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BACKGROUND: Cognitive behaviour therapy (CBT) for patients with treatment-resistant depression (TRD) aims to reframe underlying conditional beliefs that are thought to maintain depression. AIM: To systematically explore conditional beliefs expressed by primary-care based patients with TRD, defined as non-response to at least 6 weeks of antidepressants. METHOD: Conditional beliefs (stated in an "If. . .then. . ." format) were extracted from a random sample of 50 sets of therapist notes from the CoBalT trial, a large randomized controlled trial of CBT for TRD in primary care. The beliefs were separated into their two constituent parts; the demands (Ifs) and consequences (thens). An approach based on framework analysis provided a systematic way of organizing the data, and identifying key themes. RESULTS: Four main themes emerged from the demand part of the conditional beliefs (Ifs): 1. High standards; 2. Putting others first/needing approval; 3. Coping; and 4. Hiding "true" self. Three main themes emerged from the consequence part of the conditional beliefs (thens): 1. Defectiveness; 2. Responses of others; 3. Control of emotions. CONCLUSIONS: Identifying common themes in the conditional beliefs of patients with TRD adds to our clinical understanding of this client group, providing useful information to facilitate the complex process of collaborative case conceptualization and working with conditional beliefs within CBT interventions.

Original publication




Journal article


Behav Cogn Psychother

Publication Date





513 - 526


CBT, Treatment-resistant depression, chronic depression, conditional beliefs, Adult, Antidepressive Agents, Cognitive Therapy, Culture, Depression, Depressive Disorder, Depressive Disorder, Treatment-Resistant, Emotions, Female, Humans, Male, Middle Aged, Primary Health Care, Randomized Controlled Trials as Topic