Clinical Edge

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Treatment Attendance Patterns in MDD

In patients with major depressive disorder (MDD), very early termination from services was higher in cognitive therapy (CT) compare with dynamic psychotherapy (DT), a recent study found. 237 patients with MMD participated in a non-inferiority trial comparing short-term DT to CT. Patients in both conditions were offered 16 sessions of treatment and had up to 5 months to complete treatment. Researchers found:

  • 27% of patients from both treatment groups discontinued treatment very early after only an intake session or a single treatment session.
  • Patients in CT were significantly more likely to terminate treatment prematurely.
  • Baseline physical health functioning, subthreshold psychotic symptoms, Session 2 ratings of agreement on tasks, and Session 2 ratings of treatment sensibility all independently predicted premature termination of services.

Citation:

Gibbons MBC, et al. Predictors of treatment attendance in cognitive and dynamic therapies for major depressive disorder delivered in a community mental health setting. [Published online ahead of print June 17, 2019]. J Consult Clin Psychol. doi: 10.1037/ccp0000414.

Commentary:

This paper by Gibbons et al. contributes to the literature that exists regarding compliance and adherence with psychotherapy visits and procedures. Interestingly, here the cognitive approach which has greater structure, utilized between sessions assignments, is a partnering yet directive approach that was met with greater early termination for major depressive disorder patients. The authors suggest that clinicians must try to match therapeutic predictors to the type of therapy chosen. Experientially, patients with more maladaptive personality traits or temperaments seem to do less well in structured, directive approaches could be a confounding variable that was not addressed between the groups? Regardless, it makes the most clinical sense to try to gauge through inquiry (or by using therapeutic alliance surveys perhaps) to determine how tenuous therapeutic relationships are within the first few sessions regardless of therapeutic approach. —Thomas L. Schwartz, MD; Senior Associate Dean of Education, Interim Chair/Professor of Psychiatry, SUNY Upstate Medical University.