The study investigates the relative efficacy of Interpersonal Psychotherapy and Brief Relational Therapy for Major Depressive Disorder. The primary hypothesis is that there will be no mean difference in efficacy between treatments, but that Brief Relational Therapy will be more efficacious for more self-critical patients and Interpersonal Psychotherapy will be more efficacious for less self-critical patients.

Brief Title

Linköping University Relational and Interpersonal Psychotherapy Project

Official Title

Randomized Controlled Trial of Interpersonal and Brief Relational Psychotherapy for Major Depressive Disorder.

Brief Summary

The study investigates the relative efficacy of Interpersonal Psychotherapy and Brief <br /> Relational Therapy for Major Depressive Disorder. The primary hypothesis is that there will <br /> be no mean difference in efficacy between treatments, but that Brief Relational Therapy will <br /> be more efficacious for more self-critical patients and Interpersonal Psychotherapy will be <br /> more efficacious for less self-critical patients.

Detailed Description

Interventions Interpersonal Psychotherapy (IPT; Klerman et. al., 1984) is an evidence-based,
time-limited treatment originally developed for treating Major Depressive Disorder, although
it has been extended and developed for Bulimia Nervosa and recently also for Post-Traumatic
Stress Disorder. The treatment is structured and focuses on relieving depressive symptoms by
targeting interpersonal problems in the patients' current life situation. In the first four
sessions an interpersonal problem area is identified that is asssumed to maintain the
patient's depression and this problem is agreed upon as a therapy focus. Four types of focus
areas are used in IPT: grief, role transitions, conflicts, and interpersonal deficits. In the
middle phase of therapy the agreed upon focus area is worked with in a problem-solving
fashion, and the patient is also encouraged to seek interpersonal support from his or her
environment. IPT has been established as an evidence-based treatment for Major Depression
(Roth & Fonagy, 2005), and a recent meta-analysis concluded that it was slightly superior to
other established treatments for MDD including Cognitive Behavior Therapy (Cuijpers, van
Straaten, Andersson & van Oppen, 2008).

Brief Relational Therapy (BRT; Safran & Muran, 2000) is a relatively new version of
Short-Term Psychodynamic Psychotherapy, based on relational psychoanalytic theory in
combination with research on processes of rupture and repair of the therapeutic alliance. The
therapeutic alliance, operationalized as the positive bond between patient and therapist in
combination with agreement on tasks and goals of treatment, is the single most robust
predictor of good outcome in psychotherapy research (Lambert & Ogles, 2004). BRT was
developed to help patients who had previously failed in psychotherapeutic treatment(s),
presumably because of trouble in establishing a working therapeutic alliance with their
therapist(s). Therapists are trained to be highly attentive to the therapeutic relationship
and to signs of ruptures in the alliance, and to use self-disclosure and meta-communication
about ruptures in order to repair the therapy alliance and at the same time help patients to
develop a generalized capacity for observing self and others (mentalization). BRT has shown
preliminary evidence for efficacy with patients who are at risk of negative outcome in
psychotherapy (Safran, Muran, Samstag & Winston, 2005) and with patients diagnosed with
DSM-IV axis II personality disorders (Muran, Safran, Samstag & Winston, 2005). A specific
manual for BRT in Major Depressive Disorder is currently under development (Holmqvist, in
preparation).

Both treatments consist of 16 therapy sessions which are all video-taped for adherence
checks. The same therapists will provide both treatments, in randomized order.

Objectives The objectives of the study are to compare the new treatment BRT with the
established treatment IPT in the alleviation of Major Depressive Disorder. The hypothesis of
the trial is that BRT will be superior for patients who have more difficulty establishing a
therapeutic alliance, while IPT will be superior for patients with less difficulty
establishing a therapeutic alliance. Previous research indicates that baseline self-critical
perfectionism negatively predicts outcome in IPT as well as several other brief
psychotherapeutic treatments for depression, and that this is because self-critical
perfectionism will cause problems in the therapeutic alliance (Luyten, Corveleyn & Blatt,
2005). The primary hypothesis is thus that baseline self-cricial perfectionism moderates the
relationship between treatment and outcome. Secondary exploratory objectives are to conduct
in depth process research on the mechanisms of change in these treatments, as well as
interaction effects between treatment modality and other patient characteristics.

Outcome Measures

Outcome measures are the tests that investigators perform to prove whether or not a treatment being tested in a clinical trial is having any effect.