The theoretical concept and practical clinical realization of ST represents an advancement of cognitive behavior therapy (CBT) and is based on psychological learning and attachment theories. This applies especially for more severe and complex manifestations of MDD including particularly those with comorbid personality disorders as they represent clinical reality in inpatient and day clinic settings. Considering further evidence regarding ST for the treatment of MDD we assume ST to be a promising approach in treating depression and overcoming weaknesses of CBT approaches. Bamelis and colleagues found first indices for ST as treatment for personality disorders to reduce depressive symptoms as a secondary outcome at follow up. ST was originally conceptualized for non-responders of cognitive therapy and patients suffering from personality disorder (PD). Especially personality disorders are highly prevalent in inpatient settings, they increase the time for remission, and lower positive outcome in the treatment of MDD. The latter has become increasingly popular within the last two decades and is the focus of the current study.īesides its high rates of recurrence and non-responders to therapy, MDD is characterized by its heterogeneity of symptoms and comorbidities on axis I and II. Alongside the development of innovative pharmacological approaches such as anti-inflammatory drugs, the field of psychotherapy has also evolved considerably and introduced new forms of treatment for depression such as mindfulness-based cognitive therapy, the cognitive behavioral analysis system of psychotherapy or schema therapy (ST). Even though, both approaches are effective, there is room for improvement, considering up to 50% of patients are non-responders to psychotherapy or ADM and there is a high relapse rate of 54% within 2 years. The two main treatment approaches addressing MDD are antidepressant medication (ADM) and psychotherapy. High life time prevalence, ranging from 11.1 to 14.6% across countries, stresses the necessity for the development of effective forms of treatment. For those affected, depression means personal suffering, reduced functioning and quality of life, social withdrawal, risk for co-morbid medical condition and increased mortality risk. In recent years, major depressive disorder (MDD) has become one of the three leading causes for years lived with disability with more than 264 million people affected worldwide. ![]() Further parameters on a behavioral, cognitive, psychophysiological, and biological level are measured before, during and after treatment and in 2 follow-up assessments after 6 and 24 months after end of treatment. Primary outcome is depressive symptom severity as self-assessment (Beck Depression Inventory-II) and secondary outcomes are clinical ratings of MDD (Montgomery-Asberg Depression Rating Scale), recovery rates after 7 weeks according to the Munich-Composite International Diagnostic Interview, general psychopathology (Brief Symptom Inventory), global functioning (World Health Organization Disability Assessment Schedule), and clinical parameters such as dropout rates. All study therapists undergo a specific training and supervision and therapy adherence is assessed. Over the course of 7 weeks, we compare schema therapy with cognitive behavioral therapy and individual supportive therapy, conducted in individual and group sessions and with no restrictions regarding concurrent antidepressant medication, thus approximating real-life treatment conditions. In the current protocol, we outline OPTIMA (OPtimized Treatment Identification at the MAx Planck Institute): a single-center randomized controlled trial of schema therapy as a treatment approach for MDD in an inpatient and day clinic setting. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. ![]() If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. ![]() The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.
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