Change in RF in IPT and CBT for Major Depressive Disorder Annika - - PowerPoint PPT Presentation

Change in RF in IPT and CBT for Major Depressive Disorder

Annika Ekeblad, PhD, Clinical Psychologist Psychiatric Clinic, County Council of Västernorrland Linköping University

Background: The CIPPS project, Psychiatric Clinic, Sundsvall, Sweden

2

Aims

• Compare treatment outcome between CBT

and IPT in MDD

• Study the significance of a potential

moderator variable, mentalization

• Study potential changes in the level of

mentalization

3

Background: Mentalization and RF

• Mentalization: understanding that mental

states underlie behavior

– Operationalization: Reflective function (RF); Depression-specific RF (DSRF); adaptation to depression

• RF low in patients with MDD; Unclear if cause
• r effect (or third factor?)

4

Key questions: Mentalization and RF

• RF changed by treatment or co-varies with

depression symptoms?

• Do different treatment approaches influence

RF differently?

5

Study design

• RCT of IPT vs CBT in MDD
• 96 patients included
• Few exclusion criteria
• Satisfactory adherence to

treatment models

8

Assessed for eligibility (n= 99) Excluded (n=3) - Declined to participate (n=3)

• not randomization

(n=1)

• not video (n=2)

Completers (n=35; 24 women, 11 men) Drop outs (n=8) (4 women, 4 men) IPT (n=48; 33 women, 15 men)

• Did not start therapy

(n=5; women)

• Started therapy (n=43)

CBT (n=48; 33 women, 15 men)

• Did not start therapy

(n=1; woman)

• Started therapy (n=47)

Completers (n=28; 19 women, 9 men) Randomized (n= 96) Allocation Completers Drop-outs Drop outs (n=19) (13 women, 6 men)

Method: Outcome assessments, predictors and moderators

• Primary outcome

measure

– BDI-II

• Secondary outcome

measures

– RF – DSRF – RTW – Drop-out rate

• Predictors / moderators

– RF – DSRF

7

Method: RF assessment

• Abbreviated form of AAI (Adult Attachment

Interview); rated with RF scale

• Depression-specific RF scale (DSRF)

Depression Specific Reflective Functioning DSRF

• Interview developed by Fredrik Falkenström

Linköping/Stockholm Sweden after Panic specific reflective functioning (PSRF) Barbara Milrod

9

Depression Specific Reflective Functioning DSRF

Interwiev:

• Why do you think you are depressed
• Did your thoughts about why you are

depressed change over time?

• Have you ever noticed that you become

more depressed by certain events, thoughts

• r feelings?

10

RF scale

• Rated from transcriptions of Adult Attachment

Interwievs

• Scale: -1 to 9 from anti-mentalizing to highly

reflective

• Theoretical ”normal” level is 5

11

Results: Outcome trajectories

12

Results: Mentalization

RF as a predictor:

• Pre-treatment RF predicted:

– treatment results – alliance

• No difference between treatment methods

RF and DSRF levels:

• RF increased during IPT treatment (and not in CBT)
• RF after treatment was still low in depressed patients
• DSRF did not change over treatment (but significant decrease

in DSRF at session 5)

13 13

RF and DSRF predicting change in depression severity

Change in RF from pre- to post treatment

• Used only patients who completed treatment (N

= 63)

– 56 AAI interviews before treatment – 44 AAI interviews after treatment

• Average pre-post difference 0.32 (t (40) = 2.16, p

= .04)

• Correlation between change in RF and change in

BDI-II: r = .11 (ns)

15 15

Change in RF from pre- to post treatment

• Difference in pre-post change between

treatments statistically significant (F (1, 39) = 6.08, p = .02)

• CBT (N = 18): Pre RF = 2.89, Post RF = 2.92
• IPT (N = 24): Pre RF = 2.67, Post RF = 3.27

16 16

Change in DSRF from pre- to post treatment

• Used only patients who completed treatment

(N = 63)

– 53 DSRF interviews before treatment – 45 DSRF interviews after treatment

• Average change from pre- to post non-

significant

• Difference between treatments in pre- to

post change non-significant

17 17

Clinical implications

Potential clinical implications:

• Supports the value of CBT and IPT for severely

depressed patients

• Drop-outs from CBT
• Select depressed patients for CBT that are

motivated

• Important to offer different forms of therapy
• Patients with poor capacity for mentalization not

good candidates for these treatments

• IPT contributed to an increase in RF - but did not

result in a normal RF level; make efforts to adapt IPT for the purpose of increasing RF?

18 18

Limitations

19

• Large rate of attrition
• Compensated to some degree by multiple

imputation

www.liu.se

Thank you for listening!

annika.ekeblad@lvn.se