Psychoeducational treatment and prevention of depression: The “coping with depression” course thirty years later

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Abstract

The “Coping with Depression” course (CWD) is by the far the best studied psychoeducational intervention for the treatment and prevention of depression, and is used in routine practice in several countries. The CWD is a highly structured cognitive-behavioral intervention, which has been adapted for several goals, contexts, and target populations. The efficacy of the CWD has been examined in 25 randomized controlled trials. We conducted a meta-analysis of these studies. The 6 studies aimed at the prevention of new cases of major depression were found to result in a reduced risk of getting major depression of 38% (incidence rate ratio was 0.62). The 18 studies examining the CWD as a treatment of depression found a mean effect size (Cohen's d) of 0.28. Direct comparisons with other psychotherapies did not result in any indication that the CWD was less efficacious. The CWD is a flexible treatment which can easily be adapted for different populations and this may have led researchers to use this intervention for complex target groups, which in turn may have resulted in a lower mean effect size. The CWD has contributed considerably to the development and innovation of prevention and treatment of depression in many target populations.

Introduction

Depressive disorders are highly prevalent (Kessler et al., 1994, ESEMED, 2004), have a high incidence (Waraich, Goldner, Somers, & Hsu, 2004), are associated with a substantial loss of quality of life in patients and their relatives (Ustun et al., 2004, Saarni et al., 2007), with increased mortality rates (Cuijpers & Smit, 2002), with high levels of service use, and with considerable economic costs (Berto et al., 2000, Greenberg and Birnbaum, 2005, Smit et al., 2006). Major depression is currently the fourth disorder worldwide in terms of disease burden, and it is expected to be the disorder with the highest disease burden in high-income countries by the year 2030 (Mathers & Loncar, 2006).

In the past decades, several effective treatments have become available for the treatment of depressive disorders, including pharmacological treatments (Anderson, 2001), electroconvulsive therapies (Pagnin, de Queiroz, Pini, & Cassano, 2004), and bright light therapy (Golden et al., 2005). A large body of research has shown that several types of psychotherapy are also effective in the treatment of depression, including cognitive behavior therapy (Gloaguen et al., 1998, Churchill et al., 2001), behavioral activation treatments (Cuijpers, van Straten, Warmerdam, 2007a), marital therapy (Barbato & D'Avanzo, 2006), problem-solving treatments (Cuijpers, van Straten, Warmerdam, 2007b), psychodynamic therapy (Leichsenring, 2001) and interpersonal psychotherapy (De Mello, De Jesus Mari, Bacaltchuk, Verdeli, & Neugebauer, 2005).

One of the most important types of psychological treatment for depression is the “Coping with Depression” course (CWD). The first version of this treatment was developed in the late 1970s by the last author of this paper (prof. Lewinsohn) and his associates. Since the publication of the manual (Lewinsohn, Antonuccio, Breckenridge, & Teri, 1984; Table 1), many other researchers and practitioners have used this course in the treatment, prevention and relapse prevention of depression in many target groups. The course materials have been translated into several languages, and the course is actively used in many countries, including the United States, Canada, Germany, Finland, Mexico, The Netherlands and Perú. The CWD is now one of the most widely available psychological treatments for depression worldwide and is one of the best studied psychological treatments of depression in general.

In this paper we will give an overview of this treatment method and the results of research examining the efficacy and effectiveness. First we will describe the characteristics of the CWD, and the possible uses of the course in research and practice. Then we will present a meta-analytic overview of the randomized controlled studies that have examined the effects of the CWD.

Section snippets

Characteristics of the CWD

The CWD is a cognitive behavioral intervention for depression with several specific characteristics. One important characteristic of the CWD is the psychoeducational approach. In a psychoeducational treatment the “patient” works through a standardized psychological treatment protocol more or less independently. The standardized psychological treatment protocol can be written down in book form, but it can also be available through other media, such as a personal computer, CD-ROM, or television.

Selection and inclusion of studies

We used several methods to identify studies examining the effects of the CWD. First, because the authors of the current paper were involved in many of the relevant studies, we collected the data of our own studies and the references of studies by colleagues which were known by us. Second, we used a large database of studies on the psychological treatment of depression in general to identify studies on the CWD we were not aware of. This database, how it was developed and the methods used, have

Description of included studies

A total of 25 studies met all inclusion criteria. Selected characteristics of these studies are presented in Table 2.

Six studies were aimed at preventing the onset of depressive disorders, while the other 19 studies were aimed at the treatment of existing depressive disorders or symptoms. Eight studies were aimed at adolescents, seven on adults in general, three on older adults, five on minority groups, and three on other target groups (alcoholics, women with postpartum depression, and young

Discussion

In this review we discussed the basic characteristics, and the many different versions of the CWD that have been developed and tested in randomized trials in the past thirty years. We saw that the CWD is a flexible, highly structured, cognitive-behavioral intervention, based on the social learning theory, which can be adapted for prevention, treatment, and relapse prevention of prevention and has been used in group and individual format, but also as guided self-help and Internet-based

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