title: Therapist-rated outcomes in a randomized clinical trial comparing cognitive behavioral therapy and psychodynamic therapy for major depression.
abstract: BACKGROUND
  The efficacy of psychodynamic therapy (PDT) for depression is debated due to a paucity of high-quality studies. We compared short psychodynamic supportive psychotherapy (SPSP) to cognitive behavioral therapy (CBT) in a randomized clinical trial. We used therapist-rated outcomes to examine how the course of change during treatment could be best represented and to compare treatment efficacy, hypothesizing non-significant differences.
  
  
  METHODS
  Three hundred and forty-one adults meeting DSM-IV criteria for a depressive episode and with Hamilton Depression Rating Scale (HAM-D) scores ≥14 were randomized to 16 sessions of individual manualized CBT or SPSP. Severely depressed patients (HAM-D>24) received additional antidepressant medication. After each session, therapists rated the Clinical Global Impression Scale subscales 'Severity of Illness' (CGI-S) and 'Global Improvement' (CGI-I), and the DSM-IV Axis V Global Assessment of Functioning Scale (GAF). We fitted growth curves using mixed model analyses with intention-to-treat samples.
  
  
  RESULTS
  CGI-S and GAF scores during treatment were best represented by a linear symptom decrease. CGI-I scores were best represented by an S-shaped curve with relative more improvement in the first and last phases than in the middle phase of treatment. No significant post-treatment treatment differences were found. A non-significant trend for a treatment effect on CGI-S scores vanished when controlling for therapist gender and profession.
  
  
  CONCLUSIONS
  Therapists were not specifically trained for CGI and GAF assessments.
  
  
  CONCLUSIONS
  These findings add to the evidence-base of PDT for depression. Therapist characteristics and differences between severity and improvement measures might influence ratings and need to be taken into account when using therapist-rated outcome measures.
authors.affiliation: VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands. Electronic address: e.driessen@vu.nl.
authors.forename: Ellen
authors.initials: E
authors.lastname: Driessen
authors.affiliation: Arkin Mental Health Care, Amsterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: Van Henricus
authors.affiliation: Arkin Mental Health Care, Amsterdam, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Peen
authors.affiliation: Arkin Mental Health Care, Amsterdam, The Netherlands; ProPersona Mental Health, Nijmegen, The Netherlands.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Don
authors.affiliation: Arkin Mental Health Care, Amsterdam, The Netherlands.
authors.forename: Simone
authors.initials: S
authors.lastname: Kool
authors.affiliation: Arkin Mental Health Care, Amsterdam, The Netherlands.
authors.forename: Dieuwertje
authors.initials: D
authors.lastname: Westra
authors.affiliation: Arkin Mental Health Care, Amsterdam, The Netherlands.
authors.forename: Mariëlle
authors.initials: M
authors.lastname: Hendriksen
authors.affiliation: VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands.
authors.forename: Pim
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: VU University Amsterdam, Department of Health Sciences, Amsterdam, The Netherlands; VU University Medical Center Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, The Netherlands.
authors.forename: Jos W R
authors.initials: JW
authors.lastname: Twisk
authors.affiliation: VU University Amsterdam, Department of Clinical Psychology, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University and VU University Medical Center Amsterdam, The Netherlands; Arkin Mental Health Care, Amsterdam, The Netherlands.
authors.forename: Jack J M
authors.initials: JJ
authors.lastname: Dekker
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011614:Psychotherapy, Brief; D064889:Psychotherapy, Psychodynamic; D016896:Treatment Outcome
keywords: Cognitive behavioral therapy; Depression; Efficacy; Psychodynamic therapy; Psychotherapy; Therapist-rated outcomes