Center for Economics and Neuroscience, University of Bonn, Nachtigallenweg 86, D-53127, Bonn, Germany; Institute of Experimental Epileptology and Cognition Research, University of Bonn, Sigmund-Freud-Strasse 25, D-53127, Bonn, Germany.
Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Charitéplatz 1, D-10117, Berlin, Germany.
Behav Res Ther. 2020 Jan;124:103512. doi: 10.1016/j.brat.2019.103512. Epub 2019 Nov 4.
Does the pre-treatment profile of individuals with persistent depressive disorder (PDD) moderate their benefit from disorder-specific Cognitive Behavioral System of Psychotherapy (CBASP) versus supportive psychotherapy (SP)? We investigated this question by analyzing data from a multi-center randomized clinical trial comparing the effectiveness of 48 weeks of CBASP to SP in n = 237 patients with early-onset PDD who were not taking antidepressant medication. We statistically developed an optimal composite moderator as a weighted combination of 13 preselected baseline variables and used it for identifying and characterizing subgroups for which CABSP may be preferable to SP or vice versa. We identified two distinct subgroups: 58.65% of the patients had a better treatment outcome with CBASP, while the remaining 41.35% had a better outcome with SP. At baseline, patients responding more favorably to CBASP were more severely depressed and more likely affected by moderate-to-severe childhood trauma including early emotional, physical, or sexual abuse, as well as emotional or physical neglect. In contrast, patients responding more favorably to SP had a higher pre-treatment global and social functioning level, a higher life quality and more often a recurrent illness pattern without complete remission between the episodes. These findings emphasize the relevance of considering pre-treatment characteristics when selecting between disorder-specific CBASP and SP for treating PDD. The practical implementation of this approach would advance personalized medicine for PDD by supporting mental health practitioners in their selection of the most effective psychotherapy for an individual patient.
患有持续性抑郁障碍（PDD）的个体的治疗前特征是否会影响他们从特定于障碍的认知行为系统疗法（CBASP）与支持性心理疗法（SP）中获益？我们通过分析一项比较 48 周 CBASP 与 SP 在 n = 237 名未服用抗抑郁药的早期 PDD 患者中的有效性的多中心随机临床试验数据来研究这个问题。我们通过统计方法开发了一个最佳综合调节变量，作为 13 个预选基线变量的加权组合，并使用它来识别和描述亚组，在这些亚组中，CBASP 可能优于 SP，反之亦然。我们确定了两个不同的亚组：58.65%的患者接受 CBASP 治疗的效果更好，而其余 41.35%的患者接受 SP 治疗的效果更好。在基线时，对 CBASP 反应更有利的患者抑郁程度更严重，更有可能受到中度至重度儿童创伤的影响，包括早期的情感、身体或性虐待，以及情感或身体忽视。相比之下，对 SP 反应更有利的患者治疗前的总体和社会功能水平更高，生活质量更高，更常出现反复发作的疾病模式，而在发作之间没有完全缓解。这些发现强调了在选择针对 PDD 的特定于障碍的 CBASP 和 SP 时考虑治疗前特征的重要性。这种方法的实际实施将通过支持心理健康从业者为个体患者选择最有效的心理疗法，为 PDD 的个性化医学提供支持。
