Approximately 3.8% of the world’s population suffer from a major depressive disorder. There are several effective treatments for depression, including pharmacology and psychotherapy, but the effects tend to be modest. The most researched and widely available psychological treatment is cognitive-behavioral therapy (CBT). However, many patients do not respond to existing evidence-based treatments like CBT. Patients may have their own specific preferences for treatments and potentially experience different responses to available treatments. In this large randomized controlled trial, Miggiels and colleagues tested in a randomized controlled trial a short-term psychodynamic supportive therapy (SPSP) for depressive disorders. They compared SPSP to CBT in a “non-inferiority” trial. That is, they tested if there was a significant difference between the treatments and if the difference was smaller than a pre-established clinically acceptable difference (on average, less than a 5 point difference on a standardized depression scale). They expected that SPSP would be non-inferior to CBT on the primary outcome of depression at post-treatment. The study included 290 patients who had moderate to severe depression and who received 16 sessions of either SPSP or CBT. The study had 40 experienced and trained therapists who followed the SPSP or CBT treatment protocol. The estimated mean post-treatment difference between SPSP and CBT was 2.54 points on the depression scale in favour of SPSP (95 % CI: -0.63 to 5.72), indicating no statistically significant and clinically meaningful difference between the treatments. The improvement rates between treatment groups did not differ significantly between CBT and SPSP (CBT 20.7 % vs SPSP 23.6 %; X2 (df = 1) = 0.52, p = 0.59). However, there was a difference between the rates of those no longer meeting the criteria for depression (CBT 9.0% vs SPSP 20.5 %; X2 (df = 1) = 6.06, p = 0.01) in favour of SPSP. There was also a small but statistically significant difference in scores of general well-being favouring SPSP. In general, the effects of both treatments on depressive symptoms were small to moderate.
Practice Implications
The study demonstrates in a non-inferiority randomized controlled trial that there were no major differences between SPSP and CBT in treating depression. One could speculate that the similar effects of the treatments might be due to other underlying factors (therapist interpersonal skills, therapeutic alliance, patient characteristics) common to all psychotherapies. The psychodynamic therapy was not inferior to CBT, potentially opening up another treatment option for those with depressive disorders.
Miggiels, M., ten Klooster, P., Beekman, A., Bremer, S., Dekker, J., Janssen, C., van Dijk, M.K. (2025). The D*Phase-study: Comparing short-term psychodynamic psychotherapy and cognitive behavioural therapy for major depressive disorder in a randomized controlled non-inferiority trial. Journal of Affective Disorders, 371, 344-351. https://doi.org/10.1016/j.jad.2024.10.122.
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