That was the question at the center of a recent study led by Sarah R. Braun of the University of Vienna in Austria. Braun and her colleagues chose to focus on bona fide treatments for depression and examine which of these approaches provide the best outcomes based on clinician and client ratings. “Bona fide” implies that a treatment adheres to high clinical standards and that it be intended for a clear therapeutic purpose with a distinct and specific motivation.
Some bona fide approaches for the treatment of depression, and those included in Braun’s study were cognitive behavioral therapy (CBT), non-CBT therapies such as psychodynamic therapy and behavior activation therapy, and finally, supportive therapies that comprised new and alternative methods, both bona fide and others.
Braun used 53 existing research studies to conduct her analysis. She utilized two methods of evaluation; the traditional meta-analysis and the mixed comparison or network meta-analysis. She looked at age, gender, comorbid conditions, length of therapy session, and symptom levels to arrive at her conclusions.
Her findings revealed that although specific approaches did emerge as more effective than others, there were conditions that influenced those outcomes. However, in general, supportive and alternative therapies were less effective than any of the bona fide therapies examined in this study. Broken down by therapy type, cognitive behavioral therapy appeared superior when the sessions were longer than 90 minutes, but when they were shorter, behavior activation therapy proved more beneficial.
Further, women responded better to CBT than men, but older individuals had better outcomes with behavior activation therapy, but only when it was conducted on an individual versus group level. Another interesting finding was that individuals with comorbid anxiety and depression saw the most significant improvements with CBT.
Surprisingly, Braun also found that some of the newest approaches resulted in the most positive outcomes, at least on an individual level. Self-esteem therapy, problem solving therapy, and cognitive behavioral analysis, treatments designed specifically for depression, all had very positive results, although the sample sizes studied were small compared to samples studied in other approaches. Additionally, clinical significance for supportive therapies was not consistent with the positive outcomes reported by clients and clinicians.
In sum, this study shows that there are a myriad of factors that influence treatment outcome above and beyond therapeutic approach. Braun added, “Future research should address patient characteristics, like gender, age or comorbid mental disorders, more explicitly and determine which treatments work best with which group of patients.”
Braun, S.R., Gregor, B., Tran, U.S. (2013). Comparing bona fide psychotherapies of depression in adults with two meta-analytical approaches. PLoS ONE 8(6): e68135. doi:10.1371/journal.pone.0068135
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