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Treatment Effects on the Social Adjustment of Depressed Patients

Treatment Effects on the Social Adjustment of Depressed Patients Abstract The effects of maintenance treatment on social adjustment are examined in depressed outpatients randomly assigned to eight months of amitriptyline hydrochloride, a placebo, or no pill, with or without psychotherapy, using a 2 × 3 factorial design. Results for the 106 patients who completed the trial show a significant main effect for psychotherapy apparent only after six to eight months' treatment. Psychotherapy improved overall adjustment, work performance, and communication, and reduced friction and anxious rumination. There was no effect on the patients' social adjustment for amitriptyline and there were no drug/psychotherapy interactions. The results support the value of weekly maintenance psychotherapy in recovering depressives. Since amitriptyline has been shown to reduce relapse and prevent symptom return, and psychotherapy was shown to enhance adjustment, there is evidence for combined treatments. References 1. Frank JD: Persuasion and Healing . Baltimore, Johns Hopkins Press, 1961. 2. Weissman MM, Paykel ES: The Depressed Woman: A study of Social Relationships. Chicago, University of Chicago Press, to be published. 3. Klerman GL, et al: Treatment of depression by drugs and psychotherapy . Am J Psychiatry 131:186-191, 1974. 4. Raskin A, et al: Replication of factors of psychopathology in interview, ward behavior and self report ratings of hospitalized depressives . J Nerv Ment Dis 148:87-98, 1969.Crossref 5. Cartwright RD: A comparison of the response to psychoanalytic and client-centered psychotherapy , in Gottschalk LA, Auerbach AH (eds): Methods of Research in Psychotherapy . New York, Appleton-Century Crofts Inc, 1966. 6. Traux CB, Carkhuff RR: Towards Effective Counseling and Psychotherapy, Training and Practice . Chicago, Aldine Press, 1967. 7. Weissman MM, Prusoff BA, Paykel ES: Checklist quantification of a psychological therapy: Pilot studies of reliability and utility . J Nerv Ment Dis 154:125-136, 1972.Crossref 8. Weissman MM, et al: The social role performance of depressed women: Comparisons with a normal group . Am J Orthopsychiatry 41:391-405, 1971.Crossref 9. Paykel ES, et al: Dimensions of social adjustment in depressed women . J Nerv Ment Dis 152:158-172, 1971.Crossref 10. Gurland BJ, et al: The structured and scaled interview to assess maladjustment (SSIAM); Description, rationale, and development . Arch Gen Psychiatry 27:259-264, 1972.Crossref 11. Hollingshead A: Two Factor Index of Social Position . Copyrighted, mimeographed, New Haven, Conn, Yale University, 1957. 12. Fiske DW, et al: Planning of research on effectiveness of psychotherapy . Arch Gen Psychiatry 22:22-32, 1970.Crossref 13. Levine S: Some suggestions for treating the depressed patients . Psychoanal Quart 34:37-65, 1965. 14. Park LC, Imboden JB: Clinical and heuristic value of clinical drug research . J Nerv Ment Dis 151:322-340, 1970.Crossref 15. Kubie LS: The process of evaluation of therapy in psychiatry . Gen Psychiatry 28:880-884, 1973.Crossref 16. Goldman RK, Mendelsohn GA: Psychotherapeutic change and social adjustment: A report of a national survey of psychotherapists . J Abnorm Soc Psychol 74:164-172, 1969.Crossref 17. Malan DH, et al: A study of psychodynamic changes in untreated neurotic patients . Br J Psychiatry 114:525-551, 1968.Crossref 18. Strupp HH, Bergin AE: Some empirical and conceptual bases for coordinated research in psychotherapy; A critical review of issues, trends, and evidence . Int J Psychiatry 7:18-90, 1969. 19. Cawley R: The evaluation of psychotherapy . Psychol Med 1:101-103, 1971.Crossref 20. Murriel SA: Intra-family variables and psychotherapy outcome research . Psychother Theory Res Practice 7:19-21, 1970.Crossref 21. Katz MM, Lyerly SB: Methods of measuring adjustment and social behavior in the community: Rationale, description, discriminative validity and scale development . Psychol Rep 13:503-535, 1963.Crossref 22. Spitzer RL, Endicott JE: The value of the interview for the evaluation of psychotherapy , in Hammer M, et al (eds): Psychopathology: Contributions in the Biological, Behavioral and Social Sciences . New York, John Wiley & Sons Inc, 1973. 23. Jacobson E: Transference problems in the psychoanalytic treatment of severely depressive patients . J Am Psychoanal Assoc 2:595-606, 1954.Crossref 24. Cohen MB, et al: An intensive study of 12 cases of manic depressive psychoses . Psychiatry 17:103-137, 1954. 25. Bonime W: The psychodynamics of neurotic depression , in Arieti S (ed): American Handbook of Psychiatry . New York, Basic Books Inc Publisher, 1966, vol 3. 26. Spiegel R: Communications in the psychoanalysis of depressives , in Psychoanalysis and Human Values . New York, Grune & Stratton Inc, 1960, pp 209-220. 27. Segal SP: Research on the outcome of social work therapeutic interventions: A review of the literature . J Health Soc Behav 13:3-17, 1972.Crossref 28. Fisher J: Is casework effective? A review . Soc Work , pp 5-20, (January) 1973. 29. Luborsky L, et al: Factors influencing the outcome of psychotherapy: A review of quantitative research . Psychol Bull 75:145-185, 1971.Crossref 30. Uhlenhuth EH, Lipman RA, Covi L: Combined pharmacotherapy and psychotherapy . J Nerv Ment Dis 1:52-64, 1969.Crossref 31. Deykin EY, Weissman MM, Tanner J: Participation of depressed women in psychotherapy. J Nerv Ment Dis, to be published. 32. Weissman MM, Klerman GL: Psychotherapy with depressed women: An empirical study of content themes and reflection . Br J Psychiatry 123:55-61, 1973.Crossref 33. Deykin EY, Weissman MM, Klerman GL: Treatment of depressed women: Therapeutic issue with hospitalized patients and outpatients . Br J Soc Work 1:277-291, 1971. 34. Weissman MM, Geanakoplos E, Prusoff BA: Social class and attrition in depressed outpatients . Soc Casework 54:162-170, 1973. 35. Hogarty GE, Goldberg SC, and the Collaborative Study Group: Drugs and sociotherapy in the aftercare of schizophrenic patients . Arch Gen Psychiatry 28:56-64, 1973.Crossref 36. Covi L, Lipman R, Derogatis LR: Drugs and group therapy in depressive disorders. Read before the Annual Meeting of the American Psychiatric Association. Honolulu, May 1973. 37. Friedman AS, et al: Drugs and family therapy in treatment of depression. Read before the Annual Meeting of the ACNP, San Juan, Puerto Rico, December 1972. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

Treatment Effects on the Social Adjustment of Depressed Patients

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References (41)

Publisher
American Medical Association
Copyright
Copyright © 1974 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1974.01760120033006
Publisher site
See Article on Publisher Site

Abstract

Abstract The effects of maintenance treatment on social adjustment are examined in depressed outpatients randomly assigned to eight months of amitriptyline hydrochloride, a placebo, or no pill, with or without psychotherapy, using a 2 × 3 factorial design. Results for the 106 patients who completed the trial show a significant main effect for psychotherapy apparent only after six to eight months' treatment. Psychotherapy improved overall adjustment, work performance, and communication, and reduced friction and anxious rumination. There was no effect on the patients' social adjustment for amitriptyline and there were no drug/psychotherapy interactions. The results support the value of weekly maintenance psychotherapy in recovering depressives. Since amitriptyline has been shown to reduce relapse and prevent symptom return, and psychotherapy was shown to enhance adjustment, there is evidence for combined treatments. References 1. Frank JD: Persuasion and Healing . Baltimore, Johns Hopkins Press, 1961. 2. Weissman MM, Paykel ES: The Depressed Woman: A study of Social Relationships. Chicago, University of Chicago Press, to be published. 3. Klerman GL, et al: Treatment of depression by drugs and psychotherapy . Am J Psychiatry 131:186-191, 1974. 4. Raskin A, et al: Replication of factors of psychopathology in interview, ward behavior and self report ratings of hospitalized depressives . J Nerv Ment Dis 148:87-98, 1969.Crossref 5. Cartwright RD: A comparison of the response to psychoanalytic and client-centered psychotherapy , in Gottschalk LA, Auerbach AH (eds): Methods of Research in Psychotherapy . New York, Appleton-Century Crofts Inc, 1966. 6. Traux CB, Carkhuff RR: Towards Effective Counseling and Psychotherapy, Training and Practice . Chicago, Aldine Press, 1967. 7. Weissman MM, Prusoff BA, Paykel ES: Checklist quantification of a psychological therapy: Pilot studies of reliability and utility . J Nerv Ment Dis 154:125-136, 1972.Crossref 8. Weissman MM, et al: The social role performance of depressed women: Comparisons with a normal group . Am J Orthopsychiatry 41:391-405, 1971.Crossref 9. Paykel ES, et al: Dimensions of social adjustment in depressed women . J Nerv Ment Dis 152:158-172, 1971.Crossref 10. Gurland BJ, et al: The structured and scaled interview to assess maladjustment (SSIAM); Description, rationale, and development . Arch Gen Psychiatry 27:259-264, 1972.Crossref 11. Hollingshead A: Two Factor Index of Social Position . Copyrighted, mimeographed, New Haven, Conn, Yale University, 1957. 12. Fiske DW, et al: Planning of research on effectiveness of psychotherapy . Arch Gen Psychiatry 22:22-32, 1970.Crossref 13. Levine S: Some suggestions for treating the depressed patients . Psychoanal Quart 34:37-65, 1965. 14. Park LC, Imboden JB: Clinical and heuristic value of clinical drug research . J Nerv Ment Dis 151:322-340, 1970.Crossref 15. Kubie LS: The process of evaluation of therapy in psychiatry . Gen Psychiatry 28:880-884, 1973.Crossref 16. Goldman RK, Mendelsohn GA: Psychotherapeutic change and social adjustment: A report of a national survey of psychotherapists . J Abnorm Soc Psychol 74:164-172, 1969.Crossref 17. Malan DH, et al: A study of psychodynamic changes in untreated neurotic patients . Br J Psychiatry 114:525-551, 1968.Crossref 18. Strupp HH, Bergin AE: Some empirical and conceptual bases for coordinated research in psychotherapy; A critical review of issues, trends, and evidence . Int J Psychiatry 7:18-90, 1969. 19. Cawley R: The evaluation of psychotherapy . Psychol Med 1:101-103, 1971.Crossref 20. Murriel SA: Intra-family variables and psychotherapy outcome research . Psychother Theory Res Practice 7:19-21, 1970.Crossref 21. Katz MM, Lyerly SB: Methods of measuring adjustment and social behavior in the community: Rationale, description, discriminative validity and scale development . Psychol Rep 13:503-535, 1963.Crossref 22. Spitzer RL, Endicott JE: The value of the interview for the evaluation of psychotherapy , in Hammer M, et al (eds): Psychopathology: Contributions in the Biological, Behavioral and Social Sciences . New York, John Wiley & Sons Inc, 1973. 23. Jacobson E: Transference problems in the psychoanalytic treatment of severely depressive patients . J Am Psychoanal Assoc 2:595-606, 1954.Crossref 24. Cohen MB, et al: An intensive study of 12 cases of manic depressive psychoses . Psychiatry 17:103-137, 1954. 25. Bonime W: The psychodynamics of neurotic depression , in Arieti S (ed): American Handbook of Psychiatry . New York, Basic Books Inc Publisher, 1966, vol 3. 26. Spiegel R: Communications in the psychoanalysis of depressives , in Psychoanalysis and Human Values . New York, Grune & Stratton Inc, 1960, pp 209-220. 27. Segal SP: Research on the outcome of social work therapeutic interventions: A review of the literature . J Health Soc Behav 13:3-17, 1972.Crossref 28. Fisher J: Is casework effective? A review . Soc Work , pp 5-20, (January) 1973. 29. Luborsky L, et al: Factors influencing the outcome of psychotherapy: A review of quantitative research . Psychol Bull 75:145-185, 1971.Crossref 30. Uhlenhuth EH, Lipman RA, Covi L: Combined pharmacotherapy and psychotherapy . J Nerv Ment Dis 1:52-64, 1969.Crossref 31. Deykin EY, Weissman MM, Tanner J: Participation of depressed women in psychotherapy. J Nerv Ment Dis, to be published. 32. Weissman MM, Klerman GL: Psychotherapy with depressed women: An empirical study of content themes and reflection . Br J Psychiatry 123:55-61, 1973.Crossref 33. Deykin EY, Weissman MM, Klerman GL: Treatment of depressed women: Therapeutic issue with hospitalized patients and outpatients . Br J Soc Work 1:277-291, 1971. 34. Weissman MM, Geanakoplos E, Prusoff BA: Social class and attrition in depressed outpatients . Soc Casework 54:162-170, 1973. 35. Hogarty GE, Goldberg SC, and the Collaborative Study Group: Drugs and sociotherapy in the aftercare of schizophrenic patients . Arch Gen Psychiatry 28:56-64, 1973.Crossref 36. Covi L, Lipman R, Derogatis LR: Drugs and group therapy in depressive disorders. Read before the Annual Meeting of the American Psychiatric Association. Honolulu, May 1973. 37. Friedman AS, et al: Drugs and family therapy in treatment of depression. Read before the Annual Meeting of the ACNP, San Juan, Puerto Rico, December 1972.

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Jun 1, 1974

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