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INTRODUCTION: Different types of psychotherapy are effective for treating major depressive disorder across groups yet show large within-group differences. Patient personality style is considered a potentially useful variable for treatment matching. OBJECTIVE: This study is the first experimental test of the interaction between therapeutic approach and patients' dependent versus self-critical personality styles. METHODS: A pragmatic stratified parallel trial was carried out with 100 adult patients diagnosed with DSM-IV-TR major depressive disorder. They were randomly assigned to short-term (16-20 sessions) cognitive behavioral therapy (CBT) or short-term psychodynamic psychotherapy (STPP). Patients were assessed at baseline, during therapy, post-therapy, and at 3- and 6-month follow-up. Primary outcome is depression severity measured by the Hamilton Rating Scale for Depression posttreatment. Primary analysis was by intention to treat. This trial is registered with the ISRCTN registry (
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Terapia Cognitivo-Conductual , Trastorno Depresivo Mayor , Psicoterapia Psicodinámica , Adulto , Humanos , Trastorno Depresivo Mayor/diagnóstico , Resultado del Tratamiento , CogniciónRESUMEN
Aim: Exploring change processes underlying "good outcome" in psychotherapy for major depression. We examined the perspectives of patients who "recovered" and "improved" (Jacobson & Truax) following time-limited CBT and PDT. Method: In the context of an RCT on the treatment of major depression, patients were selected based on their pre-post outcome scores on the BDI-II: we selected 28 patients who recovered and 19 who improved in terms of depressive symptoms. A grounded theory analysis was conducted on post-therapy client change interviews, resulting in an integrative conceptual model. Results: According to recovered and improved patients, change follows from an interaction between therapy, therapist, patient, and extra-therapeutic context. Both helping and hindering influences were mentioned within all four influencing factors. Differences between recovered and improved patients point at the role of patients' agency and patients' internal and external obstacles. However, patients marked as "improved" described heterogeneous experiences. CBT- and PDT-specific experiences were also observed, although our findings suggest the possible role of therapist-related influences. Conclusion: From patients' perspectives, various change processes underlie "good outcome" that do not necessarily imply an "all good process". This supports a holistic, multidimensional conceptualization of change processes in psychotherapy and calls for more fine-grained mixed-methods process-outcome research.
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Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/terapia , Psicoterapia , Investigación Cualitativa , Adulto , Femenino , Humanos , Resultado del TratamientoRESUMEN
This study explored the meaning of "good outcome" within and beyond the much-used statistical indices of clinical significance in standard outcome research as developed by Jacobson and Truax (1991). Specifically, we examined the experiences of patients marked as "recovered" and "improved" following cognitive-behavioral therapy and psychodynamic therapy for major depression. A mixed-methods study was conducted using data gathered in an RCT, including patients' pre-post outcome scores on the Beck Depression Inventory-II and posttreatment client change interviews. We selected 28 patients who showed recovery and 19 patients who showed improvement in self-reported depression symptoms. A grounded theory analysis was performed on patients' interviews, ultimately resulting in a conceptual model of "good outcome." From patients' perspectives, good outcome can be understood as feeling empowered, finding personal balance and encountering ongoing struggle, indicating an ongoing process and variation in experience. The Jacobson-Truax classification of "good outcome" could not account for the (more pessimistic) nuances in outcome experiences, especially for "improved" patients, and did not grasp the multidimensional nature of outcome as experienced by patients. It is recommended that statistical indications of clinical meaningfulness are interpreted warily and ideally contextualized within personal narratives. Further research on the phenomenon of change and good outcome is required, aiming at integrating multiple perspectives and methods accordingly the multidimensional phenomenon under study. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Comprensión , Trastorno Depresivo Mayor/psicología , Trastorno Depresivo Mayor/terapia , Psicoterapia/métodos , Recuperación de la Función , Autoinforme , Adulto , Bélgica/epidemiología , Terapia Cognitivo-Conductual/métodos , Terapia Cognitivo-Conductual/tendencias , Comprensión/fisiología , Trastorno Depresivo Mayor/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Psicoterapia/tendencias , Recuperación de la Función/fisiología , Resultado del Tratamiento , Adulto JovenRESUMEN
The application of time limits (i.e. restricting the amount of sessions before the beginning of psychotherapy) has become ingrained in psychotherapy research and in the context of managed care, mostly due to pragmatic and economic reasons. However, little is know on how this technique interferes with the psychotherapeutic process. Although several theorists have considered the possible advantages and drawbacks of the technique, research explaining these mechanisms is scattered. By conducting this review, we strived to answer two questions: (1) Does a time limit alter the psychotherapeutic process? And (2) In what way? In doing so, this study aspires to grant more insight into the mechanisms of time limited psychotherapy and aimes to contribute to a first understanding of the dynamics of a time restricted therapy process. We searched for articles in the databases of Web of Science and Pubmed. Our review identified 28 studies that provide empirical grounds to explain processes involved when applying a time limit to psychotherapy. Qualitative research suggests that a time limit exerts pressure on the therapy process and creates an expectancy effect, which can have both positive and negative consequences. Additionally, time limits can be associated to therapists taking on a more directive role in therapy. Results show that a time limit is anything but a neutral intervention; it is a technique that complexly interacts with therapy processes on multiple grounds. Further research is vital to determine which environment is appropriate for its application.
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BACKGROUND: Major depressive disorder is a leading cause of disease burden worldwide, indicating the importance of effective therapies. Outcome studies have shown overall efficacy of different types of psychotherapy across groups, yet large variability within groups. Although patient characteristics are considered crucial in understanding outcome, they have received limited research attention. This trial aims at investigating the interaction between therapeutic approach (pre-structured versus explorative) and the personality style of patients (dependent versus self-critical), which is considered a core underlying dimension of depressive pathology. METHODS/DESIGN: This study is a pragmatic stratified (dependent and self-critical patients) parallel trial with equal randomization (allocation 1:1) conducted in Flanders, Belgium. One hundred and four patients will be recruited and randomized to either 16-20 sessions of cognitive behavioral therapy for depression (pre-structured approach) or 16-20 sessions of short-term psychodynamic psychotherapy for depression (explorative approach) conducted by trained psychotherapists in private practices. The primary outcome is the severity of depression as measured by the Hamilton Rating Scale for Depression at completion of therapy. Secondary outcome measures include self-reported depressive and other symptoms, interpersonal functioning, idiosyncratic complaints, and the presence of the diagnosis of depression. Additional measures include biological measures, narrative material (sessions, interviews), and health care costs. DISCUSSION: This trial presents the test of an often-described, yet hardly investigated interaction between important personality dimensions and therapeutic approach in the treatment of depression. Results could inform therapists on how to match psychotherapeutic treatments to specific personality characteristics of their patients. TRIAL REGISTRATION: Isrctn.com, ISRCTN17130982 . Registered on 2 February 2015.