Predictors of Depression Treatment Response in an Intensive CBT Partial Hospital

Beard, Courtney; Stein, Aliza T.; Hearon, Bridget A.; Lee, Josephine; Hsu, Kean J.; Björgvinsson, Thröstur

doi:10.1002/jclp.22269

Cited by 28 publications

(26 citation statements)

References 35 publications

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“…This is in contrast to inflexible policies on treatment length that might not have facilitated this change. Further evidence for this proposition is found in the many time-limited interventions which show that patients with more severe interpersonal problems or a PD diagnosis, attain less benefit from treatment (Beard et al, 2016;Goddard et al, 2015;Haug et al, 2015;Porter & Chambless, 2015). The few studies that do not find this effect still report lower rates of acceptability or completion for PD patients (Aaronson et al, 2008;Bédard et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…The evidence from trials aimed at a particular clinical disorder which includes patients with comorbid PD, or a high degree of interpersonal problems, provides mixed results in terms of their moderating effect. Most studies find that the presence of PD, or a high degree of interpersonal problems, predicts poorer outcomes (Beard et al, 2016;Goddard et al, 2015;Haug et al, 2015;Newton-Howes et al, 2006;Porter & Chambless, 2015) while others do not (Aaronson et al, 2008;Bédard et al, 2015;Carter et al, 2013;Dreessen & Arntz, 1998;Olatunji et al, 2010). A parallel to research on treatment outcomes is treatment retention, which demonstrates the same pattern of mixed findings.…”

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confidence: 99%

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Comparing the magnitude of improvement for patients with and without personality disorders in open-ended psychotherapy

Nordmo¹,

Monsen²,

Høglend³

et al. 2020

Preprint

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Psychotherapy tends to produce meaningful and sustained positive changes for individuals suffering from a mental illness. A salient distinction can be made between patients with a Personality Disorder (PD) and those without. There is some evidence that patients with PD have poorer treatment outcomes, but the majority of these studies are from time-limited interventions that might be less suited for patients with PD. In contrast, the present study provided open-ended psychotherapy to a sample of patients (N = 370), half of which had at least one PD before treatment. The therapists received instruction to organize their treatments in cooperation with patients so that therapy was tailored to each patient’s individual needs and characteristics. The results revealed that patients with a PD demonstrated equal symptomatic improvement and greater interpersonal improvement compared to patients without a PD. Similarly, observer-rated diagnostic changes were equivalent across the two groups. Both groups demonstrated enduring improvements when assessed at a two-and-half-year follow-up. The degree of personality pathology was positively related to the magnitude of change, i.e. patients with more severe personality problems demonstrated greater gains in the open-ended treatment format.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparing the magnitude of improvement for patients with and without personality disorders in open-ended psychotherapy

Nordmo¹,

Monsen²,

Høglend³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…According to Risch et al (2012), relapse may be due to the reactivation of dysfunctional thoughts when confronted with new stressful events. Moreover, a substantial group of patients does not respond to usual CBT (Hofmann et al, 2012; Button et al, 2015; Beard et al, 2016). We hypothesize that the long-term efficacy of CBT could be increased by more rigorously addressing the mechanisms underlying the persistence of dysfunctional expectations.…”

Section: The Relevance Of Expectations In Major Depressionmentioning

confidence: 99%

On the Maintenance of Expectations in Major Depression – Investigating a Neglected Phenomenon

2017

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In this perspective paper, we suggest that among patients suffering from major depressive disorder (MDD), dysfunctional expectations are maintained despite experiences that are contrary to these expectations. Surprisingly, this persistence of expectations in MDD has not yet been addressed by empirical studies. We argue that it is worthwhile to investigate this phenomenon with the aim of improving the treatment of MDD, and we provide a theoretical framework for understanding it. It is hypothesized that the persistence of expectations is primarily due to a process called immunization. That is, people experiencing depressive symptoms may cognitively reappraise the contradictory experience such that expectations do not need to be changed. There may be two mechanisms underlying this immunization: (1) the experience in the expectation-violating situation is considered to be an exception; or (2) the credibility of the information gained from the experience is called into question. Moreover, the maintenance of expectations may be particularly persistent if a person’s expectations reflect his or her self-concept, as self-concept has been shown to be associated with future expectations. To empirically examine the hypothesized maintenance of expectations in MDD, we propose an experimental approach which could provide important implications for the treatment of MDD within cognitive behavioral therapy. We suggest that psychological interventions such as behavioral experiments should more rigorously focus on patients’ appraisal of expectation-violating experiences in order to prevent immunization processes. Therapists should continuously examine whether patients’ expectations were modified and should address the reasons for the maintenance of expectations.

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“…More recently, among persons with MDD receiving acute-phase treatment (supportive-expressive psychotherapy, or clinical management plus either pill placebo or active medication), those with favorable outcome expectations developed a stronger therapeutic alliance, which in turn predicted better outcomes (Barber et al, 2014). Moreover, among patients receiving CT for depression in a partial hospitalization program (Beard et al, 2016), and in a sample of outpatients receiving CT for seasonal affective disorder (Meyerhoff & Rohan, 2016), favorable treatment expectations predicted better response.…”

mentioning

confidence: 99%

Could Treatment Matching Patients’ Beliefs About Depression Improve Outcomes?

et al. 2019

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Patients' beliefs about depression and expectations for treatment can influence outcomes of major depressive disorder (MDD) treatments. We hypothesized that patients with weaker biological beliefs (less endorsement of (a) biochemical causes and (b) need for medication), and more optimistic treatment expectations (greater improvement and shorter time to improvement), have better outcomes in cognitive therapy (CT). Outpatients with recurrent MDD who received acutephase CT (N = 152), and a subset of partial or unstable responders (N = 51) randomized to 8 months of continuation CT or fluoxetine with clinical management, completed repeated measures of beliefs, expectations, and depression. As hypothesized, patients with weaker biological beliefs about depression, and patients who expected a shorter time to improvement, experienced greater change in depressive symptoms and more frequent response to acute-phase CT. Moreover, responders who received continuation treatment better matched to their biological beliefs (i.e., responders with weaker biological beliefs about depression who received continuation CT, or responders with stronger biological beliefs about depression who received continuation fluoxetine)

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Predictors of Depression Treatment Response in an Intensive CBT Partial Hospital

Cited by 28 publications

References 35 publications

Comparing the magnitude of improvement for patients with and without personality disorders in open-ended psychotherapy

Comparing the magnitude of improvement for patients with and without personality disorders in open-ended psychotherapy

On the Maintenance of Expectations in Major Depression – Investigating a Neglected Phenomenon

Could Treatment Matching Patients’ Beliefs About Depression Improve Outcomes?

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