Abstract
BackgroundSeveral evidence-based psychotherapeutic treatment options are available for depression, but the treatment results could be improved. The D*Phase study directly compares short-term psychodynamic supportive psychotherapy (SPSP) and cognitive behavioural therapy (CBT) for Major Depressive Disorder (MDD). The objectives are 1. to investigate if, from a group level perspective, SPSP is not inferior to CBT in the treatment of major depressive disorder, 2. to build a model that may help predict the optimal type of treatment for a specific individual; and 3. to determine whether a change of therapist or a change of therapist and treatment method are effective strategies to deal with non-response. Furthermore (4.), the effect of the therapeutic alliance, treatment integrity and therapist allegiance on treatment outcome will be investigated.MethodIn this pragmatic randomised controlled trial, 308 patients with a primary diagnosis of MDD are being recruited from a specialised mental health care institution in the Netherlands. In the first phase, patients are randomised 1:1 to either SPSP or CBT. In case of treatment non-response, a second phase follows in which non-responders from treatment phase one are randomised 1:1:1 to one of three groups: continuing the initial treatment with the same therapist, continuing the initial treatment with another therapist or continuing the other type of treatment with another therapist. In both treatment phases, patients are offered sixteen twice-weekly psychotherapy sessions. The primary outcome is an improvement in depressive symptoms. Process variables, working alliance and depressive symptoms, are frequently measured. Comprehensive assessments take place before the start of the first phase (at baseline), in week one, two and four during the treatment, and directly after the treatment (week eight).DiscussionWhile the naturalistic setting of the study involves several challenges, we expect, by focusing on a large and diverse number of research variables, to generate important knowledge that may help enhance the effect of psychotherapeutic treatment for MDD.Trial registrationThe study was registered on 26 August 2016 with the Netherlands Trial Register, part of the Dutch Cochrane Centre (NL5753), https://www.trialregister.nl/trial/5753
Highlights
Several evidence-based psychotherapeutic treatment options are available for depression, but the treatment results could be improved
While the naturalistic setting of the study involves several challenges, we expect, by focusing on a large and diverse number of research variables, to generate important knowledge that may help enhance the effect of psychotherapeutic treatment for Major Depressive Disorder (MDD)
The overarching purpose of the study described in this protocol is to acquire knowledge that can help increase the effectiveness of psychotherapy for depression in clinical practice
Summary
Several evidence-based psychotherapeutic treatment options are available for depression, but the treatment results could be improved. The D*Phase study directly compares short-term psychodynamic supportive psychotherapy (SPSP) and cognitive behavioural therapy (CBT) for Major Depressive Disorder (MDD). Cognitive behavioural therapy (CBT) has been studied most [5, 6], there is no robust evidence indicating that efficacy varies between CBT and other evidence-based types of psychotherapeutic treatment for MDD such as interpersonal psychotherapy, behavioural activation, problem-solving therapy and psychodynamic psychotherapy [7,8,9]. The fact that the outcome estimates of different kinds of psychotherapy for MDD seem to be quite similar has led some people to argue that the effects of the different available psychotherapeutic treatment methods can mainly be attributed to common factors [10,11,12]. The presumed equivalence of different forms of psychotherapy gives rise to an important debate about the possible working mechanisms underlying psychotherapy for depression
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