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Flashcards in The efficacy of CBT for adult depression Deck (22)
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1
Q

What are the 5 R’s to measure outcome in clinical trials?

A
  1. Response
  2. Remission
  3. Recovery
  4. Relapse
  5. Recurrence
2
Q

What does (positive treatment) response correspond to?

A

Severity is 50% of that at the start of the treatment

3
Q

What does remission correspond to?

A

No or few symptoms for 1-2 months

4
Q

What does recovery correspond to?

A

Sustained remission fo between 6-12 months

  • ideally, having remitted and recovered, patents will stay well
  • top up CBT sessions may be offered to help sustain this remission
5
Q

What does relapse correspond to?

A

Episode of depression after remission but before recovery

6
Q

What does recurrence correspond to?

A

Episode of depression after recovery

7
Q

What does an acute phase correspond to?

A

From beginning decline of patient, progression to disorder, until remission

8
Q

What are the two types of predictors?

A

> Non-specific predictors
- associated with overall outcome regardless of treatment

> Moderator
- baseline, or other characteristics, that interact with the treatment and influence the size of the eventual treatment effect

9
Q

What is the typical treatment guidance for severe depression?

A

Antidepressant medication, not CBT

10
Q

Why is antidepressant medication the typical treatment guidance for severe depression, and not CBT?

A

Evidence that depression severity is a moderator of CBT outcome

  • meta-analyses
  • but based on average group-effects across studies, not individual patient outcome
11
Q

Which gap on the treatment guidance for severe depression did the meta-analysis of Weitz and colleagues (2015) address?

A

Previous meta-analyses supporting antidepressant medication for severe depression instead of CBT were based on average group-effects across studies, not individual patient outcome

-> Weitz et al. (2015): individual patient-data meta-analysis

12
Q

What did the individual patient-data meta-analysis of Weitz and colleagues (2015) consist of?

A

> 24 trials, individual data from 16

> 1700 patients CBT vs. medication

> Does baseline severity predict outcome differences between CBT and Medication?

  • change in mean depression scores
  • response
  • remission
13
Q

What were the results of the meta-analysis of Weitz and colleagues (2015)?

A

> Depression severity does not moderate CBT outcome at individual patient level

> Patients with more severe depression show a greater response whatever the treatment

-> Antidepressant medication should not be the automatic first choice treatment for severe depression

14
Q

What are four factors that predict outcome in CBT?

A
  1. Therapist and centre expertise
  2. Patient characteristics
  3. Psychiatric co-morbidity
  4. Dysfunctional attitudes
15
Q

What makes the therapist and centre expertise a predictor of outcome in CBD?

A

> Better outcomes with more experienced therapists

> Better outcomes in specialist centres than in routine clinical settings

> Therapists skill and experience will impact efficacy
- inexperience may be a better gauge for real-world application

16
Q

What makes patient characteristics a predictor of outcome in CBT?

A

> We know little about factors of age, gender, education

> e.g. Married vs. cohabiting patients do better than single patients

17
Q

What makes psychiatric co-morbidity a predictor of outcome in CBT?

A

> Poor response where depression is present with another significant psychiatric disorder

> e.g. STAR*D trial (Farabaugh et al., 2012):

  • standard antidepressant, if no response -> switch treatment (including CBT)
  • patients with depression and anxiety show lower overall remission rates with both CBT and medication

-> co-morbid depression and anxiety is a non-specific predictor of poor treatment outcome, rather than the moderator of CBT outcomes specifically

18
Q

What makes dysfunctional attitudes a predictor of outcome in CBT?

A

High baseline levels of dysfunctional attitudes predict poor treatment outcome to CBT and medication

19
Q

What are dysfunctional attitudes?

A

Set of general beliefs that an individual holds

20
Q

Which factor has been shown to be the most important predictor of relapse in depression?

A

Ending treatment while patient still has residual symptoms of depression, even when meeting criterion for recovery or even short-term remission

21
Q

What does the presence of residual symptoms of depression strongly predict?

A

Relapse

- wether original treatment is psychotherapy, or medication, or their combination

22
Q

What are the various residual symptoms of depression?

A
  • Low mood
  • Irritability
  • Anhedonia
  • Low motivation
  • Social avoidance
  • Dysfunctional attitudes
  • Rumination
  • Sleep disturbance