Can Personality Style Predict Which Type of Therapy Works Best for Depression?

What you need to know

• This study tested whether people with different personality styles respond better to cognitive-behavioral therapy (CBT) or psychodynamic therapy for depression.
• Contrary to expectations, personality style did not predict which therapy worked better.
• Both CBT and psychodynamic therapy were effective at reducing depression symptoms overall.
• The study highlights the need for more research on personalized approaches to depression treatment.

Background on depression and psychotherapy

Depression is a common mental health condition that affects millions of people worldwide. It can cause persistent feelings of sadness, loss of interest in activities, changes in sleep and appetite, and difficulties with concentration and decision-making. Thankfully, there are effective treatments available, including different types of psychotherapy.

Two of the most widely used psychotherapy approaches for depression are cognitive-behavioral therapy (CBT) and psychodynamic therapy:

• CBT focuses on identifying and changing negative thought patterns and behaviors that contribute to depression. It tends to be more structured and skills-focused.

• Psychodynamic therapy aims to increase self-awareness and explore how past experiences and unconscious factors may be influencing current feelings and behaviors. It tends to be more open-ended and exploratory.

Research has shown that both CBT and psychodynamic therapy can be effective for treating depression. However, not everyone responds equally well to every type of therapy. This has led researchers to investigate whether certain patient characteristics might predict which therapy approach works best for a particular individual.

The potential role of personality style

One patient characteristic that has been proposed to potentially influence therapy outcomes is personality style. Specifically, researchers have identified two broad personality styles that may shape how people experience and cope with depression:

1. Dependent personality style: People with this style tend to be very focused on relationships and seeking support and approval from others. Their self-esteem is heavily tied to feeling connected to and cared for by others.

2. Self-critical personality style: People with this style tend to be very focused on achievement, self-definition, and maintaining independence. Their self-esteem is heavily tied to meeting high personal standards and avoiding failure.

Some researchers have hypothesized that these personality styles might predict which therapy approach works best:

• Dependent individuals might benefit more from the structure and interpersonal support provided by CBT.

• Self-critical individuals might benefit more from the exploratory, insight-oriented nature of psychodynamic therapy.

However, this idea had not been thoroughly tested in a rigorous clinical trial. The Ghent Psychotherapy Study set out to do just that.

The Ghent Psychotherapy Study

This study, conducted in Belgium, was designed to directly test whether personality style predicts differential outcomes between CBT and psychodynamic therapy for depression. Here are the key details:

• 100 adults diagnosed with major depressive disorder were recruited
• Participants were assessed as having either a dependent or self-critical personality style
• They were randomly assigned to receive either 16-20 sessions of CBT or short-term psychodynamic psychotherapy (STPP)
• Depression symptoms were measured before treatment, after treatment, and at 3 and 6 month follow-ups
• The main outcome was depression severity as rated by independent evaluators using a standardized scale

The researchers hypothesized that:

1. Dependent individuals would show better outcomes with CBT
2. Self-critical individuals would show better outcomes with STPP

Key findings

Contrary to expectations, the study found no evidence that personality style predicted which therapy worked better:

• There was no significant interaction between personality style and therapy type in predicting depression outcomes.
• Both CBT and STPP were similarly effective at reducing depression symptoms overall.
• Improvements in depression were generally maintained at the 6-month follow-up for both therapies.

In other words, dependent and self-critical individuals benefited equally from CBT and psychodynamic therapy. The researchers found no support for the idea that matching therapy type to personality style leads to better outcomes.

Some other noteworthy findings:

• 85.7% of participants who completed treatment no longer met diagnostic criteria for major depression afterwards.
• However, many still had some lingering depression symptoms - only 31.2% reached full remission.
• A substantial portion (44%) sought additional treatment after completing the study therapy.

Implications and future directions

This study provides important new evidence on the question of personalized treatment for depression. The results suggest that, at least when it comes to personality style, we may not yet be able to predict which therapy will work best for a particular individual.

However, this doesn’t mean the search for personalized approaches is futile. The researchers emphasize several important points:

1. More complex interactions may be at play. Future studies could look at how multiple patient characteristics interact with therapy factors to influence outcomes.

2. Different factors may predict outcomes for different individuals. What works best may vary from person to person in ways we don’t yet fully understand.

3. We need to look beyond just symptom reduction. Things like patient preferences, quality of life, and long-term functioning are also important to consider.

4. Understanding how therapy works is just as important as knowing if it works. We need more research on the specific mechanisms of change in different therapies.

The authors suggest several promising directions for future research:

• Examining other potential predictors of therapy outcomes, like patients’ expectations or the quality of the therapeutic relationship
• Using more in-depth, qualitative methods to understand patients’ experiences in therapy
• Investigating whether factors like treatment length or session frequency influence outcomes
• Looking at a wider range of outcomes beyond just symptom measures

Conclusions

• Personality style (dependent vs self-critical) does not appear to predict whether CBT or psychodynamic therapy will be more effective for an individual with depression.
• Both CBT and psychodynamic therapy can be effective treatments for depression.
• More research is needed to understand what factors might help match patients to the most effective treatment approach.
• Developing truly personalized depression treatments likely requires considering multiple complex factors, not just single patient characteristics.

While this study didn’t find the clear-cut prediction they were looking for, it represents an important step in the journey toward more personalized and effective mental health care. By rigorously testing our assumptions and exploring new ideas, we can continue to improve how we understand and treat depression.