A randomized trial of telephone psychotherapy and pharmacotherapy for depression: Continuation and durability of effects.

Randomized trial evidence and expert guidelines are mixed regarding the value of combined pharmacotherapy and psychotherapy as initial treatment for depression. This study describes long-term results of a randomized trial (N = 393) evaluating telephone-based cognitive-behavioral therapy (CBT) plus care management for primary care patients beginning antidepressant treatment versus usual care. In a repeated measures linear model with adjustment for baseline scores, the phone therapy group showed significantly lower mean Hopkins Symptom Checklist (HSCL) Depression Scale scores (L. Derogatis, K. Rickels, E. Uhlenhuth, & L. Covi, 1974) from 6 months to 18 months versus usual care, F(1, 336) = 11.28, p = .001. Average HSCL depression scores over the period from 6 months to 18 months were 0.68 (SD = 0.55) in the telephone therapy group and 0.85 (SD = 0.65) in the usual-care comparison group. Addition of a brief, structured CBT program can significantly improve clinical outcomes for the large number of patients beginning antidepressant treatment in primary care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal psychotherapy for co-occurring depression and chronic pain.

Up to 37% of individuals experience chronic pain during their lifetimes. Approximately one fourth of primary care patients with chronic pain also meet criteria for major depression. Many of these individuals fail to receive psychotherapy or other treatment for their depression; moreover, when they do, physical pain is often not addressed directly. Women, socioeconomically disadvantaged individuals, African Americans, and Latinos all report higher rates of pain and depression compared with other groups. This article describes a version of interpersonal psychotherapy tailored for patients with comorbid depression and chronic pain, interpersonal psychotherapy for depression and pain (IPT-P). IPT-P potentially could be delivered to many patient populations in a range of clinical settings, but this article focuses on its delivery within primary care settings for socioeconomically disadvantaged women. Adaptations include a brief 8-session protocol that incorporates strategies for anticipating barriers to psychotherapy, accepting patients' conceptualization of their difficulties, encouraging patients to consider the impact of their pain on their roles and relationships, emphasizing self-care, incorporating pain management techniques, and flexible scheduling. In addition, IPT-P is designed as an adjunct to usual medical pain treatment, and seeks to engage non–treatment-seeking patients in psychotherapy by focusing on accessibility and relevance of the intervention to concerns common among patients with pain. Identifying patients with comorbid depression and chronic pain and offering IPT-P as a treatment option have the potential to improve clinical outcomes for individuals with depression and chronic pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient group psychotherapy for the elderly: an alternative to institutionalization

Two case studies illustrate the positive effects of group psychotherapy for elderly outpatients of a municipal hospital in an industrial community of Baltimore. Most of the outpatients were depressed about physical, mental, or social losses. A total of five brief therapy groups were established. Each group had a maximum of 12 members and met in the hospital for an hour and a half once a week for 12 consecutive weeks. Members could continue in subsequent 12-week sessions if they desired. As a result of their participation in groups, many members became involved in volunteer or part-time work, renewed contact with family and friends, and were better able to deal with life's stresses.     

Benchmarks for psychotherapy efficacy in adult major depression.

This study estimates pretreatment-posttreatment effect size benchmarks for the treatment of major depression in adults that may be useful in evaluating psychotherapy effectiveness in clinical practice. Treatment efficacy benchmarks for major depression were derived for 3 different types of outcome measures: the Hamilton Rating Scale for Depression (M. A. Hamilton, 1960, 1967), the Beck Depression Inventory (A. T. Beck, 1978; A. T. Beck & R. A. Steer, 1987), and an aggregation of low reactivity-low specificity measures. These benchmarks were further refined for 3 conditions: treatment completers, intent-to-treat samples, and natural history (wait-list) conditions. The study confirmed significant effects of outcome measure reactivity and specificity on the pretreatment-posttreatment effect sizes. The authors provide practical guidance in using these benchmarks to assess treatment effectiveness in clinical settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Varieties of transference patterns in psychotherapy

This investigation explored the nature of transference of interpersonal patterns in patients' psychotherapy narratives. The relation between interpersonal patterns with significant others in a patient's life and the pattern with the therapist early in treatment was examined. Cluster analysis was used to categorize similar relationships for each of 35 patients. Many patients revealed multiple interpersonal themes in their relationship narratives. Furthermore, these interpersonal themes correlated significantly with the interpersonal pattern extracted from narratives told about the therapist for many of the patients who discussed the therapeutic relationship during therapy. However, the interpersonal pattern evident in the relationship with the therapist was not necessarily the most pervasive pattern exhibited in the narratives about significant others.     

Relationship patterns of never-married men and their implications for psychotherapy.

Interviewed 30 never-married, White, heterosexual men aged 40–50 yrs concerning their relational patterns with regard to experiences in the families in which they grew up, romantic relationships, friendships, views of marriage, and thoughts about generativity. These men all valued independence and self-reliance, and practiced avoidance and emotional detachment in their relationships. Implications for psychotherapy are discussed in regard to the varied levels of functioning presented by the sample. Therapeutic difficulties include the potential for clients to flee psychotherapy prematurely or to approach psychotherapy in a guarded, tentative manner, because they fear losing their independence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pilot study of affect-focused psychotherapy for antepartum depression.

Logically, psychotherapy should be the first-line treatment for depression during pregnancy, yet there have been very few nondrug interventions tested in this patient population. The present study examines the impact of affect-focused psychotherapy as a treatment for antepartum depression. The treatment model was thought to be feasible to test with this population because depressed pregnant women are in need of an integrative model that can engage the client quickly and work rapidly to reduce symptom distress. Participants were 10 pregnant women with major depressive disorder who were treated with five sessions of affect-focused psychotherapy, as outlined in a published treatment manual. All therapy sessions were videotaped. Results indicate that participants experienced significant improvements in depressive symptoms, as well as increased therapeutic alliance and patient-therapist bond. These preliminary results provide promising data that demonstrate the effectiveness of a short-term (five-session) affect-focused psychotherapeutic treatment with a patient population suffering from antepartum depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outpatient psychotherapy with dangerous clients: A model for clinical decision making.

The precedent-setting 1976 judicial decision of Tarasoff v. Regents of the University of California established a duty to protect whereby psychotherapists are expected to exercise reasonable care to protect the potential victims of their clients' violent behavior. However, no standard of care for dangerous clients has been established. In this article, the authors present a model for clinical decision making to determine the best interventions for dealing with dangerous outpatient clients. The model takes into account the degree of violence risk and the strength of the therapeutic alliance. Four cases are presented to illustrate the application of the model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practice patterns for the outpatient treatment of depression in a case-managed delivery system: A utilization study.

Have you ever wondered how long it takes the average outpatient provider to treat a patient with a depression-related diagnosis? This article provides baseline data by diagnostic categories for women treated for depression. As a managed behavioral health care company, ValueOptions partnered with the Virginia Academy of Clinical Psychologists to study how providers use various treatment modalities. Furthermore, this study investigated average length of treatment by diagnostic category. The authors hope this information generates discussion regarding appropriate expectations for treatment and, thus, improves the quality of care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dose–effect relations in time-limited psychotherapy for depression.

Criteria for reliable and clinically significant improvement were applied to standard and individually tailored outcome measures data from 212 depressed clients who had been randomly assigned to receive either 8 or 16 sessions of time-limited psychotherapy. The data were used to address 2 questions: (a) Is the dose-effect curve for psychological symptoms negatively accelerated? and (b) is there a differential rate of response for acute, chronic, and characterological/interpersonal components of depression? The results supported the differential rate of response of different components of depression and suggested qualifications to the acute, chronic, and characterological/interpersonal components and evidence that both supported and qualified previous suggestions that the dose effect curve is negatively accelerated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A review of the neurobiological effects of psychotherapy for depression.

Although randomized, controlled clinical trials have shown that different forms of psychotherapy may be efficacious for depression, psychotherapy has not been widely reported to have effects upon the neurobiological concomitants of depression in similar ways as medication. Neuroendocrinal changes that occur during depression (principally hypercortisolaemia) produce structural and functional alterations to the prefrontal cortex, hippocampus, and amygdala, plus the connectivity between these regions of the brain. This article reviews the evidence to date regarding the neurobiological effects of psychotherapy for depression and suggests a hypothetical pathway linking the nurturing effects of the therapist–patient “bond” and restoration of neuroendocrinal “balance.” This pathway may provide a neurobiological causal link between psychotherapy and alleviation of depression in the same way as that which exists for pharmacological treatments, and argues for a model of depression that includes both biological and psychological effects of psychotherapy when considering treatment choice and application. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Maintenance of gains versus relapse following brief psychotherapy for depression.

Cross-sectional and longitudinal data are presented from a 2-year follow-up study of 91 older adults, initially diagnosed as in an episode of major depressive disorder (MDD), who were treated with brief cognitive, behavioral, or psychodynamic psychotherapy. Using research diagnostic criteria (RDC), 52%, 58%, and 70% of the sample did not meet criteria for any RDC depressive disorder at posttherapy, and 12- and 24-month follow-ups, respectively. There were no significant differences in response rate by therapy modality. Using Longitudinal Interval Follow-Up Evaluation (LIFE) by R. Shapiro and M. Keller (1979) and M. B. Keller et al (see record 1988-01549-001) methodology, we noted that patients not depressed at posttreatment remained depression-free for longer time periods than those who were minor or MDD. These rates compare favorably with published reports on younger depressed patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychotherapy for depression in children and adolescents: A meta-analysis.

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Voices of bulimia: Experiences in integrated psychotherapy.

The participation of 5 23–30 yr old bulimic females in integrated psychotherapy is used as a basis for a clinical analysis of how Ss experienced the disorder, thought about themselves, related to significant others, and experienced the therapeutic process. The treatment integrated principles from psychoanalysis and cognitive-behavioral, family, and group therapies, as well as from social learning and small group therapy for a short, intensive daily period. The bulimic is preoccupied with food and engages in a self-defeating way to gain control over life events or emotions that seem out of control. The bingeing response may be associated with loneliness, tension, hostility, and anxiety. Each S was competitive and perfectionistic. Although each was intelligent and talented, the pressure they imposed on themselves was too great to bear. Each felt deprived of maternal love. Each felt she disappointed her mother, usually for not conforming to a more feminine stereotype. Ss confronted their feelings toward others in fantasy through psychodrama—then interacted with the real parent and important others on family therapy nights. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relation between specific and general dimensions of the psychotherapy process in interpersonal psychotherapy of depression.

This article examines the relation between general dimensions of the psychotherapy process, rated with the Vanderbilt Psychotherapy Process Scale (VPPS), and a type of manual-guided psychotherapy, Short-Term Interpersonal Psychotherapy of Depression (IPT). With the use of data from a training program in IPT, two types of analyses were performed. First, VPPS factors were correlated with IPT therapist competence ratings. This analysis showed that all VPPS-rated dimensions of patient and therapist behaviors were significantly correlated with IPT competence ratings. Especially strong correlations occurred between IPT competence ratings and the VPPS therapist factors of (a) Exploration and (b) Warmth and Friendliness. Second, to evaluate whether the general process features that influenced IPT competence ratings were also related to the therapy's effectiveness, correlations between VPPS process dimensions and patient outcome were performed. This analysis indicated that VPPS-rated therapist behaviors were significantly predictive of patient outcome, whereas patient behaviors were generally not significantly related to outcome. Taken together, the findings indicate the importance of general aspects of the psychotherapy process in therapist evaluation and efficacy of manual-guided psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integration of drug therapy and psychotherapy concepts in treatment of depression

The treatment of depressive disorders comprises an adequate pharmacological as well as psychotherapeutical intervention. The following article will demonstrate pragmatic treatment steps and corresponding problems in relation to the time context of the disorder as well as the treatment (1. Initial contact 2. First control, 3. Intermediate treatment phase. 4. Treatment termination). Without introducing innovative treatment techniques, basic biological assumptions as well as psychological aspects of depressive disorders are combined in a pragmatic way. Furthermore, new developments in psychopharmacology are taken into regard.