Symptom-specific effects of counselling for depression compared to cognitive–behavioural therapy

Abstract

BackgroundCognitive–behavioural therapy (CBT) and counselling for depression (CfD) are recommended first-line treatments for depression. While they approach change differently, there is little understanding of the impact those approaches have on change during treatment.ObjectivesThis study aimed to identify whether CBT and CfD target different symptoms and explore the implications of modelling choices when quantifying change during treatment.MethodsSymptom-specific effects of treatment were identified using moderated network modelling. This was a retrospective cohort study of 12 756 individuals who received CBT or CfD for depression in primary/community care psychological therapy services in England. Change was modelled several ways within the whole sample and a propensity score matched sample (n=3446).FindingsCBT for depression directly affected excessive worry, trouble relaxing and apprehensive expectation and had a stronger influence on changes between suicidal ideation and concentration. CfD had a stronger direct influence on thoughts of being a failure and on the associated change between being an easily annoyed and apprehensive of expectation. There were inconsistencies when modelling change using the first and second appointments as the baseline. Residual score models produced more conservative findings than models using difference scores.ConclusionsCfD and CBT for depression have differential effects on symptoms demonstrating specific mechanisms of change.Clinical implicationsCBT was uniquely associated with changes in symptoms associated with anxiety and may be better suited to those with anxiety symptoms comorbid to their depression. When assessing change, the baseline should be the first therapy session, not the pretreatment assessment. Residual change scores should be preferred over difference score methods.

Towards precision in the diagnostic profiling of patients: leveraging symptom dynamics as a clinical characterisation dimension in the assessment of major depressive disorder

“…secondary) effects on specific symptoms via changes first occurring in other symptoms directly influenced by treatments. 42 , 43 This reflects that an understanding of the symptom relationship patterns in a particular patient presents opportunities for personalised treatment. A recent trial investigated this by obtaining the symptom relationship patterns of different individuals with eating disorders through ecological momentary assessments, where clinicians thereafter used this information to match patients to specific evidence-based psychotherapy modules aimed at targeting symptoms with the strongest and highest number of connections to other symptoms in each patient.…”

Towards precision in the diagnostic profiling of patients: leveraging symptom dynamics in the assessment of major depressive disorder

“…This is because recent studies have found indirect (i.e. secondary) effects on specific symptoms via changes first occurring in other symptoms directly influenced by treatments [46][47][48] . This reflects that an understanding of the symptom relationship patterns in a patient presents opportunities for personalised treatment.…”

Examining bi-directional change in sleep and depression symptoms in individuals receiving routine psychological treatment

“…For the primary analysis, the PHQ-2 and the sleep item were used as the ‘sleep’ and ‘depressive symptom’ factors. Recent findings indicate that the second, rather than first, session might be better to use as the baseline when modelling change in symptoms during and pre-post treatment in settings such as those from which data were gathered for this study ( O'Driscoll et al, 2023 ). This is because the first appointment is an assessment, whereas the second session is typically the point at which formal treatment starts.…”