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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses results from recent studies in 4 forms of empirically validated psychotherapy. Various topics include cognitive behavior therapy, behavior activation, interpersonal psychotherapy, and psychodynamic psychotherapy.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emood disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EMichael E. Thase, MD, University of Pennsylvania, Philadelphia, PA, discussed results from recent studies in 4 forms of empirically validated psychotherapy.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECognitive Behavior Therapy (CBT)\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003E\u201cCBT is by far the most extensively studied of the 4,\u201d said Dr. Thase. Recent studies include a trial from New Zealand that compared CBT with interpersonal psychotherapy (IPT) in 177 out-patients with major depressive disorder (MDD). Subjects received 8 to 19 therapy sessions over 16 weeks. The primary outcome was improvement in MADRS score. Although there was no difference in the 2 therapies on the primary outcome, results of a secondary analysis, conducted to determine the effect of personality disorder (PD) on both therapies, showed that PD did not adversely affect treatment response in patients who received CBT but did have an adverse affect on treatment response in those who received IPT [Joyce PF et al. \u003Cem\u003EBr J Psychiatry\u003C\/em\u003E 2007].\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EAlthough similar results concerning the effect of PD were seen in a sub-analysis from NIMH Treatment with Depression Collaborative study results, Fournier and colleagues found that while CBT was more than 20% better for the non-PD patients, pharmacotherapy was more than 20% better for the PD patients (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Fournier JC et al. \u003Cem\u003EBr J Psychiatry\u003C\/em\u003E 2008]. \u201cThese conflicting results,\u201d said Dr. Thase, \u201cmay indicate that in patients with significant PD, combination therapy might be the best option.\u201d\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/3\/22\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Personality Disorder and Response Rates: CBT Versus Medication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1686822163\u0022 data-figure-caption=\u0022Personality Disorder and Response Rates: CBT Versus Medication.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/3\/22\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/3\/22\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/3\/22\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10899\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EPersonality Disorder and Response Rates: CBT Versus Medication.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-6\u0022\u003ECBT also was evaluated in the STAR*D trial. Patients who did not benefit from citalopram alone were assigned to citalopram + CBT, citalopram + another antidepressant, CBT alone, or another antidepressant alone. Response and remission rates were similar between those who received any CBT and those who were assigned to medication alone; however, remission was significantly more rapid in subjects who received citalopram plus another medication versus those who received citalopram plus CBT (\u003Ca id=\u0022xref-fig-2-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F2\u0022\u003EFigure 2\u003C\/a\u003E) [Thase M et al. \u003Cem\u003EJ Clin Psychiatry\u003C\/em\u003E 2007].\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/3\/22\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Remission on CBT Versus Medication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1686822163\u0022 data-figure-caption=\u0022Remission on CBT Versus Medication.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 2.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/3\/22\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/3\/22\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 2.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/3\/22\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10902\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003ERemission on CBT Versus Medication.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EBehavior Activation (BA)\u003C\/h2\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EWhen Dimijian and colleagues compared the efficacy of BA versus CBT or antidepressant medication in a randomized, placebo-controlled trial in 241 adults with MDD, they found that among more severely depressed patients, BA was comparable with antidepressant medication and that both significantly outperformed CBT [Dimidjian S et al. \u003Cem\u003EJ Consult Clin Psychol\u003C\/em\u003E 2006].\u003C\/p\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EHowever, a meta-analysis of 16 BA studies (including the Dimijian study) that comprised 780 subjects found no significant difference between BA and CBT. The differences between BA and cognitive therapy at follow-up also were non-significant [Cuijpers P et al. \u003Cem\u003EClin Psychol Rev\u003C\/em\u003E 2007] According to Dr. Thase, \u201cBoth of these studies show that BA is effective, and what is exciting about BA is that it is the kind of strategy that less sophisticated clinicians can learn to do and learn to do very quickly.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EInterpersonal Psychotherapy (IPT)\u003C\/h2\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EIn one recent study, 124 moderate to severely depressed inpatients received either an intensive dose of individual and group IPT sessions along with pharmacotherapy or pharmacotherapy + clinical management. Patients received 15 individual sessions + 8 group sessions. The authors found that brief, intensive IPT was superior to standard treatment for these severely ill, hospitalized patients, and the differential effects lasted for 3 months [Schramm E et al. \u003Cem\u003EJ Affect Disord\u003C\/em\u003E 2007].\u003C\/p\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EIPT does not appear to work in all patient populations. Results of a 12-week study in depressed patients who also had coronary artery disease (CAD) showed that IPT had no effect either alone or in combination, although citalopram did [Lesp\u00e9rance et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2007]. In addition, in a long-term study in older patients (\u0026gt;70 years) that evaluated whether maintenance antidepressant pharmacotherapy and IPT were able to sustain the health-related quality of life gains that were achieved during short-term treatment, Dombrovski found no benefit with IPT [Dombrovski AY et al. \u003Cem\u003EJ Am Geriatr Soc\u003C\/em\u003E 2007].\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EPsychodynamic Psychotherapy (PDP)\u003C\/h2\u003E\n         \u003Cp id=\u0022p-12\u0022\u003EUntil recently, there has been little scientific evidence that PDP has the same benefits as CBT or IPT. However, in a meta-analysis of 3 randomized, controlled trials that comprised 313 patients, de Maat and colleagues found that although medication combined with PDP was more effective than PDP alone, PDP alone was more effective than medication alone in treating depression [de Maat et al. in press].\u003C\/p\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EIn conclusion, Dr. Thase stated that, \u201cWe now have evidence from randomized, controlled trials that the modern depression-focused psychotherapies are effective for many patients with MDD. This is important, because if you don\u0027t use psychotherapy and focus primarily on pharmacotherapy, you are dealing with an incompletely effective modality of treatment. Of course, for the more-difficult-to-treat or the incompletely remitted patient, the additional benefit of using the 2 treatments in combination is an important and, in some ways, unique aspect that a psychiatrist can bring to treatment.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/3\/22.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmdxq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmdxq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}