One-year follow-up of a randomized trial with a dilemma-focused intervention for depression: Exploring an alternative to problem-oriented strategies

Abstract

BackgroundCognitive behavioural therapy (CBT) is aimed to counteract cognitions and behaviours that are considered as dysfunctional. The aim of the study is to test whether the inclusion of a non-counteractive approach (dilemma-focused intervention, DFI) in combination with CBT group therapy will yield better short- and long-term outcomes than an intervention conducted entirely using CBT.MethodA total of 128 patients with depression and at least one cognitive conflict, of six health community centres in Barcelona, participated from November of 2011 to December of 2014 in seven weekly group CBT sessions and were then randomly allocated to either DFI or CBT (eight individual sessions each) by an independent researcher. Depressive symptoms were assessed with the Beck Depression Inventory-II at baseline, at the end of therapy and three- and twelve-month follow-ups. Therapists did not participate in any of the assessments nor in the randomisation of patients and evaluators were masked to group assignment. Both intention to treat and complete case analyses were performed using linear mixed models with random effects.FindingsAccording to intention-to-treat analysis (F2, 179 = 0.69) and complete case analysis (F2, 146 = 0.88), both conditions similarly reduced the severity of symptoms across posttreatment assessments. For the 77 participants (CBTgroup +CBTindividual = 40; CBTgroup+DFIindividual = 37) that completed allocated treatment and one-year follow-up assessment, response and remission rates were relative higher for the DFI condition, however no significant differences were found between treatment conditions. The relapse rates were similar between treatment conditions (CBTgroup +CBTindividual = 7/20; CBTgroup+DFIindividual = 8/22).InterpretationAlthough using a counteractive approach across all the treatment sessions is quite effective, it does not seem to be necessary to produce significant improvement. DFI may be considered as an alternative, which could be included in a wider treatment for depression.Trial registrationClinicalTrials.gov; ID: NCT01542957.

Patterns of change and their relationship to outcome and follow-up in group and individual psychotherapy for depression.

“…One initiative aimed at improving the efficacy of psychotherapy for depression was the research project "Efficacy of a dilemma-focused intervention for unipolar depression" (Feixas et al, 2013(Feixas et al, , 2018. In this project, the initiative taken by the researchers was studying factors related to psychopathology (section 1.2.1), particularly cognitive conflicts (CCs).…”

“…The current dissertation studied the patterns of change (trajectories) in a sample of patients that, in the context of a randomised controlled trial (RCT) for depression (Feixas et al, 2013(Feixas et al, , 2018, received two interventions sequentially: first, cognitive-behaviour group therapy (CBGT), regarded as low-intensity CBT (Söchting, Wilson, & De Gagné, 2010), for all patients, and then, one of two types of cognitive individual therapy (high-intensity treatments) where patients were randomly allocated to either standard cognitive-behaviour therapy (CBT; Beck, Rush, Shaw, & Emery, 1979) or dilemma-focused therapy (DFT; . Analyses of this RCT study both at end of therapy and follow up assessments (Feixas et al, , 2018 showed that both conditions of treatment were equally efficacious.…”

“…In the study of Feixas et al (2013Feixas et al ( , 2018, a self-report measure of depression was used as primary outcome, and general functioning, psychological distress, and indexes from the repertory grid technique (RGT; Kelly, 1955Kelly, /1991) -for assessing self-ideal discrepancy, perceived social isolation, and conflictual construction of the self-were used secondarily. In this study, the patterns are tracked in terms of psychological distress assessed session by session.…”

“…First, a review of state of the art regarding psychotherapy research and depression is presented. Second, the attempts that have been made to improve psychotherapy for depression, and the research programme from which the study of Feixas et al (2013Feixas et al ( , 2018 was designed, are explained. Third, recent paradigms in psychotherapy research and treatment personalisation, from which this dissertation was derived, are described.…”

“…Third, recent paradigms in psychotherapy research and treatment personalisation, from which this dissertation was derived, are described. Finally, the contributions of one of the instruments used in the study of Feixas et al (2013Feixas et al ( , 2018, the RGT, and its potential utilisation for treatment personalisation are discussed.…”