pleasant ac-
tivities at posttreatment ( M = 1.25) than pretreatment ( M = 1.07; F =
14.29,p < .Ol), with no difference noted berween posttreatment and follow-up.
N o significant differences on Obtained Reinforcement were obtained be-
tween the cognitive conditions at either posttreatmenc or follow-up. However,
an inspection of mean scores, presented in Table 6, suggested different patterns
of improvement between the cognitive restructuring and distancing plus cogni-
tive restructuring conditions. Specifically, both conditions indicated higher
enjoyabilicy obtained through pleasant activities at posttreatment, with a con-
tinuation of improvement throughout follow-up noted for the distancing plus
cognitive-restructuring condition. The cognitive-restructuring condition, by
contrast, showed a loss of treatment gains during follow-up. Mann-Whitney
tests detected no differences in change scores from pre- to posttreatment or from
pretreatment 10 follow-up between the two conditions. An analysis of post-
 ANALYSIS OF COGNITIVE THERAPY

TABLE G
OBTAINEDREINFORCEMENT SCORES FOR COGNITIVEA N D BEHAVIORAL CONDITIONS
Conditions Assessment Occasion
Pretreaunent Posttreatment Follow-up
M SD M SD M SD
p p p p p p

Cognitive Restructuring .94" .14 1.18 .20 1.05 .2G

Distancing Plus
Cognitive Restructuring .84 .38 .98 .48 1.11 .45
N o Homework .81 .29 .97 .48 .90 .42
Homework .97 .27 1.19 .18 1.25 .17
*Higher scores indicate improvement.

treatment to follow-up change scores, however, showed a significant difference

(U = 3, p = .008).
Nonparametric tests of the behavioral factor were nonsignificant at post-
treatment bur marginally significant at follow-up ( U = 8, p = .07), with
higher scores noted for subjects with homework; see Table 6. Both behavioral
conditions showed improvement from pre- to posttreaunent, with only those
subjects receiving behavioral homework displaying continued improvement
during the follow-up period.
Compa7ison t o Rwh, et al. (1977)
In the absence of a control group against which to evaluate over-all im-
provement, some question might be raised about attributing gains to specific
treatment effects. T o address this issue, the present results were compared to
those of Rush, et d. (1977). This particular investigation was selected for
comparison because it is probably the most widely cited comparative outcome
study on cognitive therapy. The comparison also provided an indirect means
of validating whether "cognitive therapy" as implemented in the present study
approached the cognitive treatment evaluated by Rush and his associates.
Because subjects in the Rush, et al. study received up to 20 therapy ses-
sions over a 12-wk. period, their Beck scores obtained at the end of Session 12
were compared with those at posttreatment from the present study. Paired
comparisons found no difference between the Rush, et al. sample and the cog-
nitive restructuring (U = 32.5, f > .05 and distancing plus cognitive rescruc-
turing conditions (U = 42.5, p > .05).

Component Imp2ications
One major purpose of the present investigation was to begin to identify
which components, or combination, within cognitive therapy contribute most
to its efficacy. It generally was expected that the three components would
combine in a simple additive fashion.
950 R. D. Z E T n E & S. C . HAYES

Time-series analyses indicated that distancing and cognicive restructuring

components were equally effective when analyzed in isolation and when added
to baseline. Further, adding cognitive restructuring to distancing did not re-
liably result in a trend towards greater improvement. This indicates that the
addition of cognitive restructuring merely continued any trends already asso-
ciated with the introduction and implementation of distancing. This interpre-
tation questions the view that distancing procedures constitute the "first, critical
step" within cognitive therapy and suggest that such techniques, if expanded,
might constirute a legitimate treatment in their own right.
Given the ascribed role of distancing within cognitive therapy, it always
preceded cognitive restructuring in the sequencing of components. Possibly
either component delivered second would not add to the effects of the initial
component. Additional research, therefore, might evaluate further the impact
of distancing procedures when they follow cognitive restructuring.
A pattern similar to that obtained in adding cognirive restructuring to dis-
tancing was noted when behavioral homework was introduced. This indicates
that the addition of homework merely continued any preexisting therapeutic
trends rather than interacting with those components already introduced.
The only indication of an interaction among the components was noted on
Beck's inventory. The lowest depression was reported by subjects in the dis-
tancing plus cognitive-restructuring condition who were assigned behavioral
horneworl<. The results also indicated main effects for the cognitive and be-
havioral factors, suggesting that the inclusion of distancing added to treatment
effects associated with results of the rime-series analyses. The analysis of Beck
scores, however, included follow-up data, whiIe the time-series analysis was re-
stricted to trends during the active treatment phase, suggesting an "incubation
effect" for both distancing and homework components.
Procers Implications
A second major purpose of the current study was to begin to evaluate
mechanisms through which the components of cognitive therapy affect depres-
sion. Results were consistent in tentatively suggesting that distancing and be-
havioral homework operate through mechanisms other than those posited by
cognitive theory.
Distancing
N o differential reduction in depressogenic beliefs, as assessed by the Dys-
functional Attitude Scale, was noted for the distancing plus cogni-'LIV~-restructur-
ing condition. This suggests that the therapeutic impact of distancing proce-
dures did not occur through processes typically proposed by cognitive theory.
The only difference between the two cognirive conditions among the
process measures was on the Obtained Reinforcement scale of the Pleasant
 ANALYSIS OF COGNITIVE THERAPY 95 1

Events Schedule. The distancing-plus-cognitive-restructuring subjects reported

an increase in pleasure obtained from various activities during posttreatment to
follow-up, whereas cognitive-restructuring subjects indicated a decrease. This
suggests that distancing may have operated through a behavioral mechanism.
That is, the inclusion of distancing possibly was instrumental in enabling sub-
jects to make more effective contact with the natural consequences surrounding
pleasant activities.
Several interpretations might be offered to account for differential trends
on Obtained Reinforcement. The possibility that distancing procedures facili-
tated change in some unassessed cognitive process, which in turn mediated
changes in this score, cannot be ruled out. A more plausible interpretation is
that distancing procedures exerted their primary influence through a behavioral
process. In particular, being "caught up" in one's cognitive activity may create
an insensitivity to the natural contingencies surrounding pleasant events. The
results of several recent human operant investigations suggest. that responding
under the control of verbal stimuli, such as thoughts and beliefs, often is insen-
sitive to the natural contingencies surrounding such behavior (Catania, Mac-
thews, & Shimoff, 1982; Hayes, Brownscein, Zettle, Rosenfarb, & Korn, 1986;
Shimoff, Catania, & Matthews, 1951). By enabling depressed individuals to
"step b a c k from their own private events, distancing procedmes may help
reduce control exerted by depressive thoughts and thereby increase the sensi-
tivity of behavior to its natural consequences.
Behavioral Homework
Subjects who received behavioral homework reported obtaining greater
enjoyment from engaging in pleasant activities than those not receiving home-
work. Behavioral homework, like distancing, did not induce a differential
increase in Activity Level per se nor enhance the capacity of subjects to antici-
pate enjoyment from a wider array of pleasant activities. One interpretation of
the effects of homework is that such assignments also may enable the behavior
of depressives to make more effective contact with natural contingencies sur-
rounding pleasant events. Such verbal behavior may have enabled subjects to
contact those contingencies more effectively.
The proposed interpretation of the process through which homework
assignments exerted their impact is supported further by results on the Dys-
functional Attitudes Scale. Homework assignments within cognitive therapy
generally are thought to contribute to the efficacy of treatment by providing
direct, experientially based tests of depressogenic beliefs. It was expected then
that lower scores would be associated with the inclusion of behavioral hy-
pothesis-testing. Scores for dysfunctional attitudes were directly opposite to
those predicted. At both posttreatment and follow-up, subjects who received
behavioral homework reported greater endorsement of dysfunctional attitudes
952 R. D. ZETTLE & S. C HAYES

thought to underlie depression. This suggests a direct contradiction of Beck's

theory of depression or, alternatively, that the scale does not properly evaluate
depressogenic beliefs.
T h e over-all results are consistent in suggesting chat cognitive therapy may
initiate therapeutic change by transferring control exerted by private events
over depressive women's behavior to control by direct contingencies which then
support more adaptive functioning. Given the small sample, however, more
research with similar and differing depressive populations is needed to sub-
stantiate further this interpretation. T h e current findings should be viewed
as suggestive and tentative. Whether or not cognitive therapy affects depres-
sion through processes posited by cognitive theory, of course, does not detract
from its current status. One possible implication of the present findings is
that the efficacy of cognitive therapy might be enhanced even further by modifi-
cations in its components which maximize processes through which therapeutic
change apparently is initiated. For example, additional research might assess
the impact of expanding the rather limited array of distancing procedures and
o I placing greater emphasis o n the role of behavioral homework assignments
within cognitive therapy.

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CATANIA,A. C., MAmEWS, B. A., & SHIMOFF,E. (1982) Instructed versus shaped
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Accepied November 13, I987.