None listed
Conditions
Brief summary
Background: A few recent studies have found indications of the effectiveness of inpatient psychotherapy for depression, usually of an extended duration. However, there is a lack of controlled studies in this area and to date no study of adequate quality on brief psychodynamic psychotherapy for depression during short inpatient stay exists. The present article describes the protocol of a study that will examine the relative efficacy, the cost-effectiveness and the cost-utility of adding an Inpatient Brief Psychodynamic Psychotherapy to pharmacotherapy and treatment-as-usual for inpatients with unipolar depression. Methods/Design: The study is a one-month randomized controlled trial with a two parallel group design and a 12-month naturalistic follow-up. A sample of 140 consecutive adult inpatients with unipolar depression and Montgomery-Asberg Depression Rating Scale score over 18 will be recruited. The study is carried out in the university hospital section for mood disorders in Lausanne, Switzerland. Patients are assessed upon admission, and at 1-, 3- and 12- month follow-ups. Inpatient therapy is a manualized brief intervention, combining the virtues of inpatient setting and of time-limited dynamic therapies (focal orientation, fixed duration, resource-oriented interventions). Treatment-as-usual represents the best level of practice for a minimal treatment condition usually proposed to inpatients. Final analyses will follow an intention–to-treat strategy. Depressive symptomatology is the primary outcome and secondary outcome includes measures of psychiatric symptomatology, psychosocial role functioning, and psychodynamic-emotional functioning. The mediating role of the therapeutic alliance is also examined. Allocation to treatment groups uses a stratified block randomization method with permuted block. To guarantee allocation concealment, randomization is done by an independent researcher. Discussion: Despite the large number of studies on treatment of depression, there is a clear lack of controlled research in inpatient psychotherapy during the acute phase of a major depressive episode. Research on brief therapy is important to take into account current short lengths of stay in psychiatry. The current study has the potential to scientifically inform appropriate inpatient treatment. This study is the first to address the issue of the economic evaluation of inpatient psychotherapy.
Interventions
Inpatient brief psychodynamic therapy
Our manualized intervention model proposes a brief psychodynamic intervention program in 12 sessions over 4 weeks (Ambresin G, de Coulon N, Despland JN: Traitement psychodynamique bref de la depression pour patient hospitalise, Unpublished manuscript, Institute for Psychotherapy, Centre Hospitalier Universitaire Vaudois and University of Lausanne; 2008). Sessions are 45 minutes long (3 sessions per week). It is based on the Bush, Rudden & Shapiro (2004) man
Inpatient brief psychodynamic therapy Our manualized intervention model proposes a brief psychodynamic intervention program in 12 sessions over 4 weeks (Ambresin G, de Coulon N, Despland JN: Traitement psychodynamique bref de la depression pour patient hospitalise, Unpublished manuscript, Institute for Psychotherapy, Centre Hospitalier Universitaire Vaudois and University of Lausanne; 2008). Sessions are 45 minutes long (3 sessions per week). It is based on the Bush, Rudden & Shapiro (2004) manual of psychodynamic treatment of depression to help the therapy focalize on relevant depression foci. For transference, personality organization and conflictual themes the intervention is based on Despland, Michel, & de Roten (2010) manual on brief psychodynamic psychotherapy. Both manuals were adapted to the brief inpatient setting. Put briefly, the 12-session psychotherapy approaches the crisis in the patient’s intrapsychic and interpersonal equilibrium that led to a hospital admission, within the context of depression. It focuses on both the patient’s conscious and unconscious motives for admission. The initial hypothesis is based on the dynamic relationship established between the therapist and the patient during the first three sessions (pre-transference), on the patient’s present crisis, and on the dynamics that form the core of his/her depressive episode. Following sessions focalize further on helping the patient to gain a better understanding of the psychological factors that led to the emergence of depressive symptoms and to address his/her vulnerability to those dynamics. Final sessions address the patient’s feelings and fantasies about termination as well as the decision regarding a therapy of longer duration or long-term psychiatric treatment if necessary.
Sponsors
Centre for Psychotherapy Research
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
All patients admitted in the university psychiatric hospital section specialized for the treatment of mood, anxiety and personality disorders are eligible to participate in the study if they meet the following inclusion criteria: (1) Age 18-65 years old; (2) unipolar major depressive episode; (3) Montgomery-Asberg Depression Rating Scale > 18; (4) sufficient mastery of the French language.
Exclusion criteria
(1) Any organic medical disorder, or persistent substance use/dependence which might affect brain function (memory, level of consciousness, cognitive abilities) thereby impairing the individual from participating and benefiting from psychotherapy; (2) A psychotic disorder which makes a pronounced break in reality testing chronically or intermittently likely, such as schizophrenia, delusional disorder, or bipolar manic-depression (Type I); (3) Any of the following which are considered unlikely to benefit from either treatment: axis II paranoid, schizoid or schizotypal, and borderline personality disorder; antisocial personality; recent suicide attempts with acute risk for suicide; other principal axis I disorder; severe cognitive impairment; previous absence of response to the study treatments.
Outcome results
None listed