CBT After ECT: New Study From Germany

Out on PubMed, from investigators in Germany and Switzerland, is this study:

EffECTively Treating Depression: A Pilot Study Examining Manualized Group CBT as Follow-Up Treatment After ECT.

Carstens L, Hartling C, Aust S, Domke AK, Stippl A, Spies J, Brakemeier EL, Bajbouj M, Grimm S.Front Psychol. 2021 Sep 3;12:723977. doi: 10.3389/fpsyg.2021.723977. eCollection 2021.PMID: 34539527 

The abstract is copied below:

Background: There is an urgent need for effective follow-up treatments after acute electroconvulsive therapy (ECT) in depressed patients. Preliminary evidence suggests psychotherapeutic interventions to be a feasible and efficacious follow-up treatment. However, there is a need for research on the long-term usefulness of such psychotherapeutic offers in a naturalistic setting that is more representative of routine clinical practice. Therefore, the aim of the current pilot study was to investigate the effects of a half-open continuous group cognitive behavioral therapy (CBT) with cognitive behavioral analysis system of psychotherapy elements as a follow-up treatment for all ECT patients, regardless of response status after ECT, on reducing depressive symptoms and promoting psychosocial functioning. 

Method: Group CBT was designed to support patients during the often-difficult transition from inpatient to outpatient treatment. In a non-controlled pilot trial, patients were offered 15 weekly sessions of manualized group CBT (called EffECTiv 2.0). The Montgomery-Åsberg Depression Rating Scale was assessed as primary outcome; the Beck Depression Inventory, WHO Quality of Life Questionnaire-BREF, and the Cognitive Emotion Regulation Questionnaire were assessed as secondary outcomes. Measurements took place before individual group start, after individual group end, and 6 months after individual group end. 

Results: During group CBT, Post-ECT symptom reduction was not only maintained but there was a tendency toward a further decrease in depression severity. This reduction could be sustained 6months after end of the group, regardless of response status after ECT treatment. Aspects of quality of life and emotion regulation strategies improved during group CBT, and these improvements were maintained 6 months after the end of the group. 

Conclusion: Even though the interpretability of the results is limited by the small sample and the non-controlled design, they indicate that manualized group CBT with cognitive behavioral analysis system of psychotherapy elements might pose a recommendable follow-up treatment option after acute ECT for depressed patients, regardless of response status after ECT. This approach might not only help to further reduce depressive symptoms and prevent relapse, but also promote long-term psychosocial functioning by improving emotion regulation strategies and psychological quality of life and thus could be considered as a valuable addition to clinical routine after future validation.

Keywords: chronic depression; cognitive behavioral analysis system of psychotherapy; cognitive behavioral therapy; electroconvulsive therapy; follow-up treatment; group therapy.

The pdf is here.

And from the text:

To the best of the authors’ knowledge, there are a total of three previous studies to date that have investigated the effectiveness and efficacy of psychotherapeutic treatments after acute ECT treatment in severely depressed patients. All three mentioned studies are carefully conducted and provide very promising first findings concerning the effectiveness and efficacy of psychotherapy in this difficult-to-treat population. However, due to the limitations mentioned above (longer waiting period due to closed group setting, exclusion of patients diagnosed with bipolar disorders, as well as exclusion of the so-called non-responders, and omission of psychosocial functioning assessment) these previous implementations allow relatively little assumptions concerning the long-term usefulness of such psychotherapeutic approaches in more naturalistic settings.

Consequently, in a pragmatic approach, the current non-controlled study aimed to examine the effects of a half-open continuous group CBT with CBASP elements as follow-up treatment for all ECT patients regardless of response status after ECT on reducing depressive symptoms and promoting psychosocial functioning.

Conclusion

To the authors’ best knowledge, this is the first time effects of group CBT as follow-up treatment after ECT was examined regardless of ECT response status. In this pilot study, symptom improvement after ECT treatment was not only maintained but there was a tendency toward further reductions in depression severity, which could be sustained 6 months after group end. For the first time, the changes in psychosocial functioning were assessed as well and results suggest favorable effects on cognitive emotion regulation strategies and psychological quality of life that could also be maintained 6 months after group end. Thus, our findings provide preliminary evidence that after future validation, group CBT with CBASP elements might provide a useful addition to clinical routine as follow-up treatment for all patients after antidepressant ECT treatment, regardless of response status.

Studies of psychotherapy as an add-on treatment after ECT are rare; this small pilot study (n=14) adds some data to the evidence base. It is novel in that it includes all comers, both responders and non-responders to ECT.  It also looks at quality of life and "cognitive emotion regulation strategies." Treatment as usual was allowed with all modalities, including maintenance ECT. Results were encouraging, suggesting that further research into making psychotherapy post ECT more widely available should be carried out.

This is published in a psychology journal, with no denigration of ECT, something that is not all that common. 

A full read, for followers of the continuation treatment literature, will be ~15 minutes.