Samenvatting

FOR WHOM ARE COGNITIVE BEHAVIORAL THERAPY AND MINDFULNESS TRAINING EFFECTIVE AND WHY?
E. SNIPPE, J. FLEER & M.J. SCHROEVERS
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.


1079 Weergaven
5 Downloads
Log in
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

Literatuurlijst

  1. Ali, S., Stone, M. A., Peters, J.L., Davies, M.J. & Khunti, K. (2006). The prevalence of co-morbid depression in adults with type 2 diabetes: A systematic review and meta-analysis. Diabetic Medicine, 23(11), 1165- 1173. doi:10.1111/j.1464-5491.2006.01943.x
  2. Barber, J.P. (2009). Toward a working through of some core confl icts in psychotherapy research. Psychotherapy Research, 19(1), 1-12. doi:10.1080/10503300802609680
  3. Beck, Rush, A.J., Shaw, B.F. & Emery, G. (1979). Cognitive therapy of depression. New York: Wiley.
  4. Bockting, C.L.H., Schene, A.H., Spinhoven, P., Koeter, M.W.J., Wouters, L.F., Huyser, J. & Kamphuis, J.H. (2005). Preventing relapse/recurrence in recurrent depression with cognitive therapy: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 73(4), 647- 657. doi:10.1037/0022-006X.73.4.647
  5. Bolger, N. & Laurenceau, J. (2013). Intensive longitudinal methods: An introduction to diary and experience sampling research. New York, NY US: Guilford Press.
  6. Bordin, E.S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252-260. doi:10.1037/h0085885
  7. Castonguay, L.G., Goldfried, M.R., Wiser, S., Raue, P.J. & Hayes, A.M. (1996). Predicting the eff ect of cognitive therapy for depression: A study of unique and common factors. Journal of Consulting and Clinical Psychology, 64(3), 497-504. doi:10.1037/0022-006X.64.3.497
  8. Constantino, M.J., Ametrano, R.M. & Greenberg, R.P. (2012). Clinician interventions and participant characteristics that foster adaptive patient expectations for psychotherapy and psychotherapeutic change. Psychotherapy, 49(4), 557-569.
  9. Constantino, M.J., Arnkoff , D.B., Glass, C.R., Ametrano, R.M. & Smith, J.Z. (2011). Expectations. Journal of Clinical Psychology, 67(2), 184-192. doi:10.1002/jclp.20754
  10. Cuijpers, P., Straten, A. van, Driessen, E., Oppen, P. van, Bockting, C. & Andersson, G. (2012). Depression and dysthymic disorders. In P. Sturmey & M. Hersen (Eds.), Handbook of evidence-based practice in clinical psychology, vol 2: Adult disorders (pp. 243-284). Hoboken, NJ US: John Wiley & Sons Inc. doi:10.1002/9781118156391.ebcp002011
  11. Driessen, E. & Hollon, S.D. (2010). Cognitive behavioral therapy for mood disorders: Effi cacy, moderators and mediators. Psychiatric Clinics of North America, 33(3), 537-555. doi:10.1016/j.psc.2010.04.005
  12. Elvins, R. & Green, J. (2008). The conceptualization and measurement of therapeutic alliance: An empirical review. Clinical Psychology Review, 28(7), 1167-1187. doi:10.1016/j.cpr.2008.04.002
  13. Fennell, M. & Segal, Z. (2011). Mindfulness-based cognitive therapy: Culture clash or creative fusion? Contemporary Buddhism, 12(1), 125-142. doi:10.1080/14639947.2011.564828
  14. Goldstein, A.P. (1960). Patient’s expectancies and non-specifi c therapy as a basis for (un)spontaneous remission. Journal of Clinical Psychology, 16(4), 399-403. doi:10.1002/1097-4679
  15. Hamaker, E.L. (2012). Why researchers should think ‘within-person’: A paradigmatic rationale. In M.R. Mehl & T.S. Conner (Eds.), Handbook of research methods for studying daily life. (pp. 43-61). New York, NY US: Guilford Press.
  16. Hollon, S.D. & Ponniah, K. (2010). A review of empirically supported psychological therapies for mood disorders in adults. Depression and Anxiety, 27(10), 891-932. doi:10.1002/da.20741
  17. Horvath, A.O., Del Re, A.C., Flückiger, C. & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9-16. doi:10.1037/a0022186
  18. Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. New York: Hyperion.
  19. Kazdin, A.E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1-27. doi:10.1146/annurev.clinpsy.3.022806.091432.
  20. Khoury, B., Lecomte, T., Fortin, G., Masse, M., Therien, P. et al. (2013). Mindfulness-based therapy: A comprehensive meta-analysis. Clinical Psychology Review, 33(6), 763-771. doi:10.1016/j.cpr.2013.05.005
  21. Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T. et al. (2015). Eff ectiveness and cost-eff ectiveness of mindfulness-based cognitive therapy compared with maintenance antidepressant treatment in the prevention of depressive relapse or recurrence (PREVENT): A randomised controlled trial. The Lancet. doi:10.1016/S0140-6736 (14)62222-4
  22. Ma, S.H. & Teasdale, J.D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of diff erential relapse prevention eff ects. Journal of Consulting and Clinical Psychology, 72(1), 31-40. doi:10.1037/0022-006X.72.1.31
  23. Molenaar, P.C.M. (2004). A manifesto on psychology as idiographic science: Bringing the person back into scientifi c psychology, this time forever. Measurement: Interdisciplinary Research and Perspectives, 2(4), 201- 218. doi:10.1207/s15366359mea0204_1
  24. Schroevers, M.J., Tovote, K.A., Keers, J.C., Links, T.P., Sanderman, R. & Fleer, J. (2015). Individual mindfulness-based cognitive therapy for people with diabetes: A pilot randomized controlled trial. Mindfulness, 6(1), 99-110. doi:10.1007/s12671-013-0235-5
  25. Segal, Z.V., Williams, J.M.G. & Teasdale, J.D. (2002). Mindfulness-based cognitive therapy for depression. New York: The Guilford Press.
  26. Snippe, E., Fleer, J., Tovote, K.A., Sanderman, R., Emmelkamp, P.M.G. & Schroevers, M.J. (2015). The therapeutic alliance predicts outcomes of cognitive behavior therapy but not of mindfulness-based cognitive therapy for depressive symptoms. Psychotherapy and Psychosomatics, volume 84, no. 5, doi:10.1159/000379755
  27. Snippe, E., Bos, E. H., van, d. P., Sanderman, R., Fleer, J., & Schroevers, M. J. (2015). Time-series analysis of daily changes in mindfulness, repetitive thinking, and depressive symptoms during mindfulness-based treatment. Mindfulness, 6(5), 1053-1062. doi:10.1007/s12671-014-0354-7
  28. Snippe, E., Nyklícek, I., Schroevers, M.J. & Bos, E.H. (2015). The temporal order of change in daily mindfulness and aff ect during mindfulnessbased stress reduction. Journal of Counseling Psychology, 62(2), 106-114. doi:10.1037/cou0000057
  29. Snippe, E., Schroevers, M.J., Annika Tovote, K., Sanderman, R., Emmelkamp, P.M.G. & Fleer, J. (2015). Patients’ outcome expectations matter in psychological interventions for patients with diabetes and comorbid depressive symptoms. Cognitive Therapy and Research, 39(3), 307-317. doi:10.1007/s10608-014-9667-z
  30. Strunk, D.R., Brotman, M.A. & DeRubeis, R.J. (2010). The process of change in cognitive therapy for depression: Predictors of early intersession symptom gains. Behaviour Research and Therapy, 48(7), 599-606. doi:10.1016/j.brat.2010.03.011
  31. Teasdale, J.D., Segal, Z.V., Williams, J.M.G., Ridgeway, V.A., Soulsby, J.M. & Lau, M. A. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 68(4), 615-623.
  32. Teasdale, J.D., Segal, Z. & Williams, J.M. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help? Behaviour Research and Therapy, 33(1), 25-39. doi:10.1016/0005-7967(94)E0011-7
  33. Tovote, K.A., Fleer, J., Snippe, E., Peeters, A.C.T.M., Emmelkamp, P.M.G. et al. (2014). Individual mindfulness-based cognitive therapy and cognitive behavior therapy for treating depressive symptoms in patients with diabetes: Results of a randomized controlled trial. Diabetes Care, 37(9), 2427-2434. doi:10.2337/dc13-2918
  34. Van der Velden, A.M., Kuyken, W., Wattar, U., Crane, C., Pallesen, K. J. et al. (2015). A systematic review of mechanisms of change in mindfulnessbased cognitive therapy in the treatment of recurrent major depressive disorder. Clinical Psychology Review, 37, 26-39.
  35. Webb, C.A., Kertz, S.J., Bigda-Peyton, J. & Björgvinsson, T. (2013). The role of pretreatment outcome expectancies and cognitive–behavioral skills in symptom improvement in an acute psychiatric setting. Journal of Aff ective Disorders, doi:10.1016/j.jad.2013.02.016
  36. Westra, H.A., Arkowitz, H. & Dozois, D.J.A. (2009). Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: A preliminary randomized controlled trial. Journal of Anxiety Disorders, 23(8), 1106-1117. doi:10.1016/j. janxdis.2009.07.014