A modular add-on approach for patients with comorbid depression and a history of childhood maltreatment

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While disorder-specific approaches for the treatment of depression have proven efficacy, there is a large proportion of patients not reaching response or remission most likely due to the inter-individual heterogeneity of etiological mechanisms of depression. In addition, there is a high rate of comorbid disorders in depression, particularly in patients with early abuse or neglect, which is not addressed by disorder-specific methods. A promising approach to address those issues is to complement interventions for depression by circumscribed psychotherapy modules targeting typical dysfunctions in a transdiagnostic way. Depending upon the patients’ presenting problems and disturbed functions, specific modules are selected. Thus, the intervention is more flexible and personalized than traditional standardized treatment. The Modular Based Psychotherapy (MBP) model proposed here complements standard Cognitive Behavioral Therapy (CBT) for depression with modules compiling specific strategies from Cognitive Behavioral Analysis System of Psychotherapy, mentalization-based therapy, and mindfulness-based treatment, all supported by previous trials. The modules focus on three disturbed systems critically related to childhood maltreatment: the negative valence system (acute, potential, and sustained threat), the system of social processes (understanding mental states), and the arousal system (emotion awareness and emotional regulation). The aim of this bi-centric study is to assess whether in patients with comorbid depression and childhood maltreatment an individual treatment with CBT+MBP is superior to standard CBT in reducing depressive symptoms. Seventy outpatients with episodic or persistent major depression, comorbidity on axis I and/or II, and a history of childhood maltreatment will be randomized to either 20 individual sessions of CBT+MBP or 20 individual sessions of standard CBT over 16 weeks. Additional treatment with SSRI or SNRI is allowed if medication has been stable for at least four weeks before randomization. The primary hypothesis is that MBP as an add-on module to standard CBT is more effective than standard CBT alone in reducing depressive symptoms after 16 weeks of treatment.