Table 40-2 Randomized clinical trials comparing depression-focused psychotherapies and nonpharmacological control conditions as acute-phase treatments of major depressive disorder

Table 40-2 Randomized clinical trials comparing depression-focused psychotherapies and nonpharmacological control conditions as acute-phase treatments of major depressive disorder
Treatment	Study	N	Duration (weeks)	Comparison of efficacy
Interpersonal
	Weissman et al. 1979	96	16	IPT > nonscheduled treatment
	Elkin et al. 1989	239	16	IPT ≥ placebo + CMA
				IPT = CT
Behavioral
	Fuchs and Rehm 1977	28	6	BT > waiting list
	Shaw 1977	32	4	BT (group) > waiting list
				BT (group) = attentional control
				BT (group) = CT (group)
	McLean and Hakstian 1979	178	10	BT > relaxation training
				BT > dynamic psychotherapy
	Rehm et al. 1979	24	6	BT (group) > assertion training (group)
	Zeiss et al. 1979	66	12	BT > waiting list^b
	Fleming and Thornton 1980	35	4	BT (group) ≥ dynamic therapy (group)
				BT (group) ≥ CT (group)^c
	Rehm et al. 1981	49	7	BT (group) > waiting list
	Gallagher and Thompson 1982 (geriatric patients)	37	12	BT ≥ dynamic psychotherapy
				BT = CT
	Wilson 1982	64	8	BT ≥ relaxation training
				BT > waiting list
	Kornblith et al. 1983	49	12	BT (group) ≤ dynamic therapy (group)
	Wilson et al. 1983	25	8	BT > waiting list
				BT = CT^c
	R. A. Brown and Lewinsohn 1984	63	8	BT (group = individual) > waiting list
	Hersen et al. 1984	120	12	BT = dynamic psychotherapy
	Rude 1986	48	5	BT ≥ waiting list
				BT = CT^c
	Thompson et al. 1987 (geriatric patients)	91	16	BT > waiting list
				BT = dynamic psychotherapy
				BT = CT
	Nezu and Perri 1989	39	10	BT (group) > waiting list
				BT (group) > nondirective therapy (group)
	Sher et al. 1990	26	12	BT (marital) > waiting list
	N. S. Jacobson et al. 1991	72	16	BT (marital) ≥ CT
	Beach and O'Leary 1992	45	15	BT (marital) = CT
				BT (marital) = waiting list
	N. S. Jacobson et al. 1996	149	16	BA = AT = CT
Cognitive
	Shaw 1977	32	4	CT (group) > attentional control
				CT (group) > waiting list
				CT (group) = BT (group)
	Fleming and Thornton 1980	35	4	CT (group)^c ≤ BT (group)
				CT (group)^c = dynamic psychotherapy (group)
	Comas-Diaz 1981	26	4	CT (group)^c > waiting-list assessment
	Gallagher and Thompson 1982 (geriatric patients)	37	12	CT = BT
				CT ≥ dynamic psychotherapy
	Wilson et al. 1983	25	8	CT^c > waiting list
				CT^c = BT
	Steuer et al. 1984 (geriatric patients)	33	36	CT (group) ≥ dynamic therapy (group)
	Ross and Scott 1985	51	12	CT > waiting list
				CT (group) = CT (individual)
	Rude 1986	48	5	CT^c > waiting list
				CT^c = BT
	Beutler et al. 1987	56	20	CT (group) + placebo > supportive care + placebo
	Covi and Lipman 1987	70	14	CT (group) > "traditional" process group
	Thompson et al. 1987 (geriatric patients)	91	16	CT > waiting list
				CT = dynamic psychotherapy
				CT = BT
	Hogg and Deffenbacher 1988 (college students)	37	8	CT (group)^c = waiting list^d
				CT (group)^c = dynamic psychotherapy (group)
	Elkin et al. 1989	239	16	CT ≥ placebo + clinical management^a
				CT = interpersonal
	M. J. Scott and Stradling 1990Study 1: Primary care setting	67	12	CT > waiting list
				CT (group) = CT (individual)
	M. J. Scott and Stradling 1990Study 2: Employee assistance setting	36	12	CT (group) = CT (individual)
	Selmi et al. 1990	36	6	CT = computerized CT
				CT > waiting list
	N. S. Jacobson et al. 1991	72	16	CT^e ≥ BT (marital)
	Beach and O'Leary 1992	45	15	CT > waiting list
				CT = BT (marital)
	Propst et al. 1992f (devoutly religious patients)	59	12	CT ("conventional") > waiting list
				CT ("conventional") = pastoral counseling
				CT (religious) > pastoral counseling
				CT (religious) ≥ CT (nonreligious)
	Shapiro et al. 1994		16	CT ≥ psychodynamic interpersonal
	N. S. Jacobson et al. 1996	149	16	CT = AT = BA
Note. IPT = interpersonal psychotherapy; AT = automatic thoughts; BA = behavioral activation; BT = behavior therapy; CMA = clinical management; CT = cognitive therapy; ">" indicates more efficacy; "≥" indicates at least as much efficacy and sometimes more; "=" indicates equal efficacy.
^aGeneral pattern of results favored active treatments over control, especially for IPT (relative to placebo) in more severely depressed patients.
^bWaiting-list control period was 4 weeks long.
^cCT condition is not fully representative of Beck's (1976) model of treatment.
^dWaiting-list group was not randomly assigned. Waiting-list subjects' treatment was delayed by the Christmas holiday break in classes.
^eCT was more effective in couples whose marriages were not distressed.
^fThis included two forms of CT: "conventional" and a specially modified form integrating religious beliefs and metaphors.
Source. Adapted and updated from Shea et al. 1988.

Table 40-2 Randomized clinical trials comparing depression-focused psychotherapies and nonpharmacological control conditions as acute-phase treatments of major depressive disorder
Treatment	Study	N	Duration (weeks)	Comparison of efficacy
Interpersonal
	Weissman et al. 1979	96	16	IPT > nonscheduled treatment
	Elkin et al. 1989	239	16	IPT ≥ placebo + CMA
				IPT = CT
Behavioral
	Fuchs and Rehm 1977	28	6	BT > waiting list
	Shaw 1977	32	4	BT (group) > waiting list
				BT (group) = attentional control
				BT (group) = CT (group)
	McLean and Hakstian 1979	178	10	BT > relaxation training
				BT > dynamic psychotherapy
	Rehm et al. 1979	24	6	BT (group) > assertion training (group)
	Zeiss et al. 1979	66	12	BT > waiting list^b
	Fleming and Thornton 1980	35	4	BT (group) ≥ dynamic therapy (group)
				BT (group) ≥ CT (group)^c
	Rehm et al. 1981	49	7	BT (group) > waiting list
	Gallagher and Thompson 1982 (geriatric patients)	37	12	BT ≥ dynamic psychotherapy
				BT = CT
	Wilson 1982	64	8	BT ≥ relaxation training
				BT > waiting list
	Kornblith et al. 1983	49	12	BT (group) ≤ dynamic therapy (group)
	Wilson et al. 1983	25	8	BT > waiting list
				BT = CT^c
	R. A. Brown and Lewinsohn 1984	63	8	BT (group = individual) > waiting list
	Hersen et al. 1984	120	12	BT = dynamic psychotherapy
	Rude 1986	48	5	BT ≥ waiting list
				BT = CT^c
	Thompson et al. 1987 (geriatric patients)	91	16	BT > waiting list
				BT = dynamic psychotherapy
				BT = CT
	Nezu and Perri 1989	39	10	BT (group) > waiting list
				BT (group) > nondirective therapy (group)
	Sher et al. 1990	26	12	BT (marital) > waiting list
	N. S. Jacobson et al. 1991	72	16	BT (marital) ≥ CT
	Beach and O'Leary 1992	45	15	BT (marital) = CT
				BT (marital) = waiting list
	N. S. Jacobson et al. 1996	149	16	BA = AT = CT
Cognitive
	Shaw 1977	32	4	CT (group) > attentional control
				CT (group) > waiting list
				CT (group) = BT (group)
	Fleming and Thornton 1980	35	4	CT (group)^c ≤ BT (group)
				CT (group)^c = dynamic psychotherapy (group)
	Comas-Diaz 1981	26	4	CT (group)^c > waiting-list assessment
	Gallagher and Thompson 1982 (geriatric patients)	37	12	CT = BT
				CT ≥ dynamic psychotherapy
	Wilson et al. 1983	25	8	CT^c > waiting list
				CT^c = BT
	Steuer et al. 1984 (geriatric patients)	33	36	CT (group) ≥ dynamic therapy (group)
	Ross and Scott 1985	51	12	CT > waiting list
				CT (group) = CT (individual)
	Rude 1986	48	5	CT^c > waiting list
				CT^c = BT
	Beutler et al. 1987	56	20	CT (group) + placebo > supportive care + placebo
	Covi and Lipman 1987	70	14	CT (group) > "traditional" process group
	Thompson et al. 1987 (geriatric patients)	91	16	CT > waiting list
				CT = dynamic psychotherapy
				CT = BT
	Hogg and Deffenbacher 1988 (college students)	37	8	CT (group)^c = waiting list^d
				CT (group)^c = dynamic psychotherapy (group)
	Elkin et al. 1989	239	16	CT ≥ placebo + clinical management^a
				CT = interpersonal
	M. J. Scott and Stradling 1990Study 1: Primary care setting	67	12	CT > waiting list
				CT (group) = CT (individual)
	M. J. Scott and Stradling 1990Study 2: Employee assistance setting	36	12	CT (group) = CT (individual)
	Selmi et al. 1990	36	6	CT = computerized CT
				CT > waiting list
	N. S. Jacobson et al. 1991	72	16	CT^e ≥ BT (marital)
	Beach and O'Leary 1992	45	15	CT > waiting list
				CT = BT (marital)
	Propst et al. 1992f (devoutly religious patients)	59	12	CT ("conventional") > waiting list
				CT ("conventional") = pastoral counseling
				CT (religious) > pastoral counseling
				CT (religious) ≥ CT (nonreligious)
	Shapiro et al. 1994		16	CT ≥ psychodynamic interpersonal
	N. S. Jacobson et al. 1996	149	16	CT = AT = BA
Note. IPT = interpersonal psychotherapy; AT = automatic thoughts; BA = behavioral activation; BT = behavior therapy; CMA = clinical management; CT = cognitive therapy; ">" indicates more efficacy; "≥" indicates at least as much efficacy and sometimes more; "=" indicates equal efficacy.
^aGeneral pattern of results favored active treatments over control, especially for IPT (relative to placebo) in more severely depressed patients.
^bWaiting-list control period was 4 weeks long.
^cCT condition is not fully representative of Beck's (1976) model of treatment.
^dWaiting-list group was not randomly assigned. Waiting-list subjects' treatment was delayed by the Christmas holiday break in classes.
^eCT was more effective in couples whose marriages were not distressed.
^fThis included two forms of CT: "conventional" and a specially modified form integrating religious beliefs and metaphors.
Source. Adapted and updated from Shea et al. 1988.