Recovery from chronic depression and structural change: 5‐year outcomes after psychoanalytic and cognitive‐behavioural long‐term treatments (LAC depression study)

Abstract

Objective Psychotherapy of chronic depression has remained a challenge due to limited prognosis and high rates of recurrence. We present 5‐year outcome data from a multicentre trial comparing psychoanalytic (PAT) and cognitive‐behavioural (CBT) long‐term treatments with randomized and preferred allocations analysing symptom (N = 227) and structural change (N = 134) trajectories. Method Self‐ and blinded expert ratings of depression symptoms were performed at yearly intervals using the Beck Depression Inventory‐II (BDI‐II) and Quick Inventory of Depressive Symptoms (QIDS‐C). Blinded expert ratings of Operationalized Psychodynamic Diagnosis (OPD) and the Heidelberg Restructuring Scale (HRS) at baseline, 1, 3, and 5 years assessed structural change in a subsample. Results Lasting and comparable symptom changes were achieved by PAT and CBT. However, compared to CBT, PAT was more successful in restructuring, a major goal of long‐term psychodynamic treatments with high frequency and duration. Limitations Due to practical reasons, the time criterion for chronic depression of an acute phase had to be defined for over 1 year in the present study, which does not correspond to the DSM‐5 criterion of 2 years. Therapy duration and session frequency were not incorporated into the statistical models. Conclusion Long‐term psychotherapy helps patients with a yearlong history of depression and often multiple unsuccessful treatment attempts to achieve lasting symptom changes. Future follow‐up will clarify whether restructuring promotes further sustainable improvements.

Efficacy of high-intensity versus low-intensity psychoanalytically oriented long-term treatments and determinants of outcome: individual participant data Meta-analysis of Long-term Analytic treatment Studies (MeLAS)

“…Huber et al 30 found psychoanalytic treatment to be more effective than CBT at long-term follow-up, while others reported a comparable reduction of symptoms in psychoanalytic therapy and CBT, 34 35 but stronger evidence for restructuring in psychoanalytic treatment groups. 32 35 Other studies have focused on the comparison of psychodynamic psychotherapy with more intensive and longer psychoanalytic treatment and found the latter to be more effective at 1-year 36 or 3-year follow-up. 37 Town et al 38 found that therapy effects were maintained and continued to improve following termination of psychodynamic therapies of different frequencies and lengths.…”

“…Huber et al 30 found psychoanalytic treatment to be more effective than CBT at long-term follow-up, while others reported a comparable reduction of symptoms in psychoanalytic therapy and CBT,34 35 but stronger evidence for restructuring in psychoanalytic treatment groups 32 3536 or 3-year follow-up 37.…”