A Comparison of Cognitive and Dynamic Therapy for Depression in Community Settings

The goal of this study is to conduct a randomized, comparative, non-inferiority clinical trial that tests the hypothesis that a widely used form of manualized dynamic psychotherapy (supportive-expressive psychodynamic therapy) is not inferior to cognitive therapy when implemented in community mental health settings for the treatment of major depressive disorder (MDD). The specific aims are (1) to conduct a randomized non-inferiority trial to compare supportive-expressive psychodynamic therapy and cognitive therapy for patients with MDD and (2) to assess the comparative effectiveness of supportive-expressive psychodynamic therapy and cognitive therapy on secondary measures of symptoms, patient functioning, and quality of life.

Patient mediators of outcome will also be examined through an additional grant awarded to Paul Crits-Christoph, Ph.D. This grant was funded by the National Institutes of Mental Health - RO1MH092363-01. This grant is entitled:"The mechanisms of cognitive and dynamic therapy in community settings."

Recruitment will occur solely through community mental health clinics in and around Philadelphia.

Inclusion criteria

• Confirmed diagnosis of major depressive disorder
• Able to read at the 4th grade level or higher
• Willingness to be randomized and participate in research

Exclusion criteria

• Current or past diagnosis of schizophrenia, seizure disorder, bipolar disorder, psychotic features, or clinically significant organic pathology
• Significant suicidal risk/ideation requiring immediate referral for more intensive treatment, or specific gesture in the last 6 months
• Current substance abuse or dependence requiring immediate referral to substance abuse program
• Acute medical problem requiring immediate inpatient treatment
• Need for referral to a partial hospitalization program