Moderation of the Alliance-Outcome Association by Prior Depressive Episodes: Differential Effects in Cognitive-Behavioral Therapy and Short-Term Psychodynamic Supportive Psychotherapy.

Prior studies have suggested that the association between the alliance and depression improvement varies as a function of prior history of depression. We sought to replicate these findings and extend them to short-term psychodynamic supportive psychotherapy (SPSP) in a sample of patients who were randomized to one of these treatments and were administered the Helping Alliance Questionnaire (N=282) at Week 5 of treatment. Overall, the alliance was a predictor of symptom change (d=0.

Therapist-rated outcomes in a randomized clinical trial comparing cognitive behavioral therapy and psychodynamic therapy for major depression.

Background: The efficacy of psychodynamic therapy (PDT) for depression is debated due to a paucity of high-quality studies. We compared short psychodynamic supportive psychotherapy (SPSP) to cognitive behavioral therapy (CBT) in a randomized clinical trial. We used therapist-rated outcomes to examine how the course of change during treatment could be best represented and to compare treatment efficacy, hypothesizing non-significant differences.

Is the alliance always a predictor of change in psychotherapy for depression?

Objective: Although without a doubt alliance has a consistent impact on outcome, to date it remains unclear whether alliance directly accounts for symptom change.

Method: Using data from a randomized clinical trial, the alliance-outcome timeline was analyzed. The Relationship factor of the Helping Alliance Questionnaire I (measured twice, middle and late during treatment) was used.

The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: a randomized clinical trial.

Objective: The efficacy of psychodynamic therapies for depression remains open to debate because of a paucity of high-quality studies. The authors compared the efficacy of psychodynamic therapy with that of cognitive-behavioral therapy (CBT), hypothesizing nonsignificant differences and the noninferiority of psychodynamic therapy relative to CBT.

Method: A total of 341 adults who met DSM-IV criteria for a major depressive episode and had Hamilton Depression Rating Scale (HAM-D) scores ≥14 were randomly assigned to 16 sessions of individual manualized CBT or short-term psychodynamic supportive therapy.

What is the best sequential treatment strategy in the treatment of depression? Adding pharmacotherapy to psychotherapy or vice versa?

Background: Insufficient response to monotreatment for depression is a common phenomenon in clinical practice. Even so, evidence indicating how to proceed in such cases is sparse.

Methods: This study looks at the second phase of a sequential treatment algorithm, in which 103 outpatients with moderately severe depression were initially randomized to either short-term supportive psychodynamic therapy (PDT) or antidepressants.

Psychometric properties of the Helping Alliance Questionnaire-I in psychodynamic psychotherapy for major depression.

The psychometric properties of the Helping Alliance Questionnaire-I were analyzed at two times in short-term psychoanalytic supportive psychotherapy for outpatient depression. Exploratory factor analysis conducted in 142 patients generated a model that was confirmed in a different validation sample (n=106) using confirmatory factor analysis. Two factors were found to have satisfactory psychometric properties and a consistent structure over time: relationship and internal change.

Patient preference compared with random allocation in short-term psychodynamic supportive psychotherapy with indicated addition of pharmacotherapy for depression.

Depressed patients randomized to psychotherapy were compared with those who had been chosen for psychotherapy in a treatment algorithm, including addition of an antidepressant in case of early nonresponse. There were no differences between randomized and by-preference patients at baseline in adherence and outcome. About half of the early nonresponders refused the additional medication.

Predictive value of object relations for therapeutic alliance and outcome in psychotherapy for depression: an exploratory study.

The concept of object relations has been shown to be relevant for the process and outcome of psychodynamic psychotherapies. However, little is known about its relevance for the psychotherapeutic treatment of depression. In this study, we explored the predictive value of object relational functioning (ORF) for the therapeutic alliance and outcome of short-term psychodynamic supportive psychotherapy in patients with mild to moderately severe depression.

Cognitive Behavioral Therapy versus Short Psychodynamic Supportive Psychotherapy in the outpatient treatment of depression: a randomized controlled trial.

Background: Previous research has shown that Short Psychodynamic Supportive Psychotherapy (SPSP) is an effective alternative to pharmacotherapy and combined treatment (SPSP and pharmacotherapy) in the treatment of depressed outpatients. The question remains, however, how Short Psychodynamic Supportive Psychotherapy compares with other established psychotherapy methods. The present study compares Short Psychodynamic Supportive Psychotherapy to the evidence-based Cognitive Behavioral Therapy in terms of acceptability, feasibility, and efficacy in the outpatient treatment of depression.

Short psychodynamic supportive psychotherapy, antidepressants, and their combination in the treatment of major depression: a mega-analysis based on three randomized clinical trials.

The efficacy of Short Psychodynamic Supportive Psychotherapy (SPSP) has not yet been compared with pharmacotherapy. A mega-analysis based on three original Randomized Clinical Trials (RCTs) was performed. Patients with (mild to moderate) major depressive disorder were randomized in (24 weeks) SPSP (n = 97), pharmacotherapy (n = 45), or their combination (n = 171).

Does early response predict outcome in psychotherapy and combined therapy for major depression?

Background: To examine the predictive value of early response for final outcome of psychotherapy and combined therapy in major depression.

Methods: Mild- to moderately depressed patients were treated with either Short-Term Psychodynamic Supportive Psychotherapy (SPSP) (N=63) only, or combined with an antidepressant (N=127). Early response was defined as a reduction of more than 25% on the HAM-D-17 after 2 months.

Does adding psychotherapy to pharmacotherapy improve social functioning in the treatment of outpatient depression?

The existence of an overall association between severity of depression and level of social functioning is well documented. To increase the probability of a long-term recovery, a normal level of social functioning is essential. It is currently unknown whether combined therapy has a better outcome than pharmacotherapy with regard to social functioning.