Childhood maltreatment and differential treatment response and recurrence in adult major depressive disorder
Harkness, Kate L.; Bagby, R. Michael; Kennedy, Sidney H
Journal of Consulting and Clinical Psychology, Vol 80(3), Jun 2012, 342-353
Objective: A substantial number of patients with major depressive disorder (MDD) do not respond to treatment, and recurrence rates remain high.
The purpose of this study was to examine a history of severe childhood abuse as a moderator of response following a 16-week acute treatment trial, and of recurrence over a 12-month follow-up.
Method: Participants included 203 adult outpatients with MDD (129 women; age 18–60). The design was a 16-week single-center randomized, open label trial of interpersonal psychotherapy, cognitive-behavioral therapy, or antidepressant medication, with a 12-month naturalistic follow-up, conducted at a university psychiatry center in Canada.
The main outcome measure was Hamilton Depression Rating Scale scores at treatment end point. Childhood maltreatment was assessed at the completion of treatment using an interview-based contextual measure of childhood physical, sexual, and emotional abuse. Multiple imputation was adopted to estimate missing values.
Results: Patients with severe maltreatment were significantly less likely to respond to interpersonal psychotherapy than to cognitive-behavioral therapy or medication (OR = 3.61), whereas no differences among treatments were found in those with no history of maltreatment (ORs < 1.50). Furthermore, maltreatment significantly predicted a shorter time to recurrence over follow-up across treatment conditions (OR = 3.04).These findings were replicated in the sample with complete case data.
Conclusions: Patients with a history of childhood abuse may benefit more from antidepressant medication or cognitive-behavioral therapy than from interpersonal psychotherapy. However, these patients remain vulnerable to recurrence regardless of treatment modality.
A Rating Scale for Depression
By M. Hamilton,
Journal of Neurology, Neurosurgery, and Psychiatry 23:56-62, 1960
This is the original publication of the HAM-D.
It appears that talk therapy to heal/mend/cure/treat the development of multiple personalities would be better treated using other methods namely Cognitive-Behavioral Therapy (CBT).
Why do few, if any, dissociative identity disorder patients get help using Cognitive Behavioral Therapy with the treatment packages they purchase? JB
- Beck Institute for Cognitive Behavior Therapy http://www.beckinstitute.org/what-is-cognitive-behavioral-therapy/
Cognitive Behavior Therapy
Developed by Dr. Aaron T. Beck, Cognitive Therapy (CT), or Cognitive Behavior Therapy (CBT), is a form of psychotherapy in which the therapist and the client work together as a team to identify and solve problems.
Therapists use the Cognitive Model to help clients overcome their difficulties by changing their thinking, behavior, and emotional responses. Cognitive therapy has been found to be effective in more than 1000 outcome studies for a myriad of psychiatric disorders, including depression, anxiety disorders, eating disorders, and substance abuse, among others, and it is currently being tested for personality disorders.
It has also been demonstrated to be effective as an adjunctive treatment to medication for serious mental disorders such as bipolar disorder and schizophrenia. Cognitive therapy has been extended to and studied for adolescents and children, couples, and families.
Its efficacy has also been established in the treatment of certain medical disorders, such as irritable bowel syndrome, chronic fatigue syndrome, hypertension, fibromyalgia, post-myocardial infarction depression, noncardiac chest pain, cancer, diabetes, migraine, and other chronic pain disorders.
has proven useful for determining the level of depression before, during, and after treatment.
It is based on the clinician’s interview with the patient and probes symptoms such as depressed mood, guilty feelings, suicide, sleep disturbances, anxiety levels and weight loss.
The interview and scoring takes about 15 minutes. The rater enters a number for each symptom construct that ranges from 0 (not present) to 4 (extreme symptoms).
* alterations in pagination by blogger
- The Cognitive Behavioral Miracle – Controlling your Emotions (brainblogger.com)