Chronic depression better treatable with specific psychotherapy
Even seriously ill patients can be helped
Specific psychotherapy for the treatment of chronic depression, in which stressful relationship experiences are taken into account, is superior to non-specific supportive psychotherapy. This was discovered by researchers from the Medical Center - University of Freiburg in collaboration with the University Medical Center Hamburg-Eppendorf (UKE) and six other German universities. The results of the clinical study were published on February 1, 2017 in JAMA Psychiatry, one of the most important psychiatric journals.
Chronic depression is considered difficult to treat: the majority of patients do not respond to multiple attempts at psychotherapy and medication. "Chronic depression therefore leads to a considerable burden of disease, which is characterized above all by a long-lasting restriction of performance and quality of life," explains Prof. Dr. Elisabeth Schramm, Department of Psychiatry and Psychotherapy at the Medical Center - University of Freiburg, who conducted the study together with Prof. Dr. Dr. Martin Härter, Head of the Institute and Polyclinic for Medical Psychology, PD Dr. Levente Kriston and Ramona Meister from the UKE side.
268 patients treated at eight university centers
In recent years, a specific and structured psychotherapy for the treatment of chronic depression, the "Cognitive Behavioral Analysis System of Psychotherapy" (CBASP), was developed for the first time. In this treatment developed by James McCullough in the USA, therapists focus intensively on the stressful relationship experiences that many chronically depressed patients report. "During therapy, patients learn to recognize the connection between their current problems and previous hurtful experiences and to manage their interpersonal relationships more successfully in everyday life," says UKE Professor Martin Härter.
In this study, which was funded by the German Research Foundation, the scientists compared the effectiveness of CBASP with supportive psychotherapy. To this end, they treated 268 patients with early-onset chronic depression at eight university centers (Lübeck, Hamburg, Heidelberg, Tübingen, Bonn, Marburg, Mannheim, Freiburg). The patients were randomly assigned to one of the two treatments. The individual outpatient therapy lasted one year, comprised 32 sessions and was carried out without concomitant medication.
Therapy reduces depressive symptoms and improves quality of life
Both treatments led to a significant improvement for the patients. This was evident both in the reduction of depressive symptoms and in improved general performance and quality of life. However, more patients responded to the specific therapy with CBASP at the end of treatment (response rate 53 percent with CBASP compared to 41 percent with supportive therapy). A complete improvement in depressive symptoms (remission) was also achieved significantly more frequently with CBASP (37 percent compared to 26 percent). This is a considerable success given the severity and persistence of the illness, according to the scientists.
"In our view, the most important result of this study is that even difficult-to-treat chronic depressive patients can be helped with disorder-specific psychotherapy alone if this psychotherapy is offered over a longer period of time," explains Prof. Schramm. The study is also the first in which the effectiveness of the newly developed method was tested in comparison to non-specific psychotherapy. Prof. Härter adds: "It may be possible to increase the success of the treatment by combining psychotherapy and antidepressant medication in the future; this would have to be investigated in follow-up studies."
Original title of the publication: Effect of disorder-specific versus non-specific psychotherapy for chronic depression: A randomized clinical trial
DOI: 10.1001/jamapsychiatry.2016.3880
Link to the publication: jamanetwork.com/journals/jamapsychiatry/fullarticle/2600225
Contact:
Prof. Dr. Elisabeth Schramm
Department of Psychiatry and Psychotherapy
Uniklinik Freiburg
Phone: 0761 270-69670
elisabeth.schramm@uniklinik-freiburg.de
Prof. Dr. Dr. Martin Härter
Institute and Polyclinic for Medical Psychology
University Medical Center Hamburg-Eppendorf (UKE)
Phone: 040 7410-52978
m.haerter@uke.de
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