Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder

Ilinca Serbanescu; Matthias Backenstrass; Sarah Drost; Bernd Weber; Henrik Walter; Jan Philipp Klein; Ingo Zobel; Martin Hautzinger; Ramona Meister; Martin Härter; Elisabeth Schramm; Dieter Schoepf

doi:10.3389/fpsyt.2020.607300

Impact of Baseline Characteristics on the Effectiveness of Disorder-Specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy in Outpatient Treatment for Persistent Depressive Disorder

Front Psychiatry. 2020 Dec 21:11:607300. doi: 10.3389/fpsyt.2020.607300. eCollection 2020.

Authors

Ilinca Serbanescu¹, Matthias Backenstrass^{1

2}, Sarah Drost³, Bernd Weber^{4

5}, Henrik Walter⁶, Jan Philipp Klein⁷, Ingo Zobel⁸, Martin Hautzinger⁹, Ramona Meister¹⁰, Martin Härter¹⁰, Elisabeth Schramm¹¹, Dieter Schoepf^{3

12}

Affiliations

¹ Department of Clinical Psychology and Psychotherapy, University of Heidelberg, Heidelberg, Germany.
² Institute of Clinical Psychology, Hospital Stuttgart, Stuttgart, Germany.
³ Department of Psychiatry and Psychotherapy, Cognitive Behavioral Analysis System of Psychotherapy Center of Competence, University of Bonn, Bonn, Germany.
⁴ Institute of Experimental Epileptology and Cognition Research, University of Bonn, Bonn, Germany.
⁵ Center for Economics and Neuroscience, University of Bonn, Bonn, Germany.
⁶ Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Berlin, Germany.
⁷ Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany.
⁸ Psychology School at the Fresenius University of Applied Sciences Berlin, Berlin, Germany.
⁹ Department of Psychology, Clinical Psychology and Psychotherapy, Eberhard Karls University Tübingen, Tübingen, Germany.
¹⁰ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany.
¹¹ Department of Psychiatry and Psychotherapy, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany.
¹² Department of Psychiatry and Psychotherapy, Vitos Weil-Lahn, Weilmünster, Germany.

Abstract

Importance: In the treatment of persistent depressive disorder (PDD), disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been shown to be superior to Supportive Psychotherapy (SP) in outpatients. It remains to clear which subgroups of patients benefit equally and differentially from both psychotherapies. Objective: To identify those patient-level baseline characteristics that predict a comparable treatment effectiveness of CBASP and SP and those that moderate the differential effectiveness of CBASP compared to SP. Design, setting and participants: In this analysis of a 48-week multicenter randomized clinical trial comparing CBASP to SP in adult antidepressant-free outpatients with early-onset PDD, we evaluated baseline variables from the following domains as potential predictors and moderators of treatment effectiveness: socio-demography, clinical status, psychosocial and global functioning, life quality, interpersonal problems, childhood trauma, treatment history, preference for psychotherapy, and treatment expectancy. Interventions: A 48-week treatment program with 32 sessions of either CBASP or SP. Main outcomes and measures: Depression severity measured by the 24-item Hamilton Rating Scale for Depression (HRSD-24) at week 48. Results: From N = 268 randomized outpatients, N = 209 completed the 48-week treatment program. CBASP completers had significantly lower post-treatment HRSD-24 scores than SP completers (mean_CBASP=13.96, sd_CBASP= 9.56; mean_SP= 16.69, sd_SP= 9.87; p = 0.04). A poor response to both therapies was predicted by higher baseline levels of clinician-rated depression, elevated suicidality, comorbid anxiety, lower social functioning, higher social inhibition, moderate-to-severe early emotional or sexual abuse, no preference for psychotherapy, and the history of at least one previous inpatient treatment. Moderator analyses revealed that patients with higher baseline levels of self-rated depression, comorbidity of at least one Axis-I disorder, self-reported moderate-to-severe early emotional or physical neglect, or at least one previous antidepressant treatment, had a significantly lower post-treatment depression severity with CBASP compared to SP (all p < 0.05). Conclusions and relevance: A complex multifactorial interaction between severe symptoms of depression, suicidality, and traumatic childhood experiences characterized by abuse, social inhibition, and anxiety may represent the basis of non-response to psychotherapy in patients with early onset PDD. Specific psychotherapy with CBASP might, however, be more effective and recommendable for a variety of particularly burdened patients compared to SP.

Keywords: CBASP; childhood trauma; moderator analysis; persistent depressive disorder; personalized medicine; predictor analysis; supportive psychotherapy.