'Two-plus-one' therapy works for mild depression, study suggests

V ery brief therapy shows considerable promise for successfully treating patients with low-level, or subsyndromal, depression, according to a recent British study.

The researchers embarked on the study to determine whether short-term therapy helps mildly depressed patients--many of whom don't receive treatment because, in the streamlining of health care, insurance companies sometimes assume that patients with milder forms don't really need it.

In their study, they tested what they call a "two-plus-one" treatment model, in which patients received two therapy sessions one week apart, and a third session three months later. Participants were 67 men and 47 women in white-collar jobs.

The clients, classified as either stressed, subclinically depressed or clinically depressed at low levels, according to scores on the intake Beck Depression Inventory (BDI), received the two-plus-one treatment in either a purely cognitive-behavioral or purely psychodynamic- interpersonal form, either immediately or four weeks after completing the BDI.

At the end of treatment, delayed- and immediate-therapy clients scored much the same, with all three mildly depressed groups taking significant strides toward conquering their depression. Those with subclinical depression showed the most improvement--72 percent of them showed significantly positive changes on the BDI--while 67 percent of those with stress and 65 percent of those with low-level depression showed similar improvement.

On follow-up one year later, cognitive-behavioral therapy emerged as more effective than the psychodynamic type, a pattern that wasn't evident right away.

The study's lead researcher, Michael Barkham, PhD, of the University of Leeds, says a cognitive-behavioral approach may work best with the problems mildly depressed patients have.

"Interestingly, the stressed group benefited most from cognitive-behavioral therapy, perhaps indicating that it provides a more natural approach to addressing 'everyday' problems than psychodynamic methods," says Barkham of the study, published in the April issue of APA's Journal of Consulting and Clinical Psychology (Vol. 67, No. 2,
p. 201-211).

Ultimately, says Barkham, the study suggests that practitioners can deliver brief structured interventions in a strictly cognitive-behavioral or psychodynamic mode and expect good results with subsyndromal depression.

"It's consistent with the notion of motivating clients to draw on their own resources in order to change their current situation," he says.

--B. Murray



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