Detecting Critical Decision Points in Psychotherapy and Psychotherapy plus Medication for Chronic Depression

• Type of Material: Article
• Authors: Dana Steidtmann, Stanford University; Rachel Manber, Stanford University; Christine Blasey, Stanford University; John C. Markowitz, Columbia University; Daniel N. Klein, SUNY Stony Brook; Barbara Rothbaum, Emory University; Michael E. Thase, University of Pennsylvania; James H. Kocsis, Weill Cornell Medical College; Bruce A. Arnow, Stanford University
• Language: English
• Date: 2013-10-01
• Publisher: American Psychological Association
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 American Psychological Association.
• Final Published Version (URL): http://dx.doi.org/10.1037/a0033250
• Title of Journal or Parent Work: Journal of Consulting and Clinical Psychology
• ISSN: 0022-006X
• Volume: 81
• Issue: 5
• Start Page: 783
• End Page: 792
• Grant/Funding Information: This work was supported in part by the National Institute of Mental Health T32-MH019938-18 awarded to Alan F. Schatzberg.; Financial support for data collection was provided by Bristol Myers Squibb.
• Keywords: SEQUENCED TREATMENT ALTERNATIVES; adaptive designs; psychotherapy for depression; OUTCOMES; Social Sciences; STAR-ASTERISK-D; PHARMACOTHERAPY; FEEDBACK; INVENTORY; COMBINATION; ANTIDEPRESSANTS; Psychology, Clinical; STRATEGIES; receiver operating curve; RATIONALE; chronic depression; psychotherapy nonremission; Psychology
• Research Categories: Psychology, Clinical; Health Sciences, Pharmacology

Abstract

Objective: We sought to quantify clinical decision points for identifying depression treatment nonremitters prior to end-of-treatment. Method: Data came from the psychotherapy arms of a randomized clinical trial for chronic depression. Participants (n = 352; 65.6% female; 92.3% White; mean age = 44.3 years) received 12 weeks of cognitive behavioral analysis system of psychotherapy (CBASP) or CBASP plus an antidepressant medication. In half of the sample, receiver operating curve analyses were used to identify efficient percentage of symptom reduction cut points on the Inventory of Depressive Symptoms-Self-Report (IDS-SR) for predicting end-of-treatment nonremission based on the Hamilton Rating Scale for Depression (HRSD). Sensitivity, specificity, predictive values, and Cohen's kappa for identified cut points were calculated using the remaining half of the sample. Results: Percentage of IDS-SR symptom reduction at Weeks 6 and 8 predicted end-of-treatment HRSD remission status in both the combined treatment (Week 6 cut point = 50.0%, Cohen's κ =.42; Week 8 cut point = 54.3%, Cohen's κ =.45) and psychotherapy only (Week 6 cut point = 60.7%, Cohen's κ =.41; Week 8 cut point = 48.7%, Cohen's κ =.49). Status at Week 8 was more reliable for identifying nonremitters in psychotherapy-only treatment. Conclusions: Those with chronic depression who will not remit in structured, time-limited psychotherapy for depression, either with therapy alone or in combination with antidepressant medication, are identifiable prior to end of treatment. Findings provide an operationalized strategy for designing adaptive psychotherapy interventions.