Functioning and depression in patients under cognitivebehavioral psychotherapy

Jasna Petković, Emir Tupković


In the present study we analyzed 30 patients (20 females and10 males) diagnosed with a severe depressive disorder, meanage 37.6 ± 9.3 years, who were under cognitive-behavioralpsychotherapy. The patients were divided into three groups:one group was submitted to group therapy only (group I),the other one to individual therapy (group II), while thethird group was submitted to combined individual and grouppsychotherapy (group III). We applied the Beck DepressionInventory (BDI) scale and Global Assessment of Functioning(GAF) scale at the beginning of treatment and at its end(namely, after 12 months), and again six months later followingthe one-year period of treatment. At the beginning oftreatment the median values of the whole group were notedas follows: BDI 42, and GAF 50.5. After one year of psychotherapythe median values of improvement were registeredas follows: in respect of BDI it was recorded as 38, while forGAF it was recorded as 22. GAF score correlated very significantlywith BDI (-0.52). Six months after the last individualand group sessions were held all parameters were significantlyworsened. At this stage there was a moderate correlationof GAF with BDI (-0.47). Through all the stages BDI valuein group I showed a significant correlation with GAF: -0.65before the introduction of therapy, -0.48 after psychotherapy,and -0.48 after a six-month period without therapy. Similarvalues were observed in group II: -0.58 before therapy, -0.36after therapy, and -0.85 six months later, while in group IIIthe following values were observed: -0.58 before therapy, -0.36after therapy and -0.47 six months later. Conclusion: GAF ismost strongly correlated with BDI in all stages, both in thestage of improvement or aggravation of illness and it may beapplied as a useful screening test in further psychotherapeuticstrategy. The combined individual and group psychotherapyincreases the overall functioning rate regardless of a significantlylesser improvement of depression in comparison withthe isolated group psychotherapy.


Cognitive-behavioral Psychotherapy, Scale of global assessment of functioning, Depression.

Full Text:



Anonymous. Diagnostic and statistical manual of mental disorders, American Psychiatric Association, fourth edition, Washington, DC: American Psychiatric Association. 1994.

Piersma HL, Boes JL. The GAF and psychiatric outcome: A descriptive report. Community Mental Health Journal. 1997;33:35-40.

Bodland O, Kullgren G, Ekselius L, Lindstrom E, Von Knorring L. Axis V - Global Assessment of Functioning Scale: Evaluation of a self-report version. Acta Psychiatrica Scandinavia. 1994;90:342-7.

Phelan M, Wykes T, Goldman H. Global function scales. Social Psychiatry and Psychiatric Epidemiology. 1994;29:205-11.

Coffey M, Jones S, Thornicroft G. A brief mental health outcome scale: relationships between scale scores and diagnostic/sociodemographic variables in the long-term mentally ill. Journal of Psychiatric Mental Health Nursing. 1996;3:89-93.

Roy-Byrne P, Dagadakis C, Unutzer J, Ries R. Evidence for limited validity of the revised Global Assessment of Functioning Scale. Psychiatric Services 1996;47:864-6.

Skodol AE, Link BG, Shrout PE., Horwath E. The revision of axis V in DSM-III-R: Should symptoms have been included? American Journal of Psychiatry. 1988a;145: 825-9.

Skodol AE, Link BG, Shrout PE, Horwath E. Toward construct validity for DSM-III Axis V. Psychiatry Research. 1988b;24:13-23.

Endicott J, Spitzer R, Fleiss J, Cohen J. The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry. 1976;33:766-71.

Coulehan J, Schulberg H, Block M, Madonia M, Rodriguez E. Treating depressed primary care patients improves their physical, mental, and social functioning. Archives of Internal Medicine. 1997;157:1113-20.

Endicott J, Spitzer R, Fleiss J, Cohen J. The Global Assessment Scale: A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry. 1976;33:766-71.

Hall RCW. Global Assessment of Functioning: A modified scale. Psychosomatics. 1995;36:267-75.

Mueser KT, Becker DR, Torrey WC, Xie H, Bond GR, Drake RE, Dain BJ. Work and nonvocational domains of functioning in persons with severe mental illness: A longitudinal analysis. Journal of Nervous and Mental Disease. 1997;185:419-26.

Van Gastel A, Schotte C, Maes M. The prediction of suicidal intent in depressed patients. Acta Psychiatrica Scandinavia. 1997;96:254-9.

Brekke JS. An examination of the relationships among three outcome scales in schizophrenia. Journal of Nervous Mental Disease. 1992;180:162-7.

Meltzer HY, Thompson PA, Myung AL., Ranjan R. Neuropsychologic deficits in schizophrenia: Relation to social function and effect of antipsychotic drug treatment. Neuropsychopharmacology. 1996;14:27S-33S.

Jones SH, Thornicroft G, Coffey M, Dunn G. A brief mental health outcome scale: Reliability and validity of the Global Assessment of Functioning (GAF). British Journal of Psychiatry. 1995;166:654-9.

Westermeyer J, Neider J. Social networks and psychopathology among substance abusers. American Journal of Psychiatry. 1988;145:1265-9.

Furukawa T, Awaji R, Nakazato H, Sumita Y. Predictive validity of subtypes of chronic affective disorders derived by cluster analysis. Acta Psychiatrica Scandinavia. 1995;91:379-85.

Hawthorne WB, Fals-Stewart W, Lohr JB. A treatment outcome study of community-based residential care. Hospital Community Psychiatry. 1994;45:152-5.

Howes JL, Haworth H, Reynolds P, Kavanaugh M. Outcome evaluation of a short-term mental health day treatment program. Canadian Journal of Psychiatry. 1997;42:502-8.

Kocsis JH, Zisook S, Davidson J, Shelton R, Yonkers K, Hellerstein DJ, Rosenbaum J, Halbreich U. Double-blind comparison of sertraline, imipramine, and placebo in the treatment of dysthymia: Psychosocial outcomes. American Journal of Psychiatry. 1997;154:390-5.

Linehan MM, Tutek DA, Heard HL, Armstrong HE. Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients. American Journal of Psychiatry.


Piersma HL, Boes JL. The GAF and psychiatric outcome: A descriptive report. Community Mental Health Journal. 1997;33:35-40.

Rund BR, Sollien T, Fjell A, Borchgrevink T, Hallert M, Naess PO. The Psychosis Project: outcome and cost-effectiveness of a psychoeducational treatment programme for schizophrenic adolescents. Acta Psychiatrica Scandinavia. 1994;89:211-8. 26. Walton SA, Berk M, Brook S. Superiority of lithium over verapamil in mania: A randomized, controlled, single-blind trial. Journal of Clinical Psychiatry 1996;57:543-6.

Vetter P, Koller O. Clinical and psychosocial variables in different diagnostic groups: Their interrelationships and value as predictors of course and outcome during a 14-year follow-up. Psychopathology. 1996;29:159-68.

Beiser M, Fleming JAE, Fleming MB, Lacono WG, Lin T. Refining the diagnosis of schizophreniform disorder. American Journal of Psychiatry. 1988;145:695-700.

Gordon RE, Plutzky M, Gordon KK, Guerra M. Using the Axis V Scale to evaluate therapeutic outcome of psychiatric treatment. Canadian Journal of Psychiatry. 1988;. 33: 194-6.


  • There are currently no refbacks.

2016 Department of Medical Sciences, Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina. All rights reserved.
The full text of articles published in this journal can be used free of charge for personal and educational purposes while respecting authors and publishers’ copyrights. For commercial purposes no part of this journal may be reproduced without the written permission of the publisher.