The clinical effectiveness of evidence-based interventions for depression: A pragmatic trial in routine practice

Abstract

a b s t r a c tBackground: Controversy persists about how effectively empirically-supported treatments for major depression work in actual clinical practice as well as how patients choose among them. We examined the acute phase effectiveness of cognitive therapy (CT), interpersonal psychotherapy (IPT), and combined psychotherapy-pharmacotherapy (PHT) in a naturalistic setting, allowing patients their choice of treatment. Methods: The study compared CT (n ¼ 63), IPT (n ¼56), CT-PHT (n ¼34), and IPT-PHT (n ¼21) for 174 subjects with major depression in a secondary care mood disorders clinic. Patient preference, rather than randomization, determined treatment selection. The Beck Depression Inventory-II (BDI) was the primary outcome variable. Exclusion criteria were minimal. Results: All treatments were associated with a reduction in depressive symptoms, with a 35% remission rate by week 26. Overall improvement was well within ranges reported in efficacy trials. On average, treatment effects of the different interventions straddled the same range, but moderation analyses revealed that BDI scores dropped faster in the first 16 weeks in patients who received CT alone than patients who received CT and pharmacotherapy, a pattern not found in patients who received IPT (with or without pharmacotherapy). Limitations: Limitations consist of a modest sample size, choice of treatment was made by participants which may have been influenced by many sources, and the absence of a non-active control group. Conclusions: This study supports the effectiveness of empirically-supported antidepressant treatments selected by patients in routine settings, and provides an indication that speed of therapeutic response may vary amongst treatments.

Implementing evidence‐based treatment protocols: Flexibility within fidelity.

“…Evidence for this point comes from several studies that have implemented evidence-based treatments in uncontrolled studies and in naturalistic settings and compared the outcomes to tightly controlled RCTs. For example, Peeters et al (2013) allowed patients to select their preferred treatment for depression in a naturalistic setting. Several of the participants had high levels of comorbidity and recurrence of depression, and may not have met inclusion criteria for many efficacy studies.…”

Subclinical psychotic experiences and bipolar spectrum features in depression: association with outcome of psychotherapy

“…The current data came from an observational study designed to examine the effectiveness of evidence-based treatments for depression in routine clinical practice. Thus, treatment allocation was based on participants' preference and not on randomization (Peeters et al 2013). Peeters et al (2013) previously showed that psychotherapy interventions, alone or in combination with pharmacotherapy, are effective in a routine clinical setting.…”

“…Thus, treatment allocation was based on participants' preference and not on randomization (Peeters et al 2013). Peeters et al (2013) previously showed that psychotherapy interventions, alone or in combination with pharmacotherapy, are effective in a routine clinical setting. CBT was provided by experienced therapists who received appropriate training and followed the procedures outlined in standard texts of cognitive therapy for depression (Beck & Rush, 1979).…”

Assessing personality change with Blatt's anaclitic and introjective configurations and Shedler-Westen Assessment Procedure profiles: two case studies in psychodynamic treatment

“…The Ablon and Jones study (Ablon & Jones, 1999), working on transcripts of treatment sessions of TDCRP, found that both CBT and IPT had closer adherence to the cognitive-behavioral prototype, that produced more positive correlations with outcome measures, than to the reference model. Such overlapping was later corroborated by other studies: CBT and IPT, whether combined or not with medication, should ultimately lead to similar outcomes (Quilty, McBride, Bagby, 2008;Peeters et al, 2013). Other compelling studies based on the TDCRP have laid emphasis on the contribution of the therapist in the psychotherapeutic process, bringing to light the scope of their influence in outcome results (Blatt, Sanislow, Zuroff, & Pilkonis, 1996).…”