Effect of Disorder-Specific vs Nonspecific Psychotherapy for Chronic Depression
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Effect of Disorder-Specific vs Nonspecific Psychotherapy for Chronic Depression : A Randomized Clinical Trial. / Schramm, Elisabeth; Kriston, Levente; Zobel, Ingo; Bailer, Josef; Wambach, Katrin; Backenstrass, Matthias; Klein, Jan Philipp; Schoepf, Dieter; Schnell, Knut; Gumz, Antje; Bausch, Paul; Fangmeier, Thomas; Meister, Ramona; Berger, Mathias; Hautzinger, Martin; Härter, Martin.
in: JAMA PSYCHIAT, Jahrgang 74, Nr. 3, 01.03.2017, S. 233-242.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Effect of Disorder-Specific vs Nonspecific Psychotherapy for Chronic Depression
T2 - A Randomized Clinical Trial
AU - Schramm, Elisabeth
AU - Kriston, Levente
AU - Zobel, Ingo
AU - Bailer, Josef
AU - Wambach, Katrin
AU - Backenstrass, Matthias
AU - Klein, Jan Philipp
AU - Schoepf, Dieter
AU - Schnell, Knut
AU - Gumz, Antje
AU - Bausch, Paul
AU - Fangmeier, Thomas
AU - Meister, Ramona
AU - Berger, Mathias
AU - Hautzinger, Martin
AU - Härter, Martin
PY - 2017/3/1
Y1 - 2017/3/1
N2 - Importance: Chronic depression is a highly prevalent and disabling disorder. There is a recognized need to assess the value of long-term disorder-specific psychotherapy.Objective: To evaluate the efficacy of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) compared with that of nonspecific supportive psychotherapy (SP).Design, Setting, and Participants: A prospective, multicenter, evaluator-blinded, randomized clinical trial was conducted among adult outpatients with early-onset chronic depression who were not taking antidepressant medication. Patients were recruited between March 5, 2010, and October 16, 2012; the last patient finished treatment on October 14, 2013. Data analysis was conducted from March 5, 2014, to October 27, 2016.Interventions: The treatment included 24 sessions of CBASP or SP for 20 weeks in the acute phase, followed by 8 continuation sessions during the next 28 weeks.Main Outcomes and Measures: The primary outcome was symptom severity after 20 weeks (blinded observer ratings) as assessed by the 24-item Hamilton Rating Scale for Depression (HRSD-24). Secondary outcomes were rates of response (reduction in HRSD-24 score of ≥50% from baseline) and remission (HRSD-24 score ≤8), as well as self-assessed ratings of depression, global functioning, and quality of life.Results: Among 622 patients assessed for eligibility, 268 were randomized: 137 to CBASP (96 women [70.1%] and 41 men [29.9%]; mean [SD] age, 44.7 [12.1] years) and 131 to SP (81 women [61.8%] and 50 men [38.2%]; mean [SD] age, 45.2 [11.6] years). The mean (SD) baseline HRSD-24 scores of 27.15 (5.49) in the CBASP group and 27.05 (5.74) in the SP group improved to 17.19 (10.01) and 20.39 (9.65), respectively, after 20 weeks, with a significant adjusted mean difference of -2.51 (95% CI, -4.16 to -0.86; P = .003) and a Cohen d of 0.31 in favor of CBASP. After 48 weeks, the HRSD-24 mean (SD) scores were 14.00 (9.72) for CBASP and 16.49 (9.96) for SP, with an adjusted difference of -3.13 (95% CI, -5.01 to -1.25; P = .001) and a Cohen d of 0.39. Patients undergoing CBASP were more likely to reach response (48 of 124 [38.7%] vs 27 of 111 [24.3%]; adjusted odds ratio, 2.02; 95% CI, 1.09 to 3.73; P = .03) or remission (27 of 124 [21.8%] vs 14 of 111 [12.6%]; adjusted odds ratio, 3.55; 95% CI, 1.61 to 7.85; P = .002) after 20 weeks. Patients undergoing CBASP showed significant advantages in most other secondary outcomes.Conclusions and Relevance: Highly structured specific psychotherapy was moderately more effective than nonspecific therapy in outpatients with early-onset chronic depression who were not taking antidepressant medication. Adding an extended phase to acute psychotherapy seems promising in this population.Trial Registration: clinicaltrials.gov Identifier: NCT00970437.
AB - Importance: Chronic depression is a highly prevalent and disabling disorder. There is a recognized need to assess the value of long-term disorder-specific psychotherapy.Objective: To evaluate the efficacy of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) compared with that of nonspecific supportive psychotherapy (SP).Design, Setting, and Participants: A prospective, multicenter, evaluator-blinded, randomized clinical trial was conducted among adult outpatients with early-onset chronic depression who were not taking antidepressant medication. Patients were recruited between March 5, 2010, and October 16, 2012; the last patient finished treatment on October 14, 2013. Data analysis was conducted from March 5, 2014, to October 27, 2016.Interventions: The treatment included 24 sessions of CBASP or SP for 20 weeks in the acute phase, followed by 8 continuation sessions during the next 28 weeks.Main Outcomes and Measures: The primary outcome was symptom severity after 20 weeks (blinded observer ratings) as assessed by the 24-item Hamilton Rating Scale for Depression (HRSD-24). Secondary outcomes were rates of response (reduction in HRSD-24 score of ≥50% from baseline) and remission (HRSD-24 score ≤8), as well as self-assessed ratings of depression, global functioning, and quality of life.Results: Among 622 patients assessed for eligibility, 268 were randomized: 137 to CBASP (96 women [70.1%] and 41 men [29.9%]; mean [SD] age, 44.7 [12.1] years) and 131 to SP (81 women [61.8%] and 50 men [38.2%]; mean [SD] age, 45.2 [11.6] years). The mean (SD) baseline HRSD-24 scores of 27.15 (5.49) in the CBASP group and 27.05 (5.74) in the SP group improved to 17.19 (10.01) and 20.39 (9.65), respectively, after 20 weeks, with a significant adjusted mean difference of -2.51 (95% CI, -4.16 to -0.86; P = .003) and a Cohen d of 0.31 in favor of CBASP. After 48 weeks, the HRSD-24 mean (SD) scores were 14.00 (9.72) for CBASP and 16.49 (9.96) for SP, with an adjusted difference of -3.13 (95% CI, -5.01 to -1.25; P = .001) and a Cohen d of 0.39. Patients undergoing CBASP were more likely to reach response (48 of 124 [38.7%] vs 27 of 111 [24.3%]; adjusted odds ratio, 2.02; 95% CI, 1.09 to 3.73; P = .03) or remission (27 of 124 [21.8%] vs 14 of 111 [12.6%]; adjusted odds ratio, 3.55; 95% CI, 1.61 to 7.85; P = .002) after 20 weeks. Patients undergoing CBASP showed significant advantages in most other secondary outcomes.Conclusions and Relevance: Highly structured specific psychotherapy was moderately more effective than nonspecific therapy in outpatients with early-onset chronic depression who were not taking antidepressant medication. Adding an extended phase to acute psychotherapy seems promising in this population.Trial Registration: clinicaltrials.gov Identifier: NCT00970437.
KW - Adult
KW - Ambulatory Care
KW - Chronic Disease
KW - Cognitive Therapy
KW - Comorbidity
KW - Depressive Disorder, Major
KW - Dysthymic Disorder
KW - Female
KW - Humans
KW - Male
KW - Middle Aged
KW - Psychotherapy
KW - Comparative Study
KW - Journal Article
KW - Randomized Controlled Trial
U2 - 10.1001/jamapsychiatry.2016.3880
DO - 10.1001/jamapsychiatry.2016.3880
M3 - SCORING: Journal article
C2 - 28146251
VL - 74
SP - 233
EP - 242
JO - JAMA PSYCHIAT
JF - JAMA PSYCHIAT
SN - 2168-622X
IS - 3
ER -