Effectiveness of Schema Therapy versus Cognitive Behavioral Therapy versus Supportive Therapy for Depression in Inpatient and Day Clinic Settings: A Randomized Clinical Trial.

INTRODUCTION: Schema therapy (ST) reduces depressive symptoms, but clinical trials have not investigated its effectiveness for patients suffering from severe forms of depression and high rates of comorbidities. There is high demand for exploring and improving treatments for this patient group. The objective of the current study was to evaluate whether ST is more effective than individual supportive therapy (IST) and noninferior compared with cognitive behavioral therapy (CBT) in treating depression. METHODS: For this clinical trial, medicated patients were recruited in inpatient and day clinic settings. The major inclusion criteria were age between 18 and 75 years and primary diagnosis of depression without psychotic symptoms. A total of 292 participants were randomized to ST, CBT, or IST and received 7 weeks of psychotherapy (up to 14 individual and 14 group sessions). The primary outcome was change in depression severity after treatment measured by Beck Depression Inventory-II. Primary test for efficacy was superiority of ST over IST. Secondary test was noninferiority of ST compared with CBT. Multilevel modeling was conducted. The results at 6-month follow-up were explored. RESULTS: Across treatment, ST was not superior to IST. Secondary outcome analyses and completer analyses showed similar results. However, ST showed clinically relevant noninferiority compared with CBT. CONCLUSION: ST for depression as part of a psychiatric care program showed clinical noninferiority compared to CBT, without being superior to IST. ST represents a potentially useful addition to the therapeutic repertoire for the treatment of depression but its efficacy, including long-term efficacy, should be evaluated further.

Interpersonal similarity of autistic traits predicts friendship quality.

Autistic traits are known to be associated with social interaction difficulties. Yet, somewhat paradoxically, relevant research has been typically restricted to studying individuals. In line with the 'dialectical misattunement hypothesis' and clinical insights of intact social interactions among autistic individuals, we hypothesized that friendship quality varies as a function of interpersonal similarity and more concretely the difference value of autistic traits in a dyad, above and beyond autistic traits per se. Therefore, in this study, we used self-report questionnaires to investigate these measures in a sample of 67 neurotypical dyads across a broad range of autistic traits. Our results demonstrate that the more similar two persons are in autistic traits, the higher is the perceived quality of their friendship, irrespective of friendship duration, age, sex and, importantly, the (average of) autistic traits in a given dyad. More specifically, higher interpersonal similarity of autistic traits was associated with higher measures of closeness, acceptance and help. These results, therefore, lend support to the idea of an interactive turn in the study of social abilities across the autism spectrum and pave the way for future studies on the multiscale dynamics of social interactions.

Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT.

BACKGROUND: Major depressive disorder represents (MDD) a major cause of disability and disease burden. Beside antidepressant medication, psychotherapy is a key approach of treatment. Schema therapy has been shown to be effective in the treatment of psychiatric disorders, especially personality disorders, in a variety of settings and patient groups. Nevertheless, there is no evidence on its effectiveness for MDD in an inpatient nor day clinic setting and little is known about the factors that drive treatment response in such a target group. METHODS: In the current protocol, we outline OPTIMA (OPtimized Treatment Identification at the MAx Planck Institute): a single-center randomized controlled trial of schema therapy as a treatment approach for MDD in an inpatient and day clinic setting. Over the course of 7 weeks, we compare schema therapy with cognitive behavioral therapy and individual supportive therapy, conducted in individual and group sessions and with no restrictions regarding concurrent antidepressant medication, thus approximating real-life treatment conditions. N = 300 depressed patients are included. All study therapists undergo a specific training and supervision and therapy adherence is assessed. Primary outcome is depressive symptom severity as self-assessment (Beck Depression Inventory-II) and secondary outcomes are clinical ratings of MDD (Montgomery-Asberg Depression Rating Scale), recovery rates after 7 weeks according to the Munich-Composite International Diagnostic Interview, general psychopathology (Brief Symptom Inventory), global functioning (World Health Organization Disability Assessment Schedule), and clinical parameters such as dropout rates. Further parameters on a behavioral, cognitive, psychophysiological, and biological level are measured before, during and after treatment and in 2 follow-up assessments after 6 and 24 months after end of treatment. DISCUSSION: To our knowledge, the OPTIMA-Trial is the first to investigate the effectiveness of schema therapy as a treatment approach of MDD, to investigate mechanisms of change, and explore predictors of treatment response in an inpatient and day clinic setting by using such a wide range of parameters. Insights from OPTIMA will allow more integrative approaches of psychotherapy of MDD. Especially, the identification of intervention-specific markers of treatment response can improve evidence-based clinical decision for individualizing treatment. TRIAL REGISTRATION: Identifier on clinicaltrials.gov : NCT03287362 ; September, 12, 2017.

Preventing depression in the offspring of parents with depression: A systematic review and meta-analysis of randomized controlled trials.

One major predictor of depression onset is having a depressed parent. This study provides the first systematic review and meta-analysis of preventive interventions for offspring of depressed parents. We searched six literature databases and included randomized controlled trials which concerned the non-depressed offspring (aged 18 or younger) of a depressed parent, who received a preventive intervention designed to reduce the risk of depression or a comparison condition. Primary and secondary outcome measures were the severity and incidence of childhood depression. 14 publications reporting data from seven trials (n=935 children) were included and were of relatively high quality. The effect of the interventions (versus any control condition) on depressive and internalising symptoms at post-intervention follow-up (up to four months) was small but significant [g'=-0.20, 95% CI (-0.34; -0.06), p=0.005; I2=0.00%]. The interventions also had a small but significant effect on depression incidence [Risk Ratio=0.56; 95% CI(0.41;0.77); d'=-0.42]. Intervention effects were not present in the short-term (up to 12months post-intervention) or long-term (15-72months post-intervention) follow-ups. Interventions targeting the offspring of depressed parents show promise not only in reducing symptoms of depression but also in preventing the onset of depression, at least immediately after the intervention.