Outcomes of patients completing and not completing cognitive therapy for depression

Cahill, Jane; Barkham, Michael; Hardy, Gillian E.; Rees, Anne; Shapiro, David A.; Stiles, William B.; Macaskill, Norman D.

doi:10.1348/014466503321903553

Cited by 104 publications

(93 citation statements)

References 30 publications

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“…Reported psychotherapy drop-out rates in depression vary from 10 to 50% [67,68,69,70]. Settings similar to ours also found drop-out rates of around 40% [9,71].…”

Section: Discussionsupporting

confidence: 75%

What Is the Best Sequential Treatment Strategy in the Treatment of Depression? Adding Pharmacotherapy to Psychotherapy or Vice Versa?

Dekker

Van

Hendriksen

et al. 2012

Psychother Psychosom

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Background: Insufficient response to monotreatment for depression is a common phenomenon in clinical practice. Even so, evidence indicating how to proceed in such cases is sparse. Methods: This study looks at the second phase of a sequential treatment algorithm, in which 103 outpatients with moderately severe depression were initially randomized to either short-term supportive psychodynamic therapy (PDT) or antidepressants. Patients who reported less than 30% symptom improvement after 8 weeks were offered combined treatment. Outcome measures were the Hamilton Depression Rating Scale (HAM-D), the Clinical Global Impression of Severity and Improvement, the SCL-90 depression subscale and the EuroQOL questionnaire. Results: Despite being nonresponsive, about 40% of patients preferred to continue with monotherapy. At treatment termination, patients initially randomized to PDT had improved more than those initially receiving antidepressants, as indicated by the HAM-D and the EuroQOL, independently of whether the addition was accepted or not. Conclusions: Starting with psychotherapy may be preferable in mildly and moderately depressed outpatients. For patients who receive either PDT or antidepressants, combined therapy after early nonresponse seems to be helpful. Nevertheless, this sequential strategy is not always preferred by patients.

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“…Reported psychotherapy drop-out rates in depression vary from 10 to 50% [67,68,69,70]. Settings similar to ours also found drop-out rates of around 40% [9,71].…”

Section: Discussionsupporting

confidence: 75%

What Is the Best Sequential Treatment Strategy in the Treatment of Depression? Adding Pharmacotherapy to Psychotherapy or Vice Versa?

Dekker

Van

Hendriksen

et al. 2012

Psychother Psychosom

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“…As others have noted, the number of sessions was strongly linked to successful outcome of treatment [26-28]. We saw a high rate of attrition, though it was highly variable between programmes.…”

Section: Discussionmentioning

confidence: 52%

Counselling in humanitarian settings: a retrospective analysis of 18 individual-focused non-specialised counselling programmes

et al. 2013

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BackgroundMédecins Sans Frontières (MSF) provides individual counselling interventions in medical humanitarian programmes in contexts affected by conflict and violence. Although mental health and psychosocial interventions are a common part of the humanitarian response, little is known about how the profile and outcomes for individuals seeking care differs across contexts. We did a retrospective analysis of routine programme data to determine who accessed MSF counselling services and why, and the individual and programmatic risk factors for poor outcomes.MethodsWe analysed data from 18 mental health projects run by MSF in 2009 in eight countries. Outcome measures were client-rating scores (1–10 scale; 1 worst) for complaint severity and functioning and counsellor assessment. The effect of client and programme factors on outcomes was assessed by multiple regression analysis. Logistic regression was used to assess binary outcome variables.Results48704 counselling sessions were held with 14963 individuals. Excluding women-focused projects, 66.8% of patients were women. Mean (SD) age was 33.3 (14.1) years. Anxiety-related complaints were the most common (35.0%), followed by family-related problems (15.7%), mood-related problems (14.1%) and physical complaints (13.7%). Only 2.0% presented with a serious mental health condition. 27.2% did not identify a traumatic precipitating event. 24.6% identified domestic discord or violence and 17.5% psychological violence as the precipitating event. 6244 (43.9%) had only one session. For 91% of 7837 who returned, the counsellor reported the problem had decreased or resolved. The mean (SD) complaint rating improved by 4.7 (2.4) points (p < 0.001) and by 4.2 (2.3, p < 0.001) for functional rating. Risk factors for poorer outcomes were few sessions, non-conflict setting (stable or societal violence settings), serious mental health condition, or attending a large, recently opened project.ConclusionsThe majority of clients accessing counselling services present with anxiety related complaints. Attrition rates were high. Good outcomes were recorded among those who attended for more than one visit. Lessons learned included the importance of adaptation of approach in non-conflict contexts such as societal violence or post-conflict contexts. There is a need for further research to evaluate the intervention against a control group.

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“…Repeated data is particularly useful in the event of patients unexpectedly dropping out of therapy, when the last available questionnaire can serve as a proxy outcome measure (e.g. Cahill et al, 2003). However, the consistently high patient participation in the Tuke House programme and in completing outcome measures after therapy reduced the need for weekly data.…”

Section: Limitations and Future Researchmentioning

confidence: 99%

Practice-Based Evidence for a Brief Time-Intensive Multi-Modal Therapy Guided by Group-Analytic Principles and Method

et al. 2003

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Group analysts are increasingly being called upon to provide effectiveness evidence, which may be critical to the development of group analysis as a therapeutic intervention in National Health Service provision of psychotherapies. This article describes a practice-based outcomes research initiative conducted in a timelimited group-analytic programme. The research was manageable and informative for profiling patients before therapy, recording benefits during therapy, and measuring outcomes at the end of the programme. Results suggest that the therapeutic programme is effective in terms of yielding decreased symptoms and improved mental health, but longer follow-up is needed to measure benefits in interpersonal functioning. The research was conducted by clinicians in collaboration with academic researchers and demonstrates the benefits of a positive clinician-researcher relationship. Carrying out the research has helped the clinicians to address the national agenda of evidence-based practice and accountability.

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Outcomes of patients completing and not completing cognitive therapy for depression

Cited by 104 publications

References 30 publications

What Is the Best Sequential Treatment Strategy in the Treatment of Depression? Adding Pharmacotherapy to Psychotherapy or Vice Versa?

What Is the Best Sequential Treatment Strategy in the Treatment of Depression? Adding Pharmacotherapy to Psychotherapy or Vice Versa?

Counselling in humanitarian settings: a retrospective analysis of 18 individual-focused non-specialised counselling programmes

Practice-Based Evidence for a Brief Time-Intensive Multi-Modal Therapy Guided by Group-Analytic Principles and Method

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