Marianne Leuzinger-Bohleber1,2, Martin Hautzinger3, Georg Fiedler4, Wolfram Keller5, Ulrich Bahrke6,7, Lisa Kallenbach6, Johannes Kaufhold6, Mareike Ernst2, Alexa Negele2, Margerete Schoett7, Helmut Küchenhoff8, Felix Günther8, Bernhard Rüger8, Manfred Beutel2. 1. 1 Sigmund-Freud-Institut, IDeA Center, Center for Adaptive and Individual Development and Adaptive Education for Children-at-Risk, Frankfurt, Germany, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Mainz, Sigmund-Freud-Institut, Myliustr, Frankfurt, Germany. 2. 2 University Medical Center, Mainz, Germany. 3. 3 Department of Clinical Psychology, University of Tuebingen, Tübingen, Germany. 4. 4 Center for Suicidal Research, University Hospital Eppendorf, Hamburg, Germany. 5. 5 Medical Hospital in the Theodor-Wenzel-Werk, Berlin, Germany. 6. 6 Department of Psychoanalysis, University of Kassel, Kassel, Germany. 7. 7 Sigmund-Freud-Institut, Frankfurt a.M, Germany. 8. 8 Statistical Consulting Unit StaBLab, Ludwig-Maximilians-Universität München, München, Germany.
Abstract
OBJECTIVE: For chronic depression, the effectiveness of brief psychotherapy has been limited. This study is the first comparing the effectiveness of long-term cognitive-behavioural therapy (CBT) and long-term psychoanalytic therapy (PAT) of chronically depressed patients and the effects of preferential or randomized allocation. METHODS: A total of 252 adults met the inclusion criteria (aged 21-60 years, major depression, dysthymia, double depression for at least 24 months, Quick Inventory of Depressive Symptoms [QIDS] >9, Beck Depression Inventory II [BDI] >17, informed consent, not meeting exclusion criteria). Main outcome measures were depression self-rating (BDI) and rating (clinician-rated QIDS [QIDS-C]) by independent, treatment-blinded clinicians. Full remission rates (BDI ≤12, QIDS-C ≤5) were calculated. An independent center for data management and biostatistics analyzed the treatment effects and differences using linear mixed models (multilevel models and hierarchical models). RESULTS: The average BDI declined from 32.1 points by 12.1 points over the first year and 17.2 points over 3 years. BDI overall mean effect sizes increased from d = 1.17 after 1 year to d = 1.83 after 3 years. BDI remission rates increased from 34% after 1 year to 45% after 3 years. QIDS-C overall effect sizes increased from d = 1.56 to d = 2.08, and remission rates rose from 39% after 1 year to 61% after 3 years. We found no significant differences between PAT and CBT or between preferential and randomized allocation. CONCLUSIONS: Psychoanalytic as well as cognitive-behavioural long-term treatments lead to significant and sustained improvements of depressive symptoms of chronically depressed patients exceeding effect sizes of other international outcome studies.
RCT Entities:
OBJECTIVE: For chronic depression, the effectiveness of brief psychotherapy has been limited. This study is the first comparing the effectiveness of long-term cognitive-behavioural therapy (CBT) and long-term psychoanalytic therapy (PAT) of chronically depressedpatients and the effects of preferential or randomized allocation. METHODS: A total of 252 adults met the inclusion criteria (aged 21-60 years, major depression, dysthymia, double depression for at least 24 months, Quick Inventory of Depressive Symptoms [QIDS] >9, Beck Depression Inventory II [BDI] >17, informed consent, not meeting exclusion criteria). Main outcome measures were depression self-rating (BDI) and rating (clinician-rated QIDS [QIDS-C]) by independent, treatment-blinded clinicians. Full remission rates (BDI ≤12, QIDS-C ≤5) were calculated. An independent center for data management and biostatistics analyzed the treatment effects and differences using linear mixed models (multilevel models and hierarchical models). RESULTS: The average BDI declined from 32.1 points by 12.1 points over the first year and 17.2 points over 3 years. BDI overall mean effect sizes increased from d = 1.17 after 1 year to d = 1.83 after 3 years. BDI remission rates increased from 34% after 1 year to 45% after 3 years. QIDS-C overall effect sizes increased from d = 1.56 to d = 2.08, and remission rates rose from 39% after 1 year to 61% after 3 years. We found no significant differences between PAT and CBT or between preferential and randomized allocation. CONCLUSIONS: Psychoanalytic as well as cognitive-behavioural long-term treatments lead to significant and sustained improvements of depressive symptoms of chronically depressedpatients exceeding effect sizes of other international outcome studies.
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