A Comparison of Cognitive and Dynamic Therapy for Depression in Community Settings

Study Overview
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Brief Summary
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The goal of this study is to compare supportive-expressive therapy, a type of psychodynamic psychotherapy, with cognitive therapy for the treatment of depression in community mental health consumers. Hypothesized mediators of treatment will also be examined.

Detailed Description
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The goal of this study is to conduct a randomized, comparative, non-inferiority clinical trial that tests the hypothesis that a widely used form of manualized dynamic psychotherapy (supportive-expressive psychodynamic therapy) is not inferior to cognitive therapy when implemented in community mental health settings for the treatment of major depressive disorder (MDD). The specific aims are (1) to conduct a randomized non-inferiority trial to compare supportive-expressive psychodynamic therapy and cognitive therapy for patients with MDD and (2) to assess the comparative effectiveness of supportive-expressive psychodynamic therapy and cognitive therapy on secondary measures of symptoms, patient functioning, and quality of life. Patient mediators of outcome will also be examined through an additional grant awarded to Paul Crits-Christoph, Ph.D. This grant was funded by the National Institutes of Mental Health - RO1MH092363-01. This grant is entitled:The mechanisms of cognitive and dynamic therapy in community settings. Recruitment will occur solely through community mental health clinics in and around Philadelphia.

Official Title
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A Comparison of Cognitive and Dynamic Therapy for MDD in Community Settings

Conditions
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Major Depressive Disorder

Intervention / Treatment
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* Behavioral: Cognitive Therapy
* Behavioral: Supportive-Expressive Psychodynamic Therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Confirmed diagnosis of major depressive disorder Able to read at the 4th grade level or higher Willingness to be randomized and participate in research Exclusion Criteria: Current or past diagnosis of schizophrenia, seizure disorder, bipolar disorder, psychotic features, or clinically significant organic pathology Significant suicidal risk/ideation requiring immediate referral for more intensive treatment, or specific gesture in the last 6 months Current substance abuse or dependence requiring immediate referral to substance abuse program Acute medical problem requiring immediate inpatient treatment Need for referral to a partial hospitalization program

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cognitive Therapy<br> | Behavioral: Cognitive Therapy<br>* 16 sessions of cognitive therapy administered weekly by a community mental health therapist<br>* Other names: CBT;|
| Experimental: Dynamic Therapy<br> | Behavioral: Supportive-Expressive Psychodynamic Therapy<br>* 16 sessions of supportive-expressive psychodynamic therapy administered weekly by a community mental health therapist<br>* Other names: Short Term Dynamic Therapy;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hamilton Rating Scale for Depression (HAM-D) |  | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| BASIS-24 |  | 6 months | 
| Beck Depression Inventory - II (BDI-II) |  | 6 months | 
| Medical Outcomes Study 36-Item Short Form (SF-36) | Measure of general functionality | 6 months | 
| Quality of Life Inventory (QOLI) |  | 6 months | 
| Ways of Responding (WOR) |  | 2 months | 
| Dysfunctional Attitudes Scale (DAS) |  | 2 months | 
| Psychological Distance Scaling Task (PDST) |  | 2 months | 
| Self-Understanding of Interpersonal Patterns Scale-Revised (SUIP-R) |  | 2 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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depression, community mental health, treatment, psychotherapy, mediators