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Ten month outcome of cognitive behavioural therapy v. interpersonal psychotherapy in patients with major depression: a randomised trial of acute and maintenance psychotherapy

Published online by Cambridge University Press:  09 May 2017

R. Mulder ,
J. Boden ,
J. Carter ,
S. Luty  and
P. Joyce
R. Mulder*
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
J. Boden
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
J. Carter
Affiliation:
Department of Psychological, Canterbury University, Christchurch, New Zealand
S. Luty
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
P. Joyce
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
*
*Address for correspondence: Professor R. Mulder, Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand. (Email: [email protected])
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Abstract

Background

Cognitive behaviour therapy (CBT) and interpersonal psychotherapy (IPT) are the most studied psychotherapies for treatment of depression, but they are rarely directly compared particularly over the longer term. This study compares the outcomes of patients treated with CBT and IPT over 10 months and tests whether there are differential or general predictors of outcome.

Methods

A single centre randomised controlled trial (RCT) of depressed outpatients treated with weekly CBT or IPT sessions for 16 weeks and then 24 weeks of maintenance CBT or IPT. The principle outcome was depression severity measured using the MADRS. Pre-specified predictors of response were in four domains: demographic depression, characteristics, comorbidity and personality. Data were analysed over 16 weeks and 40 weeks using general linear mixed effects regression models.

Results

CBT was significantly more effective than IPT in reducing depressive symptoms over the 10 month study largely because it appeared to work more quickly. There were no differential predictors of response to CBT v. IPT at 16 weeks or 40 weeks. Personality variables were most strongly associated with overall outcome at both 16 weeks and 40 weeks. The number of personality disorder symptoms and lower self-directness and reward dependence scores were associated with poorer outcome for both CBT and IPT at 40 weeks.

Conclusions

CBT and IPT are effective treatments for major depression over the longer term. CBT may work more quickly. Personality variables are the most relevant predictors of outcome.

Keywords

CBTIPTmajor depressionpersonalitypsychotherapyRCT
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 14 , October 2017 , pp. 2540 - 2547
Copyright
Copyright © Cambridge University Press 2017 

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References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.Google Scholar
Beck, AT, Rush, AJ, Shaw, BF, Emery, G (1979). Cognitive Therapy of Depression. The Guilford Press: New York.Google Scholar
Bulik, CM, Sullivan, PF, Carter, FA, Mcintosh, VV, Joyce, PR (1999). Predictors of rapid and sustained response to cognitive-behavioral therapy for bulimia nervosa. International Journal of Eating Disorders 26, 137–144.Google Scholar
Cuijpers, P, Van Straten, A, Andersson, G, Van Oppen, P (2008). Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology 76, 909–922.Google Scholar
Dabbs, JM, Carr, TS, Frady, RL, Riad, JK (1995). Testosterone, crime, and misbehavior among 692 male prison inmates. Personality and Individual Differences 18, 627–633.Google Scholar
Elkin, I, Shea, M, Watkins, J, Imber, S, Sotsky, S, Collins, J, Glass, D, Pilkonis, P, Leber, W, Docherty, J, Fiester, S, Parloff, M (1989). National institute of mental health treatment of depression collaborative research program: general effectiveness of treatments. Archives of General Psychiatry 46, 971–982.Google Scholar
Foulds, JA, Mulder, RT, Newton-Howes, G, Adamson, SJ, Boden, JM, Sellman, JD (2016). Personality predictors of drinking outcomes in depressed alcohol-dependent patients. Alcohol and Alcoholism 51, 296–301.Google Scholar
Frank, E (1991). Interpersonal psychotherapy aas a maintenance treatment for patients with recurrent depression. Psychotherapy 28, 259–266.Google Scholar
Hill, CE, O'grady, KE, Elkin, I (1992). Applying the Collaborative Study Psychotherapy Rating Scale to rate therapist adherence in cognitive-behavior therapy, interpersonal therapy, and clinical management. Journal of Consulting and Clinical Psychology 60, 73–79.Google Scholar
Joyce, PR, Mckenzie, JM, Carter, JD, Rae, AM, Luty, SE, Frampton, CMA, Mulder, RT (2007). Temperament, character and personality disorders as predictors of response to interpersonal psychotherapy and cognitive-behaviour therapy for depression. British Journal of Psychiatry 190, 503–508.Google Scholar
Klerman, GL, Weissman, MM, Rounsaville, BJ, Chevron, ES (1984). Interpersonal Psychotherapy of Depression. Basic Books: New York.Google Scholar
Lemmens, LH, Arntz, A, Peeters, F, Hollon, SD, Roefs, A, Huibers, MJ (2015). Clinical effectiveness of cognitive therapy v. interpersonal psychotherapy for depression: results of a randomized controlled trial. Psychological Medicine 45, 2095–2110.Google Scholar
Luty, SE, Carter, JD, Mckenzie, JM, Rae, AM, Frampton, CMA, Mulder, RT, Joyce, PR (2007). Randomised controlled trial of interpersonal psychotherapy and cognitive behaviour therapy for depression. British Journal of Psychiatry 190, 496–502.Google Scholar
Munder, T, Brutsch, O, Leonhart, R, Gerger, H, Barth, J (2013). Researcher allegiance in psychotherapy outcome research: an overview of reviews. Clinical Psychology Review 33, 501–511.Google Scholar
Newton-Howes, G, Tyrer, P, Johnson, T, Mulder, R, Kool, S, Dekker, J, Schoevers, R (2014). Influence of personality on the outcome of treatment in depression: systematic review and meta-analysis. Journal of Personality Disorders 28, 577–593.Google Scholar
O'malley, SS, Foley, SH, Rounsaville, BJ, Watkins, JT, Sotsky, SM, Imber, SD, Elkin, I (1988). Therapist competence and patient outcome in interpersonal psychotherapy of depression. Journal of Consulting and Clinical Psychology 56, 496–501.Google Scholar
Quilty, LC, De Fruyt, F, Rolland, JP, Kennedy, SH, Rouillon, PF, Bagby, RM (2008). Dimensional personality traits and treatment outcome in patients with major depressive disorder. Journal of Affective Disorders 108, 241–250.Google Scholar
Rush, AJ, Wisniewski, SR, Zisook, S, Fava, M, Sung, SC, Haley, CL, Chan, HN, Gilmer, WS, Warden, D, Nierenberg, AA, Balasubramani, GK, Gaynes, BN, Trivedi, MH, Hollon, SD (2012). Is prior course of illness relevant to acute or longer-term outcomes in depressed out-patients? A STAR*D report. Psychological Medicine 42, 1131–1149.Google Scholar
Statacorp (2011). Stata Statistical Software: Release 12. StataCorp LP: College Station, TX.Google Scholar