The Role of Psychological Interventions in the Maintenance Treatment of Depression

Schramm, Elisabeth; Elsaeßer, Moritz; Guidi, Jenny

doi:10.1159/000522014

Cited by 5 publications

(5 citation statements)

References 9 publications

(9 reference statements)

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“…A more tailored approach regarding functioning may as such be required, for example, by work-focused CBT for those who struggle with work-related issues. Other promising approaches to better tailor treatment content to specific problems and to prevent relapse include staging in planning an intervention according to specific phases of a depressive disorder [37] or by sub-type of coexisting anxiety and depression [44, 45]. For instance, applying a sequential combination of pharmacotherapy and psychotherapy is associated with reduced risk of relapse in major depression [44] and should hence be considered for the more severe cases.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis

Smith¹,

Aarø²,

Knapstad³

2023

Psychother Psychosom

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Introduction: The temporal relationship between symptoms and functioning in the context of cognitive behavioral therapy (CBT) for anxiety and depression is not fully understood, and there are few high-quality studies that have examined to what extent late intervention effects of CBT on functioning are mediated by initial intervention effects on symptoms while accounting for the initial effects on functioning and vice versa. Objective: The aim of the study was to investigate whether intervention effects on symptoms and functioning at 12-month follow-up were mediated by intervention effects on these outcomes at 6-month follow-up. Methods: Participants with anxiety and/or mild-to-moderate depression were randomly assigned to a primary mental health care service (n = 463) or treatment-as-usual (n = 215). Main outcomes were depressive symptoms (Patient Health Questionnaire [PHQ-9]), anxiety (General Anxiety Disorder-7 [GAD-7]), and functioning (Work and Social Adjustment Scale [WSAS]). Direct/indirect effects were derived using the potential outcomes and counterfactual framework. Results: The intervention effect on functioning at 12 months was largely explained by intervention effects at 6 months on depressive symptoms (51%) and functioning (39%). The intervention effect on depressive symptoms at 12 months was largely explained by the intervention effect at 6 months on depressive symptoms (70%) but not by functioning at 6 months. The intervention effect on anxiety at 12 months was only partly accounted for by intervention effects at 6 months on anxiety (29%) and functioning (10%). Conclusions: The findings suggest that late intervention effects of CBT on functioning were to a substantial degree explained by initial intervention effects on depressive symptoms even after accounting for initial effects on functioning. Our results support the importance of symptoms as an outcome in the context of CBT delivered in primary health care.

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Section: Discussionmentioning

confidence: 99%

The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis

Smith¹,

Aarø²,

Knapstad³

2023

Psychother Psychosom

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“…As the discovery of a one-size-fits-all panacea is unlikely [46,47], clinicians should utilize a broad array of flexible and multidisciplinary modalities for patient-specific recommendations and personalized treatment options [48,49]. This includes evidence-based decision support tools [27,48], systematic follow-up assessments [50,51], and innovative approaches such as the sequential model [47,[52][53][54][55][56] or modular psychotherapy [57][58][59] taking comorbidities and transdiagnostic factors such as childhood maltreatment [29,60,61] into consideration. For this, it would be helpful that mental health is no longer defined one-sidedly as the mere absence of symptoms.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Clusters of Long-Term Trajectories in Patients with Early-Onset Chronic Depression: 2 Years of Naturalistic Follow-Up after Extensive Psychological Treatment

Elsaesser,

Feige,

Kriston

et al. 2023

Psychother Psychosom

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Introduction: In clinical trials, mostly group-level treatment effects of repeated cross-sectional measures are analyzed. However, substantial heterogeneity regarding individual symptom profiles and the variability of treatment effects are often neglected, especially over the long-term course. To provide effective personalized treatments, investigations of these characteristics are urgently needed. Methods: Depression severity ratings over 104 weeks of follow-up after year-long treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Supportive Psychotherapy (SP) were analyzed. Longitudinal cluster analysis and multinomial logistic regression analysis were conducted to investigate intraindividual trajectories from one of the largest psychotherapy trials in early-onset chronic depression. Results: Two-year post-study-treatment trajectories of N = 188 patients with early-onset chronic depression were grouped into four prototypical clusters. Overall, 16.0% of patients remitted (cluster 1) and most of them did not receive any treatment during the 2-year follow-up. However, 84.0% of patients continued to experience subthreshold (37.2% cluster 2) or major depressive symptoms (46.8% clusters 3–4) and spent on average more than half of the follow-up in pharmacological and psychological treatment. Hierarchical regression analysis indicated that previous study treatment with CBASP or SP did not significantly predict cluster allocation, while baseline variables accounted for a large proportion of explained variance (R2 N = 0.64). Conclusion: While some patients experienced stable remission over 2 years of follow-up, the majority of patients experienced subthreshold or major depressive symptoms regardless of former study treatment with CBASP or SP. This calls for a long-term perspective implementing staging and innovative treatment approaches such as the sequential model or modular psychotherapy.

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“…As the discovery of a one-size-fits-all panacea is unlikely (32,33), clinicians should utilize a broad array of flexible and multidisciplinary modalities for patient-specific recommendations and personalized treatment options (34,35). This includes evidence-based decision support tools (27,34), systematic follow-up assessments (36,37), and innovative approaches such as the sequential model (38,39,33,40,41) or modular psychotherapy (42)(43)(44) taking comorbidities and transdiagnostic factors such as childhood maltreatment or social functioning into account.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal clusters of long-term trajectories in patients with early-onset chronic depression: Two years of naturalistic follow-up after extensive psychological treatment

Elsaeßer¹,

Feige²,

Kriston³

et al. 2023

Preprint

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Introduction: In randomized trials, mostly group-level treatment effects of repeated cross-sectional measures are analyzed. However, substantial heterogeneity regarding individual symptom profiles and variability of treatment effects are often neglected, particularly over the long-term course.Objective: Ratings of depression severity over 104 weeks of follow-up after yearlong acute and continuation treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Supportive Psychotherapy (SP) were investigated to cluster intraindividual trajectories and identify risk and protective factors. Methods: Longitudinal cluster analysis and multinomial logistic regression analysis were conducted to group intraindividual long-term trajectories from one of the largest psychotherapy trials in early-onset chronic depression.Results: Two-year post-treatment trajectories of N=176 patients with early-onset chronic depression were clustered into four groups. Only 16.5% of patients remitted (Cluster 1), while the majority continued to experience subthreshold (35.8% Cluster 2) or major depressive symptoms (47.7% Cluster 3-4). Patients previously treated with the CBASP had a 45% lower risk of experiencing major depressive symptoms (Cluster 3) than patients in the SP group (RR=0.55, 95% CI=0.31 to 0.97, p=.03). Further treatment in the health care system during follow-up, especially psychological outpatient treatment, reduced depression severity. Comorbid disorders or childhood emotional/physical abuse had detrimental effects.Conclusion: Despite significant effects in favor of acute treatment with CBASP compared to SP, the majority of patients experienced subthreshold or major depressive symptoms over two years of follow-up. This calls for a long-term perspective with innovative treatment approaches such as the sequential model or modular psychotherapy.

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The Role of Psychological Interventions in the Maintenance Treatment of Depression

Cited by 5 publications

References 9 publications

The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis

The Importance of Symptom Reduction for Functional Improvement after Cognitive Behavioral Therapy for Anxiety and Depression: A Causal Mediation Analysis

Longitudinal Clusters of Long-Term Trajectories in Patients with Early-Onset Chronic Depression: 2 Years of Naturalistic Follow-Up after Extensive Psychological Treatment

Longitudinal clusters of long-term trajectories in patients with early-onset chronic depression: Two years of naturalistic follow-up after extensive psychological treatment

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