Abstract
Background: Evidence on the long-term efficacy of psychotherapeutic approaches for chronic depression is scarce. Objective: To evaluate the effects of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) compared to Supportive Psychotherapy (SP) 1 year and 2 years after treatment termination. Methods: In this study, we present 1- and 2-year follow-up assessments of a prospective, multicenter, evaluator-blinded, randomized clinical trial of outpatients with early-onset chronic major depression (n = 268). The initial treatment included 32 sessions of CBASP or SP over 48 weeks. The primary outcome was the rate of “well weeks” (Longitudinal Interval Follow-Up Evaluation; no/minimal symptoms) after 1 year and 2 years. The secondary outcomes were, among others, clinician- and self-rated depressive symptoms, response/remission rates, and quality of life. Results: Of the 268 randomized patients, 207 (77%) participated in the follow-up. In the intention-to-treat analysis, there was no statistically significant difference between CBASP and SP patients in experiencing well weeks (CBASP: mean [SD] of 48.6 [36.9] weeks; SP: 39.0 [34.8]; rate ratio 1.26, 95% CI 0.99–1.59, p = 0.057, d = 0.18) and in remission rates (CBASP: 1 year 40%, 2 years 40.2%; SP: 1 year 28.9%, 2 years 33%) in the 2 years after treatment. Statistically significant effects were found in favor of CBASP 1 year after treatment termination regarding the rate of well weeks, self-rated depressive symptoms, and depression-related quality of life. Conclusions: CBASP lost its superiority over SP at some point between the first and the second year. This suggests the necessity of maintenance treatment for early-onset chronically depressed patients remitted with CBASP during the acute therapy phase, as well as the sequential integration of other treatment strategies, including medication for those who did not reach remission.
References
1.
Cuijpers
P
. Four decades of outcome research on psychotherapies for adult depression: an overview of a series of meta-analyses
. Can Psychol
. 2017
;58
(1
):7
–19
. 0708-55912.
Conradi
HJ
, Bos
EH
, Kamphuis
JH
, de Jonge
P
. The ten-year course of depression in primary care and long-term effects of psychoeducation, psychiatric consultation and cognitive behavioral therapy
. J Affect Disord
. 2017
Aug
;217
:174
–82
.
[PubMed]
0165-03273.
Seemüller
F
, Obermeier
M
, Schennach
R
, Bauer
M
, Adli
M
, Brieger
P
, et al. Stability of remission rates in a 3-year follow-up of naturalistic treated depressed inpatients
. BMC Psychiatry
. 2016
May
;16
(1
):153
.
[PubMed]
1471-244X4.
Murphy
JA
, Byrne
GJ
. Prevalence and correlates of the proposed DSM-5 diagnosis of Chronic Depressive Disorder
. J Affect Disord
. 2012
Jul
;139
(2
):172
–80
.
[PubMed]
0165-03275.
Wiersma
JE
, van Oppen
P
, van Schaik
DJ
, van der Does
AJ
, Beekman
AT
, Penninx
BW
. Psychological characteristics of chronic depression: a longitudinal cohort study
. J Clin Psychiatry
. 2011
Mar
;72
(3
):288
–94
.
[PubMed]
0160-66896.
Imel
ZE
, Malterer
MB
, McKay
KM
, Wampold
BE
. A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia
. J Affect Disord
. 2008
Oct
;110
(3
):197
–206
.
[PubMed]
0165-03277.
Karyotaki
E
, Smit
Y
, Holdt Henningsen
K
, Huibers
MJ
, Robays
J
, de Beurs
D
, et al. Combining pharmacotherapy and psychotherapy or monotherapy for major depression? A meta-analysis on the long-term effects
. J Affect Disord
. 2016
Apr
;194
:144
–52
.
[PubMed]
0165-03278.
Negt
P
, Brakemeier
EL
, Michalak
J
, Winter
L
, Bleich
S
, Kahl
KG
. The treatment of chronic depression with cognitive behavioral analysis system of psychotherapy: a systematic review and meta-analysis of randomized-controlled clinical trials
. Brain Behav
. 2016
May
;6
(8
):e00486
.
[PubMed]
2162-32799.
McCullough
JP
. Treatment for chronic depression: cognitive behavioral analysis system of psychotherapy
. New York (NY)
: Guilford Press
; 2000
.10.
Rief
W
, Bleichhardt
G
, Dannehl
K
, Euteneuer
F
, Wambach
K
. Comparing the efficacy of CBASP with two versions of CBT for depression in a routine care center: a randomized clinical trial
. Psychother Psychosom
. 2018
;87
(3
):164
–78
.
[PubMed]
0033-319011.
Kocsis
JH
, Gelenberg
AJ
, Rothbaum
BO
, Klein
DN
, Trivedi
MH
, Manber
R
, et al.; REVAMP Investigators
. Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial
. Arch Gen Psychiatry
. 2009
Nov
;66
(11
):1178
–88
.
[PubMed]
0003-990X12.
Klein
DN
, Santiago
NJ
, Vivian
D
, Blalock
JA
, Kocsis
JH
, Markowitz
JC
, et al. Cognitive-behavioral analysis system of psychotherapy as a maintenance treatment for chronic depression
. J Consult Clin Psychol
. 2004
Aug
;72
(4
):681
–8
.
[PubMed]
0022-006X13.
Bausch
P
, Fangmeier
T
, Schramm
E
, Zobel
I
, Drost
S
, Schnell
K
, et al. Cognitive behavioral analysis system of psychotherapy versus escitalopram in patients with chronic depression: results from a naturalistic long-term follow-up
. Psychother Psychosom
. 2017
;86
(5
):308
–10
.
[PubMed]
0033-319014.
Schramm
E
, Zobel
I
, Dykierek
P
, Kech
S
, Brakemeier
EL
, Külz
A
, et al. Cognitive behavioral analysis system of psychotherapy versus interpersonal psychotherapy for early-onset chronic depression: a randomized pilot study
. J Affect Disord
. 2011
Mar
;129
(1-3
):109
–16
.
[PubMed]
0165-032715.
Klerman
GL
, Weissman
MM
, Rounsaville
BJ
, Chevron
ES
. Interpersonal psychotherapy of depression: a brief, focused, specific strategy
. New York
: Basic Books
; 1994
.16.
Brakemeier
EL
, Radtke
M
, Engel
V
, Zimmermann
J
, Tuschen-Caffier
B
, Hautzinger
M
, et al. Overcoming treatment resistance in chronic depression: a pilot study on outcome and feasibility of the cognitive behavioral analysis system of psychotherapy as an inpatient treatment program
. Psychother Psychosom
. 2015
;84
(1
):51
–6
.
[PubMed]
0033-319017.
Guidi
J
, Brakemeier
EL
, Bockting
CL
, Cosci
F
, Cuijpers
P
, Jarrett
RB
, et al. Methodological recommendations for trials of psychological interventions
. Psychother Psychosom
. 2018
;87
(5
):276
–84
.
[PubMed]
0033-319018.
Schramm
E
, Kriston
L
, Zobel
I
, Bailer
J
, Wambach
K
, Backenstrass
M
, et al. Effect of disorder-specific vs nonspecific psychotherapy for chronic depression: a randomized clinical trial
. JAMA Psychiatry
. 2017
Mar
;74
(3
):233
–42
.
[PubMed]
2168-622X19.
Keller
MB
, Lavori
PW
, Friedman
B
, Nielsen
E
, Endicott
J
, McDonald-Scott
P
, et al. The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies
. Arch Gen Psychiatry
. 1987
Jun
;44
(6
):540
–8
.
[PubMed]
0003-990X20.
Schramm
E
, Hautzinger
M
, Zobel
I
, Kriston
L
, Berger
M
, Härter
M
. Comparative efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus supportive psychotherapy for early onset chronic depression: design and rationale of a multisite randomized controlled trial
. BMC Psychiatry
. 2011
Aug
;11
(1
):134
.
[PubMed]
1471-244X21.
Markowitz
JC
. What is supportive psychotherapy?
Focus
. 2014
;12
(3
):285
–9
. 1047-071922.
Cuijpers
P
, Driessen
E
, Hollon
SD
, van Oppen
P
, Barth
J
, Andersson
G
. The efficacy of non-directive supportive therapy for adult depression: a meta-analysis
. Clin Psychol Rev
. 2012
Jun
;32
(4
):280
–91
.
[PubMed]
0272-735823.
Klein
DN
, Shankman
SA
, Rose
S
. Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression
. Am J Psychiatry
. 2006
May
;163
(5
):872
–80
.
[PubMed]
0002-953X24.
Hamilton
M
. Development of a rating scale for primary depressive illness
. Br J Soc Clin Psychol
. 1967
Dec
;6
(4
):278
–96
.
[PubMed]
0007-129325.
Rush
AJ
, Trivedi
MH
, Ibrahim
HM
, Carmody
TJ
, Arnow
B
, Klein
DN
, et al. The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression
. Biol Psychiatry
. 2003
Sep
;54
(5
):573
–83
.
[PubMed]
0006-322326.
Rush
AJ
, Gullion
CM
, Basco
MR
, Jarrett
RB
, Trivedi
MH
. The inventory of depressive symptomatology (IDS): psychometric properties
. Psychol Med
. 1996
May
;26
(3
):477
–86
.
[PubMed]
0033-291727.
Endicott
J
, Spitzer
RL
, Fleiss
JL
, Cohen
J
. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance
. Arch Gen Psychiatry
. 1976
Jun
;33
(6
):766
–71
.
[PubMed]
0003-990X28.
Gandek
B
, Ware
JE
, Aaronson
NK
, Apolone
G
, Bjorner
JB
, Brazier
JE
, et al. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment
. J Clin Epidemiol
. 1998
Nov
;51
(11
):1171
–8
.
[PubMed]
0895-435629.
Ware
J
Jr, Kosinski
M
, Keller
SD
. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity
. Med Care
. 1996
Mar
;34
(3
):220
–33
.
[PubMed]
0025-707930.
Hunt
SM
, McKenna
SP
. The QLDS: a scale for the measurement of quality of life in depression
. Health Policy
. 1992
Oct
;22
(3
):307
–19
.
[PubMed]
0168-851031.
Whalley
D
, McKenna
SP
. Measuring quality of life in patients with depression or anxiety
. Pharmacoeconomics
. 1995
Oct
;8
(4
):305
–15
.
[PubMed]
1170-769032.
Maier-Diewald
W
, Wittchen
HU
, Hecht
H
, Werner-Eilert
K
. Die Münchener Ereignisliste (MEL) - Anwendungsmanual
. München
: Max-Planck-Institut für Psychiatrie
; 1983
.33.
Rubin
D
. Multiple imputation for nonresponse in surveys
. New York
: John Wiley and Sons
; 2004
.34.
Robertson
MC
, Campbell
AJ
, Herbison
P
. Statistical analysis of efficacy in falls prevention trials
. J Gerontol A Biol Sci Med Sci
. 2005
Apr
;60
(4
):530
–4
.
[PubMed]
1079-500635.
Herbison
P
, Robertson
MC
, McKenzie
JE
. Do alternative methods for analysing count data produce similar estimates? Implications for meta-analyses
. Syst Rev
. 2015
Nov
;4
(1
):163
.
[PubMed]
2046-405336.
Engel
C
, Meisner
C
, Wittorf
A
, et al. Longitudinal data analysis of symptom score trajectories using linear mixed models in a clinical trial
. Int J Stats.
2013
;2
(4
):305
–15
. 37.
Azuero
A
. A note on the magnitude of hazard ratios
. Cancer
. 2016
Apr
;122
(8
):1298
–9
.
[PubMed]
0008-543X38.
Chinn
S
. A simple method for converting an odds ratio to effect size for use in meta-analysis
. Stat Med
. 2000
Nov
;19
(22
):3127
–31
.
[PubMed]
0277-671539.
Manber
R
, Arnow
B
, Blasey
C
, Vivian
D
, McCullough
JP
, Blalock
JA
, et al. Patient’s therapeutic skill acquisition and response to psychotherapy, alone or in combination with medication
. Psychol Med
. 2003
May
;33
(4
):693
–702
.
[PubMed]
0033-291740.
Guidi
J
, Tomba
E
, Fava
GA
. The sequential integration of pharmacotherapy and psychotherapy in the treatment of major depressive disorder: a meta-analysis of the sequential model and a critical review of the literature
. Am J Psychiatry
. 2016
Feb
;173
(2
):128
–37
.
[PubMed]
0002-953X41.
Dekker
J
, Van
HL
, Hendriksen
M
, Koelen
J
, Schoevers
RA
, Kool
S
, et al. What is the best sequential treatment strategy in the treatment of depression? Adding pharmacotherapy to psychotherapy or vice versa?
Psychother Psychosom
. 2013
;82
(2
):89
–98
.
[PubMed]
0033-319042.
Graham
JW
, Schafer
JL
. On the performance of multiple imputation for multivariate data with small sample size. Statistical Strategies for Small Sample Research
. Thousand Oakes (CA)
: Sage
; 1999
. pp. 1
–29
.43.
Vittengl
JR
. Poorer long-term outcomes among persons with major depressive disorder treated with medication
. Psychother Psychosom
. 2017
;86
(5
):302
–4
.
[PubMed]
0033-319044.
Furukawa
TA
, Efthimiou
O
, Weitz
ES
, Cipriani
A
, Keller
MB
, Kocsis
JH
, et al. Cognitive-behavioral analysis system of psychotherapy, drug, or their combination for persistent depressive disorder: personalizing the treatment choice using individual participant data network metaregression
. Psychother Psychosom
. 2018
;87
(3
):140
–53
.
[PubMed]
0033-319045.
Kordy
H
, Wolf
M
, Aulich
K
, Bürgy
M
, Hegerl
U
, Hüsing
J
, et al. Internet-delivered disease management for recurrent depression: a multicenter randomized controlled trial
. Psychother Psychosom
. 2016
;85
(2
):91
–8
.
[PubMed]
0033-3190© 2019 S. Karger AG, Basel
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