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Narrative Therapy vs. Cognitive-Behavioral Therapyfor moderate depression: Empirical evidence from acontrolled clinical trialRodrigo T. Lopesa, Miguel M. Gonalvesa, Paulo P.P. Machadoa, Dana Sinaib, Tiago Bentoc &Joo Salgadoca School of Psychology, University of Minho, Braga, Portugalb Department of Psychology, Ben Gurion University of the Negev, Be'er Sheva, Israelc Instituto Superior da Maia, CINEICC/ISMAI, Maia, PortugalPublished online: 30 Jan 2014.
To cite this article: Rodrigo T. Lopes, Miguel M. Gonalves, Paulo P.P. Machado, Dana Sinai, Tiago Bento & Joo Salgado ,Psychotherapy Research (2014): Narrative Therapy vs. Cognitive-Behavioral Therapy for moderate depression: Empiricalevidence from a controlled clinical trial, Psychotherapy Research, DOI: 10.1080/10503307.2013.874052
To link to this article: http://dx.doi.org/10.1080/10503307.2013.874052
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Narrative Therapy vs. Cognitive-Behavioral Therapy for moderatedepression: Empirical evidence from a controlled clinical trial
RODRIGO T. LOPES1, MIGUEL M. GONALVES1, PAULO P.P. MACHADO1,DANA SINAI2, TIAGO BENTO3, & JOO SALGADO3
1School of Psychology, University of Minho, Braga, Portugal; 2Department of Psychology, Ben Gurion University of theNegev, Beer Sheva, Israel & 3Instituto Superior da Maia, CINEICC/ISMAI, Maia, Portugal
(Received 3 February 2012; revised 10 October 2013; accepted 8 December 2013)
AbstractBackground: Systematic studies of the efficacy of Narrative Therapy (NT) for depression are sparse.Objective: To evaluatethe efficacy of individual NT for moderate depression in adults compared to Cognitive-Behavioral Therapy (CBT).Method:Sixty-three depressed clients were assigned to either NT or CBT. The Beck Depression Inventory-II (BDI-II) and OutcomeQuestionnaire-45.2 (OQ-45.2) were used as outcome measures. Results: We found a significant symptomatic reduction inboth treatments. Group differences favoring CBT were found on the BDI-II, but not on the OQ-45.2. Conclusions: Pre- topost-treatment effect sizes for completers in both groups were superior to benchmarked waiting-list control groups.
Keywords: depression; treatment of depression; psychological treatment of depression; Empirically Supported Therapy(EST); Narrative Therapy; Cognitive-Behavioral Therapy
Depression is among themost commonmental healthproblems for which help is sought (Andrews &Thomson, 2009; Roness, Mykletun, & Dahl, 2005).Despite the fact that 12 treatments for unipolardepression are currently listed as having reliableempirical support (for a complete list, see Hayes andStrunk, n.d.), a considerable proportion of clientsleave treatment without substantial gains and/orrelapse after treatment. Thus, outcome researchwith an emphasis on treatment efficacy is recom-mended (Chambless & Hollon, 1998; Chamblesset al., 1998; Kendall, 1998; Kendall, Holmbeck, &Verduin, 2004).
Narrative Therapy (NT; White, 2007; White &Epston, 1990) is a psychotherapeutic approachbased on the notion that people construct narra-tives to define themselves and give meaning totheir daily experiences and life events. Psycholo-gical suffering is viewed as a problem-saturatedway of constructing life stories and a personsidentity. These rigid self-narratives constrain the
persons actions, feelings, and thoughts (White,2007) and obscure life alternatives. The purpose ofpsychotherapy is to help clients narrate their lifestories in richer and more gratifying ways. Thisview of the human being as a meaning-makingagent has had a considerable impact on clinicalpsychology and psychotherapy in recent years(Angus & McLeod, 2004).
Although widely practiced throughout the world,NT remains underresearched (Busch, 2011; Che-nail, DeVicentis, Kiviat, & Somers, 2012; Etchison &Kleist, 2000). Some qualitative process researchstudies (Matos, Santos, Gonalves, & Martins, 2009;Moreira, Beutler, & Gonalves, 2008) and severalcase studies (Betchley & Falconer, 2002; Cashin,2008; da Costa, Nelson, Rudes, & Guterman, 2007;Draucker, 1998; Kropf & Tandy, 1998; Nylund,2002; Palgi & Ben-Ezra, 2010; Rothschild, Brownlee,& Gallant, 2000; Young, 2008) suggest positive out-comes for a wide range of problems and disorders.However, only one of these qualitative studies
Correspondence concerning this article should be addressed to Miguel M. Gonalves, University of Minho, School of Psychology, Braga,Portugal. Email: email@example.com
Psychotherapy Research, 2014http://dx.doi.org/10.1080/10503307.2013.874052
2014 Society for Psychotherapy Research
(Kropf & Tandy, 1998) has addressed the effective-ness of NT for depression, and none have done so in acontrolled clinical trial. To the best of our knowledge,only one study tested the efficacy of NT (White &Epston, 1990) in a large sample of adults withmoderate depression using a treatment manual.Vromans and Schweitzer (2011) found a large pre-to post-treatment effect size (d = 1.36) for those whocompleted the NT intervention (38 out of the initial47 clients). Moreover, a clinical significance analysisperformedwith completers according to Jacobson andTruaxs (1991) criteria indicated that 74% of theparticipants improved reliably, 61% moved to thefunctional population range, and 53% recovered. Itwas also found that NT completers showed significantimprovements on ameasure of interpersonal difficult-ies. Intention-to-treat (ITT) analysis obtained a largepre-post effect size (d = 1.10) that was comparable toother treatments. Although this study had methodo-logical strengths, such as the use of a structuredinterview for diagnostic assessment at pre-treatment,assessment of clinically significant change, and follow-up assessment at 3 months, it lacked a comparisongroup.
Because establishing a waiting list control group oradministering a placebo in clinical trials is oftenethically controversial, Chambless and Hollon(1998) suggested comparison with an empiricallysupported intervention for the same population.Cognitive-Behavioral Therapy for depression(CBT; Beck, Rush, Shaw, & Emery, 1979) is astrong candidate for a comparison group in thetreatment of depression. It has received consistentempirical support since the first study in the 1970s(Rush, Beck, Kovacs, & Hollon, 1977), and itremains one of the best-known psychological treat-ments for depression (Butler, Chapman, Forman, &Beck, 2006; Cuijpers, van Straten, Andersson, & vanOppen, 2008; DeRubeis & Crits-Christoph, 1998;Dobson, 1989; Gloaguen, Cottraux, Cucherat, &Blackburn, 1998).
The present study aims to test the efficacy of NTin a comparative controlled trial with CBT as thecomparison group and a primary focus on thereduction of depressive symptoms. The secondaryaim of this study is to assess the reduction of generalpsychological distress. Thus, the specific researchquestions were (1) whether NT is as efficacious asCBT in reducing depressive symptoms in adults;(2) whether clients in the two treatments experiencechanges at different rates; and (3) whether thedropout rates differ significantly between the twotreatments. It was expected that NT outcomeswould be comparable to CBT.
Clients. Eligibility criteria were (a) having adiagnosis of Major Depressive Disorder accordingto the Diagnostic and Statistical Manual of MentalDisorders (DSM-IV; American Psychiatric Associ-ation, 2000), (b) being over 18 years old, (c)agreeing to sign an informed consent to t