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.

Judgment of emotional information expressed by prosody and semantics in patients with unipolar depression.

It was the aim of this study to investigate the impact of major depressive disorder (MDD) on judgment of emotions expressed at the verbal (semantic content) and non-verbal (prosody) level and to assess whether evaluation of verbal content correlate with self-ratings of depression-related symptoms as assessed by Beck Depression Inventory (BDI). We presented positive, neutral, and negative words spoken in happy, neutral, and angry prosody to 23 MDD patients and 22 healthy controls (HC) matched for age, sex, and education. Participants rated the valence of semantic content or prosody on a 9-point scale. MDD patients attributed significantly less intense ratings to positive words and happy prosody than HC. For judgment of words, this difference correlated significantly with BDI scores. No such correlation was found for prosody perception. MDD patients exhibited attenuated processing of positive information which generalized across verbal and non-verbal channels. These findings indicate that MDD is characterized by impairments of positive rather than negative emotional processing, a finding which could influence future psychotherapeutic strategies as well as provide straightforward hypotheses for neuroimaging studies investigating the neurobiological correlates of impaired emotional perception in MDD.