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

Psychological interventions for post-stroke anxiety and depression: Current approaches and future perspectives

Psychological interventions have demonstrated efficacy in improving patients’ emotional state, cognition, and thinking abilities, thereby enhancing their quality of life and survival. This review examines literature from the China National Knowledge Infrastructure, Wanfang Data, Web of Science, and PubMed databases published over the past decade, focusing on the use of psychotherapy for post-stroke anxiety and depression. The prevalence of anxiety and depression is significantly higher among patients who have experienced a stroke than in the general population, possibly due to vestibular dysfunction following brain injury. Current psychological interventions for stroke patients include cognitive behavioral therapy, supportive psychotherapy, music and art therapy, and exercise therapy. These approaches have been shown to promote psychological wellbeing and physical rehabilitation.

Heterogeneity of Treatment Outcomes Across Therapists and Sites in a Randomized Multicentre Psychotherapy Trial

OBJECTIVE

Establishing robust evidence for psychotherapeutic treatment efficacy is crucial in evidence-based medicine for mental disorders. Randomized controlled trials (RCTs) are key to minimizing biases such as selection effects and baseline imbalances between study groups. However, another challenge to robust evidence in psychotherapy research is heterogeneity in treatment outcomes due to therapists and clinical sites. While this has been frequently observed in naturalistic settings, therapist- and site-related heterogeneity in treatment outcomes has been understudied in RCTs.

METHOD

The present study addresses this gap in a secondary data analysis, examining how therapists and clinical sites differ in treatment outcomes and differential/average treatment effect (i.e., outcome differences between treatment groups) within a large, multicentre RCT. We analysed data from 255 patients with chronic depression treated by 79 therapists in nine study sites, that received two different active psychotherapeutic interventions.

RESULTS

Therapist- and site-related variances in treatment outcomes appeared relatively small, accounting for 1.1% [0.0%, 8.1%] and 1.7% [0.0%, 9.9%] of the total variance, respectively. Notably, site-related variance in differential treatment effects appeared relatively larger at 12.5% [0.1%, 44.4%]. These variances were only partially explained by patient or therapist characteristics.

CONCLUSION

While the sample size only allowed to estimate the variance contributions of therapists and sites with high uncertainty, the relative size comparison points to the importance of considering site heterogeneity in evaluating RCTs' differential treatment effects. Further research on site characteristics' impact could enhance understanding of psychotherapeutic treatment efficacy across diverse contexts.

Tailored internet-delivered cognitive behavior therapy for depression in older adults: a randomized controlled trial

BACKGROUND

Depression is a common and serious problem in older adults, but few have access to psychological treatments. Internet-delivered Cognitive Behavioral Therapy (ICBT) has the potential to improve access and has been found to be effective in adults with depression. The aim of this study was to examine the effects of tailored ICBT for depression in older adults aged 65 years or older. We also investigated if cognitive flexibility could predict outcome.

METHODS

Following online recruitment from the community, included participants were randomly allocated to either ten weeks of clinician guided ICBT (n = 50) or to an active control group in the form of non-directive support (n = 51). Primary depression outcome was the Geriatric Depression Scale (GDS-15). Several secondary outcomes were used, such as the Beck Depression Inventory (BDI-II) and the Patient Health Questionnaire (PHQ-9).

RESULTS

Both treatment and active control groups significantly reduced their levels of depression, and the treatment group showed significantly greater improvement on the GDS-15 and BDI-II, but not on the PHQ-9. Between-group effect sizes as Cohen's d were 0.78 (CI95% 0.36-1.20) on the GDS-15 and 0.53 (CI95% 0.11-0.94) on the BDI-II.

CONCLUSIONS

Tailored ICBT is superior to an active control for older adults with depression. Between-group effects were smaller than in previous RCTs, most likely because of the use of an active control condition. Cognitive flexibility did not predict outcome. We conclude that ICBT can be used for older adults with depression, and thus increase access to psychotherapy for this group.

TRIAL REGISTRATION

This trial was retrospectively registered in clinicaltrials.gov (no. NCT05269524) the 8th of March 2022.

Interpersonal Psychotherapy for the Treatment of Depression in Parkinson's Disease: Results of a Randomized Controlled Trial

BACKGROUND

Depression is a common nonmotor complication in Parkinson's disease (PD). However, few studies have evaluated the efficacy of first-line psychological therapies for depression in this patient population.

OBJECTIVES

This randomized controlled trial evaluated the efficacy of interpersonal psychotherapy (IPT), an empirically validated intervention for depression that focuses on the bidirectional relationship between mood disturbance and interpersonal and social stressors. A secondary aim was to assess maintenance of treatment gains at 6-month follow-up.

METHODS

Participants with PD stages I to III and a comorbid depressive disorder were randomly assigned to 12 sessions of IPT (n = 32) or supportive therapy (ST) (n = 31), our active control intervention. The primary outcome was the Hamilton Depression Rating Scale (HAM-D) administered blindly by telephone. Secondary outcomes included self-report depression and anxiety, quality of life, clinician-rated motor symptom, interpersonal relationships, and attachment style.

RESULTS

IPT compared to ST resulted in a greater reduction in posttreatment HAM-D scores (least square mean difference = -3.77, 95% confidence interval [CI]: -6.19 to -1.34, P = 0.003) and was associated with a greater odds of meeting remission (odds ratio = 3.23, 95% CI: 1.10-9.51, P = 0.034). The advantage of IPT over ST on HAM-D scores and remission rates was not sustained at the 6-month follow-up. Both treatments improved self-report depression, anxiety, quality of life, and aspects of interpersonal functioning.

CONCLUSIONS

This trial demonstrates the benefits of acute treatment with IPT in reducing depressive symptoms in PD. Clinicians should consider psychotherapy, alone or in combination with medication, as an important treatment option for PD depression. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Participant acceptability and clinician satisfaction of cognitive behavioural therapy and medication management algorithm compared with enhanced standard care for treatment of depression among youth with HIV

Background: Primary results of the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) 2002 trial showed that cognitive behavioural therapy (CBT) and medication management algorithm (MMA) (COMB-R) significantly improved depression in youth with HIV (YWH) compared with enhanced standard care (ESC). Acceptability and satisfaction were examined among study participants and clinicians.Method: Between March 2017 and March 2019, 13 U.S. sites enrolled YWH, aged 12-24, diagnosed with nonpsychotic depression. Sites were randomised to either COMB-R (CBT by a therapist and licensed prescriber) or ESC (standard psychotherapy and medication management). After the intervention (week 24), participants, prescribers, and therapists rated acceptability and satisfaction. We compared site-level means using Wilcoxon tests.Results: Both COMB-R (n = 69) and ESC (n = 71) participants had a mean age of 21.4 years, with 53% female, and 54% having acquired HIV perinatally. Baseline age, sex, depression levels, RNA viral load, and CD4 count were comparable between arms. The distribution of site-level mean participant acceptability was greater in COMB-R compared with ESC (p = 0.04). The distribution of site-level mean prescriber satisfaction was greater in COMB-R (p = 0.01). The was no evidence that the site-level mean therapist satisfaction did not differ between arms (p = 0.52).Discussion: Acceptability and satisfaction for participants and licensed prescribers were higher at COMB-R sites compared with standard of care, indicating that this tailored, manual-guided, collaborative, measured care intervention was less burdensome in terms of the number of visits. Patient and medication provider satisfaction rates were higher than standard of care.Conclusion: While these results support the use of CBT and MMA in treating depression among YWH, further research is required to determine generalisability.

Affect-Focused and Exposure-Focused Psychotherapies

The authors discuss the two broad domains of affect-focused and exposure-focused psychotherapies, defining the characteristics and potential advantages and disadvantages of each. The two domains differ in their theoretical approaches, structures, and techniques. Exposure-focused therapies have come to dominate research and practice, leading to the relative neglect of affect-focused therapies. When the two approaches have been examined in well-conducted clinical trials, they generally appear to be equally beneficial for treating common mood, anxiety, and trauma disorders, although further research may better define differential therapeutics. The authors argue for better training in affect awareness and tolerance across psychotherapies and use a brief case vignette to illustrate several aspects of these different approaches.