Childhood depression: a place for psychotherapy

Trowell, Judith; Joffe, Ilan; Campbell, Jesse W.; Clemente, Carmen; Almqvist, Fredrik; Soininen, Mika; Koskenranta-Aalto, Ulla; Weintraub, Sheila; Kolaitis, Gerasimos; Tomaras, Vlassis; Anastasopoulos, Dimitris; Grayson, Kate; Barnes, Jacqueline; Tsiantis, John

doi:10.1007/s00787-006-0584-x

Cited by 131 publications

(61 citation statements)

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“…76 The STPP method 73,77 draws on a long history in the UK of psychoanalytic work with depressed children and young people, 77,78 including an earlier clinical trial, in which STPP for children with depression demonstrated good outcomes. 35 As with the other manuals used in IMPACT, the STPP manual 74 provided a guide to practice but not a recipe or a step-by-step guide, and drew on the existing skills and training of child and adolescent psychotherapists already working in the NHS.…”

Section: Short-term Psychoanalytic Psychotherapymentioning

confidence: 99%

“…At the time of starting Improving Mood with Psychoanalytic and Cognitive Behaviour Therapy (IMPACT), it was standard practice (in keeping with NICE guidelines) to start treatment with specific psychological therapy. In addition, unlike prior UK RCT studies, 12,35 we added potential moderators of recurrence risk and relapse rates. These were individual differences in (1) self-reported rumination (persistently brooding or dwelling, often to the exclusion of other themes in the patient's life) 36,37 and (2) depressive thinking style (the extent to which patients with clinical depression may be characterised in terms of immaturity of the cognitive styles of self-criticism and perfectionism).…”

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confidence: 99%

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Cognitive–behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial

Goodyer

Reynolds

Barrett

et al. 2017

Health Technol Assess

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BackgroundAlthough there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years.ObjectiveTo determine whether or not either of two specialist psychological treatments, cognitive–behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief psychosocial intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment.DesignObserver-blind, parallel-group, pragmatic superiority randomised controlled trial.SettingA total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London.ParticipantsAdolescents aged 11–17 years withDiagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses.InterventionsIn total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up.Main outcome measuresMean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation.ResultsThere were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = –0.578, 95% confidence interval (CI) –2.948 to 4.104;p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = –1.898, 95% CI –4.922 to 1.126;p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49–52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome.ConclusionsThe three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings.LimitationsNeither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data.Trial registrationCurrent Controlled Trials ISRCTN83033550.FundingThis project was funded by the National Institute for Heath Research Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 12. See the National Institute for Heath Research Journals Library website for further project information. Funding was also provided by the Department of Health. The funders had no role in the study design, patient recruitment, data collection, analysis or writing of the study, any aspect pertinent to the study or the decision to submit toThe Lancet.

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Section: Short-term Psychoanalytic Psychotherapymentioning

confidence: 99%

mentioning

confidence: 99%

Cognitive–behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial

Goodyer

Reynolds

Barrett

et al. 2017

Health Technol Assess

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“…However one conclusion that has already been drawn from clinical experience of delivering it (and from a previous study Trowell (2012), is that not only may a fixed term of once-weekly treatment for a year not be harmful, compared with treatments without a predefined ending, but that it may even be beneficial especially to adolescent patients.It seems likely that training in time-limited therapy will now be added to the training requirements of the child psychotherapy profession. Should this trial prove successful in terms of treatment outcomes, it seems likely that NICE will take a much more favourable view than hiitherto of the value of psychoanalytic treatment at least for severe depressive illness.…”

Section: The Programme Of This Conference Gives Considerable Emphasismentioning

confidence: 99%

Psychotherapy in a neoliberal world

Rustin

2015

European Journal of Psychotherapy & Counselling

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“…The capacity of attachment models to explain and indeed predict patterns of development, including across generations, has been amply demonstrated. The literature on the outcomes of psychoanalytic psychotherapy with children and adolescents (Kennedy 2004, Kennedy and Midgley 2007, Trowell 2012) also indicates, that these methods achieve considerably better outcomes than routine psychiatric treatments. 4 The fact that these results can be achieved by practitioners from different therapeutic schools does not invalidate their theories, since therapists from different schools of psychoanalysis share many fundamental assumptions.…”

Section: Commentarymentioning

confidence: 99%