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BackgroundSuicidal ideation (SI) is common in chronic depression, but only limited evidence exists for the assumption that psychological treatments for depression are effective for reducing SI. Methods In the present study, the effects of Mindfulness-based Cognitive Therapy (MBCT; group version) plus treatment-as-usual (TAU: individual treatment by either a psychiatrist or a licensed psychotherapist, including medication when indicated) and Cognitive Behavioral Analysis System of Psychotherapy (CBASP; group version) plus TAU on SI was compared to TAU alone in a prospective, bi-center, randomized controlled trial. The sample consisted of 106 outpatients with chronic depression. Results Multivariate regression analyses revealed different results, depending on whether SI was assessed via self-report (Beck Depression Inventory suicide item) or via clinician rating (Hamilton Depression Rating Scale suicide item). Whereas significant reduction of SI emerged when assessed via clinician rating in the MBCT and CBASP group, but not in the TAU group while controlling for changes in depression, there was no significant effect of treatment on SI when assessed via self-report. Limitations SI was measured with only two single items. Conclusions Because all effects were of small to medium size and were independent of effects from other depression symptoms, the present results warrant the application of such psychotherapeutical treatment strategies like MBCT and CBASP for SI in patients with chronic depression.
Identifying effective and sustainable treatments for chronic depression is a key issue in current psychiatric research. However, there are only very few psychotherapy studies that report follow-up effects. For the only specific psychological approach to the treatment of chronic depression, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), preliminary follow-up studies [2-4] showed promising results. For Mindfulness-Based Cognitive Therapy (MBCT) for treatment-resistant depression, there is only one follow-up study . Up to now, no results comparing follow-up data between MBCT and CBASP have been available. The present study investigated the follow-up of a randomized controlled trial comparing CBASP and MBCT (both applied in a group format) with treatment-as-usual (TAU) in patients with chronic depression. In addition, the moderating role of childhood adversities on outcomes was explored.
The Article by Willem Kuyken and colleagues1 about the effectiveness of mindfulness-based cognitive therapy (MBCT) in prevention of depressive relapses is highly relevant for clinical practice and justifies MBCT as a clinically relevant alternative to maintenance antidepressant medication. We speculate that the design of the study might have biased the results against even stronger measurable effects of MBCT. In the study, general practitioners were recommended to start medication tapering after week 6 of MBCT—so tapering and MBCT treatment obviously overlapped to some extent. Since evidence is accumulating that withdrawal symptoms after discontinuation of selective serotonin reuptake inhibitors (SSRIs) are more detrimental and prolonged than assumed (up to 1 year),2 we suggest that the discontinuation process might have interfered with the therapeutic effects of MBCT. In a systematic review,2 gradual tapering did not eliminate withdrawal reactions. We do not know what the predominant class of medication was in the study by Kuyken and colleagues,1 but it seems likely that SSRIs were involved to a large extent. Thus, we argue that, by consecutively undertaking medication tapering followed by a longer washout period before starting MBCT, even stronger effects of MBCT might be observed. In other studies, responders to cognitive behavioral therapy showed relapse rates of 39% in the 68 weeks after psychotherapy and 68% after discontinuation of medication;3 therefore, the discontinuation syndrome might explain the relatively high relapse rate of 44% in Kuyken and colleagues' study of MBCT.
Objective: Mindfulness-based cognitive therapy (MBCT) has recently been proposed as a treatment option for chronic depression. The cognitive behavioral analysis system of psychotherapy (CBASP) is the only approach specifically developed to date for the treatment of chronically depressed patients. The efficacy of MBCT plus treatment-as-usual (TAU), and CBASP (group version) plus TAU, was compared to TAU alone in a prospective, bicenter, randomized controlled trial. Method: One hundred and six patients with a current DSM–IV defined major depressive episode and persistent depressive symptoms for more than 2 years were randomized to TAU only (N = 35), or to TAU with additional 8-week group therapy of either 8 sessions of MBCT (n = 36) or CBASP (n = 35). The primary outcome measure was the Hamilton Depression Rating Scale (24-item HAM-D, Hamilton, 1967) at the end of treatment. Secondary outcome measures were the Beck Depression Inventory (BDI; Beck, Steer, & Brown, 1996) and measures of social functioning and quality of life. Results: In the overall sample as well as at 1 treatment site, MBCT was no more effective than TAU in reducing depressive symptoms, although it was significantly superior to TAU at the other treatment site. CBASP was significantly more effective than TAU in reducing depressive symptoms in the overall sample and at both treatment sites. Both treatments had only small to medium effects on social functioning and quality of life. Conclusions: Further studies should inquire whether the superiority of CBASP in this trial might be explained by the more active, problem-solving, and interpersonal focus of CBASP.
ObjectiveTo capture any sleep quality changes associated with group psychotherapy. Patients/methods Physician-referred, chronically depressed patients (n = 25) were randomized to either eight group sessions of Mindfulness-based Cognitive Therapy (MBCT, n = 9) plus Treatment As Usual (TAU), or the Cognitive Behavioral Analysis System of Psychotherapy (CBASP, n = 8) plus TAU, or to TAU only (control group, n = 8). Participants recorded their sleep at home. The primary outcome variables were: stable and unstable sleep, which were assessed using cardiopulmonary coupling (CPC) analysis, and estimated total sleep and wake time (minutes). Cardiopulmonary coupling measures heart rate variability and the electrocardiogram's R-wave amplitude fluctuations associated with respiration. Results By post-treatment night 6, the CBASP group had more stable sleep (p = 0.044) and less wake (p = 0.004) compared with TAU, and less wake vs MBCT (p = 0.039). Conclusion The CBASP group psychotherapy treatment improved sleep quality compared with Treatment As Usual.