Comparative effectiveness of short-term psychodynamic psychotherapy and cognitive behavioral therapy for major depression in psychiatric outpatient clinics: a randomized controlled trial.

BACKGROUND

More studies with low risk of bias on the effectiveness of cognitive behavioral therapy (CBT) and short-term psychodynamic psychotherapy (STPP) for major depressive disorder (MDD) are needed. This study compares the outcome of CBT and STPP and examines the improvements in each treatment, focusing on effect sizes, reliable change, dropout rates, and remission rates, using broad inclusion criteria (e.g. participants using antidepressants or with strong suicidal ideation).

METHODS

One hundred patients were randomly allocated to CBT or STPP. All patients were offered either 16 weekly sessions followed by 3 monthly booster sessions in CBT, or 28 weekly sessions in STPP. Primary outcome measures were Hamilton Depression Rating Scale (HDRS) and Beck's Depression Inventory-II (BDI-II). Secondary outcome measures were Work and Social Adjustment Scale (WSAS), Generalized Anxiety Disorder-7 (GAD-7), Global Assessment of Functioning (GAF) and Short Form Health Survey-12 (SF-12).

RESULTS

No significant differences in outcomes were found between the two treatment groups on any of the measures. The within-group effects were large (> 0.8) for the primary outcome measures and moderate to large for the secondary outcome measures. According to the reliable change index (RCI), 79% of patients reliably improved on HDRS and 76% improved on BDI-II, whereas respectively 6% and 10% reliably deteriorated.

CONCLUSIONS

These findings support the assumption that CBT and STPP are equally effective treatments for patients with depressive disorders in psychiatric outpatient clinics. Additionally, they strengthen the evidence for the effectiveness of both CBT and STPP in these settings, while also highlighting that not all depressed patients respond to short-term treatment.

CLINICAL TRIAL REGISTRATION: Clinical Trial gov. Identifier: NCT03022071. Date of registration: 2016-11-14.