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Strand ER, Nordahl H. Do Patient's Interpersonal Problems Improve Following Metacognitive Therapy? A Systematic Review and Meta-Analysis. Clin Psychol Psychother 2024; 31:e2973. [PMID: 38572800 DOI: 10.1002/cpp.2973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/05/2024]
Abstract
Metacognitive therapy (MCT) aims to modify dysfunctional metacognitions that are thought to be universal determinants of emotional distress and psychological dysfunction more generally. MCT is an effective treatment for emotional distress symptoms, but less is known about its effect for other types of psychological problems. Interpersonal problems are common in psychological disorders and should be improved following psychotherapy. Therefore, we conducted a systematic review and meta-analysis of trials on the effects associated with MCT for interpersonal problems among adults with mental health disorders published until 15 November 2023 using PubMed, Cochrane Library and PsycNet. Trials with a minimum of 10 participants were included. A total of six studies based on five trials reported on the effectiveness of MCT for interpersonal problems and met our inclusion criteria. Two trials evaluated MCT for patients with major depressive disorders, two for patients with anxiety disorders and one for borderline personality disorder. Three of the trials were randomized controlled trials. Four of the trials reported follow-up data but varied in their time-points. The within-group effect size estimate from pretreatment to posttreatment across five trials was large (g = 0.865, 95% CI [0.512-1.218]). Our results indicate that MCT is an effective treatment for improving interpersonal problems in individuals with common mental disorders, even though the treatment is short and primarily concern improving mental regulation through modifying metacognitions. While this finding is in line with metacognitive theory, more trials evaluating personality and interpersonal functioning are needed to draw firm conclusions.
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Affiliation(s)
- Eivind R Strand
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olav's Hospital, Nidaros DPS, Trondheim, Norway
| | - Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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van Tatenhove M, Koppers D, Peen J, Dekker JJM. Group schema therapy: the temporal relationship between early maladaptive schemas and global psychological distress. Psychother Res 2023:1-10. [PMID: 38109491 DOI: 10.1080/10503307.2023.2292151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/24/2023] [Indexed: 12/20/2023] Open
Abstract
Schema therapy is an effective treatment for personality disorders (PDs). The theory of schema therapy assumes that the decrease of global psychological distress is mediated by change in Early Maladaptive Schemas. The few studies that have investigated a temporal relationship have produced contradictory results. This study examined the temporal relationship between changes in Early Maladaptive Schemas and global psychological distress in Group Schema Therapy (GST) for patients with personality disorders. Assessments were made of 115 patients at baseline, after 20, 40 and after 60 sessions of treatment. We used the Young Schema Questionnaire (YSQ) to measure the severity of Early Maladaptive Schemas and the Symptom Check List-90 Revisited (SCL-90R) to measure global psychological distress. Linear mixed model analyzes were used to examine the temporal relationship between the initial phase (0-20 and 0-40 sessions) and the later phase (40-60 sessions). Change in Early Maladaptive Schemas does not precede change in global psychological distress. Conversely, global psychological distress does not precede change in Early Maladaptive Schemas; the improvement in both indicators is concurrent. In this study, we could not confirm that the decrease of Early Maladaptive Schemas precedes decrease of global psychological distress. We found a concurrent relationship.
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Affiliation(s)
- Marianne van Tatenhove
- NPI Centre for Personality Disorders, Arkin Mental Health Care Institute, Amsterdam, Netherlands
| | - David Koppers
- Research Department, Arkin Mental Health Care Institute, Amsterdam, Netherlands
| | - Jaap Peen
- Research Department, Arkin Mental Health Care Institute, Amsterdam, Netherlands
| | - Jack J M Dekker
- Research Department, Arkin Mental Health Care Institute, Amsterdam, Netherlands
- Department of Clinical Psychology, Free University Amsterdam, Amsterdam, Netherlands
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3
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Lorenzo-Luaces L. Identifying active ingredients in cognitive-behavioral therapies: What if we didn't? Behav Res Ther 2023; 168:104365. [PMID: 37453179 PMCID: PMC10534234 DOI: 10.1016/j.brat.2023.104365] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/24/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
Identifying active ingredients of psychological interventions is a major goal of psychotherapy researchers that is often justified by the promise that it will lead to improved patient outcomes. Much of this "active ingredients" research is conducted within randomized controlled trials (RCTs) with patient populations, putting it in Phase T2 of the clinical-translational spectrum. I argue that RCTs in patient populations are very "messy laboratories" in which to conduct active ingredient work and that T0 and T1 research provide more controlled contexts. However, I call attention to the long road from identifying active ingredients of CBTs, whether in T0, T1, or T2 research, to improving outcomes. Dissemination and implementation research (T3 and T4 approaches) may be conceptually closer to improving outcomes. Given how common and disabling mental health symptoms are, I argue that if researchers want to improve patient outcomes, these research programs must receive more attention including work on the uptake of psychological interventions as well as work on optimal ordering of existing interventions.
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Goldstein Ferber S, Shoval G, Weller A, Zalsman G. Not one thing at a time: When concomitant multiple stressors produce a transdiagnostic clinical picture. World J Psychiatry 2023; 13:402-408. [PMID: 37547732 PMCID: PMC10401502 DOI: 10.5498/wjp.v13.i7.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/07/2023] [Accepted: 06/19/2023] [Indexed: 07/17/2023] Open
Abstract
A condition of exposure to multiple stressors resulting in a mixed clinical picture spanning conventional categories without meeting any of them in full, encompasses a risk for a list of comorbidities preventing appropriate prevention and treatment. New transformative transdiagnostic approaches suggest changes spanning conventional categories. They base their systems of classification on biomarkers as well as on brain structural and functional dysregulation as associated with behavioral and emotional symptoms. These new approaches received critiques for not being specific enough and for suggesting a few biomarkers for psychopathology as a whole. Therefore, they put the value of differential diagnosis at risk of avoiding appropriate derived prevention and treatment. Multiplicity of stressors has been considered mostly during and following catastrophes, without considering the resulting mixed clinical picture and life event concomitant stressors. We herewith suggest a new category within the conventional classification systems: The Complex Stress Reaction Syndrome, for a condition of multiplicity of stressors, which showed a mixed clinical picture for daily life in the post coronavirus disease 2019 era, in the general population. We argue that this condition may be relevant to daily, regular life, across the lifespan, and beyond conditions of catastrophes. We further argue that this condition may worsen without professional care and it may develop into a severe mental health disorder, more costly to health systems and the suffering individuals. Means for derived prevention and treatment are discussed.
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Affiliation(s)
- Sari Goldstein Ferber
- Department of Psychology and Brain Sciences, University of Delaware, Newark, DE 19716, United States
- Psychology and Gonda Brain Research Center, Bar Ilan University, Ramat Gan 5317000, Israel
| | - Gal Shoval
- Department of Neuroscience, Princeton University, New Jersey, NJ 08544, United States
- Geha Mental Health Center, Petah Tiqva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 77096, Israel
| | - Aron Weller
- Psychology and Gonda Brain Research Center, Bar Ilan University, Ramat Gan 5317000, Israel
| | - Gil Zalsman
- Geha Mental Health Center, Petah Tiqva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 77096, Israel
- Department of Psychiatry, Columbia University, New York, NY 10032, United States
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5
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Persons JB, Marker CD, Bailey EN. Changes in affective and cognitive distortion symptoms of depression are reciprocally related during cognitive behavior therapy. Behav Res Ther 2023; 166:104338. [PMID: 37270956 DOI: 10.1016/j.brat.2023.104338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 05/11/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
We tested the predictions from Beck's cognitive theory that change in cognitive distortions precedes and predicts change in affective symptoms of depression, and his secondary prediction that change in affective symptoms precedes and predicts change in cognitive distortions during the course of cognitive behavior therapy (CBT; Beck, 1963). We used bivariate latent difference score modeling to examine change in affective and cognitive distortion symptoms of depression over time in a sample of 1402 outpatients who received naturalistic CBT in a private practice setting. Patients completed the Beck Depression Inventory (BDI) at each therapy session to monitor their progress in treatment. We selected items from the BDI to create measures of affective and cognitive distortion symptoms that allowed us to assess change in those phenomena over the course of treatment. We examined BDI data from up to 12 sessions of treatment for each patient. As predicted by Beck's theory, we found that change in cognitive distortion symptoms preceded and predicted change in affective symptoms of depression, and that change in affective symptoms preceded and predicted change in cognitive distortion symptoms. Both effects were small in size. These findings support the notion that change in affective and cognitive distortion symptoms of depression each precedes and predicts the other - that is, they are reciprocal in nature during cognitive behavior therapy. We discuss implications of our findings for the nature of the change process in CBT.
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Affiliation(s)
- Jacqueline B Persons
- Oakland Cognitive Behavior Therapy Center, USA; University of California, Berkeley, USA.
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Schneider BC, Veckenstedt R, Karamatskos E, Pinho LG, Morgado B, Fonseca C, Moritz S, Jelinek L. Negative cognitive beliefs, positive metacognitive beliefs, and rumination as mediators of metacognitive training for depression in older adults (MCT-Silver). Front Psychol 2023; 14:1153377. [PMID: 37034960 PMCID: PMC10074596 DOI: 10.3389/fpsyg.2023.1153377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/02/2023] [Indexed: 04/11/2023] Open
Abstract
Background Metacognitive Training for Depression in older adults (MCT-Silver; www.uke.de/mct-silver) is a cognitive-behavioral based group intervention that aims at reducing depression by targeting (meta)cognitive beliefs and rumination. In the present study, it was examined whether negative cognitive beliefs, positive metacognitive beliefs and/or rumination may be implicated as mediators of MCT-Silver's effects on depression. Materials and methods We conducted a secondary analysis of a randomized controlled trial comparing MCT-Silver to an active control intervention (cognitive remediation) including 66 older adults (60 years and older) with complete baseline data. Clinician-rated (Hamilton Depression Rating Scale) and self-reported (Beck Depression Inventory-II) depression, negative cognitive beliefs (Dysfunctional Attitudes Scale-18B), positive metacognitive beliefs (positive beliefs subscale; Metacognition Questionnaire-30) and rumination (10-item Ruminative Response Scale) were assessed before (pre) and after 8 weeks of treatment (post), as well as 3 months later (follow-up). It was examined whether change in depression (pre- to follow-up) was mediated by change in negative cognitive beliefs, positive metacognitive beliefs and/or rumination (pre- to post-assessment). Results Mediation results differed for self-reported vs. clinician-rated depression. The effect of MCT-Silver on reduction in clinician-rated depression was mediated by a reduction in self-reported rumination, whereas reduction in self-reported depression was mediated by a reduction in negative cognitive beliefs. Positive metacognitive beliefs were not a significant mediator for either outcome. Conclusion The current study provides initial evidence for the roles of negative cognitive beliefs and rumination in the treatment of depression in later life with MCT-Silver. Given the divergence of findings and lack of causal precedence, mechanisms of change for MCT-Silver cannot yet be equivocally identified.
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Affiliation(s)
- Brooke C. Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Brooke C. Schneider,
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evangelos Karamatskos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lara Guedes Pinho
- Nursing Department, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
| | | | - César Fonseca
- Nursing Department, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Shaygan M, Hosseini FA, Negad SS. Temporal relationships between changes in depression and suicidal ideation: A mediation analysis in a randomized double-blinded clinical trial. Psychol Psychother 2022; 96:364-382. [PMID: 36563040 DOI: 10.1111/papt.12444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/02/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES There is a considerable debate regarding the possible dependence between depression and suicidal ideation treatments. The present study used a novel mediation approach in a randomized comparison of pharmacotherapy and combined therapy to explore whether depressive symptoms mediate the association between treatment and suicidal ideation and whether it depends on the treatment condition. DESIGN This study is a randomized, controlled, parallel group (1:1), clinical trial using a novel mediation approach for longitudinal data. Latent difference score modelling was utilized to investigate whether changes in depressive symptoms drive subsequent changes in suicide ideation. METHOD Participants were 94 depressive suicidal outpatients who were assessed regarding depressive symptoms and suicidal ideation over the course of an experiment (0-2-7 months). Direct and indirect associations between (change in) depressive symptoms and (change in) suicidal ideation were explored using Pearson's correlations and latent difference score model. RESULTS The results showed that depression treatment affects not only suicidal ideation directly but also its influence on suicidal ideation occurs via improvement in depressive symptoms. It was found a more significant effect of combining pharmacotherapy and PPT (in comparison with the pharmacotherapy alone) on the early and late improvements of suicidal ideation (Δ 0-2 and Δ 2-7) via the early improvement of depressive symptoms (Δ 0-2). CONCLUSIONS The findings indicate that changes in depressive symptoms preceded changes in suicidal ideation. Our results highlighted that improving depressive symptoms could be a primary target in treating patients with depression experiencing suicidal thoughts.
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Affiliation(s)
- Maryam Shaygan
- Faculty of Nursing and Midwifery, Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Alsadat Hosseini
- Community Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Laposa JM, Katz DE, Lisi DM, Hawley LL, Quigley L, Rector NA. Longitudinal changes in intolerance of uncertainty and worry severity during CBT for generalized anxiety disorder. J Anxiety Disord 2022; 91:102623. [PMID: 35994883 DOI: 10.1016/j.janxdis.2022.102623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/17/2022] [Accepted: 08/11/2022] [Indexed: 10/15/2022]
Abstract
Intolerance of uncertainty (IU) is a key construct in generalized anxiety disorder (GAD), but little is known about the concurrent and temporal patterns of associations between IU and GAD symptom severity during treatment. In addition, most of the extant literature focuses on IU as a unidimensional construct, whereas some researchers conceptualize IU as being comprised of two dimensions, inhibitory and prospective IU. Ninety individuals with GAD completed measures of IU and worry severity at pre-treatment, session 4, session 8, and end of treatment (session 12), during group-based cognitive behavior therapy (CBT) for GAD. Longitudinal multilevel modeling showed that IU predicted worry severity concurrently, but not prospectively over time; this pattern of associations was found with the total IUS score and the inhibitory (but not prospective) subscale score. Further, the relationship between IU total scores and worry severity became stronger over time. The relationship between inhibitory (but not prospective) IU and worry also became stronger over time. When the order of the variables in the model was reversed, worry severity also predicted concurrent but not future IU. Therefore, change in IU is associated with change in worry throughout the course of CBT, particularly as treatment progresses, though its directional association as a cause and/or effect remains unclear.
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Affiliation(s)
- Judith M Laposa
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 100 Stokes St., Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada.
| | - Danielle E Katz
- Forest Hill Centre for Cognitive Behavioural Therapy, 439 Spadina Road, Toronto, Ontario, Canada
| | - Diana M Lisi
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada
| | - Lance L Hawley
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada
| | - Leanne Quigley
- Ferkauf Graduate School of Psychology, 1165 Morris Park Ave, The Bronx, NY, United States
| | - Neil A Rector
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, Canada; Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada
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9
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Strappini F, Socci V, Saliani AM, Grossi G, D’Ari G, Damato T, Pompili N, Alessandri G, Mancini F. The therapeutic alliance in cognitive-behavioral therapy for obsessive-compulsive disorder: A systematic review and meta-analysis. Front Psychiatry 2022; 13:951925. [PMID: 36147968 PMCID: PMC9488733 DOI: 10.3389/fpsyt.2022.951925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background The therapeutic alliance has been recognized as one of the most researched key elements of treatment across different therapeutic approaches and diagnostic domains. Despite its importance, our current understanding of its clinical relevance in patients with obsessive-compulsive disorder (OCD) is still debated. This study aimed to examine empirical evidence on the effect of alliance on treatment outcomes in Cognitive Behavioral Therapy (CBT) in patients with OCD in a systematic review and meta-analysis. Methods Original peer-reviewed articles until March 2022 were included if they were (1) written in English; (2) included a clinical group with a current primary OCD diagnosis; (3) involved individual CBT; (4) used a validated therapeutic alliance scale that was related to the outcome measurement; (5) reported an effect size. Results Thirteen studies were included, six of which contained sufficient statistical information to be included in the meta-analysis. A total of 897 patients took part in all reviewed studies. We found a modest effect of alliance on post-treatment outcome [Tau 2 = -0.1562 (C.I. 95%: -0.2542 to -0.0582)]. Discussion The results show the existence of considerable variability and methodological inconsistencies across studies. We discuss the role of methodological factors that could account for this divergence, the research limitations, and the implications for current research. Systematic review registration [https://osf.io/dxez5/?view_only=bc2deaa7f0794c8dbef440255b2d4b3b].
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Affiliation(s)
| | - Valentina Socci
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, Coppito, Italy
| | | | - Giuseppe Grossi
- Association School of Cognitive Psychotherapy (APC-SPC), Rome, Italy
| | - Giulia D’Ari
- Association School of Cognitive Psychotherapy (APC-SPC), Rome, Italy
| | - Titti Damato
- Association School of Cognitive Psychotherapy (APC-SPC), Rome, Italy
| | - Nicole Pompili
- Association School of Cognitive Psychotherapy (APC-SPC), Rome, Italy
| | - Guido Alessandri
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Francesco Mancini
- Association School of Cognitive Psychotherapy (APC-SPC), Rome, Italy
- Department of Human Sciences, Guglielmo Marconi University, Rome, Italy
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10
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Rumination, automatic thoughts, dysfunctional attitudes, and thought suppression as transdiagnostic factors in depression and anxiety. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-020-01086-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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11
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Bozzatello P, Giordano B, Montemagni C, Rocca P, Bellino S. Real-World Functioning in Psychiatric Outpatients: Predictive Factors. J Clin Med 2022; 11:jcm11154400. [PMID: 35956015 PMCID: PMC9369214 DOI: 10.3390/jcm11154400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/17/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Investigations on predictors of real-world functioning were mainly performed in patients with schizophrenia, while fewer studies have been conducted in other psychiatric disorders. Objective: Our objective was to identify clinical, socio-demographic, and illness-related predictors of real-world functioning during 12 months of standard treatments in outpatients with different diagnoses. Methods: Outpatients (n = 1019) with schizophrenia (SZ), major depressive disorder (MDD), bipolar disorder (BD), and borderline personality disorder (BPD) were evaluated with the following tools: SCID-5-CV and SCID-5-PD, CGI-S, SAT-P, DAI-10, and PSP. Change of PSP (ΔPSP) between baseline and 12 months was used as the dependent variable in multiple regression analysis. Results: Higher PSP score at baseline and the achievement of main milestones predicted better functioning after follow-up in all subgroups of patients, with the exception of BD. In the total sample, ΔPSP was related to age of onset, treatments, and quality of life, and inversely related to psychiatric anamnesis, antidepressants, and global symptoms. In SZ, ΔPSP was related to adherence and quality of life. In MDD, ΔPSP was related to psychotherapy and quality of life, and inversely related to antidepressants and global symptoms. In BD, ΔPSP was related to age of onset, antipsychotics, and quality of life, while it was inversely related to psychiatric anamnesis. In BPD, antipsychotics, mood stabilizers, psychotherapy, and quality of life were directly related to ΔPSP, while suicidal attempts and global symptoms had an inverse relation. Conclusions: Several socio-demographic and illness-related variables predicted improvement of real-world functioning, besides psychopathology and severity of the disease.
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Craner JR, Schumann ME, Barr A, Morrison EJ, Lake ES, Sutor B, Flegge LG, Gilliam WP. Mediators of change in depressed mood following pain rehabilitation among participants with mild, moderate, or severe depressive symptoms. J Affect Disord 2022; 307:286-293. [PMID: 35351491 DOI: 10.1016/j.jad.2022.03.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Prior research indicates that depression and chronic pain commonly co-exist and impact each other. Interdisciplinary pain rehabilitation programs (IPRPs) have been shown to lead to statistically and clinically significant improvements for patients who report both depressed mood and chronic pain, however there is a gap in the literature regarding the mechanisms by which these improvements occur. METHODS This two-site, distinct sample study (Study 1: N = 303, 10-week, individual format, ACT-based program; Study 2: N = 406, 3-week, group format, CBT-based program) evaluated mediators of treatment improvement in depressive symptoms among adult IPRP participants who reported elevated depressive symptoms at program admission and examined treatment mechanisms for depressive symptoms. RESULTS Self-reported pain self-efficacy and pain catastrophizing - particularly the helplessness domain - mediated the treatment-related change in depression among IPRP participants with elevated depressive symptoms across the two sites and samples. In one sample, full mediation was achieved while in the other sample, partial mediation was achieved. Participants in both samples showed improvement on all measures. LIMITATIONS This study relied on self-report measures of depressive severity and not clinical diagnosis. Results may not generalize to other populations of patients with chronic pain. There was no control condition in either study. CONCLUSION Increasing pain self-efficacy and decreasing a sense of helplessness are important treatment targets among IPRP participants who endorse symptoms of depression.
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Affiliation(s)
- Julia R Craner
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States of America; Michigan State University College of Human Medicine, Grand Rapids, MI, United States of America.
| | - Matthew E Schumann
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Aex Barr
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States of America; Michigan State University College of Human Medicine, Grand Rapids, MI, United States of America
| | - Eleshia J Morrison
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Eric S Lake
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States of America; Michigan State University College of Human Medicine, Grand Rapids, MI, United States of America
| | - Bruce Sutor
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
| | - Lindsay G Flegge
- Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, United States of America; Michigan State University College of Human Medicine, Grand Rapids, MI, United States of America
| | - Wesley P Gilliam
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, United States of America
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Huibers MJH, Van Bronswijk SC, Peeters FPML, Lemmens LHJM. Does psychological process change during psychotherapy predict long-term depression outcome after successful cognitive therapy or interpersonal psychotherapy? Secondary analysis of a randomized trial. Psychother Res 2022; 32:1047-1063. [PMID: 35442870 DOI: 10.1080/10503307.2022.2064251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Psychotherapies for depression are similarly effective, but the processes through which these therapies work have not been identified. We focus on psychological process changes during therapy as predictors of long-term depression outcome in treatment responders. METHOD Secondary analysis of a randomized trial comparing cognitive therapy (CT) and interpersonal psychotherapy (IPT) that focuses on 85 treatment responders. Using mixed-effects models, changes during therapy (0-7 months) on nine process variables were associated with depression severity (BDI-II) at follow-up (7-24 months). RESULTS A decrease in dysfunctional attitudes was associated with a decrease in depression scores over time. Improved self-esteem was associated with less depression at follow-up (borderline significant). More improvement in both work and social functioning and interpersonal problems was associated with better depression outcomes in IPT relative to CT, while less improvement in work and social functioning and interpersonal problems was associated with better outcomes in CT relative to IPT. CONCLUSIONS Less negative thinking during therapy is associated with lower depression severity in time, while changes during therapy in work and social functioning and interpersonal problems appear to predict different long-term outcomes in CT vs. IPT. If replicated, these findings can be used to guide clinical decision-making during psychotherapy.
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Affiliation(s)
- Marcus J H Huibers
- Department of Clinical Psychology, Utrecht University, Utrecht, Netherlands.,NPI Centre for Personality Disorders/Arkin, Amsterdam, Netherlands
| | - Suzanne C Van Bronswijk
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Frenk P M L Peeters
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - Lotte H J M Lemmens
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
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14
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Johannsen M, Nissen ER, Lundorff M, O'Toole MS. Mediators of acceptance and mindfulness-based therapies for anxiety and depression A systematic review and meta-analysis. Clin Psychol Rev 2022; 94:102156. [DOI: 10.1016/j.cpr.2022.102156] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/16/2022] [Accepted: 04/13/2022] [Indexed: 12/11/2022]
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Tait J, Edmeade L, Delgadillo J. Are depressed patients' coping strategies associated with psychotherapy treatment outcomes? Psychol Psychother 2022; 95:98-112. [PMID: 34617396 DOI: 10.1111/papt.12368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 07/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In theory, depression is thought to be associated with deficits in adaptive and excesses in maladaptive coping strategies. This study aimed to investigate associations between coping strategies and depression treatment outcomes. METHOD Participants (N = 126) completed measures of adaptive and maladaptive coping strategies before and after accessing evidence-based psychotherapies for depression. The primary outcome was self-reported depression severity measured with the Patient Health Questionnaire (PHQ-9). Hierarchical regression was used to investigate associations between coping strategies and post-treatment depression symptoms, controlling for therapeutic alliance and relevant demographics. RESULTS Lower pre-treatment engagement coping and higher rumination predicted higher post-treatment depression, but both of these effects became non-significant after controlling for baseline depression severity. Similarly, correlations between change in rumination and change in depression were no longer significant after controlling for baseline severity. CONCLUSIONS Deficits in adaptive (engagement) and excesses in maladaptive (rumination) coping strategies may simply be proxy indicators (epiphenomena) of depression severity. PRACTITIONER POINTS Lower pre-treatment engagement coping predicted higher post-treatment depression Higher pre-treatment rumination predicted higher post-treatment depression Change in rumination during treatment correlated with change in depression symptoms However, none of the above associations remained statistically significant after controlling for baseline depression severity.
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Affiliation(s)
- James Tait
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, UK
| | | | - Jaime Delgadillo
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, UK
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Wibbelink CJM, Arntz A, Grasman RPPP, Sinnaeve R, Boog M, Bremer OMC, Dek ECP, Alkan SG, James C, Koppeschaar AM, Kramer L, Ploegmakers M, Schaling A, Smits FI, Kamphuis JH. Towards optimal treatment selection for borderline personality disorder patients (BOOTS): a study protocol for a multicenter randomized clinical trial comparing schema therapy and dialectical behavior therapy. BMC Psychiatry 2022; 22:89. [PMID: 35123450 PMCID: PMC8817780 DOI: 10.1186/s12888-021-03670-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/21/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Specialized evidence-based treatments have been developed and evaluated for borderline personality disorder (BPD), including Dialectical Behavior Therapy (DBT) and Schema Therapy (ST). Individual differences in treatment response to both ST and DBT have been observed across studies, but the factors driving these differences are largely unknown. Understanding which treatment works best for whom and why remain central issues in psychotherapy research. The aim of the present study is to improve treatment response of DBT and ST for BPD patients by a) identifying patient characteristics that predict (differential) treatment response (i.e., treatment selection) and b) understanding how both treatments lead to change (i.e., mechanisms of change). Moreover, the clinical effectiveness and cost-effectiveness of DBT and ST will be evaluated. METHODS The BOOTS trial is a multicenter randomized clinical trial conducted in a routine clinical setting in several outpatient clinics in the Netherlands. We aim to recruit 200 participants, to be randomized to DBT or ST. Patients receive a combined program of individual and group sessions for a maximum duration of 25 months. Data are collected at baseline until three-year follow-up. Candidate predictors of (differential) treatment response have been selected based on the literature, a patient representative of the Borderline Foundation of the Netherlands, and semi-structured interviews among 18 expert clinicians. In addition, BPD-treatment-specific (ST: beliefs and schema modes; DBT: emotion regulation and skills use), BPD-treatment-generic (therapeutic environment characterized by genuineness, safety, and equality), and non-specific (attachment and therapeutic alliance) mechanisms of change are assessed. The primary outcome measure is change in BPD manifestations. Secondary outcome measures include functioning, additional self-reported symptoms, and well-being. DISCUSSION The current study contributes to the optimization of treatments for BPD patients by extending our knowledge on "Which treatment - DBT or ST - works the best for which BPD patient, and why?", which is likely to yield important benefits for both BPD patients (e.g., prevention of overtreatment and potential harm of treatments) and society (e.g., increased economic productivity of patients and efficient use of treatments). TRIAL REGISTRATION Netherlands Trial Register, NL7699 , registered 25/04/2019 - retrospectively registered.
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Affiliation(s)
- Carlijn J. M. Wibbelink
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Arnoud Arntz
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Raoul P. P. P. Grasman
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
| | - Roland Sinnaeve
- grid.5596.f0000 0001 0668 7884Department of Neurosciences, Mind Body Research, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Michiel Boog
- grid.491189.cDepartment of Addiction and Personality, Antes Mental Health Care, Max Euwelaan 1, Rotterdam, 3062 MA the Netherlands ,grid.6906.90000000092621349Institute of Psychology, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR the Netherlands
| | - Odile M. C. Bremer
- grid.491093.60000 0004 0378 2028Arkin Mental Health, NPI Institute for Personality Disorders, Domselaerstraat 128, Amsterdam, 1093 MB the Netherlands
| | - Eliane C. P. Dek
- grid.491389.ePsyQ Personality Disorders Rotterdam-Kralingen, Max Euwelaan 70, Rotterdam, 3062 MA the Netherlands
| | | | - Chrissy James
- grid.420193.d0000 0004 0546 0540Department of Personality Disorders, Outpatient Clinic De Nieuwe Valerius, GGZ inGeest, Amstelveenseweg 589, Amsterdam, 1082 JC the Netherlands
| | | | - Linda Kramer
- grid.491220.c0000 0004 1771 2151GGZ Noord-Holland-Noord, Stationsplein 138, 1703 WC Heerhugowaard, the Netherlands
| | - Maria Ploegmakers
- grid.491369.00000 0004 0466 1666Pro Persona, Siependaallaan 3, Tiel, 4003 LE the Netherlands
| | - Arita Schaling
- grid.491369.00000 0004 0466 1666Pro Persona, Willy Brandtlaan 20, Ede, 6716 RR the Netherlands
| | - Faye I. Smits
- grid.468622.c0000 0004 0501 8787GGZ Rivierduinen, Sandifortdreef 19, Leiden, 2333 ZZ the Netherlands
| | - Jan H. Kamphuis
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, Amsterdam, 1018 WS the Netherlands
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Carter JD, Jordan J, McIntosh VV, Frampton CM, Lacey C, Porter RJ, Mulder RT. Long-term efficacy of metacognitive therapy and cognitive behaviour therapy for depression. Aust N Z J Psychiatry 2022; 56:137-143. [PMID: 34250846 DOI: 10.1177/00048674211025686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the two-year outcomes for depression, anxiety, cognitive and global social functioning after cognitive behavioural therapy (CBT) and metacognitive therapy (MCT) for depression. METHOD Participants were 31 adults with a diagnosis of major depressive disorder in a randomised pilot study comparing MCT and CBT. Therapy modality differences in change in depression and anxiety symptoms, dysfunctional attitudes, metacognitions, rumination, worry and global social functioning were examined at the two-year follow-up for those who completed therapy. RESULTS Significant improvements, with large effect sizes, were evident for all outcome variables. There were no significant differences in outcome between CBT and MCT. The greatest change over time occurred for depression and anxiety. Large changes were evident for metacognitions, rumination, dysfunctional attitudes, worry and global social functioning. Sixty-seven percent had not experienced a major depression and had been well during all of the past year, prior to the follow-up assessment. CONCLUSION The finding at end treatment, of no modality specific differences, was also evident at two-year follow-up. Although CBT and MCT targeted depression, improvements were much wider, and although CBT and MCT take different approaches, both therapies produced positive change over time across all cognitive variables. CBT and MCT provide treatment options, that not only improve the longer-term outcome of depression, but also result in improvements in anxiety, global social functioning and cognitive status.
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Affiliation(s)
- Janet D Carter
- School Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Virginia Vw McIntosh
- School Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | | | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Mechanistic pathways of change in twice weekly versus once weekly sessions of psychotherapy for depression. Behav Res Ther 2022; 151:104038. [DOI: 10.1016/j.brat.2022.104038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/18/2021] [Accepted: 01/13/2022] [Indexed: 12/28/2022]
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Lechner-Meichsner F, Mauro C, Skritskaya NA, Shear MK. Change in avoidance and negative grief-related cognitions mediates treatment outcome in older adults with prolonged grief disorder. Psychother Res 2022; 32:91-103. [PMID: 33818302 PMCID: PMC8490492 DOI: 10.1080/10503307.2021.1909769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Objective: The present study investigated the role of the two theoretically derived mediators in the treatment of Prolonged Grief Disorder (PGD). Mediators were changes in avoidance and maladaptive cognitions. An additional hypothesis tested whether these candidate mediators are specific to CBT-based Complicated Grief Treatment (CGT) compared to Interpersonal Therapy (IPT). Method: We performed secondary analyses with assessment completers (n = 131) from a randomized-controlled trial with older adults with PGD. Patients received 16 sessions of CGT or IPT. Outcomes were treatment response and reductions in grief symptoms and grief-related related impairment. Results: Reductions in avoidance between baseline and week 16 mediated reductions in grief symptoms and grief-related impairment. Reductions in maladaptive grief-related cognitions over the same period mediated treatment response, reductions in grief symptoms and grief-related impairment. There were no significant treatment-mediator interactions. We could not establish that mediators changed before the outcomes. Conclusion: Results are consistent with theoretical models of PGD, including the CGT treatment model. Despite different therapeutic procedures, we found no significant interaction effect, but CGT produced larger effects. Future research needs to establish a timeline of change through the use of multiple measurements of mediators and outcomes.Trial registration: ClinicalTrials.gov identifier: NCT01244295.
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Wibbelink CJM, Lee CW, Bachrach N, Dominguez SK, Ehring T, van Es SM, Fassbinder E, Köhne S, Mascini M, Meewisse ML, Menninga S, Morina N, Rameckers SA, Thomaes K, Walton CJ, Wigard IG, Arntz A. The effect of twice-weekly versus once-weekly sessions of either imagery rescripting or eye movement desensitization and reprocessing for adults with PTSD from childhood trauma (IREM-Freq): a study protocol for an international randomized clinical trial. Trials 2021; 22:848. [PMID: 34838102 PMCID: PMC8626728 DOI: 10.1186/s13063-021-05712-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Trauma-focused treatments for posttraumatic stress disorder (PTSD) are commonly delivered either once or twice a week. Initial evidence suggests that session frequency affects treatment response, but very few trials have investigated the effect of session frequency. The present study’s aim is to compare treatment outcomes of twice-weekly versus once-weekly sessions of two treatments for PTSD related to childhood trauma, imagery rescripting (ImRs) and eye movement desensitization and reprocessing (EMDR). We hypothesize that both treatments will be more effective when delivered twice than once a week. How session frequency impacts treatment response, whether treatment type moderates the frequency effect, and which treatment type and frequency works best for whom will also be investigated. Methods The IREM-Freq trial is an international multicenter randomized clinical trial conducted in mental healthcare centers across Australia, Germany, and the Netherlands. We aim to recruit 220 participants, who will be randomized to one of four conditions: (1) EMDR once a week, (2) EMDR twice a week, (3) ImRs once a week, or (4) ImRs twice a week. Treatment consists of 12 sessions. Data are collected at baseline until one-year follow-up. The primary outcome measure is clinician-rated PTSD symptom severity. Secondary outcome measures include self-reported PTSD symptom severity, complex PTSD symptoms, trauma-related cognitions and emotions, depressive symptoms, dissociation, quality of life, and functioning. Process measures include memory, learning, therapeutic alliance, motivation, reluctance, and avoidance. Additional investigations will focus on predictors of treatment outcome and PTSD severity, change mechanisms of EMDR and ImRs, the role of emotions, cognitions, and memory, the optimization of treatment selection, learned helplessness, perspectives of patients and therapists, the network structure of PTSD symptoms, and sudden treatment gains. Discussion This study will extend our knowledge on trauma-focused treatments for PTSD related to childhood trauma and, more specifically, the importance of session frequency. More insight into the optimal session frequency could lead to improved treatment outcomes and less dropout, and in turn, to a reduction of healthcare costs. Moreover, the additional investigations will broaden our understanding of how the treatments work and variables that affect treatment outcome. Trial registration Netherlands Trial Register NL6965, registered 25/04/2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05712-9.
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Affiliation(s)
- Carlijn J M Wibbelink
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands.
| | - Christopher W Lee
- Faculty of Health and Medical Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia
| | - Nathan Bachrach
- GGZ Oost Brabant, RINO Zuid and Tilburg University, Kluisstraat 2, 5427 EM, Boekel, the Netherlands
| | - Sarah K Dominguez
- School of Psychology and Exercise Science, Murdoch University and Sexual Assault Resource Centre, 90 South Street, Murdoch, Western Australia, 6150, Australia
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Leopoldstr. 13, 80802, Munich, Germany
| | - Saskia M van Es
- PsyQ Amsterdam, Parnassia Groep, Overschiestraat 57, 1062 HN, Amsterdam, the Netherlands
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany.,Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Sandra Köhne
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Magda Mascini
- GGZ Noord-Holland-Noord, Stationsplein 138, 1703 WC, Heerhugowaard, the Netherlands
| | - Marie-Louise Meewisse
- Abate, Centre of Expertise in Anxiety and Trauma, Postweg 3, 1601 SX, Enkhuizen, the Netherlands
| | - Simone Menninga
- PsyQ Beverwijk, Parnassia Groep, Leeghwaterweg 1a, 1951 NA, Velsen-Noord, the Netherlands
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Fliednerstr. 21, 48149, Muenster, Germany
| | - Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands
| | - Kathleen Thomaes
- Sinai Center, the Psychotrauma Expertise Center of Arkin and Amsterdam UMC, location VUmc, Department Psychiatry and Department of Anatomy and Neuroscience, Laan van de Helende Meesters 2, 1186 AM, Amstelveen, the Netherlands
| | - Carla J Walton
- Centre for Psychotherapy, Hunter New England Mental Health Service, NSW, Australia, PO Box 833, Newcastle, NSW, 2300, Australia
| | - Ingrid G Wigard
- PsyQ Amsterdam, Parnassia Groep, Overschiestraat 57, 1062 HN, Amsterdam, the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Nieuwe Achtergracht 129-B, 1018 WS, Amsterdam, the Netherlands
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Temporal and specific pathways of change in cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for depression. Behav Res Ther 2021; 151:104010. [DOI: 10.1016/j.brat.2021.104010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/18/2021] [Accepted: 11/22/2021] [Indexed: 12/19/2022]
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Ezawa ID, Plate AJ, Strunk DR. What Do People Really Think of Me? Evaluating Bias in Interpersonal Predictions Over the Course of Cognitive-Behavioral Therapy of Depression. Behav Ther 2021; 52:1286-1295. [PMID: 34452680 DOI: 10.1016/j.beth.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/17/2021] [Accepted: 02/18/2021] [Indexed: 10/22/2022]
Abstract
Cognitive behavioral therapy (CBT) of depression is hypothesized to achieve its effects by correcting negative biases. However, little research has tested how biases change over the course of CBT. We focus on biases in interpersonal judgments and examine whether changes in biases occur in CBT and are associated with symptom improvements. A sample of 126 adults (60% women, mean age 31.7, 83% White) participated in CBT of depression. Observers provided ratings of patients participating in two interpersonal tasks on three occasions. Patients were asked to predict observers' ratings. In a thin slice (TS) task, observers evaluated how patients came across in a brief segment in which patients talked about themselves. In a Standard Interaction Task (SIT), observers rated the social skills patients displayed in challenging role plays. The difference between patient predictions and observer ratings provided measures of bias in these interpersonal judgments. TS and SIT bias became significantly less pessimistic and more realistic over the course of CBT. Improvements in TS bias were associated with a faster reduction in symptoms, whereas there was a non-significant trend for improvement in SIT bias being associated with faster symptom reduction. Consistent with the CBT model, negative interpersonal biases became more realistic throughout a course of CBT for depression and at least some of the changes in bias were related to therapeutic outcomes. We encourage future researchers to continue examining for whom and under which conditions correcting such biases produces the greatest benefits.
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Singla DR, MacKinnon DP, Fuhr DC, Sikander S, Rahman A, Patel V. Multiple mediation analysis of the peer-delivered Thinking Healthy Programme for perinatal depression: findings from two parallel, randomised controlled trials. Br J Psychiatry 2021; 218:143-150. [PMID: 31362799 DOI: 10.1192/bjp.2019.184] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Low-intensity psychosocial interventions have been effective in targeting perinatal depression, but relevant mechanisms of change remain unknown. AIMS To examine three theoretically informed mediators of the Thinking Healthy Programme Peer-delivered (THPP), an evidence-based psychosocial intervention for perinatal depression, on symptom severity in two parallel, randomised controlled trials in Goa, India and Rawalpindi, Pakistan. METHOD Participants included pregnant women aged ≥18 years with moderate to severe depression, as defined by a Patient Health Questionnaire 9 (PHQ-9) score ≥10, and were randomised to either THPP or enhanced usual care. We examine whether three prespecified variables (patient activation, social support and mother-child attachment) at 3 months post-childbirth mediated the effects of THPP interventions of perinatal depressive symptom severity (PHQ-9) at the primary end-point of 6 months post-childbirth. We first examined individual mediation within each trial (n = 280 in India and n = 570 in Pakistan), followed by a pooled analysis across both trials (N = 850). RESULTS In both site-specific and pooled analyses, patient activation and support at 3 months independently mediated the intervention effects on depressive symptom severity at 6 months, accounting for 23.6 and 18.2% of the total effect of THPP, respectively. The intervention had no effect on mother-child attachment scores, thus there was no evidence that this factor mediated the intervention effect. CONCLUSIONS The effects of the psychosocial intervention on depression outcomes in mothers were mediated by the same two factors in both contexts, suggesting that such interventions seeking to alleviate perinatal depression should target both social support and patient activation levels. DECLARATION OF INTEREST None.
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Affiliation(s)
- Daisy R Singla
- Assistant Professor and Clinician Scientist, Department of Psychiatry, Sinai Health System, University of Toronto, Canada
| | | | - Daniela C Fuhr
- Assistant Professor, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Siham Sikander
- Assistant Professor, Health Services Academy, Pakistan; and Human Development Research Foundation, Pakistan
| | - Atif Rahman
- Professor, Institute of Psychology Health and Society, University of Liverpool, UK
| | - Vikram Patel
- Professor, Sangath, India; Department of Global Health and Social Medicine, Harvard Medical School; and Department of Global Health and Population, Harvard TH Chan School of Public Health, Massachusetts, USA
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Baier AL, Kline AC, Feeny NC. Therapeutic alliance as a mediator of change: A systematic review and evaluation of research. Clin Psychol Rev 2020; 82:101921. [DOI: 10.1016/j.cpr.2020.101921] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 08/06/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
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Rohan KJ, Burt KB, Camuso J, Perez J, Meyerhoff J. Applying experimental therapeutics to examine cognitive and chronological vulnerabilities as mediators of acute outcomes in cognitive-behavioral therapy and light therapy for winter depression. J Consult Clin Psychol 2020; 88:786-797. [PMID: 32700956 DOI: 10.1037/ccp0000499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We applied the experimental therapeutics approach to test whether acute treatment outcomes for winter seasonal affective disorder (SAD) are mediated by a cognitive mechanism in cognitive-behavioral therapy (CBT-SAD) versus a chronobiologic mechanism in light therapy (LT). METHOD Currently depressed adults with major depression, recurrent with seasonal pattern (N = 177; 83.6% female, 92.1% non-Hispanic White, M age = 45.6) were randomized to 6 weeks of LT or group CBT-SAD. SAD symptoms were assessed weekly on the Structured Clinical Interview for the Hamilton Rating Scale for Depression-SAD Version. At pre-, mid-, and posttreatment, participants completed measures of general depressogenic cognitions (Dysfunctional Attitudes Scale; DAS); SAD-specific negative cognitions (Seasonal Beliefs Questionnaire; SBQ); chronotype (Morningness-Eveningness Questionnaire; MEQ); and depressive symptoms (Beck Depression Inventory-Second Edition). RESULTS Parallel-process growth models showed evidence for hypothesized mechanisms. For SAD-specific negative cognitions (SBQ), both symptom measures showed (1) an effect of treatment group on the slope of the mediator, with CBT-SAD demonstrating greater decreases, and (2) an effect of the slope of the mediator on the slope of the outcome. These effects held for the SBQ but not the broader measure of depressogenic cognitions (DAS). For the chronotype measure (MEQ), treatment assignment affected change, whereby LT was associated with reduced "eveningness," but this was unrelated to change in symptoms. CONCLUSIONS CBT-SAD promoted decreases in SAD-specific negative cognitions, and these changes were related to decreases in symptoms. Consistent with the theory that LT corrects misaligned circadian rhythms, LT reduced eveningness, but this did not correspond to symptom improvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Abstract
BACKGROUND Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited treatment supported by research spanning >4 decades. IPT focuses on stressful interpersonal experiences of loss, life changes, disputes, and social isolation. It emphasizes the role of relationships in recovery. This scoping review describes, within a historical perspective, IPT's evolution as an evidence-supported treatment of psychiatric disorders. METHODS English-language publications (n = 1119) identified via EMBASE, MEDLINE, PsycINFO, and Web of Science databases (1974-2017), augmented with manual reference searches, were coded for clinical focus, population demographics, format, setting, publication type, and research type. Quantitative and qualitative analyses identified IPT publications' characteristics and trends over four epochs of psychotherapy research. RESULTS IPT literature primarily focused on depression (n = 772 articles; 69%), eating disorders (n = 135; 12%), anxiety disorders (n = 68; 6%), and bipolar disorder (n = 44; 4%), with rising publication rates and numbers of well-conducted randomized, controlled trials over time, justifying inclusion in consensus treatment guidelines. Research trends shifted from efficacy trials to effectiveness studies and population-based dissemination initiatives. Process research examined correlates of improvement and efficacy moderators. Innovations included global initiatives, prevention trials, and digital, web-based training and treatment. CONCLUSION Sparked by clinical innovations and scientific advances, IPT has evolved as an effective treatment of psychiatric disorders across the lifespan for diverse patients, including underserved clinical populations. Future research to elucidate mechanisms of change, improve access, and adapt to changing frameworks of psychopathology and treatment planning is needed. IPT addresses the universal centrality of relationships to mental health, which is as relevant today as it was over 40 years ago.
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Lemmens LHJM, van Bronswijk SC, Peeters FPML, Arntz A, Roefs A, Hollon SD, DeRubeis RJ, Huibers MJH. Interpersonal Psychotherapy Versus Cognitive Therapy for Depression: How They Work, How Long, and for Whom—Key Findings From an RCT. Am J Psychother 2020; 73:8-14. [DOI: 10.1176/appi.psychotherapy.20190030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Lotte H. J. M. Lemmens
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters, Roefs); Department of Clinical Psychology, University of Amsterdam, Amsterdam (Arntz); Department of Psychology, Vanderbilt University, Nashville, Tennessee (Hollon); Department of Psychology, University of Pennsylvania, Philadelphia (DeRubeis, Huibers); Department of Clinical Psychology, VU University Amsterdam, Amsterdam (DeRubeis,
| | - Suzanne C. van Bronswijk
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters, Roefs); Department of Clinical Psychology, University of Amsterdam, Amsterdam (Arntz); Department of Psychology, Vanderbilt University, Nashville, Tennessee (Hollon); Department of Psychology, University of Pennsylvania, Philadelphia (DeRubeis, Huibers); Department of Clinical Psychology, VU University Amsterdam, Amsterdam (DeRubeis,
| | - Frenk P. M. L. Peeters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters, Roefs); Department of Clinical Psychology, University of Amsterdam, Amsterdam (Arntz); Department of Psychology, Vanderbilt University, Nashville, Tennessee (Hollon); Department of Psychology, University of Pennsylvania, Philadelphia (DeRubeis, Huibers); Department of Clinical Psychology, VU University Amsterdam, Amsterdam (DeRubeis,
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters, Roefs); Department of Clinical Psychology, University of Amsterdam, Amsterdam (Arntz); Department of Psychology, Vanderbilt University, Nashville, Tennessee (Hollon); Department of Psychology, University of Pennsylvania, Philadelphia (DeRubeis, Huibers); Department of Clinical Psychology, VU University Amsterdam, Amsterdam (DeRubeis,
| | - Anne Roefs
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters, Roefs); Department of Clinical Psychology, University of Amsterdam, Amsterdam (Arntz); Department of Psychology, Vanderbilt University, Nashville, Tennessee (Hollon); Department of Psychology, University of Pennsylvania, Philadelphia (DeRubeis, Huibers); Department of Clinical Psychology, VU University Amsterdam, Amsterdam (DeRubeis,
| | - Steven D. Hollon
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters, Roefs); Department of Clinical Psychology, University of Amsterdam, Amsterdam (Arntz); Department of Psychology, Vanderbilt University, Nashville, Tennessee (Hollon); Department of Psychology, University of Pennsylvania, Philadelphia (DeRubeis, Huibers); Department of Clinical Psychology, VU University Amsterdam, Amsterdam (DeRubeis,
| | - Robert J. DeRubeis
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters, Roefs); Department of Clinical Psychology, University of Amsterdam, Amsterdam (Arntz); Department of Psychology, Vanderbilt University, Nashville, Tennessee (Hollon); Department of Psychology, University of Pennsylvania, Philadelphia (DeRubeis, Huibers); Department of Clinical Psychology, VU University Amsterdam, Amsterdam (DeRubeis,
| | - Marcus J. H. Huibers
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters, Roefs); Department of Clinical Psychology, University of Amsterdam, Amsterdam (Arntz); Department of Psychology, Vanderbilt University, Nashville, Tennessee (Hollon); Department of Psychology, University of Pennsylvania, Philadelphia (DeRubeis, Huibers); Department of Clinical Psychology, VU University Amsterdam, Amsterdam (DeRubeis,
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Bruijniks SJE, Sijbrandij M, Huibers MJH. The effects of retrieval versus rehearsal of online problem-solving therapy sessions on recall, problem-solving skills and distress in distressed individuals: An experimental study. J Behav Ther Exp Psychiatry 2020; 66:101485. [PMID: 31491535 DOI: 10.1016/j.jbtep.2019.101485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/29/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Improving memory for the content of therapy sessions might increase the effects of psychological interventions. Previous studies showed that healthy individuals who took a memory test (retrieval) of studied material showed better long-term memory retention than individuals who restudied (rehearsal) the material. The aim of the current study was to find out whether we can translate these findings to a subclinical setting. METHODS Individuals with moderate levels of distress were randomized into retrieving (n = 46) or rehearsing (n = 49) four weekly sessions of online Problem-Solving Therapy (PST). Session recall, problem-solving skills and distress were measured at baseline, three days after each session and at one-week follow-up. RESULTS Retrieval led to overall higher recall, but this difference disappeared when controlling for the time spent on retrieval versus rehearsal. Retrieval did not lead to better problem-solving skills or less distress, compared to rehearsal. Baseline working memory performance moderated the effect of condition on recall after controlling for the time spent on retrieval versus rehearsal: the effect of retrieval compared to rehearsal on recall was larger for individuals with lower working memory performance. LIMITATIONS The sample mostly consisted of university students with overall high working memory scores. CONCLUSIONS This study provided the first evidence that retrieval of the content of PST sessions may lead to better session recall compared to rehearsal of the PST sessions in individuals with a low working memory score. Implications for the use of cognitive support strategies within a therapeutic setting are discussed.
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Affiliation(s)
- Sanne J E Bruijniks
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
| | - Marit Sijbrandij
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Marcus J H Huibers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands; Department of Psychology, University of Pennsylvania, Philadelphia, United States
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Felton JW, Hailemariam M, Richie F, Reddy MK, Edukere S, Zlotnick C, Johnson JE. Preliminary efficacy and mediators of interpersonal psychotherapy for reducing posttraumatic stress symptoms in an incarcerated population. Psychother Res 2020; 30:239-250. [PMID: 30857489 PMCID: PMC6739190 DOI: 10.1080/10503307.2019.1587192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/31/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022] Open
Abstract
AbstractObjective: Incarcerated individuals have high rates of trauma exposure. IPT reduces posttraumatic stress disorder (PTSD) symptoms in non-incarcerated adults, but has not been examined in prison populations. Moreover, little is known about the mechanisms through which IPT reduces PTSD symptoms. The current study investigated the direct and indirect effects of IPT on PTSD symptoms. We hypothesized that IPT would decrease PTSD symptoms by enhancing social support and decreasing loneliness (theorized IPT mechanisms). Method: A sub-sample of trauma-exposed participants (n = 168) were drawn from a larger randomized trial (n = 181) of IPT for major depressive disorder among prisoners. We examined a series of mediation models using non-parametric bootstrapping procedures to evaluate the indirect effect of IPT on PTSD symptoms. Results: Contrary to hypotheses, the relation between IPT and PTSD symptoms was significantly mediated through improvements in hopelessness and depressive symptoms (mechanisms of cognitive behavioral interventions), rather than through social support and loneliness. Increased social support and decreased loneliness were associated with decreased PTSD symptoms, but IPT did not predict changes in social support or loneliness. Conclusions: IPT may reduce PTSD symptoms in depressed prisoners by reducing hopelessness and depression. (ClinicalTrials.gov number NCT01685294).
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Affiliation(s)
- Julia W Felton
- Division of Public Health, Michigan State University, Flint, MI, USA
| | - Maji Hailemariam
- Division of Public Health, Michigan State University, Flint, MI, USA
| | - Fallon Richie
- Division of Public Health, Michigan State University, Flint, MI, USA
| | - Madhavi K Reddy
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Sophia Edukere
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Caron Zlotnick
- Department of Psychiatry, Butler Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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30
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Moreno-Peral P, Bellón JÁ, Huibers MJH, Mestre JM, García-López LJ, Taubner S, Rodríguez-Morejón A, Bolinski F, Sales CMD, Conejo-Cerón S. Mediators in psychological and psychoeducational interventions for the prevention of depression and anxiety. A systematic review. Clin Psychol Rev 2020; 76:101813. [PMID: 32045780 DOI: 10.1016/j.cpr.2020.101813] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/15/2019] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
Although efforts have been undertaken to determine how psychological interventions exert their effects, research on mediators and mechanisms of change remains limited, especially in the field of prevention. We aimed to assess available evidence on mediators of psychological and psychoeducational interventions for the prevention of depression and anxiety in varied populations. A systematic review using PubMed, PsycINFO, Web of Science, Embase, OpenGrey, and the Cochrane Central Register of Controlled Trials was performed. Two independent reviewers assessed the eligibility criteria of all articles, extracted data, determined the risk of bias in randomized controlled trials, and the requirements for mediators. The outcomes were mediators of the incidence of depression or anxiety and/or the reduction of symptoms of depression or anxiety. We identified 28 nested mediator studies within randomized controlled trials involving 7442 participants. Potential cognitive, behavioral, emotional and interpersonal mediators were evaluated in different psychological and psychoeducational interventions to prevent depression and anxiety. The effects were mediated mainly by cognitive variables, which were the most commonly assessed factors. For depression, the mediator with the strongest empirical support was negative thinking in adults. Cognitive change is an important mediator in preventive psychological and psychoeducational interventions for both anxiety and depression. REGISTRATION DETAILS: Registration number (PROSPERO): CRD42018092393.
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Affiliation(s)
- Patricia Moreno-Peral
- Biomedical Research Institute of Malaga (IBIMA), C/ Sevilla 23, 29009 Málaga, Spain; Prevention and Health Promotion Research Network (redIAPP), ISCIII, Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain.
| | - Juan Ángel Bellón
- Biomedical Research Institute of Malaga (IBIMA), C/ Sevilla 23, 29009 Málaga, Spain; Prevention and Health Promotion Research Network (redIAPP), ISCIII, Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain; 'El Palo' Health Centre, Health District of Primary Care Málaga-Guadalhorce, SAS, Av. Salvador Allende, 159,29018 Málaga, Spain; Department of Public Health and Psychiatry, University of Málaga, Bulevar Louis Pasteur, 32, 29010 Málaga, Spain
| | - Marcus J H Huibers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, VU Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - José M Mestre
- Instituto de Desarrollo Social y Sostenible (INDESS), Universidad de Cádiz, Avda. Universidad 4, 11405 Jerez de la Frontera, Cádiz, Spain
| | - Luís Joaquín García-López
- Department of Personality, Evaluation, and Psychological Treatment, Universidad de Jaén, Campus de las Lagunillas s/n, 23071 Jaén, Spain
| | - Svenja Taubner
- Institute for Psychosocial Prevention, University Hospital Heidelberg, University Heidelberg, Bergheimerstr. 54, 69115 Heidelberg, Germany
| | - Alberto Rodríguez-Morejón
- Department of Personality, Evaluation, and Psychological Treatment, Universidad de Málaga, Campus de Teatinos s/n, 29071 Málaga, Spain
| | - Felix Bolinski
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, VU Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Célia M D Sales
- Faculty of Psychology and Education Science at the University of Porto (FPCEUP), Center for Psychology at the University of Porto (CPUP), University of Porto, R. Alfredo Allen, 4200-135 Porto, Portugal
| | - Sonia Conejo-Cerón
- Biomedical Research Institute of Malaga (IBIMA), C/ Sevilla 23, 29009 Málaga, Spain; Prevention and Health Promotion Research Network (redIAPP), ISCIII, Gran Via de les Corts Catalanes, 587, 08007 Barcelona, Spain
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31
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Singla DR, Hollon SD, Velleman R, Weobong B, Nadkarni A, Fairburn CG, Bhat B, Gurav M, Anand A, McCambridge J, Dimidjian S, Patel V. Temporal pathways of change in two randomized controlled trials for depression and harmful drinking in Goa, India. Psychol Med 2020; 50:68-76. [PMID: 30616698 PMCID: PMC6945322 DOI: 10.1017/s0033291718003963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/24/2018] [Accepted: 12/04/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND The current study explored the temporal pathways of change within two treatments, the Healthy Activity Program (HAP) for depression and the Counselling for Alcohol Problems (CAP) Program for harmful drinking. METHODS The study took place in the context of two parallel randomized controlled trials in Goa, India. N = 50 random participants who met a priori criteria were selected from each treatment trial and examined for potential direct and mediational pathways. In HAP, we examined the predictive roles of therapy quality and patient-reported activation, assessing whether activation mediated the effects of therapy quality on depression (Patient Health Questionnaire-9) outcomes. In CAP, we examined the predictive roles of therapy quality and patient change- and counter-change-talk, assessing whether change- or counter-change-talk mediated the effects of therapy quality on daily alcohol consumption. RESULTS In HAP, therapy quality (both general and treatment-specific skills) was associated with patient activation; patient activation but not therapy quality significantly predicted depression outcomes, and patient activation mediated the effects of higher general skills on subsequent clinical outcomes [a × b = -2.555, 95% confidence interval (CI) -5.811 to -0.142]. In CAP, higher treatment-specific skills, but not general skills, were directly associated with drinking outcomes, and reduced levels of counter-change talk both independently predicted, and mediated the effects of higher general skills on, reduced alcohol consumption (a × b = -24.515, 95% CI -41.190 to -11.060). Change talk did not predict alcohol consumption and was not correlated with counter-change talk. CONCLUSION These findings suggest that therapy quality in early sessions operated through increased patient activation and reduced counter-change talk to reduce depression and harmful drinking respectively.
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Affiliation(s)
- Daisy R. Singla
- Department of Psychiatry, University of Toronto and Sinai Health System, Toronto, Canada
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - Richard Velleman
- Department of Psychology, University of Bath, Bath, UK
- Sangath, Alto Porvorim, Goa, India
| | - Benedict Weobong
- Sangath, Alto Porvorim, Goa, India
- Centre for Global Mental Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Social & Behavioral Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Abhijit Nadkarni
- Sangath, Alto Porvorim, Goa, India
- Centre for Global Mental Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - Sona Dimidjian
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Vikram Patel
- Sangath, Alto Porvorim, Goa, India
- Department of Global Health & Social Medicine, Harvard Medical School, Cambridge, USA
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
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Niedermoser DW, Kalak N, Kiyhankhadiv A, Brand S, Walter C, Schweinfurth N, Lang UE. Workplace-Related Interpersonal Group Psychotherapy to Improve Life at Work in Individuals With Major Depressive Disorders: A Randomized Interventional Pilot Study. Front Psychiatry 2020; 11:168. [PMID: 32256402 PMCID: PMC7090238 DOI: 10.3389/fpsyt.2020.00168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/21/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Individuals suffering from major depressive disorder (MDD) often report workplace-related stress as the major cause of their disorder. Accordingly, workplace-related stress was established as a fifth psychosocial problem area of Interpersonal Psychotherapy (workplace-related Interpersonal Psychotherapy, W-IPT). The aim of the study was to investigate the influence of W-IPT on depressive symptoms and on workplace-related issues in individuals with MDD compared to a treatment-as-usual (TAU) condition. METHODS A total of 27 individuals with MDD (mean age = 43 years, 48% males) were randomly assigned either to eight weekly group sessions of W-IPT or to the TAU condition. At baseline, 8 weeks later at the end of the intervention, and 20 weeks later at follow-up, the Hamilton Rating Scale for Depression was conducted. In addition, the participants completed the Beck Depression Inventory, the Work Ability Index (WAI), the Return to Work Attitude (RTW-SE), and the Insomnia Severity Index (ISI). RESULTS Symptoms of depression in experts' ratings as well as in self-rated ratings decreased over time, but more so in the W-IPT condition compared to the TAU condition [experts rating: large effect size (d = 1.25) and self-assessment: large effect sizes (d = 0.94)]. The subjective ability to work (WAI) [medium effect size (d = 0.68)], self-efficacy to returning to work RTW-SE [medium effect size (d = 0.57)], and subjective symptoms of insomnia (ISI) [large effect size (d = 1.15)] increased over time, but again more so in the W-IPT condition compared to the TAU condition. The effects of the intervention remained stable from the end of the intervention to follow-up. CONCLUSIONS The pattern of results of this pilot study suggests that a newly established fifth IPT focus on workplace-related stress appeared to be particularly efficient in individuals with MDD due to work-related stress in reducing depressive symptoms and reducing sleep complaints as well as in improving occupational outcomes.
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Affiliation(s)
- Daryl Wayne Niedermoser
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland.,Departement of Business, Kalaidos University of Applied Sciences, Zurich, Switzerland
| | - Nadeem Kalak
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Anna Kiyhankhadiv
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Serge Brand
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland.,Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.,School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Corinna Walter
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Nina Schweinfurth
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Undine E Lang
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
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Huibers MJH, Lorenzo-Luaces L, Cuijpers P, Kazantzis N. On the Road to Personalized Psychotherapy: A Research Agenda Based on Cognitive Behavior Therapy for Depression. Front Psychiatry 2020; 11:607508. [PMID: 33488428 PMCID: PMC7819891 DOI: 10.3389/fpsyt.2020.607508] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/09/2020] [Indexed: 12/12/2022] Open
Abstract
In this conceptual paper, we outline the many challenges on the road to personalized psychotherapy, using the example of cognitive behavior therapy (CBT) for depression. To optimize psychotherapy for the individual patient, we need to find out how therapy works (identification of mechanisms of change) and for whom it works (identification of moderators). To date, psychotherapy research has not resulted in compelling evidence for or against common or specific factors that have been proposed as mechanisms of change. Our central proposition is that we need to combine the "how does it work?"-question with the "for whom does it work?"-question in order to advance the field. We introduce the personalized causal pathway hypothesis that emphasizes the links and distinction between individual patient differences, therapeutic procedures and therapy processes as a paradigm to facilitate und understand the concept of personalized psychotherapy. We review the mechanism of change literature for CBT for depression to see what we have learned so far, and describe preliminary observational evidence supporting the personalized causal pathway hypothesis. We then propose a research agenda to push the ball forward: exploratory studies into the links between individual differences, therapeutic procedures, therapy processes and outcome that constitute a potential causal pathway, making use of experience sampling, network theory, observer ratings of therapy sessions, and moderated mediation analysis; testing and isolation of CBT procedures in experiments; and testing identified causal pathways of change as part of a personalized CBT package against regular CBT, in order to advance the application of personalized psychotherapy.
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Affiliation(s)
- Marcus J H Huibers
- Department of Clinical Psychology, Vrije Universiteit Amsterdan (VU), University Amsterdam, Amsterdam, Netherlands.,Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Lorenzo Lorenzo-Luaces
- Psychological and Brain Sciences, Indiana University-Bloomington, Bloomington, IN, United States
| | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit Amsterdan (VU), University Amsterdam, Amsterdam, Netherlands
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34
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Markowitz JC, Milrod B, Luyten P, Holmqvist R. Mentalizing in Interpersonal Psychotherapy. Am J Psychother 2019; 72:95-100. [DOI: 10.1176/appi.psychotherapy.20190021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- John C. Markowitz
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Markowitz); Department of Psychiatry, Weill Medical College, Cornell University, New York (Milrod); Department of Psychology and Educational Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Luyten); Department of Brain Sciences, University College London, London (Luyten); Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden (Holmqvist)
| | - Barbara Milrod
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Markowitz); Department of Psychiatry, Weill Medical College, Cornell University, New York (Milrod); Department of Psychology and Educational Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Luyten); Department of Brain Sciences, University College London, London (Luyten); Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden (Holmqvist)
| | - Patrick Luyten
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Markowitz); Department of Psychiatry, Weill Medical College, Cornell University, New York (Milrod); Department of Psychology and Educational Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Luyten); Department of Brain Sciences, University College London, London (Luyten); Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden (Holmqvist)
| | - Rolf Holmqvist
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Markowitz); Department of Psychiatry, Weill Medical College, Cornell University, New York (Milrod); Department of Psychology and Educational Sciences, Katholieke Universiteit Leuven, Leuven, Belgium (Luyten); Department of Brain Sciences, University College London, London (Luyten); Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden (Holmqvist)
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35
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Stone SJ, Strunk DR. Fostering Cognitive Change in Cognitive Therapy of Depression: An Investigation of Therapeutic Strategies. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10055-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Hofheinz C, Reder M, Michalak J. How specific is cognitive change? A randomized controlled trial comparing brief cognitive and mindfulness interventions for depression. Psychother Res 2019; 30:675-691. [DOI: 10.1080/10503307.2019.1685138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
| | - Maren Reder
- Institute of Psychology, University of Hildesheim, Hildesheim, Germany
| | - Johannes Michalak
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, German
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37
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Quigley L, Dozois DJA, Bagby RM, Lobo DSS, Ravindran L, Quilty LC. Cognitive change in cognitive-behavioural therapy v. pharmacotherapy for adult depression: a longitudinal mediation analysis. Psychol Med 2019; 49:2626-2634. [PMID: 30560738 DOI: 10.1017/s0033291718003653] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although cognitive-behavioural therapy (CBT) is a well-established treatment for adult depression, its efficacy and efficiency may be enhanced by better understanding its mechanism(s) of action. According to the theoretical model of CBT, symptom improvement occurs via reductions in maladaptive cognition. However, previous research has not established clear evidence for this cognitive mediation model. METHODS The present study investigated the cognitive mediation model of CBT in the context of a randomized controlled trial of CBT v. antidepressant medication (ADM) for adult depression. Participants with major depressive disorder were randomized to receive 16 weeks of CBT (n = 54) or ADM (n = 50). Depression symptoms and three candidate cognitive mediators (dysfunctional attitudes, cognitive distortions and negative automatic thoughts) were assessed at week 0 (pre-treatment), week 4, week 8 and week 16 (post-treatment). Longitudinal associations between cognition and depression symptoms, and mediation of treatment outcome, were evaluated in structural equation models. RESULTS Both CBT and ADM produced significant reductions in maladaptive cognition and depression symptoms. Cognitive content and depression symptoms were moderately correlated within measurement waves, but cross-lagged associations between the variables and indirect (i.e. mediated) treatment effects were non-significant. CONCLUSIONS The results provide support for concurrent relationships between cognitive and symptom change, but not the longitudinal relationships hypothesized by the cognitive mediation model. Results may be indicative of an incongruence between the timing of measurement and the dynamics of cognitive and symptom change.
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Affiliation(s)
- Leanne Quigley
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, USA
| | | | - R Michael Bagby
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Daniela S S Lobo
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Lakshmi Ravindran
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Lena C Quilty
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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38
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Bruijniks SJE, Peeters FPML, Strunk DR, Huibers MJH. Measuring Patients' Acquisition of Therapy Skills in Psychotherapy for Depression: Assessing the CCTS-SR and the IPSS-SR. Am J Psychother 2019; 72:67-74. [PMID: 31533456 DOI: 10.1176/appi.psychotherapy.20180028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Using data from 202 patients with depression, the authors conducted a psychometric evaluation of the Dutch translation of the Competencies of Cognitive Therapy Scale-Self-Report and an initial psychometric evaluation of the newly developed Interpersonal Psychotherapy Skills Scale-Self-Report.
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Affiliation(s)
- Sanne J E Bruijniks
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam (Bruijniks, Huibers); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers); Department of Psychiatry and Psychology, University Hospital Maastricht, and School for Mental Health and Neuroscience, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands (Peeters); Department of Psychology, Ohio State University, Columbus (Strunk)
| | - Frenk P M L Peeters
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam (Bruijniks, Huibers); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers); Department of Psychiatry and Psychology, University Hospital Maastricht, and School for Mental Health and Neuroscience, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands (Peeters); Department of Psychology, Ohio State University, Columbus (Strunk)
| | - Daniel R Strunk
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam (Bruijniks, Huibers); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers); Department of Psychiatry and Psychology, University Hospital Maastricht, and School for Mental Health and Neuroscience, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands (Peeters); Department of Psychology, Ohio State University, Columbus (Strunk)
| | - Marcus J H Huibers
- Department of Clinical Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam (Bruijniks, Huibers); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers); Department of Psychiatry and Psychology, University Hospital Maastricht, and School for Mental Health and Neuroscience, Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, the Netherlands (Peeters); Department of Psychology, Ohio State University, Columbus (Strunk)
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van Bentum JS, Sijbrandij M, Kerkhof AJFM, Huisman A, Arntz AR, Holmes EA, Franx G, Mokkenstorm J, Huibers MJH. Treating repetitive suicidal intrusions using eye movements: study protocol for a multicenter randomized clinical trial. BMC Psychiatry 2019; 19:143. [PMID: 31072317 PMCID: PMC6507069 DOI: 10.1186/s12888-019-2129-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a major public health problem, and it remains unclear which processes link suicidal ideation and plans to the act of suicide. Growing evidence shows that the majority of suicidal patients diagnosed with major depression or bipolar disorder report repetitive suicide-related images and thoughts (suicidal intrusions). Various studies showed that vividness of negative as well as positive intrusive images may be reduced by dual task (e.g. eye movements) interventions taxing the working memory. We propose that a dual task intervention may also reduce frequency and intensity of suicidal imagery and may be crucial in preventing the transition from suicidal ideation and planning to actual suicidal behaviour. This study aims a) to evaluate the effectiveness of an Eye Movement Dual Task (EMDT) add-on intervention targeting suicidal imagery in depressed patients, b) to explore the role of potential moderators and mediators in explaining the effect of EMDT, and c) to evaluate the cost-effectiveness of EMDT. METHODS We will conduct a multi-center randomized clinical trial (RCT) evaluating the effects of EMDT in combination with usual care (n = 45) compared to usual care alone (n = 45). Participants will fill in multiple online batteries of self-report questionnaires as well as complete a semi-structured interview (Intrusion Interview), and online computer tasks. The primary outcome is the frequency and intrusiveness of suicidal imagery. Furthermore, the vividness, emotionality, and content of the suicidal intrusions are evaluated; secondary outcomes include: suicidal behaviour and suicidal ideation, severity of depression, psychological symptoms, rumination, and hopelessness. Finally, potential moderators and mediators are assessed. DISCUSSION If proven effective, EMDT can be added to regular treatment to reduce the frequency and vividness of suicidal imagery. TRIAL REGISTRATION The study has been registered on October 17th, 2018 at the Netherlands Trial Register, part of the Dutch Cochrane Centre ( NTR7563 ).
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Affiliation(s)
- J. S. van Bentum
- 0000 0004 1754 9227grid.12380.38Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - M. Sijbrandij
- 0000 0004 1754 9227grid.12380.38Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - A. J. F. M. Kerkhof
- 0000 0004 1754 9227grid.12380.38Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - A. Huisman
- 0000 0004 1754 9227grid.12380.38Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - A. R. Arntz
- 0000000084992262grid.7177.6Department of Clinical Psychology, Universiteit van Amsterdam, Nieuwe Achtergracht 129, 1018 WS Amsterdam, The Netherlands
| | - E. A. Holmes
- 0000 0004 1936 9457grid.8993.bDepartment of Psychology, University of Uppsala, Campus Blåsenhus, Von Kraemers allé 1A och 1C, Uppsala, Sweden
| | - G. Franx
- Department of Implementation, 113 Suicide Prevention, Paasheuvelweg 25, 1105 BP Amsterdam, The Netherlands
| | - J. Mokkenstorm
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, Amsterdam Public Health Research Institute, Vrije Universiteit Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands ,Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, Netherlands ,Department of Research, 113 Suicide Prevention, Paasheuvelweg 25, 1105 BP Amsterdam, The Netherlands
| | - M. J. H. Huibers
- 0000 0004 1754 9227grid.12380.38Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands ,0000 0004 1936 8972grid.25879.31Department Psychology, University of Pennsylvania, Stephan A. Levin Building, 425 S. University Ave, Philadelphia, PA 19104-6018 USA
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Lemmens LHJM, van Bronswijk SC, Peeters F, Arntz A, Hollon SD, Huibers MJH. Long-term outcomes of acute treatment with cognitive therapy v. interpersonal psychotherapy for adult depression: follow-up of a randomized controlled trial. Psychol Med 2019; 49:465-473. [PMID: 29792234 DOI: 10.1017/s0033291718001083] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although equally efficacious in the acute phase, it is not known how cognitive therapy (CT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD) compare in the long run. This study examined the long-term outcomes of CT v. IPT for MDD. METHODS One hundred thirty-four adult (18-65) depressed outpatients who were treated with CT (n = 69) or IPT (n = 65) in a large open-label randomized controlled trial (parallel group design; computer-generated block randomization) were monitored across a 17-month follow-up phase. Mixed regression was used to determine the course of self-reported depressive symptom severity (Beck Depression Inventory II; BDI-II) after treatment termination, and to test whether CT and IPT differed throughout the follow-up phase. Analyses were conducted for the total sample (n = 134) and for the subsample of treatment responders (n = 85). Furthermore, for treatment responders, rates of relapse and sustained response were examined for self-reported (BDI-II) and clinician-rated (Longitudinal Interval Follow-up Evaluation; LIFE) depression using Cox regression. RESULTS On average, the symptom reduction achieved during the 7-month treatment phase was maintained across follow-up (7-24 months) for CT and IPT, both in the total sample and in the responder sample. Two-thirds (67%) of the treatment responders did not relapse across the follow-up period on the BDI-II. Relapse rates assessed with the LIFE were somewhat lower. No differential effects between conditions were found. CONCLUSIONS Patients who responded to IPT were no more likely to relapse following treatment termination than patients who responded to CT. Given that CT appears to have a prophylactic effect following successful treatment, our findings suggest that IPT might have a prophylactic effect as well.
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Affiliation(s)
- Lotte H J M Lemmens
- Department of Clinical Psychological Science,Faculty of Psychology and Neuroscience,Maastricht University,P.O. Box 616, 6200 MD Maastricht,The Netherlands
| | - Suzanne C van Bronswijk
- Department of Psychiatry and Psychology, Faculty of Health, Medicine and Life Sciences,Maastricht University,P.O. Box 616, 6200 MD, Maastricht,The Netherlands
| | - Frenk Peeters
- Department of Psychiatry and Psychology, Faculty of Health, Medicine and Life Sciences,Maastricht University,P.O. Box 616, 6200 MD, Maastricht,The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology,University of Amsterdam,PO Box 19268, 1000 GG Amsterdam,The Netherlands
| | - Steven D Hollon
- Department of Psychology,Vanderbilt University,306 Wilson Hall, Nashville, Tennessee,USA
| | - Marcus J H Huibers
- Department of Clinical Psychology,VU University Amsterdam,Van der Boechorststraat 1, 1081 BT Amsterdam,The Netherlands
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Cristea IA, Ioannidis JPA. Disclosures Can Always Be Improved-Reply. JAMA Psychiatry 2018; 75:1303-1304. [PMID: 30285040 DOI: 10.1001/jamapsychiatry.2018.2785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ioana-Alina Cristea
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California.,Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, Cluj-Napoca, Romania
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California.,Department of Medicine, Stanford University School of Medicine, Stanford, California
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Strand ER, Hagen R, Hjemdal O, Kennair LEO, Solem S. Metacognitive Therapy for Depression Reduces Interpersonal Problems: Results From a Randomized Controlled Trial. Front Psychol 2018; 9:1415. [PMID: 30131749 PMCID: PMC6090231 DOI: 10.3389/fpsyg.2018.01415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/20/2018] [Indexed: 11/13/2022] Open
Abstract
Interpersonal problems are significantly elevated in patients with depression. Metacognitive therapy (MCT) for depression does not address interpersonal problems but is associated with large reduction in depressive symptoms. The main aim of the current study was to explore whether MCT leads to improvements in interpersonal problems in patients with depression. The study was a waitlist controlled trial and assessments took place at pre- and post-treatment as well as 6-month follow-up. At pre-treatment, the sample had more interpersonal problems compared to samples from other studies of psychiatric outpatients. MCT was associated with large reductions in interpersonal problems. Level of interpersonal problems were not related to poorer treatment response. MCT, which does not directly target interpersonal problems, worked well for patients with depression and interpersonal problems. Future research should compare MCT with other evidence-based treatments for patients with depression and interpersonal problems.
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Affiliation(s)
- Eivind R Strand
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roger Hagen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Leif E O Kennair
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Bruijniks SJE, Franx G, Huibers MJH. The implementation and adherence to evidence-based protocols for psychotherapy for depression: the perspective of therapists in Dutch specialized mental healthcare. BMC Psychiatry 2018; 18:190. [PMID: 29898692 PMCID: PMC6000963 DOI: 10.1186/s12888-018-1768-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/25/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Although psychotherapy is an effective treatment for depression, a large number of patients still do not receive care according to the protocols that are used in clinical trials. Instead, patients often receive a modified version of the original intervention. It is not clear how and when treatment protocols are used or modified in the Dutch specialized mental health care and whether these changes lead to suboptimal adherence to treatment protocols. METHODS In the context of an ongoing multicenter trial that investigates whether twice-weekly sessions of protocolized interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) for depression lead to better treatment outcomes compared to once-weekly sessions, two focus groups using semi-structured interviews were organized. Aims were to increase insight in the adherence to and modifications of CBT and IPT protocols in the Dutch specialized mental health care for depression. Participants were fifteen therapists from seven mental health locations part of five mental health organizations. Verbatim transcripts were coded and analyzed using qualitative software. RESULTS Three themes emerged: modification as the common practice, professional and patient factors influencing the adherence to protocols and organizational boundaries and flexibility. Treatment modification appeared to happen on a frequent basis, even in the context of a trial. Definitions of treatment modifications were multiple and varied from using intuition to flexible use of the same protocol. Therapist training and supervision, the years of work experience and individual characteristics of the therapist and the patient were mentioned to influence the adherence to protocols. Modifications of the therapists depended very much on the culture within the mental health locations, who differed in terms of the flexibility offered to therapists to choose and modify treatment protocols. CONCLUSIONS Not all treatment modifications were in line with existing evidence or guidelines. Regular supervision, team meetings and a shared vision were identified as crucial factors to increase adherence to treatment protocols, whereas additional organizational factors, among which a change of mindset, may facilitate adequate implementation.
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Affiliation(s)
- Sanne J. E. Bruijniks
- 0000 0004 1754 9227grid.12380.38Department of Clinical Psychology, VU Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands
| | | | - Marcus J. H. Huibers
- 0000 0004 1754 9227grid.12380.38Department of Clinical Psychology, VU Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, the Netherlands ,0000 0004 1936 8972grid.25879.31Department of Psychology, University of Pennsylvania, Philadelphia, USA
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Haukaas RB, Gjerde IB, Varting G, Hallan HE, Solem S. A Randomized Controlled Trial Comparing the Attention Training Technique and Mindful Self-Compassion for Students With Symptoms of Depression and Anxiety. Front Psychol 2018; 9:827. [PMID: 29887823 PMCID: PMC5982936 DOI: 10.3389/fpsyg.2018.00827] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/07/2018] [Indexed: 11/13/2022] Open
Abstract
The Attention Training Technique (ATT) and Mindful Self-Compassion (MSC) are two promising psychological interventions. ATT is a 12-min auditory exercise designed to strengthen attentional control and promote external focus of attention, while MSC uses guided meditation and exercises designed to promote self-compassion. In this randomized controlled trial (RCT), a three-session intervention trial was conducted in which university students were randomly assigned to either an ATT-group (n = 40) or a MSC-group (n = 41). The students were not assessed with diagnostic interviews but had self-reported symptoms of depression, anxiety, or stress. Participants listened to audiotapes of ATT or MSC before discussing in groups how to apply these principles for their everyday struggles. Participants also listened to audiotapes of ATT and MSC as homework between sessions. Participants in both groups showed significant reductions in symptoms of anxiety and depression accompanied by significant increases in mindfulness, self-compassion, and attention flexibility post-intervention. These results were maintained at 6-month follow-up. Improvement in attention flexibility was the only significant unique predictor of treatment response. The study supports the use of both ATT and MSC for students with symptoms of depression and anxiety. Further, it suggests that symptom improvement is related to changes in attention flexibility across both theoretical frameworks. Future studies should focus on how to strengthen the ability for attention flexibility to optimize treatment for emotional disorder.
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Affiliation(s)
- Ragni B Haukaas
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingrid B Gjerde
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Grunde Varting
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard E Hallan
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Renner F, DeRubeis R, Arntz A, Peeters F, Lobbestael J, Huibers MJH. Exploring mechanisms of change in schema therapy for chronic depression. J Behav Ther Exp Psychiatry 2018; 58:97-105. [PMID: 29035800 DOI: 10.1016/j.jbtep.2017.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/13/2017] [Accepted: 10/03/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The underlying mechanisms of symptom change in schema therapy (ST) for chronic major depressive disorder (cMDD) have not been studied. The aim of this study was to explore the impact of two potentially important mechanisms of symptom change, maladaptive schemas (proxied by negative idiosyncratic core-beliefs) and the therapeutic alliance. METHODS We drew data from a single-case series of ST for cMDD. Patients with cMDD (N = 20) received on average 78 repeated weekly assessments over a course of up to 65 individual sessions of ST. Focusing on repeated assessments within-individuals, we used mixed regression to test whether change in core-beliefs and therapeutic alliance preceded, followed, or occurred concurrently with change in depressive symptoms. RESULTS Changes in core-beliefs did not precede but were concurrently related to changes in symptoms. Repeated goal and task agreement ratings (specific aspects of alliance) of the same session, completed on separate days, were at least in part associated with concurrent changes in symptoms. LIMITATIONS By design this study had a small sample-size and no control group. CONCLUSIONS Contrary to what would be expected based on theory, our findings suggest that change in core-beliefs does not precede change in symptoms. Instead, change in these variables occurs concurrently. Moreover, alliance ratings seem to be at least in part colored by changes in current mood state.
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Affiliation(s)
- Fritz Renner
- MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom; Department of Clinical Psychological Science, Maastricht University, The Netherlands.
| | - Robert DeRubeis
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, The Netherlands
| | - Frenk Peeters
- Department of Psychiatry and Neuropsychology, University Hospital Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, The Netherlands
| | - Jill Lobbestael
- Department of Clinical Psychological Science, Maastricht University, The Netherlands
| | - Marcus J H Huibers
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States; Department of Clinical Psychology, VU University Amsterdam, The Netherlands
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Bruijniks SJE, Bosmans J, Peeters FPML, Hollon SD, van Oppen P, van den Boogaard M, Dingemanse P, Cuijpers P, Arntz A, Franx G, Huibers MJH. Frequency and change mechanisms of psychotherapy among depressed patients: study protocol for a multicenter randomized trial comparing twice-weekly versus once-weekly sessions of CBT and IPT. BMC Psychiatry 2015; 15:137. [PMID: 26122891 PMCID: PMC4486419 DOI: 10.1186/s12888-015-0532-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/16/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are among the most well established therapies for the treatment of depression. However, some major questions remain unanswered. First, it is unknown what session frequency results in the most optimal (cost) effectiveness in psychotherapy. Second, the debate as to what mechanisms underlie the effect of psychotherapy has not yet been resolved. Enhancing knowledge about the optimal session frequency and mechanisms of change seems crucial in order to optimize the (cost) effectiveness of psychotherapy for depression. This study aims to compare treatment outcome of twice-weekly versus once-weekly sessions of CBT and IPT. We expect twice-weekly sessions to be more effective and lead to more rapid recovery of depressive symptoms in comparison to once-weekly sessions. Both therapy-specific and non-specific process measures will be included to unravel the mechanisms of change in psychotherapy for depression. Besides the use of self-reports and behavioral observations, this study will also examine underlying biological processes by collecting blood samples. METHOD In a multicenter randomized trial, two hundred depressed patients will be recruited from Dutch specialized mental healthcare centers and randomized into one of the following groups, all receiving a maximum of 20 sessions in different frequencies: a) twice-weekly sessions at the start of CBT, b) twice-weekly sessions at the start of IPT, c) once-weekly sessions at the start of CBT, d) once-weekly sessions at the start of IPT. Primary outcome measures are depression severity, cost-effectiveness and quality of life. Process measures include therapeutic alliance, recall, therapy-specific skills, motivation and compliance. Assessments will take place during baseline, monthly during treatment and follow-up at month 9, 12 and 24. In addition, at 12 and 24 months, the frequency of depressive episodes in the previous year will be assessed. Blood samples will be taken pre- and post-treatment. The study has been ethically approved and registered. DISCUSSION Finding that twice-weekly sessions are more effective or lead to more rapid recovery of depressive symptoms could lead to treatment adaptations that have the potential to reduce the personal and societal burden of depression. In addition, insight into the mechanisms of change and physiological processes in psychotherapy will enable us to optimize treatments and may help to understand human functioning beyond the context of treatment. TRIAL REGISTRATION The study has been registered on October 21th, 2014 at the Netherlands Trial Register, part of the Dutch Cochrane Centre ( NTR4856 ).
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Affiliation(s)
- Sanne J. E. Bruijniks
- Department of Clinical Psychology, VU University Amsterdam, and EMGO Institute, Amsterdam, The Netherlands
| | - Judith Bosmans
- Department of Health Sciences, EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, Section of Health Economics and Health Technology Assessment, VU University Amsterdam, Amsterdam, The Netherlands.
| | - Frenk P. M. L. Peeters
- Department of Psychiatry and Psychology, University Hospital Maastricht; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee USA
| | - Patricia van Oppen
- Department of Psychiatry, VU Medical Centre/GGZ ingeest, and the EMGO Institute, Amsterdam, The Netherlands.
| | | | | | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, and EMGO Institute, Amsterdam, The Netherlands.
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Gerdien Franx
- Trimbos-institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Marcus J. H. Huibers
- Department of Clinical Psychology, VU University Amsterdam, and EMGO Institute, Amsterdam, The Netherlands
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