Treating depression in an outpatient setting: Predictors of patient response to bouldering psychotherapy, cognitive behavioural therapy or exercise alone.
bouldering
cognitive behavioural therapy
depression
exercise
group psychotherapy
psychotherapy
Journal
Clinical psychology & psychotherapy
ISSN: 1099-0879
Titre abrégé: Clin Psychol Psychother
Pays: England
ID NLM: 9416196
Informations de publication
Date de publication:
29 Aug 2023
29 Aug 2023
Historique:
revised:
20
06
2023
received:
19
09
2022
accepted:
01
08
2023
medline:
29
8
2023
pubmed:
29
8
2023
entrez:
29
8
2023
Statut:
aheadofprint
Résumé
Bouldering psychotherapy (BPT) for depression has proven effective, but nothing is known about its potential predictors of response. This study should identify predictors of response to BPT, cognitive behavioural therapy (CBT) and an active control (home-based exercise programme; EP) using a literature-based model. In a multicentre randomised controlled trial, 233 outpatients were assigned to BPT, CBT or EP. Response (reduction of at least 46% on the Montgomery-Åsberg Depression Rating Scale [MADRS]) and remission (≤7 MADRS points) were defined as suggested by the literature. Predictors of response were identified twofold: (1) univariate analyses followed by logistic regression analyses in each group with all predictors yielding a univariate p-value <.20 and (2) a backward regression analysis with all potential predictors. Only variables that emerged as predictors in both types of analyses were interpreted. There was a significantly greater proportion of responders (p = .035) in the BPT than in the EP. The chance of response in the BPT was higher for patients with a higher health-related quality of life. In the EP, response was higher for patients with lower interpersonal sensitivity, suffering from their first episode and living with a partner. Response rates in BPT are similar to or even higher than in other outpatient psychotherapy group therapies. BPT and CBT are suitable for a wide range of patients, but patients with higher functionality could start with psychoeducation and exercise.
Sections du résumé
BACKGROUND
BACKGROUND
Bouldering psychotherapy (BPT) for depression has proven effective, but nothing is known about its potential predictors of response. This study should identify predictors of response to BPT, cognitive behavioural therapy (CBT) and an active control (home-based exercise programme; EP) using a literature-based model.
METHODS
METHODS
In a multicentre randomised controlled trial, 233 outpatients were assigned to BPT, CBT or EP. Response (reduction of at least 46% on the Montgomery-Åsberg Depression Rating Scale [MADRS]) and remission (≤7 MADRS points) were defined as suggested by the literature. Predictors of response were identified twofold: (1) univariate analyses followed by logistic regression analyses in each group with all predictors yielding a univariate p-value <.20 and (2) a backward regression analysis with all potential predictors. Only variables that emerged as predictors in both types of analyses were interpreted.
RESULTS
RESULTS
There was a significantly greater proportion of responders (p = .035) in the BPT than in the EP. The chance of response in the BPT was higher for patients with a higher health-related quality of life. In the EP, response was higher for patients with lower interpersonal sensitivity, suffering from their first episode and living with a partner.
CONCLUSIONS
CONCLUSIONS
Response rates in BPT are similar to or even higher than in other outpatient psychotherapy group therapies. BPT and CBT are suitable for a wide range of patients, but patients with higher functionality could start with psychoeducation and exercise.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Förderverein Kletterzentrum Aufwärts
Organisme : Oh Do Kwan Foundation Ludmilla Pankofer and Karl Wiedmeier
Informations de copyright
© 2023 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.
Références
Abdollahi, A., LeBouthillier, D. M., Najafi, M., Asmundson, G. J. G., Hosseinian, S., Shahidi, S., Carlbring, P., Kalhori, A., Sadeghi, H., & Jalili, M. (2017). Effect of exercise augmentation of cognitive behavioural therapy for the treatment of suicidal ideation and depression. Journal of Affective Disorders, 219, 58-63. https://doi.org/10.1016/j.jad.2017.05.012
Albani, C., Blaser, G., Geyer, M., Schmutzer, G., Hinz, A., Bailer, H., Grulke, N., & Brahler, E. (2006). Validierung und Normierung des "Fragebogen zur Erfassung des korperlichen Wohlbefindens" (FEW-16) von Kolip und Schmidt an einer reprasentativen deutschen Bevolkerungsstichprobe. [Validation and standardization of the "questionnaire for assessing subjective physical well-being" by Kolip and Schmidt in a representative German sample]. Psychotherapie, Psychosomatik, Medizinische Psychologie, 56(3-4), 172-181. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/16802423
Bourbeau, K., Moriarty, T., Ayanniyi, A., & Zuhl, M. (2020). The combined effect of exercise and behavioral therapy for depression and anxiety: Systematic review and meta-analysis. Behavioral Science, 10(7), 1-17. https://doi.org/10.3390/bs10070116
Box, G. E. P., & Tidwell, P. W. (1962). Transformation of the independent variables. Technometrics: A Journal of Statistics for the Physical, Chemical, and Engineering Sciences, 4(4), 531-550. https://doi.org/10.1080/00401706.1962.10490038
Carmody, T. J., Rush, A. J., Bernstein, I., Warden, D., Brannan, S., Burnham, D., Woo, A., & Trivedi, M. H. (2006). The Montgomery Asberg and the Hamilton ratings of depression: A comparison of measures. European Neuropsychopharmacology, 16(8), 601-611. https://doi.org/10.1016/j.euroneuro.2006.04.008
Chae, W. R., Nagel, J. M., Kuehl, L. K., Gold, S. M., Wingenfeld, K., & Otte, C. (2019). Predictors of response and remission in a naturalistic inpatient sample undergoing multimodal treatment for depression. Journal of Affective Disorders, 252, 99-106. https://doi.org/10.1016/j.jad.2019.04.044
Cheng, L. J., Tan, R. L., & Luo, N. (2021). Measurement properties of the EQ VAS around the globe: A systematic review and meta-regression analysis. Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research, 24(8), 1223-1233. https://doi.org/10.1016/j.jval.2021.02.003
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P. T., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P. A., & Geddess, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. Focus (American Psychiatric Publishing), 16(4), 420-429. https://doi.org/10.1176/appi.focus.16407
Clement, U., & Löwe, B. (1996). Fragebogen zum Körperbild (FKB-20). Hogrefe.
Dorscht, L., Karg, N., Book, S., Graessel, E., Kornhuber, J., & Luttenberger, K. (2019). A German climbing study on depression: A bouldering psychotherapeutic group intervention in outpatients compared with state-of-the-art cognitive behavioural group therapy and physical activation - study protocol for a multicentre randomised controlled trial. BMC Psychiatry, 19(1), 154. https://doi.org/10.1186/s12888-019-2140-5
Enns, M. W., Cox, B. J., & Pidlubny, S. R. (2002). Group cognitive behaviour therapy for residual depression: Effectiveness and predictors of response. Cognitive Behaviour Therapy, 31(1), 31-40. https://doi.org/10.1080/16506070252823643
EuroQol Group. (1990). EuroQol - a new facility for the measurement of health-related quality of life. Health Policy, 16, 199-208. https://doi.org/10.1016/0168-8510(90)90421-9
Ferring, D., & Filipp, S.-H. (1996). Messung des Selbstwertgefühls: Befunde zu Reliabilität, Validität und Stabilität der Rosenberg-Skala. Diagnostica, 42, 284-292.
Franke, G. H. (2002). SCL-90-R. Die Symptom-Checkliste von L. R. Derogatis (2nd ed.). Beltz Test.
Gartlehner, G., Wagner, G., Matyas, N., Titscher, V., Greimel, J., Lux, L., Gaynes, B. N., Viswanathan, M., Patel, S., & Lohr, K. N. (2017). Pharmacological and non-pharmacological treatments for major depressive disorder: Review of systematic reviews. BMJ Open, 7(6), e014912. https://doi.org/10.1136/bmjopen-2016-014912
Gräfe, K., Zipfel, S., Herzog, W., & Löwe, B. (2004). Screening psychischer Störungen mit dem “Gesundheitsfragebogen für Patienten (PHQ-D)”. [Screening for psychiatric disorders with the patient health questionnaire (PHQ). Results from the German validation study]. Diagnostica, 50(4), 171-181. https://doi.org/10.1026/0012-1924.50.4.171
Hallgren, M., Helgadóttir, B., Herring, M. P., Zeebari, Z., Lindefors, N., Kaldo, V., Öjehagen, A., & Forsell, Y. (2016). Exercise and internet-based cognitive-behavioural therapy for depression: Multicentre randomised controlled trial with 12-month follow-up. British Journal of Psychiatry, 209(5), 414-420. https://doi.org/10.1192/bjp.bp.115.177576
Hautzinger, M., & Kischkel, E. (1999). Kurzzeit-Psychotherapeutisches Behandlungskonzept für unterschwellige und leichte depressive Störungen. In Ein Behandlungsmanual (3.3.1 ed.). Klinik und Poliklinik für Psychiatrie und Psychotherapie der Rheinischen Friedrich Wilhelms Universität Bonn.
Hermens, M. L. M., Ader, H. J., van Hout, H. P. J., Terluin, B., van Dyck, R., & de Haan, M. (2006). Administering the MADRS by telephone or face-to-face: A validity study. Annals of General Psychiatry, 5, 3. https://doi.org/10.1186/1744-859X-5-3
Hinz, A., Klaiberg, A., Brahler, E., & Konig, H. H. (2006). Der Lebensqualitatsfragebogen EQ-5D: Modelle und Normwerte fur die Allgemeinbevolkerung. [The quality of life questionnaire EQ-5D: Modelling and norm values for the general population]. Psychotherapie, Psychosomatik, Medizinische Psychologie, 56(2), 42-48. https://doi.org/10.1055/s-2005-867061
Hinz, A., Schumacher, J., Albani, C., Schmid, G., & Brähler, E. (2006). Bevölkerungsrepräsentative Normierung der Skala zur allgemeinen Selbstwirksamkeit. Diagnostica, 52, 26-32. https://doi.org/10.1026/0012-1924.52.1.26
Jack, M. (2007). FERUS. Fragebogen zur Erfassung von Ressourcen und Selbstmanagementfähigkeiten. Hogrefe.
Karg, N., Dorscht, L., Kornhuber, J., & Luttenberger, K. (2020). Bouldering psychotherapy is more effective in the treatment of depression than physical exercise alone: Results of a multicentre randomised controlled intervention study. BMC Psychiatry, 20(1), 116. https://doi.org/10.1186/s12888-020-02518-y
Kerling, A., Tegtbur, U., Gutzlaff, E., Kuck, M., Borchert, L., Ates, Z., von Bohlen, A., Frieling, H., Hüper, K., Hartung, D., Schweiger, U., & Kahl, K. G. (2015). Effects of adjunctive exercise on physiological and psychological parameters in depression: A randomized pilot trial. Journal of Affective Disorders, 177, 1-6. https://doi.org/10.1016/j.jad.2015.01.006
Knapen, J., Vancampfort, D., Morien, Y., & Marchal, Y. (2014). Exercise therapy improves both mental and physical health in patients with major depression. Disability and Rehabilitation, 37(16), 1490-1495. https://doi.org/10.3109/09638288.2014.972579
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Krogh, J., Videbech, P., Thomsen, C., Gluud, C., & Nordentoft, M. (2012). DEMO-II trial. Aerobic exercise versus stretching exercise in patients with major depression-a randomised clinical trial. PLoS ONE, 7(10), e48316. https://doi.org/10.1371/journal.pone.0048316
Lowe, B., Decker, O., Muller, S., Brahler, E., Schellberg, D., Herzog, W., & Herzberg, P. Y. (2008). Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. Medical Care, 46(3), 266-274. https://doi.org/10.1097/MLR.0b013e318160d093
Löwe, B., Spitzer, R. L., Zipfel, S., & Herzog, W. (2002). PHQ-D. Gesundheitsfragebogen für Patienten. Manual (2nd ed.). Pfizer.
Luttenberger, K., Karg-Hefner, N., Berking, M., Kind, L., Weiss, M., Kornhuber, J., & Dorscht, L. (2021). Bouldering psychotherapy is not inferior to cognitive behavioural therapy in the group treatment of depression: A randomized controlled trial. The British Journal of Clinical Psychology, 61(2), 465-493. https://doi.org/10.1111/bjc.12347
Montgomery, S. A., & Asberg, M. (1979). A new depression scale designed to be sensitive to change. The British Journal of Psychiatry, 134(4), 382-389. https://doi.org/10.1192/bjp.134.4.382
Müller, M. J., Himmerich, H., Kienzle, B., & Szegedi, A. (2003). Differentiating moderate and severe depression using the Montgomery-Åsberg depression rating scale (MADRS). Journal of Affective Disorders, 77(3), 255-260. https://doi.org/10.1016/S0165-0327(02)00120-9
Ogrodniczuk, J. S., Piper, W. E., & Joyce, A. S. (2006). Differences in men's and women's responses to short-term group psychotherapy. Psychotherapy Research, 14(2), 231-243. https://doi.org/10.1093/ptr/kph019
Riedel, M., Moller, H. J., Obermeier, M., Schennach-Wolff, R., Bauer, M., Adli, M., Kronmüller, K., Nickel, T., Brieger, P., Laux, G., Bender, W., Heuser, I., Zeiler, J., Gaebel, W., & Seemuller, F. (2010). Response and remission criteria in major depression--a validation of current practice. Journal of Psychiatric Research, 44(15), 1063-1068. https://doi.org/10.1016/j.jpsychires.2010.03.006
Riley, R. D., Snell, K. I., Ensor, J., Burke, D. L., Harrell, F. E. Jr., Moons, K. G., & Collins, G. S. (2019). Minimum sample size for developing a multivariable prediction model: PART II - binary and time-to-event outcomes. Statistics in Medicine, 38(7), 1276-1296. https://doi.org/10.1002/sim.7992
Rosenbaum, S., Sherrington, C., & Tiedemann, A. (2015). Exercise augmentation compared with usual care for post-traumatic stress disorder: A randomized controlled trial. Acta Psychiatrica Scandinavica, 131(5), 350-359. https://doi.org/10.1111/acps.12371
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton University Press. https://doi.org/10.1515/9781400876136
Schaub, A., Roth, E., & Goldmann, U. (2013). Kognitiv-psychoedukative Therapie zur Bewältigung von Depressionen. Ein Therapiemanual (2nd ed.). Hogrefe.
Schramm, E., Zobel, I., Schoepf, D., Fangmeier, T., Schnell, K., Walter, H., Drost, S., Schmidt, P., Brakemeier, E.-L., Berger, M., & Normann, C. (2015). Cognitive behavioral analysis system of psychotherapy versus escitalopram in chronic major depression. Psychotherapy and Psychosomatics, 84(4), 227-240. https://doi.org/10.1159/000381957
Schwarzkopf, L., Dorscht, L., Kraus, L., & Luttenberger, K. (2021). Is bouldering-psychotherapy a cost-effective way to treat depression when compared to group cognitive behavioral therapy - results from a randomized controlled trial. BMC Health Services Research, 21(1), 1162. https://doi.org/10.1186/s12913-021-07153-1
Sonntag, M., Konnopka, A., Leichsenring, F., Salzer, S., Beutel, M. E., Herpertz, S., Herpertz, S., Hiller, W., Hoyer, J., Joraschky, P., Nolting, B., Pöhlmann, K., Stangier, U., Strauss, B., Willutzki, U., Wiltink, J., Leibing, E., & Konig, H. H. (2013). Reliability, validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with social phobia. Health and Quality of Life Outcomes, 11, 215. https://doi.org/10.1186/1477-7525-11-215
Spitzer, R. L., Kroenke, K., Williams, J. B., & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. https://doi.org/10.1001/archinte.166.10.1092
Sulz, S. K. D. (2011). Therapiebuch II. Strategische Kurzzeittherapie.
Tanguay-Sela, M., Rollins, C., Perez, T., Qiang, V., Golden, G., Tunteng, J. F., Perlman, K., Simard, J., Benrimoh, D., & Margolese, H. C. (2022). A systematic meta-review of patient-level predictors of psychological therapy outcome in major depressive disorder. Journal of Affective Disorders, 317, 307-318. https://doi.org/10.1016/j.jad.2022.08.041
Thimm, J. C., & Antonsen, L. (2014). Effectiveness of cognitive behavioral group therapy for depression in routine practice. BMC Psychiatry, 14, 292. https://doi.org/10.1186/s12888-014-0292-x
Thornicroft, G., Chatterji, S., Evans-Lacko, S., Gruber, M., Sampson, N., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Andrade, L., Borges, G., Bruffaerts, R., Bunting, B., de Almeida, J. M. C., Florescu, S., de Girolamo, G., Gureje, O., Haro, J. M., He, Y., Hinkov, H., … Kessler, R. C. (2017). Undertreatment of people with major depressive disorder in 21 countries. The British Journal of Psychiatry, 210(2), 119-124. https://doi.org/10.1192/bjp.bp.116.188078
von Collani, G., & Herzberg, P. Y. (2003). Eine revidierte Fassung der deutschsprachigen Skala zum Selbstwertgefühl von Rosenberg. Zeitschrift für Differentielle Und Diagnostische Psychologie, 24(1), 3-7. https://doi.org/10.1024//0170-1789.24.1.3
Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: A systematic review and meta-analysis. JAMA Psychiatry, 72(4), 334-341. https://doi.org/10.1001/jamapsychiatry.2014.2502
Westra, H. A., Dozois, D. J., & Boardman, C. (2002). Predictors of treatment change and engagement in cognitive-behavioral group therapy for depression. Journal of Cognitive Psychotherapy, 16(2), 227-241. https://doi.org/10.1891/jcop.16.2.227.63996
Williams, J. B. W., & Kobak, K. A. (2008). Development and reliability of a structured interview guide for the Montgomery-Åsberg depression rating scale (SIGMA). The British Journal of Psychiatry, 192(1), 52-58. https://doi.org/10.1192/bjp.bp.106.032532
Windle, E., Tee, H., Sabitova, A., Jovanovic, N., Priebe, S., & Carr, C. (2020). Association of patient treatment preference with dropout and clinical outcomes in adult psychosocial mental health interventions: A systematic review and meta-analysis. JAMA Psychiatry, 77(3), 294-302. https://doi.org/10.1001/jamapsychiatry.2019.3750