scholarly journals Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Johannes Kopf-Beck ◽  
Petra Zimmermann ◽  
Samy Egli ◽  
Martin Rein ◽  
Nils Kappelmann ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Treatment Response ◽  
Treatment Approach ◽  
Behavioral Therapy ◽  
Antidepressant Medication ◽  
Supportive Therapy ◽  
Cognitive Behavioral ◽  
Schema Therapy ◽  
Clinic Setting ◽  
Day Clinic

Abstract Background Major depressive disorder represents (MDD) a major cause of disability and disease burden. Beside antidepressant medication, psychotherapy is a key approach of treatment. Schema therapy has been shown to be effective in the treatment of psychiatric disorders, especially personality disorders, in a variety of settings and patient groups. Nevertheless, there is no evidence on its effectiveness for MDD in an inpatient nor day clinic setting and little is known about the factors that drive treatment response in such a target group. Methods In the current protocol, we outline OPTIMA (OPtimized Treatment Identification at the MAx Planck Institute): a single-center randomized controlled trial of schema therapy as a treatment approach for MDD in an inpatient and day clinic setting. Over the course of 7 weeks, we compare schema therapy with cognitive behavioral therapy and individual supportive therapy, conducted in individual and group sessions and with no restrictions regarding concurrent antidepressant medication, thus approximating real-life treatment conditions. N = 300 depressed patients are included. All study therapists undergo a specific training and supervision and therapy adherence is assessed. Primary outcome is depressive symptom severity as self-assessment (Beck Depression Inventory-II) and secondary outcomes are clinical ratings of MDD (Montgomery-Asberg Depression Rating Scale), recovery rates after 7 weeks according to the Munich-Composite International Diagnostic Interview, general psychopathology (Brief Symptom Inventory), global functioning (World Health Organization Disability Assessment Schedule), and clinical parameters such as dropout rates. Further parameters on a behavioral, cognitive, psychophysiological, and biological level are measured before, during and after treatment and in 2 follow-up assessments after 6 and 24 months after end of treatment. Discussion To our knowledge, the OPTIMA-Trial is the first to investigate the effectiveness of schema therapy as a treatment approach of MDD, to investigate mechanisms of change, and explore predictors of treatment response in an inpatient and day clinic setting by using such a wide range of parameters. Insights from OPTIMA will allow more integrative approaches of psychotherapy of MDD. Especially, the identification of intervention-specific markers of treatment response can improve evidence-based clinical decision for individualizing treatment. Trial registration Identifier on clinicaltrials.gov: NCT03287362; September, 12, 2017

Supportive Therapy Techniques Part I

2019 ◽  
pp. 179-191
Author(s):  
Brian A. Sharpless
Keyword(s):  
Clinical Practice ◽  
Cognitive Behavioral Therapy ◽  
Treatment Approach ◽  
Behavioral Therapy ◽  
Supportive Therapy ◽  
Cognitive Behavioral ◽  
Adaptive Skills ◽  
Patient Knowledge ◽  
Reality Testing ◽  
Number Of Patients

A number of patients seen in contemporary clinical practice are not appropriate for traditional insight-oriented therapy (i.e., expressive approaches). These may include sicker patients or those who are not interested in exploratory work. Supportive therapy refers to a flexible treatment approach that is intended to be responsive to the particular needs of these patients. Supportive therapy also benefits from the integration of techniques from other orientations (e.g., cognitive-behavioral therapy). After discussing supportive therapy more generally and differentiating it from the expressive approaches, this chapter focuses on two sets of supportive techniques. The first focuses on ways to support and enhance realistic patient self-esteem. The second set consists of techniques used to increase patient knowledge and build adaptive skills (e.g., psychoeducation, reality testing).

scholarly journals The impact of depressive symptoms on response to integrated cognitive behavioral therapy for substance use disorders and intimate partner violence

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Lourah M. Kelly ◽  
Cory A. Crane ◽  
Kristyn Zajac ◽  
Caroline J. Easton
Keyword(s):  
Intimate Partner Violence ◽  
Substance Use ◽  
Depressive Symptoms ◽  
Cognitive Behavioral Therapy ◽  
Treatment Response ◽  
Partner Violence ◽  
Behavioral Therapy ◽  
Intimate Partner ◽  
Cognitive Behavioral ◽  
Content Type

Purpose Past studies demonstrated the efficacy of integrated cognitive-behavioral therapy (CBT) for substance use disorder (SUD) and intimate partner violence (IPV) as well as high rates of depressive symptoms in this population. However, little is known about how depressive symptoms impact treatment outcomes. The authors hypothesized that integrated CBT, but not standard drug counseling (DC), would buffer the negative effects of depressive symptoms on treatment response. Design/methodology/approach A secondary analysis of a randomized trial compared men assigned to 12 weeks of integrated CBT for SUD and IPV (n = 29) to those in DC (n = 34). Findings Most (60%) of the sample reported any depressive symptoms. Controlling for baseline IPV, reporting any depressive symptoms was associated with more positive cocaine screens during treatment. Among men with depressive symptoms, integrated CBT but not DC was associated with fewer positive cocaine screens. Controlling for baseline alcohol variables, integrated CBT and depressive symptoms were each associated with less aggression outside of intimate relationships (family, strangers, etc.) during treatment. For men without depressive symptoms, integrated CBT was associated with less non-IPV aggression compared to DC. Effects were not significant for other substances, IPV, or at follow-up. Research limitations/implications This study found some evidence for differential response to CBT by depressive symptoms on cocaine and aggression at end of treatment, which did not persist three months later. Future studies should explore mechanisms of integrated CBT for SUD and IPV, including mood regulation, on depressive symptoms in real-world samples. Practical implications Integrated CBT buffered depressive symptoms’ impact on cocaine use, yet only improved non-IPV aggression in men without depressive symptoms. Originality/value Although integrated CBT’s efficacy for improving SUD and IPV has been established, moderators of treatment response have not been investigated.

scholarly journals Intraindividual variability in sleep schedule: effects of an internet-based cognitive-behavioral therapy for insomnia program and its relation with symptom remission

SLEEP ◽  
2020 ◽  
Vol 43 (12) ◽  
Author(s):  
Kelly M Shaffer ◽  
Donald Hedeker ◽  
Charles M Morin ◽  
Karen Ingersoll ◽  
Frances Thorndike ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Treatment Response ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Intraindividual Variability ◽  
Insomnia Symptom ◽  
Symptom Remission ◽  
Sleep Schedule ◽  
Post Assessment ◽  
Rising Time

Abstract Study Objectives Sleep schedule consistency is fundamental to cognitive-behavioral therapy for insomnia (CBT-I), although there is limited evidence suggesting whether it predicts treatment response. This analysis tested whether: (1) an Internet-based CBT-I program affects intraindividual variability (IIV) in sleep schedule and (2) sleep schedule IIV predicts insomnia symptom remission. Methods This secondary analysis compares participants (N = 303) randomized to an Internet-based CBT-I program (SHUTi—Sleep Healthy Using the Internet) or Internet-based patient education (PE). Participants reported daily bedtimes and rising times on 10 online sleep diaries collected over 2 weeks at baseline and 9-week post-intervention assessment. Participants completed the Insomnia Severity Index (ISI) at post-assessment and 6-month follow-up; symptom remission was defined by ISI < 8. Mixed effects location scale modeling was used to examine the effect of SHUTi on bedtime and rising time IIV; a novel two-staged analysis examined the effect of bedtime and rising time IIV on insomnia symptom remission. Results At post-assessment, SHUTi participants reported about 30% less bedtime and 32% less rising time variability compared to PE (ps < 0.03). Bedtime and rising time IIV was not independently associated with likelihood of insomnia symptom remission at the subsequent time point (ps > 0.18), nor did sleep schedule IIV moderate treatment response (ps > 0.12). Conclusions Findings demonstrate that an Internet-delivered CBT-I program can effectively increase users’ sleep schedule consistency relative to an educational control. This consistency, however, was not related to treatment outcome when defined by insomnia symptom remission, suggesting that enforcing rigid sleep schedules for patients may not be necessary for treatment success. Clinical Trial Registration NCT00328250

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