title: Detecting critical decision points in psychotherapy and psychotherapy + medication for chronic depression.
abstract: OBJECTIVE
  We sought to quantify clinical decision points for identifying depression treatment nonremitters prior to end-of-treatment.
  
  
  METHODS
  Data came from the psychotherapy arms of a randomized clinical trial for chronic depression. Participants (n = 352; 65.6% female; 92.3% White; mean age = 44.3 years) received 12 weeks of cognitive behavioral analysis system of psychotherapy (CBASP) or CBASP plus an antidepressant medication. In half of the sample, receiver operating curve analyses were used to identify efficient percentage of symptom reduction cut points on the Inventory of Depressive Symptoms-Self-Report (IDS-SR) for predicting end-of-treatment nonremission based on the Hamilton Rating Scale for Depression (HRSD). Sensitivity, specificity, predictive values, and Cohen's kappa for identified cut points were calculated using the remaining half of the sample.
  
  
  RESULTS
  Percentage of IDS-SR symptom reduction at Weeks 6 and 8 predicted end-of-treatment HRSD remission status in both the combined treatment (Week 6 cut point = 50.0%, Cohen's κ = .42; Week 8 cut point = 54.3%, Cohen's κ = .45) and psychotherapy only (Week 6 cut point = 60.7%, Cohen's κ = .41; Week 8 cut point = 48.7%, Cohen's κ = .49). Status at Week 8 was more reliable for identifying nonremitters in psychotherapy-only treatment.
  
  
  CONCLUSIONS
  Those with chronic depression who will not remit in structured, time-limited psychotherapy for depression, either with therapy alone or in combination with antidepressant medication, are identifiable prior to end of treatment. Findings provide an operationalized strategy for designing adaptive psychotherapy interventions.
authors.affiliation: Department of Psychiatry and Behavioral Sciences.
authors.forename: Dana
authors.initials: D
authors.lastname: Steidtmann
authors.forename: Rachel
authors.initials: R
authors.lastname: Manber
authors.forename: Christine
authors.initials: C
authors.lastname: Blasey
authors.forename: John C
authors.initials: JC
authors.lastname: Markowitz
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Klein
authors.forename: Barbara O
authors.initials: BO
authors.lastname: Rothbaum
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: James H
authors.initials: JH
authors.lastname: Kocsis
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Arnow
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000494:pharmacology*; D002908:Chronic Disease / Q000188:drug therapy / Q000628:therapy; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010879:Piperazines; D011569:Psychiatric Status Rating Scales; D012074:Remission Induction / Q000379:methods; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D000928:Antidepressive Agents; D010879:Piperazines; D014230:Triazoles; C051752:nefazodone