Jack Dekker

The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis

OBJECTIVESnThe efficacy of short-term psychodynamic psychotherapy (STPP) for depression is debated. Recently, a number of large-scale and high-quality studies have been conducted. We examined the efficacy of STPP by updating our 2010 meta-analysis.nnnRESULTSnAfter a thorough literature search, 54 studies (33 randomized clinical trials) totaling 3946 subjects were included. STPP was significantly more effective than control conditions at post-treatment on depression, general psychopathology and quality of life measures (d=0.49 to 0.69). STPP pre-treatment to post-treatment changes (d=0.57 to 1.18) indicated significant improvements on all outcome measures, which either significantly improved further (d=0.20 to 1.04) or were maintained from post-treatment to follow-up. No significant differences were found between individual STPP and other psychotherapies at post-treatment (d=-0.14) and follow-up (d=-0.06) in analyses that were adequately powered to detect a clinically relevant difference. STPP was significantly more efficacious than other psychotherapies on anxiety measures at both post-treatment (d=0.35) and follow-up (d=0.76).nnnCONCLUSIONnWe found clear indications that STPP is effective in the treatment of depression in adults. Although more high-quality studies are needed, particularly to assess the efficacy of STPP compared to control conditions at follow-up and to antidepressants, these findings add to the evidence-base of STPP for depression.

The effectiveness of long-term psychoanalytic therapy: A systematic review of empirical studies.

Background: There is a gap in the research literature on the effectiveness of long‐term psychoanalytic therapies (LPT). Aim: To present a systematic review of studies dealing with LPT effectiveness and published from 1970 onward. Methods: A systematic literature search for studies dealing with the effectiveness of individual LPT in ambulatory, adult patients. Data about the overall effectiveness of LPT, its impact on symptom reduction, and its effect on personality changes were pooled both at treatment termination and at follow‐up, using effect sizes (ESs) and success rates. Results: We found 27 studies (n = 5063). Psychotherapy yielded large mean ESs (0.78 at termination; 0.94 at follow‐up) and high mean overall success rates (64% at termination; 55% at follow‐up) in moderate/mixed pathology. The mean ES was larger for symptom reduction (1.03) than for personality change (0.54). In severe pathology, the results were similar. Psychoanalysis achieved large mean ESs (0.87 at termination; 1.18 at follow‐up) and high mean overall success rates (71% at termination; 54% at follow‐up) in moderate pathology. The mean ES for symptom reduction was larger (1.38) than for personality change (0.76). Conclusion: Our data suggest that LPT is effective treatment for a large range of pathologies, with moderate to large effects.

The association of depression and anxiety with pain: a study from NESDA.

Chronic pain is commonly co-morbid with a depressive or anxiety disorder. Objective of this study is to examine the influence of depression, along with anxiety, on pain-related disability, pain intensity, and pain location in a large sample of adults with and without a depressive and/or anxiety disorder. The study population consisted of 2981 participants with a depressive, anxiety, co-morbid depressive and anxiety disorder, remitted disorder or no current disorder (controls). Severity of depressive and anxiety symptoms was also assessed. In separate multinomial regression analyses, the association of presence of depressive or anxiety disorders and symptom severity with the Chronic Pain Grade and location of pain was explored. Presence of a depressive (ORu200a=u200a6.67; P<.001), anxiety (ORu200a=u200a4.84; P<.001), or co-morbid depressive and anxiety disorder (ORu200a=u200a30.26; P<.001) was associated with the Chronic Pain Grade. Moreover, symptom severity was associated with more disabling and severely limiting pain. Also, a remitted depressive or anxiety disorder showed more disabling and severely limiting pain (ORu200a=u200a3.53; P<.001) as compared to controls. A current anxiety disorder (ORu200a=u200a2.96; p<.001) and a co-morbid depressive and anxiety disorder (ORu200a=u200a5.15; P<.001) were more strongly associated with cardio-respiratory pain, than gastro-intestinal or musculoskeletal pain. These findings remain after adjustment for chronic cardio respiratory illness. Patients with a current and remitted depressive and/or anxiety disorder and those with more severe symptoms have more disabling pain and pain of cardio-respiratory nature, than persons without a depressive or anxiety disorder. This warrants further research.

INFLUENCE OF PERSONALITY ON THE OUTCOME OF TREATMENT IN DEPRESSION: SYSTEMATIC REVIEW AND META-ANALYSIS

There continues to be debate about the influence of personality disorder on the outcome of depressive disorders and is relative interactions with treatment. To determine whether personality disorder, both generically and in terms of individual clusters, leads to a worse outcome in patients with depressive disorders and whether this is influenced by type of treatment, a systematic electronic search of MEDLINE, CINAHL, and PsycINFO from 1966, 1982, and 1882, respectively, until February 2007 was undertaken. The keyword terms depression, mental illness, and personality disorder were used. All references were reviewed and personal correspondence was undertaken. Only English language papers were considered. Any English language paper studying a depressed adult population was considered for inclusion. Studies needed to clearly define depression and personality disorder using peer-reviewed instruments or International Classification of Disease/Diagnostic Statistical Manual criteria. Outcome assessment at greater than 3 weeks was necessary. Final inclusion papers were agreed on by consensus by at least two reviewers. All data were extracted using predetermined criteria for depression by at least two reviewers in parallel. Disagreement was settled by consensus. Complex data extraction was confirmed within the study group. Data were synthesized using log odds ratios in the Cochrane RevMan 5 program. The finding of comorbid personality disorder and depression was associated with a more than double the odds of a poor outcome for depression compared with those with no personality disorder (OR 2.16, CI 1.83-2.56). This effect was not ameliorated by the treatment modality used for the depressive disorder. This finding led to the conclusion that personality disorder has a negative impact on the outcome of depression. This finding is important in considering prognosis in depressive disorders.

Predicting the Outcome of Antidepressants and Psychotherapy for Depression: A Qualitative, Systematic Review

&NA; As treatment outcome in depression varies widely, it is important to understand better the predictive value of particular patient characteristics. However, qualitative systematic reviews of the association between easily identifiable patient characteristics and outcome for commonly used treatment options have been unavailable. This article provides an overview of the consistency of findings on the association between sociodemographic factors and depression characteristics, on the one hand, and outcomes of pharmacotherapy, cognitive‐behavioral therapy, and interpersonal/psychodynamic psychotherapy for major depression, on the other. There were no findings indicating that gender was associated with treatment outcome in the case of tricyclic antidepressants. There are some indications that younger patients respond worse to tricyclics, whereas especially women appeared to have better outcomes with modern antidepressants (selective serotonin/norepinephrine reuptake inhibitors). Marital status may be related to better outcome in the case of antidepressants and cognitive‐behavioral therapy. Longer duration of depression was identified as a negative predictor, most consistently in psychotherapy. In none of the treatment modalities was recurrence a negative predictor. The relation between severity of depression and outcome appeared to be complex, precluding any straightforward inferences.

The Effectiveness of the Cognitive Behavioral Analysis System of Psychotherapy for Chronic Depression : A Randomized Controlled Trial

Background: It is widely agreed that chronic depression is difficult to treat, knowledge about optimal treatment approaches is emerging. Method: A multisite randomized controlled trial was conducted comparing the cognitive behavioral analysis system of psychotherapy (CBASP), a psychotherapy model developed specifically to treat chronic depression (n = 67) with care as usual (CAU; evidence-based treatments, n = 72) over a period of 52 weeks, with 23 sessions on average, in 3 outpatient clinics in the Netherlands. In both arms algorithm-based pharmacotherapy was provided. Patients (aged 18-65) met criteria for a DSM-IV diagnosis of major depressive disorder with diagnostic specifiers (chronic, without interepisode recovery) or with co-occurring dysthymic disorder indicating a chronic course. The Inventory for Depressive Symptomatology (IDS) Self-Report was used as the primary outcome measure. Mixed-effects linear regression analysis was used to compare the changes on the IDS scores between CBASP and CAU. The IDS was administered before treatment, and after 8, 16, 32 and 52 weeks. Results: At week 52, patients assigned to CBASP had a greater reduction of depressive symptoms compared to patients assigned to CAU (t = -2.00, p = 0.05). However, CBASP and CAU did not differ from each other on the IDS after 8 weeks (t = 0.49, p = 0.63), 16 weeks (t = -0.03, p = 0.98) and 32 weeks (t = -0.17, p = 0.86) of treatment. Conclusions: This trial shows that CBASP is at least as effective as standard evidence-based treatments for chronic depression. In the long run, CBASP appears to have an added effect.

Bridging the gap for ethnic minority adult outpatients with depression and anxiety disorders by culturally adapted treatments

BACKGROUNDnCulturally adapted guideline driven depression and anxiety treatments have been developed for ethnic minority patients in Western countries to boost effectiveness for these growing and vulnerable groups. The aims of this study are to systematically review the empirical literature of outcomes associated with culturally adapted guideline driven depression and anxiety interventions, to describe the cultural adaptation and to identify the contribution of the cultural adaptation and approach as such.nnnMETHODnComprehensive search of the major bibliographical databases (Cochrane Central Register of Controlled Trials, Pubmed; Psychinfo) for randomized controlled trials.nnnRESULTSnNine eligible studies were identified and all were conducted in the USA. The pooled random standardized differences in means of the culturally adapted depression and anxiety treatment on clinical outcome was 1.06 (CI 95% 0.51-1.62, P=0.00). Two studies demonstrated effectiveness of the population specific cultural adaptation per se. All studies incorporated a focus on cultural values and beliefs as a cultural adaptation.nnnLIMITATIONnWe only identified a small number of USA studies so generalisation of the findings to other western countries can be discussed.nnnCONCLUSIONnCulturally adapted guideline driven depression and anxiety treatment was effective for USA minority patients from different cultural backgrounds. There is some evidence for the effectiveness of the population specific cultural adaptation as such.

Investigating the efficacy of integrated cognitive behavioral therapy for adult treatment seeking substance use disorder patients with comorbid ADHD: study protocol of a randomized controlled trial

BackgroundAttention deficit hyperactivity disorder (ADHD) frequently co-occurs with substance use disorders (SUD). The combination of ADHD and SUD is associated with a negative prognosis of both SUD and ADHD. Pharmacological treatments of comorbid ADHD in adult patients with SUD have not been very successful. Recent studies show positive effects of cognitive behavioral therapy (CBT) in ADHD patients without SUD, but CBT has not been studied in ADHD patients with comorbid SUD.Methods/designThis paper presents the protocol of a randomized controlled trial to test the efficacy of an integrated CBT protocol aimed at reducing SUD as well as ADHD symptoms in SUD patients with a comorbid diagnosis of ADHD. The experimental group receives 15 CBT sessions directed at symptom reduction of SUD as well as ADHD. The control group receives treatment as usual, i.e. 10 CBT sessions directed at symptom reduction of SUD only. The primary outcome is the level of self-reported ADHD symptoms. Secondary outcomes include measures of substance use, depression and anxiety, quality of life, health care consumption and neuropsychological functions.DiscussionThis is the first randomized controlled trial to test the efficacy of an integrated CBT protocol for adult SUD patients with a comorbid diagnosis of ADHD. The rationale for the trial, the design, and the strengths and limitations of the study are discussed.Trial registrationThis trial is registered in http://www.clinicaltrials.gov as NCT01431235.

The three-month effect of mobile internet-based Cognitive Therapy on the course of depressive symptoms in remitted recurrently depressed patients: Results of a Randomized Controlled Trial

Background: Internet-based cognitive therapy with monitoring via text messages (mobile CT), in addition to treatment as usual (TAU), might offer a cost-effective way to treat recurrent depression. Method: Remitted patients with at least 2 previous episodes of depression were randomized to mobile CT in addition to TAU (n = 126) or TAU only (n = 113). A linear mixed model was used to examine the effect of the treatment condition on a 3-month course of depressive symptoms after remission. Both an intention-to-treat analysis (n = 239) and a completer analysis (n = 193) were used. Depressive symptoms were assessed using the Inventory of Depressive Symptomatology (IDS-SR30) at baseline and 1.5 and 3 months after randomization. Results: Residual depressive symptoms showed a small but statistically significant decrease in the intention-to-treat group over 3 months in the mobile CT group relative to the TAU group (difference: -1.60 points on the IDS-SR30 per month, 95% CI = -2.64 to -0.56, p = 0.003). The effect of the treatment condition on the depressive symptomatology at the 3-month follow-up was small to moderate (Cohens d = 0.44). All analyses among completers (≥5 modules) showed more pronounced treatment effects. Adjustment for unequally distributed variables did not markedly affect the results. Conclusions: Residual depressive symptoms after remission showed a more favorable course over 3 months in the mobile CT group compared to the TAU group. These results are a first indication that mobile CT in addition to TAU is effective in treating recurrently depressed patients in remission. However, demonstration of its long-term effectiveness and replication remains necessary.

How do you feel? Detection of recurrent Major Depressive Disorder using a single-item screening tool

Mood is a key element of Major Depressive Disorder (MDD), and is perceived as a highly dynamic construct. The aim of the current study was to examine whether a single-item mood scale can be used for mood monitoring. One hundred thirty remitted out-patients were assessed using the Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I), Visual Analogue Mood Scale (VAMS), 17-item Hamilton Depression Rating Scale (HAM-D17), and Inventory of Depressive Symptomatology-Self Report (IDS-SR). Of all patients, 13.8% relapsed during follow-up assessments. Area under the curves (AUCs) for the VAMS, HAM-D17 and IDS-SR were 0.94, 0.91, and, 0.86, respectively. The VAMS had the highest positive predictive value (PPV) without any false negatives at score 55 (PPV=0.53; NPV=1.0) and was the best predictor of current relapse status (variance explained for VAMS: 60%; for HAM-D17: 49%; for IDS-SR: 34%). Only the HAM-D17 added significant variance to the model (7%). Assessing sad mood with a single-item mood scale seems to be a straightforward and patient-friendly avenue for life-long mood monitoring. Using a diagnostic interview (e.g., the SCID) in case of a positive screen is warranted. Repeated assessment of the VAMS using Ecological Momentary Assessment (EMA) might reduce false positives.