1
|
Cohen-Chazani Y, Lavidor M, Gilboa-Schechtman E, Roe D, Hasson-Ohayon I. Meta-Analysis of the Effect of Psychotherapy in an Inpatient Setting: Examining the Moderating Role of Diagnosis and Therapeutic Approach. Psychiatry 2022; 85:399-417. [PMID: 35442174 DOI: 10.1080/00332747.2022.2062660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The current meta-analysis investigates the efficacy of psychotherapy during psychiatric hospitalization and examines the moderating role of diagnosis and therapeutic approach. METHODS We conducted systematic searches in literature databases, including PubMed, PsycInfo, and Google Scholar. In total, 37 samples were included for the meta-analysis with a total of 4,443 patients. The primary outcome was the standardized mean differences in clinical status measured by symptomatic and functional measures. RESULTS The meta-analysis of 22 samples without a control group resulted in the upper end of the medium effect size for the overall effect of treatment during psychiatric hospitalization that included psychotherapy (k = 22, Cohen's d = 0.70, and 95% Cl 0.36 to 1.04). The meta-analysis of 15 samples with a control group resulted in the upper end of the low effect size for the contribution of psychotherapy to the improvement of patients' clinical status measured by symptomatic and functional measures (k = 15, Cohen's d = 0.43, and 95% CI 0.06 to 0.81). No significant effects were uncovered for psychotherapy orientation. Diagnosis was found to moderate the contribution of psychotherapy in an inpatient setting to the improvement of patients' clinical condition. CONCLUSION Psychotherapy during psychiatric hospitalization may be an effective treatment. Across the various samples, psychotherapy has a moderate effect on the reduction of psychiatric symptoms beyond the overall effect of ward treatment.
Collapse
|
2
|
Cohen-Chazani Y, Lysaker PH, Roe D, Hasson-Ohayon I. Metacognitive reflection and insight therapy in an inpatient setting: Transforming messianism to a coherent mission. J Clin Psychol 2021; 77:1836-1850. [PMID: 34231884 DOI: 10.1002/jclp.23209] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 06/02/2021] [Accepted: 06/22/2021] [Indexed: 01/25/2023]
Abstract
Metacognitive reflection and insight therapy (MERIT) is an integrative form of psychotherapy which seeks to help adults with serious mental illness make sense of the psychosocial challenges and possibilities they face and decide how to respond to them and direct their own recovery. In this article, we present an adaptation of MERIT to the context of an inpatient ward with an accompanied case illustration. Specifically, we describe how this approach is supported by a broad intersubjective framework, followed by a presentation of processes and contents of the treatment. Special attention is given to the concurrent improvements in reflective abilities and overall well-being of the patient. The unique role that psychotherapy in general, and approaches that emphasize reflective processes in particular, play during acute crises in an inpatient setting is discussed.
Collapse
Affiliation(s)
| | - Paul H Lysaker
- Roudebush Veteran Affairs Medical Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - David Roe
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | |
Collapse
|
3
|
Cuijpers P, Ciharova M, Miguel C, Harrer M, Ebert DD, Brakemeier EL, Karyotaki E. Psychological treatment of depression in institutional settings: A meta-analytic review. J Affect Disord 2021; 286:340-350. [PMID: 33773217 DOI: 10.1016/j.jad.2021.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many depressed patients are treated in institutional settings. The number of studies focusing on psychotherapies for depressed patients in institutional settingsis limited, and only a few up-to-date meta-analyses have integrated the results of these studies. METHODS We conducted a meta-analysis of 32 randomized trials with 37 comparisons between psychotherapy and control conditions, examining the effects of psychotherapy for adult patients in institutional settings with depressive disorders. RESULTS We found that psychotherapy had a significant, small to moderate effect on depressive symptoms (g=0.42; 95% CI: 0.29~0.56), with low to moderate heterogeneity (I2=33; 95% CI: 0~55). The effects remained small but significant after adjustment for publication bias (g=0.27; 95% CI: 0.12~0.42) and in the studies with low risk of bias (g=0.32; 95% CI: 0.11~0.52). The effects were largely retained at 9 to 15 months follow-up and still significant, again after adjustment for publication bias and in studies with low risk of bias. We found no significant difference across types of institutional settings, including psychiatric inpatient settings and nursing homes, although no studies with a low risk of bias were available in nursing homes. LIMITATIONS We included different types of institutional settings, although we did not find a significant difference between settings. The number of studies was small and risk of bias was high in a considerable number of trials. CONCLUSIONS This meta-analysis provides evidence for a small to moderate and sustained effect of psychotherapy in patients in institutional settings with depression.
Collapse
Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam.
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam
| | - Mathias Harrer
- Clinical Psychology and Psychotherapy, Institute for Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - David D Ebert
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam; Clinical Psychology and Psychotherapy, Institute for Psychology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany; Clinical Psychology and Psychotherapy, Institute for Psychology, University of Greifswald, Greifswald, Germany
| | - Eva-Lotta Brakemeier
- Clinical Psychology and Psychotherapy, Institute for Psychology, University of Greifswald, Greifswald, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam; WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam
| |
Collapse
|
4
|
Høstmaelingen A, Ulvenes P, Nissen-Lie HA, Eielsen M, Wampold BE. Comparing outcomes in chronic depression following inpatient psychotherapy for patients continuing versus discontinuing antidepressant medication. Clin Psychol Psychother 2021; 28:1111-1127. [PMID: 33527551 DOI: 10.1002/cpp.2561] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/24/2021] [Indexed: 11/09/2022]
Abstract
Research indicates that combination of psychotherapy and antidepressant medication (ADM) provides cumulative effects and thus outperforms monotherapy in treating chronic depression. In this quasi-experimental study, we explored symptom change for patients with chronic depression treated with ADM when presenting for a 12-week psychotherapeutic inpatient treatment programme. We compared outcomes through treatment and follow-up of patients who continued medication with those who discontinued. We also tested possible moderator effects of initial depression severity on change between the groups. Based on prior research, we hypothesized that combination treatment would yield better results (i.e., more reduction in depression). Patients (N = 112) were referred from general practitioners or local secondary health care. Outcome was measured by Beck Depression Inventory-II (BDI-II), and comparisons were carried out using multilevel modelling. Although 35 patients discontinued ADM during treatment, 77 continued. Both continuers and discontinuers had a significant treatment effect that was maintained at 1-year follow-up. There was no difference in outcome between continuers and discontinuers of ADM. Patients with severe depression had significantly more symptom improvement than patients with moderate depression, but depression severity did not affect outcomes across continuers and discontinuers of ADM differently. The results could indicate that patients had developed resistance and/or tolerance to the prophylactic effects of medication and that ADM did not contribute to the reduction of depressive symptoms. The findings may also indicate that psychotherapy alone in some instances can be a viable alternative to continued combined treatment. Clinicians should carefully assess benefits of patients' ongoing use of antidepressant medication when entering psychotherapy.
Collapse
Affiliation(s)
| | - Pål Ulvenes
- Department of Psychology, University of Oslo, Oslo, Norway.,Modum Bad Research Institute, Modum Bad, Vikersund, Norway
| | | | - Mikkel Eielsen
- Modum Bad Research Institute, Modum Bad, Vikersund, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bruce E Wampold
- Modum Bad Research Institute, Modum Bad, Vikersund, Norway.,Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| |
Collapse
|
5
|
Double Trouble: Treatment Considerations for Patients with Comorbid PTSD and Depression. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s40501-020-00213-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
6
|
Schefft C, Guhn A, Brakemeier EL, Sterzer P, Köhler S. Efficacy of inpatient psychotherapy for major depressive disorder: a meta-analysis of controlled trials. Acta Psychiatr Scand 2019; 139:322-335. [PMID: 30520019 DOI: 10.1111/acps.12995] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This meta-analysis investigates the efficacy of inpatient psychotherapy in major depressive disorders compared to control conditions. METHODS In total, 14 studies were entered into the meta-analysis with a total of 1.080 patients. Primary outcome was the standardized mean differences in self-rated depression outcomes. A priori planned subgroup analyses included the influence of different control conditions: (a) no psychiatric inpatient treatment (e.g., waitlist control), (b) treatment as usual (TAU; e.g., non-manualized clinical management), (c) TAU determined by study design (manualized/'placebo' control condition), as well as number of sessions and influence of self- vs. clinician ratings. RESULTS The meta-analysis of 19 available comparisons resulted in a moderate pooled effect size showing a small and statistically significant benefit of the psychotherapeutic intervention over control conditions (g = 0.24, P < 0.001, I2 = 0%). This corresponds to a number needed to treat of 7.4. The effects of the interventions were stable over 12-month follow-up (g = 0.21, P < 0.01, I2 = 30%). Comparisons with waitlist or non-standardized control treatments tended to be associated with larger effect sizes than standardized control treatments. CONCLUSIONS Despite some limitations (small number of studies), this meta-analysis provides evidence for a small but sustained effect of inpatient psychotherapy in patients with major depressive disorders.
Collapse
Affiliation(s)
- C Schefft
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Guhn
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - E-L Brakemeier
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior (CMBB), Marburg, Germany
| | - P Sterzer
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Köhler
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
7
|
Small C, Pistrang N, Huddy V, Williams C. Individual psychological therapy in an acute inpatient setting: Service user and psychologist perspectives. Psychol Psychother 2018; 91:417-433. [PMID: 29345801 DOI: 10.1111/papt.12169] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/10/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The acute inpatient setting poses potential challenges to delivering one-to-one psychological therapy; however, there is little research on the experiences of both receiving and delivering therapies in this environment. This qualitative study aimed to explore service users' and psychologists' experiences of undertaking individual therapy in acute inpatient units. It focused on the relationship between service users and psychologists, what service users found helpful or unhelpful, and how psychologists attempted to overcome any challenges in delivering therapy. DESIGN The study used a qualitative, interview-based design. METHODS Eight service users and the six psychologists they worked with were recruited from four acute inpatient wards. They participated in individual semi-structured interviews eliciting their perspectives on the therapy. Service users' and psychologists' transcripts were analysed together using Braun and Clarke's (2006, Qualitative Research in Psychology, 3, 77) method of thematic analysis. RESULTS The accounts highlighted the importance of forming a 'human' relationship - particularly within the context of the inpatient environment - as a basis for therapeutic work. Psychological therapy provided valued opportunities for meaning-making. To overcome the challenges of acute mental health crisis and environmental constraints, psychologists needed to work flexibly and creatively; the therapeutic work also extended to the wider context of the inpatient unit, in efforts to promote a shared understanding of service users' difficulties. CONCLUSIONS Therapeutic relationships between service users and clinicians need to be promoted more broadly within acute inpatient care. Psychological formulation can help both service users and ward staff in understanding crisis and working collaboratively. Practice-based evidence is needed to demonstrate the effectiveness of adapted psychological therapy models. PRACTITIONER POINTS Developing 'human' relationships at all levels of acute inpatient care continues to be an important challenge for clinical practice. Due to the distress of individuals and the constraints of the acute inpatient environment, psychologists need to be flexible and adaptable in delivering individual therapy. Making meaning and psychological formulation can give service users a sense of hope and empowerment, and can contribute to a shared understanding within the ward team of service users' difficulties.
Collapse
|
8
|
Metts AV, Keilp JG, Kishon R, Oquendo MA, Mann JJ, Miller JM. Neurocognitive performance predicts treatment outcome with cognitive behavioral therapy for major depressive disorder. Psychiatry Res 2018; 269:376-385. [PMID: 30173044 DOI: 10.1016/j.psychres.2018.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 12/20/2022]
Abstract
The current study examined the contribution of baseline neuropsychological functioning to the prediction of antidepressant outcome with cognitive behavioral therapy (CBT) for Major Depressive Disorder (MDD). We hypothesized that depressed participants who were more neurocognitively intact and had less rigid, negative thinking would respond better to CBT. Thirty-one MDD patients completed a comprehensive neuropsychological battery before initiation of CBT. A subgroup also completed a probabilistic reversal learning task. Depression severity was assessed with the Beck Depression Inventory (BDI); rigid, negative thinking was assessed with the Dysfunctional Attitudes Scale (DAS) and the Automatic Thoughts Questionnaire (ATQ) throughout treatment. Remitters were compared to non-remitters. Paradoxically, eventual remitters performed generally worse across the neuropsychological battery considered as a whole. Univariate testing showed a significant difference on only a single measure, the Continuous Performance Test d', when corrected for multiple comparisons. Baseline rigid, negative thinking did not predict treatment outcome. Results suggest that the structure of CBT may particularly benefit individuals with mild depression-related neurocognitive difficulties during a depressive episode. Further research is needed to examine these patient characteristics and their potential contribution to the mechanisms of CBT efficacy.
Collapse
Affiliation(s)
- Allison V Metts
- Department of Psychiatry, Columbia University, Molecular Imaging and Neuropathology Division, and New York State Psychiatric Institute, New York, NY, USA
| | - John G Keilp
- Department of Psychiatry, Columbia University, Molecular Imaging and Neuropathology Division, and New York State Psychiatric Institute, New York, NY, USA
| | - Ronit Kishon
- Department of Psychiatry, Columbia University, Depression Evaluation Service, and New York State Psychiatric Institute, New York, NY, USA
| | - Maria A Oquendo
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - J John Mann
- Department of Psychiatry, Columbia University, Molecular Imaging and Neuropathology Division, and New York State Psychiatric Institute, New York, NY, USA
| | - Jeffrey M Miller
- Department of Psychiatry, Columbia University, Molecular Imaging and Neuropathology Division, and New York State Psychiatric Institute, New York, NY, USA.
| |
Collapse
|
9
|
Cabanel N, Kundermann B, Franz M, Müller MJ. [Multiprofessional inpatient psychotherapy of depression in old age]. DER NERVENARZT 2018; 88:1221-1226. [PMID: 28849271 DOI: 10.1007/s00115-017-0406-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Depression is common in old age but is often underdiagnosed and inadequately treated. Although psychotherapy is considered effective for treating elderly patients with depression, it is rarely applied in inpatient settings. Furthermore, treatment on inpatient units specialized for elderly patients and implementation of a psychotherapeutic treatment approach are currently more the exception. From this background, a multiprofessional inpatient behavioral treatment program (MVT) for elderly depressed patients was developed at a specialized unit of a university-affiliated regional psychiatric hospital. The MVT is based on specific and modularized group therapies accompanied by individual therapeutic interventions. While the provision of group therapies (such as psychotherapy, social skills training, relaxation training, euthymic and mindfulness-based methods, exercise and occupational therapy as well as psychoeducational sessions for relatives) is assigned to specific professional groups, a joint multiprofessional treatment planning is of central relevance. First evaluations of different treatment components support the high acceptability of the MVT and highlight that psychotherapeutic inpatient treatment programs for the elderly are feasible. Further research is required to investigate the clinical efficacy of psychotherapy in elderly depressive inpatients.
Collapse
Affiliation(s)
- N Cabanel
- Vitos Klinik für Psychiatrie und Psychotherapie Gießen, Vitos Klinikum Gießen-Marburg, Licher Straße 106, 35394, Gießen, Deutschland.
| | - B Kundermann
- Vitos Klinik für Psychiatrie und Psychotherapie Gießen, Vitos Klinikum Gießen-Marburg, Licher Straße 106, 35394, Gießen, Deutschland.,Klinik für Psychiatrie und Psychotherapie, Philipps-Universität Marburg, Marburg, Deutschland
| | - M Franz
- Vitos Klinik für Psychiatrie und Psychotherapie Gießen, Vitos Klinikum Gießen-Marburg, Licher Straße 106, 35394, Gießen, Deutschland.,Fachbereich Medizin, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - M J Müller
- Fachbereich Medizin, Justus-Liebig-Universität Gießen, Gießen, Deutschland.,Oberberggruppe, Berlin, Deutschland
| |
Collapse
|
10
|
Kube T, Siebers VHA, Herzog P, Glombiewski JA, Doering BK, Rief W. Integrating situation-specific dysfunctional expectations and dispositional optimism into the cognitive model of depression - A path-analytic approach. J Affect Disord 2018; 229:199-205. [PMID: 29324367 DOI: 10.1016/j.jad.2017.12.082] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/17/2017] [Accepted: 12/31/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dysfunctional expectations are considered to be core features of mental disorders and, in particular, major depression. The aim of the present study was to integrate two important types of expectations into the cognitive model of depression: situation-specific dysfunctional expectations (SDE) and dispositional optimism (DO). It was hypothesized that the influence of both DO and intermediate beliefs (IB) on depressive symptoms would be mediated via SDE. METHODS We examined 95 individuals (age M = 40.7, 68.1% female) with a diagnosed major depressive disorder from two inpatient clinics and one outpatient clinic. Measurements used in the study included the Depressive Expectations Scale, Dysfunctional Attitudes Scale, Life Orientation Test Revised, and Beck's Depression Inventory-II. Relationships between the constructs were analyzed using path-analytic models with bias-corrected bootstrapping confidence intervals. RESULTS Results indicate that the effect of IB on depressive symptoms was fully mediated via SDE, while the effect of DO on depressive symptoms was partly mediated via SDE. IB and DO moderately correlated with each other. LIMITATIONS Due to the cross-sectional design of the study, it is not possible to draw unambiguous conclusions regarding the causality of the suggested relationships. CONCLUSIONS The present study stresses the crucial role of dysfunctional expectations for major depression. Moreover, it reveals that SDEs as expectations with a high level of situational specificity may pose an important link between global cognitions and depressive symptoms. Given this situational specificity, SDEs are amenable to disconfirmation through behavioral experiments and may therefore be a promising target for cognitive-behavioral interventions.
Collapse
Affiliation(s)
- Tobias Kube
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany.
| | - Verena Helena Anna Siebers
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Philipp Herzog
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Julia Anna Glombiewski
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Bettina Katharina Doering
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Winfried Rief
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| |
Collapse
|
11
|
What we know, what we do not know, and where are we heading? Efficacy and acceptability of psychological interventions for depression. Epidemiol Psychiatr Sci 2016; 25:301-8. [PMID: 26411324 PMCID: PMC7137604 DOI: 10.1017/s2045796015000815] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In the past several decades, increasing evidence supports the efficacy of psychotherapies for depression. The vast majority of findings from meta-analyses, randomized clinical trials (RCTs) and naturalistic studies have demonstrated that well-established psychotherapies (behavioural activation, problem-solving therapy, psychodynamic therapy, cognitive-behavioural therapy, interpersonal therapy and emotion-focused therapy) are superior to no-treatment and control conditions, and are in most cases equally effective in treating depression. However, despite this abundant support for psychotherapies, studies have also consistently shown high drop-out rates, high percentages of non-respondent patients who experience treatment failures, and mixed findings regarding the enduring effects of psychotherapy. Thus, there is a need to develop more personalised treatment models tailored to patients' needs. A new integrative sequential stepwise approach to the treatment of depression is suggested.
Collapse
|
12
|
Waltman SH, Creed TA, Beck AT. Are the effects of cognitive behavior therapy for depression falling? Review and critique of the evidence. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
13
|
Thoma N, Pilecki B, McKay D. Contemporary Cognitive Behavior Therapy: A Review of Theory, History, and Evidence. Psychodyn Psychiatry 2016; 43:423-61. [PMID: 26301761 DOI: 10.1521/pdps.2015.43.3.423] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cognitive behavior therapy (CBT) has come to be a widely practiced psychotherapy throughout the world. The present article reviews theory, history, and evidence for CBT. It is meant as an effort to summarize the forms and scope of CBT to date for the uninitiated. Elements of CBT such as cognitive therapy, behavior therapy, and so-called "third wave" CBT, such as dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT) are covered. The evidence for the efficacy of CBT for various disorders is reviewed, including depression, anxiety disorders, personality disorders, eating disorders, substance abuse, schizophrenia, chronic pain, insomnia, and child/adolescent disorders. The relative efficacy of medication and CBT, or their combination, is also briefly considered. Future directions for research and treatment development are proposed.
Collapse
|
14
|
Thoma N, Pilecki B, McKay D. La terapia cognitivo-comportamentale contemporanea: teoria, storia ed evidenze empiriche. PSICOTERAPIA E SCIENZE UMANE 2016. [DOI: 10.3280/pu2016-001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
15
|
Köhler S, Unger T, Hoffmann S, Mackert A, Ross B, Fydrich T. Dysfunctional cognitions of depressive inpatients and their relationship with treatment outcome. Compr Psychiatry 2015; 58:50-6. [PMID: 25639696 DOI: 10.1016/j.comppsych.2014.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dysfunctional cognitions can contribute to depression and its maintenance. They may be related to a higher relapse rate and a longer duration of the depressive episode. The relevance of dysfunctional cognitions for acute inpatient treatment of unipolar depression is examined in this study and its variability by cognitive behavioural therapy (CBT). METHODS 222 patients suffering from Major Depressive Disorder (MDD) were evaluated during their inpatient treatment by assessing admission and discharge depression scores and their relationship to dysfunctional cognitions, using the Dysfunctional Attitude Scale (DAS). The relationship between dysfunctional cognitions and treatment outcome was examined. Primary outcome measures were the Hamilton-Rating-Scale (HRSD) and the Beck Depression Inventory (BDI). RESULTS Higher age, depression severity at admission, comorbid personality disorders and recurrent depressive disorders are related with higher DAS-scores at admission. DAS-Scores declined during treatment but to a lower extend than depressive symptom scales (effect size dDAS-G t1-t2 = .31; dHRSD t1-t2 = 2.88; dBDI t1-t2 = 1.38). Higher DAS-scores at admission correlated negatively with the improvement of depressive symptoms during treatment (HRSD: r = -.62; p < .01; BDI: r = -.54; p < .01) and remission rates (HRSD: r = -.65; p < .01; BDI: r = -.48; p < .01). CBT did not additionally reduce DAS-scores compared to pharmacotherapy only. CONCLUSION Dysfunctional cognitions are relatively stable compared to other depressive symptoms and are associated with poorer treatment outcome even in combined treatment of antidepressant medication and CBT during inpatient treatment. Changes of dysfunctional cognitions seem to be a long-term treatment goal, especially because of their association with comorbid personality disorders and recurrent depressive disorders.
Collapse
Affiliation(s)
- Stephan Köhler
- Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin.
| | - Theresa Unger
- Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin.
| | - Sabine Hoffmann
- Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin.
| | - Arthur Mackert
- Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin.
| | - Barbara Ross
- Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin.
| | | |
Collapse
|
16
|
Köhler S, Wiethoff K, Ricken R, Stamm T, Baghai TC, Fisher R, Seemüller F, Brieger P, Cordes J, Malevani J, Laux G, Hauth I, Möller HJ, Zeiler J, Heinz A, Bauer M, Adli M. Characteristics and differences in treatment outcome of inpatients with chronic vs. episodic major depressive disorders. J Affect Disord 2015; 173:126-33. [PMID: 25462406 DOI: 10.1016/j.jad.2014.10.059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/28/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Approximately 20-30% of patients with Major depressive disorder (MDD) develop a chronic course of their disease. Chronic depression is associated with increased health care utilisation, hospitalisation and a higher disease burden. We identified clinical correlates and differences in treatment response of chronic MDD (cMDD) patients compared with non-chronic episodic depression in a huge sample of depressive inpatients. METHODS Data were collected from 412 inpatients who had been diagnosed with a major depressive episode (MDE; according to ICD-10) and scored 15 or higher on the 21-item Hamilton Depression Rating Scale (HRSD-21). All subjects were participants in the German Algorithm Project, phase 3 (GAP3). Patients who were diagnosed with a MDE within the last two years or longer (herein referred to as CD) were compared with non-chronic depressive patients (herein referred to as non-CD). CD and non-CD patients were assessed for the following: psychosocial characteristics, symptom reduction from hospital admission to discharge, symptom severity at discharge, remission and response rates, and pharmacological treatment during inpatient treatment. The primary outcome measure was the HRSD-21. RESULTS 13.6% (n=56) of patients met the criteria for chronic depression. Compared with non-CD patients, patients with CD showed increased axis I comorbidities (74% vs. 52%, χ(2) (1)=7.31, p=.02), a higher level of depressive symptoms at baseline and discharge, increased duration of inpatient treatment (64.8 vs. 53.3 days; t=2.86, p=.03) and lower response (HRSD: 60.0% vs. 72.0%; χ(2) (1)=3.61, p<.04; BDI: 40.5% vs. 54.2%; χ(2) (1)=3.56, p=.04) and remission rates (BDI 17.9.% vs. 29.7%; χ(2) (1)=3.42, p=.05. However, both groups achieved a comparable symptom reduction during inpatient treatment. The prescribed pharmacological strategy had no significant influence on treatment outcome in patients with CD. CONCLUSION Inpatients with CD show higher symptom severity, lower response and remission rates and a longer duration of inpatient treatment, although they achieve comparable symptom reduction during treatment. These findings support the need to recognise CD and its defining characteristics as a distinct subclass of depression.
Collapse
Affiliation(s)
- Stephan Köhler
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany.
| | - Katja Wiethoff
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany
| | - Roland Ricken
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany
| | - Thomas Stamm
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany
| | - Thomas C Baghai
- Department of Psychiatry and Psychotherapy, University Hospital Regensburg, Germany
| | - Robert Fisher
- Eastlondon NHS Foundation Trust, City and Hackney Centre for Mental Health, Donald Winnicott Centre, London, UK
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany; Lech-Mangfall-Klinik, Garmisch-Patenkirchen, Germany
| | | | - Joachim Cordes
- Department of Psychiatry and Psychotherapy, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Jaroslav Malevani
- Department of Psychiatry and Psychotherapy, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Gerd Laux
- Inn-Salzach-Klinikum, Wasserburg am Inn, Germany
| | - Iris Hauth
- Department of Psychiatry and Psychotherapy, St. Joseph-Krankenhaus, Berlin, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Joachim Zeiler
- Department of Psychiatry and Psychotherapy, Auguste-Viktoria-Krankenhaus, Berlin, Germany
| | - Andreas Heinz
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Mazda Adli
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Berlin, Germany; Fliedner Hospital Berlin, Germany
| |
Collapse
|
17
|
Crowe M, Beaglehole B, Wells H, Porter R. Non-pharmacological strategies for treatment of inpatient depression. Aust N Z J Psychiatry 2015; 49:215-26. [PMID: 25648143 DOI: 10.1177/0004867415569799] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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 evidence for non-pharmacological interventions in the treatment of moderate to severe depression in an inpatient setting. METHOD An integrative review of original research papers was conducted. The electronic databases CINAHL, MEDLINE and PsychINFO were searched using the following search terms: depression, psychosocial, psychosocial intervention, therapy, and inpatient. RESULTS Twelve studies were identified in the search for non-psychopharmacological interventions for depression commenced in an inpatient setting. The interventions included psychotherapies, behavioural activation, and chronotherapeutic interventions (controlled exposure to environmental stimuli). These studies suggest it is possible to engage severely depressed inpatients in structured interventions in an inpatient environment. The majority of studies reported favourable outcomes for the interventions compared to a control, but methodological issues were common. CONCLUSIONS A diverse range of treatment strategies has been identified in this review. These studies provide evidence that non-pharmacological treatments for depression can be given to enhance outcomes and that research can be undertaken in inpatient settings. Whilst the evidence base has limitations, this review also highlights therapeutic and research opportunities in this area.
Collapse
Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Ben Beaglehole
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Hayley Wells
- Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| |
Collapse
|
18
|
Peck KR, Smitherman TA, Baskin SM. Traditional and alternative treatments for depression: implications for migraine management. Headache 2015; 55:351-5. [PMID: 25644990 DOI: 10.1111/head.12521] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Migraine is frequently comorbid with major depressive disorder, the presence of which confers increased disability and various clinical challenges. METHODS/RESULTS The present article reviews empirically supported pharmacologic and cognitive-behavioral interventions for depression, as well as the emerging yet generally mixed efficacy for various complementary and alternative medicine depression treatments. DISCUSSION AND CONCLUSION Clinical implications and treatment strategies for migraine patients with comorbid depression are discussed. The literature reviewed here draws together clinical practice options for clinicians.
Collapse
Affiliation(s)
- Kelly R Peck
- Department of Psychology, University of Mississippi, Oxford, MS, USA
| | | | | |
Collapse
|
19
|
Abstract
Older adults with Diabetes Mellitus (DM) experience greater risk for comorbid depression compared to those who do not have DM. Undetected, untreated or under-treated depression impinges an individual's ability to manage their DM successfully, hinders their adherence to treatment regime, and undermines provider-patient relationships. Thus, in the context of caring for older adults with DM, comorbid depression presents special challenges and opportunities for clinicians. In this article, we summarize the clinical presentation of late-life depression, potential mechanisms of comorbidity of depression and DM, importance of depression in the successful management of DM, and available best practice models for depression treatment.
Collapse
Affiliation(s)
- Mijung Park
- Department of Health and Community Systems, University of Pittsburgh, School of Nursing, 3500 Victoria Street, 421 Victoria Building, Pittsburgh, PA 15213, USA.
| | - Charles F Reynolds
- NIMH Center of Excellence in Late Life Depression Prevention and Treatment, Hartford Center of Excellence in Geriatric Psychiatry, Aging Institute of UPMC Senior Services and University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213-2582, USA
| |
Collapse
|
20
|
Hayley S, Litteljohn D. Neuroplasticity and the next wave of antidepressant strategies. Front Cell Neurosci 2013; 7:218. [PMID: 24312008 PMCID: PMC3834236 DOI: 10.3389/fncel.2013.00218] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 10/29/2013] [Indexed: 12/13/2022] Open
Abstract
Depression is a common chronic psychiatric disorder that is also often co-morbid with numerous neurological and immune diseases. Accumulating evidence indicates that disturbances of neuroplasticity occur with depression, including reductions of hippocampal neurogenesis and cortical synaptogenesis. Improper trophic support stemming from stressor-induced reductions of growth factors, most notably brain derived neurotrophic factor (BDNF), likely drives such aberrant neuroplasticity. We posit that psychological and immune stressors can interact upon a vulnerable genetic background to promote depression by disturbing BDNF and neuroplastic processes. Furthermore, the chronic and commonly relapsing nature of depression is suggested to stem from "faulty wiring" of emotional circuits driven by neuroplastic aberrations. The present review considers depression in such terms and attempts to integrate the available evidence indicating that the efficacy of current and "next wave" antidepressant treatments, whether used alone or in combination, is at least partially tied to their ability to modulate neuroplasticity. We particularly focus on the N-methyl-D-aspartate (NMDA) antagonist, ketamine, which already has well documented rapid antidepressant effects, and the trophic cytokine, erythropoietin (EPO), which we propose as a potential adjunctive antidepressant agent.
Collapse
Affiliation(s)
- Shawn Hayley
- Department of Neuroscience, Carleton University Ottawa, ON, Canada
| | | |
Collapse
|