Patterns of symptom change were examined in 35 unipolar depressed outpatients treated with either cognitive therapy or pharmacotherapy (imipramine HCI). Cross-lagged panel analyses were used to evaluate the temporal relationships among changes in views of the self, hopelessness, mood, motivation and vegetative symptoms during treatment weeks 1–4.

During cognitive therapy improvements in hopelessness, views of the self and mood generally preceded changes in vegetative and motivational symptoms. On the other hand, no consistent pattern of change was associated with pharmacotherapy. While these results are compatible with the notion that cognitive therapy initially alters negative thinking and mood, which secondarily leads to improvements in vegetative and motivational symptoms, further studies with a placebo or wait-list group are needed to determine if this is a unique effect of cognitive therapy.