Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies.

Cuijpers, Pim; Straten, Annemieke van; Andersson, Gerhard; Oppen, Patricia van

doi:10.1037/a0013075

Cited by 883 publications

(547 citation statements)

References 83 publications

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“…In our sample, 86% of participants had at least one comorbid anxiety disorder (versus 56% in the perinatal sample), which could suppress treatment response (34). Furthermore, depression chronicity in our sample may explain the less robust treatment gains, as was found in a recent meta-analysis of treatments for chronic depression (39). …”

Section: Discussionmentioning

confidence: 77%

A Randomized Effectiveness Trial of Interpersonal Psychotherapy for Depressed Women With Sexual Abuse Histories

Talbot¹,

Chaudron²,

Ward³

et al. 2011

Psychiatric Services

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Objectives Many depressed women seen in community mental health centers (CMHCs) have histories of childhood sexual abuse and are economically disadvantaged. Randomized trials are needed to test the effectiveness of evidence-based interventions in this population and setting. This study compared interpersonal psychotherapy with usual care psychotherapy among women in a CMHC. Methods Among 1,100 women seeking treatment in a CMHC, 230 (21%) had major depression and histories of childhood sexual abuse. Seventy women with major depression and sexual abuse before age 18 were randomly assigned to interpersonal psychotherapy (N=37) or usual care psychotherapy (N=33). Staff clinicians provided all treatments. Participants were assessed at study entry and at ten, 24, and 36 weeks after random assignment. Generalized estimating equations were used to examine change over time. Results Compared with women assigned to usual care, women who received interpersonal psychotherapy had greater reductions in depressive symptoms (Hamilton Rating Scale, p=.05, d=.34; Beck Depression Inventory–II, p=.01, d=.29), posttraumatic stress disorder symptoms (p=.04, d=.76), and shame (p=.002, d=.38). Interpersonal psychotherapy and usual care yielded comparable improvements in social and mental health–related functioning. Conclusions Interpersonal psychotherapy compared favorably to usual care psychotherapy in a CMHC in improving psychiatric symptoms and reducing shame among sexually abused women. However, there is a critical need for continued research to develop more effective treatments for the social and psychiatric sequelae of interpersonal trauma and socioeconomic disadvantage.

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Section: Discussionmentioning

confidence: 77%

A Randomized Effectiveness Trial of Interpersonal Psychotherapy for Depressed Women With Sexual Abuse Histories

Talbot¹,

Chaudron²,

Ward³

et al. 2011

Psychiatric Services

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“…CBT is a first-line empirically supported treatment for depression, 11 which can be administered over the internet (ICBT) as guided self-help with limited online support from a therapist. Recent studies suggest that ICBT can be as effective in treating mild to moderate depression as face-to-face CBT, 12 and that tailored web-based interventions may confer additional treatment benefits in patients with high comorbidity.…”

mentioning

confidence: 99%

Exercise and internet-based cognitive–behavioural therapy for depression: multicentre randomised controlled trial with 12-month follow-up

et al. 2016

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BackgroundEvidence-based treatment of depression continues to grow, but successful treatment and maintenance of treatment response remains limited.AimsTo compare the effectiveness of exercise, internet-based cognitive–behavioural therapy (ICBT) and usual care for depression.MethodA multicentre, three-group parallel, randomised controlled trial was conducted with assessment at 3 months (post-treatment) and 12 months (primary end-point). Outcome assessors were masked to group allocation. Computer-generated allocation was performed externally in blocks of 36 and the ratio of participants per group was 1:1:1. In total, 945 adults with mild to moderate depression aged 18–71 years were recruited from primary healthcare centres located throughout Sweden. Participants were randomly assigned to one of three 12-week interventions: supervised group exercise, clinician-supported ICBT or usual care by a physician. The primary outcome was depression severity assessed by the Montgomery–Åsberg Depression Rating Scale (MADRS).ResultsThe response rate at 12-month follow-up was 84%. Depression severity reduced significantly in all three treatment groups in a quadratic trend over time. Mean differences in MADRS score at 12 months were 12.1 (ICBT), 11.4 (exercise) and 9.7 (usual care). At the primary end-point the group × time interaction was significant for both exercise and ICBT. Effect sizes for both interventions were small to moderate.ConclusionsThe long-term treatment effects reported here suggest that prescribed exercise and clinician-supported ICBT should be considered for the treatment of mild to moderate depression in adults.

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“…Meta-analytic analyses of comparative outcome studies indicate large differences in effectiveness among the major approaches to psychotherapy for most problems (Benish, Imel, & Wampold, 2008;Cuijpers, van Straten, Andersson, & van Oppen, 2008;Luborsky, Barrett, Antonuccio, Shoenberger, & Stricker, 2006;Luborsky, Rosenthal, Diguer, Andrusyna, & Berman, 2002;Westen & Morrison, 2001).…”

Section: Meta-analyses and Psychotherapy Processmentioning

confidence: 99%

Psychotherapy Outcome Research: Issues and Questions

Shean

2016

Psychodynamic Psychiatry

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Emphasis on identifying evidence-based therapies (EBTs) has increased markedly. Lists of EBTs are the rationale for recommendations for how psychotherapy provider training programs should be evaluated, professional competence assessed, and licensure and reimbursement policies structured. There are however methodological concerns that limit the external validity of EBTs. Among the most salient is the circularity inherent in randomized control trials (RCTs) of psychotherapy that constrains the manner in which the psychological problems are defined, psychotherapy can be practiced, and change evaluated. RCT studies favor therapies that focus of specific symptoms and can be described in a manual, administered reliably across patients, completed in relatively few sessions, and involve short-term evaluations of outcome. The epistemological assumptions of a natural science approach to psychotherapy research limit how studies are conducted and assessed in ways that that advantage symptom-focused approaches and disadvantage those approaches that seek to bring broad recovery-based changes. Research methods that are not limited to RCTs and include methodology to minimize the effects of "therapist allegiance" are necessary for valid evaluations of therapeutic approaches that seek to facilitate changes that are broader than symptom reduction. Recent proposals to adopt policies that dictate training, credentialing, and reimbursement based on lists of EBTs unduly limit how psychotherapy can be conceptualized and practiced, and are not in the best interests of the profession or of individuals seeking psychotherapy services.

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Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies.

Cited by 883 publications

References 83 publications

A Randomized Effectiveness Trial of Interpersonal Psychotherapy for Depressed Women With Sexual Abuse Histories

A Randomized Effectiveness Trial of Interpersonal Psychotherapy for Depressed Women With Sexual Abuse Histories

Exercise and internet-based cognitive–behavioural therapy for depression: multicentre randomised controlled trial with 12-month follow-up

Psychotherapy Outcome Research: Issues and Questions

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