Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research.

Abstract

Previous quantitative reviews of research on the efficacy of psychotherapy for depression have included only a subset of the available research or limited their focus to a single outcome measure. The present review offers a more comprehensive quantitative integration of this literature. Using studies that compared psychotherapy with either no treatment or another form of treatment, this article assesses (a) the overall effectiveness of psychotherapy for depressed clients, (b) its effectiveness relative to pharmacotherapy, and (c) the clinical significance of treatment outcomes. Findings from the review confirm that depressed clients benefit substantially from psychotherapy, and these gains appear comparable to those observed with pharmacotherapy. Initial analysis suggested some differences in the efficacy of various types of treatment; however, once the influence of investigator allegiance was removed, there remained no evidence for the relative superiority of any 1 approach. In view of these results, the focus of future research should be less on differentiating among psychotherapies for depression than on identifying the factors responsible for improvement. Depression is a prevalent clinical disorder with high economic and emotional costs. Epidemiological research has indicated that 10%-20% of the population experience a major depressive episode at some point in their lifetime (Boyd & Weissman, 1981), with the incidence highest during the adult years when family and career responsibilities may be most adversely affected (Weissman & Myers, 1978). Although the remission rate for depressive disorders is relatively high (Beck, 1967, chap. 3), a substantial portion of those afflicted remain chronically depressed (Weissman & Klerman, 1977), and those who do improve are at an increased risk for further episodes (Belsher & Costello, 1988;Kessler, 1978; Klerman, 1978). Until recently, depression was treated almost exclusively with medication, traditional insight-oriented therapy, or a combination of the two. However, the 1970s witnessed the development of a number of new therapeutic approaches, each of which pos

Preventing hung juries about therapy studies.

“…Particularly compelling is the meta-analysis of the psychotherapy of depression by Robinson, Berman, and Neimeyer (1990) . The average effect size derived from 29 studies that compared psychotherapy with waiting-list controls was 0.84 ( p < .05); however, the average effect size derived from the nine studies that compared psychotherapy with placebo was 0.28, insignificant both clinically and statistically.…”

“…The average effect size derived from 29 studies that compared psychotherapy with waiting-list controls was 0.84 ( p < .05); however, the average effect size derived from the nine studies that compared psychotherapy with placebo was 0.28, insignificant both clinically and statistically. In the peculiarly convoluted fashion that seems standard in dealing with uncomfortable facts, Robinson et al (1990) state the following:…”

Resting-State Connectivity Predictors of Response to Psychotherapy in Major Depressive Disorder

“…The lifetime prevalence rate of MDD is 16%, with an estimated 32-35 million US residents expected to develop the disorder during their lifetimes (Kessler et al, 2003). Despite the societal burden of MDD, there has been relatively little progress in improving the efficacy of established antidepressant treatments (Fournier et al, 2010;Undurraga and Baldessarini, 2012): first-line FDA-approved pharmacotherapies demonstrate average response rates of 54 vs 37% for placebo (Levkovitz et al, 2011),with similar response rates to psychotherapy (Butler et al, 2006;Robinson et al, 1990). Although a number of novel antidepressant agents are currently under development (Murrough and Charney, 2012), one approach to ameliorating the societal burden of MDD is to improve response rates to currently available antidepressant treatments by developing methods to match specific patients to personalized, empirically validated treatments (Kapur et al, 2012;.…”

Benchmarks for psychotherapy efficacy in adult major depression.

“…One factor that Weersing and Weisz (2002) did not explicitly pursue as a potential methodological issue in conducting benchmarking studies was the reactivity and specificity of outcome measures, which have repeatedly been shown to significantly affect the effect size estimates of treatment outcomes (Lambert & Bergin, 1994;Lambert, Hatch, Kingston, & Edwards, 1986;Robinson, Berman, & Neimeyer, 1990;Shadish et al, 1993Shadish et al, , 1997Shadish et al, , 2000Shapiro & Shapiro, 1982;Smith, Glass, & Miller, 1980). Reactivity is generally concerned with the sensitivity of the measure produced by the rater of the outcome-notably, an observer (either the treating clinician or an independent rater) or the client.…”