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

Abstract

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.

Psychological interventions for depression in children and adolescents: A bibliometric analysis

“…In the treatment of PDD, the combination therapy of CBASP and drugs often showed significant superiority is superior to when they are applied alone[ 27 ]. The baseline depression, anxiety, previous medications, and traumatic childhood experiences might moderate the efficacy of CBASP, which also suggests the most appropriate treatment decisions should take into account individual characteristics[ 27 - 29 ]. In addition, the most frequently reported negative effect was dependence on the therapist, which might be associated with a worse treatment outcome[ 26 ].…”

Depressive Disorder: A General Overview

“…The combination of antidepressant medication and psychotherapy to treat dysthymia has superiority [10]. particularly for those who have been depressed for an extended period of time It was determined to create the Cognitive Behavioral Analysis System of Psychotherapy for short [11]. This strategy makes use of an organized, guided "social problem-solving algorithm" to handle interpersonal obstacles, including how individuals establish cognitive and behavioral patterns, as well as how they manage issues pertaining to their relationships.…”

New Perspectives of Persistent Depressive Disorder

“…In a study of a 48 weeks clinical experiment comparing cognitive behavioral analysis system of psychotherapy and supportive psychotherapy in adult antidepressant-free patients with early-onset persistent depressive disorder, researchers set some variables from the following domains as hypotheses and reasons for treatment effectiveness: sociodemography, clinical status, psychosocial and global functioning, life quality, interpersonal problems, childhood trauma, treatment history, preference for psychotherapy, and treatment expectancy. They conclude that abuse, communication problems, and anxiety cause the severe symptoms of depression, including suicide and unpleasant childhood experiences, which is why psychotherapy is not useful in patients with the early-onset persistent depressive disorder [11]. Improving spatial working memory and attention through specific management methods may also help young people get better at these symptoms of depressive disorders [9].…”