Effect of Disorder-Specific vs Nonspecific Psychotherapy for Chronic Depression: A Randomized Clinical Trial.
OBJECTIVE
Chronic depression is a highly prevalent and disabling disorder. There is a recognized need to assess the value of long-term disorder-specific psychotherapy.


OBJECTIVE
To evaluate the efficacy of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) compared with that of nonspecific supportive psychotherapy (SP).


METHODS
A prospective, multicenter, evaluator-blinded, randomized clinical trial was conducted among adult outpatients with early-onset chronic depression who were not taking antidepressant medication. Patients were recruited between March 5, 2010, and October 16, 2012; the last patient finished treatment on October 14, 2013. Data analysis was conducted from March 5, 2014, to October 27, 2016.


METHODS
The treatment included 24 sessions of CBASP or SP for 20 weeks in the acute phase, followed by 8 continuation sessions during the next 28 weeks.


METHODS
The primary outcome was symptom severity after 20 weeks (blinded observer ratings) as assessed by the 24-item Hamilton Rating Scale for Depression (HRSD-24). Secondary outcomes were rates of response (reduction in HRSD-24 score of ≥50% from baseline) and remission (HRSD-24 score ≤8), as well as self-assessed ratings of depression, global functioning, and quality of life.


RESULTS
Among 622 patients assessed for eligibility, 268 were randomized: 137 to CBASP (96 women [70.1%] and 41 men [29.9%]; mean [SD] age, 44.7 [12.1] years) and 131 to SP (81 women [61.8%] and 50 men [38.2%]; mean [SD] age, 45.2 [11.6] years). The mean (SD) baseline HRSD-24 scores of 27.15 (5.49) in the CBASP group and 27.05 (5.74) in the SP group improved to 17.19 (10.01) and 20.39 (9.65), respectively, after 20 weeks, with a significant adjusted mean difference of -2.51 (95% CI, -4.16 to -0.86; P = .003) and a Cohen d of 0.31 in favor of CBASP. After 48 weeks, the HRSD-24 mean (SD) scores were 14.00 (9.72) for CBASP and 16.49 (9.96) for SP, with an adjusted difference of -3.13 (95% CI, -5.01 to -1.25; P = .001) and a Cohen d of 0.39. Patients undergoing CBASP were more likely to reach response (48 of 124 [38.7%] vs 27 of 111 [24.3%]; adjusted odds ratio, 2.02; 95% CI, 1.09 to 3.73; P = .03) or remission (27 of 124 [21.8%] vs 14 of 111 [12.6%]; adjusted odds ratio, 3.55; 95% CI, 1.61 to 7.85; P = .002) after 20 weeks. Patients undergoing CBASP showed significant advantages in most other secondary outcomes.


CONCLUSIONS
Highly structured specific psychotherapy was moderately more effective than nonspecific therapy in outpatients with early-onset chronic depression who were not taking antidepressant medication. Adding an extended phase to acute psychotherapy seems promising in this population.


BACKGROUND
clinicaltrials.gov Identifier: NCT00970437.
Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Elisabeth
E
Schramm
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany.
Levente
L
Kriston
Psychology School at the Fresenius University of Applied Sciences Berlin, Berlin, Germany.
Ingo
I
Zobel
Central Institute of Mental Health, Department of Clinical Psychology, Medical Faculty Mannheim/University Heidelberg, Heidelberg, Germany.
Josef
J
Bailer
Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany.
Katrin
K
Wambach
Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, Germany7Institute of Clinical Psychology, Hospital Stuttgart, Stuttgart, Germany.
Matthias
M
Backenstrass
Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany.
Jan Philipp
JP
Klein
Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.
Dieter
D
Schoepf
Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany.
Knut
K
Schnell
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg-Eppendorf, Germany.
Antje
A
Gumz
Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Paul
P
Bausch
Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Thomas
T
Fangmeier
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany.
Ramona
R
Meister
Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Mathias
M
Berger
Department of Psychology, Clinical Psychology, and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany.
Martin
M
Hautzinger
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany.
Martin
M
Härter
D000328:Adult; D000553:Ambulatory Care; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods*