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Collaborative decision making improves interpersonal psychotherapy efficiency: A randomized clinical trial with postpartum women
Journal article   Open access   Peer reviewed

Collaborative decision making improves interpersonal psychotherapy efficiency: A randomized clinical trial with postpartum women

Scott Stuart, Rebecca L. Brock, Erin Ramsdell, Stephan Arndt and Michael W. O'Hara
Journal of affective disorders reports, Vol.14, pp.100636-100636
12/01/2023
DOI: 10.1016/j.jadr.2023.100636
PMID: 38074280
url
https://doi.org/10.1016/j.jadr.2023.100636View
Published (Version of record) Open Access

Abstract

•This randomized clinical trial with 140 postpartum outpatients meeting criteria for DSM-IV major depression demonstrated that a clinician-managed version of interpersonal psychotherapy (CM-IPT) demonstrated similar outcomes as standard IPT and was superior to waitlist control.•CM-IPT – which allows patient and therapist to negotiate when to schedule sessions rather than following the standard weekly format – may be a more efficient and less expensive option for treating acute depression than mandated weekly IPT.•Permitting clinicians and patients to use their judgment is likely to be a more efficient and effective way to implement evidence-based psychotherapy in the community. Randomized controlled trials of Interpersonal Psychotherapy (IPT) and other psychotherapies for depression have required strict adherence to protocol and do not allow for clinical judgment in deciding frequency of sessions. To determine if such protocols were more effective than allowing therapists to use their clinical judgment, we compared “Clinician- Managed” IPT (CM-IPT), in which clinicians and patients with postpartum depression were allotted 12 sessions and determined collaboratively when to use them, to a once weekly 12 session protocol (“Standard IPT”). We hypothesized that CM-IPT would be more efficient, requiring fewer sessions to reach an equivalent acute outcome, and that CM-IPT would be superior over 12 months because “saved” sessions could be used for maintenance treatment. We conducted a clinical trial including 140 postpartum outpatients with DSM-IV major depression who were randomly assigned to “Standard” IPT (N=  69) or CM-IPT (N=  71). Both CM-IPT and S-IPT were highly efficacious with similar outcomes by 12 weeks but CM-IPT group utilized significantly fewer sessions. Both were superior to a waitlist control. Superiority comparisons at 12 months did not favor the CM-IPT condition. Results should be replicated in a more diverse sample to increase generalizability. CM-IPT is more efficient in treating acute depression than mandated weekly IPT. Further, permitting clinicians and patients to use their collaborative judgment is likely to be a more efficient and effective way to conduct future research and to implement evidence-based psychotherapy in the community.
 Depression Interpersonal psychotherapy Perinatal Postpartum depression

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