Dataset Information

Randomized trial of brief interpersonal psychotherapy and cognitive behavioral therapy for depression delivered both in-person and by telehealth.

ABSTRACT:

Background

Expert consensus guidelines recommend Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT), interventions that were historically delivered face-to-face, as first-line treatments for Major Depressive Disorder (MDD). Despite the ubiquity of telehealth following the COVID-19 pandemic, little is known about differential outcomes with CBT versus IPT delivered in-person (IP) or via telehealth (TH) or whether working alliance is affected.

Methods

Adults meeting DSM-5 criteria for MDD were randomly assigned to either 8 sessions of IPT or CBT (group). Mid-trial, COVID-19 forced a change of therapy delivery from IP to TH (study phase). We compared changes in Hamilton Rating Scale for Depression (HRSD-17) and Working Alliance Inventory (WAI) scores for individuals by group and phase: CBT-IP (n = 24), CBT-TH (n = 11), IPT-IP (n = 25) and IPT-TH (n = 17).

Results

HRSD-17 scores declined significantly from pre to post treatment (pre: M = 17.7, SD = 4.4 vs. post: M = 11.7, SD = 5.9; p < .001; d = 1.45) without significant group or phase effects. WAI scores did not differ by group or phase. Number of completed therapy sessions was greater for TH (M = 7.8, SD = 1.2) relative to IP (M = 7.2, SD = 1.6) (Mann-Whitney U = 387.50, z = -2.24, p = .025).

Limitations

Participants were not randomly assigned to IP versus TH. Sample size is small.

Conclusions

This study provides preliminary evidence supporting the efficacy of both brief IPT and CBT, delivered by either TH or IP, for depression. It showed that working alliance is preserved in TH, and delivery via TH may improve therapy adherence. Prospective, randomized controlled trials are needed to definitively test efficacy of brief IPT and CBT delivered via TH versus IP.

SUBMITTER: Swartz HA

PROVIDER: S-EPMC10228570 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

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Publications

Randomized trial of brief interpersonal psychotherapy and cognitive behavioral therapy for depression delivered both in-person and by telehealth.

Swartz Holly A HA Bylsma Lauren M LM Fournier Jay C JC Girard Jeffrey M JM Spotts Crystal C Cohn Jeffrey F JF Morency Louis-Phillippe LP

Journal of affective disorders 20230428

<h4>Background</h4>Expert consensus guidelines recommend Cognitive Behavioral Therapy (CBT) and Interpersonal Psychotherapy (IPT), interventions that were historically delivered face-to-face, as first-line treatments for Major Depressive Disorder (MDD). Despite the ubiquity of telehealth following the COVID-19 pandemic, little is known about differential outcomes with CBT versus IPT delivered in-person (IP) or via telehealth (TH) or whether working alliance is affected.<h4>Methods</h4>Adults mee ...[more]

PMID: 37121279

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Project description:ContextPrevious studies have found that few chronically depressed patients remit with antidepressant medications alone.ObjectiveTo determine the role of adjunctive psychotherapy in the treatment of chronically depressed patients with less than complete response to an initial medication trial.DesignThis trial compared 12 weeks of (1) continued pharmacotherapy and augmentation with cognitive behavioral analysis system of psychotherapy (CBASP), (2) continued pharmacotherapy and augmentation with brief supportive psychotherapy (BSP), and (3) continued optimized pharmacotherapy (MEDS) alone. We hypothesized that adding CBASP would produce higher rates of response and remission than adding BSP or continuing MEDS alone.SettingEight academic sites.ParticipantsChronically depressed patients with a current DSM-IV-defined major depressive episode and persistent depressive symptoms for more than 2 years.InterventionsPhase 1 consisted of open-label, algorithm-guided treatment for 12 weeks based on a history of antidepressant response. Patients not achieving remission received next-step pharmacotherapy options with or without adjunctive psychotherapy (phase 2). Individuals undergoing psychotherapy were randomized to receive either CBASP or BSP stratified by phase 1 response, ie, as nonresponders (NRs) or partial responders (PRs).Main outcome measuresProportions of remitters, PRs, and NRs and change on Hamilton Scale for Depression (HAM-D) scores.ResultsIn all, 808 participants entered phase 1, of which 491 were classified as NRs or PRs and entered phase 2 (200 received CBASP and MEDS, 195 received BSP and MEDS, and 96 received MEDS only). Mean HAM-D scores dropped from 25.9 to 17.7 in NRs and from 15.2 to 9.9 in PRs. No statistically significant differences emerged among the 3 treatment groups in the proportions of phase 2 remission (15.0%), partial response (22.5%), and nonresponse (62.5%) or in changes on HAM-D scores.ConclusionsAlthough 37.5% of the participants experienced partial response or remitted in phase 2, neither form of adjunctive psychotherapy significantly improved outcomes over that of a flexible, individualized pharmacotherapy regimen alone. A longitudinal assessment of later-emerging benefits is ongoing.

Project description:ImportanceSuicide rates continue to increase in the US. Evidence-based treatments for suicide risk exist, but their effectiveness when delivered via telehealth remains unknown.ObjectiveTo test the efficacy of brief cognitive behavioral therapy (BCBT) for reducing suicide attempts and suicidal ideation among high-risk adults when delivered via telehealth.Design, setting, and participantsThis 2-group parallel randomized clinical trial comparing BCBT with present-centered therapy (PCT) was conducted from April 2021 to September 2023 with 1-year follow-up at an outpatient psychiatry and behavioral health clinic located in the midwestern US. Participants reporting suicidal ideation during the past week and/or suicidal behavior during the past month were recruited from clinic waiting lists, inpatient service, intermediate care, research match, and direct referrals from clinicians. A total of 768 participants were invited to participate, 112 were assessed for eligibility, and 98 were eligible and randomly assigned to a treatment condition. Data analysis was from April to September 2024.InterventionsParticipants received either BCBT, an evidence-based suicide-focused treatment that teaches emotion regulation and reappraisal skills, or PCT, a goal-oriented treatment that helps participants identify adaptive responses to stressors. Participants were randomized using a computerized stratified randomization algorithm with 2 strata (sex and history of suicide attempts).Main outcomes and measuresThe primary outcome was suicide attempts as measured by the Self-Injurious Thoughts and Behaviors Interview-Revised. The secondary outcome was severity of suicidal ideation as measured by the Scale for Suicide Ideation.ResultsParticipants included 96 adults (mean [SD] age, 31.8 [12.6] years; 64 female [66.7%] and 32 male [33.3%]), with 51 receiving BCBT and 45 receiving PCT. Of all participants, 85 (88.5%) completed at least 1 session. From baseline to 12 months, 12 participants receiving PCT (estimated percentage, 35.6%) made 56 suicide attempts and 11 participants receiving BCBT (estimated percentage, 30.0%) made 36 suicide attempts. Participants randomized to BCBT made significantly fewer suicide attempts than participants randomized to PCT (mean [range], 0.70 [0.00-8.00] attempts per participant vs 1.40 [0.00-10.00] per participant) and had a 41% reduced risk for suicide attempts (hazard ratio, 0.59; 95% CI, 0.36-0.96; P = .03). Severity of suicidal ideation significantly decreased in both treatments (F4,330 = 50.1; P < .001) but did not differ between groups (F4,330 = 0.2; P = .91).Conclusions and relevanceThe findings of this randomized clinical trial suggest that BCBT delivered via video telehealth is effective for reducing suicide attempts among adults with recent suicidal thoughts and/or behaviors.Trial registrationClinicalTrials.gov Identifier: NCT04844294.

Dataset Information

Randomized trial of brief interpersonal psychotherapy and cognitive behavioral therapy for depression delivered both in-person and by telehealth.

Background

Methods

Results

Limitations

Conclusions

Publications

Randomized trial of brief interpersonal psychotherapy and cognitive behavioral therapy for depression delivered both in-person and by telehealth.

Similar Datasets

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