Personality and outcome in individuals with treatment-resistant depression—Exploring differential treatment effects in the Tavistock Adult Depression Study (TADS).

Abstract

Objective: Although research over the past decades has investigated the impact of the personality dimensions of dependency and self-criticism on treatment outcome, little is known of how these personality features influence responsiveness to treatment in patients with severe, chronic forms of depression. Method: The present study uses data from the Tavistock Adult Depression Study (TADS), a randomized controlled trial investigating the effectiveness of long-term psychoanalytic psychotherapy (LTPP) compared with treatment as usual (TAU) for individuals diagnosed with treatment-resistant depression. Patients were rated with the Anaclitic Introjective Depression Assessment Q-sort, which distinguishes between two more maladaptive (Submissive and Dismissive) and two less maladaptive (Needy and Self-Critical) subdimensions of dependent or anaclitic and self-critical or introjective depression. Multilevel modeling was used to compare individuals' growth curves of depression severity as measured by the Hamilton Rating Scale for Depression over the 18months treatment period and two-year follow-up. Rates of clinically significant change were also determined. Results: As expected, depressed patients with more maladaptive dependent and self-critical features did not benefit from LTPP or TAU. Patients with less maladaptive self-critical features benefitted from both LTPP and TAU, while those with less maladaptive dependent features showed considerable gains from LTPP but not from TAU, with medium to large effect sizes. Conclusions: Findings of this study are consistent with existing research suggesting the need to modify and tailor treatments in accordance to individuals' pretreatment personality features. Given the time and cost-intensive nature of longer-term treatment, this may be particularly important in patients with treatment-resistant depression.

Changes in anaclitic and introjective personality features in psychoanalysis: A clinician-report study.

“…To place these findings in context, a discussion of the sample is warranted. Most recent outcome studies involving psychoanalysis (Knekt et al, 2011) and long-term psychoanalytic psychotherapy (e.g., Blatt, 1992;Knekt et al, 2017;Rost et al, 2019) have involved samples with greater levels of functional impairment compared to those in the present study. Despite patients in the present study having a better functional status, the sample also reflects individuals whose functional impairment improved following psychoanalysis, which lends support that patients in this study achieved functional gains after treatment.…”

“…Numerous studies support the notion that individuals with anaclitic and introjective depression differentially respond to treatment and usually do so in ways that are consistent with their underling personality organization (e.g., Blatt, 1992;Blatt & Felsen, 1993;Blatt & Ford, 1994;Blatt & Shahar, 2004;Rost et al, 2019). Individuals with anaclitic, or dependent/relatedness, dynamics will often experience intense longings for connection and emotional support and will have powerful worries about loss, separation, or abandonment.…”

“…Needy features were related to high affiliation, and Submissive features were related to high affiliation and low dominance. Rost et al (2019) examined adult participants from the Tavistock Adult Depression Study (TADS; Fonagy et al, 2015), wherein they compared weekly long-term psychoanalytic psychotherapy versus treatment as usual (e.g., cognitive behavioral therapy (CBT), counseling, etc.) for individuals diagnosed with treatment-resistant depression.…”

Negative Effects of a Multimodal Inpatient CBASP Program: Rate of Occurrence and Their Impact on Treatment Outcome in Chronic and Treatment-Resistant Depression

“…• In addition, the level of severity of the personality dimension "dependency" may have a differential influence on the treatment outcome. Interestingly, a recent study investigated the impact on treatment outcome of the personality dimension dependency according to Blatt (54) in treatment-resistant chronically depressed patients and found that patients with more maladaptive dependent features did not benefit from a long-term psychoanalytic psychotherapy (LTPP) or treatment as usual (TAU), while those with less maladaptive dependent features showed considerable gains from LTPP but not from TAU (55). • The specific strategies of CBASP might trigger dependence on the therapist.…”

Q‐sort methodology: Bridging the divide between qualitative and quantitative. An introduction to an innovative method for psychotherapy research

“…In a second study, Rost et al. (2019) found statistical and clinical significant differential treatment responses between these four groups of depressed individuals, calling for the need to tailor psychotherapy to individuals’ pre‐treatment personality features and functioning.…”