Effectiveness Of Psychotherapy For Depression Research Articles

The effects of psychotherapy for adult depression on suicidality and hopelessness: A systematic review and meta-analysis

Although treatment guidelines suggest that suicidal patients with depression should be treated for depression with psychotherapy, it is not clear whether these psychological treatments actually reduce suicidal ideation or suicide risk. We conducted a systematic review and meta-analysis of studies on psychotherapy for depression in which outcomes on suicidality were reported. We also focused on outcomes on hopelessness because this is strongly associated with suicidal behavior in depression. Thirteen studies (with 616 patients) were included, three of which examined the effects of psychotherapy for depression on suicidal ideation and suicide risk, and eleven on hopelessness. No studies were found with suicide attempts or completed suicides as the outcome variables. The effects on suicidal ideation and suicide risk were small (g=0.12; 95% CI: -0.20-0.44) and not statistically significant. A power calculation showed that these studies only had sufficient power to find an effect size of g=0.47. The effects on hopelessness were large (g=1.10; 95% CI: 0.72-1.48) and significant, although heterogeneity was very high. Furthermore, significant publication bias was found. After adjustment of publication bias the effect size was reduced to g=0.60. At this point, there is insufficient evidence for the assumption that suicidality in depressed patients can be reduced with psychotherapy for depression. Although psychotherapy of depression may have small positive effects on suicidality, available data suggest that psychotherapy for depression cannot be considered to be a sufficient treatment. The effects on hopelessness are probably higher.

A review of the neurobiological effects of psychotherapy for depression.

Although randomized, controlled clinical trials have shown that different forms of psychotherapy may be efficacious for depression, psychotherapy has not been widely reported to have effects upon the neurobiological concomitants of depression in similar ways as medication. Neuroendocrinal changes that occur during depression (principally hypercortisolaemia) produce structural and functional alterations to the prefrontal cortex, hippocampus, and amygdala, plus the connectivity between these regions of the brain. This article reviews the evidence to date regarding the neurobiological effects of psychotherapy for depression and suggests a hypothetical pathway linking the nurturing effects of the therapist-patient "bond" and restoration of neuroendocrinal "balance." This pathway may provide a neurobiological causal link between psychotherapy and alleviation of depression in the same way as that which exists for pharmacological treatments, and argues for a model of depression that includes both biological and psychological effects of psychotherapy when considering treatment choice and application.

Effects of Psychotherapy for Depression in Children and Adolescents: What We Can (and Can't) Learn from Meta-Analysis and Component Profiling

In this column, we comment on the state of the science regarding psychotherapy for youths (including children and adolescents) with depression. We begin by discussing our recent meta-analysis of the youth depression clinical trials literature to illustrate how meta-analysis can be of use to clinicians. We consider how to interpret measures of effect size, introduce some cautionary notes, and discuss the Treatment of Adolescent Depression Study (TADS; TADS Team, 2004) as an example of factors that may contribute to effect size. Then, using a component profile, we describe the techniques most often used in the most successful treatments for youth depression. When combined, we suggest, meta-analysis and component profiling can shed light on the magnitude of treatment benefit and on the treatment techniques associated with that benefit.

The effects of borderline pathology on short-term psychodynamic psychotherapy for depression

This study examines the impact of borderline pathology (BP) on the effectiveness of short-term psychodynamic psychotherapy for depression in a naturalistic setting. Two groups were examined: 18 depressed patients with no Axis II diagnoses and 15 depressed patients with comorbid BP. Both groups demonstrated significant changes in depressive symptomatology. Likewise, many patients exhibited clinically significant reductions in depressive symptoms. Secondary analyses demonstrated significant changes for interpersonal functioning; no significant differences for therapeutic alliance were found between the two groups; and five therapist interventions were found to be more prevalent in the psychotherapy of the depressed patients with comorbid BP. The clinical utility and implications of these findings are discussed.

Effects of psychotherapy for depression in children and adolescents: a meta-analysis.

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability.

Depression in Long-Term Care: Contrasting a Disease Model with Attention to Environmental Impact.

The preceding review of depression in long-term care (LTC settings recognizes the prevalence of depression in LTC, addresses problems in assessment of depression, and examines empirical literature on the effectiveness of psychotherapy for depression. This commentary expands on the preceding review by focusing on a theoretical understanding of depression and how that understanding can inform treatment recommendations. The basic argument presented is that psychologists could best serve older adults in LTC settings by extending beyond traditional approaches to treatment of individuals who are depressed; psychologists can become good observers of the relationship of environmental factors in LTC to the internal emotional experience of depression, and then help to serve as change agents by collaborating in designing and implementing change in LTC environments. Such a radical shift could improve the quality of life for LTC residents. It also offers the possibility of defining theoretical linkages among external environmental variables, cognitive understanding of them, and emotional experience that could inform depression theory generally.

A cost-effectiveness analysis of cognitive behavior therapy and fluoxetine (prozac) in the treatment of depression

Depression affects at least 11 million Americans per year and costs the U.S. economy an estimated 44 billion dollars annually. Comprehensive review of the existing scientific evidence suggests that psychotherapy, particularly cognitive behavior therapy (CBT), is at least as effective as medication in the treatment of depression, even if severe (Antonuccio, Danton, & DeNelsky, 1995). These conclusions hold for both vegetative and social adjustment symptoms, especially when patient-rated measures are used and long-term follow-up is considered. In addition, several well-controlled studies with long-term follow-up (Evans et al., 1992; Shea et al., 1992; Simons, Murphy, Levine, & Wetzel, 1986) suggest that CBT may be more effective than drug treatment at preventing relapse. The relative effectiveness of psychotherapy for depression, particularly CBT, has been reinforced by meta-analyses reported in both psychiatry (Hollon, Shelton, & Loosen, 1991; Wexler & Cicchetti, 1992) and psychology journals (Dobson, 1989; Robinson, Berman, & Neimeyer, 1990; Steinbrueck, Maxwell, & Howard, 1983). In the era of managed care, it is not enough to be effective; treatments must be cost-effective. This paper considers the outcome studies as the basis for a cost-effectiveness comparison of drugs and psychotherapy in the treatment of unipolar depression. The analysis shows that over a 2-year period, fluoxetine alone may result in 33% higher expected costs than individual CBT treatment and the combination treatment may result in 23% higher costs than CBT alone. Supplemental analysis shows that group CBT may only result in a 2% ($596) cost savings as compared to individual treatment.

The effectiveness of dynamic psychotherapy for depression

The effectiveness of dynamic psychotherapy for depression