Reducing Relapse and Recurrence in Unipolar Depression: A Comparative Meta-Analysis of Cognitive-Behavioral Therapy's Effects

Department of Psychology, Truman State University, IRK, Missouri, United States
Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 07/2007; 75(3):475-88. DOI: 10.1037/0022-006X.75.3.475
Source: PubMed


Relapse and recurrence following response to acute-phase treatment for major depressive disorder (MDD) are prevalent and costly. In a meta-analysis of 28 studies including 1,880 adults, the authors reviewed the world's published literature on cognitive-behavioral therapies (CT) aimed at preventing relapse-recurrence in MDD. Results indicate that after discontinuation of acute-phase treatment, many responders to CT relapse-recur (29% within 1 year and 54% within 2 years). These rates appear comparable to those associated with other depression-specific psychotherapies but lower than those associated with pharmacotherapy. Among acute-phase treatment responders, continuation-phase CT reduced relapse-recurrence compared with assessment only at the end of continuation treatment (21% reduction) and at follow-up (29% reduction). Continuation-phase CT also reduced relapse-recurrence compared with other active continuation treatments at the end of continuation treatment (12% reduction) and at follow-up (14% reduction). The authors discuss implications for research and patient care and suggest directions, with methodological refinements, for future studies.

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Available from: Robin B Jarrett, Mar 12, 2014
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    • "However, relapse rates are still high, even in patients who respond to the different forms of psychotherapeutic treatment. In fact, 1 year after discontinuation of psychotherapy for acute depression, the relapse rate was 29%, and increased to 54% after 2 years (Vittengl et al. 2007). Chronic and acute stressors are well-established contributors to depression and can even trigger the onset of depressive episodes (Heim and Nemeroff 2001; McFarlane 2010). "
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    ABSTRACT: Background Depression is a severe mental disorder that challenges mental health systems worldwide as the success rates of all established treatments are limited. Eye Movement Desensitization and Reprocessing (EMDR) therapy is a scientifically acknowledged psychotherapeutic treatment for PTSD. Given the recent research indicating that trauma and other adverse life experiences can be the basis of depression, the aim of this study was to determine the effectiveness of EMDR therapy with this disorder.Method In this study, we recruited a group of 16 patients with depressive episodes in an inpatient setting. These 16 patients were treated with EMDR therapy by reprocessing of memories related to stressful life events in addition to treatment as usual (TAU). They were compared to a group of 16 controls matched regarding diagnosis, degree of depression, sex, age and time of admission to hospital, which were receiving TAU only.ResultsSixty-eight percent of the patients in the EMDR group showed full remission at end of treatment. The EMDR group showed a greater reduction in depressive symptoms as measured by the SCL-90-R depression subscale. This difference was significant even when adjusted for duration of treatment. In a follow-up period of more than 1 year the EMDR group reported less problems related to depression and less relapses than the control group.ConclusionsEMDR therapy shows promise as an effective treatment for depressive disorders. Larger controlled studies are necessary to replicate our findings.
    Brain and Behavior 04/2015; 00342(00). DOI:10.1002/brb3.342 · 2.24 Impact Factor
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    • "Treatments for MDD have been shown to be effective [2,4,5]. However, previous outcome studies also indicate that many patients still suffer from residual symptoms [6] and are likely to relapse within two years after treatment [7]. These findings indicate the need to enhance current psychotherapeutic treatments for MDD. "
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    ABSTRACT: Major Depressive Disorder is one of the most challenging mental health problems of our time. Although effective psychotherapeutic treatments are available, many patients fail to demonstrate clinically significant improvements. Difficulties in emotion regulation have been identified as putative risk and maintaining factors for Major Depressive Disorder. Systematically enhancing adaptive emotion regulation skills should thus help reduce depressive symptom severity. However, at this point, no study has systematically evaluated effects of increasing adaptive emotion regulation skills application on symptoms of Major Depressive Disorder. In the intended study, we aim to evaluate stand-alone effects of a group-based training explicitly and exclusively targeting general emotion regulation skills on depressive symptom severity and assess whether this training augments the outcome of subsequent individual cognitive behavioral therapy for depression. In the evaluation of the Affect Regulation Training, we will conduct a prospective randomized-controlled trial. Effects of the Affect Regulation Training on depressive symptom severity and outcomes of subsequent individual therapy for depression will be compared with an active, common factor based treatment and a waitlist control condition. The study sample will include 120 outpatients meeting criteria for Major Depressive Disorder. Depressive symptom severity as assessed by the Hamilton Rating Scale will serve as our primary study outcome. Secondary outcomes will include further indicators of mental health and changes in adaptive emotion regulation skills application. All outcomes will be assessed at intake and at 10 points in time over the course of the 15-month study period. Measures will include self-reports, observer ratings, momentary ecological assessments, and will be complemented in subsamples by experimental investigations and the analysis of hair steroids. If findings should support the hypothesis that enhancing regulation skills reduces symptom severity in Major Depressive Disorder, systematic emotion regulation skills training can enhance the efficacy and efficiency of current treatments for this severe and highly prevalent disorder.Trial registration: This study is registered with, number NCT01330485.
    BMC Psychiatry 01/2014; 14(1):20. DOI:10.1186/1471-244X-14-20 · 2.21 Impact Factor
    • "Both CBT and IPT have demonstrated efficacy in preventing recurrence following successful acute psychotherapy treatment (Dobson et al. 2008, Frank et al. 2007, Hollon et al. 2005a, Vittengl et al. 2007), though some studies have found IPT to be less efficacious than medication when ADM are continued through the maintenance phase (Frank et al. 1990, Reynolds et al. 1999). Such enduring effects of psychotherapy in the absence of ongoing sessions suggest that psychotherapy treatments change risk factors for recurrence in a manner that treatment with acute ADM does not (Hollon et al. 2006). "
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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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