title: Differential efficacy of cognitive behavioral therapy and psychodynamic therapy for major depression: a study of prescriptive factors.
abstract: BACKGROUND
  Minimal efficacy differences have been found between cognitive behavioral therapy (CBT) and psychodynamic therapies for depression, but little is known about patient characteristics that might moderate differential treatment effects. We aimed to generate hypotheses regarding such potential prescriptive factors.
  
  
  METHODS
  We conducted post-hoc model-based recursive partitioning analyses alongside a randomized clinical trial comparing the efficacy of CBT and short-term psychodynamic supportive psychotherapy (SPSP). Severely depressed patients received additional antidepressant medication. We included 233 adults seeking treatment for a major depressive episode in psychiatric outpatient clinics, who completed post-treatment assessment. Post-treatment mean Hamilton Depression Rating Scale scores constituted the main outcome measure.
  
  
  RESULTS
  While treatment differences (CBT v. SPSP) were minimal in the total sample of patients (d = 0.04), model-based recursive partitioning indicated differential treatment efficacy in certain subgroups of patients. SPSP was found more efficacious among moderately depressed patients receiving psychotherapy only who showed low baseline co-morbid anxiety levels (d = -0.40) and among severely depressed patients receiving psychotherapy and antidepressant medication who reported a duration of the depressive episode of ⩾1 year (d = -0.31), while CBT was found more efficacious for such patients reporting a duration <1 year (d = 0.83).
  
  
  CONCLUSIONS
  Our findings are observational and need validation before they can be used to guide treatment selection, but suggest that knowledge of prescriptive factors can help improve the efficacy of psychotherapy for depression. Depressive episode duration and co-morbid anxiety level should be included as stratification variables in future randomized clinical trials comparing CBT and psychodynamic therapy.
authors.affiliation: Department of Clinical Psychology,VU University Amsterdam,Amsterdam,The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Driessen
authors.affiliation: Department of Clinical Psychology,VU University Amsterdam,Amsterdam,The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Smits
authors.affiliation: Department of Clinical Psychology,VU University Amsterdam,Amsterdam,The Netherlands.
authors.forename: J J M
authors.initials: JJ
authors.lastname: Dekker
authors.affiliation: Arkin Mental Health Care,Amsterdam,The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Peen
authors.affiliation: Arkin Mental Health Care,Amsterdam,The Netherlands.
authors.forename: F J
authors.initials: FJ
authors.lastname: Don
authors.affiliation: Arkin Mental Health Care,Amsterdam,The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: Kool
authors.affiliation: Arkin Mental Health Care,Amsterdam,The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Westra
authors.affiliation: Arkin Mental Health Care,Amsterdam,The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Hendriksen
authors.affiliation: Department of Clinical Psychology,VU University Amsterdam,Amsterdam,The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Cuijpers
authors.affiliation: Arkin Mental Health Care,Amsterdam,The Netherlands.
authors.forename: H L
authors.initials: HL
authors.lastname: Van
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011614:Psychotherapy, Brief; D064889:Psychotherapy, Psychodynamic / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents
keywords: Depression; prescriptive factors; psychotherapies