Patient Preference as a Moderator of Outcome for Chronic Forms of Major Depressive Disorder Treated With Nefazodone, Cognitive Behavioral Analysis System of Psychotherapy, or Their Combination
ABSTRACT Little is known about moderators of response to psychotherapy, medication, and combined treatment for chronic forms of major depressive disorder (MDD). We hypothesized that patient preference at baseline would interact with treatment group to differentially affect treatment outcome.
We report outcomes for 429 patients who participated in a randomized multicenter trial of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), or combination therapy for chronic forms of MDD (DSM-IV criteria) and who indicated their preference for type of treatment at study entry. The primary outcome measures were total scores on the 24-item Hamilton Rating Scale for Depression (HAM-D-24) and categorical definitions of remission or partial response. The patients were recruited between June 1996 and December 1997.
There was an interactive effect of preference and treatment group on outcome. The treatment effect varied as a function of preference, and was particularly apparent for patients who initially expressed preference for one of the monotherapies. Patients who preferred medication had a higher remission rate (45.5%) and lower mean HAM-D-24 score (11.6) at study exit if they received medication than if they received psychotherapy (remission rate, 22.2%; mean HAM-D-24 score, 21.0). Patients who preferred psychotherapy had a higher remission rate (50.0%) and lower mean HAM-D-24 score (12.1) if they received psychotherapy than if they received medication (remission rate 7.7%, mean HAM-D-24 score 18.3). Nevertheless, treatment preference was not associated with risk of dropout from the study.
These results suggest that patient preference is a potent moderator of treatment response for patients with chronic forms of MDD; however, relatively low proportions of the patient sample preferred one of the monotherapies, participants were not blinded to treatment assignment, and there was no placebo group.
- SourceAvailable from: Hannah E. Bergman
Behaviour Research and Therapy 08/2015; 73:33-41. DOI:10.1016/j.brat.2015.07.010 · 3.85 Impact Factor
- "A recent meta-analysis found that, although individuals are more likely to receive monotherapy in clinical settings, combination treatments may be a more effective treatment than monotherapy medication for certain disorders, such as depression, panic disorder, and obsessive-compulsive disorder (Cuijpers et al., 2014). In a randomized controlled multi-site trial comparing medication, psychotherapy, and combination of medication and psychotherapy among individuals with chronic depression, treatment preferences moderated treatment outcome, such that individuals who received their preferred treatment reported less depressive symptoms and higher remission rate at the end of treatment (Kocsis et al., 2009). This study highlights the importance of presenting both monotherapy and combined therapy treatment options to individuals, if consistent with the efficacy literature, as some might not do as well if they are forced to select a monotherapy, when they really wanted combination treatment or vice versa. "
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- "In that study, assignment-preference mismatch indirectly influenced depressive symptoms at the end of treatment. Indeed, several studies have shown preference effects on outcome-relevant variables (e.g., Kocsis et al. 2009; Lin et al. 2005; Mergl et al. 2011; Moradveisi et al. 2014) as well as a greater likelihood for continuing treatment (Elkin et al. 1999), but in other studies, assignment-preference mismatch did not relate to outcomes (Dobscha et al. 2007; Dunlop et al. 2012; Leykin et al. 2007a, b). "
ABSTRACT: Beliefs about how much people can change their attributes - implicit theories - influence affective and cognitive responses to performance subsequent motivation. Those who believe their attributes are fixed view setbacks as threatening and avoid challenging situations. In contrast, those who believe these attributes are malleable embrace challenges as opportunities to grow. Although implicit theories would seem to have important mental health implications, the research linking them with clinical applications is limited. To address this gap, we assessed how implicit theories of anxiety, emotion, intelligence, and personality related to various symptoms of anxiety and depression, emotion-regulation strategies, and hypothetical treatment choices (e.g., medication versus therapy) in two undergraduate samples. Across both samples, individuals who believed their attributes could change reported fewer mental healths symptoms, greater use of cognitive reappraisal, and were more likely to choose individual therapy over medication. These findings suggest implicit theories may play an important role in the nature and treatment of mental health problems.Cognitive Therapy and Research 09/2014; 39(2). DOI:10.1007/s10608-014-9652-6 · 1.33 Impact Factor
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- "Our study suggests a qualification, as the effect was only observed for pharmacological treatment, and not for psychological treatment, as dropout from BA was not influenced by preference. The finding that differences between BA and pharmacotherapy in outcome as assessed with the HRSD was moderated by preference are in line with four previous studies reporting effects of preference on outcome (Kocsis et al., 2009; Mergl et al., 2011; Patricia et al., 2005; Steidtmann et al., 2012), but in contrast to the seven studies that did not find such effects (Bedi et al., 2000; Dunlop et al., 2012; Kwan et al., 2010; Laykin et al., 2007; Raue et al., 2009; Van et al., 2009; Ward et al., 2000). It is unclear which factors might explain the different findings across studies, but these might include differences between samples (e.g., primary vs. secondary care), differences between treatments that were compared, differences in designs, and different assessment methods of preferences. "
ABSTRACT: Preferences and attitudes patients hold towards treatment are important, as these can influence treatment outcome. In depression research, the influence of patients' preference/attitudes on outcome and dropout has mainly been studied for antidepressant medication, and less for psychological treatments. We investigated the effects of patients' preference and attitudes towards psychological treatment and antidepressant medication on treatment outcome and dropout, and tested specificity of effects. Data are based on a randomized trial testing the effectiveness of behavioural activation (BA) vs antidepressant medication (ADM) for major depression (MDD) in Iran. Patients with MDD (N = 100) were randomized to BA (N = 50) or ADM (N = 50). Patients' preference/attitudes towards psychotherapy and ADM were assessed at baseline and associated with dropout and treatment outcome using logistic regression and multilevel analysis. High scores on psychotherapy preference/attitude and low scores on ADM preference/attitude predicted dropout from ADM, while no association between dropout and preference/attitude was found in BA. Psychotherapy preference/attitude moderated the differential effect of BA and ADM on one outcome measure, but the association disappeared after one year. Because in Iran most patients have only access to ADM, offering a psychological treatment for depression could attract especially those patients that prefer this newly available treatment. Patients' preferences and attitudes towards depression treatments influence dropout from ADM, and moderate the short-term difference in effectiveness between BA and ADM. The fact that dropout from BA was not affected by preference/attitude speaks for its acceptability among patients.Journal of Behavior Therapy and Experimental Psychiatry 10/2013; 45(1):170-177. DOI:10.1016/j.jbtep.2013.10.003 · 2.23 Impact Factor