Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy.

Abstract

A total of 117 depressed clients, stratified for severity, completed 8 or 16 sessions of manualized treatment, either cognitive-behavioral psychotherapy (CB) or psychodynamic-interpersonal psychotherapy (PI). Each of 5 clinician-investigators treated clients in all 4 treatment conditions. On most measures, CB and PI were equally effective, irrespective of the severity of depression or the duration of treatment. However, there was evidence of some advantage to CB on the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). There was no evidence that CB's effects were more rapid than those of PI, nor did the effects of each treatment method vary according to the severity of depression. There was no overall advantage to 16-session treatment over 8-session treatment. However, those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions.

The empirical status of cognitive-behavioral therapy: A review of meta-analyses

“…This study also experimentally manipulated the duration of treatment (8 sessions versus 16 sessions). At the end of treatment CBT and PIT were equally effective (Shapiro et al, 1994). However, 1 year after completing treatment, patients who had received 8 sessions of PIT did worse on almost all measures compared with the other three treatment conditions (8-session CBT, 16-session PIT, and 16-session CBT).…”

“…Parker et al (2003) reviewed meta-analyses and primary studies in this area and concluded that CBT is not as effective as proponents of the therapy suggest. However, they excluded from their review highquality clinical trials showing cognitive-behavioral therapy to be superior to alternative treatments at follow-up (see Shapiro et al, 1994 for a comparison with psychodynamic therapy; Blatt, Zuroff, Bondi, & Sanislow, 2000 for a comparison with antidepressant medication). Since Parker et al did not report the criteria by which they selected research studies for their review, it is difficult to interpret their conclusions.…”

Characteristics of effective psychological treatments of depression: a metaregression analysis

“…To show that there is no association between a characteristic and effect size, it is better to conduct a trial in which individuals are randomized to an intervention with the characteristic or an intervention without that characteristic. For example, using this method, several trials have examined the effects of individual versus group treatment (e.g., , longer versus shorter treatments (e.g., Shapiro, Barkham, Rees, Hardy, Reynolds, & Startup, 1994), and the comparative effects of different types of treatment (e.g., Zeist et al, 1979).…”

A meta-analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research-specific procedures.

“…Seven studies were excluded because the necessary data to enable effect size calculation were not available (Baldoni et al, 1995;Creed et al, 2003;Guthrie, Creed, Dawson, & Tomenson, 1993;Morris, 1975;Piper, Azim, McCallum, & Joyce, 1990;Sjodin, 1983;Svedlund, Sjodin, Ottosson, & Dotevall, 1983). Hardy et al (1995) was excluded because data were reported on a subsample of Shapiro et al (1994). This process yielded 41 independent RCTs of psychodynamic psychotherapy suitable for inclusion and meta-analysis.…”

“…In the case of nine papers (Cooper, Murray, Wilson, & Romaniuk, 2003;de Jonghe et al, 2004;Hamilton et al, 2000;Linnet and Jemec, 2001;Maina et al, 2005;Monsen & Monsen, 2000;Shapiro et al, 1994/Hardy et al, 1995Svartberg, Stiles, & Seltzer, 2004;Winston et al, 1994), ratings were completed by two coders because of overlap of studies in the authors' respective databases. Interrater reliability was computed for categorical data with the kappa coefficient, and all values (range ϭ 0.84 to 1.0) were in the excellent range (Ͼ0.74; Fleiss, 1981).…”