Depression beliefs, treatment preference, and outcomes in a randomized trial for major depressive disorder

Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 1256 Briarcliff Road NE, Building A, 3rd Floor, Atlanta, GA 30306, USA.
Journal of Psychiatric Research (Impact Factor: 3.96). 11/2011; 46(3):375-81. DOI: 10.1016/j.jpsychires.2011.11.003
Source: PubMed


Previous studies suggest that individual preferences for medication- or psychotherapy-based treatments for depression may affect outcomes in clinical trials that compare these two forms of treatment. We assessed patients' beliefs about the causes of their depression, their preferred treatment, and strength of that preference in 80 patients participating in a 12-week clinical trial evaluating neuroimaging predictors of response to cognitive behavior therapy (CBT) or escitalopram. Forty-five patients expressed a preference for one of the 2 treatments, but being matched to preference did not influence remission or completion rates. Medication-preferring patients were more likely to terminate the trial early, regardless of treatment received. CBT-preferring patients rarely endorsed unknown causes for their depression, and medication-preferring patients were highly unlikely to identify pessimistic attitudes as a source of their depression. Among patients willing to be randomized to treatment, preference does not appear to strongly influence outcome. Specific preferences for CBT or medication may reflect differing conceptualizations about depressive illness, knowledge of which may enhance treatment retention and efficacy.

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Available from: Boadie Dunlop, Oct 07, 2015
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    • "In sum, treatment preferences likely reflect underlying beliefs and conceptualizations about illnesses that may be important for optimizing treatment response (e.g., Dunlop et al. 2012). Such findings linking preferences with beliefs about the origins of mental illness have direct implications for implicit theories, because entity theorists also tend to attribute abilities and personality to their genetic make-up (Dweck 2006; Dweck et al. 1995; Keller 2005), and may therefore have similar thoughts about treatment choices (i.e., medication). "
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    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
    • "These variable findings indicate the crucial contribution of how the informed consent process is performed, particularly the discussion around randomization and the patient's willingness to start the treatment regardless of preference. More generally, patients preferring ADM over psychotherapy or combination treatment have higher rates of attrition (Dunlop et al. 2012c, Steidtmann et al. 2012), which may stem from beliefs about causes of their depression (Dunlop et al. 2012c, Steidtmann et al. 2012) or from practical factors related to treatment (e.g., preference for ADM may derive from time or travel constraints, which may contribute to attrition). Two large combination trials of treatments for chronic MDD have evaluated patient preference as a predictor (Kocsis et al. 2009, Steidtmann et al. 2012). "
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    ABSTRACT: Major depressive disorder (MDD) is among the most frequent and debilitating psychiatric disorders. Efficacious psychotherapy and antidepressant medications have been developed, and two-thirds of depressed patients respond to single-modality treatment; however, only about one-third of patients remit to single-modality treatments with no meaningful differences in outcomes between treatment types. This article describes the major clinical considerations in choosing between single-modality or combination treatments for MDD. A review of the relevant literature and meta-analyses provides suggestions for which treatment to use for which patient and when each treatment or combination should be provided. The review summarizes the moderators of single-modality and combination-treatment outcomes. We describe models of mechanisms of treatment efficacy and discuss recent treatment-specific neurobiological mechanisms of change.
    Annual Review of Psychology 01/2014; 65(1):267-300. DOI:10.1146/annurev.psych.121208.131653 · 21.81 Impact Factor
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    • "However, neither preference match nor preference strength could predict symptom remission, although an unexpected negative association was found between preference strength and symptom severity at 12 weeks [13]. Dunlop et al. [14] also investigated the effect of preference strength in addition to preference matching in a study comparing CBT and escitalopram among patients with depression. In contrast to Raue et al. [13], Dunlop et al. [14] did not find any predictive value in strength of preference. "
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    ABSTRACT: Major depression is a world-wide problem that can be treated with various forms of psychotherapy. There is strong research support for treating major depression using cognitive behavior therapy delivered in the format of guided self-help via the Internet (ICBT). Recent research also suggests that psychodynamic psychotherapy can be delivered as guided self-help via the Internet (IPDT) and that it seem to be as effective as ICBT for mild to moderate depression. However, no head-to-head comparison between the two treatments exists. In the field of Internet interventions it is largely unexplored if treatment preference affects outcome and adherence. Participants were allocated to IPDT or ICBT based on their stated preference. More than half of the participants preferred ICBT (N = 30) over IPDT (N = 14). Differences in efficacy between treatments were explored. Correlations between strength of preference and treatment outcome, adherence to treatment and completion of the whole treatment program were explored. Data were collected before and after treatment, as well as in a 7-month follow-up. During the treatment period, both programs performed equally well in reducing symptoms. More participants who received IPDT completed the entire program. At follow-up, mixed-effects models showed that participants who chose ICBT improved more in terms of quality of life. The ICBT group also had a significant increase in participants who recovered from their depression from post-treatment to follow-up. Exploratory analyses indicated that strength of preference was correlated with adherence to treatment and completion of the whole program, and long-term outcome for the ICBT group. Few differences were found during the acute treatment phase, but the long-term effects are in favor of ICBT. Strength of preference for treatment seems to have a predictive value. Further research comparing the efficacy of ICBT and IPDT, and the effects of preference matching and strength of preference, is warranted.Trial registration: This trial is a continuation of the study registered as NCT01324050 at
    BMC Psychiatry 10/2013; 13(1):268. DOI:10.1186/1471-244X-13-268 · 2.21 Impact Factor
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