Effects of Treatment Duration and Severity of Depression on the Effectiveness of Cognitive-Behavioral and Psychodynamic-Interpersonal Psychotherapy
Department of Psychology, University of Sheffield, United Kingdom.Journal of Consulting and Clinical Psychology (Impact Factor: 4.85). 07/1994; 62(3):522-34. DOI: 10.1037//0022-006X.62.3.522
A total of 117 depressed clients, stratified for severity, completed 8 or 16 sessions of manualized treatment, either cognitive-behavioral psychotherapy (CB) or psychodynamic-interpersonal psychotherapy (PI). Each of 5 clinician-investigators treated clients in all 4 treatment conditions. On most measures, CB and PI were equally effective, irrespective of the severity of depression or the duration of treatment. However, there was evidence of some advantage to CB on the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). There was no evidence that CB's effects were more rapid than those of PI, nor did the effects of each treatment method vary according to the severity of depression. There was no overall advantage to 16-session treatment over 8-session treatment. However, those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions.
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- "Systematic studies of the ideal dosage of short-term psychotherapy for gaining the optimal outcome are rare, however. The Second Sheffield Psychotherapy Project (SPP2) ofShapiro et al. (1995)and the reports ofDekker et al. (2005) andMolenaar et al. (2011)found no overall difference in the reduction of depressive symptoms between courses of 8 or 16 psychotherapy sessions. Interpersonal counselling (IPC) in its original form was developed to serve as a simplified version of IPT to be administered by non-mental health professionals to treat patients with subsyndromal depression. "
ABSTRACT: Background: Psychotherapeutic treatment is underused in primary care, where even short-term psychotherapy can be perceived as too lengthy and labour-intensive. We tested here for the first time the preliminary efficacy of seven sessions of interpersonal counselling (IPC) by comparison with sixteen sessions of interpersonal psychotherapy (IPT) in regular clinical settings. Methods: Patients seeking treatment for the first time who met the DSM-IV criteria for major depressive disorder (MDD, mild/moderate) were randomized to either IPC (n=20) or IPT (n=20). The efficacy of the treatments was assessed using the 34-item Clinical Outcomes in Routine Evaluation (CORE-OM) scale and the Beck Depression Inventory (BDI) scale. Results: 90% of the patients completed all the treatment sessions. IPC delivered by psychiatric nurses in primary care proved equally as effective as IPT delivered by psychotherapists/psychologists in secondary care. The pre-treatment to 12-month follow-up within-group effect sizes were large: 1.52 (CORE-OM) and 1.41 (BDI) in the IPC group and 1.58 (CORE-OM) and 1.40 (BDI) in the IPT group. At the 12-month follow-up 59% of the patients in the IPC group and 63% in the IPT group were classified as recovered on the CORE-OM scale, with corresponding remission rates of 61% for both groups on the BDI scale. Limitations: The small sample size limited the power to detect differences between the groups and the naturalistic settings may have confounded the results. Conclusions: This clinical trial suggests that IPC is an appropriate and even sufficient first-phase intervention for handling previously untreated mild to moderate depression in primary health care. Conclusions: This clinical trial suggests that IPC is an appropriate and even sufficient first-phase intervention for handling previously untreated mild to moderate depression in primary health care.
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- "Furthermore, some of the educational categories (e.g. some college, professional degree) predict response for one depression outcome, and non-response in the other.By contrast, the finding that baseline depressive symptom severity contributes to the prediction of treatment response is consistent with and extends previous findings (Jarrett et al. 1991;Sotsky et al. 1991;Shapiro et al. 1994;Thase et al. 1994;Agosti & OcepekWelikson, 1997;Persons et al. 1999;Hamilton & Dobson, 2002;Coffman et al. 2007). However, severity of depressive symptoms was only valuable as a predictor of treatment response among those with CSE, suggesting that greater severity of symptoms only exerts its negative influence among those who do not have the confidence in the coping skills to manage stress and distress. "
ABSTRACT: Cognitive behavioral therapy (CBT) can be delivered efficaciously through various modalities, including telephone (T-CBT) and face-to-face (FtF-CBT). The purpose of this study was to explore predictors of outcome in T-CBT and FtF-CBT for depression. A total of 325 depressed participants were randomized to receive eighteen 45-min sessions of T-CBT or FtF-CBT. Depression severity was measured using the Hamilton Depression Rating Scale (HAMD) and the Patient Health Questionnaire-9 (PHQ-9). Classification and regression tree (CART) analyses were conducted with baseline participant demographics and psychological characteristics predicting depression outcomes, HAMD and PHQ-9, at end of treatment (week 18). The demographic and psychological characteristics accurately identified 85.3% and 85.0% of treatment responders and 85.7% and 85.0% of treatment non-responders on the HAMD and PHQ-9, respectively. The Coping self-efficacy (CSE) scale predicted outcome on both the HAMD and PHQ-9; those with moderate to high CSE were likely to respond with no other variable influencing that prediction. Among those with low CSE, depression severity influenced response. Social support, physical functioning, and employment emerged as predictors only for the HAMD, and sex predicted response on the PHQ-9. Treatment delivery method (i.e. telephone or face-to-face) did not impact the prediction of outcome. Findings suggest that the predictors of improved depression are similar across treatment modalities. Most importantly, a moderate to high level of CSE significantly increases the chance of responding in both T-CBT and FtF-CBT. Among patients with low CSE, those with lower depressive symptom severity are more likely to do well in treatment.
- "So stellt sich beispielsweise die Frage, inwieweit der Einfluss der anfänglichen Symptombelastung beziehungsweise der Diagnose auf das Therapieergebnis durch die Behandlungsdauer beeinflusst wird. In einer Studie mit ambulanten depressiven Patienten konnte zum Beispiel nachgewiesen werden, dass sich eine hohe Symptombelastung nur dann negativ auf das Therapieergebnis auswirkte, wenn die Patienten nicht lange genug behandelt wurden (Shapiro et al. 1994). Beachtet werden muss weiterhin, dass die Operationalisierung der Responsegruppen in den Studien anhand unterschiedlicher Kriterien erfolgte, was die Vergleichbarkeit der Ergebnisse einschränkt. "
Dataset: Non Response Review