CBT is Effective for Treatment-Resistant Depression in Community Mental Health

State mental health systems have been leaders in the implementation of evidence-based approaches to care for individuals with severe mental illness. Numerous case studies of the wide-scale implementation of research-supported models such as integrated dual diagnosis treatment and assertive community treatment are documented. However, relatively few dissemination efforts have focused on cognitive behavioral therapy (CBT) for individuals with major depression despite evidence indicating its efficacy with this population. A multi-site effectiveness trial of CBT was conducted within the Texas public mental health system. Eighty-three adults with major depression received CBT from community clinicians trained through a workshop and regular consultation with a master clinician. Outcomes were compared to a matched sample of individuals receiving pharmacotherapy. Outcome measures used included the quick inventory of depressive symptomatology and beck depression inventory. Individuals receiving CBT showed greater improvements in depression symptoms than those in the comparison group. Greater pre-treatment symptom severity predicted better treatment response, while the presence of comorbid personality disorders was associated with poorer outcomes.

Lopez, M. & Basco, M. (2014). Effectiveness of cognitive behavioral therapy in public mental health: comparison to treatment as usual for treatment-resistant depression. Administration and Policy in Mental Health Service and Research.  DOI:10.1007/s10488-014-0546-4

CBT plus Medication is Effective for Treatment Resistant Depression

According to a new study published online in The Lancet (December 7, 2012) and Contemporary Clinical Trials, cognitive behavior therapy (CBT) as an adjunct to usual care has shown to be an effective treatment for reducing depression and improving quality of life in patients with treatment resistant depression. Although pharmacotherapy is often used as a first-line treatment for depression, only one-third of patients fully respond to anti-depressants and only half receive up to a fifty percent decrease in symptoms. The current study employed a large-scale CoBalT (two parallel-group) randomized controlled trial to investigate the effectiveness of combining CBT and usual care (including pharmacotherapy) versus usual care, alone, for treatment resistant depression. Participants (n=469) ranged from age 18 to 75 and were already taking anti-depressants. They were randomly assigned to receive either CBT plus usual care (n=234) or usual care alone (n=235).

At the 6 month follow up, 46% of  participants (n=95) in the CBT plus usual care group met criteria for response to treatment, as compared to only 22% of participants (n=46)  in the usual care group. Those who received CBT were more likely to experience remission, received lower scores on the Beck Depression Inventory (BDI), and experienced fewer symptoms of anxiety and panic. At the 12-month follow up, these improvements were maintained.

This study is the first large-scale randomized control trial investigating CBT treatment as an adjunct to usual care in patients showing treatment resistance to anti-depressants.  Findings suggest that CBT in combination with usual care can be extremely effective for treating depressive symptoms and improving the quality of life of patients suffering from depression.

Wiles, N., Thomas, L., Abel, A., Ridgway, N., Turner, N., Campbell, J., Garland, A, Hollinghurst, S., Jerrom, B., Kessler, D., Kuyken, W., Morrison, J., Turner, K., Williams, C., Peters, T., & Lewis, G. (2012). Cognitivebehavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. Lancet. Published online 7th December 2012.