The limited success of most therapies available for treating chronic depression means there is a strong need for development of new treatments for this debilitating condition. In this blog post, Ioannis Malogiannis describes results of a pilot study of 12 chronically depressed patients treated with an adapted form of schema therapy, lasting 60 sessions. At the end of treatment, approximately 60% of the patients remitted or responded to therapy. This exciting pilot study supports the use of schema therapy as an effective treatment for chronic depression.

 

Ioannis A. Malogiannis, MD, PhD
Psychiatrist
Schema Therapy Supervisor, Department of Psychotherapy,

1st Psychiatric Department, Eginition Hospital, Medical School, University of Athens, Greece.

               President of the Greek Society of Schema Therapy

 

The nosological entity of chronic depression is a new challenge for Schema Therapy (ST). Chronic depression is a difficult to treat mental disorder, associated with increased functional impairment, suicide attempts and health care utilization. Early adversity, comorbid personality disorders and Early Maladaptive Schemas are the main determinants of chronic depression. Although several pharmacological and psychotherapeutic interventions have been developed for the treatment of chronic depression, the effect sizes are small, a substantial proportion of patients remain depressed and most trials suffer from lack of maintenance of their results.

The existing literature stresses the need for development of new treatments, more intensive, lengthier, dealing with personality pathology for chronically depressed patients. The limited effectiveness of the existing interventions and the effective focus of ST work on the all the determinants of chronic depression support the idea to investigate the implementation of ST in chronic depression.

We conducted a pilot single case series study. The protocol consisted of 60 sessions as follows: 12-16 initial sessions of introduction to ST and bonding between patient and therapist and then the main phase of ST provision up to 60 sessions. 12 chronically depressed patients participated. Patients were assessed three times during an 8-week baseline period, then at the end of the introductory phase, and again every 12 sessions up to the end of treatment and finally at a 6-month follow up.

At the end of treatment 7 patients (approximately 60%) remitted or responded to therapy. Depressive and anxiety symptoms significantly decreased during treatment, the effect sizes were large and maintained in the 6-months follow-up. A significant decrease of depression and anxiety symptoms was reported after the introductory phase. This effect was attributed to the use of an extremely nurturing therapeutic stance from the beginning of the intervention – one using the frame of limited re-parenting. After this phase, deterioration regarding depressive symptoms was found at the second or later assessments. This was explained as a result of the use of experiential techniques and the focus of therapeutic work on early traumatic experiences. As therapy progressed, experiential work and reparenting fulfilled the unmet core emotional needs and changed schemas and modes resulting in more lasting changes. (The Figure below presents the change of depressive symptoms, measured by the Hamilton Rating Scale for Depression - HRSD, during treatment and the 6-month follow-up)

 This pilot study supports the use of ST as an effective treatment for chronic depression. A Randomized Controlled Trial (RCT) of Group Schema Therapy for chronically depressed patients is now being prepared and will be implemented by our group in the next months.

 

 

For further reading:

1. Ioannis A. Malogiannis, Arnoud Arntz, Areti Spiropoulou, Aikaterini Aggeli, Spyridoula Karveli, Eirini Tsartsara, Miranda Vlavianou, Artemios Pehlivanidis, George Papadimitriou, Iannis Zervas. (2014). Schema Therapy for patients with chronic depression. A single case series study. Journal of Behaviour Therapy and Experimental Psychiatry, 45, 319-329.
2. F. Renner, A. Arntz, I. Leeuw, M. Huibers (2013). Treatment of Chronic depression Using Schema Therapy. Clinical Psychology: Science and Practice, 20, 166-180.