Replicating patient-level moderators of CBT and IPT's comparative efficacy for depression.

Although evidence-based psychotherapies, such as cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT), produce comparable average outcomes, it is plausible that some patients who possess one or more specific characteristics may respond better to one over the other. Addressing this what works best for whom question, researchers have tested the moderating influence of patient characteristics on comparative treatment effects (viz. aptitude-treatment interactions [ATIs]). However, few ATIs have emerged or replicated, thereby providing little treatment-selection guidance. Informed by a systematic review of patient ATIs in trials that compared CBT versus IPT for depression (Bernecker et al., 2017), this study aimed to replicate (a) significant ATIs previously established in a single study; and (b) significant ATIs previously examined twice, with only one study demonstrating a moderating effect. Data derived from a trial in which adult outpatients with major depression were randomly assigned to 16 weeks of CBT (n = 41) or IPT (n = 39). Patient characteristics were measured at baseline, and patients rated their depression throughout treatment. Multilevel models revealed one ATI replication; for patients with more self-sacrificing interpersonal problems, CBT outperformed IPT; the reverse was true for patients with fewer such problems. Other moderators either failed to replicate or directionally contradicted prior research. Results help inform optimal treatment matching for some patients, which reflects a type of psychotherapy personalization. However, they also highlight limitations of traditional ATI research and suggest that different methods are needed to inform responsive personalization efforts more expansively and reliably. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Attachment style as a moderating influence on the efficacy of cognitive-behavioral and interpersonal psychotherapy for depression: A failure to replicate.

Research on aptitude-treatment interactions, or patient characteristics that are associated with better outcome in one treatment than another, can help assign patients to the treatments that will be most personally effective. Theory and one past study suggest that adult attachment style might influence whether depressed patients respond better to cognitive-behavioral therapy (CBT) or interpersonal psychotherapy (IPT). Spurred by inconsistency in past aptitude-treatment interaction research in general, as well as concerns about the reproducibility of psychological research, we sought to replicate and extend the previous study that showed that high attachment avoidance was associated with greater depression reduction in CBT than in IPT and to improve upon that study methodologically. Using longitudinal hierarchical linear modeling, the present study examined whether, among 69 adults randomly assigned to CBT or IPT, rate of change in severity of depression symptoms was predicted by treatment condition, attachment style, and their interaction. We also conducted regression analyses to determine whether posttreatment depression was predicted by the same variables. As expected, CBT and IPT were equivalent in efficacy; however, unlike in the previous trial, there were no moderation effects of attachment. Interestingly, in some analyses, anxious attachment was associated with more positive outcomes and avoidant attachment with more negative outcomes across both treatments. The findings highlight the need for researchers to attempt replications of past studies using methods that might elucidate the reasons for discrepancies in results, and they also suggest that alternative approaches to aptitude-treatment interaction research may be more fruitful.

Childhood and family influences on body mass index in early adulthood: findings from the Ontario Child Health Study.

BACKGROUND: Overweight and obesity are steadily increasing worldwide with the greatest prevalence occurring in high-income countries. Many factors influence body mass index (BMI); however multiple influences assessed in families and individuals are rarely studied together in a prospective design. Our objective was to model the impact of multiple influences at the child (low birth weight, history of maltreatment, a history of childhood mental and physical conditions, and school difficulties) and family level (parental income and education, parental mental and physical health, and family functioning) on BMI in early adulthood. METHODS: We used data from the Ontario Child Health Study, a prospective, population-based study of 3,294 children (ages 4-16 years) enrolled in 1983 and followed up in 2001 (N = 1,928; ages 21-35 years). Using multilevel models, we tested the association between family and child-level variables and adult BMI after controlling for sociodemographic variables and health status in early adulthood. RESULTS: At the child level, presence of psychiatric disorder and school difficulties were related to higher BMI in early adulthood. At the family level, receipt of social assistance was associated with higher BMI, whereas family functioning, having immigrant parents and higher levels of parental education were associated with lower BMI. We found that gender moderated the effect of two risk factors on BMI: receipt of social assistance and presence of a medical condition in childhood. In females, but not in males, the presence of these risk factors was associated with higher BMI in early adulthood. CONCLUSION: Overall, these findings indicate that childhood risk factors associated with higher BMI in early adulthood are multi-faceted and long-lasting. These findings highlight the need for preventive interventions to be implemented at the family level in childhood.