Department of Psychiatry
Penn Behavioral Health

Center for Psychotherapy Research

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Depression Studies






Community Treatment for Depression Studies


Investigators at the Center for Psychotherapy Research are directing studies focused on treating depression in community settings.



A Comparison of Cognitive and Dynamic Therapy for Major Depressive Disorder in Community Settings

Principal Investigator: Mary Beth Connolly Gibbons, PhD (AHRQ funded)

This five-year, federally funded study seeks to explore the effectiveness of cognitive therapy (CT) and supportive-expressive psychodynamic therapy (SE) for depression in community mental health centers. Although CT has already been shown to be effective in the treatment of depression, very little research has been conducted examining the effectiveness of dynamic therapy, despite the frequency with which various dynamic therapies are implemented in clinical practice. This study will compare the effectiveness of the CT and SE in the treatment of depression in order to assess whether treatment with SE results in comparable alleviation of symptoms.

The specific aims of this study are to:

  • Conduct a randomized non-inferiority trial to compare SE and CT for patients with major depressive disorder, and
  • Assess the comparative effectiveness of SE and CT on secondary measures of symptoms, patient functioning, and quality of life.

 





The Development of a Therapist Feedback System for Major Depressive Disorder in Community Mental Health

Principal Investigator: Mary Beth Connolly Gibbons, PhD (NIMH funded)

This study seeks to establish a therapist feedback system to help clinicians better track their patients’ symptoms and outcome over the course of treatment. Although previous research has demonstrated that treatment outcomes improve when therapists receive feedback (regardless of whether that feedback is positive or negative), very few therapists in the community mental health system receive any feedback on the clients they treat. This study aims to increase the ease, efficiency, and frequency of delivering feedback to therapists treating patients for depression by establishing a feedback infrastructure in a community mental health setting and conducting a randomized pilot study exploring treatment outcomes when therapists receive feedback versus no feedback.

The specific aims of this study are to:

  • Develop a computerized administration of both the BASIS-24 and the Community Therapist Feedback Questionnaire (CTFQ) that is satisfactory to community consumers of mental health services,
  • Develop recovery curves for the BASIS-24 that can be used in the feedback system to identify patients who are not progressing across early treatment sessions,
  • Develop the algorithms for the CTFQ report that translate CTFQ subscale scores into clinical text,
  • Develop community-friendly reports based on both the BASIS-24 and the CTFQ that can be used to provide therapists with feedback on patients who are potential treatment failures,
  • Develop a computerized feedback system in the community mental health center to provide timely feedback reports to therapists, and
  • Conduct a pilot randomized study of therapist feedback versus no feedback in the treatment of major depressive disorder in community mental health.






Development of a Tool to Measure Consumer Preferences in MDD Treatment

Principal Investigator: Paul Crits-Christoph, PhD (NIMH funded)

The overall goal of this grant is to develop and pilot an instrument that helps guide clinical treatment decisions for people seeking treatment for major depressive disorder in a community mental health setting by incorporating evidence-based practice data that has been customized to the treatment preferences of individual consumers.

The specific aims of this study are:

  • To investigate the best (i.e., valid and user-friendly) method of assessing consumer preferences for evidence-based mental health treatment.
  • To utilize consumer ratings to evaluate three preferences instruments for their clarity, difficulty, reasonableness, and comfort level.
  • To determine the ability of each measure to predict time spent in initial treatment in order to ascertain the relative validity and clinical usefulness of the instruments.





The Mechanisms of Cognitive and Dynamic Therapy in Community Settings

Principal Investigator: Paul Crits-Christoph, PhD (NIMH Funded)

The study seeks to examine the mechanism of action of cognitive therapy (CT) and supportive-expressive psychodynamic therapy (SE) in a community mental health setting for major depressive disorder. The study will be appended to a recently funded comparative effectiveness study of these two psychotherapies. Studies of the mechanism of CT have rarely used an alternative psychotherapy as a comparison group; no fully adequate and comprehensive test of these potential mediators has been done to date. In the parent effectiveness study, patients are randomly assigned to receive 16 weeks of CT or SE therapy, with measures of depressive symptoms, functioning, and quality of life completed monthly. Within this study, a self-report measure of self-understanding of interpersonal patterns, a self-report measure of dysfunctional attitudes, a rater-scored measure of compensatory skills, and a computerized task that assesses underlying cognitive schemas will be administered to the same set of patients. Results of this study might have implications for the potential modifications of these treatments to enhance effectiveness and for the dissemination of evidence-based treatments to the community mental health setting.

The specific aims of this study are to:

  • To potentially identify how both CT and SE therapy work in community settings
  • To test hypotheses about variables that are proposed to be important to the mechanism of CT as potential mediators of symptom change in CT for MDD in community settings. The three potential mediator variables are:change in dysfunctional attitudes, change in underlying depressogenic schemas, and change in compensatory skills. The extent to which mean changes in these mediator variables are specific to CT, and the extent to which the relation between the mediators and symptom change is specific to CT, will be investigated by comparing effects to those found in an alternative psychotherapy (SE therapy).
  • To test the hypothesis that change in self-understanding of interpersonal patterns is a mediator of symptom change for SE therapy for MDD in community settings. The specificity of the effects, relative to CT, will also be examined.
  • To examine the proposed mediator variables for CT and SE therapy in relation to change in functioning and quality of life.

 




Comparative Effectiveness of Interventions for Depression in the Community

Principal Investigator: Mary Beth Connolly Gibbons, PhD (AHRQ funded)

Despite multiple investigations demonstrating that both medications as well as psychotherapeutic interventions are effective in the treatment of major depressive disorder, few comparative effectiveness studies have specifically informed clinical decision making at the level of both the population and the individual patient so that interventions can be disseminated efficiently.

This five year research scientist grant includes two important studies to inform the efficient dissemination of interventions for depression in the community:

  • A study of the patient baseline moderators of treatment effectiveness.
  • A study of healthcare utilization and costs associated with the utilization of mental health interventions for MDD in the community mental health system.

The specific aims of this investigation include:

  • To assess whether patient baseline skills deficits moderate the effectiveness of dynamic therapy and cognitive therapy for patients with major depressive disorder treated in the community mental health setting.
  • To assess whether patient baseline deficits moderate the effectiveness of dynamic therapy and cognitive therapy on secondary measures of outcome.
  • To explore additional baseline patient variables that may moderate the effectiveness of these psychotherapeutic approaches for patients with major depressive disorder treated in the community mental health setting.
  • To evaluate healthcare utilization and associated costs for patients treated with psychotherapy for depression in the community mental health system compared to patients who receive alternative treatments.




 

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