JustKiddo/KiddosVault huggingface dataset:
Whole-Body Hyperthermia for the Treatment of Major Depressive Disorder: A Randomized Clinical Trial.

Limitations of current antidepressants highlight the need to identify novel treatments for major depressive disorder. A prior open trial found that a single session of whole-body hyperthermia (WBH) reduced depressive symptoms; however, the lack of a placebo control raises the possibility that the observed antidepressant effects resulted not from hyperthermia per se, but from nonspecific aspects of the intervention. To test whether WBH has specific antidepressant effects when compared with a sham condition and to evaluate the persistence of the antidepressant effects of a single treatment. A 6-week, randomized, double-blind study conducted between February 2013 and May 2015 at a university-based medical center comparing WBH with a sham condition. All research staff conducting screening and outcome procedures were blinded to randomization status. Of 338 individuals screened, 34 were randomized, 30 received a study intervention, and 29 provided at least 1 postintervention assessment and were included in a modified intent-to-treat efficacy analysis. Participants were medically healthy, aged 18 to 65 years, met criteria for major depressive disorder, were free of psychotropic medication use, and had a baseline 17-item Hamilton Depression Rating Scale score of 16 or greater. A single session of active WBH vs a sham condition matched for length of WBH that mimicked all aspects of WBH except intense heat. Between-group differences in postintervention Hamilton Depression Rating Scale scores. The mean (SD) age was 36.7 (15.2) years in the WBH group and 41.47 (12.54) years in the sham group. Immediately following the intervention, 10 participants (71.4%) randomized to sham treatment believed they had received WBH compared with 15 (93.8%) randomized to WBH. When compared with the sham group, the active WBH group showed significantly reduced Hamilton Depression Rating Scale scores across the 6-week postintervention study period (WBH vs sham; week 1: -6.53, 95% CI, -9.90 to -3.16, P<.001; week 2: -6.35, 95% CI, -9.95 to -2.74, P=.001; week 4: -4.50, 95% CI, -8.17 to -0.84, P=.02; and week 6: -4.27, 95% CI, -7.94 to -0.61, P=.02). These outcomes remained significant after evaluating potential moderating effects of between-group differences in baseline expectancy scores. Adverse events in both groups were generally mild. Whole-body hyperthermia holds promise as a safe, rapid-acting, antidepressant modality with a prolonged therapeutic benefit. clinicaltrials.gov Identifier: NCT01625546.
Examination of the utility of psychotherapy for patients with treatment resistant depression: a systematic review.

To examine the utility of psychotherapy in managing treatment resistant depression. PubMed, PsycInfo, Embase, Cochrane Registry of Controlled Clinical Trials, article bibliographies. Eligible articles had to be in English and include English-speaking adult outpatients from general medical or mental health clinics. Studies had to be randomized clinical trials (RCT) involving at least one of the following psychotherapy modalities: cognitive therapy, interpersonal therapy, or behavior therapy. Patients were considered treatment resistant if they reported partial or no remission following treatment with an adequate antidepressant dose for ≥ 6 weeks. Exclusion criteria included receiving psychotherapy at the time of recruitment, and/or comorbid psychiatric conditions unlikely to be treated outside of specialized mental health care (e.g., severe substance abuse). Due to heterogeneity in study designs, a summary estimate of effect was not calculated. Studies were critically analyzed and a qualitative synthesis was conducted. Of 941 original titles, 13 articles evaluating 7 unique treatment comparisons were included. Psychotherapy was examined as an augmentation to antidepressants in five studies and as substitution treatment in two studies. A total of 592 patients were evaluated (Mean age ~40 y; Females = 50-85%; Caucasians ≥ 75%). The STAR*D trial used an equipoise stratified randomization design; the remaining studies were RCTs. Compared to active management, two good quality trials showed similar benefit from augmenting antidepressants with psychotherapy; one fair quality and one poor quality trial showed benefit from psychotherapy augmentation; and one good and one poor trial found similar benefit from substituting psychotherapy for antidepressants. One fair quality trial showed lithium augmentation to be more beneficial than psychotherapy. Review demonstrates the utility of psychotherapy in managing treatment resistant depression. However, evidence is sparse and results are mixed. Given that quality trials are lacking, rigorous clinical trials are recommended to guide practice. In the interim, primary care providers should consider psychotherapy when treating patients with treatment resistant depression.
Does psychological process change during psychotherapy predict long-term depression outcome after successful cognitive therapy or interpersonal psychotherapy? Secondary analysis of a randomized trial.

Objective Psychotherapies for depression are similarly effective, but the processes through which these therapies work have not been identified. We focus on psychological process changes during therapy as predictors of long-term depression outcome in treatment responders. Method: Secondary analysis of a randomized trial comparing cognitive therapy (CT) and interpersonal psychotherapy (IPT) that focuses on 85 treatment responders. Using mixed-effects models, changes during therapy (0-7 months) on nine process variables were associated with depression severity (BDI-II) at follow-up (7-24 months). Results: A decrease in dysfunctional attitudes was associated with a decrease in depression scores over time. Improved self-esteem was associated with less depression at follow-up (borderline significant). More improvement in both work and social functioning and interpersonal problems was associated with better depression outcomes in IPT relative to CT, while less improvement in work and social functioning and interpersonal problems was associated with better outcomes in CT relative to IPT. Conclusions: Less negative thinking during therapy is associated with lower depression severity in time, while changes during therapy in work and social functioning and interpersonal problems appear to predict different long-term outcomes in CT vs. IPT. If replicated, these findings can be used to guide clinical decision-making during psychotherapy.
Identifying relapse prevention elements during psychological treatment of depression: Development of an observer-based rating instrument.

Although observer-rated instruments assessing therapist's adherence to relapse-preventive treatments are available, they do not adequately cover specific relapse-preventive elements that focus on implementation of strategies after terminating treatment. This study describes the development of the KERI-D (Kodierbogen zur Erfassung Rückfallprophylaktischer Interventionen bei Depression/Coding System to Assess Interventions of Relapse Prevention in Depression). The KERI-D is a new observer-based rating tool for acute or continuation/maintenance-phase sessions and assesses relapse-prevention elements including implementation into patient's daily routines. The development of the KERI-D included iterative steps referring to theoretical, clinical and empirical sources. It consists of 19 content items within four categories (self-care, early warning signs, triggering events/situations, termination of therapy) and one global item. For empirical analyses, videotaped psychotherapy sessions of 36 psychotherapies were rated by three independent observers and analyzed for their psychometric properties. Most items showed moderate to good inter-rater reliability (median ICC = .80) and retest reliability (median ICC = .93). Principal-axis factor analysis revealed three subscales, and first evidence of content validity was demonstrated. No associations with clinical follow-up data were found. Analysis was limited to a relatively small sample of selected psychotherapy sessions. Evaluation of predictive validity is a desirable next step to further examine applicability and scope of the instrument. The KERI-D is the first observer-based rating instrument measuring specific relapse-prevention strategies in psychotherapy for depression. It may help to identify elements that prove effective in reducing relapse/recurrence in the long-term and thereby help to optimize effect duration of depression treatment.
The clinical effectiveness of cognitive behavior therapy and an alternative medicine approach in reducing symptoms of depression in adolescents.

The main aim of the study was to investigate the effectiveness of two psychotherapeutic approaches, cognitive behavioral therapy (CBT) and a complementary medicine method Reiki, in reducing depression scores in adolescents. We recruited 188 adolescent patients who were 12-17 years old. Participants were randomly assigned to CBT, Reiki or wait-list. Depression scores were assessed before and after the 12 week interventions or wait-list. CBT showed a significantly greater decrease in Child Depression Inventory (CDI) scores across treatment than both Reiki (p<.001) and the wait-list control (p<.001). Reiki also showed greater decreases in CDI scores across treatment relative to the wait-list control condition (p=.031). The analyses indicated a significant interaction between gender, condition and change in CDI scores, such that male participants showed a smaller treatment effect for Reiki than did female participants. Both CBT and Reiki were effective in reducing the symptoms of depression over the treatment period, with effect for CBT greater than Reiki. These findings highlight the importance of early intervention for treatment of depression using both cognitive and complementary medicine approaches. However, research that tests complementary therapies over a follow-up period and against a placebo treatment is required.
Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention.

Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders. To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD) in people with subthreshold depression (sD). A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs) were assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Costs were self-assessed through a questionnaire. Costs measured from a societal and health care perspective were related to DFYs and quality-adjusted life years (QALYs). In total, 406 participants were enrolled in the trial. The mean treatment duration was 5.84 (SD 4.37) weeks. On average, participants completed 4.93 of 6 sessions. Significantly more DFYs were gained in the intervention group (0.82 vs 0.70). Likewise, QALY health gains were in favor of the intervention, but only statistically significant when measured with the more sensitive SF-6D. The incremental per-participant costs were €136 (£116). Taking the health care perspective and assuming a willingness-to-pay of €20,000 (£17,000), the intervention's likelihood of being cost-effective was 99% for gaining a DFY and 64% or 99% for gaining an EQ-5D or a SF-6D QALY. Our study supports guidelines recommending Web-based treatment for sD and adds that this not only restores health in people with sD, but additionally reduces the risk of developing a MDD. Offering the intervention has an acceptable likelihood of being more cost-effective than enhanced usual care and could therefore reach community members on a wider scale. German Clinical Trials Register: DRKS00004709; http://www.drks.de/DRKS00004709 (Archived by WebCite at http://www.webcitation.org/6kAZVUxy9).
A comparison of transdiagnostic behavior therapy (TBT) and behavioral activation treatment for depression (BATD) in veterans with major depressive disorder.

Although frequently discussed within the scope of transdiagnostic psychotherapy protocols, limited data are available on their efficacy in patients with a principal diagnosis of major depressive disorder. The present study attempted to address that gap in the literature through a randomized clinical trial comparing transdiagnostic behavior therapy (TBT) to behavioral activation treatment for depression (BATD). Forty veterans with principal major depressive disorder were randomized into either 12 sessions of individual TBT or BATD, with symptom measures collected at baseline and posttreatment. Process variables for treatment engagement and completion also were recorded. Participants reported similar symptom improvements in depression, stress, anhedonia, and impairment across both treatments. Clinician-rated treatment improvements favored TBT. Participants in TBT also attended more appointments, canceled or missed fewer appointments, and completed the protocol at a higher rate than participants that received BATD. The present findings support TBT as an efficacious treatment for principal major depressive disorder, with potentially superior coverage of comorbid anxiety symptomatology and improved treatment adherence and completion compared to BATD. Pending replication in larger samples, TBT and other similar transdiagnostic psychotherapies should be considered for implementation across the anxiety and depressive disorders to simplify dissemination efforts for evidence-based psychotherapies and potentially improve coverage of comorbidity.
Effectiveness of stress control large group psychoeducation for anxiety and depression: Systematic review and meta-analysis.

This review sought to evaluate the effectiveness of the 'Stress Control' (SC) large psychoeducational 6-session group programme developed to increase access to treatment for patients with anxiety and depression. Systematic review and meta-analysis (Prospero registration: CRD42020173676). Pre-post and post-treatment follow-up effect sizes were extracted and synthesized in a random effects meta-analysis, and variations in effect sizes were investigated via moderator analyses. Secondary analyses synthesized between-group effect sizes from controlled studies containing comparator treatments and calculated the average dropout rate. The quality of the meta-analysis was assessed using the GRADE approach. Nineteen studies with pre-post treatment outcomes were included. The average group size was N = 39, and the average dropout rate was 34%. Pooled effect sizes indicated moderate pre-post treatment reductions in anxiety (ES = 0.58; CI 0.41 to 0.75; N = 5597; Z = 7.13; p < .001), moderate reductions in depression (ES = 0.62; CI 0.44 to 0.80; N = 5538, Z = 7.30; p < .001), and large reductions in global distress (ES = 0.86; CI 0.61 to 1.11; N = 591; Z = 7.41; p < .001). At follow-up, improvements in anxiety, depression, and global distress were maintained. When SC was compared to active and passive controls, outcomes were equivalent for anxiety (ES = 0.12, 95% CI -0.25 to 0.49, Z = -0.70; p = .482) and depression (ES = 0.15, 95% CI -0.24 to 0.54, Z = 0.84; p = .401). SC appears to be a clinically effective and durable low-intensity group intervention that facilitates access to treatment for large patient numbers. However, conclusions are limited by the low methodological quality of the evidence. The stress control version of large group psychoeducation is appropriate and effective for mild-to-moderate anxiety and depression The evidence base for stress control is predominantly made up of practice-based studies Stress control needs to form one component of the overall offer made to patients presenting with mild-to-moderate anxiety and depression The competencies required to deliver such groups need better specification.
The clinical effectiveness of an algorithm-guided treatment program for depression in specialized mental healthcare: A comparison with efficacy trials.

Doubts exist on whether effects found in randomized controlled trials (RCTs) are directly generalizable to daily clinical practice. This study aimed (a) to investigate the effectiveness of treatment options within an algorithm-guided treatment (AGT) program for depression and compare their effectiveness with outcomes of efficacy trials and (b) to assess the relation between treatment continuity and outcomes. This naturalistic study linked treatment data from January 2012 to November 2014 from a Dutch mental healthcare provider, to routine outcome monitoring (ROM) data (N = 351). Effectiveness of the treatment options (pharmacotherapy, psychotherapy and their combination) was compared to the efficacy reported in the meta-analyses. We included treatment continuity as binary variable "early terminators versus completers of the recommended number of treatment sessions". Remission rates for psychotherapy (38% [95% CI: 32-45]), pharmacotherapy (31% [95% CI: 22-42]) and combination therapy (46% [95% CI: 19-75]) were respectively lower, comparable, and comparable to those reported in the meta-analyses. Similarly, response rates were respectively lower (24% [95% CI: 19-30]), lower (21% [95% CI: 13-31]), and comparable (46% [95% CI: 19-75]) to meta-analyses results. A similar share of early terminators and completers achieved remission and response. A substantial proportion of patients had incomplete ROM data after data linkage. Limited set of patient characteristics to check for selection bias. Despite the more heterogeneous patient population in clinical practice, the effectiveness of an AGT program, emphasizing strict guideline adherence, approached that found in RCTs. A fixed number of treatment sessions may not suit all individual patients.
Improving outcomes for patients with depression by enhancing antidepressant therapy with non-pharmacological interventions: a systematic review of reviews.

To analyse literature reviews reporting outcomes of non-pharmacological interventions directed at improving the treatment of depression. A review of English articles was performed in June 2009 using the following databases: PubMed, EMBASE, International Pharmaceutical Abstracts, Web of Science, PsycINFO and the Cochrane Library. Only review articles comparing traditional pharmacotherapy and interventions combining pharmacological and non-pharmacological treatments were included. Extraction of articles and quality assessment of included reviews was performed independently by two authors using the AMSTAR score. The articles in the final data set included research on psychotherapeutic, multifaceted and single-component interventions. Single-component interventions have failed to demonstrate improved outcome for patients with depression. Collaborative care and additional psychotherapy have been shown to provide more benefits for patients than pharmacotherapy alone. Both approaches have a small effect on short-term treatment, and psychotherapy is the most effective for long-term prognosis in terms of preventing relapse. Conclusions regarding the effects of adherence-improving and multifaceted interventions are fairly certain. However, the findings about the impact of combined psychotherapy and pharmacotherapy on the outcomes of depression remain tentative due to the methodological limitations of available reviews.
Comparative efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus supportive psychotherapy for early onset chronic depression: design and rationale of a multisite randomized controlled trial.

Effective treatment strategies for chronic depression are urgently needed since it is not only a common and particularly disabling disorder, but is also considered treatment resistant by most clinicians. There are only a few studies on chronic depression indicating that traditional psycho- and pharmacological interventions are not as effective as in acute, episodic depression. Current medications are no more effective than those introduced 50 years ago whereas the only psychotherapy developed specifically for the subgroup of chronic depression, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), faired well in one large trial. However, CBASP has never been directly compared to a non-specific control treatment. The present article describes the study protocol of a multisite parallel-group randomized controlled trial in Germany. The purpose of the study is to estimate the efficacy of CBASP compared to supportive psychotherapy in 268 non-medicated early-onset chronically depressed outpatients. The intervention includes 20 weeks of acute treatment with 24 individual sessions followed by 28 weeks of continuation treatment with another 8 sessions. Depressive symptoms are evaluated 20 weeks after randomisation by means of the 24-item Hamilton Rating Scale of Depression (HRSD). Secondary endpoints are depressive symptoms after 12 and 48 weeks, and remission after 12, 20, and 48 weeks. Primary outcome will be analysed using analysis of covariance (ANCOVA) controlled for pre-treatment scores and site. Analyses of continuous secondary variables will be performed using linear mixed models. For remission rates, chi-squared tests and logistic regression will be applied. The study evaluates the comparative effects of a disorder-specific psychotherapy and a well designed non-specific psychological approach in the acute and continuation treatment phase in a large sample of early-onset chronically depressed patients. ClinicalTrials.gov (NCT00970437).
Effects of Early-Stage Group Psychoeducation Programme for Patients with Depression.

The purpose of this study was to examine the effect of a psychoeducational group programme on inpatients with depression. We compared the attributes and Inventory Scale for Mood and Sense of Fatigue (SMSF) scores of 45 people who participated in the programme (participation group) with those of 37 people who did not participate (control group). Further, we investigated the rate of readmission 6 months after discharge and the number of patients in the participation group who had consulted a psychiatric social worker. Statistically, there were no significant differences in the SMSF score between the two groups on admission and at the time of discharge. The programme had no effect on the readmission rate. However, the SMSF score of the participation group significantly improved from the start of the programme to patient discharge. Furthermore, improvement of depressive symptoms, feeling of recovery and adherence were found in the participation group. The programme seemed to provide a psychotherapeutic effect for the patients and promoted cooperation with occupational therapist and other specialists in the hospital. The efficacy of psychoeducation in preventing recurrence of depression remains to be demonstrated, and methods of investigating effective approaches for this purpose need to be considered in the future.