The impact of personality disorder pathology on the effectiveness of Cognitive Therapy and Interpersonal Psychotherapy for Major Depressive Disorder

S.C. van Bronswijk; L.H.J.M. Lemmens; W. Viechtbauer; M.J.H. Huibers; A. Arntz; F.P.M.L. Peeters

doi:10.1016/j.jad.2017.08.043

The impact of personality disorder pathology on the effectiveness of Cognitive Therapy and Interpersonal Psychotherapy for Major Depressive Disorder

S.C. van Bronswijk^*, L.H.J.M. Lemmens, W. Viechtbauer, M.J.H. Huibers, A. Arntz, F.P.M.L. Peeters

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background

Despite extensive research, there is no consensus how Personality Disorders (PD) and PD features affect outcome for Major Depressive Disorder (MDD). The present study evaluated the effects of PD (features) on treatment continuation and effectiveness in Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD.

Methods

Depressed outpatients were randomized to CT (n=72) and IPT (n=74). Primary outcome was depression severity measured repeatedly with the Beck Depression Inventory-II (BDI-II) at baseline, three months, at the start of each therapy session, at post-treatment and monthly during five months follow-up.

Results

Comorbid PD and PD features did not affect dropout. Multilevel and Cox regression models indicated no negative effect of PD on BDI-II change and remission rates during treatment and follow-up, irrespective of the treatment received. For both therapies, higher dependent PD features predicted overall lower BDI-II scores during treatment, however this effect did not sustain through follow-up. Cluster A PD features moderated treatment outcome during treatment and follow-up: individuals with high cluster A PD features had greater BDI-II reductions over time in CT as compared to IPT.

Limitations

Not all therapists and participants were blind to the assessment of PD (features), and assessments were performed by one rater. Further research must investigate the state and trait dependent changes of PD and MDD over time.

Conclusions

We found no negative impact of PD on the effectiveness and treatment retention of CT and IPT for MDD during treatment and follow-up. If replicated, cluster A PD features can be used to optimize treatment selection.

Original language	English
Pages (from-to)	530-538
Journal	Journal of Affective Disorders
Volume	225
DOIs	https://doi.org/10.1016/j.jad.2017.08.043
Publication status	Published - 2018
Externally published	Yes

Bibliographical note

Funding Information:
This research was funded by the Research Institute of Experimental Psychopathology (EPP), the Netherlands, and the Academic Community Mental Health Centre (RIAGG, now Virenze-RIAGG Maastricht) in Maastricht, the Netherlands. Both institutes had no involvement in the collection, analysis and interpretation of the data or in the writing of this article and decision to submit this article for publication.

Publisher Copyright:
© 2017 Elsevier B.V.

Funding

This research was funded by the Research Institute of Experimental Psychopathology (EPP), the Netherlands, and the Academic Community Mental Health Centre (RIAGG, now Virenze-RIAGG Maastricht) in Maastricht, the Netherlands. Both institutes had no involvement in the collection, analysis and interpretation of the data or in the writing of this article and decision to submit this article for publication.

Keywords

Cognitive Therapy
Depression
Interpersonal Psychotherapy
Personality
Psychotherapy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jad.2017.08.043

Cite this

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title = "The impact of personality disorder pathology on the effectiveness of Cognitive Therapy and Interpersonal Psychotherapy for Major Depressive Disorder",

abstract = "Background Despite extensive research, there is no consensus how Personality Disorders (PD) and PD features affect outcome for Major Depressive Disorder (MDD). The present study evaluated the effects of PD (features) on treatment continuation and effectiveness in Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD. Methods Depressed outpatients were randomized to CT (n=72) and IPT (n=74). Primary outcome was depression severity measured repeatedly with the Beck Depression Inventory-II (BDI-II) at baseline, three months, at the start of each therapy session, at post-treatment and monthly during five months follow-up. Results Comorbid PD and PD features did not affect dropout. Multilevel and Cox regression models indicated no negative effect of PD on BDI-II change and remission rates during treatment and follow-up, irrespective of the treatment received. For both therapies, higher dependent PD features predicted overall lower BDI-II scores during treatment, however this effect did not sustain through follow-up. Cluster A PD features moderated treatment outcome during treatment and follow-up: individuals with high cluster A PD features had greater BDI-II reductions over time in CT as compared to IPT. Limitations Not all therapists and participants were blind to the assessment of PD (features), and assessments were performed by one rater. Further research must investigate the state and trait dependent changes of PD and MDD over time. Conclusions We found no negative impact of PD on the effectiveness and treatment retention of CT and IPT for MDD during treatment and follow-up. If replicated, cluster A PD features can be used to optimize treatment selection.",

keywords = "Cognitive Therapy, Depression, Interpersonal Psychotherapy, Personality, Psychotherapy",

author = "\{van Bronswijk\}, S.C. and L.H.J.M. Lemmens and W. Viechtbauer and M.J.H. Huibers and A. Arntz and F.P.M.L. Peeters",

note = "Funding Information: This research was funded by the Research Institute of Experimental Psychopathology (EPP), the Netherlands, and the Academic Community Mental Health Centre (RIAGG, now Virenze-RIAGG Maastricht) in Maastricht, the Netherlands. Both institutes had no involvement in the collection, analysis and interpretation of the data or in the writing of this article and decision to submit this article for publication. Publisher Copyright: {\textcopyright} 2017 Elsevier B.V.",

year = "2018",

doi = "10.1016/j.jad.2017.08.043",

language = "English",

volume = "225",

pages = "530--538",

journal = "Journal of Affective Disorders",

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T1 - The impact of personality disorder pathology on the effectiveness of Cognitive Therapy and Interpersonal Psychotherapy for Major Depressive Disorder

AU - van Bronswijk, S.C.

AU - Lemmens, L.H.J.M.

AU - Viechtbauer, W.

AU - Huibers, M.J.H.

AU - Arntz, A.

AU - Peeters, F.P.M.L.

N1 - Funding Information: This research was funded by the Research Institute of Experimental Psychopathology (EPP), the Netherlands, and the Academic Community Mental Health Centre (RIAGG, now Virenze-RIAGG Maastricht) in Maastricht, the Netherlands. Both institutes had no involvement in the collection, analysis and interpretation of the data or in the writing of this article and decision to submit this article for publication. Publisher Copyright: © 2017 Elsevier B.V.

PY - 2018

Y1 - 2018

N2 - Background Despite extensive research, there is no consensus how Personality Disorders (PD) and PD features affect outcome for Major Depressive Disorder (MDD). The present study evaluated the effects of PD (features) on treatment continuation and effectiveness in Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD. Methods Depressed outpatients were randomized to CT (n=72) and IPT (n=74). Primary outcome was depression severity measured repeatedly with the Beck Depression Inventory-II (BDI-II) at baseline, three months, at the start of each therapy session, at post-treatment and monthly during five months follow-up. Results Comorbid PD and PD features did not affect dropout. Multilevel and Cox regression models indicated no negative effect of PD on BDI-II change and remission rates during treatment and follow-up, irrespective of the treatment received. For both therapies, higher dependent PD features predicted overall lower BDI-II scores during treatment, however this effect did not sustain through follow-up. Cluster A PD features moderated treatment outcome during treatment and follow-up: individuals with high cluster A PD features had greater BDI-II reductions over time in CT as compared to IPT. Limitations Not all therapists and participants were blind to the assessment of PD (features), and assessments were performed by one rater. Further research must investigate the state and trait dependent changes of PD and MDD over time. Conclusions We found no negative impact of PD on the effectiveness and treatment retention of CT and IPT for MDD during treatment and follow-up. If replicated, cluster A PD features can be used to optimize treatment selection.

AB - Background Despite extensive research, there is no consensus how Personality Disorders (PD) and PD features affect outcome for Major Depressive Disorder (MDD). The present study evaluated the effects of PD (features) on treatment continuation and effectiveness in Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD. Methods Depressed outpatients were randomized to CT (n=72) and IPT (n=74). Primary outcome was depression severity measured repeatedly with the Beck Depression Inventory-II (BDI-II) at baseline, three months, at the start of each therapy session, at post-treatment and monthly during five months follow-up. Results Comorbid PD and PD features did not affect dropout. Multilevel and Cox regression models indicated no negative effect of PD on BDI-II change and remission rates during treatment and follow-up, irrespective of the treatment received. For both therapies, higher dependent PD features predicted overall lower BDI-II scores during treatment, however this effect did not sustain through follow-up. Cluster A PD features moderated treatment outcome during treatment and follow-up: individuals with high cluster A PD features had greater BDI-II reductions over time in CT as compared to IPT. Limitations Not all therapists and participants were blind to the assessment of PD (features), and assessments were performed by one rater. Further research must investigate the state and trait dependent changes of PD and MDD over time. Conclusions We found no negative impact of PD on the effectiveness and treatment retention of CT and IPT for MDD during treatment and follow-up. If replicated, cluster A PD features can be used to optimize treatment selection.

KW - Cognitive Therapy

KW - Depression

KW - Interpersonal Psychotherapy

KW - Personality

KW - Psychotherapy

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DO - 10.1016/j.jad.2017.08.043

M3 - Article

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AN - SCOPUS:85028545176

SN - 0165-0327

VL - 225

SP - 530

EP - 538

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

ER -

The impact of personality disorder pathology on the effectiveness of Cognitive Therapy and Interpersonal Psychotherapy for Major Depressive Disorder

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

Access to Document

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