Not every patient who meets the diagnostic criteria for major depression needs intensive treatment. But for a select group identified using a new statistical indexing tool, cognitive behavioral therapy (CBT) may offer substantial benefits, according to research out of the Department of Psychology published in the Journal of Affective Disorders.

“There is a lot of variability in how people with depression will do over time,” says Lorenzo Lorenzo-Luaces, a sixth-year student pursuing a doctorate in psychology and lead author on the recent paper. “Some may not need a treatment for as long or as intensely. A big challenge is to identify those patients who do.”

Lorenzo-Luaces and Robert DeRubeis, the Samuel H. Preston Term Professor in the Social Sciences, began their research by looking closely at data from a study conducted in the Netherlands in which 622 clinically depressed patients were randomly assigned to one of three groups: treatment as usual, brief therapy, or CBT.

For treatment as usual, intended as a strong baseline comparison condition, “a group of clinicians would decide a patient’s treatment, considering factors like group versus individual therapy, face-to-face versus online care, and appropriate number of sessions,” Lorenzo-Luaces explains.

Brief therapy lasted five to seven sessions, and provided support and attention. CBT, consisting of 11 to 15 sessions, delved deeper into the ways in which an individual’s thinking fuels his or her depression, as well as changes a person could make to his or her behaviors and thinking patterns.

The Netherlands-based researchers had expected CBT to fare the best of the three, but they found no appreciable differences, DeRubeis says.

“They all looked to be, on average, about the same,” he says.  

DeRubeis and Lorenzo-Luaces then went a step further, incorporating five prognostic indices—what DeRubeis calls a “crystal ball” for each patient’s future health—including depression severity, hostility level, introversion, sleep problems, and employment status. The more risk factors a patient had, the more likely the depression would persist.

“In nearly three-quarters of study participants, those with better prognoses or fewer risk factors, no differences were evident in recovery rates two years later,” Lorenzo-Luaces says. “But in about one-quarter of individuals more vulnerable to depression, according to the five predictors, CBT led to much more benefit than the other two treatments.” 

These new findings could change resource distribution for depression patients by identifying those in the greatest need and providing stronger treatment to just that cohort. Such models could extend to other mental disorders, such as anxiety or schizophrenia.

The researchers add that the observed findings likely are not specific to CBT, but may reflect a broader trend applicable to individuals receiving briefer or lower intensity care.

“We suspect that many patients don’t need such heavy treatments,” DeRubeis says.

Adds Lorenzo-Luaces: “From a public health perspective, conservative treatment decisions for some patients frees up resources for others.”