A Comparison of Two Psychotherapy Programs in Persistently Depressed Treatment-Resistant Inpatients (ChangePDD)

Cognitive Behavioral Analysis System of Psychotherapy (CBASP) vs. Behavioral Activation (BA) in Persistently Depressed Treatment-resistant Inpatients: Efficacy, Moderators, and Mediators of Change

The purpose of this study is to compare the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) conducted over 16 weeks (acute and continuation treatment) with Behavioral Activation (BA; same dose and duration) in persistently depressed treatment-resistant inpatients regarding efficacy, moderators and mediators of change.

Study Overview

• Status: Recruiting
• Conditions: Treatment-resistant Depression; Persistent Depressive Disorder
• Intervention / Treatment: Behavioral: inpatient CBASP individual therapy; Behavioral: inpatient CBASP group therapy; Behavioral: inpatient CBASP exercise therapy; Behavioral: outpatient CBASP group therapy; Drug: algorithm-based study medication; Behavioral: inpatient BA individual therapy; Behavioral: inpatient BA group therapy; Behavioral: inpatient BA exercise therapy; Behavioral: outpatient BA group therapy; Behavioral: inpatient CBASP nurse contact; Behavioral: inpatient BA nurse contact

Detailed Description

About half of all psychiatric inpatients with depression suffer from persistent depressive disorder (PDD). Given their high degree of treatment-resistance (TR), comorbidity, suicidality, and hospitalization rates, this patient group appears to be particularly difficult to treat and, from a health economic perspective, constitutes a major challenge. The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is the only psychotherapy specifically tailored for PDD. Originally developed as an outpatient treatment by James P. McCullough, CBASP has been modified for the severely ill PDD patients with TR as a multimodal inpatient concept. Pilot studies indicate very good feasibility and promising outcome. Therefore, a randomized controlled trial is now mandatory for testing the superiority of the inpatient CBASP program vs. the evidence-based Cognitive Behavioral Therapy (CBT), the 'gold standard' in depression treatment. Behavioral Activation (BA) was chosen as the control intervention because BA, as a specific variant of CBT, is at least as effective as standard CBT in severely depressed patients while being easier to train and implement in inpatient settings. Both therapies will be applied as a treatment-phase program (10-week inpatient/ dayclinic acute treatment followed by 6-week outpatient continuation group-treatment) in combination with standardized and guideline-based pharmacotherapy. The proposed prospective, multi-center, randomized study with 396 PDD patients with TR will therefore address the primary research question: Is the CBASP program more effective than the BA program in this patient group? The primary hypothesis is that after 16 weeks of treatment, CBASP will show a significant superiority over BA in reducing depressive symptoms. In addition, the important psychotherapy research question: what works for whom and why? will be addressed.

Moderator analyses will examine whether child maltreatment and methylation of exon IV of the BDNF gene have an impact on the differential efficacy of the treatments. Regarding mediator analyses, it will be examined whether the differential efficacy of the treatments can be explained by treatment-specific changes in interpersonal problems or activity levels. A follow-up survey 48 weeks after the end of the interventions will provide valuable results regarding the long-term outcome of the treatments. Finally, the health economic potential of the interventions will be investigated through cost-benefit analyses in order to provide important information on the cost-effectiveness of implementation in routine care for health policy. Thus, the results of this study will have the potential to relieve the burden of this very serious and cost-intensive disorder while improving human health. In addition, moderator and mediator analyses may guide personalized treatment and enable therapists to more specifically address psychotherapeutic needs of individual PDD patients in the future.

• Study Type: Interventional
• Enrollment (Estimated): 396
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Eva-Lotta Brakemeier, Prof. Dr.; Phone Number: 3718 +49 3834 420; Email: eva-lotta.brakemeier@uni-greifswald.de
• Study Contact Backup: Name: Johannes Zimmermann, Prof. Dr.; Phone Number: 3833 +49 561 804; Email: jz@uni-kassel.de

Study Locations

• Germany
  • Bonn, Germany, 53127
    • Recruiting
    • Universitätsklinikum Bonn
    • Contact: Alexandra Philipsen, Prof. Dr.; Phone Number: +49-228-287-15723; Email: alexandra.philipsen@ukbonn.de
    • Contact: Silke Lux, Prof. Dr.; Phone Number: +49-228-287-16368; Email: silke.lux@ukbonn.de
  • Hanover, Germany, 30625
    • Terminated
    • Medizinische Hochschule Hannover
  • Jena, Germany, 07743
    • Recruiting
    • Universitätsklinikum Jena
    • Contact: Nils Opel, Prof. Dr.; Phone Number: +49 - 3641-9-390101; Email: nils.opel@med.uni-jena.de
    • Contact: Martin Walter, Prof. Dr.; Phone Number: +49-3641-9390102; Email: martin.walter@med.uni-jena.de
  • Lübeck, Germany, 23562
    • Recruiting
    • Universität zu Lübeck
    • Contact: Philipp Klein, PD Dr.; Phone Number: +49-451-500-98871; Email: philipp.klein@uksh.de
    • Contact: Bartosz Zurowski, Dr. med.; Phone Number: +49-451-500-98831; Email: bartosz.zurowski@uksh.de
  • Marburg, Germany, 35039
    • Recruiting
    • Universitätsklinikum Marburg
    • Contact: Tilo Kircher, Prof. Dr.; Phone Number: +49-6421-58-65200; Email: tilo.kircher@staff.uni-marburg.de
    • Contact: Ina Kluge, Dr.; Phone Number: +49-6421-58-6219; Email: ina.kluge@staff.uni-marburg.de
  • München, Germany, 80336
    • Recruiting
    • Klinikum der Universität München
    • Contact: Matthias Reinhard, Dr.; Phone Number: +49-89 4400-55512; Email: matthias.reinhard@med.uni-muenchen.de
    • Contact: Frank Padberg, Prof. Dr.; Phone Number: +49-89 4400-53358; Email: frank.padberg@med.uni-muenchen.de
  • Tübingen, Germany, 72076
    • Recruiting
    • Universitätsklinikum Tübingen
    • Contact: Andreas Fallgatter, Prof. Dr.; Phone Number: +49-7071-29-84858; Email: andreas.fallgatter@med.uni-tuebingen.de
    • Contact: Rainald Mössner, Prof. Dr.; Phone Number: +49-7071-29-4141; Email: rainald.moessner@med.uni-tuebingen.de
  • State of Berlin
    • Berlin, State of Berlin, Germany, 10117
      • Recruiting
      • Charité, University Medicine Berlin
      • Sub-Investigator: Henrik Walter, Prof. Dr.
      • Contact: Stephan Köhler, Prof. Dr.; Phone Number: 617408 49-30-450; Email: stephan.koehler@charite.de

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Primary DSM-5 diagnosis of PDD (300.4, 296.2x, 296.3x)
• Total Hamilton Depression Rating Scale (HDRS-24) Score ≥ 20
• Treatment-resistance (TR) (defined by the ATHF-SF or medication intolerance or one psychotherapy at least 25 sessions by a certified therapist in the current episode)
• Sufficient knowledge of the German language
• Written informed consent

Exclusion Criteria:

• Bipolar I or II disorder
• Active substance use disorders (abstinence shorter than 6 months)
• Schizophrenia spectrum and other psychotic disorders
• Antisocial personality disorder
• Acute suicidality (HRSD item 3 > 2 or agreement with C-SSRS item 4 and/or item 5)
• Previous CBASP or BA treatment within the last year
• Inability to tolerate CBASP or BA (e.g., organic brain disorders, severe cognitive deficits)
• Inability to participate in dayclinic or outpatient continuation treatment
• Participation in another (psycho)therapeutic study of an interventional nature

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Cognitive Behavioral Analysis System of Psychotherapy (CBASP); Cognitive Behavioral Analysis System of Psychotherapy (CBASP) as acute treatment (5 wk. inpatient and 5 wk. either inpatient or dayclinic) followed by continuation treatment (6 wk. outpatient group therapy).	Behavioral: inpatient CBASP individual therapy; During the 5-week inpatient phase I and the 5-week inpatient phase II / dayclinic treatment all patients in this arm will receive 2 individual CBASP therapy sessions (duration: 50 min per session).; Other Names: Cognitive Behavioral Analysis System of Psychotherapy - inpatient individual therapy; Behavioral: inpatient CBASP group therapy; During the 5-week inpatient phase I and the 5-week inpatient phase II / dayclinic treatment all patients in this arm will receive 2 CBASP group therapy sessions (duration: 100 min per session).; Other Names: Cognitive Behavioral Analysis System of Psychotherapy - inpatient group therapy; Behavioral: inpatient CBASP exercise therapy; During the 5-week inpatient phase I and the 5-week inpatient phase II / dayclinic treatment all patients in this arm will receive 1 CBASP exercise therapy (duration: 75 min per session).; Other Names: Cognitive Behavioral Analysis System of Psychotherapy - inpatient exercise therapy; Behavioral: outpatient CBASP group therapy; During the 6-week outpatient treatment all patients in this arm will receive 1 CBASP group therapy session (duration: 100 min per session).; Other Names: Cognitive Behavioral Analysis System of Psychotherapy - outpatient group therapy; Drug: algorithm-based study medication; All patients will receive an optimized, algorithm-based antidepressant medication following the current S3-Guidelines on Unipolar Depression. In case of nonresponse: 1st line dose escalation (if appropriate); 2nd line lithium augmentation; 3rd line augmentation with 2nd generation antipsychotics or evidence-based combinations of antidepressants; 4th line change of antidepressant.; Other Names: antidepressant medication; Behavioral: inpatient CBASP nurse contact; During the 5-week inpatient phase I and the 5-week inpatient phase II / dayclinic treatment all patients in this arm will receive 1 CBASP nurse contact (duration: 25 min per session).; Other Names: Cognitive Behavioral Analysis System of Psychotherapy - inpatient nurse contact
Active Comparator: Behavioral Activation (BA); Behavioral Activation (BA) as acute treatment (5 wk. inpatient and 5 wk. either inpatient or dayclinic) followed by continuation treatment (6 wk. outpatient group therapy).	Drug: algorithm-based study medication; All patients will receive an optimized, algorithm-based antidepressant medication following the current S3-Guidelines on Unipolar Depression. In case of nonresponse: 1st line dose escalation (if appropriate); 2nd line lithium augmentation; 3rd line augmentation with 2nd generation antipsychotics or evidence-based combinations of antidepressants; 4th line change of antidepressant.; Other Names: antidepressant medication; Behavioral: inpatient BA individual therapy; During the 5-week inpatient phase I and the 5-week inpatient phase II / dayclinic treatment all patients in this arm will receive 2 individual BA therapy sessions (duration: 50 min per session).; Other Names: Behavioral Activation - inpatient individual therapy; Behavioral: inpatient BA group therapy; During the 5-week inpatient phase I and the 5-week inpatient phase II / dayclinic treatment all patients in this arm will receive 2 BA group therapy sessions (duration: 100 min per session).; Other Names: Behavioral Activation - inpatient group therapy; Behavioral: inpatient BA exercise therapy; During the 5-week inpatient phase I and the 5-week inpatient phase II / dayclinic treatment all patients in this arm will receive 1 BA exercise therapy (duration: 75 min per session).; Other Names: Behavioral Activation - inpatient exercise therapy; Behavioral: outpatient BA group therapy; During the 6-week outpatient treatment all patients in this arm will receive 1 BA group therapy session (duration: 100 min per session).; Other Names: Behavioral Activation - outpatient group therapy; Behavioral: inpatient BA nurse contact; During the 5-week inpatient phase I and the 5-week inpatient phase II / dayclinic treatment all patients in this arm will receive 1 BA nurse contact (duration: 25 min per session); Other Names: Behavioral Activation - inpatient nurse contact

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hamilton Depression Rating Scale (HDRS-24), 24-item version	The change in HDRS-24 item score after 16 weeks will be the primary endpoint. The HRSD-24 is a semi-structured interview which is used to measure the severity of all symptom domains of depression as described by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) over a period of the last 7 days. It shows good psychometric properties. The HRSD-24 will be conducted by blind study raters at every time point. Raters evaluate symptom severity on a scale from 0 to 2 or 0 - 3 or 0 - 4 for each item, with higher number indicating higher symptom severity. The total score ranges from 0 to 75 with higher values indicating higher depression severity.	16 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Hamilton Depression Rating Scale (HDRS-24), 24-item version	The HDRS-24 is a semi-structured interview which is used to measure the severity of all symptom domains of depression as described by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) over a period of the last 7 days. It shows good psychometric properties. The HDRS-24 will be conducted by blind study raters at every time point. Raters evaluate symptom severity on a scale from 0 to 2 or 0 - 3 or 0 - 4 for each item, with higher number indicating higher symptom severity. The total score ranges from 0 to 75 with higher values indicating higher depression severity.	baseline, weeks 1, 2, 4, 6, 8, 10, 12, 14, 16, 64
Inventory of Depressive Symptomatology, Self-Report (IDS-SR)	The IDS-SR is a self-reported measure of depressive symptoms and used to detect change in self-rated depression severity. It shows good psychometric properties. Each item is rated from 0 to 3 by the patient, and all values are added up to an overall score. Total score ranges from 0 to 78, with higher values indicating a higher depression severity.	baseline, weeks 1, 2, 4, 6, 8, 10, 12, 14, 16, 24, 32, 40, 48, 56, 64
Brief Symptom Inventory (BSI)	The BSI is a multi-dimensional self-reported measure with a total of nine scales assessing the subjective impairment by physical and psychological symptoms. Each item is rated on a scale from 0 to 5 by the patient and are added up and t-transformed to three global indices: Global Severity Index, Positive Symptom Distress Index, Positive Symptom Total. T-Scores range from 0 to 100, with higher values indicating a higher subjective impairment.	baseline, weeks 1, 5, 10, 16, 64
Global Assessment of Functioning (GAF)	The GAF is a diagnostic measure used to assess social, occupational and psychological functioning according to DSM-IV. The score ranges from 0 to 100 with a total of ten levels of functioning and is determined by a clinical rater. Higher scores indicate a higher level of functioning and therefore a better outcome.	baseline, weeks 1, 5, 10, 16, 64
World Health Organization Quality of Life (WHOQoL-BREF)	The WHOQoL-BREF is a self-reporting measure regarding the subjective quality of life. Four broad domains of quality of life are rated by the patient on a five point scale and a mean score for each domain is calculated. Scores range between 4 and 20, with a higher score indicating a higher quality of life and therefore a better outcome.	baseline, weeks 1, 5, 10, 16, 64
Relapse rates	Relapse rates (rehospitalization, increase of HDRS-24 of equal or greater than 10 or current HDRS-24 score of equal or greater than 18 points) are measured.	16, 64
Cost interview	The cost interview assesses direct medical and non-medical costs and indirect costs due to mental disorders versus physical illnesses.	baseline, weeks 16 and 64
Response	Response (50% decrease on HDRS-24 score)	weeks 5, 10, 16, 64
Remission	Remission (HDRS-24 score of 10 or less)	weeks 5, 10, 16, 64

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Childhood Trauma Questionnaire (CTQ)	Childhood maltreatment by the definition of the World Health Organization (WHO) is assessed as a main moderator at baseline. The CTQ measures self-reported childhood trauma on five subscales. Responses are measured on a five point scale, and each subscale score has a range from 5 to 25 points. Higher scores indicate a higher severity in childhood trauma and therefore a worse outcome.	Baseline
Brain-derived neurotrophic factor (BDNF)	Brain-derived neurotrophic factor (BDNF) methylation as a main moderator.	Baseline
Inventory of Interpersonal Problems-revised (IIP-32-R)	The IIP-32-R is a self-reported questionnaire that assesses the severity of interpersonal problems on eight scales based on the two-dimensional interpersonal circumplex model as a main mediator. The items are rated on a five-point scale by the patients. A mean score is calculated, ranging from 0 to 4. A higher score indicates a higher severity of interpersonal problems and therefore a worse outcome.	Baseline, weeks 1, 2, 4, 6, 8, 10, 12, 14, 16 and 64
Behavioral Activation Depression Scale (BADS)	This self-report is designed to measure weekly changes in avoidance and activation during treatment with Behavioral Activation for depression. The BADS consists of 25 questions on four subscales, each rated on a seven point scale ranging from 0 to 6. The subscales are activation, avoidance/rumination, work/school impairment, and social impairment. A higher total score represents a higher level of activation and therefore a better outcome, while a high score in the subscale social impairment indicates a higher level of impairment and therefore a worse outcome. Scores range from 0 to 150.	Baseline, weeks 1, 2, 4, 6, 8, 10, 12, 14, 16 and 64
Step counts	Actimeter-measured step-counts as a main mediator.	Baseline, weeks 1, 2, 4, 6, 8, 10, 12, 14, 16 and 64

Collaborators and Investigators

• Sponsor: University of Greifswald
• Collaborators: German Research Foundation; Charite University, Berlin, Germany; Hannover Medical School; Ludwig-Maximilians - University of Munich; University Medicine Greifswald; University Hospital, Bonn; University Hospital Tuebingen; Jena University Hospital; University Hospital Lübeck; University of Kassel; Philipps University Marburg
• Investigators: Principal Investigator: Eva-Lotta Brakemeier, Prof. Dr., University Greifswald

Publications and helpful links

General Publications

• Richards DA, Ekers D, McMillan D, Taylor RS, Byford S, Warren FC, Barrett B, Farrand PA, Gilbody S, Kuyken W, O'Mahen H, Watkins ER, Wright KA, Hollon SD, Reed N, Rhodes S, Fletcher E, Finning K. Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. Lancet. 2016 Aug 27;388(10047):871-80. doi: 10.1016/S0140-6736(16)31140-0. Epub 2016 Jul 23.
• Dimidjian S, Hollon SD, Dobson KS, Schmaling KB, Kohlenberg RJ, Addis ME, Gallop R, McGlinchey JB, Markley DK, Gollan JK, Atkins DC, Dunner DL, Jacobson NS. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. J Consult Clin Psychol. 2006 Aug;74(4):658-70. doi: 10.1037/0022-006X.74.4.658.
• Cuijpers P, van Straten A, Warmerdam L. Behavioral activation treatments of depression: a meta-analysis. Clin Psychol Rev. 2007 Apr;27(3):318-26. doi: 10.1016/j.cpr.2006.11.001. Epub 2006 Dec 19.
• Bernstein DP, Fink LA. CTQ: Childhood Trauma Questionaire: A retrospective self-report.1998; TX: Psychological Corp.
• Brakemeier EL, Dobias J, Hertel J, Bohus M, Limberger MF, Schramm E, Radtke M, Frank P, Padberg F, Sabass L, Jobst A, Jacob GA, Struck N, Zimmermann J, Normann C. Childhood Maltreatment in Women with Borderline Personality Disorder, Chronic Depression, and Episodic Depression, and in Healthy Controls. Psychother Psychosom. 2018;87(1):49-51. doi: 10.1159/000484481. Epub 2018 Jan 6. No abstract available.
• Brakemeier EL, Engel V, Schramm E, Zobel I, Schmidt T, Hautzinger M, Berger M, Normann C. Feasibility and outcome of cognitive behavioral analysis system of psychotherapy (CBASP) for chronically depressed inpatients: a pilot study. Psychother Psychosom. 2011;80(3):191-4. doi: 10.1159/000320779. Epub 2011 Mar 10. No abstract available.
• Brakemeier EL, Normann C. Praxisbuch CBASP: Behandlung chronischer Depression; mit Online-Materialien (1. Aufl). 2012. Weinheim: Beltz.
• Brakemeier EL, Guhn A, Normann C. Praxisbuch CBASP: Behandlung chronischer Depression und Modifikationen für weitere interpersonelle Störungen; mit E-Book inside und Arbeitsmaterial; (2., überarbeitete und erweiterte Auflage). 2021; Weinheim: Beltz.
• Brakemeier EL, Radtke M, Engel V, Zimmermann J, Tuschen-Caffier B, Hautzinger M, Schramm E, Berger M, Normann C. Overcoming treatment resistance in chronic depression: a pilot study on outcome and feasibility of the cognitive behavioral analysis system of psychotherapy as an inpatient treatment program. Psychother Psychosom. 2015;84(1):51-6. doi: 10.1159/000369586. Epub 2014 Dec 24.
• Bschor T, Bauer M, Adli M. Chronic and treatment resistant depression: diagnosis and stepwise therapy. Dtsch Arztebl Int. 2014 Nov 7;111(45):766-75; quiz 775. doi: 10.3238/arztebl.2014.0766.
• DGPPN, BÄK, KBV, AWMF. S3-Leitlinie/Nationale Versorgungsleitlinie Unipolare Depression- Langfassung: Bd. Version 5 (2. Aufl.). 2015; Springer.
• Frieling H, Tadic A. Value of genetic and epigenetic testing as biomarkers of response to antidepressant treatment. Int Rev Psychiatry. 2013 Oct;25(5):572-8. doi: 10.3109/09540261.2013.816657.
• Guhn A, Kohler S, Brakemeier EL, Sterzer P. Cognitive Behavioral Analysis System of Psychotherapy for inpatients with persistent depressive disorder: a naturalistic trial on a general acute psychiatric unit. Eur Arch Psychiatry Clin Neurosci. 2021 Apr;271(3):495-505. doi: 10.1007/s00406-019-01038-5. Epub 2019 Jul 12.
• Harter M, Sitta P, Keller F, Metzger R, Wiegand W, Schell G, Stieglitz RD, Wolfersdorf M, Felsenstein M, Berger M. [Psychiatric-psychotherapeutic inpatient treatment for depression. Process and outcome quality based on a model project in Baden-Wurttemberg]. Nervenarzt. 2004 Nov;75(11):1083-91. doi: 10.1007/s00115-004-1705-8. German.
• Holzel L, Wolff Av, Kriston L, Harter M. [Risk factors for non-response in inpatient depression treatment]. Psychiatr Prax. 2010 Jan;37(1):27-33. doi: 10.1055/s-0029-1223348. Epub 2009 Oct 12. German.
• Kohler S, Sterzer P, Normann C, Berger M, Brakemeier EL. [Overcoming treatment resistance in chronic depression : The role of inpatient psychotherapy]. Nervenarzt. 2016 Jul;87(7):701-7. doi: 10.1007/s00115-015-0034-4. German.
• McCullough JP, Schramm E, Penberthy K. CBASP as a Distinctive Treatment for Persistent Depressive Disorder. 2014; Routledge. https://doi.org/10.4324/9781315743196
• Norcross JC, Wampold BE. Evidence-based therapy relationships: research conclusions and clinical practices. Psychotherapy (Chic). 2011 Mar;48(1):98-102. doi: 10.1037/a0022161.
• Sabass L, Padberg F, Normann C, Engel V, Konrad C, Helmle K, Jobst A, Worlitz A, Brakemeier EL. Cognitive Behavioral Analysis System of Psychotherapy as group psychotherapy for chronically depressed inpatients: a naturalistic multicenter feasibility trial. Eur Arch Psychiatry Clin Neurosci. 2018 Dec;268(8):783-796. doi: 10.1007/s00406-017-0843-5. Epub 2017 Sep 27.
• Spates CR, Pagoto SL, Kalata A. A qualitative and quantitative review of behavioral activation treatment of major depressive disorder. The Behavior Analyst Today. 2006; 7(4): 508-521. https://doi.org/10.1037/h0100089
• Shinohara K, Honyashiki M, Imai H, Hunot V, Caldwell DM, Davies P, Moore TH, Furukawa TA, Churchill R. Behavioural therapies versus other psychological therapies for depression. Cochrane Database Syst Rev. 2013 Oct 16;2013(10):CD008696. doi: 10.1002/14651858.CD008696.pub2.
• Snarski M, Scogin F, DiNapoli E, Presnell A, McAlpine J, Marcinak J. The effects of behavioral activation therapy with inpatient geriatric psychiatry patients. Behav Ther. 2011 Mar;42(1):100-8. doi: 10.1016/j.beth.2010.05.001. Epub 2010 Nov 20.
• Tadic A, Muller-Engling L, Schlicht KF, Kotsiari A, Dreimuller N, Kleimann A, Bleich S, Lieb K, Frieling H. Methylation of the promoter of brain-derived neurotrophic factor exon IV and antidepressant response in major depression. Mol Psychiatry. 2014 Mar;19(3):281-3. doi: 10.1038/mp.2013.58. Epub 2013 May 14. No abstract available.
• Struck N, Krug A, Yuksel D, Stein F, Schmitt S, Meller T, Brosch K, Dannlowski U, Nenadic I, Kircher T, Brakemeier EL. Childhood maltreatment and adult mental disorders - the prevalence of different types of maltreatment and associations with age of onset and severity of symptoms. Psychiatry Res. 2020 Nov;293:113398. doi: 10.1016/j.psychres.2020.113398. Epub 2020 Aug 30.
• Nemeroff CB, Heim CM, Thase ME, Klein DN, Rush AJ, Schatzberg AF, Ninan PT, McCullough JP Jr, Weiss PM, Dunner DL, Rothbaum BO, Kornstein S, Keitner G, Keller MB. Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proc Natl Acad Sci U S A. 2003 Nov 25;100(24):14293-6. doi: 10.1073/pnas.2336126100. Epub 2003 Nov 13.
• Brakemeier EL, Klein JP, Zimmermann J, Hollandt M, Reinhard MA, Boger S, Daldrup L, Eldem L, Gebhardt P, Heinrich S, Hirsmueller M, Millerowski J, Richter M, Ridderbusch IC, Suerig S, Schroeter L, Velten-Schurian K, Engeli S, Witte A, Bajbouj M, Fallgatter AJ, Kahl KG, Kircher T, Kohler S, Philipsen A, Walter M, Wolf J, Guhn A, Schweiger U, Hoyer J, Gutzmer D, Mauersberger S, Demir S, Stapel S, Hallgans J, Schule C, Frischholz C, Heitland I, Rek S, Jobst A, Kluge I, Lux S, Opel N, Orlowski S, Reinert C, Voelz H, Berwian IM, Frieling H, Maier HB, Walter H, Fassbinder E, Kaiser T, Kanter J, Swan J, Cuijpers P, Hautzinger M, Sterzer P, Padberg F. Efficacy, moderators and mediators of cognitive behavioural analysis system of psychotherapy (CBASP) versus behavioural activation (BA) in persistently depressed treatment-resistant inpatients: study protocol for the multicentre, randomised controlled changePDD trial. BMJ Open. 2026 Apr 1;16(4):e107051. doi: 10.1136/bmjopen-2025-107051.

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2021
• Primary Completion (Estimated): August 1, 2026
• Study Completion (Estimated): April 1, 2028

Study Registration Dates

• First Submitted: June 27, 2021
• First Submitted That Met QC Criteria: July 30, 2021
• First Posted (Actual): August 9, 2021

Study Record Updates

• Last Update Posted (Actual): May 26, 2026
• Last Update Submitted That Met QC Criteria: May 20, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Depression; Efficacy; Psychotherapy; Epigenetic; Child Maltreatment; Mediator; Inpatient Treatment; Moderator
• Additional Relevant MeSH Terms: Mental Disorders; Behavioral Symptoms; Mood Disorders; Depressive Disorder; Behavior; Depression; Depressive Disorder, Treatment-Resistant; Psychotropic Drugs; Pharmacologic Actions; Chemical Actions and Uses; Therapeutic Uses; Central Nervous System Agents; Antidepressive Agents
• Other Study ID Numbers: BR 4262/6-1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: In accordance with the Open Science specifications of the German Psychological Association (DGPS), anonymized data will be made available to the public via the Open Data portal of the Open Science Foundation (www.osf.io). The data will be stored when data collection is completed, but not before 01.01.2028. This step allows third parties to reproduce the analyses reported in scientific publications and to perform ad hoc analyses. The data is permanently stored on servers located in Germany. As soon as they are uploaded and published, these anonymized data cannot be deleted and are therefore also excluded from the deletion of the data in case of revocation of the study participation.
• IPD Sharing Time Frame: We will make the outcome data and then the covariate data freely available after our respective publications, but not before 01.01.2028.
• IPD Sharing Access Criteria: data will be shared with the public; data will be made available for all what types of analyses; the mechanism by which the data will be made available will be determined soon.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP; ICF; CSR

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No