Third-wave cognitive therapy versus mentalisation-based treatment for major depressive disorder: a randomised clinical trial

Abstract

ObjectiveTo compare the benefits and harms of third-wave cognitive therapy versus mentalisation-based therapy in a small sample of depressed participants.SettingThe trial was conducted at an outpatient psychiatric clinic for non-psychotic patients in Roskilde, Denmark.Participants44 consecutive adult participants diagnosed with major depressive disorder.Interventions18 weeks of third-wave cognitive therapy (n=22) versus 18 weeks of mentalisation-based treatment (n=22).OutcomesThe primary outcome was the Hamilton Rating Scale for Depression (HDRS) at end of treatment (18 weeks). Secondary outcomes were: remission (HDRS <8), Beck's Depression Inventory, Symptom Checklist 90 Revised and The WHO-Five Well-being Index 1999.ResultsThe trial inclusion lasted for about 2 years as planned but only 44 out of the planned 84 participants were randomised. Two mentalisation-based participants were lost to follow-up. The unadjusted analysis showed that third-wave participants compared with mentalisation-based participants did not differ significantly regarding the 18 weeks HDRS score (12.9 vs 17.0; mean difference −4.14; 95% CI −8.30 to 0.03; p=0.051). In the analysis adjusted for baseline HDRS score, the difference was favouring third-wave cognitive therapy (p=0.039). At 18 weeks, five of the third-wave participants (22.7%) were in remission versus none of the mentalisation-based participants (p=0.049). We recorded no suicide attempts or suicides during the intervention period in any of the 44 participants. No significant differences were found between the two intervention groups on the remaining secondary outcomes.ConclusionsThird-wave cognitive therapy may be more effective than mentalisation-based therapy for depressive symptoms measured on the HDRS. However, more randomised clinical trials are needed to assess the effects of third-wave cognitive therapy and mentalisation-based treatment for depression.Trial registration numberRegistered with Clinical Trials government identifier: NCT01070134.

Mentalization‐based treatment and its evidence‐base status: A systematic literature review

“…Jakobsen et al . () developed a RCT ( N = 44) that compared the benefits of 5 months of third‐wave (non‐specified) cognitive therapy (CT) with 5 months of MBT. The mean depression and psychiatric symptoms decreased for both conditions, but the analyses indicated that the third‐wave CT group achieved significantly greater reduction in the scores of the HDRS than the MBT group ( p = .039).…”

“…There are some limitations to this review. First, it was limited to articles written in English which may impact on the findings, particularly given the increasing body of MBT research conducted in Scandinavian countries (Bo et al ., ; Jakobsen et al ., ; Jørgensen et al ., , ; Thomsen et al ., ). Additionally, papers with non‐significant results are less likely to be published in peer‐reviewed journals, or if they are published, is more likely to be in non‐English journals (Egger et al ., ), suggesting that this review might contribute to publication bias by not including such studies.…”

“…Clinicians have incorporated MBT as an intervention for a wide range of clinical presentations (Bateman & Krawitz, ) such as eating disorders (Balestrieri, Zuanon, Pellizzari, Zappoli‐Thyrion, & Ciano, ; Robinson et al ., ), depression (Jakobsen et al ., ), and self‐harm (Rossouw & Fonagy, ) among others. MBT has been implemented in different countries such as Denmark and the Netherlands (Bales et al ., ; Jakobsen et al ., ; Jørgensen et al ., ) and is recommended in the Australian Clinical Practice guidelines (National Health and Medical Research Council, ) for the treatment and management of BPD. However, MBT is still not recommended as a first‐line First‐line treatment refers to the therapy with more scientific evidence supporting its efficacy and effectiveness.…”

Evaluation of Anticancer Generic Drugs and Branded Drugs

“…Cancer is associated not only with physical symptoms but also with a tremendous psychological impact 15 . The cost of anti-cancer drugs plays a major influence on the availability and utilization of them by the patients especially in resource poor country like India.…”

Cost analysis of oral antidepressant drugs available in India

“…Depression is associated with social, occupational, and physical impairment and mortality. [11] The cost of antidepressant drugs is a major deciding factor for patient's compliance. Owing to lack of information on comparative drug prices and quality, it is difficult for health-care providers to prescribe the most economical treatment.…”