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Differential efficacy of cognitive behavioral therapy and psychodynamic therapy for major depression: a study of prescriptive factors

Published online by Cambridge University Press:  11 January 2016

E. Driessen ,
N. Smits ,
J. J. M. Dekker ,
J. Peen ,
F. J. Don ,
S. Kool ,
D. Westra ,
M. Hendriksen ,
P. Cuijpers  and
H. L. Van
E. Driessen*
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands
N. Smits
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands
J. J. M. Dekker
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands Arkin Mental Health Care, Amsterdam, The Netherlands
J. Peen
Affiliation:
Arkin Mental Health Care, Amsterdam, The Netherlands
F. J. Don
Affiliation:
Arkin Mental Health Care, Amsterdam, The Netherlands ProPersona Mental Health, Nijmegen, The Netherlands
S. Kool
Affiliation:
Arkin Mental Health Care, Amsterdam, The Netherlands
D. Westra
Affiliation:
Arkin Mental Health Care, Amsterdam, The Netherlands
M. Hendriksen
Affiliation:
Arkin Mental Health Care, Amsterdam, The Netherlands
P. Cuijpers
Affiliation:
Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands
H. L. Van
Affiliation:
Arkin Mental Health Care, Amsterdam, The Netherlands
*
*Address for correspondence: Dr E. Driessen, Faculty of Psychology and Education, Department of Clinical Psychology, VU University Amsterdam, Transitorium 2B-57, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. (Email: e.driessen@vu.nl)
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Abstract

Background

Minimal efficacy differences have been found between cognitive behavioral therapy (CBT) and psychodynamic therapies for depression, but little is known about patient characteristics that might moderate differential treatment effects. We aimed to generate hypotheses regarding such potential prescriptive factors.

Method

We conducted post-hoc model-based recursive partitioning analyses alongside a randomized clinical trial comparing the efficacy of CBT and short-term psychodynamic supportive psychotherapy (SPSP). Severely depressed patients received additional antidepressant medication. We included 233 adults seeking treatment for a major depressive episode in psychiatric outpatient clinics, who completed post-treatment assessment. Post-treatment mean Hamilton Depression Rating Scale scores constituted the main outcome measure.

Results

While treatment differences (CBT v. SPSP) were minimal in the total sample of patients (d = 0.04), model-based recursive partitioning indicated differential treatment efficacy in certain subgroups of patients. SPSP was found more efficacious among moderately depressed patients receiving psychotherapy only who showed low baseline co-morbid anxiety levels (d = −0.40) and among severely depressed patients receiving psychotherapy and antidepressant medication who reported a duration of the depressive episode of ⩾1 year (d = −0.31), while CBT was found more efficacious for such patients reporting a duration <1 year (d = 0.83).

Conclusions

Our findings are observational and need validation before they can be used to guide treatment selection, but suggest that knowledge of prescriptive factors can help improve the efficacy of psychotherapy for depression. Depressive episode duration and co-morbid anxiety level should be included as stratification variables in future randomized clinical trials comparing CBT and psychodynamic therapy.

Keywords

Depressionprescriptive factorspsychotherapies
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 4 , March 2016 , pp. 731 - 744
Copyright
Copyright © Cambridge University Press 2016 

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