What we know, what we do not know, and where are we heading? Efficacy and acceptability of psychological interventions for depression

Abstract

In the past several decades, increasing evidence supports the efficacy of psychotherapies for depression. The vast majority of findings from meta-analyses, randomized clinical trials (RCTs) and naturalistic studies have demonstrated that well-established psychotherapies (behavioural activation, problem-solving therapy, psychodynamic therapy, cognitive-behavioural therapy, interpersonal therapy and emotion-focused therapy) are superior to no-treatment and control conditions, and are in most cases equally effective in treating depression. However, despite this abundant support for psychotherapies, studies have also consistently shown high drop-out rates, high percentages of non-respondent patients who experience treatment failures, and mixed findings regarding the enduring effects of psychotherapy. Thus, there is a need to develop more personalised treatment models tailored to patients' needs. A new integrative sequential stepwise approach to the treatment of depression is suggested. Key words: Behaviour therapy, cognitive therapy, depression, evidence-based psychiatry, psychoanalysis and psychodynamic therapies. What do we know about the efficacy of psychotherapies for depression?Depression is a pervasive mental condition which interferes with all domains of one's functioning and it is one of the most common problems leading people to seek treatment (e.g. Summers & Barber, 2010). Recent studies have shown that the approximated cumulative incidence of depression diagnosis from childhood to adulthood is between 32.54 and 51% (Rohde et al. 2012;Angst et al. 2015).In the past several decades, over 400 randomised clinical trials have investigated the efficacy of psychotherapy for depression (Cuijpers, 2015). Despite the heated debate regarding the superiority of one treatment over others, there is fairly wide acceptance of the 'Dodo Bird Verdict ' (Luborsky et al. 1975), at least in the case of depression, suggesting that all treatments are more or less equally effective (Cuijpers et al. 2008;Barth et al. 2013). Furthermore, research in the past two decades has taught us that psychotherapeutic treatments of depression are superior to waitlist and other control conditions (Barth et al. 2013;Lambert, 2013), and that psychotherapy combined with anti-depressant medication is more effective than medication alone (Barber et al. 2013;Köhler et al. 2013;Hollon et al. 2014;Fonagy, 2015;Leichsenring et al. 2015). There is also evidence suggesting that some types of psychotherapies are not only as effective as medication, but also have higher long-term enduring effects (Hollon & Ponniah, 2010;Cuijpers et al. 2013b). We begin by briefly reviewing some of the major findings that have arisen from the literature on treatments of depression, focusing only on the best-known and more widely researched. Behavioural activation (BA)BA is one of the most accepted and widely used behavioural treatments. Meta analyses found BA to be as effective as cognitive-behavioural therapy, and superior to control conditions (Cuijpers et al. 2007;Mazzuc...

Engagement in Socially and Interpersonally Rewarding Activities as a Predictor of Outcome in “Engage” Behavioral Activation Therapy for Late-Life Depression

“…Identifying activities that are most beneficial in driving depressive symptom change for specific patients could guide refinement of psychosocial interventions and development of more effective, streamlined psychotherapies. 41 This study tests the hypothesis that socialgroup as well as interpersonal-individual activities (versus solitary activities) predict greater increase in behavioral activation and greater reduction in depressive symptoms among older adults. Exploratory analyses examine whether certain types of socially rewarding activities (i.e.…”

Toward a personalized approach to psychotherapy outcome and the study of therapeutic change

“…Many medical specialties are now shifting towards a “precision medicine” model – tailoring treatment to the individual patient. In psychotherapy, this model requires a comprehensive assessment of the individual patient's functioning across multiple domains in order to develop a personalized treatment plan. Some progress has been made in the development of computerized algorithms, with preliminary evidence for efficacy of matching patients with the optimal treatment package.…”

The future of psychotherapy research: stop the waste and focus on issues that matter

“…The two Editorials in this issue give interesting perspectives on where we are with research on these therapies and what should happen in the future (Hollon, 2015; Solomonov & Barber, 2015). The first thing that stands out is that both agree that although psychotherapies are effective, there is still considerable room for improvement.…”

“…In order to reduce the disease burden of depression much research is needed in many areas. The two articles give several directions for future directions in research on psychological treatments, including research how to reduce drop-out rates for psychotherapies, because they use considerable resources with apparently little benefits (Solomonov & Barber, 2015). But also more research on the long-term effects of therapies, treatment-resistant and chronic depression, the high relapse rates and more knowledge on who benefits from which treatment are important goals for future research, as justly indicated in these two articles in this issue.…”