Does childhood emotional abuse moderate the effect of cognitive behavioral analysis system of psychotherapy versus meta-cognitive therapy in depression? A propensity score analysis on an observational study

Background Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Metacognitive Therapy (MCT) are effective for depression. CBASP might offer most benefit in patients reporting childhood emotional abuse (CEA). This needs to be confirmed in real-world settings and in comparisons with depression-specific psychotherapies. This study examines the moderating influence of CEA on the effectiveness of CBASP versus MCT. Methods In this observational study, we recruited patients treated with either CBASP or MCT in an intensive day treatment program for depression. CEA was assessed using the Childhood Trauma Questionnaire (CTQ). Patients reported symptoms weekly using the Quick Inventory of Depressive Symptoms (QIDS-SR). Mixed model analysis was run on the Intention to Treat dataset (ITT) using propensity matching to overcome baseline imbalances. Results A total of 141 patients were included in the analysis (MCT n = 78, CBASP n = 63). CEA moderated the treatment effect (time x CEA x treatment: beta = 0.03, SE = 0.01, p = 0.014). Post-hoc analyses revealed that CBASP was more effective than MCT in patients without CEA (time x treatment: beta = -0.01, SE = 0.007, p = .045). The difference between CBASP and MCT was not statistically significant for patients with CEA (beta = 0.015, SE = 0.008, p = .11). Limitations Because of non-random treatment allocation the differences between CBASP and MCT can be due to unobserved baseline imbalances. Conclusions Our findings suggest that in patients reporting CEA, CBASP might not offer additional benefits above other depression-specific psychotherapies. Public Health Significance Statements This study shows that, on average, individuals with depression benefit equally from CBASP and MCT under the conditions of routine practice. Yet, CBASP was more effective than MCT for those without childhood emotional abuse. If childhood emotional abuse was present, CBASP and MCT were equally effective.