No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Group cognitive therapy and alprazolam in the treatment of depression in older adults.
Abstract
This study was designed to explore the relative and combined effectiveness of alprazolam (Xanax) and group cognitive therapy among elderly adults experiencing major affective disorder. Fifty-six subjects with Diagnostic and Statistical Manual of Mental Disorders (DSM-III) diagnoses of major, unipolar depression were treated over a 20-week period in one of four groups: alprazolam support, placebo support, cognitive therapy plus placebo support, and cognitive therapy plus alprazolam support. The results revealed that individuals assigned to group cognitive therapy showed consistent improvement in subjective state and sleep efficiency relative to non-group-therapy subjects. No differences between alprazolam and placebo were noted, regardless of whether individuals received group cognitive therapy. Subjects assigned to group cognitive therapy were less likely than their counterparts to prematurely terminate treatment.
... Using the Cognitive Errors Questionnaire (CEQ; Lefebvre, 1981) to assess depressive thinking (cognitive distortion), Beutler et al. (1987) compared the effectiveness of (a) medication plus support, (b) placebo plus support, (c) cognitive therapy plus placebo plus support, and (d) cognitive therapy plus medication plus support. Although participants who received cognitive therapy demonstrated a significantly greater reduction in depressive symptoms compared to participants who did not receive cognitive therapy, none of the treatments resulted in a significant reduction in cognitive distortions. ...
... In our review, the results of cognitive specificity studies are more mixed than the body of research showing a link between cognitive changes and symptom reduction in cognitive therapy. As defined by significant differences in cognition between cognitive therapy and pharmacological treatments, our review finds five studies suggestive of specificity in cognitive-pharmacological comparisons (Blackburn & Bishop, 1983;Imber et al., 1990;McKnight et al., 1992;Teasdale et al., 2001;Whisman et al., 1991) and eight that are not (Beevers & Miller, 2004;Beutler et al., 1987;Bowers, 1990;Rush et al., 1981;Segal et al., 1999Segal et al., , 2006Simons et al., 1984;Stravynski et al., 1994). Moreover, study findings did not depend on type of measure used to assess cognition (i.e., significant group differences were not a function of cognitive measures used in the study). ...
A central theoretical principle guiding cognitive therapy is that mediation by cognitive processes is linked to the successful treatment of depression. The most recent review of the literature on this question is over a decade old and was suggestive of cognitive mediation for cognitive therapy, but was not conclusive. Since this review, a number of studies have been published that address cognitive mediation. The mediation hypothesis can be broadly defined as encompassing two related questions: cognitive mediation framed as “are cognitive changes associated with therapeutic improvement,” and cognitive specificity from the perspective of “are changes in cognition specific to cognitive therapy?” This latter question is particularly important when cognitive therapy is compared to pharmacotherapy. This article reviews the current literature associated with these questions. Our review indicates that the current body of research generally supports cognitive mediation, but is considerably more mixed for cognitive specificity. However, some evidence suggests that cognitive changes associated with pharmacotherapy are more superficial than those associated with cognitive therapy.
... CBT, preferably with professionals specializing in the elderly, compared with conventional pharmacological treatment, has shown outstanding efficacy in identifying triggering factors and in treating depressed elderly patients (39). To promote behavioral activation in cognitive restructuring and preventing relapses, helps to a stable and lasting change in lifestyle, more compatible with the self-care necessary in chronic diseases management like depression (40). ...
Background: Depression and cardiovascular diseases (CVD) are highly prevalent in the elderly. Depression could be a CVD risk factor as well as an ailment sequela. Objective: To review diagnostical, pathophysiological, and therapeutic factors involved in depression-cardiovascular diseases. Methods: The research was carried out using the keywords of a 10-years range of published studies in Portuguese, English, and Spanish from Scielo and PubMed databases. Inclusion criteria: In vitro studies, cohort studies, case-control, and clinical trials. Studies out of time range, mean age <60 years, other psychiatric diseases were excluded. Results: Depression and CVD in the elderly are a growing problem. Heterogeneous diagnostic scales is often observed in trials. A multidisciplinary approach is needed for better treatment in this population attached by several comorbidities. Conclusion: Depression is a risk factor for the development of CVD and can determine prognosis in the elderly.
... The risk of bias, mainly due to high rates of attrition, was deemed to be high in eight of the relevant trials, which were excluded from the synthesis. Four of these trials evaluated various forms of CBT: CBT-based group interventions [17, 18], group-based Competitive Memory Training (COMET) for depressive rumination [19], and a behavioural activation intervention Psychological Treatment of Late-Life Depression: A Systematic Review (BE-ACTIV) with individual sessions and staff training [20]. The trials were generally small pilot studies with high rates of attrition. ...
Objectives:
Depression in elderly people is a major public health concern. As response to antidepressants is often unsatisfactory in this age group, there is a need for evidence-based non-pharmacological treatment options. Our objectives were twofold: firstly, to synthesize published trials evaluating efficacy, safety and cost-effectiveness of psychological treatment of depression in the elderly and secondly, to assess the quality of evidence.
Method:
The electronic databases PubMed, EMBASE, Cochrane Library, CINAL, Scopus, and PsycINFO were searched up to 23 May 2016 for randomized controlled trials (RCTs) of psychological treatment for depressive disorders or depressive symptoms in people aged 65 years and over. Two reviewers independently assessed relevant studies for risk of bias. Where appropriate, the results were synthesized in meta-analyses. The quality of the evidence was graded according to GRADE (Grading of Recommendations Assessment, Development and Evaluation).
Results:
Twenty-two relevant RCTs were identified, eight of which were excluded from the synthesis due to a high risk of bias. Of the remaining trials, six evaluated problem-solving therapy (PST), five evaluated other forms of cognitive behavioural therapy (CBT), and three evaluated life review/reminiscence therapy. In frail elderly with depressive symptoms, the evidence supported the efficacy of PST, with large but heterogeneous effect sizes compared with treatment as usual. The results for life-review/reminiscence therapy and CBT were also promising, but because of the limited number of trials the quality of evidence was rated as very low. Safety data were not reported in any included trial. The only identified cost-effectiveness study estimated an incremental cost per additional point reduction in Beck Depression Inventory II score for CBT compared with talking control and treatment as usual.
Conclusion:
Psychological treatment is a feasible option for frail elderly with depressive symptoms. However, important questions about efficacy, generalizability, safety and cost-effectiveness remain.
... All meta-analyses were conducted using the software package meta (version 0.81) by Schwarzer (27), using a random effect size model. Table 3 presents the results of effect sizes (and confidence intervals of effect sizes) of the five (7) No AD alone arm (only AD plus CT) Beutler et al. (8) No CT or CBT alone arm (only CT plus placebo or CT plus AD) Bowers (11) No CT or CBT alone arm (only CT plus AD) Covi & Lipman (12) No AD alone arm (only AD plus CT) Dunn (13) No AD alone arm (only AD plus Ôsupportive therapyÕ) Scott & Freeman (25) BDI not used Macaskill & Macaskill (17) No CT or CBT alone arm (only CT plus AD) Zimmer et al. (26) Post-treatment results not reported AD, antidepressant drug; CT, cognitive therapy; CBT, cognitive behaviour therapy. ...
... Another meta-analysis including 48 controlled trials of patients with major depressive disorder found that cognitive therapy performed significantly better than medication and other therapies, except for psychosocial therapy, where it was equally effec- tive [96]. The addition of cognitive therapy to either pill placebo or medication in the treatment of elderly patients was found to be more effective in decreasing depressive symptoms, increasing sleep efficiency, and ensuring completion of treatment than pill placebo or medication alone [97]. How- ever, the strongest evidence for CBT involves its reduction in relapse rates for depression in compari- son to medication. ...
... 34,35 Indeed, in regard to older age groups specifically, CBT and interpersonal therapy have been found to be at least as efficacious in treating depression as pharmacotherapy. [36][37][38] ...
Depression is a major problem in long-term care (LTC) as is the lack of related empirically supported psychological treatments. This small study addressed a variant of cognitive behavioral therapy, GIST (group, individual, and staff therapy), against treatment as usual (TAU) in long-term care.
25 residents with depression were randomized to GIST (n = 13) or TAU (n = 12). Outcome measures included geriatric depression scale-short form (GDS-S), life satisfaction index Z (LSI-Z), and subjective ratings of treatment satisfaction. The GIST group participated in 15 group sessions. TAU crossed over to GIST at the end of the treatment trial.
There were significant differences between GIST and TAU in favor of GIST on the GDS-S and LSI-Z. The GIST group maintained improvements over another 14 sessions. After crossover to GIST, TAU members showed significant improvement from baseline. Participants also reported high subjective ratings of treatment satisfaction.
This trial demonstrated GIST to be more effective for depression in LTC than standard treatments.
... The authors included studies of psychiatric outpatients and studies of primary care patients. Some of the studies dealt with specific age groups, for instance elderly patients [6,36]. A wide array of therapies was included that ranged beyond formal psychotherapy, e.g. ...
Reviews of the relative efficacy of psychotherapy and combined therapy (psychotherapy with pharmacotherapy) for depression have yielded contradicting conclusions. This may be explained by the clinical heterogeneity of the studies reviewed.
To conduct a meta-analysis with an acceptable level of homogeneity in order to investigate the relative efficacy of psychotherapy and combined therapy in the acute treatment of depression.
A systematic search was performed for RCTs published between 1980 and 2005 comparing psychotherapy and combined therapy in adult psychiatric outpatients with non-psychotic unipolar major depressive disorder. The studies were classified according to the chronicity and severity of the depression. Data were pooled by means of meta-analysis and statistical tests were conducted to measure heterogeneity.
The meta-analysis included seven studies looking at a total of 903 patients. None of the heterogeneity tests established significance. This indicates a lack of evidence for the heterogeneity of the results. The dropout rates did not differ significantly between the two treatment modalities (25% in combined therapy and 24% in psychotherapy, p=0.77). At treatment termination, the intention-to-treat remission rate for combined therapy (46%) was better than for psychotherapy (34%) (p=0.0007); Relative Risk 1.32 (95% CI: 1.12-1.56), Odds Ratio 1.59 (95% CI: 1.22-2.09). In moderate depression, the difference between the remission rate for combined therapy and psychotherapy was statistically significant (47% compared to 34% respectively, p=0.001). This was not the case in mild major depression (42% compared to 37% respectively, p=0.29). The difference was also statistically significant in chronic major depression (48% compared to 32%, p<0.001), but not in non-chronic major depression (43% compared to 37%, p=0.22). On a more specific level, no differences were found in the remission rates for the treatment modalities in mild or moderate non-chronic depression. Combined therapy led to significantly better results than psychotherapy in moderate chronic depression only (48% compared to 32%, p<0.001).
In the acute treatment of adult psychiatric outpatients with major depressive disorder, patient compliance with combined therapy matches compliance with psychotherapy alone. Combined therapy is more efficacious than psychotherapy alone. However, these results depend on severity and chronicity. Combined therapy outperformed psychotherapy in moderate chronic depression only. No differences were found in mild and moderate non-chronic depression. No data were found for mild chronic depression and for severe depression.
... Results by Oei and Dingle (2001) suggest that cognitive behaviour therapy can significantly affect biological processes in depression, however no studies included biological measures of depression. The closest measures were sleep efficiency, which was classified here as a behavioural measure (Beutler et al., 1987), and immune function measures (Lutgendorf et al., 1997). Neither of these assessed the key neurochemical or endocrine functions involved in mood. ...
... Significantly , however, those older adults who received treatment reported benefiting from services at least as much as did individuals from all other age groups. Other research including objective measures of treatment outcome has consistently replicated this conclusion (Areán & Cook, 2002; Beutler et al., 1987; de Jonghe, Kool, van Aalst, Dekker, & Peen, 2001; Engels & Vermey, 1997; Reynolds et al., 1999; Scogin & McElreath, 1994 ). Although benefits to the elderly (and of course to disabled individuals who rely on Medicare) are very important in their own right, improvement of Medicare coverage also has the potential to enhance the well-being of other age groups. ...
Professional psychology's ability to meet older Americans' psychological needs and to simultaneously thrive as a profession will be closely tied to the federal Medicare program over the coming decades. Despite legislative changes in the 1980s providing professional autonomy to psychologists and expanding coverage for mental health services, Medicare coverage policies, reimbursement mechanisms, and organizational traditions continue to limit older Americans' access to psychological services. This article describes how psychologists can influence Medicare coverage policy. Specifically, the authors examine widely unrecognized policy processes and recent political developments and analyze the recent creation of a new Medicare counseling benefit, applying J. W. Kingdon's (1995) well-known model of policy change. These recent developments offer new opportunities for expanding Medicare coverage of psychological services, particularly in the areas of prevention, screening, and early intervention. The article provides an analysis to guide psychologists in engaging in strategic advocacy and incorporating psychological prevention and early intervention services into Medicare. As Medicare policy entrepreneurs, psychologists can improve the well-being of millions of Americans who rely on the national health insurance program and, in so doing, can help shape the future practice of psychology.
... Given that it is expected that 20% of the general population will be comprised of senior citizens by the year 2020 and currently individuals 65 years of age or older constitute 13% of the population (Molinari, 1999), it is imperative that more attention be given to this population and adequate assessment and treatment of depression in primary care. It is estimated that 11% to 13% of community-dwelling elders suffer from a mental disorder (Beutler et al., 1987; Evans, 1995). Furthermore, many medical illnesses in elderly people are accompanied by a psychiatric disorder. ...
Prevalence rates of depression in medically ill elderly people are strikingly high. In particular, the prevalences of depression at any given time in Alzheimer's, Parkinson's, and stroke are as high as 87%, 75%, and 79%, respectively. Proper detection and management of depression in primary care is imperative. The present review examines the risk factors, peculiarities, and etiologies of depression in these populations. We suggest that certain features of depression be considered in assessing depression in these populations and provide guidelines for distinguishing depression from medical, psychosocial, and physical complaints common in elderly people. Additionally, we explore the use of self-report instruments of depression and provide guidelines regarding the specific measures and cutoffs most appropriate for use with these populations. To this end, we hope that readers acquire a greater appreciation for the experience of depression of those suffering from these neurological disorders to aid in their assessment.
The present meta-analysis examined controlled trials of pharmacologic augmentation of cognitive-behavioral therapy (CBT) for patients with anxiety or depressive disorders. The additive effect of medications was small for both anxiety and depressive disorders at posttreatment, and there was no additive benefit after medications were discontinued. A small body of evidence suggested that antidepressant medications are an efficacious second-line treatment for patients failing to respond to CBT alone. In anxiety disorders, novel agents thought to potentiate the biological mechanisms of CBT showed small effects at posttreatment; after discontinuation, some of these agents were associated with an increasing effect.
No one remains free of problems or distress throughout their lives, but most people learn to cope with their problems or gain sufficient support and help from their personal relationships to overcome them. Some find that their distress becomes so great that their ability to cope with everyday life becomes seriously undermined. Elderly people have to face many changes specific to their age, as well as the range of problems that might occur at any time in life. Not only must they cope with changes in physical fitness and health, but they must also adapt to a wide variety of alterations, such as loss of earning power, attachments and status. Given this, most elderly people adapt well. It seems that it is the perception of younger people that the elderly are unhappy, rather than the complaint of old people themselves.
The individual and societal burden of depressive disorders is widely acknowledged, but treating these disorders remains challenging. Clinical guidelines recommend that both pharmacotherapy and psychotherapy should be considered as first-line treatments. Yet, because primary care settings are often the frontline of treatment, pharmacological treatments take precedence. In part, this may be due to the perception that psychotherapy is lengthy and time intensive, with guidelines recommending 12 to 20 1-hour sessions for most evidence-based psychotherapies. However, recent evidence seems to suggest that psychotherapies that are briefer in both duration and intensity may be efficacious in acute-phase treatment. If true, these briefer psychotherapies may be more easily integrated in primary care settings.
This discussion paper concerning guidelines on the practice of the psychotherapies by psychiatrists has been developed by a working group of the Steering Committee on the Psychotherapies formed in 1996 by the Canadian Psychiatric Association (CPA) to address the practice of psychotherapy by Canadian psychiatrists. This paper provides the profession with guidelines for clinical care related to the practice of the psychotherapies that reflect best practices based on the available evidence, with the aim of improving standards of practice within the profession. Such guidelines are intended to be linked to emerging strategies for medical education, as well as continuing medical education (CME) and clinical quality assurance (CQA) initiatives within the CPA. This paper reviews the literature, synthesizing theoretical and research contributions and available empirical data. This Working Group has attempted to reflect the clinical experience of Canadian psychiatrists and to report only material that could reasonably be applied to the various models of psychotherapy.
This review examined the effectiveness of group psychotherapy for older (55+) adults. Results from 44 studies with pre-post designs and 27 controlled studies indicated that group psychotherapy benefits older adults, with average
rs of .42 and .24 for pre-post and controlled designs, respectively. The type of therapy provided and the age of the clients were associated with pretreatment to posttreatment improvement. Clients in cognitive-behavioral group therapy improved more than those receiving reminiscence therapy. The older the average age of the group members, the less they benefited from therapy. Number of sessions attended, length of therapy sessions, the percentage of women in the group, and client living situation were not significant moderators of outcome. Overall, group interventions for older adults appear to be effective and the average effect size for pre-post studies was quite similar to those yielded by meta-analyses of group therapy with younger adults and adolescents. However, the average effect size for controlled studies of group therapy with older adults appears to be somewhat smaller than the values reported in meta-analyses with younger clients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Despite the ever-increasing clinical needs of “underserved populations,” research, practice guidelines, and clinical training programs have focused primarily on treating middle- and upper-middle-class nonminority clients. This paper high-lights the mental health needs of low-income minority patients, pointing out specific risks, obstacles to service utilization, reasons for treatment failures, and significant opportunities for clinical interventions and innovations. Countertherapeutic patient and therapist beliefs and attributions are discussed. A pilot cognitive-behavioral depression group specifically designed for low-income minority patients is used to demonstrate practical interventions and guidelines for working with this population. Preliminary results suggest that premature attrition and clinical outcomes can be significantly improved. Group structure, content, and special attention to group processes were thought to be responsible for positive findings.
Fifty-three clinically depressed geriatric inpatients assigned either to behavioral group therapy plus standard hospital treatment (n=27) or a standard hospital treatment comparison group (n=26) were assessed two weeks apart at pretest and posttest using the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HRSD), and the Depression Scale of the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-D). Patients in both groups received standard hospital programs (including pharmacotherapy); but, in addition, the experimental group participated in eight 90-minute sessions of behavioral group therapy. Both groups improved on BDI scores and HRSD ratings, but MANOVAs did not support the statistical incremental efficacy of behavioral group therapy. However, a greater percentage of patients in behavioral group therapy were exhibiting normal BDI scores and HRSD ratings at posttest. Clinical implications of these findings are discussed.
Psychotherapy, including cognitive behavioural therapy (CBT), reminiscence and general psychotherapy (GPT), is viewed as effective treatment for depression, but its efficacy in older people is not well defined. This systematic review included 14 randomized controlled trials that assessed the efficacy of psychotherapy for treating depression in elderly people (> or = 55 years). The results of this meta-analysis showed that, compared with placebo, psychotherapy was more effective in reducing depression scores (standardized mean difference -0.92; 95% confidence interval -1.21, -0.36). Subgroup analysis showed that CBT, reminiscence and GPT were all more effective than placebo; psychotherapy as an adjunct to antidepressant medication did not increase effectiveness. There was no significant difference between CBT and reminiscence in improving depression. A higher drop-out rate was observed in studies that did not include psychotherapy versus those that did, although this difference was not statistically significant. Thus, various general formats of psychotherapy are effective for treating depression in older people, although psychotherapy does not significantly increase the effectiveness of anti-depressant medication.
There is a growing need for information on evidence-based practices that may potentially address needs of elderly people with severe mental illness (SMI), and more specifically on community-based services such as assertive community treatment (ACT).
This study examines national evaluation data from fiscal year 2001-2005 from Veterans Affairs Mental Health Intensive Case Management (MHICM) program (N = 5,222), an ACT-based service model, to characterize the age distribution of participants and the distinctive needs, patterns of service delivery, and treatment outcomes for elderly veterans.
Altogether, 24.8% of participants were 55-64 years; 7.4% 65-74 years; and 2.8% were older than 75. Veterans over 75 formed a distinct subgroup that had a later age of onset of primarily nonpsychotic illnesses without comorbid substance abuse and had experienced more limited lifetime hospital treatment than younger participants. Older veterans were less symptomatic and more satisfied with their social relationships than younger clients. They mostly live independently or in minimally restrictive housing, but they received less recovery-focused services and more crisis intervention and medical services. They thus do not appear to be young patients with SMI who have aged but rather constitute a distinct group with serious late-onset problems. It is possible that MHICM services keep them in the community and avoid costly nursing home placement while providing a respite service that reduces family burden.
These data highlight the unique characteristics of older veterans receiving ACT-like services and the need to focus greater attention on recovery-oriented services as well as community support for this subgroup.
INTRODUÇÃO: Depressão é uma das doenças mentais mais prevalentes entre pessoas idosas. Embora os tratamentos farmacológicos já estejam validados, a recorrência de depressão é comum. Este artigo revisa ensaios clínicos que examinaram a eficácia da psicoterapia versus os tratamentos farmacológicos, sozinhos ou combinados, para pessoas idosas com depressão. MÉTODOS: Foi realizada busca na internet, em dois bancos de dados (Medline e PsychINFO), por ensaios clínicos randomizados e controlados publicados entre 1984 e 2001 que examinaram a eficácia de psicoterapias versus farmacoterapia para depressão em indivíduos com 60 anos ou mais, com diagnóstico de distimia, depressão menor ou maior. RESULTADOS: Foram incluídos quatro estudos. Três compararam a eficácia da psicoterapia versus a farmacoterapia durante a fase aguda e de continuação do tratamento para depressão, e um examinou a eficácia desses tratamentos durante a fase de manutenção. Tratamentos com psicoterapia (sozinha ou combinada com medicação) foram superiores à farmacoterapia em três estudos com sujeitos com depressão maior. Psicoterapia não foi superior a placebo ou antidepressivos em um estudo com sujeitos com distimia ou depressão menor. CONCLUSÃO: As evidências empíricas sobre a eficácia da psicoterapia versus a farmacoterapia para pacientes idosos com depressão são escassas e não conclusivas, sugerindo a necessidade de novos ensaios clínicos que investiguem a eficácia da psicoterapia para o tratamento de depressão em idosos.
To determine the effectiveness of acute-phase pharmacological and psychological treatments of depression in older ambulatory patients by systematically reviewing original research relevant to this topic.
Searches in MEDLINE and PsycINFO and manual reviews of bibliographies located 233 articles. Of these, 40 (37 different studies) met our 8 inclusion criteria: original research, written in English or French, subjects 55 years and older, diagnosis of depression, outpatient or community setting, prospective controlled study design, acute-phase pharmacological or psychological treatment, and outcome measure of depression. Two independent reviewers assessed the methodological quality of each article using a standard form and a quality score was computed. Quantitative data on levels of depression at the end of treatment were abstracted. Results were grouped by specific treatment comparison (type of treatment and type of control group). For comparisons that used the Hamilton Depression Rating Scale, we computed mean posttreatment differences. Effect sizes were computed from the Hamilton Depression Rating Scale or an alternative scale.
In studies that compared active drugs with placebo, the heterocyclic drugs significantly reduced the posttreatment Hamilton Depression Rating Scale score (mean difference, -5.78; 95% confidence interval, -8.31 to -3.25); other drugs had smaller effects. In studies that compared active drugs, there were no significant differences overall between different classes of drugs; selective serotonin reuptake inhibitors appeared to be as effective as heterocyclic drugs. Rational psychological treatments performed significantly better than no treatment (mean posttreatment Hamilton Depression Rating Scale difference, -7.25; 95% confidence interval, -10.10 to -4.40) but not significantly better than that for controls who received similar attention. Adjustment for the study quality score did not affect these results.
Based on comparisons with untreated controls, heterocyclic antidepressants and rational psychological therapies appear to be the most effective treatments for older ambulatory patients with mild to moderate depression. Based on drug-drug comparisons, selective serotonin reuptake inhibitors appear to be as effective as heterocyclic drugs. However, overall, the magnitude of the treatment effects is modest. Limitations in the quantity and quality of appropriate studies suggest a sober approach to treatment in this population.
Cognitive therapy (CT) has been studied in 78 controlled clinical trials from 1977 to 1996.
The meta-analysis used Hedges and Olkin d+ and included 48 high-quality controlled trials. The 2765 patients presented non-psychotic and non-bipolar major depression, or dysthymia of mild to moderate severity.
At post-test CT appeared significantly better than waiting-list, antidepressants (P < 0.0001) and a group of miscellaneous therapies (P < 0.01). But, CT was equal to behaviour therapy. As between-trial homogeneity was not met, the comparisons of CT with waiting-list or placebo, and other therapies should be taken cautiously. In contrast, between-trial homogeneity was high for the comparisons of CT with behaviour therapy and antidepressants. A review of eight follow-up studies comparing CT with antidepressants suggested that CT may prevent relapses in the long-term, while relapse rate is high with antidepressants in naturalistic studies.
CT is effective in patients with mild or moderate depression.
This paper provides the profession with guidelines for clinical care related to the practice of the psychotherapies that reflect best practices.
Background:
Patients with atypical depression are more likely to respond to monoamine oxidase inhibitors than to tricyclic antidepressants. They are frequently offered psychotherapy in the absence of controlled tests. There are no prospective, randomized, controlled trials, to our knowledge, of psychotherapy for atypical depression or of cognitive therapy compared with a monoamine oxidase inhibitor. Since there is only 1 placebo-controlled trial of cognitive therapy, this trial fills a gap in the literature on psychotherapy for depression.
Methods:
Outpatients with DSM-III-R major depressive disorder and atypical features (N = 108) were treated in a 10-week, double-blind, randomized, controlled trial comparing acute-phase cognitive therapy or clinical management plus either phenelzine sulfate or placebo. Atypical features were defined as reactive mood plus at least 2 additional symptoms: hypersomnia, hyperphagia, leaden paralysis, or lifetime sensitivity to rejection.
Results:
With the use of an intention-to-treat strategy, the response rates (21-item Hamilton Rating Scale for Depression score, < or =9) were significantly greater after cognitive therapy (58%) and phenelzine (58%) than after pill placebo (28%). Phenelzine and cognitive therapy also reduced symptoms significantly more than placebo according to contrasts after a repeated-measures analysis of covariance and random regression with the use of the blind evaluator's final Hamilton Rating Scale for Depression score. The scores between cognitive therapy and phenelzine did not differ significantly. Supplemental analyses of other symptom severity measures confirm the finding.
Conclusions:
Cognitive therapy may offer an effective alternative to standard acute-phase treatment with a monoamine oxidase inhibitor for outpatients with major depressive disorder and atypical features.
The authors evaluated the efficacy of desipramine-alone, vs. cognitive/behavioral therapy-alone (CBT) vs. a combination of the two, for the treatment of depression in older adult outpatients. Patients (N=102) meeting criteria for major depressive disorder were randomly assigned to one of these three treatments for 16 to 20 therapy sessions. All treatments resulted in substantial improvement. In general, the CBT-Alone and Combined groups had similar levels of improvement. In most analyses, the Combined group showed greater improvement than the Desipramine-Alone group, whereas the CBT-Alone group showed only marginally better improvement. The combined therapies were most effective in patients who were more severely depressed, particularly when desipramine was at or above recommended stable dosage levels. The results indicate that psychotherapy can be an effective treatment for older adult outpatients with moderate levels of depression.
This review examines the role of patient predictors of outcome in cognitive therapy of depression. Studies that meet eligibility criteria are reviewed for demonstrated linkage between various predictors (i.e., pretreatment severity, historical features, demographic predictors, dysfunctional attitudes and other cognitive features, and treatment acceptability) and outcome, and several effects are found. Notably, high pretreatment severity scores are associated with poorer response to cognitive therapy, as are high chronicity, younger age at onset, an increased number of previous episodes, and marital status. High pretreatment levels of dysfunctional attitudes and certain beliefs about the nature of depression were also found to predict differential response to cognitive therapy of depression. Limitations of the research and directions for further investigations of patient predictors of outcome in cognitive therapy of depression are provided.
Although there is evidence for the efficacy of antidepressants and for some individual and group psychotherapy interventions for depressed older adults, a significant number of these do not respond to treatment. Authors assessed the benefits of augmenting medication with group psychotherapy.
They randomly assigned 34 (largely chronically) depressed individuals age 60 and older to receive 28 weeks of antidepressant medication plus clinical management, either alone (MED) or with the addition of dialectical behavior therapy skills-training and scheduled telephone coaching sessions (MED+DBT).
Only MED+DBT showed significant decreases on mean self-rated depression scores, and both treatment groups demonstrated significant and roughly equivalent decreases on interviewer-rated depression scores. However, on interviewer-rated depression, 71% of MED+DBT patients were in remission at post-treatment, in contrast to 47% of MED patients. At a 6-month follow-up, 75% of MED+DBT patients were in remission, compared with only 31% of MED patients, a significant difference. Only patients receiving MED+DBT showed significant improvements from pre- to post-treatment on dependency and adaptive coping that are proposed to create vulnerability to depression.
Results from this pilot study suggest that DBT skills training and telephone coaching may offer promise to effectively augment the effects of antidepressant medication in depressed older adults.
Objective: To determine which factors impact on the efficacy of cognitive behavioural therapy (CBT) for depression and anxiety. Factors considered include those related to clinical practice: disorder, treatment type, duration and intensity of treatment, mode of therapy, type and training of therapist and severity of patients. Factors related to the conduct of the trial were also considered, including: year of study, country of study, type of control group, language, number of patients and percentage of dropouts from the trial.
Method: We used the technique of meta-analysis to determine an overall effect size (standardized mean difference calculated using Hedges' g) and meta-regression to determine the factors that impact on this effect size. We included randomized controlled trials with a wait list, pill placebo or attention/psychological placebo control group. Study participants had to be 18 years or older and all have diagnosed depression, panic disorder (with or without agoraphobia) or generalized anxiety disorder (GAD). Outcomes of interest included symptom, functioning and health-related quality of life measures, reported as continuous variables at post-treatment.
Results: Cognitive behavioural therapy for depression, panic disorder and GAD had an effect size of 0.68 (95% CI=0.51–0.84, n=33 studies, 52 comparisons). The heterogeneity in the effect sizes was fully explained by treatment, duration of therapy, inclusion of severe patients in the trial, year of study, country of study, control group, language and number of dropouts from the control group. Disorder was not a significant predictor of the effect size.
Conclusions: Cognitive behavioural therapy is significantly less effective for severe patients and trials that compared CBT to a wait-list control group found significantly larger effect sizes than those comparing CBT to an attention placebo, but not to a pill placebo. Further research is needed to determine whether CBT is effective when provided by others than psychologists and whether it is effective for non-English-speaking patient groups.
ResearchGate has not been able to resolve any references for this publication.