BMC Psychiatry | |
Effectiveness of cognitive behavioral group therapy for depression in routine practice | |
Liss Antonsen1  Jens C Thimm1  | |
[1] Helgeland Hospital Trust, Mo i Rana, 8607, Norway | |
关键词: Routine Care; Effectiveness; Depression; Cognitive-Behavioral Group Therapy; | |
Others : 1118275 DOI : 10.1186/s12888-014-0292-x |
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received in 2014-05-30, accepted in 2014-10-10, 发布年份 2014 | |
【 摘 要 】
Background
Previous research has shown that cognitive- behavioral group therapy (group CBT) is an effective treatment for depression. However, the effectiveness of this approach in routine care needs more research. The current study retrospectively examines the outcomes of patients who received group CBT for depression at a psychiatric outpatient clinic between 2003 and 2013.
Methods
Based on patient records, 143 patients were identified as having received the treatment, and 88 patients were included in the outcome analyses. The Beck Depression Inventory (BDI-II) score was the main outcome measure.
Results
The dropout rate was 17.5%. The average BDI-II score decreased from 28.5 to 18.5 from pre-treatment to post-treatment and remained stable at 3-months follow-up. The effect sizes at post-treatment and follow-up were large (d = .97 and d = 1.10, respectively). At post-treatment, 44% of the patients showed a significant improvement in depression, including 30% who recovered; at follow-up, the proportions increased to 57% and 40%, respectively. No predictors of dropout or treatment response were found.
Conclusions
Group CBT for depression can be delivered in routine care settings with good results. However, there are still many patients who drop out or do not benefit from treatment.
【 授权许可】
2014 Thimm and Antonsen; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
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20150206022315356.pdf | 248KB | download |
【 参考文献 】
- [1]Butler AC, Chapman JE, Forman EM, Beck AT: The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev 2006, 26:17-31.
- [2]Cuijpers P, Andersson G, Donker T, van Straten A: Psychological treatment of depression: results of a series of meta-analyses. Nord J Psychiatry 2011, 65:354-364.
- [3]Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A: The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cogn Ther Res 2012, 36:427-440.
- [4]Depression in adults. (CG90). National Institute for Health and Care Excellence, London; 2009.
- [5]Tucker M, Oei TPS: Is group more cost effective than individual cognitive behaviour therapy? The evidence is not solid yet. Behav Cogn Psychother 2007, 35:77-91.
- [6]Vos T, Corry J, Haby MM, Carter R, Andrews G: Cost-effectiveness of cognitive-behavioural therapy and drug interventions for major depression. Aust N Z J Psychiatry 2005, 39:683-692.
- [7]Morrison N: Group cognitive therapy: treatment of choice or suboptimal option? Behav Cogn Psychother 2001, 29:311-332.
- [8]Whitfield G: Group cognitive–behavioural therapy for anxiety and depression. Adv Psychiatr Treat 2010, 16:219-227.
- [9]McDermut W, Miller IW, Brown RA: The efficacy of group psychotherapy for depression: a meta-analysis and review of the empirical research. Clin Psychol-Sci Pract 2001, 8:98-116.
- [10]Oei TPS, Dingle G: The effectiveness of group cognitive behaviour therapy for unipolar depressive disorders. J Affect Disord 2008, 107:5-21.
- [11]Wampold BE, Minami T, Baskin TW, Callen Tierney S: A meta-(re)analysis of the effects of cognitive therapy versus ‘other therapies’ for depression. J Affect Disord 2002, 68:159-165.
- [12]Huntley AL, Araya R, Salisbury C: Group psychological therapies for depression in the community: systematic review and meta-analysis. Br J Psychiatry 2012, 200:184-190.
- [13]Cuijpers P, van Straten A, Warmerdam L: Are individual and group treatments equally effective in the treatment of depression in adults? A meta-analysis. Eur J Psychiatry 2008, 22:38-51.
- [14]Okumura Y, Ichikura K: Efficacy and acceptability of group cognitive behavioral therapy for depression: a systematic review and meta-analysis. J Affect Disord 2014, 164:155-164.
- [15]Roth A, Fonagy P: What works for whom: A critical review of psychotherapy research. Guilford, New York; 2005.
- [16]Zwarenstein M, Treweek S, Gagnier JJ, Altman DG, Tunis S, Haynes B, Oxman AD, Moher D: Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ 2008, 337:a2390.
- [17]Garfield SL: Some problems associated with “validated” forms of psychotherapy. Clin Psychol: Sci Pract 1996, 3:218-229.
- [18]Westen D, Morrison K: A multidimensional meta analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. J Consult Clin Psychol 2001, 69:875-899.
- [19]Westen D, Novotny CA, Thompson-Brenner H: The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychol Bull 2004, 130:631-663.
- [20]Zimmerman M, Chelminski I, Posternak MA: Generalizability of antidepressant efficacy trials: differences between depressed psychiatric outpatients who would or would not qualify for an efficacy trial. Am J Psychiatry 2005, 162:1370-1372.
- [21]Schindler AC, Hiller W, Witthoft M: Benchmarking of cognitive-behavioral therapy for depression in efficacy and effectiveness studies: how do exclusion criteria affect treatment outcome? Psychother Res 2011, 21:644-657.
- [22]Stirman SW, DeRubeis RJ, Crits-Christoph P, Rothman A: Can the randomized controlled trial literature generalize to nonrandomized patients? J Consult Clin Psychol 2005, 73:127-135.
- [23]van der Lem R, de Wever WWH, van der Wee NJA, van Veen T, Cuijpers P, Zitman FG: The generalizability of psychotherapy efficacy trials in major depressive disorder: an analysis of the influence of patient selection in efficacy trials on symptom outcome in daily practice. BMC Psychiatry 2012, 12:192. BioMed Central Full Text
- [24]Hans E, Hiller W: Effectiveness of and dropout from outpatient cognitive behavioral therapy for adult unipolar depression: a meta-analysis of nonrandomized effectiveness studies. J Consult Clin Psychol 2013, 81:75-88.
- [25]Cuijpers P, van Straten A, Bohlmeijer E, Hollon SD, Andersson G: The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychol Med 2010, 40:211-223.
- [26]Merrill KA, Tolbert VE, Wade WA: Effectiveness of cognitive therapy for depression in a community mental health center: a benchmarking study. J Consult Clin Psychol 2003, 71:404.
- [27]Westbrook D, Kirk J: The clinical effectiveness of cognitive behaviour therapy: outcome for a large sample of adults treated in routine practice. Behav Res Ther 2005, 43:1243-1261.
- [28]Shadish WR, Matt GE, Navarro AM, Siegle G, Crits-Christoph P, Hazelrigg MD, Jorm AF, Lyons LC, Nietzel MT, Prout HT, Robinson L, Smith ML, Svartberg M, Weiss B: Evidence that therapy works in clinically representative conditions. J Consult Clin Psychol 1997, 65:355-365.
- [29]Shadish WR, Navarro AM, Matt GE, Phillips G: The effects of psychological therapies under clinically representative conditions: a meta-analysis. Psychol Bull 2000, 126:512-529.
- [30]Beck AT, Rush AJ, Shaw BF, Emery G: Cognitive therapy of depression. Guilford, New York; 1979.
- [31]Beck AT, Steer RA, Brown GK: Manual for the Beck Depression Inventory-II. Psychological Corporation, San Antonio, TX; 1996.
- [32]Dahl AA, Kruger MB, Dahl NH, Karlsson H, Von Knorring L, Stordal E: SPIFA: a presentation of the Structured Psychiatric Interview for General Practice. Nord J Psychiatry 2009, 63:443-453.
- [33]Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998, 59:22-33.
- [34]Hagen R, Gråwe RW: Mestring av depresjon: manual. Tapir akademisk forl, Trondheim; 2006.
- [35]Aasen H: An empirical investigation of depression symptoms: norms, psychometric characteristics and factor structure of the Beck Depression Inventory-II. Main thesis.. University of Bergen, Department of Psychology, Bergen; 2001.
- [36]Beck AT, Brown G, Epstein N, Steer RA: An inventory for measuring clinical anxiety - psychometric properties. J Consult Clin Psychol 1988, 56:893-897.
- [37]Nordhagen T: Beck Anxiety Inventory: translation and validation of a Norwegian version. Main thesis.. University of Bergen, Department of Psychology, Bergen; 2001.
- [38]Gueorguieva R, Krystal JH: Move over anova: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Arch Gen Psychiatry 2004, 61:310-317.
- [39]West BT: Analyzing longitudinal data with the linear mixed models procedure in SPSS. Eval Health Prof 2009, 32:207-228.
- [40]Schlomer GL, Bauman S, Card NA: Best practices for missing data management in counseling psychology. J Couns Psychol 2010, 57:1-10.
- [41]Sterne JAC, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, Wood AM, Carpenter JR: Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ 2009, 339:157-160.
- [42]Little RJA: A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc 1988, 83:1198-1202.
- [43]Schafer JL, Graham JW: Missing data: our view of the state of the art. Psychol Methods 2002, 7:147.
- [44]IBM SPSS Missing Values 20. IBM Cooperation, New York; 2011.
- [45]Jacobson NS, Truax P: Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991, 59:12-19.
- [46]Bauer S, Lambert MJ, Nielsen SL: Clinical significance methods: a comparison of statistical techniques. J Pers Assess 2004, 82:60-70.
- [47]Seggar LB, Lambert MJ, Hansen NB: Assessing clinical significance: application to the Beck Depression Inventory. Behav Ther 2002, 33:253-269.
- [48]Cohen J: Statistical power analysis for the behavioral sciences. Laurence Erlbaum, Hillsdale, N. J.; 1988.
- [49]Hiller W, Schindler AC, Lambert MJ: Defining response and remission in psychotherapy research: a comparison of the RCI and the method of percent improvement. Psychother Res 2012, 22:1-11.
- [50]Teri L, Lewinsohn PM: Individual and group treatment of unipolar depression: comparison of treatment outcome and identification of predictors of successful treatment outcome. Behav Ther 1986, 17:215-228.
- [51]Neimeyer RA, Kazantzis N, Kassler DM, Baker KD, Fletcher R: Group cognitive behavioural therapy for depression outcomes predicted by willingness to engage in homework, compliance with homework, and cognitive restructuring skill acquisition. Cogn Behav Ther 2008, 37:199-215.
- [52]van der Lem R, van der Wee NJA, van Veen T, Zitman FG: Efficacy versus effectiveness: a direct comparison of the outcome of treatment for mild to moderate depression in randomized controlled trials and daily practice. Psychother Psychosom 2012, 81:226-234.
- [53]Keitner GI, Ryan CE, Solomon DA: Realistic expectations and a disease management model for depressed patients with persistent symptoms. J Clin Psychiatry 2006, 67:1412-1421.
- [54]Peeters F, Huibers M, Roelofs J, van Breukelen G, Hollon SD, Markowitz JC, van Os J, Arntz A: The clinical effectiveness of evidence-based interventions for depression: a pragmatic trial in routine practice. J Affect Disord 2013, 145:349-355.
- [55]Fournier JC, DeRubeis RJ, Shelton RC, Hollon SD, Amsterdam JD, Gallop R: Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression. J Consult Clin Psychol 2009, 77:775.
- [56]Schindler A, Hiller W, Witthöft M: What predicts outcome, response, and drop-out in CBT of depressive Adults? A naturalistic Study. Behav Cogn Psychother 2013, 41:365-370.
- [57]Organista KC, Muñoz RF, González G: Cognitive-behavioral therapy for depression in low-income and minority medical outpatients: description of a program and exploratory analyses. Cogn Ther Res 1994, 18:241-259.
- [58]Oei TP, Kazmierczak T: Factors associated with dropout in a group cognitive behaviour therapy for mood disorders. Behav Res Ther 1997, 35:1025-1030.
- [59]Arnow BA, Blasey C, Manber R, Constantino MJ, Markowitz JC, Klein DN, Thase ME, Kocsis JH, Rush AJ: Dropouts versus completers among chronically depressed outpatients. J Affect Disord 2007, 97:197-202.
- [60]Bagby RM, Quilty LC, Segal ZV, McBride CC, Kennedy SH, Costa PT Jr: Personality and differential treatment response in major depression: a randomized controlled trial comparing cognitive-behavioural therapy and pharmacotherapy. Can J Psychiatry Revue Can de Psychiatr 2008, 53:361.
- [61]Newton-Howes G, Tyrer P, Johnson T, Mulder R, Kool S, Dekker J, Schoevers R: Influence of personality on the outcome of treatment in depression: systematic review and meta-analysis.J Pers Disord in press
- [62]Reis S, Grenyer BF: Fearful attachment, working alliance and treatment response for individuals with major depression. Clin Psychol Psychother 2004, 11:414-424.
- [63]Walfish S, McAlister B, O’Donnell P, Lambert MJ: An investigation of self-assessment bias in mental health providers. Psychol Rep 2012, 110:639-644.
- [64]Knaup C, Koesters M, Schoefer D, Becker T, Puschner B: Effect of feedback of treatment outcome in specialist mental healthcare: meta-analysis. Br J Psychiatry 2009, 195:15-22.
- [65]Renaud J, Russell JJ, Myhr G: Predicting who benefits most from cognitive‐behavioral therapy for anxiety and depression.J Clin Psychol in press
- [66]Segal ZV, Williams M, Teasdale JD, Kabat-Zinn J: Mindfulness-based cognitive therapy for depression. Guilford Press, New York; 2013.
- [67]Wells A: Metacognitive therapy for anxiety and depression. Guilford Press, New York; 2009.
- [68]Lambert M: Presidential address: what we have learned from a decade of research aimed at improving psychotherapy outcome in routine care. Psychother Res 2007, 17:1-14.
- [69]Howard KI, Lueger RJ, Maling MS, Martinovich Z: A phase model of psychotherapy outcome: causal mediation of change. J Consult Clin Psychol 1993, 61:678-685.