RESUMEN
A significant number of psychotherapy clients remain untreated, and dropping out is one of the main reasons. Still, the literature around this subject is incoherent. The present study explores potential pre-treatment predictors of dropout in a sample of clients who took part in a clinical trial designed to test the efficacy of narrative therapy for major depressive disorder compared to cognitive-behavioral therapy. Logistic regression analysis showed that: (1) treatment assignment did not predict dropout, (2) clients taking psychiatric medication at intake were 80% less likely to drop out from therapy, compared to clients who were not taking medication, and (3) clients presenting anxious comorbidity at intake were 82% less likely to dropout compared to those clients not presenting anxious comorbidity. Results suggest that clinicians should pay attention to depressed clients who are not taking psychiatric medication or have no comorbid anxiety. More research is needed in order to understand this relationship.
Un número significativo de clientes de psicoterapia no recibe tratamiento adecuado y el abandono del mismo es una de las principales razones. La literatura existente al respecto es contradictoria. Este estudio explora potenciales predictores del abandono en una muestra de clientes que participaron de un ensayo clínico diseñado para demostrar la eficacia de la terapia narrativa en el trastorno depresivo mayor en comparación con la terapia cognitivo-conductual. Los resultados muestran que (1) la asignación del tratamiento no predecía el abandono, (2) los clientes que al comenzar el tratamiento estaban medicados tuvieron un 80% menos de probabilidad de abandonar la psicoterapia, comparado con los clientes no medicados y (3) los clientes que padecían de comorbilidad ansiosa tuvieron un 82% menos de probabilidad de abandonar la psicoterapia comparado con los clientes sin comorbilidad. Los clínicos deberían prestar especial atención a los clientes sin medicación o que no padezcan de comorbilidad ansiosa. Se requiere más investigación para comprender esta relación.
RESUMEN
Results from an earlier clinical trial comparing narrative therapy with cognitive-behavioural therapy (Lopes et al., 2013) suggested that narrative therapy is efficacious for depression. However, there were significant differences in symptom reduction on the Beck Depression Inventory-II, favouring cognitive-behavioural therapy, if dropouts were included in the analysis, suggesting that time to recovery or improvement would differ in both treatments. Contrarily, results showed that treatment assignment was not a predictor for differential effect. Using a survival analytic approach, it was found that four sessions were necessary for 50% improvement and 16 sessions for 50% recovery. Additionally, depressive symptoms changes occurred significantly faster than interpersonal changes, again regardless of treatment assignment. These results support previous findings of the dose-response literature and of the phase model of change, with the advantage of being specific to psychotherapy with depressive clients.
Asunto(s)
Terapia Cognitivo-Conductual , Trastorno Depresivo Mayor/terapia , Relaciones Interpersonales , Terapia Narrativa , Adulto , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/terapia , Comorbilidad , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Encuestas y CuestionariosRESUMEN
BACKGROUND: In a previous clinical controlled trial (Lopes et al., 2014), narrative therapy (NT) showed promising results in ameliorating depressive symptoms with comparable outcomes to cognitive-behavioral therapy (CBT) when patients completed treatment. This paper aims to assess depressive symptoms and interpersonal problems in this clinical sample at follow-up. METHODS: Using the Beck Depression Inventory-II and Outcome Questionnaire-45.2 Interpersonal Relations Scale, naturalistic prospective follow-up assessment was conducted at 21 and 31 months after the last treatment session. RESULTS: At follow-up, patients kept improving in terms of depressive symptoms and interpersonal problems. The odds that a patient maintained recovery from depressive symptoms at follow-up were five times higher than the odds that a patient maintained recovery from interpersonal problems. In the same way, the odds of a patient never recovering from interpersonal problems were five times higher than the odds of never recovering from depressive symptoms. LIMITATIONS: The study did not control for the natural course of depression or treatment continuation. CONCLUSIONS: For depressed patients with greater interpersonal disabilities, longer treatment plans and alternative continuation treatments should be considered.
Asunto(s)
Terapia Cognitivo-Conductual , Depresión/terapia , Trastorno Depresivo/terapia , Relaciones Interpersonales , Terapia Narrativa , Adulto , Cognición , Terapia Cognitivo-Conductual/métodos , Depresión/psicología , Trastorno Depresivo/psicología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Inventario de Personalidad , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Recurrencia , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Systematic studies of the efficacy of Narrative Therapy (NT) for depression are sparse. OBJECTIVE: To evaluate the efficacy of individual NT for moderate depression in adults compared to Cognitive-Behavioral Therapy (CBT). METHOD: Sixty-three depressed clients were assigned to either NT or CBT. The Beck Depression Inventory-II (BDI-II) and Outcome Questionnaire-45.2 (OQ-45.2) were used as outcome measures. RESULTS: We found a significant symptomatic reduction in both treatments. Group differences favoring CBT were found on the BDI-II, but not on the OQ-45.2. CONCLUSIONS: Pre- to post-treatment effect sizes for completers in both groups were superior to benchmarked waiting-list control groups.