The Effectiveness of an Intensive Inpatient Psychotherapy Program for Chronic Depression: A naturalistic comparison with wait list

Abstract

Background Patients with chronic depression (CD) typically have an early symptom onset, more psychiatric comorbidities, more treatment attempts, and more frequent and longer inpatient hospitalizations than patients with major depressive disorders. The main purpose of this study was to investigate the effectiveness of an intensive inpatient psychotherapy program for patients with chronic depression (CD). The primary research question was whether two intensive psychodynamic inpatient treatments, affect phobia therapy (APT) and VITA, were superior to an outpatient wait list condition, receiving treatment as usual (TAU), at completion of treatment. To investigate if a potential difference between the intensive treatment and the wait list control group was dependent on a specific psychotherapeutic model, the study contrasted two therapies with similar intensity, but different theoretical rationales. Methods Two hundred eighty patients with CD were included in a naturalistic study. Patients were assessed at four time points; assessment, start of therapy, end of therapy and 1-year follow-up. Three comparisons were performed with patients matched across groups; Intensive inpatient treatment program (APT + VITA) vs wait list during treatment, APT vs VITA during treatment and APT vs VITA during follow-up. The outcome measure was the BDI-II. Results Intensive inpatient treatment program vs. wait list showed a significant difference in favor of the intensive treatment. No significant differences were found between APT and VITA during therapy or follow-up; but both groups had large effect sizes during treatment, which were maintained during follow-up. Conclusions The intensive inpatient psychotherapy program showed superior effect on chronic depression over an outpatient wait list condition receiving treatment as usual (TAU), but no significant differences were found between the two intensive inpatient psychodynamic treatments. The results provide support for the effectiveness of an intensive inpatient psychotherapy program in treatment of chronic and severe disorders, such as CD, which could be of benefit for policymakers and the health care sector as they are allocating recourses efficiently. Trial registration This study has been retrospectively registered on ClinicalTrials.gov (NCT05221567) on February 3rd, 2022.

The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders – an umbrella review based on updated criteria

“…A recent meta-analysis on effectiveness of routinely delivered psychotherapies 45 found large pre-post effect sizes in depression outcomes (d=0.96, 95% CI: 0.88-1.04), with no differences between CBT and PDT (d=-0.07 in favor of PDT). These results were corroborated by a recent effectiveness study on PDT in chronic depression, which found a large effect size (d=-0.90) in comparison to a waiting list condition 56 . As suggested by one RCT, PDT may be a cost-effective intervention in treatment-resistant depressive disorders as compared to TAU 57 .…”

Self-compassion and fear of compassion in the treatment of chronic depression: Mechanisms of change?

“…However, the treatment assignment was at the discretion of the interviewing clinician and might have been based on other factors such as the patient's interest or group availability. The preliminary analyses did not show differences among the treatments regarding symptomatology, demographics, and treatment outcome, which are further supported by a study with a comparable sample from the same unit conclusion (Eielsen et al, 2022).…”

“…Short-term psychodynamic psychotherapy (STPP; also called short-term dynamic psychotherapy) refers to a family of short-term psychodynamic therapies that focuses on emotion, including compassion. STPP has proven effective for patients with depression (Abbass et al, 2006; Cuijpers et al, 2008; Driessen et al, 2015), particularly chronic and treatment-resistant depression (Eielsen et al, 2022; Solbakken & Abbass, 2015; Stålsett et al, 2012; Town et al, 2017). Theories of STPP have emotional processes as the core element and conceptualize the relationship between emotions and depression in the context of interpersonal and intrapsychic conflict (e.g., Abbass, 2015; Blagys & Hilsenroth, 2000; Luborsky & Crits-Christoph, 1998; McCullough-Vaillant, 1997).…”