Brief Supportive Psychotherapy Research Articles

A randomized control clinical trial of brief supportive psychotherapy in acute coronary syndrome patients: focus on neutrophil-lymphocyte ratio and psychological symptoms

Background Neutrophil-lymphocyte ratio (NLR) may predict prognosis in acute coronary syndrome (ACS) patients. Psychological conditions play a role before, during and after infarction that can be treated with brief supportive psychotherapy (BSP). This study aimed to analyze effect of BSP on NLR and psychological symptoms (PS) in ACS patients. Methods This double opened clinical randomized study included ACS patients who were treated in Intensive Cardiac Care Unit (ICCU) Cipto Mangunkusumo Hospital, Jakarta in April to July 2019. The BSP was planned for 5 sessions as long as the patients were in ICCU. NLR and PS that was evaluated using hospital anxiety depression scale were measured at baseline and after last BSP or right before discharged from ICCU. Data were analyzed with independent t-test or Mann-Whitney test. Results We recruited 32 patients in BSP and 35 patients in control group. The median age was 55 (32 – 86) years old and mostly were men (75%). The median length of stay in ICCU was 5 (2-13) days. NLR was similar in BSP and control group (3.35 [2.26] vs 3.63 [1.79], p=0.346). ΔNLR was higher in BSP than control group in patients without CHF (3.87 [5.48] vs 0.33 [2.54], p=0.007) and without CAD (3.88 [4.55] vs 0.84 [2.51], p=0.014). Meanwhile, Δ depression score was higher in BSP than control group in patients with CHF (1.73 [3.58] vs -1.27 [2.8], p=0.041) and with CAD (2.08 [3.4] vs -0.8 [3.3], p=0.035). Conclusions There was influence of BSP on NLR in ACS patients without CHF or CAD, and psychological symptoms in ACS ones with CHF or CAD. This trial had registered in ClinicalTrial.gov.id with code number NCT04274205.

Supportive Evidence: Brief Supportive Psychotherapy as Active Control and Clinical Intervention.

Supportive psychotherapy has long had an undeservedly weak reputation. This review aims to describe the use of manualized, time-limited brief supportive psychotherapy (BSP) and its testing in clinical trials across three decades. Although numerous clinical descriptions of supportive psychotherapy exist, its use is reportedly widespread, and several supportive psychotherapies have been used in psychotherapy trials, BSP is the first and sole supportive psychotherapy manualized for research. BSP was designed as a nondirective, affect-focused, bare-bones common-factors treatment. Collecting data from the nine randomized controlled trials involving BSP, eight of them published, the author presents a narrative summary of findings. Eight trials addressed mood disorders and one addressed social anxiety disorder. Sample size varied. Most BSP trials resulted in "dead heat" comparable outcomes. BSP generally showed large effect sizes for improvement on the primary outcome variable (range d=0.62-1.01). Delivering it won over some therapists from exposure-based backgrounds. Despite its perennial role as an unfavored control condition, BSP held its own in competition with more symptom-focused therapies, usually producing a dead-heat outcome. The findings indicate the importance of psychotherapeutic common factors and the potency of BSP as an active treatment condition.

The Effect of Brief Supportive Psychotherapy on Prevention of Psychiatric Morbidity in Women with Miscarriage: A Randomized Controlled Trial about the First 24-hours of Hospitalization.

ObjectivesMiscarriage is a common pregnancy complication causing substantial psychiatric complications. This study was designed to investigate whether the administration of brief supportive psychotherapy (BSP) is effective on the management of women with miscarriage when conducted in the first 24 hours of hospitalization in order to prevent symptoms of anxiety, depression, and grief at four-months post-miscarriage.MethodsWe conducted a randomized clinical trial on 79 women with miscarriage hospitalized in Ayatollah Rohani teaching hospital. The women were randomly assigned into two groups (39 in the experimental group and 40 in the control group). All interventions were implemented for two study groups during the first 24 hours of hospitalization in a private room in the hospital. The experimental group received a two-hour BSP. The objective outcomes were assessed using Hospital Anxiety and Depression Scale and Perinatal Grief Scale (PGS), which has three subscales (active grief, difficulty coping, and despair) and were measured before the intervention and at four-months post-miscarriage.ResultsThe results of pre-tests in the follow-up of the trial suggested that the participants who received BSP reported significant reductions in the mean scores of active grief (-34.2±9.7 vs. 28.1±-6.9), difficulty coping (27.1±6.4 vs. 23.3±4.3), despair (28.0±8.4 vs. 22.8±5.2), and total PGS (89.6±23.1 vs. 74.4±15.3), in contrast to participants in the control group who did not report such results. Further, the results of generalized estimating equations models revealed that brief supportive psychotherapy caused a significant decrease in the level of factors including active grief, difficulty coping, despair, total perinatal grief, anxiety symptoms, and depressive symptoms in subjects in the experimental group compared to those in the control group after miscarriage. Also, the frequency of anxiety symptoms (13.5% vs. 60.5%), depressive symptoms (32.4% vs. 71.1%), and grief symptoms (10.8% vs. 65.8%) was found to be significantly lower in the group receiving psychotherapy than in the control group at four-months follow-up.ConclusionsAdministration of BSP session during the first 24 hours of hospitalization for women with miscarriage can be considered a reliable method to prevent anxiety symptoms, depression symptoms, and perinatal grief at four-months follow-up.

A randomized trial of interpersonal psychotherapy, problem solving therapy, and supportive therapy for major depressive disorder in women with breast cancer

Breast cancer (BC) is a risk factor for major depressive disorder (MDD), yet little research has tested the efficacy of different psychotherapies for depressed women with BC. This study, the largest to date, compared outcomes of three evidence-based, 12-week therapies in treating major depressive disorder among women with breast cancer. This randomized trial compared interpersonal psychotherapy (IPT), problem solving therapy (PST), and brief supportive psychotherapy (BSP). Conducted at the outpatient clinic of the New York State Psychiatric Institute/Columbia University, the trial offered bilingual treatment by treatment-specific psychotherapists supervised by treatment experts. The primary outcome was change in the Hamilton Depression Rating Scale (HAM-D) at 12weeks. Secondary outcomes included other validated patient-reported outcomes for depression and quality of life. Of 179 women with breast cancer screening positive for depression at the Columbia Cancer Center, 134 eligible patients signed informed treatment consent. Half of patients were Hispanic and economically disadvantaged. Most women had stage I (35.2%) or II (36.9%) BC; 9% had stage IV. The three brief psychotherapies showed similar improvements on the HAM-D, with large pre-post effect sizes (d ~ 1.0); a priori defined response rates were 35% for IPT, 50% for PST and 31% for BSP, and remission rates 25%, 30% and 27%, respectively. The three treatments also showed similar improvements in the Quality of Life Enjoyment and Satisfaction Questionnaire. Dropout was high, ranging from 37 to 52% across treatments. Predictors of dropout included having < 16years of education and annual family income < $20,000. Among patients who completed treatment, all three psychotherapies were associated with similar, meaningful improvements in depression. Physical distance between the oncology and psychiatric treatment sites might have contributed to high dropout. This study suggests various psychotherapy approaches may benefit patients with breast cancer and major depression.

Therapist Use of Specific and Nonspecific Strategies Across Two Affect-Focused Psychotherapies for Depression: Role of Adherence Monitoring.

Psychotherapists routinely use both specific and non-specific strategies to deliver empirically supported treatments (ESTs). Psychotherapy adherence monitoring has traditionally focused on assessing therapist use of EST-specific strategies (to distinguish between ESTs), paying less attention to non-specific techniques common to multiple psychotherapies. This study used the Collaborative Study Psychotherapy Rating Scale (CSPRS) to evaluate therapist use of both specific and non-specific techniques in two affect-focused ESTs for depression. Blinded raters evaluated 180 recorded sessions of interpersonal psychotherapy (IPT) and brief supportive psychotherapy (BSP). Because IPT and BSP both emphasize attention to affective states and developing a warm therapy relationship, we expected overlap across scales measuring therapist warmth, empathy, and focus on feelings. In contrast, we expected differences in scales measuring therapist directiveness, as well as IPT- and BST-specific interventions. Results showed raters displayed good inter-rater reliability on primary subscales and could discriminate between two treatments with considerable overlap. Both IPT and BSP therapists used similarly high levels of non-specific, facilitative interventions. Expectedly, IPT therapists were more directive and used more IPT-specific strategies, while BSP therapists utilized more non-directive, supportive strategies. Unexpectedly, BSP therapists showed greater focus on feelings than IPT therapists. Exploratory analyses suggested that greater focus on feelings in early sessions was associated with greater depressive symptom reduction in the first eight weeks of treatment for both ESTs. Additional treatment adherence research is needed to investigate both shared and distinctive features of ESTs, as well as the effect of the relative use of specific versus non-specific interventions on psychotherapy outcomes.

What is Supportive Psychotherapy?

This article reviews the meaning, use, and utility of supportive psychotherapy, a widespread treatment with an undeservedly malign birthright and history. This entails sorting through the historical definitions of supportive therapy and reviewing its good research track record achieved despite being the comparison condition. The author then defines brief supportive psychotherapy (BSP), a manualized, “common factors” treatment that has fared well in research settings, which may provide a model for clinical and research use in the future.

Brief dynamic therapy and depression severity: A single-blind, randomized study

BackgroundBrief dynamic therapy (BDT) has been shown to be effective in treating depressive disorders. Nevertheless, whether its effect is related to the severity of depression is still unknown. The aim of this study was to analyze whether the efficacy of BDT is related to severity of depressive symptoms in patients with mild to moderate unipolar depressive disorders. MethodsA randomized clinical trial compared BDT with brief supportive psychotherapy (BSP) in 88 outpatients with depressive disorders. Two subgroups of patients were considered for statistical analysis: with mild depressive disorders (HAM-D17 baseline score: 8–13) and with moderate depressive disorders (HAM-D17 baseline score: 14–18). Patients were assessed at start of treatment (baseline-T0), at the end of treatment (T1) and at 6-month follow-up (T2). ResultsIn the subgroup of patients with mild depressive disorders, no statistically significant differences emerged between the two treatments on all efficacy measures. In the subgroup of patients with moderate depressive disorders, the remission rates of patients treated with BDT were higher than those of patients treated with BSP at 6 month of follow-up (90.5% vs. 34.8%: p<.005). LimitationsThe sample size was relatively small; a longer follow-up period should be considered to assess the efficacy of BDT in terms of prevention of recurrences. ConclusionsThe efficacy of BDT in treating depressive disorders is higher in moderate than in mild depression.

Patient treatment preference as a predictor of response and attrition in treatment for chronic depression.

Findings regarding the relationship between patient treatment preference and treatment outcome are mixed. This is a secondary data analysis investigating the relationship between treatment preference, and symptom outcome and attrition in a large two-phase depression treatment trial. Patients met DSM-IV criteria for chronic forms of depression. Phase I was a 12-week, nonrandomized, open-label trial in which all participants (n = 785) received antidepressant medication(s) (ADM). Phase I nonremitters were randomized to Phase II, in which they received 12 weeks of either cognitive-behavioral system of psychotherapy (CBASP) + ADM (n = 193), brief supportive psychotherapy (BSP) + ADM (n = 187), or ADM only (n = 93). Participants indicated their treatment preference (medication only, combined treatment or no preference) at study entry. Symptoms were measured at 2-week intervals with the 24-item Hamilton Rating Scale for Depression (HAM-D). A large majority of patients reported a preference for combined treatment. Patients who preferred medication only were more likely to endorse a chemical imbalance explanation for depression, whereas those desiring combined treatment were more likely to attribute their depression to stressful experiences. In Phase I, patients who expressed no treatment preference showed greater rates of HAM-D symptom reduction than those with any preference, and patients with a preference for medication showed higher attrition than those preferring combined treatment. In Phase II, baseline treatment preference was not associated with symptom reduction or attrition. Treatment preferences may moderate treatment response and attrition in unexpected ways. Research identifying factors associated with differing preferences may enable improved treatment retention and response.

Social problem solving and depressive symptoms over time: a randomized clinical trial of cognitive-behavioral analysis system of psychotherapy, brief supportive psychotherapy, and pharmacotherapy.

Depression is associated with poor social problem solving, and psychotherapies that focus on problem-solving skills are efficacious in treating depression. We examined the associations between treatment, social problem solving, and depression in a randomized clinical trial testing the efficacy of psychotherapy augmentation for chronically depressed patients who failed to fully respond to an initial trial of pharmacotherapy (Kocsis et al., 2009). Participants with chronic depression (n = 491) received cognitive-behavioral analysis system of psychotherapy (CBASP; McCullough, 2000), which emphasizes interpersonal problem solving, plus medication; brief supportive psychotherapy (BSP) plus medication; or medication alone for 12 weeks. CBASP plus pharmacotherapy was associated with significantly greater improvement in social problem solving than BSP plus pharmacotherapy, and a trend for greater improvement in problem solving than pharmacotherapy alone. In addition, change in social problem solving predicted subsequent change in depressive symptoms over time. However, the magnitude of the associations between changes in social problem solving and subsequent depressive symptoms did not differ across treatment conditions. It does not appear that improved social problem solving is a mechanism that uniquely distinguishes CBASP from other treatment approaches.

Cognitive Behavioral Analysis System of Psychotherapy and Brief Supportive Psychotherapy for Augmentation of Antidepressant Nonresponse in Chronic Depression&lt;subtitle&gt;The REVAMP Trial&lt;/subtitle&gt;&lt;alt-title&gt;Augmentation With CBASP and BSP for Depression&lt;/alt-title&gt;

Previous studies have found that few chronically depressed patients remit with antidepressant medications alone. To determine the role of adjunctive psychotherapy in the treatment of chronically depressed patients with less than complete response to an initial medication trial. This trial compared 12 weeks of (1) continued pharmacotherapy and augmentation with cognitive behavioral analysis system of psychotherapy (CBASP), (2) continued pharmacotherapy and augmentation with brief supportive psychotherapy (BSP), and (3) continued optimized pharmacotherapy (MEDS) alone. We hypothesized that adding CBASP would produce higher rates of response and remission than adding BSP or continuing MEDS alone. Eight academic sites. Chronically depressed patients with a current DSM-IV-defined major depressive episode and persistent depressive symptoms for more than 2 years. Phase 1 consisted of open-label, algorithm-guided treatment for 12 weeks based on a history of antidepressant response. Patients not achieving remission received next-step pharmacotherapy options with or without adjunctive psychotherapy (phase 2). Individuals undergoing psychotherapy were randomized to receive either CBASP or BSP stratified by phase 1 response, ie, as nonresponders (NRs) or partial responders (PRs). Proportions of remitters, PRs, and NRs and change on Hamilton Scale for Depression (HAM-D) scores. In all, 808 participants entered phase 1, of which 491 were classified as NRs or PRs and entered phase 2 (200 received CBASP and MEDS, 195 received BSP and MEDS, and 96 received MEDS only). Mean HAM-D scores dropped from 25.9 to 17.7 in NRs and from 15.2 to 9.9 in PRs. No statistically significant differences emerged among the 3 treatment groups in the proportions of phase 2 remission (15.0%), partial response (22.5%), and nonresponse (62.5%) or in changes on HAM-D scores. Although 37.5% of the participants experienced partial response or remitted in phase 2, neither form of adjunctive psychotherapy significantly improved outcomes over that of a flexible, individualized pharmacotherapy regimen alone. A longitudinal assessment of later-emerging benefits is ongoing.

Pilot Study of Interpersonal Psychotherapy Versus Supportive Psychotherapy for Dysthymic Patients With Secondary Alcohol Abuse or Dependence

Interpersonal psychotherapy (IPT) has demonstrated efficacy for depression but yielded negative results for substance disorders. Alcohol abuse frequently complicates mood disorders. This pilot study compared IPT with brief supportive psychotherapy (BSP) for dysthymic disorder and alcohol abuse. We hypothesized that effect sizes would suggest greater IPT efficacy for both diagnoses, despite limited statistical power. Subjects with primary DSM-IV dysthymic disorder and secondary alcohol abuse/dependence were randomly assigned 16 weeks of IPT (N = 14) or BSP (N = 12). Patients in both treatments reported improved depressive symptoms and alcohol abstinence. IPT had a large and BSP a moderate effect size in depression, whereas BSP had a moderate and IPT a small effect size in percentage of days abstinent. This pilot study offers initial data on IPT and BSP for comorbid chronic depression and alcohol abuse/dependence. Results suggest IPT may have specific antidepressant benefits for dysthymic alcoholic patients but not in treating alcoholism.

Therapists’ Responses to Training in Brief Supportive Psychotherapy

There is little research addressing supportive psychotherapy training. This article describes training clinicians in a form of brief supportive psychotherapy (BSP) for a multisite depression study, and reports on a survey of therapist attitudes toward BSP. We hypothesized that while most therapists would report acclimating to BSP, cognitive-behavioral therapy (CBT)-trained therapists would report greater frustration with BSP. Sixteen (89%) of 18 therapists completed a brief questionnaire. Therapists reported gaining comfort with supportive concepts and interventions. Therapists with cognitive behavior therapy orientations did not report significantly greater frustration with intervention restrictions. All practitioners indicated they were already using or were planning to use BSP outside the study, and that BSP training had altered their appreciation of psychotherapy. Most study therapists lacked prior supportive therapy training but reported adapting to BSP and appreciating its strengths and limitations.

Combined Brief Dynamic Therapy and Pharmacotherapy in the Treatment of Major Depressive Disorder: A Pilot Study

Background: The relative efficacy of supplemental psychotherapy in the treatment of depression is still a matter of debate. Moreover, the superiority of brief dynamic therapy (BDT) over supportive psychotherapies is not well established. The aim of this study is to compare the efficacy of BDT added to medication with that of brief supportive psychotherapy (BSP) added to medication in the treatment of major depressive disorder. Method: A 12-month randomized clinical trial compared BDT (n = 18) with BSP (n = 17) combined with antidepressants in outpatients with major depressive disorder. Both psychotherapies were added during the first 6 months of the trial; all patients continued to be treated with only pharmacotherapy (paroxetine or citalopram) in the following 6-month continuation phase. Efficacy was assessed using the 17-item Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety and the Clinical Global Impression (CGI). The data analysis was conducted on two samples: the per-protocol (PP) sample and the observed-cases (OC) sample. Results: Thirty-two patients completed the study. Although at the end of the combined therapies (T2) no differences emerged between the two treatment approaches, the group of patients treated with BDT showed a further clinical improvement at the end of the study (T3): a significant reduction in symptomatology emerged on the HAM-D (PP sample: F = 75.154, p = 0.03; OC sample: F = 67.149, p = 0.022) and on the CGI total scores (PP sample: F = 78.527, p = 0.016; OC sample: F = 74.104, p = 0.007). The difference in remission rates on the HAM-D (75 vs. 12.5% at T3) is statistically significant favoring BDT. Conclusions: BDT combined with antidepressants is preferable to supportive psychotherapy combined with medication in the treatment of outpatients with major depression.

A comparative trial of psychotherapy and pharmacotherapy for “pure” dysthymic patients

Background Psychotherapy of “pure” dysthymic disorder remains understudied. This article reports outcomes of an acute randomized trial of 94 subjects treated for 16 weeks with either interpersonal psychotherapy (IPT), brief supportive psychotherapy (BSP), sertraline, or sertraline plus IPT. Methods Recruited by clinical referral and advertising, subjects met DSM-IV criteria for early onset dysthymic disorder, with no episode of major depression in the prior six months. They were randomly assigned to one of four 16-week treatments, with options for crossover or continuation treatment. Results were analyzed from the intention-to-treat sample by ANCOVA, controlling for baseline depressive severity. Results Subjects improved in all conditions over time, with the cells including sertraline pharmacotherapy showing superiority over psychotherapy alone for response and remission. Response rates were 58% for sertraline alone, 57% for combined treatment, 35% for IPT, and 31% for BSP. Limitations The study was underpowered and may have employed too “active” a control condition. Follow-up data were unobtainable. Conclusions In this acute trial for “pure” dysthymic disorder, sertraline with or without IPT showed advantages relative to IPT and BSP. Methodological difficulties may have limited differential outcome findings. This study bolsters a small but growing literature on the treatment of dysthymic disorder, suggesting that pharmacotherapy may acutely benefit patients more than psychotherapy.

Randomized Controlled Trial Comparing Brief Dynamic and Supportive Therapy with Waiting List Condition in Minor Depressive Disorders

Background: Although many evidences suggest the presence of specific therapeutic factors in brief dynamic therapy (BDT), few studies have investigated its efficacy in the treatment of depressive disorders in comparison to other psychotherapies. The aim of this study was to determine whether BDT is more effective than brief supportive psychotherapy (BSP) and waiting list condition in the treatment of minor depressive disorders. Method: Thirty patients with primary DSM-IV dysthymic disorder, depressive disorder not otherwise specified or adjustment disorder with depressed mood completed a randomized controlled trial with three treatment groups (BDT, BSP, waiting list condition). A 6-month follow-up was performed for patients treated with both psychotherapeutic approaches. Other psychiatric treatments were not permitted throughout the treatment period and the 6-month follow-up. Symptoms were assessed at baseline, at the end of treatment, and after 6 months of follow-up. Results: Patients treated with both psychotherapeutic approaches showed a significant improvement after treatment in comparison to non-treated controls, but BDT was more effective at follow-up evaluation. Conclusions: BDT is a promising treatment for minor depressive disorders. This study also suggests that BDT is more effective than supportive psychotherapy in improving the long-term outcome of depressive disorders.