by Practice Research and Policy Staff
This article is the first in a series of research summaries that pertain to professional psychology. The APA Practice Organization (APAPO) plans to include these summaries, representing a small selection of recent research, periodically in PracticeUpdate. We anticipate a topical focus, beginning with this one on depression. APAPO welcomes your feedback and suggestions about topics that would interest you.
October 28, 2009 — Symptoms of depression are common presenting complaints in psychological practice. Many psychologists are skilled at helping clients overcome their depression. The following articles published in 2009 focus on the treatment of depression and may provide new insights to assist psychologists in providing effective and responsive care for their clients.
Fournier, J. C., DeRubeis, R. J., Shelton, R. C., Hollon, S. D., Amsterdam, J. D., & Gallop, R. (2009). Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression. Journal of Consulting and Clinical Psychology, 77, 775-787.
Summary: A recent randomized controlled trial (RCT) assigned 60 individuals to receive outpatient cognitive therapy for their depression and 120 individuals to receive antidepressant medication. Across both treatments, each offered for 16 weeks, those individuals who were chronically depressed, older or lower in intelligence experienced relatively poorer response to treatment compared to others involved in the study. The authors suggest that presence of one or more of these characteristics may indicate a need for a treatment other than those provided in the study.
Additional study may answer whether a longer treatment or a modified version of the treatment offered may yield more positive outcomes for individuals with these characteristics, or whether alternative treatments yield greater benefits. Three variables were found to predict a superior response to cognitive therapy relative to antidepressant medications: marriage (or cohabitation); unemployment; and, having experienced a greater number of stressful (positive and negative) recent life events.
Practical considerations: The findings may be useful to psychologists when discussing treatment options and recommendations with individuals, their families and their health care providers.
Ellison, J. A., Greenberg, L. S., Goldman, R. N., & Angus, L. (2009). Maintenance of gains following experiential therapies for depression. Journal of Consulting and Clinical Psychology, 77, 103-112.
Summary: Two short-term, experiential psychotherapies for individuals with depression were compared in a randomized controlled trial. Both treatments used a client-centered approach, but one was enhanced by the addition of emotion-focused interventions to address affective-cognitive problems.
Across both conditions, clients made gains that were maintained at 6 months. However, at an 18-month follow-up, those individuals who had received treatment with emotion-focused interventions showed more improvement on measures of depressive symptomatology and self-esteem. These clients also reported using the emotional processing skills learned in therapy to help address distressing life events.
Practical considerations: Psychologists may want to consider adding specific experiential strategies — such as "two chair dialogues" to engage the client's inner critical voice — that facilitate self acceptance, development of new meanings of situations and letting go of negative affect in order to enhance treatment outcomes for depressed patients.
Yonkers, K.A., Wisner, K.L., Stewart, D.E., Oberlander, T.F., Dell, D.L., Stotland, N., Ramin, S., Chaudron, L., & Lockwood, C. (2009). The management of depression during pregnancy: A report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. General Hospital Psychiatry, 31, 403-413.
Summary: Representatives from the American Psychiatric Association, the American College of Obstetricians and Gynecologists and a consulting developmental pediatrician reviewed articles on fetal and neonatal outcomes associated with depression and antidepressant treatment during childbearing. Both depressive symptoms and antidepressant exposure are associated with fetal growth changes and shorter gestations, but the majority of studies that evaluated antidepressant risks were unable to control for the possible effects of a depressive disorder.
It is important for pregnant women to receive treatment for their depression. Psychotherapy alone is an appropriate treatment for many women, an important consideration since some women are concerned about taking antidepressant medication while they are pregnant. Yet pregnant women with more severe depression — including repeated episodes and/or thoughts of suicide — need to consider the possible effect of discontinuing their medication, including the risk of increased symptoms.
Practical considerations: Psychologists may wish to discuss with depressed patients who are pregnant the importance of treatment for their depression and help these women weigh the relative risks and benefits of psychotherapy and pharmacotherapy in relieving depression.
Joiner, T.E., Van Orden, K.A., Witte, T.K., Selby, E.A., Ribeiro, J.D., Lewis, R., & Rudd, M.D. (2009). Main predictions of the interpersonal-psychological theory of suicidal behavior: Empirical tests in two samples of young adults. Journal of Abnormal Psychology, 118, 634-646.
Summary: Joiner's interpersonal-psychological theory of suicidal behavior proposes that an individual will not die by suicide unless he or she has both the desire and the capability to do so.
A community sample of young adults (ages 19-26) were surveyed regarding depressive symptoms, suicidal ideation, perceptions of mattering to others, and family social support. Those who perceived less family social support and less "mattering" (suggesting feelings of personal burdensomeness and social alienation) reported more depressive symptoms and suicidality.
A second study evaluated young adults seeking treatment for suicidality. Those with a history of suicide attempts, high perceived burdensomeness and low belonging were more likely to have current suicidal behavior.
Practical considerations: Psychologists treating depressed individuals will want to carefully assess for history of suicidality and suicide attempts, as the latter suggests the capability to commit suicide. In addition, psychologists will want to assess for desire to commit suicide by evaluating perceptions of social alienation and burdensomeness to others in order to identify those clients more likely to attempt suicide, and provide appropriate clinical interventions where indicated.
Note: Subscribers to PsycNet can read articles published in APA journals. Other articles may be accessible through Medline or other databases.