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Dynamic interpersonal therapy for moderate to severe depression: a pilot randomized controlled and feasibility trial

Published online by Cambridge University Press:  14 May 2019

Peter Fonagy Open the ORCID record for Peter Fonagy [Opens in a new window] ,
Alessandra Lemma ,
Mary Target ,
Sally O'Keeffe ,
Matthew P. Constantinou ,
Tamara Ventura Wurman ,
Patrick Luyten ,
Elizabeth Allison ,
Anthony Roth  and
John Cape
...Show all authors
Peter Fonagy*
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK Anna Freud National Centre for Children and Families, London, UK
Alessandra Lemma
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
Mary Target
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
Sally O'Keeffe
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK Anna Freud National Centre for Children and Families, London, UK
Matthew P. Constantinou
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
Tamara Ventura Wurman
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
Patrick Luyten
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
Elizabeth Allison
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
Anthony Roth
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
John Cape
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
Stephen Pilling
Affiliation:
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
*
Author for correspondence: Peter Fonagy, E-mail: p.fonagy@ucl.ac.uk
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Abstract

Background

Improving Access to Psychological Therapies (IAPT) services treat most patients in England who present to primary care with major depression. Psychodynamic psychotherapy is one of the psychotherapies offered. Dynamic Interpersonal Therapy (DIT) is a psychodynamic and mentalization-based treatment for depression. 16 sessions are delivered over approximately 5 months. Neither DIT's effectiveness relative to low-intensity treatment (LIT), nor the feasibility of randomizing patients to psychodynamic or cognitive-behavioural treatments (CBT) in an IAPT setting has been demonstrated.

Methods

147 patients were randomized in a 3:2:1 ratio to DIT (n = 73), LIT (control intervention; n = 54) or CBT (n = 20) in four IAPT treatment services in a combined superiority and feasibility design. Patients meeting criteria for major depressive disorder were assessed at baseline, mid-treatment (3 months) and post-treatment (6 months) using the Hamilton Rating Scale for Depression (HRSD-17), Beck Depression Inventory-II (BDI-II) and other self-rated questionnaire measures. Patients receiving DIT were also followed up 6 months post-completion.

Results

The DIT arm showed significantly lower HRSD-17 scores at the 6-month primary end-point compared with LIT (d = 0.70). Significantly more DIT patients (51%) showed clinically significant change on the HRSD-17 compared with LIT (9%). The DIT and CBT arms showed equivalence on most outcomes. Results were similar with the BDI-II. DIT showed benefit across a range of secondary outcomes.

Conclusions

DIT delivered in a primary care setting is superior to LIT and can be appropriately compared with CBT in future RCTs.

Keywords

AdultsDITdynamic interpersonal therapyIAPTImproving Access to Psychological Therapiesmajor depressionmentalization-basedpsychodynamicrandomized controlled trialtime-limited treatment
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 6 , April 2020 , pp. 1010 - 1019
Copyright
Copyright © Cambridge University Press 2019

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References

Abbass, AA, Kisely, SR, Town, JM, Leichsenring, F, Driessen, E, De Maat, S, Gerber, A, Dekker, J, Rabung, S, Rusalovska, S and Crowe, E (2014) Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews, CD004687.Google ScholarPubMed
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington, DC: American Psychiatric Association.Google Scholar
Bateman, A and Fonagy, P (2009) Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. American Journal of Psychiatry 166, 1355–1364.CrossRefGoogle ScholarPubMed
Bateman, A and Fonagy, P (eds) (2019) Handbook of Mentalizing in Mental Health Practice, 2nd ed. Washington, DC: American Psychiatric Publishing.Google Scholar
Bateman, A, O'Connell, J, Lorenzini, N, Gardner, T and Fonagy, P (2016) A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder. BMC Psychiatry 16, 304.CrossRefGoogle ScholarPubMed
Beck, AT and Haigh, EA (2014) Advances in cognitive theory and therapy: the generic cognitive model. Annual Review of Clinical Psychology 10, 1–24.CrossRefGoogle ScholarPubMed
Beck, A, Steer, R and Brown, G (1996) Manual for the Beck Depression Inventory-II (BDI-II). San Antonio: Psychological Corporation.Google Scholar
Clark, DM, Canvin, L, Green, J, Layard, R, Pilling, S and Janecka, M (2018) Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. Lancet 391, 679–686.CrossRefGoogle ScholarPubMed
Connolly Gibbons, MB, Gallop, R, Thompson, D, Luther, D, Crits-Christoph, K, Jacobs, J, Yin, S and Crits-Christoph, P (2016) Comparative effectiveness of cognitive therapy and dynamic psychotherapy for major depressive disorder in a community mental health setting: a randomized clinical noninferiority trial. JAMA Psychiatry 73, 904–911.CrossRefGoogle Scholar
Coull, G and Morris, PG (2011) The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: a systematic review. Psychological Medicine 41, 2239–2252.CrossRefGoogle ScholarPubMed
Cuijpers, P, van Straten, A, Andersson, G and van Oppen, P (2008) Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. Journal of Consulting and Clinical Psychology 76, 909–922.CrossRefGoogle ScholarPubMed
Cuijpers, P, Geraedts, AS, van Oppen, P, Andersson, G, Markowitz, JC and van Straten, A (2011) Interpersonal psychotherapy for depression: a meta-analysis. American Journal of Psychiatry 168, 581–592.CrossRefGoogle ScholarPubMed
Cuijpers, P, Berking, M, Andersson, G, Quigley, L, Kleiboer, A and Dobson, KS (2013) A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry 58, 376–385.CrossRefGoogle ScholarPubMed
Cuijpers, P, Koole, SL, van Dijke, A, Roca, M, Li, J and Reynolds, CF IIIrd (2014) Psychotherapy for subclinical depression: meta-analysis. British Journal of Psychiatry 205, 268–274.CrossRefGoogle ScholarPubMed
Cuijpers, P, van Straten, A, Bohlmeijer, E, Hollon, SD and Andersson, G (2010) The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychological Medicine 40, 211–223.Google Scholar
de Beurs, E and Zitman, FG (2006) De Brief Symptom Inventory (BSI). De betrouwbaarheid en validiteit van een handzaam alternatief voor de SCL-90. Maandblad Geestelijke Volksgezondheid 61, 120–141.Google Scholar
Dozois, DJA, Dobson, KS and Ahnberg, JL (1998) A psychometric evaluation of the Beck Depression Inventory-II. Psychological Assessment 10, 83–89.CrossRefGoogle Scholar
Driessen, E, Cuijpers, P, de Maat, SCM, Abbass, AA, de Jonghe, F and Dekker, JJM (2010) The efficacy of short-term psychodynamic psychotherapy for depression: a meta-analysis. Clinical Psychology Review 30, 25–36.CrossRefGoogle ScholarPubMed
Driessen, E, Hegelmaier, LM, Abbass, AA, Barber, JP, Dekker, JJ, Van, HL, Jansma, EP and Cuijpers, P (2015) The efficacy of short-term psychodynamic psychotherapy for depression: a meta-analysis update. Clinical Psychology Review 42, 1–15.CrossRefGoogle ScholarPubMed
Erford, BT, Johnson, E and Bardoshi, G (2017) Meta-analysis of the English version of the Beck Depression Inventory–Second Edition. Measurement and Evaluation in Counseling and Development 49, 3–33.CrossRefGoogle Scholar
Fonagy, P (2015) The effectiveness of psychodynamic psychotherapies: an update. World Psychiatry 14, 137–150.CrossRefGoogle ScholarPubMed
Fraley, RC, Waller, NG and Brennan, KA (2000) An item response theory analysis of self-report measures of adult attachment. Journal of Personality and Social Psychology 78, 350–365.CrossRefGoogle ScholarPubMed
Furukawa, TA, Noma, H, Caldwell, DM, Honyashiki, M, Shinohara, K, Imai, H, Chen, P, Hunot, V and Churchill, R (2014) Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis. Acta Psychiatrica Scandinavica 130, 181–192.CrossRefGoogle ScholarPubMed
Gerber, AJ, Kocsis, JH, Milrod, BL, Roose, SP, Barber, JP, Thase, ME, Perkins, P and Leon, AC (2011) A quality-based review of randomized controlled trials of psychodynamic psychotherapy. American Journal of Psychiatry 168, 19–28.CrossRefGoogle ScholarPubMed
Guy, A, Loewenthal, D, Thomas, R and Stephenson, S (2012) Scrutinising NICE: the impact of the National Institute for Health and Clinical Excellence Guidelines on the provision of counselling and psychotherapy in primary care in the UK. Psychodynamic Practice 18, 25–50.CrossRefGoogle Scholar
Hamilton, M (1960) A rating scale for depression. Journal of Neurology, Neurosurgery & Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Hanson, K, Webb, TL, Sheeran, P and Turpin, G (2016) Attitudes and preferences towards self-help treatments for depression in comparison to psychotherapy and antidepressant medication. Behavioural and Cognitive Psychotherapy 44, 129–139.CrossRefGoogle ScholarPubMed
Hollon, SD, Stewart, MO and Strunk, D (2006) Enduring effects for cognitive behavior therapy in the treatment of depression and anxiety. Annual Review of Psychology 57, 285–315.CrossRefGoogle ScholarPubMed
Horowitz, LM, Rosenberg, SE, Baer, BA, Ureno, G and Villasenor, VS (1988) Inventory of Interpersonal Problems: psychometric properties and clinical applications. Journal of Consulting and Clinical Psychology 56, 885–892.CrossRefGoogle ScholarPubMed
Jacobson, NS and Truax, P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 12–19.CrossRefGoogle ScholarPubMed
Karyotaki, E, Smit, Y, de Beurs, DP, Henningsen, KH, Robays, J, Huibers, MJ, Weitz, E and Cuijpers, P (2016) The long-term efficacy of acute-phase psychotherapy for depression: a meta-analysis of randomized trials. Depression and Anxiety 33, 370–383.CrossRefGoogle ScholarPubMed
Kernberg, OF (1988) Object relations theory in clinical practice. Psychoanalytic Quarterly 57, 481–504.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL and Williams, JB (2001) The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–613.CrossRefGoogle ScholarPubMed
Leichsenring, F, Luyten, P, Hilsenroth, MJ, Abbass, A, Barber, JP, Keefe, JR, Leweke, F, Rabung, S and Steinert, C (2015) Psychodynamic therapy meets evidence-based medicine: a systematic review using updated criteria. The Lancet. Psychiatry 2, 648–660.CrossRefGoogle ScholarPubMed
Lemma, A, Target, M and Fonagy, P (2010) The development of a brief psychodynamic protocol for depression: Dynamic Interpersonal Therapy (DIT). Psychoanalytic Psychotherapy 24, 329–346.CrossRefGoogle Scholar
Lemma, A, Target, M and Fonagy, P (2011) The development of a brief psychodynamic intervention (dynamic interpersonal therapy) and its application to depression: a pilot study. Psychiatry 74, 41–48.CrossRefGoogle ScholarPubMed
Lemma, A, Target, M and Fonagy, P (2012) Adherence Rating Scale for Dynamic Interpersonal Therapy. Unpublished manuscript. London: University College London.Google Scholar
Lemma, A, Target, M and Fonagy, P (2017) Manual for Dynamic Interpersonal Therapy (DIT), 2nd Edn. London: Anna Freud National Centre for Children and Families/Tavistock Clinic.Google Scholar
Lemmens, LHJM, Arntz, A, Peeters, F, Hollon, SD, Roefs, A and Huibers, MJH (2015) Clinical effectiveness of cognitive therapy v. interpersonal psychotherapy for depression: results of a randomized controlled trial. Psychological Medicine 45, 2095–2110.CrossRefGoogle ScholarPubMed
Lopez, AD, Mathers, CD, Ezzati, M, Jamison, DT and Murray, CJL (2006) Global Burden of Disease and Risk Factors. New York: Oxford University Press.CrossRefGoogle ScholarPubMed
Luborsky, L and Crits-Christoph, P (1998) Understanding Transference: The Core Conflictual Relationship Theme Method. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Luyten, P and Blatt, SJ (2012) Psychodynamic treatment of depression. Psychiatric Clinics of North America 35, 111–129.CrossRefGoogle ScholarPubMed
McHugh, RK, Whitton, SW, Peckham, AD, Welge, JA and Otto, MW (2013) Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review. Journal of Clinical Psychiatry 74, 595–602.CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (2009) Depression: The treatment and management of depression in adults. Clinical Guideline 90. National Institute for Health and Clinical Excellence: London.Google Scholar
National Institute for Health and Care Excellence (2017) Depression: The treatment and management of depression in adults (guidelines under consultation). National Institute for Health and Care Excellence: London.Google Scholar
Perfect, D, Jackson, C, Pybis, J and Hill, A (2016) Choice of Therapies in IAPT: An Overview of the Availability and Client Profile of Step 3 Therapies. Lutterworth: British Association for Counselling & Psychotherapy.Google Scholar
Roth, AD and Pilling, S (2015) A competency framework for the practice of psychological interventions: Cognitive and behavioural therapy. Available at https://www.ucl.ac.uk/pals/research/clinical-educational-and-health-psychology/research-groups/core/competence-frameworks-2.Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R and Dunbar, GC (1998) 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. Journal of Clinical Psychiatry 59(suppl. 20), 22–33.Google ScholarPubMed
Spielmans, GI, Berman, MI and Usitalo, AN (2011) Psychotherapy versus second-generation antidepressants in the treatment of depression: a meta-analysis. Journal of Nervous and Mental Disease 199, 142–149.CrossRefGoogle ScholarPubMed
Steinert, C, Munder, T, Rabung, S, Hoyer, J and Leichsenring, F (2017) Psychodynamic therapy: as efficacious as other empirically supported treatments? A meta-analysis testing equivalence of outcomes. American Journal of Psychiatry 174, 943–953.CrossRefGoogle ScholarPubMed
The Community Mental Health Team (2016) Psychological Therapies: Annual Report on the use of IAPT Services. England, 2015-16. Leeds: NHS Digital.Google Scholar
The EuroQol Group (1990) EuroQol – a new facility for the measurement of health-related quality of life. Health Policy 16, 199–208.CrossRefGoogle Scholar
Trajkovic, G, Starcevic, V, Latas, M, Lestarevic, M, Ille, T, Bukumiric, Z and Marinkovic, J (2011) Reliability of the Hamilton rating scale for depression: a meta-analysis over a period of 49 years. Psychiatry Research 189, 1–9.CrossRefGoogle Scholar
Weissman, MM, Prusoff, BA, Thompson, WD, Harding, PS and Myers, JK (1978) Social adjustment by self-report in a community sample and in psychiatric outpatients. Journal of Nervous and Mental Disease 166, 317–326.CrossRefGoogle Scholar
World Health Organization (2001) The World Health Report 2001: Mental Health: New Understanding, New Hope. Geneva: World Health Organization.Google Scholar
Zimmerman, M, McGlinchey, JB, Posternak, MA, Friedman, M, Boerescu, D and Attiullah, N (2008) Remission in depressed outpatients: more than just symptom resolution? Journal of Psychiatric Research 42, 797–801.CrossRefGoogle ScholarPubMed
Zimmerman, M, Martinez, JH, Young, D, Chelminski, I and Dalrymple, K (2013) Severity classification on the Hamilton depression rating scale. Journal of Affective Disorders 150, 384–388.CrossRefGoogle ScholarPubMed
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