Efficacy versus Effectiveness: A Direct Comparison of the Outcome of Treatment for Mild to Moderate Depression in Randomized Controlled Trials and Daily Practice

268

171

Background: Deficits in emotion regulation skills are possible factors maintaining major depressive disorder (MDD). Therefore, the aim of the study was to test whether integrating a systematic emotion regulation training (ERT) enhances the efficacy of routine inpatient cognitive behavioral therapy (CBT) for MDD. Methods: In a prospective randomized controlled trial, 432 inpatients meeting criteria for MDD were assigned to receive either routine CBT or CBT enriched with an intense emotion regulation skills training (CBT-ERT). Results: Participants in the CBT-ERT condition demonstrated a significantly greater reduction in depression (response rates - CBT: 75.5%, CBT-ERT: 84.9%; remission rates - CBT: 51.1%, CBT-ERT: 65.1%). Moreover, CBT-ERT participants demonstrated a significantly greater reduction of negative affect, as well as a greater increase of well-being and emotion regulation skills particularly relevant for mental health. Conclusions: Integrating strategies that target emotion regulation skills improves the efficacy of CBT for MDD.

Section: Discussionmentioning

confidence: 99%

Emotion Regulation Skills Training Enhances the Efficacy of Inpatient Cognitive Behavioral Therapy for Major Depressive Disorder: A Randomized Controlled Trial

Berking

Ebert

Cuijpers³

et al. 2013

268

171

“…While some of these individuals may suffer from mild or subthreshold mental health problems, little evidence supports the benefits of antidepressants in these cases [56,57]. Even in patients with major depression, the benefits of treatment in routine treatment settings fall short of those reported in randomized clinical trials [58]. Inappropriate use of antidepressant medications is especially of concern in the older adults who are prone to drug-drug interactions [59,60,61,62].…”

Section: Discussionmentioning

confidence: 99%

Clinician-Identified Depression in Community Settings: Concordance with Structured-Interview Diagnoses

Mojtabai

2013

Background: Relatively little is known about the prevalence and correlates of overdiagnosis of depression in community settings. This study examined the extent to which individuals with clinician-identified depression in the community meet the criteria for DSM-IV major depressive episodes (MDE) and characteristics of these individuals. Methods: In a sample of 5,639 participants with clinician-identified depression drawn from the 2009-2010 United States National Survey of Drug Use and Health, the proportion of participants who met the 12-month MDE criteria, ascertained by a structured interview, and variations in MDE diagnosis across different groups of participants were examined. Mental health profiles and service use of participants who met the MDE criteria were compared to those who did not meet these criteria. Results: Only 38.4% of participants with 12-month clinician-identified depression met the 12-month MDE criteria. Older adults were less likely than younger adults to meet the criteria - only 14.3% of those 65 years old or older met the criteria, whereas participants with more education and those with poorer overall health were more likely to meet the criteria. Participants who did not meet the 12-month MDE criteria reported less distress and impairment in role functioning and used fewer services. A majority of both groups, however, were prescribed and used psychiatric medications. Conclusions: Depression overdiagnosis and overtreatment is common in community settings in the USA. There is a need for improved targeting of diagnosis and treatments of depression and other mental disorders in these settings.

“…The study was designed to maximize applicability and generalizability of the results to usual care settings [24,25]. …”

Section: Methodsmentioning

confidence: 99%

A Transdiagnostic Internet-Based Maintenance Treatment Enhances the Stability of Outcome after Inpatient Cognitive Behavioral Therapy: A Randomized Controlled Trial

Ebert

Tarnowski

Gollwitzer

et al. 2013

Background: High relapse rates following acute treatment for common mental health disorders support the importance of developing maintenance phase interventions. Internet-based interventions have been effective for a broad range of mental disorders, but less is known about their potential to enhance long-term outcomes of traditional face-to-face therapy. Therefore, the goal of the present study was to evaluate a transdiagnostic Internet-based maintenance treatment (TIMT) with the purpose of fostering long-term effects of inpatient psychotherapy. Method: In this pragmatic randomized controlled trial, a sample of 400 inpatients with affective, neurotic, and/or behavioral disorders was assigned to either 12 weeks of TIMT + treatment as usual (TAU) or to TAU-only following hospital discharge. TIMT consists of a self-management module, asynchronous patient-coach communication, online patient support group, and online-based monitoring of psychopathological symptoms. Self-ratings of psychopathological symptoms were conducted at the beginning of inpatient treatment (t1), at discharge from inpatient treatment/start of TIMT (t2), and at 3-month (t3) and 12-month follow-ups (t4). Results: The TIMT + TAU group was superior to the TAU-only group with regard to differences in change of general psychopathological symptom severity from discharge to 3- and 12-month follow-up. Moreover, participants of the TIMT + TAU group showed less frequent symptom deteriorations and were more often in remission/recovery than controls. Conclusion: TIMT effectively enhances long-term outcome of inpatient psychotherapy.