Psychotherapy for depression: A randomized clinical trial comparing schema therapy and cognitive behavior therapy

Carter, J. D., McIntosh, V. V., Jordan, J., Porter, R. J., Frampton, C. M., & Joyce, P. R. (2013). Psychotherapy for depression: A randomized clinical trial comparing schema therapy and cognitive behavior therapy. Journal of Affective Disorders, 151(2), 500–505. https://doi.org/10.1016/j.jad.2013.06.034

Summary by: Serra Bıtrak

The article I presented is called “Psychotherapy for Depression: A Randomized Clinical Trial Comparing Schema Therapy and Cognitive Behavior Therapy.” by Carter and colleagues (2013). Since the article focuses on Schema Therapy and Cognitive Behavior Therapy, it is important to mention the differences between CBT and ST. We can say that ST mostly concentrates specifically on the schema and what prevents individuals from getting their core needs met. The literature proposes that to make a lasting change, the schema must be modified, especially for people dealing with more persistent problems such as chronic depression. Therefore, based on the literature, the study aimed to compare the efficacy of ST with the traditional CBT for individuals with a major depressive episode. 

The study design was a randomized clinical trial study with 100 adult participants. The participants were recruited from either referrals from General Practitioner’s (GP’s) and mental health services or they could also self-refer. The recruitment took place between the years 2004 to 2008. Sixty nine percent of the participants were women. They were assessed and treated in an outpatient clinical research unit in the Department of Psychological Medicine, University of Otago, New Zealand. The exclusion criteria were moderate or severe alcohol or drug dependence, a history of mania, schizophrenia, major physical illness which would interfere with treatment, and failure to respond to a recent (past year) trial of CBT or ST.

As for the procedure, they did an initial screening by phone, followed by a baseline assessment which used Structured Clinical Interview for DSM-IV Axis I disorders (SCID-PQ), and after that, participants were randomly assigned to weekly therapy sessions for either CBT or ST for 6 months, followed by monthly sessions which were 6 more months. To assess the therapists’ competency, Cognitive therapy rating scale for CBT and its modified form for ST was used by choosing random sessions. Then, to measure participants' depression levels, Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory was used. The first is a clinician-rated scale while the other is self-rated.

The results showed that there were no significant differences between the two therapies at the end of weekly therapy sessions or at the end of the whole therapy (i.e. end of monthly sessions). In terms of participants who reached remission or recovery, again, there was no significant difference. And also, they checked if having a comorbid personality disorder would affect the outcome, but there was no difference for that either.

Therefore, in conclusion, it can be said that this was the first randomized clinical trial comparing the two therapy modalities, and this is of course a limitation, because the results may not be very generalizable, so a replication is needed. And even though there wasn’t a significant difference, these results mean that CBT and ST are comparable when it comes to their effectiveness. Since their approaches are different, depending on the individual’s needs, they now have an option and can prefer one or the other.