Change in RF in IPT and CBT for Major Depressive Disorder

Transcription

1 Change in RF in IPT and CBT for Major Depressive Disorder Annika Ekeblad, PhD, Clinical Psychologist Psychiatric Clinic, County Council of Västernorrland Linköping University

2 Background: The CIPPS project, Psychiatric Clinic, Sundsvall, Sweden 2

3 Aims 3 Compare treatment outcome between CBT and IPT in MDD Study the significance of a potential moderator variable, mentalization Study potential changes in the level of mentalization

4 Background: Mentalization and RF 4 Mentalization: understanding that mental states underlie behavior Operationalization: Reflective function (RF); Depression-specific RF (DSRF); adaptation to depression RF low in patients with MDD; Unclear if cause or effect (or third factor?)

5 Key questions: Mentalization and RF 5 RF changed by treatment or co-varies with depression symptoms? Do different treatment approaches influence RF differently?

6 Study design Assessed for eligibility (n= 99) 8 Excluded (n=3) - Declined to participate (n=3) not randomization (n=1) not video (n=2) RCT of IPT vs CBT in MDD Randomized (n= 96) 96 patients included Few exclusion criteria Satisfactory adherence to treatment models IPT (n=48; 33 women, 15 men) Did not start therapy (n=5; women) Started therapy (n=43) Drop outs (n=8) (4 women, 4 men) Allocation Drop-outs CBT (n=48; 33 women, 15 men) Did not start therapy (n=1; woman) Started therapy (n=47) Drop outs (n=19) (13 women, 6 men) Completers (n=35; 24 women, 11 men) Completers Completers (n=28; 19 women, 9 men)

7 Method: Outcome assessments, predictors and moderators 7 Primary outcome measure BDI-II Secondary outcome measures RF DSRF RTW Drop-out rate Predictors / moderators RF DSRF

8 Method: RF assessment Abbreviated form of AAI (Adult Attachment Interview); rated with RF scale Depression-specific RF scale (DSRF)

9 Depression Specific Reflective Functioning DSRF Interview developed by Fredrik Falkenström Linköping/Stockholm Sweden after Panic specific reflective functioning (PSRF) Barbara Milrod 9

10 Depression Specific Reflective Functioning Interwiev: DSRF -Why do you think you are depressed -Did your thoughts about why you are depressed change over time? -Have you ever noticed that you become more depressed by certain events, thoughts or feelings? 10

11 RF scale 11 Rated from transcriptions of Adult Attachment Interwievs Scale: -1 to 9 from anti-mentalizing to highly reflective Theoretical normal level is 5

12 Results: Outcome trajectories 12

13 Results: Mentalization 13 RF as a predictor: Pre-treatment RF predicted: treatment results alliance No difference between treatment methods RF and DSRF levels: RF increased during IPT treatment (and not in CBT) RF after treatment was still low in depressed patients DSRF did not change over treatment (but significant decrease in DSRF at session 5)

14 RF and DSRF predicting change in depression severity

15 Change in RF from pre- to post treatment Used only patients who completed treatment (N = 63) 56 AAI interviews before treatment 44 AAI interviews after treatment Average pre-post difference 0.32 (t (40) = 2.16, p =.04) Correlation between change in RF and change in BDI-II: r =.11 (ns) 15

16 Change in RF from pre- to post treatment 16 Difference in pre-post change between treatments statistically significant (F (1, 39) = 6.08, p =.02) CBT (N = 18): Pre RF = 2.89, Post RF = 2.92 IPT (N = 24): Pre RF = 2.67, Post RF = 3.27

17 Change in DSRF from pre- to post 17 treatment Used only patients who completed treatment (N = 63) 53 DSRF interviews before treatment 45 DSRF interviews after treatment Average change from pre- to post nonsignificant Difference between treatments in pre- to post change non-significant

18 Clinical implications 18 Potential clinical implications: Supports the value of CBT and IPT for severely depressed patients Drop-outs from CBT Select depressed patients for CBT that are motivated Important to offer different forms of therapy Patients with poor capacity for mentalization not good candidates for these treatments IPT contributed to an increase in RF - but did not result in a normal RF level; make efforts to adapt IPT for the purpose of increasing RF?

19 19 Limitations Large rate of attrition Compensated to some degree by multiple imputation

20 Thank you for listening!