Effectiveness of Schema Therapy versus Cognitive Behavioral Therapy versus Supportive Therapy for Depression in Inpatient and Day Clinic Settings: A Randomized Clinical Trial.

IF 16.3 1区 医学 Q1 PSYCHIATRY Psychotherapy and Psychosomatics Pub Date : 2024-01-01 Epub Date: 2024-01-04 DOI:10.1159/000535492
Johannes Kopf-Beck, Celina L Müller, Jeanette Tamm, Julia Fietz, Nils Rek, Leah Just, Zoe Ilona Spock, Katharina Weweck, Keisuke Takano, Martin Rein, Martin E Keck, Samy Egli
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Abstract

Introduction: Schema therapy (ST) reduces depressive symptoms, but clinical trials have not investigated its effectiveness for patients suffering from severe forms of depression and high rates of comorbidities. There is high demand for exploring and improving treatments for this patient group. The objective of the current study was to evaluate whether ST is more effective than individual supportive therapy (IST) and noninferior compared with cognitive behavioral therapy (CBT) in treating depression.

Methods: For this clinical trial, medicated patients were recruited in inpatient and day clinic settings. The major inclusion criteria were age between 18 and 75 years and primary diagnosis of depression without psychotic symptoms. A total of 292 participants were randomized to ST, CBT, or IST and received 7 weeks of psychotherapy (up to 14 individual and 14 group sessions). The primary outcome was change in depression severity after treatment measured by Beck Depression Inventory-II. Primary test for efficacy was superiority of ST over IST. Secondary test was noninferiority of ST compared with CBT. Multilevel modeling was conducted. The results at 6-month follow-up were explored.

Results: Across treatment, ST was not superior to IST. Secondary outcome analyses and completer analyses showed similar results. However, ST showed clinically relevant noninferiority compared with CBT.

Conclusion: ST for depression as part of a psychiatric care program showed clinical noninferiority compared to CBT, without being superior to IST. ST represents a potentially useful addition to the therapeutic repertoire for the treatment of depression but its efficacy, including long-term efficacy, should be evaluated further.

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住院和日间诊所抑郁症患者接受模式疗法与认知行为疗法和支持疗法的疗效对比:随机临床试验
简介模式疗法(ST)可减轻抑郁症状,但临床试验尚未研究其对严重抑郁症和高合并症患者的疗效。针对这一患者群体,探索和改进治疗方法的需求很高。本研究的目的是评估 ST 在治疗抑郁症方面是否比个体支持疗法(IST)更有效,以及与认知行为疗法(CBT)相比是否不具劣势:这项临床试验招募了住院和日间诊所的药物治疗患者。主要纳入标准为年龄在 18 岁至 75 岁之间,主要诊断为无精神病症状的抑郁症。共有 292 名参与者被随机分配到 ST、CBT 或 IST,并接受了为期 7 周的心理治疗(最多 14 次个人治疗和 14 次小组治疗)。主要结果是治疗后抑郁严重程度的变化,由贝克抑郁量表-II测量。主要疗效检验是 ST 优于 IST。次要检验是 ST 与 CBT 相比的非劣效性。进行了多层次建模。结果:结果:在所有治疗中,ST 并不优于 IST。次要结果分析和完成者分析显示了相似的结果。然而,与 CBT 相比,ST 显示出临床相关的非劣势:作为精神病治疗项目的一部分,ST治疗抑郁症的临床效果不优于CBT,但也不优于IST。ST是对抑郁症治疗的一种潜在有益补充,但其疗效(包括长期疗效)仍有待进一步评估。
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来源期刊
Psychotherapy and Psychosomatics
Psychotherapy and Psychosomatics 医学-精神病学
CiteScore
29.40
自引率
6.10%
发文量
46
期刊介绍: Psychotherapy and Psychosomatics is a reputable journal that has been published since 1953. Over the years, it has gained recognition for its independence, originality, and methodological rigor. The journal has been at the forefront of research in psychosomatic medicine, psychotherapy research, and psychopharmacology, and has contributed to the development of new lines of research in these areas. It is now ranked among the world's most cited journals in the field. As the official journal of the International College of Psychosomatic Medicine and the World Federation for Psychotherapy, Psychotherapy and Psychosomatics serves as a platform for discussing current and controversial issues and showcasing innovations in assessment and treatment. It offers a unique forum for cutting-edge thinking at the intersection of medical and behavioral sciences, catering to both practicing clinicians and researchers. The journal is indexed in various databases and platforms such as PubMed, MEDLINE, Web of Science, Science Citation Index, Social Sciences Citation Index, Science Citation Index Expanded, BIOSIS Previews, Google Scholar, Academic Search, and Health Research Premium Collection, among others.
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