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ew research compares the long term
effect of two different forms of therapy for chronic depression and finds that
the benefits of one approach, which experts developed specifically for this
form of depression, fade 2 years after the treatment ends.
New research assesses the long term benefits of a form of CBT for people with chronic depression.
According
to estimates, 3–6% of people are likely to experience chronic depression at some
point during their life.
Unlike
episodic depression, chronic depression — also known as persistent depressive
disorder or dysthymia — is a condition that lasts for 2 years without interruption.
However,
it's not just the duration of the condition that separates chronic depression
from episodic major depression.
Chronic
depression significantly interferes with day-to-day activities, raises the risk
of suicide, and is more likely to occur alongside other psychiatric disorders.
Chronic
depression is also likely to be more severe and more difficult to treat than
episodic major depression.
In
chronic depression, the chances of relapse are higher, so in addition to antidepressants, psychotherapy, or a
combination of the two, people with chronic depression need a form of
maintenance therapy to ensure that they stay in remission.
So
far, the cognitive behavioral analysis system of psychotherapy (CBASP) has been
the only type of therapy that experts have designed specifically for treating
chronic depression, and several trials that compared it with antidepressants
found the approach to be successful.
But, how does CBASP fare in the long term? New
research, appearing in the journalPsychotherapy and Psychosomatics, investigates.
Elisabeth
Schramm, from the department of psychiatry and psychotherapy at the University
of Freiburg in Germany, is the lead author of the new study, which compares the
benefits of CBASP with those of "supportive psychotherapy" at 1 and 2
years after the end of the treatment.
CBASP benefits fade 2 years after treatment
Some
people define CBASP as a form of cognitive behavioral therapy (CBT),
but, in addition to behavioral elements, CBASP includes interpersonal,
cognitive, and psychodynamic strategies in its approach.
In
CBASP, the therapist helps the client break down distressing interpersonal
interactions and determine crucial points at which said interactions could have
evolved in a different way if the client had had a different attitude.
Supportive
psychotherapy, on the other hand, focuses on improving the
self-esteem, resilience, and adaptability of the individual by encouraging them
and offering them help to find practical solutions to new situations that might
be distressing.
In
the current study, Schramm and colleagues compared the two therapies in a
"prospective, multicenter, evaluator-blinded, randomized clinical
trial" of 268 people who had just received a diagnosis of chronic
depression.
The
first treatment consisted of 32 sessions of either CBASP or supportive therapy
over 48 weeks. Schramm and team assessed the rate of "well weeks"
after 1 and 2 years as the primary outcome.
Secondary
outcomes included "clinician- and self-rated depressive symptoms, response/remission
rates, and quality of life."
The results revealed that although CBASP is more
beneficial than supportive therapy after 1 year, this type of therapy loses its
effectiveness 1–2 years after completion of the treatment. Schramm and colleagues
conclude:
"This suggests the necessity of
maintenance treatment for early-onset chronically depressed patients remitted
with CBASP during the acute therapy phase, as well as the [...] integration of
other treatment strategies, including medication for those who did not reach
remission."
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