Effects up to 20-Year Follow-Up of Preventive Cognitive Therapy in Adults Remitted from Recurrent Depression: The DELTA Study

Abstract

<b><i>Introduction:</i></b> Major depressive disorder (MDD) is common, and recurrence rates are high. Preventive Cognitive Therapy (PCT), has been shown to prolong time to recurrence and reduce risk of recurrence(s) over 2–10 years in patients with recurrent depression. <b><i>Objective:</i></b> The aim of the study was to examine the effectiveness of PCT over 20 years on time to first recurrence, cumulative proportion of first recurrences, percentage of depression-free time, mean severity of recurrences, and the number of recurrences within a patient. <b><i>Methods:</i></b> Adults remitted from recurrent MDD were randomized to PCT or Treatment As Usual (TAU). Clinical outcomes were assessed using the SCID over 20 years. We used Cox regression analyses, Kaplan-Meier analyses, ANOVA, and negative binomial regression and tested for interaction with the number of previous episodes. <b><i>Results:</i></b> There was a significant interaction effect for number of previous episodes with treatment condition on time to first recurrence (Wald[1, <i>n</i> = 172] = 8.840, <i>p</i> = 0.003). For participants with more than 3 previous episodes, the mean time to recurrence was 4.8 years for PCT versus 1.6 years for TAU; the cumulative proportion of first recurrences was 87.5% for PCT and 100% for TAU. For participants with more than 3 previous episodes, exploratory analyses suggest that PCT had 53% less recurrences and percentage of depression-free time was significantly higher compared to TAU. There were no significant effects on mean severity. <b><i>Conclusions:</i></b> Up to 20 years, for MDD patients with more than 3 previous episodes, those who received PCT had significantly longer time to a first recurrence and lower recurrence risk and may have less recurrences and more depression-free time compared to TAU. This suggests long term protective effects of PCT up to 20-years.

Alleviating the burden of depression: a simulation study on the impact of mental health services

“…Although chronic cases account for over four fifths of the disease burden, these cases are not adequately addressed by the current healthcare system. Given the lifelong course of the disease in many cases, a long-term perspective and more flexible strategies to manage depression are needed (Bockting et al , 2015 ; Legemaat et al , 2023 ). During symptom-free periods, low-intensity digital interventions might be applied to prolong periods of well-being and monitor symptoms in order to detect relapses and initiate adequate treatment without delays (Kordy et al , 2016 ).…”

Understanding mechanisms of depression prevention: study protocol of a randomized cross-over trial to investigate mechanisms of mindfulness and positive fantasizing as intervention techniques for reducing perseverative cognition in remitted depressed individuals

“…The positive fantasizing technique is part of the PCT intervention [ 22 ]. PCT has been shown to be effective in preventing for depressive relapse and reducing depressive symptoms [ 13 , 15 , 16 , 18 , 19 , 42 ]. In our previous study [ 29 ], we isolated a short fantasizing exercise of ten minutes from the full protocol, and found that a single session was effective at reducing negative affect when measured directly after the single-session intervention.…”

“…Two psychological interventions, namely positive fantasizing and mindfulness , are core therapeutic components of multiple sessions protocolized treatments. Preventive Cognitive Therapy (PCT) delivered during the remitted phase has proven effective in lowering relapse risk [ 13 – 19 ]. Positive fantasizing is a core component of PCT that is aimed at challenging dysfunctional attitudes and schemas by using positive phantasy with help of imagery, enhancing positive affect and positive cognitions.…”

“…Comparing the effects of interventions in both rMDD and ND individuals allows us to study whether therapeutic techniques, developed and often studied in a clinical sample, work similar or different in ND individuals. Since most studies focus on the effects of mindfulness and positive fantasizing in a clinical sample [ 16 , 19 , 27 , 28 , 42 ], we hypothesize these techniques to be effective in reducing PC in rMDD individuals but expect that the interventions may show different effects on PC in ND individuals.…”

A Dynamical Systems View of Psychiatric Disorders—Practical Implications

“…Population studies suggest that mental health may be improved through lifestyle elements such as physical exercise, 44 social activity, 45 and diet composition. 46,47 However, for any individual it may be challenging to reveal which lifestyle changes or therapies 48 work. Data on traditional end points such as recurrence may take long to obtain.…”