Patient choice in depression psychotherapy: Outcomes of patient-preferred therapy versus randomly allocated therapy

Abstract

Objective: Patient choice is recognized as a factor that influences clinical outcomes and treatment evaluation in mental health care. However, research on how having a choice affects patients with depression has been rare. This Dutch study examined whether patients randomly selected to choose between two types of depression psychotherapy benefited more from treatment than patients randomly assigned to an intervention. Methods: Data were derived from a trial of outpatients with depression who were randomly assigned to cognitive therapy (CT), interpersonal psychotherapy (IPT), or a 2-month waitlist control condition followed by the patient's choice of CT or IPT. Treatment groups were combined into a no-choice condition (N5151), with the waitlist as the choice condition (N531). Multilevel regression was used to compare depression severity (measured with the Beck Depression Inventory-II [BDI-II]) and general psychological distress (measured with the Brief Symptom Inventory [BSI]) posttreatment and at the 5-month followup. Differences in patients' pretreatment expectations, beliefs about treatment credibility, and posttreatment evaluation were examined. Results: No significant differences in clinical outcomes were found between the choice and no-choice conditions (mean difference: BDI-II posttreatment5-0.55, 95% confidence interval [CI]5-5.25 to 4.15; follow-up52.10, 95% CI5-4.01 to 8.20; BSI posttreatment5-1.89, 95% CI5-15.35 to 11.58; follow-up53.13, 95% CI5-12.32 to 18.57). Patients in both groups reported comparable scores on pretreatment expectations, credibility beliefs, and posttreatment evaluation. Neither expectations nor credibility beliefs were predictive of clinical outcomes. Conclusions: Our findings did not support the value of patient choice. Considering the exploratory nature of the trial, future studies designed to examine the effects of choice in depression treatment are recommended.