Research on treatments of depression
Today, I present three studies of treatment for depression. First, Cuijpers, Harrer, Miguel, Ciharova & Karyotaki (2023) published “Five Decades of Research on Psychological Treatments of Depression: A historical and meta-analytic overview” in American Psychologist. Here are the edited abstract and impact statements:
Since the 1970s, hundreds of randomized trials have examined the effects of psychotherapies for depression, and this number is increasing every year. In this study, we report outcomes from a living systematic review of these studies. We use Poisson regression analyses to examine if the proportions of studies have changed over time across the characteristics of the participants, therapies, and studies. We also present a meta-analysis of the effects across the major types, formats, targets, and age groups. We included 562 randomized controlled trials (669 comparisons; 66,361 patients). Most trials are conducted in adults and the relative proportion of trials in children and adolescents, as well as in older patients is significantly decreasing. The effects in children and adolescents are also significantly smaller than in adults (p = .007). Cognitive behavior therapy (CBT) is by far the best examined type of therapy (52%), but not necessarily more effective than other therapies. Over time, the proportion of studies examining several other types of therapy is significantly decreased compared to CBT. The quality of trials has increased over time, but still, a majority do not meet basic quality criteria, not even in recent years. The effects found in studies with low risk of bias are significantly smaller than in other studies (b = −0.21; SE = 0.05; p < .001). Most trials are conducted in the United States, but the proportion of studies in other parts of the world is rapidly increasing. The evidence that psychotherapies are effective is strong and growing every year.
Hundreds of randomized trials have shown that these therapies are effective, but research in children and adolescents is lagging behind, as well as research on other therapies than cognitive behavior therapy. The quality of trials is increasing over time, although there is still room for improvement.
I found this work helpful in identifying the limitations of much research on depression and the small effect sizes. This suggests the need to do more research on diverse approaches to treatment. The next study takes a more focused approach. Geschwind, Bosgraaf, Bannink & Peeters (2020) published “Positivity Pays Off: Clients’ perspectives on positive compared with traditional cognitive behavioral therapy for depression” in Psychotherapy. The edited abstract and impact statements follow:
In this qualitative study, we explored the experiences of clients receiving cognitive behavioral therapy (CBT) for major depressive disorder. All participants received 8 sessions of traditional CBT (based on Beck, Rush, Shaw, & Emergy, 1979) and 8 sessions of positive CBT (order counterbalanced). The aim of the study was to examine clients’ experience of positive CBT and to contrast this with their experience of traditional CBT. Positive CBT structurally and selectively focuses on better moments (exceptions to the problem as opposed to the problem), strengths, and positive emotions and integrates traditional CBT with solution-focused brief therapy and positive psychology. In addition to conducting interviews with 12 individuals, the second author attended all therapy sessions of 4 clients and observed biweekly supervision sessions as further methods of data collection. Qualitative analysis showed that, despite initial skepticism, clients preferred positive CBT and indicated experiencing a steeper learning curve during positive, compared with traditional, CBT for depression. The popularity of positive CBT was attributable to 4 influences: feeling good and empowered, benefitting from upward spiral effects of positive emotions, learning to appreciate baby steps, and (re)discovering optimism as a personal strength.
How do clients with moderate to severe depression experience positive cognitive behavioral therapy (i.e., CBT with a structural focus on better moments, strengths, and positive emotions)? Respondents in this qualitative study perceived the structural focus on better moments, strengths, and positive emotions as enjoyable and motivating for change. Paying explicit attention to positive emotions in psychotherapy may be beneficial, given that respondents appreciated the lightness of tone and viewed exploration of their strengths, shared laughter, and compliments as memorable, motivating, and empowering. Next steps include replication of these findings in a larger sample receiving only positive CBT (rather than positive CBT as part of their treatment) and exploration of long-term effects, potentially expanding to different disorders and settings.
It’s a small sample and a qualitative study but I found the results interesting. They make perfect sense and I look forward to further research on positive CBT. Finally, Turi, Courtwright, Dixon, O'Neill, Marchiano & Poghosyan (2024) published “Primary Care Models and Depression Outcomes in Rural Adult Populations: A systematic review” in Journal of Rural Mental Health. The edited abstract and impact statements are as follows:
Rural populations rely on primary care services for depression care due to shortages and maldistributions of specialty mental health care favoring urban areas. Yet, it is unknown which primary care models are effective at reducing depressive symptoms and emergency department (ED) use for depression among rural populations. The purpose of this systematic review is to synthesize the effectiveness of primary care models on depressive symptoms and ED utilization for depression in rural populations. PubMed, APA PsycInfo, CINAHL, and reference lists of included studies were searched. Eligible articles focused on the impact of primary care models on depressive symptoms or ED utilization for depression among rural populations in the United States. Seventeen studies met the inclusion criteria. Three care models were identified in the studies, including collaborative care (i.e., team-based integrated care that tracks patient populations with a registry; n = 7), tele-psychotherapy (i.e., identification of patients in primary care and referral to virtual psychotherapy; n = 6), or self-management support (i.e., identification of patients in primary care and referral to community support for depression self-management; n = 4). These care models were associated with improved patient-reported depressive symptoms such as Patient Health Questionnaire reported remission of depression (score < 5). No studies assessed depression ED utilization as an outcome. Collaborative care, tele-psychotherapy, and self-management support may be effective at reducing depressive symptoms, specifically in rural populations and should be implemented at the practice level. Research focused on primary care models and ED utilization for depression among rural populations is needed.
Collaborative care, tele-psychotherapy, and self-management support may be effective primary care models for reducing the depressive symptoms among rural populations who face decreased access to care for mental health services.
The lack of available care for people experiencing depression is commonly noted. People in rural areas across the country face additional challenges. Practitioners may benefit from expanding their knowledge of and ability to support these primary care models. Taken together, these studies illustrate the importance of having multiple tools available when dealing with depressed clients.