Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: phase II trial.

BACKGROUND: Although cognitive-behavioural therapy (CBT) is an effective treatment for depression, less than half of patients achieve satisfactory symptom reduction during treatment. Targeting known psychopathological processes such as rumination may increase treatment efficacy. The aim of this study was to test whether adding group rumination-focused CBT (RFCBT) that explicitly targets rumination to routine medical management is superior to adding group CBT to routine medical management in treating major depression. METHODS: A total of 131 outpatients with major depression were randomly allocated to 12 sessions group RFCBT v. group CBT, each in addition to routine medical management. The primary outcome was observer-rated symptoms of depression at the end of treatment measured on the Hamilton Rating Scale for Depression. Secondary outcomes were rumination at post-treatment and depressive symptoms at 6 months follow-up (Trial registered: NCT02278224). RESULTS: RFCBT significantly improved observer-rated depressive symptoms (Cohen's d 0.38; 95% CI 0.03-0.73) relative to group CBT at post-treatment on the primary outcome. No post-treatment differences were found in rumination or in depressive symptoms at 6 months follow-up, although these secondary analyses may have been underpowered. CONCLUSIONS: This is the first randomized controlled trial providing evidence of benefits of RFCBT in major depression compared with CBT. Group RFCBT may be a beneficial alternative to group CBT for major depression.

Rumination-focused cognitive behaviour therapy for non-responsive chronic depression: an uncontrolled group study.

BACKGROUND: One-third of patients with depression do not respond satisfactorily to treatment, and approximately 20% of all patients treated for depression develop a chronic depression. One approach to more effective treatment of chronic and treatment-resistant depression is to target rumination - an underlying mechanism implicated in the development and maintenance of depression. AIM: The purpose of this uncontrolled group study was to investigate the feasibility of individual rumination-focused cognitive behavioural therapy (RfCBT) for patients with chronic and treatment-resistant depression. METHOD: A total of 10 patients with chronic and treatment-resistant depression were offered 12-16 individual sessions of RfCBT. The primary outcome was depressive symptoms as measured by Hamilton Depression Scale at pre-, post- and 3-month follow-up. Secondary symptoms measured included self-reported rumination and worry. RESULTS: There was a significant reduction in depressive symptoms (p < 0.05), rumination (p < 0.01) and worry (p < 0.5) from pre- to post-treatment. Half of the participants (n = 5) showed significant reliable change on levels of depressive symptoms post-treatment. The reduction in depressive symptoms, rumination and worry were maintained at follow-up. CONCLUSIONS: RfCBT was associated with significant reductions in depressive symptoms in a small sample with chronic and treatment-resistant depression. Despite limitations of being a small uncontrolled study with limited follow-up, these results are promising in a difficult to treat population. RfCBT warrants further systematic evaluation.

[Intersectorial co-operation in psychiatry]. / Sektorsamarbejde i psykiatrien.

INTRODUCTION: Critical intersectorial problems of co-operation are revealed through an organizational psychological analysis focusing on intergroup dynamics. The aim of the paper is to examine and improve the intersectorial co-operation in psychiatry and present a new trio-interview design that includes patients as well as staff. MATERIAL AND METHODS: Results from a follow-up study investigating the co-operation between Psychiatric Center Amager (PCA) and socialpsychiatric institutions (SPI) in Copenhagen is presented and analysed. The study was based on data gathered via structured interviews with patients and staff from both sectors (n = 60 in 2005, n = 87 in 2007), employing quantitative as well as qualitative methods. The newly developed trio-interview design with informant-triads for studies of the quality of intersectorial co-operation in psychiatry was applied to the study. RESULTS: Quantitative data from the patients showed that the co-operation was generally considered to be unsatisfactory in 2005 and 2007. SPI satisfaction estimates concerning the latest hospitalization period were higher in 2007 than in 2005. Staff from both sectors estimated that co-operation was significantly higher during 2007 than during 2005. Qualitative data showed that in 2007, staff was the decisive factor. CONCLUSION: The co-operation was estimated to be unsatisfactory in 2005 and 2007. Measures to strengthen intersectorial co-operation were implemented in 2006, but had limited effect.