Psychotherapy For Depressive Disorders Research Articles

Redefining effect size interpretations for psychotherapy RCTs in depression

IntroductionEffect sizes are often used to interpret the magnitude of a result and in power calculations when planning research studies. However, as effect size interpretations are context-dependent, Jacob Cohen's suggested guidelines for what represents a small, medium, and large effect are unlikely to be suitable for a diverse range of research populations and interventions. Our objective here is to determine empirically-derived effect size thresholds associated with psychotherapy randomized controlled trials (RCTs) in depression by calculating the effect size distribution. Material and methodsWe extracted effect sizes of 366 RCTs provided by the systematic review of Cuijpers and colleagues (2020) on psychotherapy for depressive disorders across all age-groups. The 50th percentile effect size, as this represents a medium effect size, and the 25th (small) and 75th (large) percentile effect sizes were calculated to determine empirically-derived effect size thresholds. ResultsAfter adjusting for publication bias, 0.27, 0.53, and 0.86 represent small, medium, and large effect sizes, respectively, in psychotherapy for depressive disorders. DiscussionThe effect size distribution for psychotherapy treatment in depression indicates that observed effect size thresholds are larger than Cohen's suggested effect size thresholds (0.2, 0.5, and 0.8). These results have implications for the interpretation of study effects and the planning of future studies via power analyses, which often use effect size thresholds.

Blended Psychotherapy: Treatment Concept and Case Report for the Integration of Internet- and Mobile-Based Interventions into Brief Psychotherapy of Depressive Disorders

Background: Blended psychotherapy (bPT) is a treatment that integrates internet- and mobile-based interventions into out-/inpatient psychotherapy. It can enrich the therapy by using online-based treatment modules as therapeutic extension that patients use time- and location-independently between face-to-face sessions. It could potentially improve the efficacy of psychotherapy and increase the number of treated persons through saved therapist time. The case report aims to facilitate the understanding of the blended treatment components. Case Report: A 4-month short-time depression treatment with six face-to-face therapy sessions, six online lessons, and app ratings of a 48-year-old female patient is presented based on the CARE guidelines and quantitative and qualitative measures (treatment documentation). Depressive symptoms were clinically significantly reduced (PHQ-9, 0–27: T0 = 17; T1 = 7) from a moderately severe to a subclinical-mild degree, and no diagnostic criteria were met in the 12-month follow-up diagnostic interview. The patient showed a maximum treatment satisfaction (ZUF-8, 8–32: T1 = 32) and adherence and rated the therapeutic working alliance (WAI, 12–60: T1 = 57) highly positive. Conclusion: bPT reduced depressive symptoms for this patient. Strengths of the treatment were the facilitated use of the internet-based elements with a full-time job and the individualization within the face-to-face sessions through the therapist. Treatment success was limited by the predetermined six sessions, which hindered addressing all topics and conducting relapse prevention.

How do adolescents with depression experience improvement in psychodynamic psychotherapy? A qualitative study

BackgroundThere is emerging evidence for the effectiveness of psychodynamic psychotherapy for depressive disorders. However, we know less of how this relation-focused therapy mode is experienced and what the patients themselves identify as helpful. Hence, the purpose of this study is to explore adolescents’ experiences of factors promoting improvement in psychodynamic therapy.MethodsEight female patients participating in a Norwegian study on psychodynamic therapy, the First Experimental Study of Transference Work – In Teenagers (FEST-IT), were included. The participants were offered a total number of 28 sessions. Semi-structured qualitative interviews about experiences with therapy were then conducted and analysed with systematic text condensation and hermeneutic interpretation.ResultsThe analysis revealed four main themes. ‘Exploring oneself’ comprises autonomy and acknowledgment, openness, insight and acceptance of oneself. ‘Therapist relation and characteristics’ includes confidence and trust in and support from the therapist as well as having a trustworthy and experienced therapist. ‘Focusing on everyday life’ includes learning and practical orientation. ‘Time factors’ refers to duration and frequency.ConclusionsTogether with a supportive and listening therapist, the adolescents improve by exploring themselves within the frames of a time-limited treatment period. Improvement seems to be experienced through better relations to oneself and to others and by finding one’s place in the family, or at school. Adolescents value problem solving and help with concrete challenges. Hence, therapy should be tailored to the needs of adolescents with depression and incorporate the challenges they face in their everyday life.Trial registrationClinicalTrials.gov. Id: NCT01531101. Date of registry: 8 February 2012, retrospectively registered.

Psychotherapy of depressive disorders : Procedures, evidence and perspectives

Depressive disorders are associated with ahigh burden of suffering and significantly reduce the well-being and the self-esteem of affected patients. Psychotherapy is one of the main treatment options for depressive disorders. The aim of this article is to present the current evidence for antidepressive psychotherapeutic treatments. During the revision of the German S3- and National Disease Management Guideline (NDMG) on unipolar depression in 2015, acomprehensive and systematic evidence search was conducted. The results of this search along with asystematic update are summarized. The most intensively investigated psychotherapeutic method is cognitive behavioral therapy (CBT), which proved to be effective in many trials. Evidence also exists for psychodynamic psychotherapy and interpersonal therapy (IPT), followed by systemic therapy and client-centered psychotherapy; however, the evidence is less robust. Psychotherapy alone or in combination with pharmacotherapy was shown to be an effective treatment option. Psychotherapy represents akey element in the treatment of depressive disorders.

Clinically significant change in psychotherapy for depressive disorders

BackgroundThe assessment of change has been a problematic issue in psychotherapy research and has become increasingly important in the up rise of evidence-based practices. MethodsIn the present paper, the clinical significance of the change of 243 patients who received one of nine treatments for depression was analysed using the Reliable Change Index [Jacobson, N.S., Follette, W.C., Revenstorf, D., 1984. Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance. Behav. Ther. 15, 336–352.] and normative comparisons (Equivalency Testing; [Kendall, P.C., Marrs-Garcia, A., Nath, S.R., Sheldrick, R.C., 1999. Normative comparisons for the evaluation of clinical significance. J. Consult. Clin. Psychol. 67, 285–299.]). While the first method addresses the question of whether or not the change that occurred was large enough to be attributable to treatment rather than to measurement error, the second method addresses the issue of comparing the level of functioning of treated individuals with non-clinical population. Hence, the nine treatments of depression were compared in terms of their reliability and clinical significance. Traditional statistical tests in treatment outcome studies were also conducted. ResultsFindings support the importance of analysing the clinical significance of change during psychotherapy. While all but one treatment led to statistical significant changes in depressive symptoms, differences among treatments were found in terms of their reliability and clinical significance. LimitationsSmall sample sizes and representativeness of each treatment warrant further replication of these results. ConclusionsImplications of the use of clinical significance testing in the exploration of empirical support for psychotherapy treatments in conjunction with traditional statistical analyses are discussed, which will be more readily useful and meaningful to clinicians who wish to embark in evidence-based practices.

Diagnosis and Psychotherapy of Depressive Disorders

Depressive disorders are very common and serious illness in many psychiatric practices. We are accustomed to normal depression in everyday life, but the pathologically depressive conditions are regarded as a seriously urgent illness by the majority of psychiatrists because of the high risk of suicidal or self-destructive behaviors. Diagnosis of depressive disorders is not a hard task with the exception of the cases of masked depression and secondary depression. Nonetheless we have experienced many unpredictable psychiatric accidents during the course of treatment for the depressives. Generally speaking, major depression shows a good response to antideressants, but a chronic course is the rule in dysthymic condition, and consequently we need psychothereutic intervention. Although psychiatry today is biologically-oriented, the necessity for psychotherapy is now accepted in practice. Bio-psycho-social model in modern psychiatry helps to understand the depressives with the multi-modal therapeutic approaches. Presumably I think we have to practice psychotherapy for the depressives at all times even when the biological cause of depression is clear. Depression is like a mixture of psycholological and biological phenomena.

P03.450 Pharmachotherapy and psychotherapy of depressive disorders

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Long-Term Evaluation of the Effectiveness of Additional Autogenic Training in the Psychotherapy of Depressive Disorders

This paper presents the results of a 3-year follow-up study on the effectiveness of additional autogenic training (AT; a psychophysiological self-control method using self-inductions of physical and mental relaxation) in the psychotherapy of outpatients with depressive disorders. Subjects were 55 patients (aged 22-69 years) with depressive disorders diagnosed according to ICD-10. Subjects were randomized to one of three groups: Group A participated in 40 single psychotherapy sessions over a period of 20 weeks; Group B learned AT in the first 10 weeks and had 20 single psychotherapy sessions as well as AT practice in the second 10 weeks; Group C was the waiting-list control group in the first 10 weeks and had 20 single psychotherapy sessions as well as AT learning in the second 10 weeks. Tests for depressive symptoms (BDI) and psychosomatic complaints (AT-SYM) were given before the start of treatment, after 10 weeks, after 20 weeks, as well as 8 months and 3 years after the end of treatment. In addition, at both follow-ups information were gathered on disease course, relapses, psychotherapy and medical treatments, as well as AT practice. Long-term follow-up shows that controlled and supervised use of AT before or in combination with psychotherapy has more positive effects than psychotherapy alone. Compared to psychotherapy without AT (Group A), combined psychotherapy and AT (Groups B and C) resulted in significantly lower rates of relapse and treatment reentry as well as in significantly more stable positive treatment effects in the reduction of depression and psychosomatic symptoms at the second follow-up.