Moderating effect of comorbid anxiety disorders on treatment outcome in a randomized controlled psychotherapy trial in early-onset persistently depressed outpatients

Assmann, Nele; Schramm, Elisabeth; Kriston, Levente; Hautzinger, Martin; Härter, Martin; Schweiger, Ulrich; Klein, Jan Philipp

doi:10.1002/da.22839

Cited by 16 publications

(11 citation statements)

References 30 publications

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“…This RCT demonstrated that, in unmedicated Future studies should examine moderators of this sequential mediation. For example, the effect could be particularly prominent in certain subpopulations, such as patients reporting early emotional abuse or patients suffering from comorbid social anxiety, because these subgroups benefitted most from CBASP in this trial [5,6]. These variables are also important in the CBASP model because interpersonal fear avoidance mediates the association between emotional abuse and specific social skill deficits in PDD [7].…”

Section: Karger@kargercommentioning

confidence: 99%

Changes in Therapeutic Alliance and in Social Inhibition as Mediators of the Effect of the Cognitive Behavioral Analysis System of Psychotherapy: A Secondary Analysis from a Randomized Clinical Trial

Klein

Probst

Kriston

et al. 2020

Psychother Psychosom

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adult outpatients with early-onset PDD, CBASP leads to greater improvements in depression at the end of treatment [3] and 1 year later (but not beyond that) [4]. We conducted a sequential mediation analysis testing the hypothesis that the treatment effect (CBASP vs. SP) on outcome is mediated by a sequential indirect effect of treatment-specific improvements in the therapeutic relationship and a subsequent decrease in social inhibition.The inclusion and exclusion criteria of this RCT are described elsewhere [3]. Briefly, the acute-phase treatment consisted of 24 sessions of CBASP or SP over 20 weeks. In the continuation phase, 8 further sessions were administered between week 20 and 48. In CBASP, the therapeutic relationship is explicitly targeted using techniques that are collectively labeled disciplined personal involvement. For example, positive in-session experiences with the therapist are contrasted with hurtful reactions from significant others to promote safety in the therapeutic dyad (interpersonal discrimination exercise). SP calls for a far less structured approach to the therapeutic relationship and relies on the broader common factors of psychotherapy.Our analysis was performed in a modified intention-to-treat population that included all randomized patients for whom data were available for the mediating variables for at least 1 of the assessments (256 out of 268 patients, 95.5%). These mediating variables were the Helping Alliance Questionnaire (HAQ) and the Inventory of Interpersonal Problems (IIP). Outcome was measured using the clinician-rated Hamilton Rating Scale for Depression (HRSD-24). Out of the subsample analyzed in the current report, 130 patients (50.8%) were randomized to CBASP and 126 patients (49.2%) to SP. The mean age of the patients was 45.05 years (SD 11.8), 64.8% were female (n = 166). We imputed missing values for the HAQ, the IIP, and the HRSD-24 by using the mean of the posterior distribution from the fully conditional specification method obtained by the iterative Markov Chain Monte Carlo estimation.We examined sequential mediation via an ordinary leastsquares path analysis using a bootstrapping approach facilitated by the PROCESS macro version 2.16. The independent variable was group allocation (CBASP vs. SP), the dependent variable was the total score of the HRSD at week 48 (end of treatment), and the putative mediating variables were change of the HAQ between week 1 and the end of the acute treatment phase at week 20 (M 1 ) and subsequent change in the social inhibition subscale of the IIP during the continuation phase from week 20 to 48 (M 2 ). These time points were chosen to establish a temporal sequence of treatmentinduced changes in the therapeutic relationship followed by improvement in interpersonal functioning. For further details of the analysis, see Figure 1.This analysis revealed that a significant part of the association between treatment and outcome is mediated through the sequential indirect effect of improvement in HAQ (M 1 ) and reduction in the IIP social i...

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Section: Karger@kargercommentioning

confidence: 99%

Changes in Therapeutic Alliance and in Social Inhibition as Mediators of the Effect of the Cognitive Behavioral Analysis System of Psychotherapy: A Secondary Analysis from a Randomized Clinical Trial

Klein

Probst

Kriston

et al. 2020

Psychother Psychosom

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“…It also remains to be seen if the same results emerge if psychotherapy is conducted in an individual format as opposed to group format and if CBASP or MBCT are compared with other forms of psychotherapy. Results of a recent study comparing CBASP as an individual therapy with supportive psychotherapy in patients with chronic depression, however, suggests that individual CBASP as well is particularly effective for nonassertive patients, since comorbid social anxiety moderated outcomes in favor of CBASP (Assmann et al, 2018). Furthermore, more research is necessary to explore whether interpersonal problems moderate intervention effects on other outcome or process variables like the therapeutic alliance (Mander et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Patients' interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness‐based cognitive therapy and a group version of the cognitive‐behavioral analysis system of psychotherapy in chronic depression

et al. 2020

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Objectives: Interpersonal problems were examined as moderators of depression outcomes between mindfulnessbased cognitive therapy (MBCT) and cognitive behavioral analysis system of psychotherapy (CBASP) in patients with chronic depression. Methods: Patients received treatment-as-usual and, in addition, were randomized to 8-weeks of MBCT (n = 34) or 8-weeks of CBASP (n = 34). MBCT and CBASP were given in a group format. The Hamilton depression rating scale (HAM-D) was the primary and the Beck Depression Inventory (BDI-II) the secondary outcome. The subscales of the Inventory of interpersonal problems (IIP-32) were moderators. Multilevel models were performed.

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“…The self-rating socio-demographic questionnaire was adapted from the version developed by the Epidemiology Department of Harbin Medical University and was used to collect detailed background information on family psychiatric history, childhood trauma history, and socioeconomic background. The HRSD-24 ( 23 ) is widely used to measure depression symptoms; ( 24 – 26 ) a number of patients above the threshold (21 points) were included in the study. The LES questionnaire for measuring negative life events contained 48 items in three dimensions: family life (28 items), work-related problems (13 items), and social and other aspects (seven items).…”

Section: Methodsmentioning

confidence: 99%

Association Between FoxO1, A2M, and TGF-β1, Environmental Factors, and Major Depressive Disorder

et al. 2020

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Introduction Investigations of gene-environment (G×E) interactions in major depressive disorder (MDD) have been limited to hypothesis testing of candidate genes while poly-gene-environmental causation has not been adequately address. To this end, the present study analyzed the association between three candidate genes, two environmental factors, and MDD using a hypothesis-free testing approach. Methods A logistic regression model was used to analyze interaction effects; a hierarchical regression model was used to evaluate the effects of different genotypes and the dose-response effects of the environment; genetic risk score (GRS) was used to estimate the cumulative contribution of genetic factors to MDD; and protein-protein interaction (PPI) analyses were carried out to evaluate the relationship between candidate genes and top MDD susceptibility genes. Results Allelic association analyses revealed significant effects of the interaction between the candidate genes Forkhead box ( Fox ) O1, α2-macroglobulin ( A2M ), and transforming growth factor ( TGF ) -β1 genes and the environment on MDD. Gene-gene (G×G) and gene-gene-environment (G×G×E) interactions in MDD were also included in the model. Hierarchical regression analysis showed that the effect of environmental factors on MDD was greater in homozygous than in heterozygous mutant genotypes of the FoxO1 and TGF-β1 genes; a dose-response effect between environment and MDD on genotypes was also included in this model. Haplotype analyses revealed significant global and individual effects of haplotypes on MDD in the whole sample as well as in subgroups. There was a significant association between GRS and MDD (P = 0.029) and a GRS and environment interaction effect on MDD (P = 0.009). Candidate and top susceptibility genes were connected in PPI networks. Conclusions FoxO1 , A2M , and TGF-β1 interact with environmental factors and with each other in MDD. Multi-factorial G×E interactions may be responsible for a higher explained variance and may be associated with causal factors and mechanisms that could inform new diagnosis and therapeutic strategies, which can contribute to the personalized medicine of MDD.

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Moderating effect of comorbid anxiety disorders on treatment outcome in a randomized controlled psychotherapy trial in early-onset persistently depressed outpatients

Cited by 16 publications

References 30 publications

Changes in Therapeutic Alliance and in Social Inhibition as Mediators of the Effect of the Cognitive Behavioral Analysis System of Psychotherapy: A Secondary Analysis from a Randomized Clinical Trial

Changes in Therapeutic Alliance and in Social Inhibition as Mediators of the Effect of the Cognitive Behavioral Analysis System of Psychotherapy: A Secondary Analysis from a Randomized Clinical Trial

Patients' interpersonal problems as moderators of depression outcomes in a randomized controlled trial comparing mindfulness‐based cognitive therapy and a group version of the cognitive‐behavioral analysis system of psychotherapy in chronic depression

Association Between FoxO1, A2M, and TGF-β1, Environmental Factors, and Major Depressive Disorder

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