Behavioural therapy for treatment resistant depression
09 September 2011
A large trial assessing an adaptation of dialectical behaviour therapy to test its effectiveness in treatment-resistant depression has been funded by the EME programme.
Most depression is treatable, however about one third of patients with major depression respond poorly to current treatments and endure severely disrupted family, social and working life. Psycho-social treatments for chronic and treatment-resistant depression (TRD) are currently limited in effectiveness and understudied. Many TRD and chronically depressed patients suffer from a personality disorder or from problems such as masking inner feelings, perfectionism, aloof/distant relationships, rigidity, or high risk avoidance.
Dialectical behaviour therapy (DBT), a type of cognitive behaviour therapy, has proven efficacy in treating borderline personality disorder, reducing suicide risk, and reducing symptoms of depression in patients. Small studies have found that it is effective for depressed patients for whom drug treatment has failed. Because of its efficacy in treating a personality disorder, DBT has become well established in the UK.
The research is led by Professor Thomas Lynch of the University of Southampton, who is one of the world's leading researchers in Dialectical Behaviour Therapy. The team will recruit up to 276 patients across three sites and will compare treatment as usual to DBT. Over six months the DBT group will receive 24 individual sessions and 24 group sessions, and a second group will only receive the usual treatment.
The researchers will look at the effect of being randomly allocated to DBT rather than treatment as usual and at the effect of exposure to a specific 'dose' of DBT. The primary outcome will be symptoms of depression measured at randomisation, and then six, 12 and 18 months later. Secondary outcomes will include remission from depression and suicidal thoughts/behaviour.
Additional analyses will test whether variables such as childhood abuse and reward insensitivity modify treatment effects. Longitudinal data will be used to examine patterns of change and cross-lagged effects among depressive symptoms, alliance ratings and skills learnt in DBT.
Professor Lynch commented; "The major difference between DBT for TRD and other empirically validated treatments for depression is that we do not consider depression the primary problem—our approach contends that an over-controlled personality style limits opportunities to learn new skills and flexibly interact with others—and if not addressed, depression becomes more rigid, resistant to change, and chronic in nature." He added "We shall also make extra measurements to help understand how DBT helps depressed participants specifically: therapeutic alliance, the emotional coping skills taught in DBT, and expectancy."
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