1. The Efficacy of Cognitive-Behavioral Therapy and Psychodynamic Therapy in the Outpatient Treatment of Major Depression: A Randomized Clinical Trial.
- Author
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Driessen, Ellen, Vanx, Henricus L., Don, Frank J., Peen, Jaap, Kool, Simone, Westra, Dieuwertje, Hendriksen, Mariëlle, Schoevers, Robert A., Cuijpers, Pim, Twisk, Jos W.R., and Dekker, Jack J.M.
- Subjects
MENTAL depression ,COGNITIVE therapy ,HAMILTON Depression Inventory ,ANTIDEPRESSANTS ,DISEASE remission - Abstract
Objective: The efficacy of psychodynamic therapies for depression remains open to debate because of a paucity of high-quality studies. The authors compared the efficacy of psychodynamic therapy with that of cognitive-behavioral therapy (CBT), hypothesizing nonsignificant differences and the noninferiority of psychodynamic therapy relative to CBT. Method: A total of 341 adults who met DSM-IV criteria for a major depressive episode and had Hamilton Depression Rating Scale (HAM-D) scores ⩾14 were randomly assigned to 16 sessions of individual manualized CBT or short-term psychodynamic supportive therapy. Severely depressed patients (HAM-D score >24) also received antidepressant medication according to protocol. The primary outcome measure was posttreatment remission rate (HAM-D score ⩽7). Secondary outcome measures included mean posttreatment HAM-D score and patient-rated depression score and 1-year follow-up outcomes. Data were analyzed with generalized estimating equations and mixedmodel analyses using intent-to-treat samples. Noninferiority margins were prespecified as an odds ratio of 0.49 for remission rates and a Cohen's d value of 0.30 for continuous outcome measures. Results: No statistically significant treatment differences were found for any of the outcome measures. The average posttreatment remission rate was 22.7%. Noninferiority was shown for posttreatment HAM-D and patient-rated depression scores but could not be demonstrated for posttreatment remission rates or any of the followup measures. Conclusions: The findings extend the evidence base of psychodynamic therapy for depression but also indicate that timelimited treatment is insufficient for a substantial number of patients encountered in psychiatric outpatient clinics. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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