CBT VERSUS SUPPORTIVE THERAPY FOR DEPRESSION

Abstract

If the review of controlled trials suggests the efficacy of cognitive-behavioral therapy (CBT) for depressive disorders in children and adolescents, it is premature to conclude that CBT is their treatment of choice, as stated by Compton et al. (2004). The superiority of CBT over nondirective supportive therapy (NST) has not yet been proven in child and adolescent depression. There is only one study comparing CBT with NST in adolescent major depressive disorder. This study found no significant differences in long-term outcome between the two types of psychotherapy (Birmaher et al., 2000). A more recent study found that CBT was not superior to clinical monitoring with placebo, although CBT included fifteen 50to 60-minute sessions versus six 20to 30-minute sessions for the attention-placebo condition (March et al., 2004). Moreover, some analyses suggest that the effectiveness of treatment in controlled studies is greater than that obtained in clinical settings (Weisz et al., 1992). This difference might be heightened for CBT, which requires a high level of clinician involvement and activity that can be difficult to maintain all through a day of clinical practice. The lack of professionals skilled in CBT for children and adolescents and the absence of evidence of CBT superiority over NST suggest brief supportive therapy as the first-line individual treatment for adolescent depressive disorders. More studies comparing CBT with NST for depressed children and adolescents are needed, particularly effectiveness trials in community settings.