Psychoanalytic and cognitive-behavior therapy of chronic depression: study protocol for a randomized controlled trial

Abstract

BackgroundDespite limited effectiveness of short-term psychotherapy for chronic depression, there is a lack of trials of long-term psychotherapy. Our study is the first to determine the effectiveness of controlled long-term psychodynamic and cognitive-behavioral (CBT) treatments and to assess the effects of preferential vs. randomized assessment.Methods/designPatients are assigned to treatment according to their preference or randomized (if they have no clear preference). Up to 80 sessions of psychodynamic or psychoanalytically oriented treatments (PAT) or up to 60 sessions of CBT are offered during the first year in the study. After the first year, PAT can be continued according to the ‘naturalistic’ usual method of treating such patients within the system of German health care (normally from 240 up to 300 sessions over two to three years). CBT therapists may extend their treatment up to 80 sessions, but focus mainly maintenance and relapse prevention. We plan to recruit a total of 240 patients (60 per arm). A total of 11 assessments are conducted throughout treatment and up to three years after initiation of treatment. The primary outcome measures are the Quick Inventory of Depressive Symptoms (QIDS, independent clinician rating) and the Beck Depression Inventory (BDI) after the first year.DiscussionWe combine a naturalistic approach with randomized controlled trials(RCTs)to investigate how effectively chronic depression can be treated on an outpatient basis by the two forms of treatment reimbursed in the German healthcare system and we will determine the effects of treatment preference vs. randomization.Trial registrationhttp://www.controlled-trials.com/ISRCTN91956346

The INDDEP study: inpatient and day hospital treatment for depression – symptom course and predictors of change

“…It´s a common, internationally used, licence-free instrument which has a self-report and an expert rating form [23]. The QIDS was chosen as its total score is also used as the main outcome criterion in a large trial on outpatient psychotherapy for chronic depression that is currently conducted in Germany (“LAC-study”, [39]).…”

Pluralistic approaches to the study of process and outcome in psychoanalysis. The LAC depression study: a case in point

“…In the following paragraph, we are illustrate the theses discussed above that different forms of psychoanalytical research can be combined in a fruitful way. We will summarize an ongoing study comparing the outcome of psychoanalyses and psychoanalytic long-term therapies, on the one hand, and cognitive behavioural treatments, on the other hand (for details see Beutel et al, 2012;Leuzinger-Bohleber, 2015a).…”

“…On the other hand, we attempt simultaneously to further clinical and conceptual research of psychoanalysis and thus to represent, in a self-critical but authentic manner, psychoanalysis as an independent, specific research method in the actual discourse concerning the politics of health care. The LAC Study is a multi-centre study combining a naturalistic and an experimental design which facilitates the examination of the influence of randomized and preferred treatments (see Figure 2; for a full, detailed study protocol, see Beutel et al, 2012) 2 and to describe the course of the treatment effects. Furthermore, differential indication criteria are to be formulated.…”

Empirically supported methods of short-term psychodynamic therapy in depression – Towards an evidence-based unified protocol

“…From the presently available description of the treatment (Taylor, 2010), it is not clear whether specific treatment modules can be identified. In another ongoing RCT, this approach is presently being applied to the treatment of chronic depression (Beutel et al, 2012). Treatment duration was extended to up to 240-300 sessions.…”