Depression and Dysthymic Disorders

Abstract

In this chapter, we review 10 evidence-based psychotherapies for depression in adults, which have been examined in two independent randomized controlled trials. These therapies are: cognitive behavior therapy (CBT), behavioral activation treatment (BAT), self-control therapy, problem-solving therapy, social skills training, interpersonal psychotherapy (IPT), nondirective supportive therapy, short-term psychodynamic psychotherapy, reminiscence and life review therapy for older adults, and couple therapy. For each of these evidence-based psychotherapies, we summarized consensus panel recommendations and clinical guidelines, reviewed the results of earlier meta-analyses of efficacy studies, and provided a meta-analytic summary of randomized controlled studies examining each type of psychotherapy. The majority of studies have examined the efficacy of CBT, but a considerable number of studies have examined other psychotherapies, including IPT and BAT. All psychotherapies were found to have a significant effect on depression in adults compared to control groups, and when comparing the different types of psychotherapy directly, we found only few indications that some therapies were more efficacious than others (Cuijpers et al., 2008b). Furthermore, the detected differences between studies were small and could very well be caused by outliers. Most evidence indicates that CBT is as effective as pharmacotherapy and that a combined treatment is more efficacious than pharmacotherapy alone, but not than CBT alone. IPT seems to be somewhat less efficacious than pharmacotherapy and there was a trend indicating that a combined treatment of IPT and pharmacotherapy is more efficacious than IPT alone. At the long term, there is evidence that CBT may prevent relapse rates. Keywords: depression; dysthymia; meta-analysis; treatment guidelines; cognitive behavior therapy; behavioral activation treatment; problem-solving therapy; interpersonal psychotherapy; nondirective supportive therapy; psychodynamic psychotherapy