Posted by Phillipa on August 4, 2011, at 23:32:15
This form of CBT focuses on repetitive thoughts concerning symptoms, meds, depression interesting new way to use CBT. Phillipa
From Medscape Medical News > Psychiatry
CBT Cuts Relapse Rates in Persistent Depression
Deborah BrauserAuthors and Disclosures
August 3, 2011 Adding rumination-focused cognitive behavior therapy (CBT) to standard treatment can decrease persistent depression, new research suggests.
In a phase 2 randomized controlled trial (RCT) of 42 patients with residual depression, those receiving up to 12 sessions of the combined therapy showed significantly improved symptoms, increased remission rates, and decreased relapse rates compared with those receiving treatment as usual (TAU) only.
"The key messages are that rumination might be a maintaining factor in residual depression and that adding a psychological treatment for rumination to antidepressant medication produces significant improvements in this hard-to-treat group," lead study author Edward R. Watkins, PhD, professor of Experimental and Applied Clinical Psychology and cofounder of the Mood Disorders Center at the University of Exeter, United Kingdom, told Medscape Medical News.
The investigators note that this is the first RCT to show benefits of rumination-focused CBT in this patient population.
However, they write that it "lacked an attentional control group so cannot test whether the effects were as a result of the specific content of rumination-based CBT vs nonspecific therapy effects."
The study was published online July 21 in the British Journal of Psychiatry.
Room for Improvement
"About 20% of major depressive episodes become chronic and medication refractory and also appear to be less responsive to standard CBT," the investigators write.
"Our combined psychological and pharmacological treatments for residual depression need improvement. Whilst there is considerable evidence about the impact of rumination in the course of depression, to date, there had been no studies directly attempting to target it," added Dr. Watkins.
For this study, 42 outpatients in England older than 18 years diagnosed as having residual depression were randomized to receive either rumination-focused CBT plus TAU (n = 21; 67% female; 95% white; mean age, 43 years ) or TAU alone (n = 21; 48% female; 95% white; mean age, 45 years). All participants were evaluated at baseline and 6 months later.
Depressive rumination was defined as "repetitive thinking about the causes, meanings, and implications of depressed feelings, symptoms, problems, and upsetting events." Rumination-focused CBT is designed to shift these negative thoughts to constructive rumination. It differs from standard CBT because it focuses on directly modifying the process of thinking.
"TAU consisted of ongoing maintenance antidepressant medication and outpatient clinical management," the study authors write.
The primary outcome measure was a significant lowering of residual depressive symptom severity, as shown with a 50% or more decrease in baseline score on the Hamilton Depression Rating Scale for Depression (HRSD).
Secondary outcomes included changes in self-reported rumination, number of comorbid psychiatric disorders, and number of patients in remission (an HRSD score <8 and Beck Depression Inventory [BDI] score of <9 at the end of the study) and/or relapse.
Greater Treatment Response
Results showed significantly fewer residual depressive symptoms in the group receiving rumination-focused CBT compared with the TAU group on both the BDI (P = .002) and the HRSD (P = .009).
In addition, this group showed a significantly greater rate of treatment response (81% vs 26%, P < .001) and remission (62% vs 21%, P < .05), lower rates of relapse (9.5% vs 53%, P < .010), and less comorbid Axis II diagnoses (P = .02). There was also a nonsignificant trend for fewer comorbid Axis I disorders (P = .068).
"Our findings are encouraging as they suggest that focusing on 1 aspect of residual depression rumination in addition to ongoing antidepressant medication, may yield improvement in depressive symptoms in a medication-refractory group," write the investigators.
"Nonetheless, as the first exploratory trial, there is a need for further RCTs to replicate these findings in other settings based on the extant effect sizes observed in this study and to examine cost-effectiveness in a fully powered phase 3 trial."
Dr. Watkins reported that his team now want "to better understand the mechanisms by which the treatment might work through both experimental and dismantling studies," in addition to examining the other modalities of therapy delivery.
"We are currently conducting studies looking at an Internet-based version of the intervention in adolescents and young adults, in collaboration with colleagues in Amsterdam. These studies also provide the opportunity to examine the efficacy of the treatment approach in a large-scale trial," he said.
The study was funded by a Young Investigators Grant to Dr. Watkins from the National Alliance for Research into Schizophrenia and Depression. The study authors have disclosed no relevant financial relationships.
Br J Psychiatry. Published online July 21, 2011
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