Long-term outcomes of once weekly v. twice weekly sessions of cognitive behavioral therapy and interpersonal psychotherapy for depression.

BACKGROUND: Twice weekly sessions of cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) for major depressive disorder (MDD) lead to less drop-out and quicker and better response compared to once weekly sessions at posttreatment, but it is unclear whether these effects hold over the long run. AIMS: Compare the effects of twice weekly v. weekly sessions of CBT and IPT for depression up to 24 months since the start of treatment. METHODS: Using a 2 × 2 factorial design, this multicentre study randomized 200 adults with MDD to once or twice weekly sessions of CBT or IPT over 16-24 weeks, up to a maximum of 20 sessions. Main outcome measures were depression severity, measured with the Beck Depression Inventory-II and the Longitudinal Interval Follow-up Evaluation. Intention-to-treat analyses were conducted. RESULTS: Compared with patients who received once weekly sessions, patients who received twice weekly sessions showed a significant decrease in depressive symptoms up through month 9, but this effect was no longer apparent at month 24. Patients who received CBT showed a significantly larger decrease in depressive symptoms up to month 24 compared to patients who received IPT, but the between-group effect size at month 24 was small. No differential effects between session frequencies or treatment modalities were found in response or relapse rates. CONCLUSIONS: Although a higher session frequency leads to better outcomes in the acute phase of treatment, the difference in depression severity dissipated over time and there was no significant difference in relapse.

Working through the body in metacognitive interpersonal therapy to change relational patterns in dependent personality disorder: The case of Lia.

Persons with dependent personality disorder (DPD) have difficulties describing their inner world, and in realizing their negative ideas about the self, such as being weak, unworthy or powerless are just ideas. As a consequence, they tend to over-rely on others and may lose control over their emotions. Treating these persons can gain benefits from including body-focused techniques as they can promote a) awareness of internal states, b) better emotion regulation, c) the capacity to consider their negative ideas about themselves as not necessarily true, and d) gain power of and agency. We will describe the therapist used body-focused techniques in the context of Metacognitive Interpersonal Therapy when treating Lia, a 40-year-old woman suffering from DPD who also suffered from generalized anxiety disorder and had difficulties in making autonomous choices. She had a romantic relationship with a man she described as distant and judgmental so she felt lonely and not entitled to express her discomfort or capable to break up. The therapist used body-focused techniques, together with behavioural exposure, mindfulness and guided imagery, to let Lia be more aware of her thoughts and feelings, and then to regulate affects and realize she had previously capacities. At therapy termination anxiety diminished and she could break up with the partner and start a new one where she felt free to express herself. We suggest how bodily-focused techniques can be used to enhance therapy effectiveness in DPD.

Effects of Therapeutic Alliance in Interpersonal Psychotherapy Among Adolescent Girls With Loss-of-Control Eating.

OBJECTIVE: Interpersonal psychotherapy (IPT) has been proposed for prevention of excess weight gain among adolescents with loss-of-control (LOC) eating. Mixed findings from a trial testing this conjecture warrant elucidation of potential outcome predictors. The therapeutic alliance (adolescent-facilitator emotional bond and task collaboration) may be important for IPT but has received little attention in weight-related interventions. This study evaluated associations of adolescent-reported therapeutic alliance during IPT with weight- and eating-related outcomes. METHODS: Secondary analyses of a randomized controlled trial were conducted to compare group IPT to health education (HE) for preventing excess weight gain among 113 girls (ages 12-17) with body mass index (BMI) at the 75th to 97th percentile and LOC eating. BMI and LOC eating were measured at baseline, 12 weeks (postintervention), and 1 year. Multilevel modeling was used to test associations between change in therapeutic alliance (from session 1 to session 12) and changes in weight- and eating-related outcomes (from postintervention to 1 year). Analyses were controlled for therapeutic alliance after session 1 and for baseline and postintervention outcome values; group assignment (IPT vs. HE) was a moderator. RESULTS: Increases in emotional bond were associated with decreased weight and with greater decreases in number of LOC eating episodes at 1 year in the IPT group (p<0.05) and with weight gain in the HE group (p<0.05). Greater task collaboration was related to greater weight gain at 1-year follow-up, regardless of group assignment (p<0.05). CONCLUSIONS: The association of therapeutic alliance during IPT with weight and LOC eating outcomes among adolescent girls merits further investigation.

A Randomized Control Trial Study to Assess the Effectiveness of Interpersonal Psychotherapy on Symptom Reduction and Relapse Prevention for Depression among the Depression Patients.

BACKGROUND: Depression is a serious illness; approximately 40%-60% of patients develop relapse, and this risk increases up to 90%. Interpersonal psychotherapy (IPT) is an effective method to minimize depressive symptoms and relapse. OBJECTIVES: This randomized control trial study is designed to assess the effectiveness of IPT on depression symptom reduction and relapse prevention. MATERIALS AND METHODS: Three hundred depressed patients from a selected psychiatric hospital in UP, India, were recruited by a simple random sampling technique that randomly allocated 150 participants to the experimental group and 150 to the control group by tossing a coin. Depressive symptoms were assessed using the Hamilton Depression Rating Scale, which has 17 items. On the 2nd day of the trial, the experimental group received IPT. It helped the participants recognize their emotions and urge themselves to express them, both of which had a direct positive impact on their sad mood. The IPT efficacy assessment was done at the end of the 4 weeks of the intervention, and the relapse prevention assessment was undertaken 4 months later. The control group was kept with the actual treatment modalities and psychoeducation sessions, and they were assessed in the same way as the experimental group. RESULTS: Findings illustrated that the reduction of depressive symptoms with (t = 33.61) (P = 0.0000) and relapse prevention with (t = 2.7484) (P = 0.0067) are significant, respectively. Furthermore, symptom reduction and relapse prevention had an association with some demographical data at P < 0.05, 0.001. CONCLUSION: IPT is an effective intervention for reducing depressive symptoms and preventing relapse.

Interpersonal Psychotherapy for Depression in Parkinson's Disease: A Feasibility Study.

Individuals living with Parkinson's disease (PD) experience interpersonal stressors that contribute to depressive risk. Interpersonal psychotherapy (IPT) emphasizes the bidirectional relationship between interpersonal stressors and mood may therefore be a suitable treatment for PD-depression. The primary aim of this study was to evaluate the feasibility of delivering 12 sessions of IPT to depressed PD patients and explore the need for modifications. A secondary aim was to obtain descriptive information about efficacy outcomes. The study used a pre-post design without a comparison group. Participants were 12 PD patients with a major depressive disorder. IPT was well accepted and tolerated by patients and required minimal modifications. Compliance with session attendance and completion of study questionnaires were excellent and treatment satisfaction was high. Depression scores declined from baseline to endpoint, with 7 patients meeting criteria for remission at endpoint. Findings are encouraging and a larger randomized controlled trial is currently underway to ascertain if IPT is an efficacious treatment for PD-depression.

Telephone-delivered Interpersonal Psychotherapy: a systematic review.

BACKGROUND: The aim of this paper is to review evidence on Interpersonal Psychotherapy (IPT) administered via telephone (IPT-T). METHODS: We conducted a systematic review of studies published between January 1, 1990 and June 30, 2020, assessing the efficacy of IPT administered by phone, using PubMed. RESULTS: Originally, we found 60 papers; the final selection led to 13 papers. Six studies were performed using a randomized clinical trial methodology (6/13, 46.2%), three were prospective open-label not randomized studies (3/13, 15.7%), three were pilot studies (3/13, 23.1%), and one was a feasibility/acceptance study (1/13, 7.7%). The number of subjects included in the studies ranged between 14 and 442 (mean: 140.0 ± 124.9), for a total of 1850 patients. The mean age of the enrolled subjects was 47.8 ± 9.3 years (range: 27.4-70.4). Thirty-four different instruments were utilized. Qualitative synthesis was conducted only on randomized controlled trials (RCTs), namely on six studies. RCTs were almost all of good quality (mean score/standard deviation of the RCT-Psychotherapy Quality Rating Scale omnibus rating: 5.6 ± 1.2 points; range: 3-7). CONCLUSIONS: IPT-T showed response rates similar to IPT administered in the usual way. Results are limited by small samples sizes, selection bias of the less severe depressed patients, and the heterogeneity of rating scales.

Examining changes in binge-eating disorder network centrality and structure in patients treated with cognitive-behavioral therapy versus interpersonal psychotherapy.

OBJECTIVE: A sizeable minority of patients with binge-eating disorder (BED) do not fully respond to evidence-based treatments. Evidence to guide refinements of treatments is needed. Conceptualizing BED as arising from a network of symptom-to-symptom interactions allows for identification of the most strongly connected symptoms, which could inform intervention targets. This study estimated networks of BED features at pretreatment and posttreatment to assess whether cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) differentially impacted the interrelationships of BED symptoms/features. METHODS: Participants were 392 adults (83% women, 88% white) with BED who received CBT (n = 236) or IPT (n = 156) and assessed at pretreatment and posttreatment. Networks were estimated across timepoints and treatments. Expected influence (EI) was calculated; symptoms with the highest EI have the most strong and frequent associations with other symptoms. We also assessed whether the symptoms with the highest and lowest EI predicted posttreatment remission indicators. RESULTS: In the CBT and IPT networks, shape concern, weight concern, and eating concern had the highest EI at pretreatment and posttreatment. EI significantly increased from pretreatment to posttreatment for some symptoms in CBT but did not change for any symptoms in IPT. Shape concern significantly and positively predicted BED remission indicators in CBT and IPT. CONCLUSIONS: CBT and IPT similarly impacted interrelations among BED features. Pretreatment EI predicted posttreatment remission indicators, indicating that pretreatment centrality could signal meaningful intervention targets. Clinical implications and avenues for future research are discussed including how personalized network analysis may advance the understanding of the clinical utility of centrality. PUBLIC SIGNIFICANCE: Cognitive behavioral therapy and interpersonal therapy for binge-eating disorder, which are two leading evidence-based treatments for binge-eating disorder that are quite different in their models and approaches, similarly impacted interrelations among binge-eating disorder symptoms. In addition, the most strongly interconnected symptom predicted indicators of remission. Studying the interrelations among symptoms may provide new insight on how treatments impact symptom relationships and inform intervention targets.

Couple-based interpersonal psychotherapy for first-time parents: A process evaluation.

PURPOSE: First-time parents have an increased risk of depression during the transition to parenthood, which has long-term adverse effect on the infant development. Interpersonal psychotherapy (IPT) has been shown to effectively reduce postnatal depression. The objectives of this study were to explore first-time parents' perceptions of a couple-based IPT program and to identify positive and negative influences on the effectiveness of the intervention through a process evaluation. DESIGN AND METHODS: A process evaluation was conducted as part of a randomized controlled trial of a couple-based IPT program. A program satisfaction questionnaire was used to assess the participants' satisfaction with the structure, process and outcome of the program. Semi-structured telephone interviews were conducted with a purposive sample of 44 first-time parents who had received the couple-based IPT. The interview data were analyzed by thematic analysis. RESULTS: The qualitative findings showed that the parents perceived couple-based IPT as useful for enhancing their interpersonal relationship, emotional control and competence in child care. The successful implementation of the couple-based IPT program was influenced by its delivery by midwives, the interactive lessons used to engage the participants, the close fit of the teaching contents to the needs of first-time parents and the flexible program schedule and delivery mode. CONCLUSIONS: The process evaluation indicates that couple-based IPT is an acceptable and feasible intervention for first-time parents to facilitate a healthy transition to parenthood. PRACTICE IMPLICATIONS: The couple-based IPT can be used as an adjunct to standard care to promote perinatal health.

Depression Prevention in Pediatric Primary Care: Implementation and Outcomes of Interpersonal Psychotherapy-Adolescent Skills Training.

This study evaluated the fidelity, feasibility, acceptability, and preliminary outcomes of a depression prevention program, interpersonal psychotherapy-adolescent skills training (IPT-AST), in urban pediatric primary care (PC) with a sample of primarily Black youth. Twenty-two adolescents with elevated depressive symptoms participated in this open clinical trial. Adolescents were identified through a screening questionnaire completed at well visits. Ratings of IPT-AST fidelity and session attendance were recorded. Youth and caregivers reported on their attitudes toward the intervention and completed measures of adolescents' symptoms and functioning pre- and post-intervention. Results demonstrated high levels of fidelity, attendance, and acceptability, despite some difficulties with recruitment. Adolescents and caregivers reported significant improvements in functioning. There were marginally significant reductions in self-reported depression, anxiety, and total mental health symptoms. Caregivers reported a significant decrease in total mental health symptoms. Findings provide preliminary information regarding the implementation and effects of IPT-AST when delivered in PC.

Pilot Study of Blended-Format Interpersonal Psychotherapy for Major Depressive Disorder.

OBJECTIVE: Blended-format interpersonal psychotherapy (IPT) is an integrated approach consisting of alternating face-to-face (in person or videoconferencing) and online sessions, and this format may increase access to care, empower patients, and improve quality and cost-effectiveness of care. This study, conducted in the Netherlands, was one of the first to investigate the feasibility of blended-format IPT in specialized mental health care. METHODS: Participants (ages 18-64, N=21) with a unipolar depressive episode were recruited at an outpatient mood disorder clinic. In this pre-post nonrandomized pilot study, the blended IPT consisted of six online sessions alternated with six to 10 in-person or videoconferencing sessions. Feasibility (defined as >60% of the participants having completed >50% of the online sessions), usability (via the System Usability Scale [SUS]), satisfaction (via the Client Satisfaction Questionnaire-8 [CSQ-8] and qualitative interviewing), and symptom reduction (via the nine-item Patient Health Questionnaire [PHQ-9]) were assessed. RESULTS: Of the participants, 90% (95% CI=70%-99%) completed all online sessions. Mean±SD scores were 25.12±3.55 (of 32) on the CSQ-8 and 66.0±12.4 (of 100) on the SUS. PHQ-9 scores (N=21) decreased significantly, from 17.48±5.41 at baseline to 11.90±6.45 postintervention, indicating improvement (t=4.86, df=20, p=0.001). Hedges' g was 0.90 (95% CI=0.44-1.41), indicating a large effect size. The treatment response rate was 33% (95% CI=15%-57%); the remission rate was 19% (95% CI=6%-42%). CONCLUSIONS: Blended-format IPT was feasible, and patients were satisfied with the intervention. The therapy described here may serve as a starting point for cost-effectiveness research on this promising format.

Change in reflective functioning in interpersonal psychotherapy and cognitive behavioral therapy for major depressive disorder.

BACKGROUND: Patients with Major Depressive Disorder (MDD) have been found to have restricted capacity for mentalization, and it is possible that this constitutes a vulnerability factor for developing depression. Due to its focus on linking depressive symptomatology to emotions and interpersonal relations, it was hypothesized that Interpersonal Psychotherapy (IPT) would improve mentalization more than Cognitive Behavioral Therapy (CBT). METHODS: In a randomized controlled trial of 90 patients undergoing IPT and CBT for MDD, Reflective Functioning (RF) was rated from Adult Attachment and from Depression-Specific Reflective Functioning (DSRF) Interviews before and after therapy. Treatment outcome was assessed using the Beck Depression Inventory-II. RESULTS: The interaction between time and treatment approach was statistically significant, with RF improving significantly more in IPT than in CBT. Change in RF was not correlated with change in depression. The difference in DSRF ratings before and after therapy was not statistically significant for any of the treatments. CONCLUSIONS: IPT may improve mentalization more than CBT. However, although RF increased significantly in IPT, the mean level was still low after therapy. A limitation of the study is the large amount of post-treatment missing data. More research is needed to understand the potential role of mentalization in symptom reduction.

Effect of Problem Area on Outcomes Among Adolescents Treated With Interpersonal Psychotherapy for Depression.

OBJECTIVE: Interpersonal psychotherapy for adolescents (IPT-A) aims to treat depression by addressing one of four problem areas: grief, role disputes, role transitions, or interpersonal deficits. This study compared the characteristics of adolescents by problem area and evaluated the impact of problem area on outcomes. METHODS: Forty adolescents (ages 12-17) participated in a randomized trial of adaptive treatment strategies that included IPT-A. RESULTS: Adolescents with role disputes were younger than adolescents with interpersonal deficits or role transitions and had worse expectations for therapeutic alliance than those in the transitions group. Adolescents with interpersonal deficits had higher attachment avoidance than those in the transitions group. Posttreatment, adolescents in the transitions group had more severe depression and social adjustment problems than those in the deficits group and more social adjustment problems than those in the disputes group. CONCLUSIONS: This preliminary study's findings suggest that differing IPT-A problem areas may affect prognosis.

Pilot Study of Group Interpersonal Psychotherapy for Depression Among Young People With Chronic Illness.

OBJECTIVE: Interpersonal psychotherapy (IPT) is an evidence-based treatment for depression, demonstrating efficacy with adolescents and young adults. Social support is proposed to be an important treatment component and may be helpful for adolescents and young adults with chronic illness. The authors sought to assess the feasibility of delivering IPT to this population and to examine changes in depressive symptoms and perceived social support. METHODS: An open-label feasibility trial of group-based IPT was conducted for adolescents and young adults with chronic illness (N=17). The 12-session group IPT was concurrent with group members' individual psychotherapy, and group IPT was focused on providing support in navigating interpersonal challenges related to the participants' chronic illness. Participants completed questionnaires assessing depressive symptoms and social support before treatment, midtreatment (6 weeks), and after treatment (12 weeks). Generalized estimating equation models, adjusted for repeated measures, were used to assess changes in depressive symptoms and social support over the course of treatment. RESULTS: Deidentified clinical examples illustrated how IPT was practiced in a community mental health setting. Evidence for the feasibility of group IPT was mixed. Although participants had poor session attendance, there was a significant decrease in depressive symptoms (ß=-2.94, 95% CI=-5.30 to -0.59, p=0.014) and a significant increase in perceived social support (ß=4.24, 95% CI=0.51 to 7.98, p=0.026) by the end of treatment. CONCLUSIONS: IPT may help address depressive symptoms and enhance social support among adolescents and young adults with chronic illness. Further research and adaptation are needed to address feasibility challenges in delivering group IPT to this population.

The effect of interpersonal psychotherapy on quality of life among breast cancer patients with common mental health disorder: a randomized control trial at Tikur Anbessa Specialized Hospital.

PURPOSE: To determine the effect of interpersonal psychotherapy on anxiety, depression, and quality of life among breast cancer patients with mental health disorders at Tikur Anbessa Specialized Hospital, Ethiopia. METHODS: A two-arm parallel randomized controlled trial study was conducted among 114 (n = 57 intervention, and n = 57 control group) breast cancer patients with common mental health disorder at the oncology center of Tikur Anbessa Specialized Hospital. The hospital anxiety and depression measurement scale was used to assess depression and anxiety disorder and a 30-item quality of life questionnaire was used to assess the quality of life. General linear model analysis was done, confounding factors were controlled, and p < 0.05 was used to declare statistical significance. RESULTS: Patients in the intervention group showed a significant improvement in the anxiety (coefficient - 3.68; 95% CI - 5.67, - 1.69; p < 0.001), depression (coefficient - 3.22; 95% CI - 4.7, - 1.69; p < 0.001), physical functioning (coefficient 10.55; 95% CI 3.13, 17.98; p = 0.006), health-related quality of life (coefficient 21.85; 95% CI 14.1, 29.59; p < 0.001), insomnia (coefficient - 19.56; 95% CI - 31.87, - 7.25; p = 0.002), and fatigue (coefficient - 11.37; 95% CI - 21.49, - 1.24; p = 0.028) respectively. CONCLUSIONS: The adapted Ethiopian version of interpersonal psychotherapy had improved anxiety, depression, and some domains of health-related quality of life. Hence, health programmers should consider incorporating it as a treatment option in oncology centers. TRIAL REGISTRATION NUMBER: PACTR202011629348967 granted on 20 November 2020 which was retrospectively registered.

Interpersonal Psychotherapy's problem areas as an organizing framework to understand depression and sexual and reproductive health needs of Kenyan pregnant and parenting adolescents: a qualitative study.

BACKGROUND: Peripartum adolescents experience significant interpersonal transitions in their lives. Depression and emotional distress are often exacerbated by adolescents' responses to these interpersonal changes. Improved understanding of pregnancy-related social changes and maladaptive responses to these shifts may inform novel approaches to addressing the mental health needs of adolescents during the perinatal period. The paper aims to understand the sources of psychological distress in peripartum adolescents and map these to Interpersonal Psychotherapy's (IPT) problem areas as a framework to understand depression. METHOD: We conducted interviews in two Nairobi primary care clinics with peripartum adolescents ages 16-18 years (n = 23) with experiences of depression, keeping interpersonal psychotherapy framework of problem areas in mind. We explored the nature of their distress, triggers, antecedents of distress associated with an unplanned pregnancy, quality of their relationships with their partner, parents, and other family members, perceived needs, and sources of support. RESULTS: We found that the interpersonal psychotherapy (IPT) framework of interpersonal problems covering grief and loss, role transitions, interpersonal disputes, and social isolation was instrumental in conceptualizing adolescent depression, anxiety, and stress in the perinatal period. CONCLUSION: Our interviews deepened understanding of peripartum adolescent mental health focusing on four IPT problem areas. The interpersonal framework yields meaningful information about adolescent depression and could help in identifying strategies for addressing their distress.

Does psychological process change during psychotherapy predict long-term depression outcome after successful cognitive therapy or interpersonal psychotherapy? Secondary analysis of a randomized trial.

Objective Psychotherapies for depression are similarly effective, but the processes through which these therapies work have not been identified. We focus on psychological process changes during therapy as predictors of long-term depression outcome in treatment responders. Method: Secondary analysis of a randomized trial comparing cognitive therapy (CT) and interpersonal psychotherapy (IPT) that focuses on 85 treatment responders. Using mixed-effects models, changes during therapy (0-7 months) on nine process variables were associated with depression severity (BDI-II) at follow-up (7-24 months). Results: A decrease in dysfunctional attitudes was associated with a decrease in depression scores over time. Improved self-esteem was associated with less depression at follow-up (borderline significant). More improvement in both work and social functioning and interpersonal problems was associated with better depression outcomes in IPT relative to CT, while less improvement in work and social functioning and interpersonal problems was associated with better outcomes in CT relative to IPT. Conclusions: Less negative thinking during therapy is associated with lower depression severity in time, while changes during therapy in work and social functioning and interpersonal problems appear to predict different long-term outcomes in CT vs. IPT. If replicated, these findings can be used to guide clinical decision-making during psychotherapy.

Preliminary Effectiveness of Group Interpersonal Psychotherapy for Young Kenyan Mothers With HIV and Depression: A Pilot Trial.

OBJECTIVE: The authors adopted a task-sharing strategy in which lay health workers delivered group interpersonal psychotherapy (IPT-G) in primary care clinics in Nairobi, Kenya, to young mothers with HIV and depression. The study examined the acceptability, feasibility, and effectiveness of IPT-G in improving depression and antiretroviral therapy adherence. METHODS: Twenty-four mothers (ages 18-24 years and 6-12 weeks postpartum) participated. The women were randomly assigned to IPT-G or to a waitlist. Eight lay providers administered the IPT-G sessions across 8 weeks. The primary outcome was pre- to postintervention change in depression scores as measured on the Edinburgh Postnatal Depression Scale. The secondary outcome was antiretroviral therapy adherence. All waitlist participants subsequently received the intervention, and a secondary outcome, within-group analysis, was conducted and included those participants. RESULTS: Participants' median age was 23.0 years, 17 (71%) lived with a partner, and 19 (79%) had fewer than two children. The intervention group had a mean±SD depression score of 15.9±4.3 at baseline and 6.8±7.0 postintervention. For the waitlist control group, the mean score was 17.3±5.9 at baseline and 13.2±6.6 at the first follow-up. Waitlist participants had significantly greater mean depression scores than did intervention group participants at the first follow-up (after the intervention group's 8-week IPT-G) (ß=6.42, 95% confidence interval=1.17 to 11.66, p=0.017). No difference was observed between groups in antiretroviral therapy adherence. CONCLUSIONS: This study provides preliminary evidence that IPT-G led by community health workers may have benefits for postpartum depression among young mothers with HIV.

Interpersonal Psychotherapy and Mentalizing-Synergies in Clinical Practice.

Interpersonal psychotherapy (IPT) is an evidence-supported, relationally focused treatment for people living with depression and other psychiatric disorders in the context of stressful life events. Mentalizing, also relationally focused, promotes the ability to perceive, understand, and interpret human behavior in terms of intentional mental states of others or oneself, in order to support social leaning. IPT and mentalization-based treatments (MBT) both seek to improve interpersonal effectiveness, albeit with different emphases in the therapeutic process, with IPT promoting interpersonal problem solving and MBT promoting understanding of the obstacles to this outcome. In this article, the authors propose that the central intentions of IPT and mentalizing are essentially linked and complementary; understanding others and oneself in relationships facilitates interpersonal problem resolution and symptomatic recovery and enhances resilience. The clinical synergies of IPT and mentalizing are elaborated and illustrated through a case example of treatment for a socially isolated woman with depression and interpersonal sensitivities.

Pilot Randomized Controlled Trial of Interpersonal Psychotherapy for Women With Depression in Iran.

OBJECTIVE: Interpersonal psychotherapy (IPT) is an evidence-based psychotherapy, developed to treat major depressive disorder. The aim of this study was to conduct a preliminary investigation of the effects of IPT on depressive symptoms and quality of life among women with depression in Iran. METHODS: Adult women ages ≥18 who met DSM-5 criteria for a current major depressive episode (N=30) were randomly assigned to receive 12 weeks of individual IPT or to a waitlist control (WLC) group. RESULTS: Compared with women assigned to WLC, those assigned to IPT had significantly lower depression scores (F=155.1; df=1 and 26; p<0.001) and higher quality-of-life scores (F=137.5; df=1 and 26; p<0.001) posttreatment, with controls for pretreatment values. CONCLUSIONS: Compared with WLC, IPT was associated with greater reductions in depression and improvements in quality of life, suggesting the promise of this approach for treating depression among Iranian women.

Interpersonal psychotherapy delivered by nonspecialists for depression and posttraumatic stress disorder among Kenyan HIV-positive women affected by gender-based violence: Randomized controlled trial.

BACKGROUND: HIV-positive women suffer a high burden of mental disorders due in part to gender-based violence (GBV). Comorbid depression and posttraumatic stress disorder (PTSD) are typical psychiatric consequences of GBV. Despite attention to the HIV-GBV syndemic, few HIV clinics offer formal mental healthcare. This problem is acute in sub-Saharan Africa, where the world's majority of HIV-positive women live and prevalence of GBV is high. METHODS AND FINDINGS: We conducted a randomized controlled trial at an HIV clinic in Kisumu, Kenya. GBV-affected HIV-positive women with both major depressive disorder (MDD) and PTSD were randomized to 12 sessions of interpersonal psychotherapy (IPT) plus treatment as usual (TAU) or Wait List+TAU. Nonspecialists were trained to deliver IPT inside the clinic. After 3 months, participants were reassessed, and those assigned to Wait List+TAU were given IPT. The primary outcomes were diagnosis of MDD and PTSD (Mini International Neuropsychiatric Interview) at 3 months. Secondary outcomes included symptom measures of depression and PTSD, intimate partner violence (IPV), and disability. A total of 256 participants enrolled between May 2015 and July 2016. At baseline, the mean age of the women in this study was 37 years; 61% reported physical IPV in the past week; 91% reported 2 or more lifetime traumatic events and monthly income was 18USD. Multilevel mixed-effects logistic regression showed that participants randomized to IPT+TAU had lower odds of MDD (odds ratio [OR] 0.26, 95% CI [0.11 to 0.60], p = 0.002) and lower odds of PTSD (OR 0.35, [0.14 to 0.86], p = 0.02) than controls. IPT+TAU participants had lower odds of MDD-PTSD comorbidity than controls (OR 0.36, 95% CI [0.15 to 0.90], p = 0.03). Linear mixed models were used to assess secondary outcomes: IPT+TAU participants had reduced disability (-6.9 [-12.2, -1.5], p = 0.01), and nonsignificantly reduced work absenteeism (-3.35 [-6.83, 0.14], p = 0.06); partnered IPT+TAU participants had a reduction of IPV (-2.79 [-5.42, -0.16], p = 0.04). Gains were maintained across 6-month follow-up. Treatment group differences were observed only at month 3, the time point at which the groups differed in IPT status (before cross over). Study limitations included 35% attrition inclusive of follow-up assessments, generalizability to populations not in HIV care, and data not collected on TAU resources accessed. CONCLUSIONS: IPT for MDD and PTSD delivered by nonspecialists in the context of HIV care yielded significant improvements in HIV-positive women's mental health, functioning, and GBV (IPV) exposure, compared to controls. TRIAL REGISTRATION: Clinical Trials Identifier NCT02320799.