Recovery from chronic depression and structural change : 5-year outcomes after psychoanalytic and cognitive-behavioural long-term treatments (LAC depression study)
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Abstract
Objective: Psychotherapy of chronic depression has remained a challenge due to
limited prognosis and high rates of recurrence. We present 5-year outcome data from
a multicentre trial comparing psychoanalytic (PAT) and cognitive-behavioural (CBT)
long-term treatments with randomized and preferred allocations analysing symptom
(N = 227) and structural change (N = 134) trajectories.
Method: Self- and blinded expert ratings of depression symptoms were performed
at yearly intervals using the Beck Depression Inventory-II (BDI-II) and Quick
Inventory of Depressive Symptoms (QIDS-C). Blinded expert ratings of
Operationalized Psychodynamic Diagnosis (OPD) and the Heidelberg Restructuring
Scale (HRS) at baseline, 1, 3, and 5 years assessed structural change in a
subsample.
Results: Lasting and comparable symptom changes were achieved by PAT and
CBT. However, compared to CBT, PAT was more successful in restructuring, a
major goal of long-term psychodynamic treatments with high frequency and
duration.
Limitations: Due to practical reasons, the time criterion for chronic depression of an
acute phase had to be defined for over 1 year in the present study, which does not
correspond to the DSM-5 criterion of 2 years. Therapy duration and session
frequency were not incorporated into the statistical models.
Conclusion: Long-term psychotherapy helps patients with a yearlong history of
depression and often multiple unsuccessful treatment attempts to achieve lasting
symptom changes. Future follow-up will clarify whether restructuring promotes
further sustainable improvements.
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Clinical psychology & psychotherapy, Version of Record (VoR), Wiley, New York, NY u.a., 2022, https://doi.org/10.1002/cpp.2793