Journal of Affective Disorders
Volume 151, Issue 2,
, Pages 500-505
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The efficacy of Cognitive Behavior Therapy (CBT) for depression has been robustly supported, however, up to fifty percent of individuals do not respond fully. A growing body of research indicates Schema Therapy (ST) is an effective treatment for difficult and entrenched problems, and as such, may be an effective therapy for depression.
In this randomized clinical trial the comparative efficacy of CBT and ST for depression was examined. 100 participants with major depression received weekly cognitive behavioral therapy or schema therapy sessions for 6 months, followed by monthly therapy sessions for 6 months. Key outcomes were comparisons over the weekly and monthly sessions of therapy along with remission and recovery rates. Additional analyses examined outcome for those with chronic depression and comorbid personality disorders.
ST was not significantly better (nor worse) than CBT for the treatment of depression. The therapies were of comparable efficacy on all key outcomes. There were no differential treatment effects for those with chronic depression or comorbid personality disorders. Limitations: This study needs replication.
This preliminary research indicates that ST may provide an effective alternative therapy for depression.
Cognitive behavior therapy (CBT) is recommended as one of the first-line treatments for individuals with major depression (Ellis et al., 2003, National Institute for Clinical Excellence (NICE), 2004). Despite the proven effectiveness of CBT only 40–50% with depression will make a full recovery with their first course of treatment, and some are likely to have a poor outcome despite completing treatment. Moreover, 3–5% may develop a chronic clinical course of depression which is resistant to treatment (Fournier et al., 2009, Hollon et al., 2005, Kessler et al., 1994). Other than chronicity, a number of other factors have been proposed to limit the effectiveness of CBT. Perhaps with the most contradictory evidence, is the treatment outcome when personality disorders are comorbid. A number of studies indicate that treatments are less effective when a comorbid personality disorder is present (e.g. Bagby et al., 2008, Gorwood et al., 2010), with a recent meta analysis reporting the risk of poor outcome doubles (Newton-Howes et al., 2006). Other studies and reviews report no difference in outcome between depressed individuals with and without personality disorders (Kelly et al., 2009, Kool et al., 2005, Niemeyer and Musch, 2013, van den Hout et al., 2006).
Limitations in the effectiveness of traditional CBT for depression, and growing recognition that depression is a chronic and/or recurrent disorder for many people often associated with other comorbid axis I and II problems, has led to increased use by clinicians of Schema Therapy (ST) in the treatment of depression. Schema Therapy was initially developed by Young (1990) for the treatment of personality dysfunction. In contrast to traditional CBT, ST concentrates immediately and specifically on the schema and related developmental processes that prevent individuals having their core needs met in an adaptive manner. It has been proposed that these schema must be modified in order to bring about lasting change, particularly for individuals with more difficult or entrenched problems such as chronic or recurrent depression (Overholser, 1997, Riso et al., 2003, Safran and Segal, 1990, Young, 1990). Further, it has been proposed that any treatment that fails to reorganize or disrupt these fundamental assumptions leaves people cognitively at risk for the reactivation of maladaptive schemas during times of personal stress (Segal et al., 1988), and therefore at increased risk of depression reoccurring. These propositions are supported by research indicating that therapy that focuses more on interpersonal and developmental issues promotes long lasting recovery from depression and, importantly, reduces the risk of relapse (Hayes et al., 1996). Schema change has been associated with the resolution of symptomatic distress (Nordahl and Nysaeter, 2005).
Despite the widespread application of ST, there is still limited research investigating the efficacy of this therapy. Existing research indicates that ST is an effective treatment for borderline personality disorder (Farrell et al., 2009, Giesen-Bloo et al., 2006, Nadort et al., 2009, Nordahl et al., 2005, Nordahl and Nysaeter, 2005), substance dependence (Ball, 1998), chronic agoraphobia (Bamber, 2004) and borderline personality disorder and post-traumatic stress disorder in war veterans (Young, 2005). In the recent randomized clinical trial comparing ST and transference focused psychotherapy, ST also had a significantly lower rate of drop out from treatment than transference focused therapy (Giesen-Bloo et al., 2006). To date the efficacy of ST in treating depression has not been examined, however, specific schemas identified by Young have been shown to be a risk factor for depression (Halvorsen et al., 2010) and preliminary evidence suggests that ST may be effective for depression (Hawke and Provencher, 2011).
The primary aim of the current study was to compare the efficacy of ST with that of traditional CBT for individuals with a current major depressive episode. It was hypothesized that ST would be superior to CBT in achieving sustained change (percentage improvement on the Mongomery Asberg Depression Rating Scale (MADRS)) in depression. Secondary aims were to compare sustained change on self-report (percentage improvement on Beck Depression Inventory-II (BDI-II)) between ST and CBT and to compare the rates of remission and recovery.
Given the proposition that ST may be more effective for chronic problems and/or entrenched problems, we also examined whether or not ST would be more effective in those with chronic depression. Similarly, given that ST was initially developed for those with personality disorders, and given the equivocal treatment outcome findings when depression is comorbid with personality disorders, we examined whether or not ST would produce better outcomes for those depressed patients with a personality disorder.
Participants (males n=31; females n=69) recruited for this study had a principal current diagnosis of major depressive disorder (DSM-IV American Psychiatric Association, 1994) and were over the age of 18 years. Participants were assessed and treated in an outpatient clinical research unit in the Department of Psychological Medicine, University of Otago, Christchurch, New Zealand. Participants were required to be free of any centrally active drug, other than an occasional hypnotic and the oral
Fig. 1 shows the flow of participants through the study. 192 depressed individuals were screened for the study, 100 were randomized to therapy; 50 to CBT and 50 to ST. Seventy eight percent of participants randomized to ST completed (minimum 15 sessions) weekly sessions and 60% completed monthly sessions (minimum 3), and 68% of participants randomized to CBT completed the weekly sessions and 50% completed the monthly sessions. There was no significant difference between ST and CBT in the number
The present study found no difference between ST and CBT outcomes for depression when outcome was assessed with the MADRS and the BDI-II at the end of weekly and monthly (end treatment) therapy sessions. Rates of remission and recovery were also similar between the therapies. At the end of treatment the average percentage change on the clinician-rated MADRS was 50%, with 53 percent of the sample defined as recovered, finding that are consistent with previous treatment studies despite
Role of funding source
This research was funded by grants from the Health Research Council of New Zealand (HRC). The HRC had no further role in any aspect of the study.
Conflict of interest
There are no conflicts of interest.
This research was funded by grants from the Health Research Council of New Zealand (HRC). Particular thanks to the researchers, therapists and clinicians who worked on this study and a special thanks to all those who participated in the study.
- S.A. Ball
Manualized treatment for substance abusers with personality disorders: dual focus schema therapy
- J.D. Carter et al.
Patient predictors of response to cognitive behaviour therapy and interpersonal therapy in a randomized clinical trial for depression
Journal of Affective Disorders
- J.M. Farrell et al.
A schema-focused approach to group psychotherapy for outpatients with borderline personality disorder: a randomized control trial
Journal of Behavior Therapy and Experimental Psychiatry
- B. Kelly et al.
Impact of severity of personality disorder on the outcome of depression
- S. Kool et al.
Efficacy of pharmacotherapy in depressed patients with and without personality disorders: a systematic review and meta-analysis
- H.M. Nordahl et al.
Schema therapy for patients with borderline personality disorder: a single case series
Journal of Behavior Therapy and Experimental Psychiatry
- B.E. Wampold et al.
A meta-(re)analysis of the effects of cognitive therapy versus ‘other therapies’ for depression
Journal of Affective Disorders
- American Psychiatric Association
Diagnostic and statistical manual of mental disorders
- M. Bagby et al.
Personality and differential treatment response in major depression: a randomized controlled trial comparing cognitive-behavioral therapy and pharmacotherapy
Canadian Journal of Psychiatry
- M. Bamber
The good, the bad and the defenceless Jimmy—a single case study of schema mode therapy
Clinical Psychology and Psychotherapy
Cognitive Therapy of Depression
Beck Depression Inventory—2nd Edition Manual
Cognitive Therapy: Basics and Beyond
Outcome effects of receiving a preferred, randomly assigned or nonpreferred therapy
Journal of Consulting and Clinical Psychology
National Institute of Mental Health Treatment of Depression Collaborative Reseach Program: general effectiveness of treatments
Archives of General Psychiatry
RANZCP clinical practice guidelines
Summary of guidelines for the treatment of depression Australian Psychiatry
Structured Clinical Interview for DSM-IV: Axis II Personality Disorders (SCID-II)
Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression
Journal of Consulting and Clinical Psychology
Outpatient psychotherapy for borderline personality disorder
Archives of General Psychiatry
Effects of vcolunterring and responsibility on perceived value and effectiveness of a clinical treatment
Journal of Consulting and Clinical Psychology
Treatment response in major depression: effects of personality dysfunction and prior depression
The British Journal of Psychiatry
Dysfunctional attitudes and early maladaptive schemas as predictors of depression: a 9-year follow-up study
Cognitive Therapy and Research
Effectiveness of and dropout from outpatient cognitive behavioural therapy for adult unipolar depression: a meta-analysis of nonrandomized effectiveness studies
Journal of Consulting and Clinical Psychology
Schema theory and schema therapy in mood and anxiety disorders: a review
Journal of Cognitive Psychotherapy: An International Quarterly
Effectiveness of targeting the vulnerability factors of depression in cognitive therapy
Journal of Consulting and Clinical Psychology
A single case series of imagery rescripting of intrusive autobiographical memories in depression
2023, Journal of Behavior Therapy and Experimental Psychiatry
Intrusive memories are a common feature of depression, thought to be related to the onset and maintenance of the disorder. Intrusive memories have been successfully targeted in posttraumatic stress disorder through imagery rescripting. Yet there is limited evidence for the effectiveness of this technique in depression. We examined whether 12 weekly sessions of imagery rescripting was associated with reductions in depression, rumination and intrusive memories in a sample of patients with major depressive disorder (MDD).
Fifteen clinically depressed participants completed 12 weeks of imagery rescripting treatment while completing daily measures of depression symptoms, rumination and intrusive memory frequency.
There were significant reductions on pre-post treatment and daily assessment measures of depression symptoms, rumination and intrusive memories. Reductions in depression symptoms represented a large effect size, while 13 participants (87%) showed reliable improvement and 12 participants (80%) demonstrated clinically significant improvement and no longer met diagnostic criteria for MDD.
The sample size was small, however the intensive daily assessment protocol ensured the viability of within-person analyses.
Imagery rescripting as a stand-alone intervention appears to be effective at reducing depression symptoms. Additionally, the treatment was well tolerated by clients and observed to overcome several traditional treatment barriers in this population.
A meta-analysis of CBT efficacy for depression comparing adults and older adults
2022, Journal of Affective Disorders
This meta-analysis investigates CBT treatment efficacy fordepression, and compares outcomes between adults (young and middle aged) and older adults (OA). Methodology. Effect sizes (Hedges' g) were obtained from 37 peer-reviewed RCTs, 25 adult papers (participant n=2948) and 12 OA papers (participant n=551), and analysed with the random effects model. Results. No significant difference between age groups is reported in terms of CBT efficacy for depression compared to other treatments (Qbetween (1)=0.06, p=.89), with the overall effect favouring CBT over any other treatments (g=0.48, 95% CI=0.29–0.68). The same pattern of results was found when restricting studies to those which used active control conditions (Qbetween (1)=0.03, p=.86) or passive control conditions (Q (1)=2.45, p=.12). Discussion. No significant differences in efficacy for CBT treatment for depression are found when comparing adults and OA. CBT is as efficacious with OA as with adults.
Pathways from exposure to racial/ethnic discrimination to depression: Testing a social-cognitive model
2022, Social Science and Medicine
Citation Excerpt :
Studies of discrimination, relational schemas, and depression have implications for clinical interventions and public health messaging intended to reduce discrimination and mitigate its mental health consequences. Treatments focused on addressing negative schemas have been successful in managing depression (Carter et al., 2013). Yet, psychological interventions rarely address the psychosocial sequela of racism (Meyer and Zane, 2013).
Interpersonal racial/ethnic discrimination is a risk factor for depression across the lifespan in minoritized racial/ethnic groups. This study tests a model proposing that social cognitive processes, including relational schemas, mediate the link between discrimination and depression. Relational schemas enable individuals to form mental representations of others, reflecting prior social learning and generating expectations about future social relations. Racism-related relational schemas include, among others, concerns about being rejected or invalidated, concerns about confirming negative stereotypes held by others, and cynical mistrust of others. Prior studies have typically examined the mediating role of one or two relational schemas in the association between discrimination and depression; less is known about the unique and combined effects of multiple dimensions of racism-related social cognition.
The model was tested in a convenience sample of ethnically diverse, non-white participants recruited from two sites, a community medical center (N=136; Mage=38, SD=13.0) and a private university (N=120; Mage=19.4, SD=1.3), yielding a consolidated sample of 256 participants (64% women). Data were collected between September 2016 and April 2018. Participants completed paper-and-pencil self-report measures of exposure to interpersonal discrimination, depressive symptoms, and eight measures of relational schemas.
Confirmatory factor analysis indicated that the eight relational schemas defined three primary dimensions: concerns about rejection and invalidation, social vigilance, and mistrust. A structural equation model in which the association between exposure to discrimination and depressive symptoms operates through latent factors representing three social-cognitive dimensions demonstrated adequate fit (CFI=0.96, RMSEA=0.06, SRMR=0.04). A significant mediational effect was found only for concerns about rejection and invalidation.
The conceptual model supported by this study may help inform psychological interventions aimed at mitigating the detrimental effects of racial/ethnic discrimination on mental health.
The five year outcome of major depression: Effects of baseline variables and type of treatment
2022, Journal of Psychiatric Research
Depression is commonly a relapsing or chronic disorder. Long-term outcome is therefore important. We report on the outcome of major depression five years after receiving treatment with medication or psychotherapy.
472 patients were treated in three consecutive randomised controlled trials in one clinical research centre. 298 were followed up at five years. Of these, 106 patients were treated with medications, while the remaining 192 were given psychotherapy. The a priori outcome measure was mood symptoms in the two years prior to the assessment.
The majority (56%) of patients had no depressive symptoms in the prior two years. One third (32%) had fluctuating depression, while 12% were chronic depressed. Predictors of outcome were few; baseline severity, suicidality, personality pathology, and type of treatment. Those receiving medication did somewhat worse, even when adjusted for this group's higher depression severity, suicidality and personality pathology at baseline.
Long-term depressive symptoms are common after evidence-based treatment, although over half the patients appear to recover. Psychotherapy may be superior to medication in reducing the level of symptoms in the longer term. Personality remains one of the few baseline predictors of long-term outcome.
Determinants of the remission heterogeneity in bipolar disorders: The importance of early maladaptive schemas (EMS)
2020, Journal of Affective Disorders
Citation Excerpt :
In conclusion, it appears important to identify and treat EMS in clinical practice to improve the patient's remission, and then, to reach recovery. Schemas therapy (Young et al., 2003), the therapy focused on EMS, may be an effective therapeutic avenue given that its efficacy in disorders which shared similar clinical characteristics with BD (unipolar disorder, Carter et al., 2013; borderline personality disorder, Jacob and Arntz, 2013). These results about remission constitute the first step and encourage future research to model the recovery in BD, as Jones et al. (2013) did by developing a questionnaire that assesses recovery in BD specifically.
A crucial health issue is to understand the remission heterogeneity of Bipolar Disorders by considering symptomatology as well as functioning. A new perspective could be elements of the construction of individual identity. This exploratory study aimed to explore the remission heterogeneity of patients with BD in terms of Early Maladaptive Schemas (EMS) by preferring a person-oriented approach.
This study included euthymic patients recruited into the FACE-BD cohort. The remission was assessed by the Montgomery-Asberg Depression Rating Scale and the Young Mania Rating Scale for its symptomatic dimension and by the Functioning Assessment Short Test for its functional dimension. The activation of the eighteen EMS was assessed by the Young Schema Questionnaire 3 Short Form. Clustering was performed to identify profiles according to the patients’ remission. Clusters identified were compared on the EMS activation by using analysis of variance and post-hoc tests.
Among the 100 euthymic patients included, four profiles of remission were identified: cluster 1 “Global Remission” (34%), cluster 2 “Hypomanic residual” (20%), cluster 3 “Depressive residual and functional impairment” (36%) and cluster 4 “Global handicap” (10%). Two out of three EMS discriminated against these profiles. The activation of specific EMS clarifies the singularity of each remission profile.
For the symptomatic dimension, cut-offs chosen could be discussed as well as the scale assessing residual depressive symptoms.
This study participates in a comprehensive model of remission by integrating the symptomatology, the functioning, and the EMS. Identifying and treating EMS may improve patients remission to reach recovery.
Dynamic indices of methamphetamine dependence and HIV infection predict fluctuations in affective distress: A five-year longitudinal analysis
Journal of Affective Disorders, Volume 151, Issue 2, 2013, pp. 728-737
Methamphetamine (METH) use and human immunodeficiency virus (HIV) infection are highly comorbid, and both are associated with increased prevalence of affective distress. Delineating the trajectory of affective distress in the context of METH dependence and HIV infection is important given the implications for everyday functional impairment, adverse health behaviors, and increased risk for adverse health outcomes.
We conducted a five-year longitudinal investigation involving 133 METH-dependent (74 HIV seropositive) and 163 non-METH-dependent (90 HIV seropositive) persons to examine both long-standing patterns and transient changes in affective distress. Mixed-effect regression models with random subject-specific slopes and intercepts evaluated the effect of METH dependence, HIV serostatus, and related variables on affective distress, as measured by the Profile of Mood States.
Transient changes in affective distress were found to be greater among those with a diagnosis of current MDD, briefer durations of abstinence from METH, and higher quantity of METH consumed. Weak associations were observed among static (time-independent predictors) covariates and long-standing patterns in affective distress.
Study lacked data pertaining to the participants' involvement in METH treatment and relied on respondent-driven sampling.
Our longitudinal investigation of the trajectory of affective distress indicated that specific and dynamic indices of current METH use were associated with greater transient changes in mood. In the evaluation and treatment of affective distress, recency and quantity of current METH use are important to consider given their association with heightened affective distress and mood instability over time.
Dimensional endophenotypes in bipolar disorder: Affective dysregulation and psychosis proneness
Journal of Affective Disorders, Volume 151, Issue 2, 2013, pp. 695-701
The clinical phenotype of bipolar disorder (BPD) is heterogeneous and the genetic architecture of the disorder is complex and not well understood. Given these complications, it is possible that the identification of intermediate phenotypes (“endophenotypes”) will be useful in elucidating the complex genetic mechanisms that result in the disorder. The examination of unaffected relatives is critical in determining whether a particular trait is genetically-relevant to BPD. However, few dimensional traits related to BPD have been assessed in unaffected relatives of patients.
We assessed affective temperament and schizotypy in 55 discordant sibling pairs and 113 healthy controls (HCs) using the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego, Auto-questionnaire version (TEMPS-A) to assess affective temperament and the Schizotypal Personality Questionnaire (SPQ) to assess schizotypy.
BPD patients scored significantly higher than HCs on all subscales of the SPQ and on all but one subscale (hyperthymic) of the TEMPS-A (all p<0.01). Siblings demonstrated scores that were significantly intermediate to patients and HCs on the anxious subscale of the TEMPS-A and on the interpersonal deficits and disorganized subscales of the SPQ.
We did not investigate the BPD spectrum as most patients were diagnosed with BPD I (n=47). Most of the patients had experienced psychosis (n=42) and so we were unable to examine whether psychosis status impacted upon affective temperament or schizotypy in patients or their siblings.
These data suggest that schizotypy and affective temperament represent dimensional traits that are likely to underlie the genetic risk for BPD.
Depression with psychotic features is influenced by the polymorphism of the serotonin transporter gene
Journal of Affective Disorders, Volume 151, Issue 2, 2013, pp. 605-610
Current diagnostic classifications regard psychotic symptoms during depressive episodes as indicators of depression severity. However, growing evidence suggests that depression with psychotic symptoms (MDP) may represent a distinct subtype of depression. In the course of the search for discriminating factors we tested the hypothesis that the serotonin transporter gene (5-HTTLPR) may interact with the manifestation of psychotic symptoms in acute depression.
112 inpatients (61 female) with a depressive episode (16 bipolar, 86 unipolar) at admission were genotyped for 5-HTTLPR variants. Psychotic symptoms und general psychopathology were evaluated comprehensively using the Manual of the Association for Methodology and Documentation in Psychiatry (Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie, 1981). For statistical analysis a chi-square test and a logistic regression model was used.
16 (14.3%) out of 112 patients were currently presenting with psychotic symptoms. The primary finding of our study was the higher prevalence of the s-allele of the 5-HTTLPR within the group of MDP patients (Pearson χ²=7.87; df=2; p<0.03). Secondly, in a logistic regression model, 5-HTTLPR was found to significantly contribute to the diagnosis of MDP (χ²=6.5; df=1; p=0.01). This effect was even more pronounced upon comparing only severely depressed patients with MDP patients. From a psychopathological perspective, MDP patients showed higher AMDP hostility and apathy scores but equal AMDP depression scores.
This is the first study to show an influence of 5-HTTLPR on psychotic symptoms in acutely depressed patients.
The lack of a control group and the relatively small sample size limits the present study's findings, thus replication in a larger sample is necessary.
A pilot randomized controlled trial of a depression and disease management program delivered by phone
Journal of Affective Disorders, Volume 151, Issue 2, 2013, pp. 769-774
Depression in medically ill patients occurs at twice the rate found in the general population. Though pharmacologic and psychotherapeutic interventions for depression are effective, response to treatment and access to care are barriers for this population. A multidimensional telehealth intervention was designed to focus on these barriers by delivering a phone based intervention that addressed managing one's illness and coping emotionally.
Veterans with diabetes, hypertension, or chronic pain and depressive symptoms were randomized to one of three conditions: Usual Care (n=23), Illness Management Only (n=31), or Combined Psychotherapy and Illness Management (n=29). Those randomized to the Combined or Illness Management Only intervention group received 10 phone visits. Veterans in the Combined group received all aspects of the illness management program plus a manualized depression intervention. Subjects completed assessments at baseline, week 5, and 10 to test the main hypothesis that veterans in the Combined condition would have a greater decline in depressive symptoms.
The Combined intervention yielded a significant decline in depressive symptoms when compared with Usual Care. However, the there was no significant difference between the Combined and Illness Management Only groups.
This is a pilot study with a small sample size relative to a standard randomized controlled trial in psychotherapy.
This telephone-based intervention succeeded in reducing depressive symptoms in veterans with chronic illness. It adds to the building evidence base for providing phone-delivered mental health services.
Trajectories of individual symptoms in remitters versus non-remitters with depression
Journal of Affective Disorders, Volume 151, Issue 2, 2013, pp. 506-513
It remains unclear regarding the contribution of each individual symptom in predicting the outcome in major depressive disorder (MDD). The objective of this analysis was to evaluate trajectories of individual symptoms over time to identify which specific depressive item(s) could predict subsequent clinical response.
The data of 2874 outpatients with nonpsychotic MDD who received citalopram for up to 14 weeks in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial were analyzed. Average trajectories of individual symptoms over time were estimated for remitters and non-remitters. Moreover, specific symptoms whose improvement at week 2 predicted remission were identified, using binary logistic regression analysis.
Trajectories were significantly different between remitters and non-remitters in all depressive symptoms. All depressive symptoms in the 16-item Quick Inventory of Depressive Symptomatology, Self-Report (QIDS-SR16) in the two groups, except for hypersomnia and weight change in non-remitters, substantially improved within 2 weeks and gradually continued to improve thereafter throughout the 14 weeks. Early improvements in the following five symptoms, in order of magnitude, in the QIDS-SR16 were significantly associated with remission: sad mood, negative self-view, feeling slowed down, low energy, and restlessness (P<0.001, P<0.001, P=0.001, P=0.004, P=0.021).
The participants were limited to the nonpsychotic MDD outpatients who received citalopram. Further, symptomatology was not evaluated at the very beginning of treatment.
While the data pertain to citalopram and replication is necessary for other antidepressants, early improvements in certain core depressive symptoms may serve as a predictor of subsequent remission.
Placing transdermal selegiline for major depressive disorder into clinical context: Number needed to treat, number needed to harm, and likelihood to be helped or harmed
Journal of Affective Disorders, Volume 151, Issue 2, 2013, pp. 409-417
This is a quantitative review of existing studies of transdermal selegiline for major depressive disorder.
Data for dichotomous outcomes were extracted from the five 6–8 week studies of transdermal selegiline. Number needed to treat (NNT) vs. placebo was calculated for response and remission using standard definitions. Number needed to harm (NNH) vs. placebo for commonly encountered adverse events (AEs), AEs associated with sexual function, incidence of weight gain ≥5% from baseline, and discontinuation due to an AE, were also calculated. Data was pooled as appropriate and likelihood to be helped or harmed (LHH) ratios contrasting remission with selected tolerability outcomes were determined.
When pooling together the two pivotal trials as identified in product labeling, NNT for response was 11 (95% CI 6–109) and for remission, 9 (95% CI 6–28). Pooling all trials, NNH for application site reaction was 7 (95% CI 6–10) and for insomnia, 19 (95% CI 12–41). There were no clinically relevant differences from placebo regarding weight gain or impairment in sexual functioning. NNH for discontinuation due to an AE was 32 (95% CI 19–132). LHH for remission vs. discontinuation from treatment due to an AE was 3.6.
The studies included were not identical in design. The studies were registrational in nature and thus not necessarily generalizable.
NNT for transdermal selegiline for efficacy is similar to that for other antidepressant regimens for which similar analyses have been published. There appear to be no clinically relevant effects of selegiline on weight or sexual functioning.
Copyright © 2013 Elsevier B.V. All rights reserved.
What is the most effective type of psychological treatment for depression according to empirical research? ›
Cognitive behavioral therapy (CBT) is one of the most evidence-based psychological interventions for the treatment of several psychiatric disorders such as depression, anxiety disorders, somatoform disorder, and substance use disorder.Which form of therapy is most effective for major depression? ›
Cognitive behavioral therapy (CBT)
This type of psychotherapy focuses on changing both negative thought processes and behaviors that contribute to depression symptoms. According to research, CBT offers some of the most promising evidence for effective therapeutic treatment for depression available.
Types of Cognitive Behavioral Therapy
Cognitive Therapy (CT) Dialectical Behavior Therapy (DBT) Rational Emotive Behavior Therapy (REBT)
In CBT, recognizing automatic thoughts and how they make patients feel and behave is sufficient. However, in schema therapy, the focus is to do all of the above while changing the schemas so that they are no longer a hindrance to the patient's adult life.What are the 2 most effective treatment methods for most types of depression? ›
Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms.What 3 types of therapy have been found to be most effective in treating depression? ›
Three of the more common methods used in depression treatment include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. Often, a blended approach is used.What is one of the better approaches to treating depression? ›
Education, lifestyle changes, social support and psychological therapy are important treatments for depression. People may also require antidepressant medication. Medications may take up to six weeks to be effective, so be patient. Take the time to find the treatment that's right for you.What is the most successful form of therapy? ›
Cognitive behavioral therapy is considered the gold standard in psychotherapy.Which psychological therapy would be beneficial to treat depression? ›
Cognitive behavioural therapy focuses on helping patients become aware of how certain negative automatic thoughts, attitudes, expectations, and beliefs contribute to feelings of sadness and anxiety.What is the difference between cognitive therapy and psychotherapy? ›
Cognitive therapy is more focused on changing unhealthy thought patterns while traditional psychotherapy focuses more on understanding the underlying causes of the condition. Depending on the individual's needs, either approach may be beneficial.
Uses for CBT
In addition to depression or anxiety disorders, CBT can also help people with: bipolar disorder. borderline personality disorder. eating disorders – such as anorexia and bulimia.
The cognitive approach to treating depression is a type of therapy that focuses on identifying and challenging negative thought patterns that contribute to depressive symptoms. The goal is to help individuals develop more positive and realistic ways of thinking, leading to improved mental health and well-being.What is schema therapy best for? ›
Who can benefit from Schema Therapy? Studies show Schema Therapy is effective for people diagnosed or presenting with features of personality disorders. It can help people with childhood traumas, eating disorders and addictions, to identify and address the underlying schemas from which issues arise.What is an example of a schema therapy? ›
Another example can be given for the Defectiveness schema: A person using an avoidance coping style might avoid situations that make them feel defective, or might try to numb the feeling with addictions or distractions. A person using a surrender coping style might tolerate unfair criticism without defending themself.What is the success rate of schema therapy? ›
This study demonstrates that schema therapy leads to complete recovery in about 50% of the patients, and to significant improvement in two-thirds.What is the fastest and probably most effective treatment for severe cases of depression? ›
Antidepressants can be helpful for people with moderate or severe depression. They're the most effective treatment for relieving symptoms quickly, particularly in severe depression.What is currently the most effective treatment for severe or treatment resistant depression? ›
Psychological counseling (psychotherapy) by a psychiatrist, psychologist or other mental health professional can be very effective. For many people, psychotherapy combined with medication works best. It can help identify underlying concerns that may be adding to your depression.What are the two most effective forms of treatment for mental health disorders? ›
Medication paired with psychotherapy is the most effective way to promote recovery.What are two psychological treatments for depression? ›
Depth psychotherapy: This is similar to analytical therapy, but it focuses more on current conflicts. Systemic therapy: Systemic therapy is based on the assumption that relationships between people, especially those within the family, play an important role in the development and treatment of depression.What is the most intense psychotherapy? ›
Psychoanalysis. One of the earliest forms of psychotherapy, psychoanalysis was invented by Dr. Sigmund Freud, who sought to uncover the mechanisms behind patients' seemingly illogical responses. Psychoanalysis is one of the more intense forms of therapy and is typically composed of three-to-five sessions each week.
Cognitive-Behavioral Therapy (CBT)
A well-established, highly effective, and lasting treatment is called cognitive-behavioral therapy, or CBT. It focuses on identifying, understanding, and changing thinking and behavior patterns.
Esketamine is a prescription nasal spray. The low-dose psychedelic drug boosts the activity of glutamate in parts of your brain related to mood. Glutamate's job is to excite cells in the brain and nervous system. Esketamine can trigger new connections in your brain too.Which two therapies may be equally effective in reducing depression? ›
For depression, two kinds of psychotherapy called cognitive-behavioral therapy and interpersonal psychotherapy, as well as antidepressant medications, have been shown to be helpful. There is some evidence that combining psychotherapy and medications may be more effective than either treatment alone.What is the best strategy in treating major depressive disorder and persistent depressive disorder? ›
Different types of psychotherapy, such as cognitive behavioral therapy, can be effective for persistent depressive disorder. You and your therapist can discuss your goals for therapy and other issues, such as the length of treatment.
- Brainspotting. Brainspotting has a lot to do with your brain and your eyes. ...
- Neurofeedback Therapy. ...
- Transcranial Magnetic Stimulation (TMS) ...
- Hypnotherapy. ...
- Cognitive Control Training.
CBT alone is 50-75% effective for overcoming depression and anxiety after 5 – 15 modules.What is the single strongest therapist determinant of successful therapy? ›
The single greatest determinant of improvement in therapy is the client's resources.What does cognitive therapy rely on the most to treat depression? ›
Cognitive therapy is a treatment process that helps patients correct false self-beliefs that lead to certain moods and behaviors. The fundamental principle behind cognitive therapy is that a thought precedes a mood, and that both are interrelated with a person's environment, physical reaction, and subsequent behavior.Which psychological treatments found to be most effective for mood disorders? ›
Cognitive Behavioral Therapy (CBT) is the most widely researched form of therapy for mood disorders, including depression and bipolar disorder.What is the most effective form of therapy for psychological problems? ›
Adopting strategies to change thinking patterns is the focus here. This treatment approach is effective and can be used with patients who experience depression, anxiety, or phobias. Cognitive therapy may be combined with behavior therapy, which can provide a more comprehensive experience for patients.
In fact, CBT is actually a form of psychotherapy, although people commonly think they are different. In a nutshell: psychotherapy tends to cover a broad range of therapy options, including CBT, and provides improvements with consistent sessions over the longer term.Do I need psychotherapy or CBT? ›
CBT might use your past experiences to help make sense of your current patterns, but the focus remains on making changes in the here and now. Psychodynamic psychotherapy is particularly useful when unresolved issues from childhood and adolescence get in the way of making changes in your life.Why is CBT the best psychotherapy? ›
It's often the preferred type of psychotherapy because it can quickly help you identify and cope with specific challenges. It generally requires fewer sessions than other types of therapy and is done in a structured way. CBT is a useful tool to address emotional challenges.What are the weaknesses of cognitive behavioral therapy? ›
Disadvantages of CBT
Due to the structured nature of CBT, it may not be suitable for people with more complex mental health needs or learning difficulties. As CBT can involve confronting your emotions and anxieties, you may experience initial periods where you are more anxious or emotionally uncomfortable.
Those who have maladaptive coping mechanisms that greatly impact their mental health are typically good candidates for CBT. However, individuals who experience mental health issues due to racism, classism, ableism, etc. may not find relief with CBT.Is CBT the gold standard for psychotherapy? ›
Taking into account the number of publications/studies, academic programs, and/or practicing professionals, cognitive behavioral therapy (CBT) is arguably the gold standard of the psychotherapy field.Which therapist developed a cognitive therapy for depression? ›
In the 1960s, Aaron Beck developed cognitive behavior therapy (CBT) or cognitive therapy.What are the three cognitive explanations for major depressive disorder? ›
Beck also asserts that there are three main dysfunctional belief themes (or "schemas") that dominate depressed people's thinking: 1) I am defective or inadequate, 2) All of my experiences result in defeats or failures, and 3) The future is hopeless.What are the weaknesses of cognitive explanation of depression? ›
However, one weakness of the cognitive approach is that it does not explain the origins of irrational thoughts and most of the research in this area is correlational. Therefore, we are unable to determine if negative, irrational thoughts cause depression, or whether a person's depression leads to a negative mindset.What are the disadvantages of schema therapy? ›
- Possibility of not being as effective in inpatient settings in which catering to individual needs is difficult4.
- The process of change could include the emergence of intense emotions, which can overwhelm people14.
The Schema Domains define 5 broad categories of emotional needs of a child (connection, mutuality, reciprocity, flow and autonomy). When these needs are not met, schemas develop that lead to unhealthy life patterns.What are the problems with schema therapy? ›
One major concern regarding schema therapy relates to the cost and length of time of the treatment. Given that schema therapy works to treat chronic problems, treatment often takes longer and costs more than other time-limited evidence-based interventions.What are 3 examples of schemas? ›
Examples of schemata include rubrics, perceived social roles, stereotypes, and worldviews.What are the four goals of schema therapy? ›
The main goals of Schema Therapy are: to help patients strengthen their Healthy Adult mode; weaken their Maladaptive Coping Modes so that they can get back in touch with their core needs and feelings; to heal their early maladptive schemas; to break schema-driven life patterns; and eventually to get their core ...What is schema therapy model of depression? ›
Schema Therapy (ST) is an integrative treatment approach that targets maladaptive cognitive schemas through cognitive, behavioral, interpersonal, and experiential interventions. ST has been studied in patients with chronic depression with good results.How many sessions are needed for schema therapy? ›
As an approximation, a typical course of Schema Therapy may require 30 – 50 sessions of 1 hour duration for moderate difficulties. For very entrenched or severe difficulties schema therapy may be delivered longer term. Therapy sessions are usually provided on a weekly basis.What is the main criticism of schema theory? ›
Abstract. Schema Theory is intuitively appealing although it has not always received positive press; critics of the approach argue that the concept is too ambiguous and vague and there are inherent difficulties associated with measuring schemata. As such, the term schema can be met with scepticism and wariness.Why is schema therapy better than CBT? ›
In CBT, recognizing automatic thoughts and how they make patients feel and behave is sufficient. However, in schema therapy, the focus is to do all of the above while changing the schemas so that they are no longer a hindrance to the patient's adult life.What psychotherapy approach currently has the most empirical support? ›
(2)]: (1) CBT is the most researched form of psychotherapy. (2) No other form of psychotherapy has been shown to be systematically superior to CBT; if there are systematic differences between psychotherapies, they typically favor CBT.What is empirical research used for with psychological treatments? ›
Empirical research in psychology is very important. Firstly, it helps to identify how well-intentioned people, like therapists and police detectives, can elicit inaccurate information.
Psychotherapy, also known as talk therapy, can help those with mental disorders or emotional difficulties. It can lessen symptoms and help individuals function better in their everyday lives.What is considered to be an empirically supported treatment option for depressive disorders? ›
Evidence-based treatments for major depression include: Medication. Cognitive Behavioral Therapy (CBT) Interpersonal Therapy.Why is CBT the most effective therapy? ›
It's often the preferred type of psychotherapy because it can quickly help you identify and cope with specific challenges. It generally requires fewer sessions than other types of therapy and is done in a structured way. CBT is a useful tool to address emotional challenges.Which therapy is the most widely used form of psychotherapy? ›
Common Types Of Therapy: Cognitive Behavioral Therapy (CBT)
Cognitive behavioral therapy, or CBT, is the “most common type of therapy, no doubt,” says Johnsen.
Focusing on empirically supported treatments serves as a quality control system for the field of Psychology, and protects it from becoming “watered down” by treatment approaches that lack efficacy. By using this system it also becomes less likely that one will make ethical missteps.Why do psychologists use empirical methods? ›
Psychologists use the scientific method to collect, analyze, and interpret evidence. Employing the scientific method allows the scientist to collect empirical data objectively, which adds to the accumulation of scientific knowledge.What is an example of empirical method in psychology? ›
An example of empirical analysis would be if a researcher was interested in finding out whether listening to happy music promotes prosocial behaviour. An experiment could be conducted where one group of the audience is exposed to happy music and the other is not exposed to music at all.What is the most effective psychotherapy for treating mental disorders? ›
Psychotherapy paired with medication is the most effective way to promote recovery. Examples include: Cognitive Behavioral Therapy, Exposure Therapy, Dialectical Behavior Therapy, etc.Which therapy has the highest success rate? ›
1. Inpatient treatment. Inpatient treatment is one of the most effective mental health treatment options available. This type of treatment involves staying in a hospital or other facility where you can receive 24-hour care and supervision.What is the best initial treatment for depression? ›
In general, because of the side effect and safety profile, selective serotonin reuptake inhibitors (SSRIs) are considered to be the first line antidepressants. Other preferred options include tricyclic antidepressants, mirtazapine, bupropion, and venlafaxine.
The kind of psychological treatment that is most commonly used for depression is known as cognitive behavioral therapy (often called “CBT” for short).What kind of psychotherapy is used for depression? ›
Three common types of psychotherapy for the treatment of major depressive disorder and generalized anxiety disorder are cognitive behavioural therapy (CBT), interpersonal therapy, and supportive therapy.