When 2 brief psychotherapy models—Cognitive Behavioral Therapy (CBT) and Short-Term Psychodynamic Psychotherapy (STPP)—were compared with treatment as usual in patients with major depressive disorder (MDD), long-term maintenance of functional capacity was shown to depend not only on the intervention but also on the patient’s education level, work situation, and severity of the depressive symptoms at the initiation of the treatment.
The randomized clinical trial, published in Psychiatry Research, was conducted among adult patients who sought psychotherapeutic treatment at the Mental Health Research and Extension Clinic of the Catholic University of Pelotas in Brazil. Patients between 18 and 60 years of age who were diagnosed with MDD and had not received psychotherapeutic or pharmacologic treatment elsewhere for ≥2 months were eligible for participation. Over the course of a 3-year follow-up period, the investigators sought to compare the intervention model groups (CBT and STPP) with a naturalistic control group who received treatment as usual. All interventions occurred in 50-minute sessions once weekly for 14 to 16 weeks.
A total of 75 outpatients (median age, 33 years; 82.7% women) were enrolled in the study and stratified into 3 groups: TAU (n=35), STPP (n=20), and CBT (n=20). Therapeutic responses in terms of depressive symptom improvement were maintained 3 years after the brief models of psychotherapy stopped being used. After 3 years, participants who responded to treatment had significantly lower Beck Depression Inventory (P <.001) and Functional Assessment Short Test (P =.025) scores compared with those in the treatment-as-usual group. Moreover, educational level (P =.017), severity of depressive symptoms at baseline (P <.001), and exposure to treatment (P =.029) all had an effect on the severity of depressive symptoms during the 3-year follow-up. However, there were no notable differences between the 2 intervention groups, CBT and STPP.
The study was limited by a high dropout rate, although some patients who dropped out were included in the treatment-as-usual group, which cannot be considered randomized as a result. The investigators concluded that additional studies are warranted to further explore whether these brief treatments, which proved effective after 3 years compared with the usual treatment, would maintain their effectiveness if the participants were followed for longer periods.
dos Santos ÉN, Molina ML, Mondin T, et al. Long-term effectiveness of two models of brief psychotherapy for depression: a three-year follow-up randomized clinical trial. Psychiatry Res. 2020:112804. doi: 10.1016/j.psychres.2020.112804