Jacques Barber, PhD, dean of Adelphi’s Gordon F. Derner School of Psychology, joined a research team to explore whether psychotherapy or medication is a better way to treat depression. Meta-analysis of decades of work offers clues.
Major depressive disorder is the leading cause of disability for Americans ages 15 to 44, according to the Anxiety and Depression Association of America. While depression can be effectively treated by psychotherapy, medication or a combination of both, patients must often cycle through a variety of treatments to find the one that works best. Could there be a way to sidestep this frustrating process by creating personalized plans that match specific symptoms to specific treatments?
Jacques Barber, PhD, dean of Adelphi’s Gordon F. Derner School of Psychology, joined a team of 21 researchers—including some of the best-known names in psychology and psychiatry today—to find out. “Psychotherapy or medication for depression? Using individual symptom meta-analyses to derive a Symptom-Oriented Therapy (SOrT) metric for a personalised psychiatry,” published last year in BMC Medicine, contains a meta-analysis of 38 randomized clinical trials conducted over the last several decades. Dr. Barber and his colleagues combed through a treasure trove of data to discover which therapies yielded the best results for key symptoms of depression, such as lack of appetite and difficulty sleeping.
The researchers first examined the data using the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Then they used the Symptom Oriented Therapy (SOrT) metric, which combines meta-analytic effect sizes with patients’ symptom profiles to quantify potential preference for either psychotherapy or medication. Although the paper “did not find robust indications for symptom-specific effectiveness differences between treatments,” nevertheless, there are other promising research directions, including evidence that some patients with a certain genotype respond better to certain types of treatment or medication.
“You personalize the treatment, just like you do with precision medicine,” Dr. Barber said. “’Precision psychotherapy’ is a term that people are going to hear a lot more going forward.”
The paper’s results directly build on studies Dr. Barber has conducted in the past—notably, a groundbreaking 2012 article, “Short-term dynamic psychotherapy versus pharmacotherapy for major depressive disorder: a randomized, placebo-controlled trial,” published in the Journal of Clinical Psychiatry. Additionally, it is an extension of a 2016 study he and several colleagues contributed to that journal, “Reducing dropout in treatment for depression.” To date, Dr. Barber has published more than 196 refereed journal articles, 80 chapters and eight books in the field of psychotherapy and personality.
The recent paper “Psychotherapy or medication for depression?” reaffirms Dr. Barber’s earlier conclusions. When comparing the different types of treatments for depression in general, the team could see no major difference between the treatment options. Nevertheless, they found that psychotherapy is often the better choice because it has a lower dropout rate, as Dr. Barber asserted in 2016. “Psychotherapy is more acceptable to many people than medication.” Furthermore, there is growing evidence that psychotherapy prevents relapse (perhaps because of skills acquired) while medication does not.
Dr. Barber’s most recent work, “Processes of therapeutic change: Results from the Cornell-Penn Study of Psychotherapies for Panic Disorder,” published in the Journal of Counseling Psychology in March 2020, also compares two different types of therapy: cognitive behavioral therapy and panic-focused psychodynamic psychotherapy. The study’s results show that patients’ ability to understand their symptoms can lead to better outcomes for both types of treatment.
Dr. Barber’s research is also informing the way he trains future psychologists and researchers at Adelphi. In his lab, undergraduate students are learning interview skills by transcribing therapy sessions conducted for the study, and doctoral candidates are using the same interviews to rate a number of variables, including the coping mechanisms and the therapeutic interventions used by the study participants.
Dr. Barber is gratified that the work he and his colleagues did more than a decade ago is still being used today—and pointing the way toward the future. He is also delighted that some of his students are developing their own way of answering research questions using more sophisticated methods than the ones he has learned. “This is definitely the direction that science is moving: from individual studies toward collective studies like this one,” he said.