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Symptom-specific effects of counselling for depression compared to cognitive–behavioural therapy

BACKGROUND: Cognitive–behavioural therapy (CBT) and counselling for depression (CfD) are recommended first-line treatments for depression. While they approach change differently, there is little understanding of the impact those approaches have on change during treatment. OBJECTIVES: This study aime...

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Autores principales: O'Driscoll, Ciarán, Buckman, Joshua E J, Saunders, Rob, Ellard, Sarah, Naqvi, Syed Ali, Singh, Satwant, Wheatley, Jon, Pilling, Stephen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10035778/
https://www.ncbi.nlm.nih.gov/pubmed/36792174
http://dx.doi.org/10.1136/bmjment-2022-300621
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author O'Driscoll, Ciarán
Buckman, Joshua E J
Saunders, Rob
Ellard, Sarah
Naqvi, Syed Ali
Singh, Satwant
Wheatley, Jon
Pilling, Stephen
author_facet O'Driscoll, Ciarán
Buckman, Joshua E J
Saunders, Rob
Ellard, Sarah
Naqvi, Syed Ali
Singh, Satwant
Wheatley, Jon
Pilling, Stephen
author_sort O'Driscoll, Ciarán
collection PubMed
description BACKGROUND: Cognitive–behavioural therapy (CBT) and counselling for depression (CfD) are recommended first-line treatments for depression. While they approach change differently, there is little understanding of the impact those approaches have on change during treatment. OBJECTIVES: This study aimed to identify whether CBT and CfD target different symptoms and explore the implications of modelling choices when quantifying change during treatment. METHODS: Symptom-specific effects of treatment were identified using moderated network modelling. This was a retrospective cohort study of 12 756 individuals who received CBT or CfD for depression in primary/community care psychological therapy services in England. Change was modelled several ways within the whole sample and a propensity score matched sample (n=3446). FINDINGS: CBT for depression directly affected excessive worry, trouble relaxing and apprehensive expectation and had a stronger influence on changes between suicidal ideation and concentration. CfD had a stronger direct influence on thoughts of being a failure and on the associated change between being an easily annoyed and apprehensive of expectation. There were inconsistencies when modelling change using the first and second appointments as the baseline. Residual score models produced more conservative findings than models using difference scores. CONCLUSIONS: CfD and CBT for depression have differential effects on symptoms demonstrating specific mechanisms of change. CLINICAL IMPLICATIONS: CBT was uniquely associated with changes in symptoms associated with anxiety and may be better suited to those with anxiety symptoms comorbid to their depression. When assessing change, the baseline should be the first therapy session, not the pretreatment assessment. Residual change scores should be preferred over difference score methods.
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spelling pubmed-100357782023-08-21 Symptom-specific effects of counselling for depression compared to cognitive–behavioural therapy O'Driscoll, Ciarán Buckman, Joshua E J Saunders, Rob Ellard, Sarah Naqvi, Syed Ali Singh, Satwant Wheatley, Jon Pilling, Stephen BMJ Ment Health Psychotherapies BACKGROUND: Cognitive–behavioural therapy (CBT) and counselling for depression (CfD) are recommended first-line treatments for depression. While they approach change differently, there is little understanding of the impact those approaches have on change during treatment. OBJECTIVES: This study aimed to identify whether CBT and CfD target different symptoms and explore the implications of modelling choices when quantifying change during treatment. METHODS: Symptom-specific effects of treatment were identified using moderated network modelling. This was a retrospective cohort study of 12 756 individuals who received CBT or CfD for depression in primary/community care psychological therapy services in England. Change was modelled several ways within the whole sample and a propensity score matched sample (n=3446). FINDINGS: CBT for depression directly affected excessive worry, trouble relaxing and apprehensive expectation and had a stronger influence on changes between suicidal ideation and concentration. CfD had a stronger direct influence on thoughts of being a failure and on the associated change between being an easily annoyed and apprehensive of expectation. There were inconsistencies when modelling change using the first and second appointments as the baseline. Residual score models produced more conservative findings than models using difference scores. CONCLUSIONS: CfD and CBT for depression have differential effects on symptoms demonstrating specific mechanisms of change. CLINICAL IMPLICATIONS: CBT was uniquely associated with changes in symptoms associated with anxiety and may be better suited to those with anxiety symptoms comorbid to their depression. When assessing change, the baseline should be the first therapy session, not the pretreatment assessment. Residual change scores should be preferred over difference score methods. BMJ Publishing Group 2023-02-15 /pmc/articles/PMC10035778/ /pubmed/36792174 http://dx.doi.org/10.1136/bmjment-2022-300621 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Psychotherapies
O'Driscoll, Ciarán
Buckman, Joshua E J
Saunders, Rob
Ellard, Sarah
Naqvi, Syed Ali
Singh, Satwant
Wheatley, Jon
Pilling, Stephen
Symptom-specific effects of counselling for depression compared to cognitive–behavioural therapy
title Symptom-specific effects of counselling for depression compared to cognitive–behavioural therapy
title_full Symptom-specific effects of counselling for depression compared to cognitive–behavioural therapy
title_fullStr Symptom-specific effects of counselling for depression compared to cognitive–behavioural therapy
title_full_unstemmed Symptom-specific effects of counselling for depression compared to cognitive–behavioural therapy
title_short Symptom-specific effects of counselling for depression compared to cognitive–behavioural therapy
title_sort symptom-specific effects of counselling for depression compared to cognitive–behavioural therapy
topic Psychotherapies
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10035778/
https://www.ncbi.nlm.nih.gov/pubmed/36792174
http://dx.doi.org/10.1136/bmjment-2022-300621
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