A pilot randomised controlled trial of a brief cognitive behavioural group intervention to reduce recurrence rates in late life depression

Effectiveness of CBT and its modifications for prevention of relapse/recurrence in depression: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

CBT and its modifications are effective for depression, but its efficacy for preventing depressive relapse/recurrence remains unclear.

METHODS

A systematic review and meta-analysis was conducted scrutinizing the efficacy of CBT and its modifications for preventing depressive relapse/recurrence in randomized controlled trials. The retrieval database included PubMed, Web of Science, MEDLINE, and three major Chinese databases (CNKI, VIP, Wanfang), and the retrieval period was from January 1, 2009, to July 1, 2022. Data were analyzed by RevMan 5.4 and Stata 16.

RESULTS

A total of 28 randomized controlled trials with 3938 participants were included. The relapse/recurrence rates in CBT and its modifications and the control group were 31.6 % and 41.3 %, respectively; CBT and its modifications significantly reduced the risk of developing a new depressive episode (RR, 0.73, 95%CI, 0.64-0.83). Stratified by follow-up time, both CBT and its modifications significantly reduced the relapse/recurrence of depression at ≤12 months (RR, 0.61, 95%CI, 0.47-0.79) and > 12 months (RR, 0.74, 95%CI, 0.59-0.93) compared with other active treatments. The beneficial effects of CBT and its modifications alone in reducing depressive relapse/recurrence were equivalent to those of antidepressant medication alone (RR, 1.01, 95 % CI, 0.79-1.28). Meta-regression results showed that the intervention method (P = 0.005) was one of the sources of heterogeneity.

LIMITATIONS

Further subgroup analysis is limited by the literature.

CONCLUSION

CBT and its modifications are reliable interventions for preventing relapse/recurrence in patients with depression. Further research is needed to determine the specific conditions for CBT and its applications in clinical practice.

Psychological interventions to prevent relapse in anxiety and depression: A systematic review and meta-analysis

Objectives

The aim of this review is to establish the effectiveness of psychological relapse prevention interventions, as stand-alone interventions and in combination with maintenance antidepressant treatment (M-ADM) or antidepressant medication (ADM) discontinuation for patients with remitted anxiety disorders or major depressive disorders (MDD).

Methods

A systematic review and a meta-analysis were conducted. A literature search was conducted in PubMed, PsycINFO and Embase for randomised controlled trials (RCTs) comparing psychological relapse prevention interventions to treatment as usual (TAU), with the proportion of relapse/recurrence and/or time to relapse/recurrence as outcome measure.

Results

Thirty-six RCTs were included. During a 24-month period, psychological interventions significantly reduced risk of relapse/recurrence for patients with remitted MDD (RR 0.76, 95% CI: 0.68–0.86, p<0.001). This effect persisted with longer follow-up periods, although these results were less robust. Also, psychological interventions combined with M-ADM significantly reduced relapse during a 24-month period (RR 0.76, 95% CI: 0.62–0.94, p = 0.010), but this effect was not significant for longer follow-up periods. No meta-analysis could be performed on relapse prevention in anxiety disorders, as only two studies focused on relapse prevention in anxiety disorders.

Conclusions

In patients with remitted MDD, psychological relapse prevention interventions substantially reduce risk of relapse/recurrence. It is recommended to offer these interventions to remitted MDD patients. Studies on anxiety disorders are needed.

Systematic review registration number

PROSPERO 2018: CRD42018103142.

An investigation into the factor structure of the Cognitive Therapy Scale - Revised (CTS-R) in a CBT training sample

BACKGROUND

Effective monitoring of cognitive behaviour therapy (CBT) competence depends on psychometrically robust assessment methods. While the UK Cognitive Therapy Scale - Revised (CTS-R; Blackburn et al., 2001) has become a widely used competence measure in CBT training, practice and research, its underlying factor structure has never been investigated.

AIMS

This study aimed to present the first investigation into the factor structure of the CTS-R based on a large sample of postgraduate CBT trainee recordings.

METHOD

Trainees (n = 382) provided 746 mid-treatment audio recordings for depression (n = 373) and anxiety (n = 373) cases scored on the CTS-R by expert markers. Tapes were split into two equal samples counterbalanced by diagnosis and with one tape per trainee. Exploratory factor analysis was conducted. The suggested factor structure and a widely used theoretical two-factor model were tested with confirmatory factor analysis. Measurement invariance was assessed by diagnostic group (depression versus anxiety).

RESULTS

Exploratory factor analysis suggested a single-factor solution (98.68% explained variance), which was supported by confirmatory factor analysis. All 12 CTS-R items were found to contribute to this single factor. The univariate model demonstrated full metric invariance and partial scalar invariance by diagnosis, with one item (item 10 - Conceptual Integration) demonstrating scalar non-invariance.

CONCLUSIONS

Findings indicate that the CTS-R is a robust homogenous measure and do not support division into the widely used theoretical generic versus CBT-specific competency subscales. Investigation into the CTS-R factor structure in other populations is warranted.

The effect of CBT and its modifications for relapse prevention in major depressive disorder: a systematic review and meta-analysis

BACKGROUND

The risk of relapse in major depressive disorder (MDD) is associated with high worldwide disease burden. Cognitive behavioral therapy (CBT) and its modifications might be effective in relapse prevention. The aim of this review was to evaluate the efficacy of these treatments for reducing relapse of MDD.

METHODS

The retrieval was performed in the databases of MEDLINE via Pubmed, EMBASE and PsycINFO via OVID, The Cochrane Library and four Chinese databases. Clinical trials registry platforms and references of relevant articles were retrieved as well. Hazard ratio (HR) and corresponding 95% confidence interval (CI) were used to pool evidences.

RESULTS

A total of 16 eligible trials involving 1945 participants were included. In the first 12 months, CBT was more efficacious than control in reducing the risk of developing a new episode of depression for MDD patients in remission (HR:0.50, 95%CI:0.35-0.72, I² = 11%). Mindfulness-based cognitive therapy (MBCT) was more efficacious than control only among patients with 3 or more previous depressive episodes (HR:0.46, 95%CI:0.31-0.70, I² = 38%). Besides, compared with maintenance antidepressant medication (m-ADM), MBCT was a more effective intervention (HR:0.76, 95%CI:0.58-0.98, I² = 0%). These positive effects might be only maintained at two and nearly 6 years follow up for CBT.

CONCLUSION

The use of CBT for MDD patients in remission might reduce risk of relapse. Besides, the effect of MBCT was moderated by number of prior episodes and MBCT might only be effective for MDD patients with 3 or more previous episodes. Further exploration for the influence of previous psychological intervention is required.

Continuation and maintenance treatments for depression in older people

BACKGROUND

Depressive illness is common in old age. Prevalence in the community of case level depression is around 15% and milder forms of depression are more common. It causes significant distress and disability. The number of people over the age of 60 years is expected to double by 2050 and so interventions for this often long-term and recurrent condition are increasingly important. The causes of late-life depression differ from depression in younger adults and so it is appropriate to study it separately.This is an update of a Cochrane review first published in 2012.

OBJECTIVES

To examine the efficacy of antidepressants and psychological therapies in preventing the relapse and recurrence of depression in older people.

SEARCH METHODS

We performed a search of the Cochrane Common Mental Disorders Group's specialised register (the CCMDCTR) to 13 July 2015. The CCMDCTR includes relevant randomised controlled trials (RCTs) from the following bibliographic databases: The Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). We also conducted a cited reference search on 13 July 2015 of the Web of Science for citations of primary reports of included studies.

SELECTION CRITERIA

Both review authors independently selected studies. We included RCTs involving people aged 60 years and over successfully treated for an episode of depression and randomised to receive continuation and maintenance treatment with antidepressants, psychological therapies, or a combination.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data. The primary outcome for benefit was recurrence rate of depression (reaching a cut-off on any depression rating scale) at 12 months and the primary outcome for harm was drop-outs at 12 months. Secondary outcomes included relapse/recurrence rates at other time points, global impression of change, social functioning, and deaths. We performed meta-analysis using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with 95% confidence intervals (CI).

MAIN RESULTS

This update identified no further trials. Seven studies from the previous review met the inclusion criteria (803 participants). Six compared antidepressant medication with placebo; two involved psychological therapies. There was marked heterogeneity between the studies.Comparing antidepressants with placebo on the primary outcome for benefit, there was a statistically significant difference favouring antidepressants in reducing recurrence compared with placebo at 12 months with a GRADE rating of low for quality of evidence (three RCTs, n = 247, RR 0.67, 95% CI 0.54 to 0.82; number needed to treat for an additional beneficial outcome (NNTB) 5). Comparing antidepressants with placebo on the primary outcome for harms, there was no difference in drop-out rates at 12 months' follow-up, with a GRADE rating of low.There was no significant difference between psychological treatment and antidepressant in recurrence rates at 12 months (one RCT, n = 53) or between combination treatment and antidepressant alone at 12 months.

AUTHORS' CONCLUSIONS

This updated Cochrane review supports the findings of the original 2012 review. The long-term benefits and harm of continuing antidepressant medication in the prevention of recurrence of depression in older people are not clear and no firm treatment recommendations can be made on the basis of this review. Continuing antidepressant medication for 12 months appears to be helpful with no increased harms; however, this was based on only three small studies, relatively few participants, use of a range of antidepressant classes, and clinically heterogeneous populations. Comparisons at other time points did not reach statistical significance.Data on psychological therapies and combined treatments were too limited to draw any conclusions on benefits and harms.The quality of the evidence used in reaching these conclusions was low and the review does not, therefore, offer clear guidance to clinicians and patients on best practice and matching interventions to particular patient characteristics.Of note, we identified no new studies that evaluated pharmacological or psychological interventions in the continuation and maintenance treatment of depression in older people. We are aware of studies conducted since the previous review that included both older people and adults under the age of 65 years, but these fall outside of the remit of this review. We believe that there remains a need for studies solely recruiting older people, particularly the 'older old' with comorbid medical problems. However, these studies are likely to be challenging to conduct and may not, so far, have been prioritised by funders.

Combining pharmacotherapy and psychotherapy or monotherapy for major depression? A meta-analysis on the long-term effects

BACKGROUND

The present meta-analysis aimed to examine to what extent combined pharmacotherapy with psychotherapy results in a different response to treatment compared to psychotherapy or pharmacotherapy alone in adults with major depression at six months or longer postrandomization.

METHODS

A systematic literature search resulted in 23 randomized controlled trials with 2184 participants. Combined treatment was compared to either psychotherapy or anti-depressant medication alone in both the acute phase and the maintenance phase. Odds ratios of a positive outcome were calculated for all comparisons.

RESULTS

In acute phase treatment, combined psychotherapy with antidepressants outperformed antidepressants alone at six months or longer postrandomization in patients with major depressive disorder (OR=2.93, 95%CI 2.15-3.99, p<0.001). Heterogeneity was zero (95%CI 0-57%, p>0.05). However, combined therapy resulted in equal response to treatment compared to psychotherapy alone at six months or longer postrandomization. As for the maintenance treatment, combined maintenance psychotherapy with antidepressants resulted in better-sustained treatment response compared to antidepressants at six months or longer postrandomization (OR=1.61, 95%CI 1.14-2.27, p<0.05). Heterogeneity was zero (95%CI 0-68%, p>0.05).

CONCLUSIONS

Combined therapy results in a superior enduring effect compared to antidepressants alone in patients with major depression. Psychotherapy is an adequate alternative for combined treatment in the acute phase as it is as effective as combined treatment in the long-term.

The Effect of a Resourcefulness Training Intervention on Relocation Adjustment and Adaptive Functioning among Older Adults in Retirement Communities

The population of older adults is increasing rapidly and is expected to reach 83.7 million by the year 2050. Previous research demonstrates that greater resourcefulness is associated with better quality of life and life satisfaction. The purpose of this pilot study was to evaluate the effects of a resourcefulness training intervention on positive cognitions, resourcefulness, relocation adjustment, and adaptive functioning among older adults who have relocated to retirement communities. Resourcefulness theory provided the theoretical framework for this study. Forty older adults who relocated to three retirement communities in Milwaukee, WI were randomly assigned to either a diversional activity group or to a resourcefulness training (RT) intervention group. Two older adults dropped out of the study (one from the diversional activity group and one from the RT group), leaving 38 elders. The results of the study indicated that there were slight increases (a trend) in the mean of positive cognitions, relocation adjustment, adaptive functioning, and personal resourcefulness in the expected direction for the RT intervention group as compared to the diversional group. Recommendations for future research include the use of larger and more diverse samples over a longer periods of time (6 weeks and 12 weeks post-intervention) as well as the use of cut scores on the resourcefulness scale so that the RT training intervention is taught to those who need it.

Psychosocial interventions with art, music, Tai Chi and mindfulness for subsyndromal depression and anxiety in older adults: A naturalistic study in Singapore

OBJECTIVES

Subsyndromal depression (SSD) and subsyndromal anxiety (SSA) are common in the elderly and if left untreated, contributes to a lower quality of life, increased suicide risk, disability and inappropriate use of medical services. Innovative approaches are necessary to address this public health concern. We evaluate a community-based psychosocial intervention program and its effect on mental health outcomes in Singaporean older adults.

METHOD

Elderly participants with SSD and SSA, as assessed on the Geriatric Depression Scale and Geriatric Anxiety Inventory, were included. Intervention groups include Tai Chi exercise, Art Therapy, Mindfulness Awareness Practice and Music Reminiscence Therapy. The program was divided into a single intervention phase and a combination intervention phase. Outcomes were measured with the Zung Self-Rating Depression Scale (SDS) and Zung Self-Rating Anxiety Scale (SAS) at baseline, 4 weeks, 10 weeks, 24 weeks and 52 weeks. The program had ethics board approval.

RESULTS

A hundred and one subjects (25 males, 76 females; mean age = 71 years, SD = 5.95) participated. There were significant reductions in SDS and SAS scores in the single intervention phase (P < 0.05), and these reductions remained significant at week 52, after completion of the combination intervention phase, relative to baseline (P < 0.001).

CONCLUSION

Participating in these psychosocial interventions led to a positive improvement in SSD and SSA symptoms in these elderly subjects over a year. This simple, inexpensive and culturally acceptable approach should be adequately studied and replicated in other communities.

Group psychoeducative cognitive-behaviour therapy for mixed anxiety and depression with older adults

OBJECTIVES

There is a dearth of older adult evidence regarding the group treatment for co-morbid anxiety and depression. This research evaluated the effectiveness of a low-intensity group psychoeducational approach.

METHOD

Patients attended six sessions of a manualised cognitive-behavioural group. Validated measures of anxiety, depression and psychological well-being were taken at assessment, termination and six-week follow-up from patients, who also rated the alliance and their anxiety/depression at each group session. Staff rated patients regarding their functioning at assessment, termination and six-week follow-up. Outcomes were categorised according to whether patients had recovered, improved, deteriorated or been harmed. Effect sizes were compared to extant group interventions for anxiety and depression.

RESULTS

Eight groups were completed with 34 patients, with a drop-out rate of 17%. Staff and patient rated outcome measures showed significant improvements (with small effect sizes) in assessment to termination and assessment to follow-up comparisons. Over one quarter (26.47%) of patients met the recovery criteria at follow-up and no patients were harmed. Outcomes for anxiety were better than for depression with the alliance in groups stable over time.

CONCLUSION

The intervention evaluated shows clinical and organisational promise. The group approach needs to be further developed and tested in research with greater methodological control.

Can non-pharmacological interventions prevent relapse in adults who have recovered from depression? A systematic review and meta-analysis of randomised controlled trials

OBJECTIVE

To identify studies of non-pharmacological interventions provided following recovery from depression, and to evaluate their efficacy in preventing further episodes.

METHOD

We identified relevant randomised controlled trials from searching MEDLINE, Embase, PsycINFO, CENTRAL, and ProQuest, searching reference and citation lists, and contacting study authors. We conducted a meta-analysis of relapse outcomes.

RESULTS

There were 29 eligible trials. 27 two-way comparisons including 2742 participants were included in the primary analysis. At 12months cognitive-behavioural therapy (CBT), mindfulness-based cognitive therapy (MBCT), and interpersonal psychotherapy (IPT) were associated with a 22% reduction in relapse compared with controls (95% CI 15% to 29%). The effect was maintained at 24months for CBT, but not for IPT despite ongoing sessions. There were no 24-month MBCT data. A key area of heterogeneity differentiating these groups was prior acute treatment. Other psychological therapies and service-level programmes varied in efficacy.

CONCLUSION AND IMPLICATIONS

Psychological interventions may prolong the recovery a person has achieved through use of medication or acute psychological therapy. Although there was evidence that MBCT is effective, it was largely tested following medication, so its efficacy following psychological interventions is less clear. IPT was only tested following acute IPT. Further exploration of sequencing of interventions is needed.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO 2011:CRD42011001646.

Psychological management of unipolar depression

OBJECTIVE

To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of psychological treatments in depression derived from a literature review.

METHOD

Medical databases including MEDLINE and PubMed were searched for pertinent literature, with an emphasis on recent publications.

RESULTS

Structured psychological treatments such as cognitive behaviour therapy and interpersonal therapy (IPT) have a robust evidence base for efficacy in treating depression, even in severe cases of depression. However, they may not offer benefit as quickly as antidepressants, and maximal efficacy requires well-trained and experienced therapists. These therapies are effective across the lifespan and may be preferred where it is desired to avoid pharmacotherapy. In some instances, combination with pharmacotherapy may enhance outcome. Psychological therapy may have more enduring protective effects than medication and be effective in relapse prevention. Newer structured psychological therapies such as mindfulness-based cognitive therapy and acceptance and commitment therapy lack an extensive outcome literature, but the few published studies yielding positive outcomes suggest they should be considered options for treatment.

CONCLUSION

Cognitive behaviour therapy and IPT can be effective in alleviating acute depression for all levels of severity and in maintaining improvement. Psychological treatments for depression have demonstrated efficacy across the lifespan and may present a preferred treatment option in some groups, for example, children and adolescents and women who are pregnant or postnatal.

Continuation and maintenance treatments for depression in older people

BACKGROUND

Depressive illness in older people causes significant suffering and health service utilisation. Relapse and recurrence rates are high.

OBJECTIVES

To examine the efficacy of antidepressants and psychological therapies in preventing the relapse and recurrence of depression in older people.

SEARCH METHODS

Search of the Cochrane Depression, Anxiety and Neurosis Review Group's specialized register (the CCDANCTR) up to 22 June 2012. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE, (1974 to date) MEDLINE (1950 to date) and PsycINFO (1967 to date). We handsearched relevant journals, contacted experts in the field and examined reference lists, conference proceedings and bibliographies.

SELECTION CRITERIA

Both review authors independently selected studies. We included randomised controlled trials (RCTs) involving people aged 60 and over successfully treated for an episode of depression and randomised to receive continuation and maintenance treatment with antidepressants, psychological therapies, or combination.

DATA COLLECTION AND ANALYSIS

Data were extracted independently by the two authors.The primary outcome was relapse/recurrence rate of depression (reaching a cut-off on any depression rating scale) at six-monthly intervals. Secondary outcomes included global impression of change, social functioning, and deaths. Meta-analysis was performed using risk ratio for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95% confidence intervals.

MAIN RESULTS

Seven studies met the inclusion criteria (803 participants). Six compared antidepressant medication with placebo; two involved psychological therapies. There was marked heterogeneity between the studies.Comparing antidepressants with placebo, at six months follow-up there was no significant difference. At 12 months follow-up there was a statistically significant difference favouring antidepressants in reducing recurrence compared with placebo (three RCTs, N = 247, RR = 0.67, 95% CI 0.55 to 0.82; NNTB = five). At 24 months there was no significant difference for antidepressants overall, however, for the subgroup of tricyclic antidepressants there was significant benefit (three RCTs, N = 169, RR = 0.70, 95% CI 0.50 to 0.99; NNTB = five). At 36 months there was no significant difference for antidepressants overall. There was no difference in treatment acceptability or death rates between antidepressant and placebo.There was no significant difference between psychological treatment and antidepressant in recurrence rates at 12, 24, and 36 months (one RCT, N = 53) or between combination and antidepressant alone.Overall, the included studies were at low risk of bias.

AUTHORS' CONCLUSIONS

The long-term benefits of continuing antidepressant medication in the prevention of recurrence of depression in older people are not clear and no firm treatment recommendations can be made on the basis of this review. Continuing antidepressant medication for 12 months appears to be helpful but this is based on only three small studies with relatively few participants using differing classes of antidepressants in clinically heterogeneous populations. Comparisons at other time points did not reach statistical significance. Data on psychological therapies and combined treatments are too limited to draw any conclusions.

The effect of cognitive behavioral group therapy for depression: a meta-analysis 2000-2010

OBJECTIVE

The goals of the meta-analysis were to investigate the overall effectiveness of cognitive behavioral group therapy (CBGT) for depression and relapse prevention in depression from 2000 to 2010, and to investigate how the variables (episode, residual symptoms, group size, control group, group manual, therapist experience, therapy frequency, session length, and take-home assignment) of a CBGT study could affect the effect size.

METHOD

This study collected actual study designs sought of CBGT for depression published from 2000 to 2010. These studies were then cross-referenced using Medical Subject Headings (MeSH) with the following keywords: group therapy, cognitive therapy, cognitive behavioral therapy, cognitive behavioral group therapy, psychotherapy, depression, relapse, and recurrence. The quality of the studies was evaluated using Cochrane Collaboration Guidelines. The effect size of CBGT on depression and relapse prevention in depression used the formula devised by Hedges and Olkin (1985).

RESULTS

The study investigated the results of 32 studies on the effect of CBGT for depression. The CBGT had an immediate (g=-0.40) and continuous effect over 6 months (g=-0.38), but no continuous effect after 6 months (g=-0.06). The CBGT lowered the relapse rate of depression (RD = 0.16). Variables significantly different from each other in terms of immediate effect were: CBGT versus usual care, therapy sessions lasting longer than 1 hour, and take-home assignments. Preintervention severity of depression and patient turnover rate were found to be significantly related to the size of the immediate effect. The relapse rate after 6 months was significantly related only to "participants have no residual symptoms/participants did not mention residual symptoms."

CONCLUSIONS

Researchers and clinicians should take note that CBGT had a moderate effect on the level of depression and a small effect on the relapse rate of depression. The results of this study suggest that the patient should receive a course of therapy at least every 6 months.

Augmenting antidepressant medication with modular CBT for geriatric generalized anxiety disorder: a pilot study

OBJECTIVE

Generalized anxiety disorder (GAD) is a prevalent psychiatric condition in older adults with deleterious effects on health and cognition. Although selective serotonin reuptake inhibitor (SSRI) medications have some efficacy as acute treatments for geriatric GAD, incomplete response is the most common outcome of monotherapy. We therefore developed a novel sequential treatment strategy, using personalized, modular cognitive-behavioral therapy (mCBT) to augment SSRI medication.

METHOD

In an open label pilot study (N = 10), subjects received a sequenced trial of 12 weeks of escitalopram followed by 16 weeks of escitalopram augmented with mCBT. We also examined the maintenance effects of mCBT over a 28-week follow-up period following drug discontinuation and termination of psychotherapy.

RESULTS

Results suggest that (1) adding mCBT to escitalopram significantly reduced anxiety symptoms and pathological worry, resulting in full remission for most patients and (2) some patients maintained response after all treatments were withdrawn.

CONCLUSION

Findings suggest that mCBT may be an effective augmentation strategy when added to SSRI medication and provide limited support for the long-term benefit of mCBT after discontinuation of pharmacotherapy.

Optimal duration of combined psychotherapy and pharmacotherapy for patients with moderate and severe depression: a meta-analysis

BACKGROUND

To investigate the most effective duration of combined psychotherapy and pharmacotherapy for achieving remission and preventing relapse in depressive patients as compared to pharmacotherapy alone.

METHODS

A systematic review of English articles using PubMed, EMBASE, Web of Science, the Cochrane Library, and PsychINFO was performed in September 2009. Clinical studies comparing pharmacotherapy alone with pharmacotherapy in combination with a psychological intervention for depression treatment that reported response, remission or relapse as outcomes were included in the analysis. For each of the studies, clinical binary outcomes such as response, remission or relapse were extracted.

RESULTS

All pooled analyses were based on random-effects models. Twenty-one article describing the influence of additional psychotherapy on remission and 15 articles reporting the influence on relapse in depression were included in the analysis. Patients receiving combined treatment experienced remission more often than those receiving pharmacotherapy alone, with the highest odds ratio OR, 2.36; 95% CI, 1.58-3.55 observed at 4months after commencing the treatment. Patients receiving pharmacotherapy alone also demonstrated a higher risk for relapse compared to those receiving combined treatment.

LIMITATIONS

We restricted our search to only English language publications. Studies investigating relapse or recurrence rates are often of small size.

CONCLUSION

Pharmacotherapy enhanced with psychotherapy is associated with a higher probability of remission and a lower risk of relapse, as compared to antidepressants alone for depression treatment. Receiving psychotherapy in both the acute and continuation phases is the most effective option. Further research is needed to investigate the influence of additional psychotherapy on different patients.

Is group psychotherapy effective in older adults with depression? A systematic review

OBJECTIVE

Earlier reviews and meta-analyses have consistently concluded that psychological treatment of depression is effective in older adults. We conducted a systematic review randomised controlled trials of group psychotherapy to present the best available evidence in relation to its effectiveness in older adults with depressive disorders.

METHODS

Electronic databases were searched to identify randomised controlled trials. Selected studies were quality assessed and data extracted by two reviewers.

RESULTS

Six trials met the inclusion criteria. The trials included in the review examined group interventions based on the cognitive behavioural therapy (CBT) model with active therapeutic interventions or waiting list controls. Group psychotherapy is an effective intervention in older adults with depression in comparison to waiting list controls, the overall effect size is very modest (MD = -3.92, 95%CI: -6.18, -1.67). The reported benefits of group intervention in comparison to other active interventions did not reach statistical significance. The benefits of group psychotherapy were maintained at follow-up. The quality of the studies varied and studies were heterogeneous.

CONCLUSIONS

Although quality of many studies was not optimal, the results of this meta analysis support the results of earlier meta analyses. Group cognitive behavioural therapy is effective in older adults with depression.

A review of empirically supported psychological therapies for mood disorders in adults

BACKGROUND

The mood disorders are prevalent and problematic. We review randomized controlled psychotherapy trials to find those that are empirically supported with respect to acute symptom reduction and the prevention of subsequent relapse and recurrence.

METHODS

We searched the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to identify appropriate articles.

RESULTS

One hundred twenty-five studies were found evaluating treatment efficacy for the various mood disorders. With respect to the treatment of major depressive disorder (MDD), interpersonal psychotherapy (IPT), cognitive behavior therapy (CBT), and behavior therapy (BT) are efficacious and specific and brief dynamic therapy (BDT) and emotion-focused therapy (EFT) are possibly efficacious. CBT is efficacious and specific, mindfulness-based cognitive therapy (MBCT) efficacious, and BDT and EFT possibly efficacious in the prevention of relapse/recurrence following treatment termination and IPT and CBT are each possibly efficacious in the prevention of relapse/recurrence if continued or maintained. IPT is possibly efficacious in the treatment of dysthymic disorder. With respect to bipolar disorder (BD), CBT and family-focused therapy (FFT) are efficacious and interpersonal social rhythm therapy (IPSRT) possibly efficacious as adjuncts to medication in the treatment of depression. Psychoeducation (PE) is efficacious in the prevention of mania/hypomania (and possibly depression) and FFT is efficacious and IPSRT and CBT possibly efficacious in preventing bipolar episodes.

CONCLUSIONS

The newer psychological interventions are as efficacious as and more enduring than medications in the treatment of MDD and may enhance the efficacy of medications in the treatment of BD.

Cognitive behavioural therapy with older adults: enthusiasm without the evidence?

Cognitive behavioural interventions specifically for older people have been described and researched for the last 30 years. However, despite a robust evidence base to support the use of CBT in the treatment of mental disorders in younger adults, trials with older people have generally been of poor methodological quality. Therefore, the potential of CBT to improve the outcome of late-life mental illness has not yet been adequately tested and demonstrated. The priorities, if this is to happen, are to develop standardized, reproducible CBT interventions and to evaluate these in large trials alongside medication or as part of case-management interventions.