Efficacy of Ultrabrief Cognitive and Behavioural Therapy Performed by Psychiatric Residents on Depressed Inpatients

study for ethical reasons, there was no significant difference in terms of type, duration and doses between the 2 groups. The mean age was 48.4 8 12.7 years and there was no difference in any measured variable – age, gender, professional and marital status, time between inclusion in study and admission to hospital, length and severity of actual MDD, and personality traits – between the 2 treatment groups. It was the first depressive episode for 2 patients in the UCBT group and for 4 in the TAU group, and 2 patients in the UCBT group were considered as refractory ( 1 2 years), but none in the TAU group. The main outcome measures were 2 scales measuring depressive disorder intensity: the 17-item clinicianrated HAM-D [15] and the 21-item self-rated BDI-II [16] . The secondary outcome measures were therapeutic alliance evaluated by the 19-item clinician and patient versions of the Luborsky Helping Alliance questionnaire (HAq) [17] and the remission rates in each group. As therapeutic alliance may depend on the therapists’ confidence in their own skills [18] , we hypothesized that therapists receiving structured clinical guidelines through UCBT would feel more self-confident, resulting in an improved therapeutic alliance. Participants were assessed by the HAM-D and BDI-II at baseline and after 6 sessions of either UCBT or TAU. The clinicians performing the psychotherapy were also assessed by the HAq at baseline and at the end of the 6 sessions. The BDI-II was also administered 2 months after the end of treatment via a telephone interview. There were 4 treating therapists in the UCBT group and 5 in the TAU group. All were psychiatric residents and had no specific ability in any form of psychotherapy. The therapists for the UCBT group received 4 h of training in UCBT and a treatment manual. Furthermore, their practice was supervised once weekly by a senior psychotherapist certified by the French CBT Association. The 6 UCBT sessions included psychoeducation about depressive disorder and the CBT model of depressive disorder during the first session. Each session began by planning activities and setting goals for the next session. During sessions 2–5, automatic thoughts were also examined. Sessions 3–5 focused on cognitive restructuring including alternative thoughts and cognitive distortions, while the recognition of potential dysfunctional schemas identified through painful situations was the focus of sessions 5 and 6. For the TAU group, the sessions were not structured and consisted of symptom severity assessment, biography exploration and supportive sessions. All patients received the same number of 45-min-long sessions. UCBT replaced TAU sessions. Repeated measures t tests showed significant preto posttreatment decreases in HAM-D and BDI-II scores in both groups ( table 1 ). A mixed-model ANOVA with 1 between-group factor (UCBT vs. TAU) and 1 within-group factor (baseline vs. posttreatment symptom rating) revealed a significant group-bytime interaction on the posttreatment HAM-D (F = 6.66; p = 0.018), suggesting greater improvement in the UCBT group than in the TAU group. The effect of time was also significant (F = Depression is a major public health problem. Reference treatments consist of both psychotherapy and pharmacotherapy. Although cognitive and behavioural therapy (CBT) has been shown to be efficient in major depressive disorder (MDD) [1–3] , studies assessing its efficacy among inpatients are scarce [4–11] . To date, only 2 studies have explored ultrabrief cognitiveor behaviouralbased therapies in the hospital setting. The first reported the superiority of behavioural therapy over supportive therapy [12] , while the second failed to show any differences between cognitive or behavioural therapies and supportive therapy [13] . We report the results of a randomized, controlled study comparing the efficacy of 6 sessions of ultrabrief cognitive and behavioural therapy (UCBT) to treatment as usual (TAU) in 22 inpatients suffering from MDD admitted because of symptom severity or suicidal ideations. We hypothesized that improvement in depressive symptoms as measured by the Hamilton Depression Rating Scale (HAM-D) and the Beck Depression Inventory (BDIII) in inpatients suffering from MDD would be greater in the UCBT group than in the TAU group. We also hypothesized that the increase in therapeutic alliance would be larger in the UCBT group. Diagnosis of MDD was made by 2 psychiatrists according to DSM-IV-TR criteria [14] with a structured interview. Participants (aged 1 18 years) were provided with information about the study and were asked to sign a consent form. In order to keep the patients blinded, they were told they would receive an efficacious pharmacological treatment adapted to their condition and would be randomized to either the ‘usual interviews’ (TAU) or ‘more structured interviews’ (UCBT). Inclusion criteria were diagnosis of MDD, exclusion criteria were delusion symptoms or dementia. There were 11 patients in each group (7 females and 4 males). The therapists were randomly assigned to 1 of the 2 arms (i.e. 4 therapists received UCBT training and 5 administered TAU) using a randomization table, and patients were assigned to the therapist on call on the day of their admission, the on-call schedule having been randomly determined in advance. Both UCBT and TAU were performed by psychiatric residents over a 2-week period. All patients were on antidepressants, and although doses did not stay stable during the Received: April 9, 2010 Accepted after revision: December 2, 2010 Published online: September 28, 2011