Stage models encourage a longitudinal perspective on the care of those with major depression: supporting vigilance to the risk for stage progression and the selection of interventions to address that risk. A central goal for this article is to evaluate the role of cognitive-behavior therapy (CBT) in addressing stage progression in the treatment of major depression. We summarize the evidence supporting depression-focused CBT for: (1) preventing depression onset, (2) treating syndromal depression, (3) treating residual symptoms, (4) preventing relapse, and (5) addressing pharmacologic treatment resistance. In addition, consistent with the goal of aiding prevention and intervention development by refining mechanistic treatment targets, we evaluate the role of two specific risk-factors for stage progression: insomnia and rumination. These risk factors have a feed-forward relationship with stress, both being amplified by stress and amplifying the negative consequences of stress. Moreover, each of these risk factors predict depression stage transmissions across multiple stages, and both are modifiable with treatment. Accordingly, insomnia and rumination appear to serve as excellent mechanistic targets for the prevention of depression stage progression. These findings are discussed in relation to current limitations and future research directions for targeting these risk factors and furthering the effective treatment of depression.

阶段模型鼓励从纵向角度看待重度抑郁症患者的护理：支持对阶段进展风险保持警惕，并选择干预措施来应对该风险。本文的中心目标是评估认知行为疗法 (CBT) 在解决重度抑郁症治疗阶段进展方面的作用。我们总结了支持以抑郁症为中心的 CBT 的证据：(1) 预防抑郁症发作，(2) 治疗综合征性抑郁症，(3) 治疗残留症状，(4) 预防复发，(5) 解决药物治疗耐药性。此外，为了与通过完善机械治疗目标来帮助预防和干预发展的目标相一致，我们评估了两个特定危险因素对阶段进展的作用：失眠和沉思。这些风险因素与压力具有前馈关系，既会因压力而放大，也会放大压力的负面后果。此外，这些危险因素中的每一个都预测抑郁症阶段在多个阶段的传播，并且两者都可以通过治疗来改变。因此，失眠和沉思似乎是预防抑郁阶段进展的极好机制目标。讨论了这些发现与针对这些风险因素和进一步有效治疗抑郁症的当前局限性和未来研究方向。