Ego-defense mechanisms and brief psychotherapies for the management of major depressive disorder in adults: A longitudinal and quasi-experimental study.

OBJECTIVE: To evaluate the effect of psychotherapies on ego defense mechanisms and the reduction of depressive symptoms in a 12-month follow-up period. METHODS: This longitudinal and quasi-experimental study nested within a randomized clinical trial included a clinical sample of adults (18-60 years) diagnosed with major depressive disorder using the Mini-International Neuropsychiatric Interview. Two models of psychotherapy were used: Supportive Expressive Dynamic Psychotherapy (SEDP) and Cognitive Behavioral Therapy (CBT). Defense Style Questionnaire 40 was used to analyze defense mechanisms and the Beck Depression Inventory was used to measure the depressive symptoms. RESULTS: The total sample comprised 195 patients (113 SEDP and 82 CBT), with the mean age was 35.63 (11.44) years. After adjustments, increased mature defenses was significantly associated with reduced depressive symptoms at all follow-up times (p < 0.001) and the decrease in immature defenses was significantly associated with the reduction of depressive symptoms at all follow-up times (p < 0.001). While neurotic defenses were not associated with a reduction in depressive symptoms at any time of follow-up (p > 0.05). CONCLUSION: Both models of psychotherapy were effective in increasing mature defenses and decreasing immature ones, as well as decreasing depressive symptoms at all evaluation times. With this, it is understood that a greater understanding of these interactions will allow a more adequate diagnostic and prognostic evaluation and the design of useful strategies that adapt to the patient's reality.

Immature defense mechanisms predict poor response to psychotherapy in major depressive patients with comorbid cluster B personality disorder

Objective: To evaluate the impact of defense mechanisms at baseline on depressive symptoms after brief psychotherapies and after 6-months of follow-up among depressed patients with and without cluster B personality disorders (PDs). Methods: This quasi-experimental study nested within a randomized clinical trial included a clinical sample of adults (18-60 years) diagnosed with major depressive disorder using the Mini-International Neuropsychiatric Interview. The Millon Clinical Multiaxial Inventory-III was applied to assess PD, the Defense Style Questionnaire 40 was used to analyze defense mechanisms, and the Beck Depression Inventory was used to measure the severity of depressive symptoms. Adjusted analysis was performed by linear regression. Results: The final sample consisted of 177 patients diagnosed with major depressive disorder, of whom 39.5% had cluster B PDs. Immature defenses at baseline significantly predicted the persistence of depressive symptoms at post-intervention and at 6-months of follow-up only in patients with PDs. Conclusion: In depressed patients with cluster B PDs, immature defenses predicted a poor response to brief therapies. The assessment of immature defenses at baseline can help identify patients at greater risk of poor therapeutic results and enable more appropriate treatment choices.

Immature defense mechanisms predict poor response to psychotherapy in major depressive patients with comorbid cluster B personality disorder.

OBJECTIVE: To evaluate the impact of defense mechanisms at baseline on depressive symptoms after brief psychotherapies and after 6-months of follow-up among depressed patients with and without cluster B personality disorders (PDs). METHODS: This quasi-experimental study nested within a randomized clinical trial included a clinical sample of adults (18-60 years) diagnosed with major depressive disorder using the Mini-International Neuropsychiatric Interview. The Millon Clinical Multiaxial Inventory-III was applied to assess PD, the Defense Style Questionnaire 40 was used to analyze defense mechanisms, and the Beck Depression Inventory was used to measure the severity of depressive symptoms. Adjusted analysis was performed by linear regression. RESULTS: The final sample consisted of 177 patients diagnosed with major depressive disorder, of whom 39.5% had cluster B PDs. Immature defenses at baseline significantly predicted the persistence of depressive symptoms at post-intervention and at 6-months of follow-up only in patients with PDs. CONCLUSION: In depressed patients with cluster B PDs, immature defenses predicted a poor response to brief therapies. The assessment of immature defenses at baseline can help identify patients at greater risk of poor therapeutic results and enable more appropriate treatment choices.

Dropout in brief psychotherapy for major depressive disorder: Randomized clinical trial.

The aim of this paper is to analyse the factors associated with the dropout from brief psychotherapy for adults with major depressive disorder (MDD) treated at a mental health outpatient clinic. This is a randomized clinical trial with two models of psychotherapy: cognitive behavioural therapy (CBT) and supportive expressive dynamic psychotherapy (SEDP). MDD and anxiety disorders were evaluated through the Mini International Neuropsychiatric Interview-Plus. The personality disorders were evaluated by the Millon Clinical Multiaxial Inventory-III. The severity of depressive symptoms was measured using the Beck Depression Inventory-II and resilience through Resilience Scale. Of the 215 participants, 41.9% abandoned psychotherapy (n = 90), and, of these, 54.4% (n = 49) abandoned after the fourth session. The proportion of psychotherapy dropout was higher among those with nonwhite skin colour, belonging to economic classes C and D, who had children and whose depressive symptoms were moderate. Presence of obsessive-compulsive personality trait was protective against dropout. The damage caused by this abrupt interruption is evident for all those involved in the psychotherapeutic process, so the clinician should pay attention to the predictors found in this study in order to develop strategies that promote therapeutic adherence.