Investigating Care Dependency and Its Relation to Outcome (ICARE): Results From a Naturalistic Study of an Intensive Day Treatment Program for Depression

Abstract

Background: This study explores the association of experienced dependency in psychotherapy as measured with the CDQ (Care Dependency Questionnaire) and treatment outcome in depression. Furthermore, the course of care dependency and differences in the CDQ scores depending on the received type of treatment, MCT (metacognitive therapy), or CBASP (cognitive behavioral analysis system of psychotherapy), were investigated.Methods: The study follows a prospective, parallel group observational design. Patients suffering from depression received an 8-week intensive day clinic program, which was either CBASP or MCT. The treatment decision was made by clinicians based on the presented symptomatology and with regard to the patients' preferences. The patients reported depressive symptoms with the QIDS-SR16 (Quick Inventory of Depressive Symptomatology) and levels of experienced care dependency with the German version of the CDQ on a weekly basis. Mixed-model analyses were run to account for the repeated-measures design.Results: One hundred patients were included in the analyses. Results indicate that higher levels of care dependency might predict a less favorable outcome of depressive symptomatology. Levels of care dependency as well as depressive symptoms decreased significantly over the course of treatment. There was no significant between-group difference in care dependency between the two treatment groups.Conclusion: The results suggest that care dependency might be associated with a worse treatment outcome in depressed patients. In general, care dependency seems to be a dynamic construct, as it is changing over time, while the levels of care dependency seem to be independent from the received type of treatment. Future research should continue investigating the mechanisms of care dependency in a randomized controlled design.Clinical Trial Registration:https://www.drks.de/drks_web/, identifier: DRKS00023779.

“I Need You!” Patients’ Care Dependency Patterns During Psychotherapy for Personality Disorders and Its Association with Symptom Reduction and Wish for Treatment Continuation

“…That means that both the specific characteristics of this patients sample as well as the type of treatment (i.e., group psychotherapy according to psychodynamic or schema-focused therapy) may have influenced patients' care dependency patterns during treatment. Although comparable results have been found in a clinical sample with depressed patients and other types of treatment (metacognitive therapy versus cognitive behavioral analysis system of psychotherapy, both delivered in an 8-week day treatment program, Glanert et al, 2021), it is still unknown to what extent the current findings can be generalized to other patient groups and to different treatment approaches and treatment modalities.…”

“…These findings hint towards a negative effect of care dependency on treatment outcome. Indeed, Glanert et al (2021) found that higher levels of care dependency in a sample of depressed patients predicted less favorable treatment outcome.…”

“…Recent studies comparing care dependency (i.e., patients' dependency on a mental health care treatment or therapist) and trait dependency levels showed that care dependency levels can indeed be distinguished from trait dependency levels and self-reported symptoms of PDs (Geurtzen et al, 2018(Geurtzen et al, , 2019. Also, it was shown that levels of care dependency changed over time during treatment, both in an 8-week outpatient cognitive behavioral therapy (CBT) program among students (Geurtzen et al, 2019), as well as in an 8-week daycare program for depressed patients (Glanert et al, 2021). The first aim of the current research is to further validate the assumption that care dependency is a contextual construct, by tracking patients' dependency over time during their treatment in a sample of patients with PDs.…”

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

“…In addition, the most frequently reported negative effect was dependence on the therapist, which might be associated with a worse treatment outcome[ 26 ]. However, our knowledge of the specific mechanisms of care dependency is little, it should be investigated broadly in future research[ 30 ].…”