Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder

Serbanescu, Ilinca; Walter, Henrik; Schnell, Knut; Kessler, Henrik; Weber, Bernd; Drost, Sarah; Groß, Magdalena; Neudeck, Peter; Klein, Jan Philipp; Assmann, Nele; Zobel, Ingo; Backenstraß, Matthias; Hautzinger, Martin; Meister, Richard; Härter, Martin; Schramm, Elisabeth; Schoepf, Dieter

doi:10.1016/j.brat.2019.103512

Cited by 11 publications

(19 citation statements)

References 39 publications

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“…Although the authors caution against the strong interpretation of their estimates, and the idea of partitioning "variance explained" in psychotherapy has been criticized (DeRubeis, Gelfand, et al, 2014) these numbers may make one pessimistic about the potential benefits of matching patients, at least to NDST versus a specific therapeutic condition like CBT. If only a small percentage of variance is accounted for by specific therapeutic techniques versus non-specific therapeutic support, it is sensible to question how much could be accounted for contrasts of two different techniques (but, see Serbanescu et al (2020)). When the techniques are very different (e.g., behavioral activation vs. psychoanalysis), it may be expected that completely different types of patients benefit from the interventions.…”

Section: Powermentioning

confidence: 99%

Personalized Medicine and Cognitive Behavioral Therapies for Depression: Small Effects, Big Problems, and Bigger Data

et al. 2020

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Cognitive-behavioral therapies (CBTs) are the most widely studied form of psychotherapy for disorders like depression and anxiety. Nonetheless, there is heterogeneity in response to CBTs vs. other treatments. Researchers have become increasingly interested in using pre-treatment individual differences (i.e., moderators) to match patients to the most effective treatments for them. Several methods to combine multiple variables to create precision treatment rules (PTRs) that identify subgroups have been proposed. We review the rationale behind multivariable PTRs as well as the findings of studies that have used different PTRs. We identify conceptual and methodological issues in the literature. Multivariable treatment assignment is a promising avenue of research. Nonetheless, effect sizes appear to be small and most of the samples that have been used to study these questions have been grossly underpowered to detect small effects. We recommend researchers explore multivariable treatment selection strategies, particularly those resembling risk-stratification, in heterogeneous samples of patients undergoing low-intensity CBTs vs. realistic minimal controls.

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Section: Powermentioning

confidence: 99%

Personalized Medicine and Cognitive Behavioral Therapies for Depression: Small Effects, Big Problems, and Bigger Data

et al. 2020

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“…So far, a number of secondary analyses of this trial have been performed in order to analyze if CBASP outperformed SP for patients with early trauma (16), comorbid personality disorders (17), comorbid anxiety disorders (18), as well as various baseline characteristics combined to one single moderator (19). With regard to early trauma, only those patients reporting early severe-to-moderate emotional abuse seemed to benefit significantly more from CBASP than from SP at week 20 (16).…”

Section: Introductionmentioning

confidence: 99%

“…However, the CBASP was significantly more effective than SP in patients with comorbid anxiety disorders compared to those without anxiety disorders in terms of both depression severity and interpersonal problems as outcomes (18). In a more recent secondary analysis (19), the data of this trial was analyzed with a modern moderator approach combined with two machine learning algorithms. An optimal composite moderator (M * ) was developed as a weighted combination of 13 preselected baseline variables and used for identifying and characterizing subgroups for which CABSP was more beneficial to SP and vice versa, focusing on the change in depression severity from baseline to week 48.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the present analysis will also examine the same baseline variables as moderators of differential treatment effectiveness of CBASP vs. SP at week 48. This will be done for statistical reasons (for determining if a variable is a predictor, one has to examine its interaction effect with the group variable), as well as for reasons of comparability with the previous moderator analysis (19) which was based on a more modern approach. Statistical models such as the one applied in the previous analysis (19), which are based on integrating several multi-domain baseline variables into one moderator to identify subpopulations with different treatment responses, are particularly useful for the prediction of treatment response in samples which are sufficiently statistically powered, and can be further validated as a prediction algorithm in new clinical populations.…”

Section: Introductionmentioning

confidence: 99%

“…This will be done for statistical reasons (for determining if a variable is a predictor, one has to examine its interaction effect with the group variable), as well as for reasons of comparability with the previous moderator analysis (19) which was based on a more modern approach. Statistical models such as the one applied in the previous analysis (19), which are based on integrating several multi-domain baseline variables into one moderator to identify subpopulations with different treatment responses, are particularly useful for the prediction of treatment response in samples which are sufficiently statistically powered, and can be further validated as a prediction algorithm in new clinical populations. In comparison, the more classical approach of selecting and testing one baseline variable as predictor and moderator per model, which will be used in the analysis presented here, provides evidence about the individual impact of single baseline characteristics on the treatment outcome.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder

et al. 2020

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Importance: In the treatment of persistent depressive disorder (PDD), disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been shown to be superior to Supportive Psychotherapy (SP) in outpatients. It remains to clear which subgroups of patients benefit equally and differentially from both psychotherapies.Objective: To identify those patient-level baseline characteristics that predict a comparable treatment effectiveness of CBASP and SP and those that moderate the differential effectiveness of CBASP compared to SP.Design, setting and participants: In this analysis of a 48-week multicenter randomized clinical trial comparing CBASP to SP in adult antidepressant-free outpatients with early-onset PDD, we evaluated baseline variables from the following domains as potential predictors and moderators of treatment effectiveness: socio-demography, clinical status, psychosocial and global functioning, life quality, interpersonal problems, childhood trauma, treatment history, preference for psychotherapy, and treatment expectancy.Interventions: A 48-week treatment program with 32 sessions of either CBASP or SP.Main outcomes and measures: Depression severity measured by the 24-item Hamilton Rating Scale for Depression (HRSD-24) at week 48.Results: From N = 268 randomized outpatients, N = 209 completed the 48-week treatment program. CBASP completers had significantly lower post-treatment HRSD-24 scores than SP completers (meanCBASP=13.96, sdCBASP= 9.56; meanSP= 16.69, sdSP= 9.87; p = 0.04). A poor response to both therapies was predicted by higher baseline levels of clinician-rated depression, elevated suicidality, comorbid anxiety, lower social functioning, higher social inhibition, moderate-to-severe early emotional or sexual abuse, no preference for psychotherapy, and the history of at least one previous inpatient treatment. Moderator analyses revealed that patients with higher baseline levels of self-rated depression, comorbidity of at least one Axis-I disorder, self-reported moderate-to-severe early emotional or physical neglect, or at least one previous antidepressant treatment, had a significantly lower post-treatment depression severity with CBASP compared to SP (all p < 0.05).Conclusions and relevance: A complex multifactorial interaction between severe symptoms of depression, suicidality, and traumatic childhood experiences characterized by abuse, social inhibition, and anxiety may represent the basis of non-response to psychotherapy in patients with early onset PDD. Specific psychotherapy with CBASP might, however, be more effective and recommendable for a variety of particularly burdened patients compared to SP.

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Identifying subgroups with differential response to CBASP versus Escitalopram during the first eight weeks of treatment in outpatients with persistent depressive disorder

Serbanescu,

Schramm,

Walter

et al. 2023

Eur Arch Psychiatry Clin Neurosci

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There exists little empirical evidence helping clinicians to select the most effective treatment for individual patients with persistent depressive disorder (PDD). This study identifies and characterizes subgroups of patients with PDD who are likely to benefit more from an acute treatment with psychotherapy than from pharmacotherapy and vice versa. Non-medicated outpatients with PDD were randomized to eight weeks of acute treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP; n = 29) or escitalopram plus clinical management (ESC/CM; n = 31). We combined several baseline variables to one composite moderator and identified two subgroups of patients: for 56.0%, ESC/CM was associated with a greater reduction in depression severity than CBASP, for the remaining 44.0%, it was the other way around. Patients likely to benefit more from ESC/CM were more often female, had higher rates of moderate-to-severe childhood trauma, more adverse life events and more previous suicide attempts. Patients likely to benefit more from CBASP were older, had more often an early illness onset and more previous treatments with antidepressants. Symptomatic response, remission, and reductions in symptom severity occurred more often in those patients treated with their likely more effective treatment condition. The findings suggest that the baseline phenotype of patients with PDD moderates their benefit from acute treatment with CBASP relative to ESC/CM. Once confirmed in an independent sample, these results could serve to guide the choice between primarily psychotherapeutic or pharmacological treatments for outpatients with PDD.

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Combining baseline characteristics to disentangle response differences to disorder-specific versus supportive psychotherapy in patients with persistent depressive disorder

Cited by 11 publications

References 39 publications

Personalized Medicine and Cognitive Behavioral Therapies for Depression: Small Effects, Big Problems, and Bigger Data

Personalized Medicine and Cognitive Behavioral Therapies for Depression: Small Effects, Big Problems, and Bigger Data

Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder

Identifying subgroups with differential response to CBASP versus Escitalopram during the first eight weeks of treatment in outpatients with persistent depressive disorder

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