Although cognitive behavioral therapy (CBT) and mindfulness-based cognitive therapy (MBCT) are effi cacious in reducing depressive symptoms, not all individuals benefit from these treatments. This article examines for whom and why CBT and MBCT are eff ective. The results showed that individuals with higher expectations of treatment outcomes are more involved in treatment and benefi t more from CBT and MBCT. Furthermore, positive ratings of therapeutic alliance predict depressive symptom reduction in CBT, but not in MBCT. Increasing mindfulness might explain why mindfulness training is benefi cial as we found that daily increases in mindfulness preceded rather than followed improvements in mood during mindfulness training. However, the impact of mindfulness on mood diff ered between individuals. This article shows that the eff ectiveness of psychological treatments may depend on the care-recipient.

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Stel: je zit al maanden niet goed in je vel, hebt moeite je bed uit te komen en je hebt nergens zin meer in. Je besluit naar een psycholoog te gaan. Hoe groot is de kans dat dit helpt? Het is bekend dat ongeveer de helft van de mensen met een depressie baat heeft bij een psychologische behandeling. Evelien Snippe en collega’s vroegen zich af waarom en voor wie behandeling voor depressie helpt.

Ondanks dat niet iedereen met depressieve klachten baat heeft bij een psychologische behandeling, blijkt uit onderzoek dat iets doen gemiddeld beter is dan niets doen. Mensen met depressieve klachten knappen eerder op als ze een psychologische behandeling krijgen, zoals cognitieve gedragstherapie (CGT), dan als ze wachten tot hun klachten overgaan (Hollon & Ponniah, 2010)16. Het onderzoek tot dusver wekt de indruk dat het niet uitmaakt welke evidence based behandeling mensen krijgen voor depressie; gemiddeld zijn ze even effectief.

Toch verbeteren de depressieve klachten bij slechts de helft van de mensen (Cuijpers et al., 2012)10 en is het goed mogelijk dat de ene behandeling beter aansluit bij de klachten van sommigen en een andere behandelvorm beter bij die van anderen. Het probleem van eerdere onderzoeken is dat er enkel gekeken werd naar de ‘gemiddelde’ effectiviteit, waardoor er geen zicht is op bij wie een bepaalde behandeling aanslaat. Als de effectiviteit van behandelingen op groepsniveau vergeleken wordt, zullen individuele verschillen


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