Time to improve and recover from depressive symptoms and interpersonal problems in a clinical trial

28 Oct. 2013 [Epub ahead of print]
Results froman earlier clinical trial comparing narrative therapywith cognitive–behavioural therapy (Lopes
et al., 2013) suggested that narrative therapy is efficacious for depression. However, there were significant
differences in symptom reduction on the Beck Depression Inventory-II, favouring cognitive–behavioural
therapy, if dropouts were included in the analysis, suggesting that time to recovery or improvement would
differ in both treatments. Contrarily, results showed that treatment assignment was not a predictor for differential
effect. Using a survival analytic approach, it was found that four sessions were necessary for 50%
improvement and 16 sessions for 50% recovery. Additionally, depressive symptoms changes occurred
significantly faster than interpersonal changes, again regardless of treatment assignment. These results
support previous findings of the dose–response literature and of the phase model of change, with the advantage
of being specific to psychotherapywith depressive clients. Practitioner Message For 50% of clients with major depressive disorder, it takes four sessions to improve and 16 sessions to recover, regardless of whether they were treated with narrative therapy or cognitive-behavioural therapy. For those clients who recover, they do so by session 11.Clients change depressive symptoms more consistently and much faster than they change interpersonal problems. For clients who will not recover during brief interventions and especially for clients who present strong interpersonal problems at onset, long-term treatment plans should be considered.More emphasis should be laid on symptomatic relief in the early stages of treatment and on interpersonal issues at later stages.
This article was supported by the Portuguese Foundation for Science and Technology (FCT), by the grant PTDC/PSI-PCL/121525/2010 (Ambivalence and unsuccessful psychotherapy, 2011-2014) and by the PhD grant [SFRH/BD/47343/2008]. The authors would like to kindly thank Michael J. Lambert for the valuable input on the data analysis and encouragement. An earlier version of this article was presented at the 43rd International Meeting of the Society for Psychotherapy Research (SPR) held in Virginia Beach, VA, USA, in June 2012.