Efficacy of hypnotherapy compared to cognitive behavioral therapy for mild to moderate depression - Results of a randomized controlled rater-blind clinical trial.

BACKGROUND: Methodologically well-designed RCTs concerning the efficacy of Hypnotherapy in the treatment of Major Depression are lacking. The aim of this study was to determine whether Hypnotherapy (HT) is not inferior to Cognitive Behavioral Therapy (CBT), the gold-standard psychotherapy, in the percentage reduction of depressive symptoms, assessed in mild to moderate Major Depression (MD). METHODS: This study reports the main results of a monocentric two-armed randomized-controlled rater-blind clinical trial. A total of 152 patients with MD were randomized to either CBT or HT receiving outpatient individual psychotherapy with 16 to 20 sessions for the duration of six months. The primary outcome was the mean percentage improvement in depressive symptoms assessed with the Montgomery-Asberg Depression Rating Scale (MADRS) before and after treatment. RESULTS: The difference in the mean percentage symptom reduction between HT and CBT was 2.8 (95% CI=-9.85 to 15.44) in the Intention-to-treat sample and 4.0 (95% CI=-9.27 to 17.27) in the Per Protocol sample (N=134). Concerning the pre-specified non-inferiority margin of -16.4, both results confirm the non-inferiority of HT to CBT. The results for the follow-ups six and twelve months after the end of the treatment support the primary results. LIMITATIONS: For ethical reasons the trial did not include a control group without treatment; therefore we can only indirectly conclude that both treatment conditions are effective. CONCLUSION: This is the first study to demonstrate that HT was not inferior to CBT in MD, while employing rigorous methodological standards.

[How to care for homeless mentally ill men in the community - a randomised intervention study]. / Versorgung obdachloser und wohnungsloser psychisch kranker Männer in der Kommune - eine kontrollierte Interventionsstudie.

OBJECTIVE: The aim of the present study was to clarify whether the mediation of homeless persons identified as mentally ill into the sociopsychiatric or the help-seeking system can be facilitated by a short-term intervention. METHOD: Probands with at least one psychiatric diagnosis according to ICD-10 (73 % of the sample) were randomized to the intervention group (manualized procedure with five brief contacts) or to the control group (no intervention). The course of the contacts and the further help-seeking behavior after 4 and 8 months were registered. RESULTS: The very sporadic participation of the patients in the therapeutic discussion permitted a manualized procedure in individual cases only. The establishment of contact was very successful, but the problem-centered procedure only within limits. The intergroup comparison revealed no fundamental differences in the utilization of offers of support during the course of the study. Overall, however, the number of users tended to increase, with an increased contact frequency being recorded especially among those participating in therapeutic discussions. CONCLUSIONS: Only a relatively small proportion of the clientele can be reached through short-term behavior therapy. Fundamentally a low-profile, primarily outreach-based offer founded on longer-term contact appears to be more promising.

Prevalence of mental illness among homeless men in the community--approach to a full census in a southern German university town.

AIM: Within the framework of a study of homeless men in the university town of Tubingen in southern Germany, the prevalence of psychiatric disorders and the existing help-seeking behavior, among other things, were to be recorded. METHOD: A total of 151 men belonging to the target group were identified; 91 of them participated in the study. Besides the psychiatric diagnosis, the registered data included psychopathology, cognitive capacity, social functioning and satisfaction with life, as well as social history and case history. RESULTS: Of the probands, 73% were suffering from at least one ongoing psychiatric disorder (diagnosed according to ICD-10 and DSM-IV), primarily alcohol dependence (74%) and drug dependence (34 %), 26% were suffering from an anxiety disorder, 15% from an affective disorder, and 11 % from a disorder of the schizophrenic spectrum. Comorbidity was diagnosed in 67%. Targeted help-seeking behavior concerning the psychiatric or addictive symptoms was extremely rare. Emergency contacts existed with hospitals and general practitioners. DISCUSSION: This study represents the first attempt within Germany and Europe at a full census of homeless men. In international terms, the target region-a small town on the fringes of a conurbation-is a special case. However, compared with studies of help-seeking populations in large cities, virtually no differences were recorded with respect to the prevalence of psychiatric disorders or to help-seeking behavior concerning psychiatric problems and addictions. On the other hand, a substantial number of those concerned evade a resource-intensive, outreach-based study like the present one. Because of German data protection legislation, data on these subjects remain sparse. Concepts aimed at improving the health care system for this target group were found to be dependent in no small measure on the success of the initial contact.