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CBT or Psychodynamic Psychotherapy for Depressed Outpatients?

Summary and Comment |
September 6, 2013

CBT or Psychodynamic Psychotherapy for Depressed Outpatients?

  1. Joel Yager, MD

After 16 sessions, depression in less than one fourth of patients remitted, and no differences were seen between treatments.

  1. Joel Yager, MD

Debate about the relative merits of cognitive-behavioral therapy (CBT) and psychodynamic psychotherapy for major depression is ongoing, but few studies have compared the therapies directly. In an industry-supported study, investigators randomized 341 unmedicated adults with unipolar major depression seen in Dutch psychiatric clinics to CBT or short-term psychodynamic supportive psychotherapy (16 sessions within 22 weeks).

Participants were not currently misusing substances. Approximately half of the group had experienced two or more previous episodes of depression, nearly half had immigrant backgrounds, and many had low socioeconomic status. Psychodynamic psychotherapy used supportive and insight-oriented techniques to explore emotional issues, current relationships, internalized past relationships, and intrapersonal patterns. In all, 142 patients with severe depression at baseline or during treatment also received antidepressant medications, starting with a venlafaxine protocol.

No significant differences between treatments were found. Dropouts occurred in 31% and 26% of the CBT and psychodynamic psychotherapy groups, respectively. Remission was seen in 24% of CBT patients and 21% of those receiving psychodynamic psychotherapy (response: 39% and 37%, respectively). Medication did not improve outcomes. During the 1-year follow-up, 45% of CBT and 33% of psychodynamic psychotherapy patients received additional treatment; remission was seen in 35% of CBT patients and 27% of psychodynamic psychotherapy patients.

Comment

Several findings bear mention: Treatment groups differed on no outcomes, only 23% of the population remitted during treatment, and 40% sought additional treatment after the trial ended, suggesting that brief, time-limited psychotherapies are insufficient for treating many depressed patients, particularly those with chronic illness and low socioeconomic status. In larger studies, subanalyses of sociodemographic and clinical features might identify populations who could achieve better outcomes with each treatment — and other populations requiring other effective interventions.

  • Disclosures for Joel Yager, MD at time of publication Editorial boards Bulletin of the Menninger Clinic; Eating Disorders: Journal of Treatment and Research; Eating Disorders Review (Editor-in-Chief); Harvard Review of Psychiatry; International Journal of Eating Disorders; UpToDate Leadership positions in professional societies American Psychiatric Association (Chair, Steering Committee and Executive Committee on Practice Guidelines; Co-Chair, DSM5 Clinical and Public Health Committee; Chair, Council on Research and Quality Care)

Citation(s):

Reader Comments (1)

ANNE OCONNOR Other Healthcare Professional, Geriatrics, private practice

It has been my experience that CBT is effective because the patient benefits from understanding the reasons for their behavior. Along with CBT, I use supportive therapy to reinforce the progress or lack of progress the patient is making.

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