Dyadic Discord and Acute Phase Cognitive Therapy Outcomes in Recurrent MDD

Dyadic discord may not be associated with a response to treatment, but might positively affect the levels of depressive symptoms at the end of the acute phase of cognitive therapy, according to an article published in Behavior Therapy.

The study analyzed a total of 219 married or cohabiting patients who were diagnosed with recurrent major depressive disorder, using a Structured Clinical Interview from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition at the initial evaluation. In the acute phase of cognitive therapy, patients participated in sessions twice weekly for 4 weeks. Early responders after these 8 sessions were identified and continued with 1 session/week for 8 weeks (16 total sessions). Late responders continued with 2 sessions/week for 4 weeks followed by 1 session/week for 4 weeks (20 total sessions). The severity of the depression was measured using the Hamilton Rating Scale for Depression, Beck Depression Inventory, and self-reporting Inventory of Depressive Symptomatology. Dyadic discord was measured using the Dyadic Adjustment Scale before and after the treatment. If the patients missed no more than 2 cognitive therapy sessions in 16 or 20 session protocol in the acute phase, then cognitive therapy was deemed complete. The investigators defined the acute phase response as no longer meeting the criteria for major depressive episode and having a final acute phase Hamilton Rating score of ≤12.

The results of the study show that dyadic discord is associated with some of the cognitive therapy outcomes but not all of them. There was no association between pretreatment dyadic discord and completion of cognitive therapy (beta=0.008, standard error [SE]=0.008, P =.32). Similarly, pretreatment dyadic discord was not associated with the response to cognitive therapy (beta=-0.007, SE=0.006, P =.22). However, it was associated with more depressive symptoms post cognitive therapy (beta=0.114, SE=0.043, P =.01, r=0.19). The data also show that dyadic discord does significantly decrease during cognitive therapy (F [2410]=35.56; P <.001). It was also observed that 23.3% of initially discordant couples moved to no discordant status at the end of cognitive therapy and depressive symptoms did not mediate dyadic discord.

One important limitation of this study is the lack of a control group, due to which the authors are unable to make causal claims that cognitive therapy solely caused or improved depressive symptoms or reduced dyadic discord. Another limitation is that the study did not include partnerships in which the couple was dating, but not cohabiting. The authors also indicate that the majority of the therapists and patients were Caucasian and there was no record of the mental status of the partner and their perception of the dyadic discord.

Study researchers conclude that the current study contributes to the understanding of dyadic discord’s role in cognitive therapy treatment. Future research is needed to evaluate the extent to which cognitive therapy could be enhanced by including the partner as a coach during cognitive therapy.

Please see the original reference for a full list of authors’ disclosures.

Reference
Trombello JM, Vittengl JR, Denton WH, Minhajuddin A, Thase ME, Jarrett RB. The role of dyadic discord in outcomes in acute phase cognitive therapy for adults with recurrent major depressive disorder [published online December 6, 2019]. Behav Ther. doi: 10.1016/j.beth.2018.11.006