Treating depression in an outpatient setting: Predictors of patient response to bouldering psychotherapy, cognitive behavioural therapy or exercise alone.

BACKGROUND: Bouldering psychotherapy (BPT) for depression has proven effective, but nothing is known about its potential predictors of response. This study should identify predictors of response to BPT, cognitive behavioural therapy (CBT) and an active control (home-based exercise programme; EP) using a literature-based model. METHODS: In a multicentre randomised controlled trial, 233 outpatients were assigned to BPT, CBT or EP. Response (reduction of at least 46% on the Montgomery-Åsberg Depression Rating Scale [MADRS]) and remission (≤7 MADRS points) were defined as suggested by the literature. Predictors of response were identified twofold: (1) univariate analyses followed by logistic regression analyses in each group with all predictors yielding a univariate p-value <.20 and (2) a backward regression analysis with all potential predictors. Only variables that emerged as predictors in both types of analyses were interpreted. RESULTS: There was a significantly greater proportion of responders (p = .035) in the BPT than in the EP. The chance of response in the BPT was higher for patients with a higher health-related quality of life. In the EP, response was higher for patients with lower interpersonal sensitivity, suffering from their first episode and living with a partner. CONCLUSIONS: Response rates in BPT are similar to or even higher than in other outpatient psychotherapy group therapies. BPT and CBT are suitable for a wide range of patients, but patients with higher functionality could start with psychoeducation and exercise.

Association of cognitive dietary restraint and disinhibition with prediabetes--cross-sectional and longitudinal data of a feasibility study in German employees.

OBJECTIVE: To investigate the impact of eating behaviour traits on central obesity, prediabetes and associated major dietary food patterns. DESIGN: Assessment of eating behaviour was based on the revised German version of the Three-Eating Factor Questionnaire using cross-sectional and longitudinal data of a feasibility study in employees. Data on lifestyle and nutrition were obtained by validated self-administered questionnaires. Baseline characteristics were analysed by the univariate χ2 test or the Mann-Whitney test. To quantify correlations linear regression analysis was used. SETTING: The Delay of Impaired Glucose Tolerance by a Healthy Lifestyle Trial (DELIGHT), which investigated measures to prevent type 2 diabetes mellitus in 2004-2008. SUBJECTS: Employees (21-64 years, 127 men, 157 women) with elevated waist circumference (men ≥ 94 cm, women ≥ 80 cm) of five medium-sized companies in northern Germany. RESULTS: At baseline (T0), BMI but particularly waist circumference showed a strong inverse correlation with flexible control (P < 0.0001) and a positive correlation with disinhibition (P < 0.0001) and rigid control (P = 0.063). Flexible control was also significantly inversely related to fasting plasma glucose (P = 0.040), energy intake (P < 0.0001), intake of meat and meat products (P = 0.0001), and positively associated with intake of fruit and vegetables (P < 0.0001) at baseline (T0). Changes in flexible control within the first year of intervention (T1 v. T0) predicted changes in central obesity (P < 0.0001) and fasting plasma glucose (P = 0.025). CONCLUSIONS: DELIGHT shows that flexible control characterizes individuals with a higher dietary quality, a lower waist circumference and a lower glucose level. Enhancing flexible control more than rigid control, and decreasing disinhibition, seems beneficial in terms of central adiposity and glucose levels.