title: Maintenance cognitive-behavioral therapy and manualized psychoeducation in the treatment of recurrent depression: a multicenter prospective randomized controlled trial.
abstract: OBJECTIVE
  This multicenter study compared the relapse and recurrence outcomes of two active treatments, maintenance cognitive-behavioral therapy (CBT) and manualized psychoeducation, both in addition to treatment as usual, in patients in remission from depression.
  
  
  METHODS
  This was a multicenter prospective randomized observer-blinded study with two parallel groups. The authors assessed 180 patients with three or more previous major depressive episodes who met remission criteria over a 2-month baseline period and who were randomly assigned to 16 sessions of either maintenance CBT or manualized psychoeducation over 8 months and then followed up for 12 months. The main outcome measure was time to first relapse or recurrence of a major depression, based on DSM-IV criteria, as assessed by blinded observers with the Longitudinal Interval Follow-Up Evaluation.
  
  
  RESULTS
  Cox regression analysis showed that time to relapse or recurrence of major depression did not differ significantly between treatment conditions, but a significant interaction was observed between treatment condition and number of previous episodes (<5 or ≥5). Within the subsample of patients with five or more previous episodes, maintenance CBT was significantly superior to manualized psychoeducation, whereas for patients with fewer than five previous episodes, no significant treatment differences were observed in time to relapse or recurrence.
  
  
  CONCLUSIONS
  The results indicate that maintenance CBT has significant effects on the prevention of relapse or recurrence only in patients with a high risk of depression recurrence. For patients with a moderate risk of recurrence, nonspecific effects and structured patient education may be equally effective.
authors.affiliation: Department of Psychology, University of Frankfurt, Germany. stangier@psych.uni-frankfurt.de
authors.forename: Ulrich
authors.initials: U
authors.lastname: Stangier
authors.forename: Christine
authors.initials: C
authors.lastname: Hilling
authors.forename: Thomas
authors.initials: T
authors.lastname: Heidenreich
authors.forename: Anne Katrin
authors.initials: AK
authors.lastname: Risch
authors.forename: Arnd
authors.initials: A
authors.lastname: Barocka
authors.forename: Ralf
authors.initials: R
authors.lastname: Schlösser
authors.forename: Kai
authors.initials: K
authors.lastname: Kronfeld
authors.forename: Christian
authors.initials: C
authors.lastname: Ruckes
authors.forename: Hartmut
authors.initials: H
authors.lastname: Berger
authors.forename: Joachim
authors.initials: J
authors.lastname: Röschke
authors.forename: Florian
authors.initials: F
authors.lastname: Weck
authors.forename: Stephan
authors.initials: S
authors.lastname: Volk
authors.forename: Martin
authors.initials: M
authors.lastname: Hambrecht
authors.forename: Richard
authors.initials: R
authors.lastname: Serfling
authors.forename: Ralf
authors.initials: R
authors.lastname: Erkwoh
authors.forename: Aglaja
authors.initials: A
authors.lastname: Stirn
authors.forename: Thomas
authors.initials: T
authors.lastname: Sobanski
authors.forename: Martin
authors.initials: M
authors.lastname: Hautzinger
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D055502:Secondary Prevention; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents