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Long-term psychoanalytic and cognitive-behavior therapy of chronic depression a randomized controlled trial (LAC-Study)

Principal inverstigators Mainz

Univ.-Prof. Dr. Manfred E. Beutel
Univ.-Prof. Marianne Leuzinger-Bohleber

Project team Frankfurt

PD Dr. Ulrich Bahrke
Dr. Alexa Negele
Dipl.-Psych. Lisa Kallenbach
Dipl.-Psych. Johannes Kaufhold
Prof. Dr. Luise Laezer

Project team Mainz

M.Sc. (Psych.) Lina Krakau
Dr. Mareike Ernst
Dr. Fabian Escher

Research topic

The LAC study is the first controlled psychotherapy trial comparing the results of psychoanalytic (PAT) and cognitive-behavioral (CBT) long-term psychotherapy in chronically depressed patients with randomized and preferred assignment. Of initially 554 interviewed patients, 252 were enrolled in the study at four treatment centers.
Both psychotherapies proved successful three years after the start of treatment in achieving a significant reduction in symptoms in these chronically ill patients.
The mean BDI value (patients' self-assessments) of 32.1 points decreased by 12.1 points after just one year and by as much as 17.2 points after three years, resulting in very high effect sizes: d = 1.17 after one year and d = 1.83 after three years. Assessments of the independent blinded raters showed analogous results: The mean QIDS-C values decreased in the first year from 14.1 to 7.1 and further to 7.0 three years after the start of treatment. Effect sizes were also very high: they increased from d = 1.56 after one year to d = 2.08 after three years after the start of treatment. The achieved remission rates were higher compared to other studies: 39% of patients showed full remission after only one year, and 61% after three years after the start of treatment. Long-term psychotherapy seems to be a promising treatment approach for chronically depressed individuals.
Contrary to the hypothesis of the study, there was no statistically significant difference between symptom reduction in the two different treatments or randomized and preferred allocation, presumably due to insufficient power in the randomized group. However, at three years follow up significantly more patients in PAT (60%) compared to CBT (36%) fulfilled the criteria of a structural change measured with the Heidelberg restructuring scale. Furthermore, the correlation of structural changes and reduction of depressive symptoms was stronger in PAT compared to CBT.
Currently, further data analyses with regard to later follow-ups, the influence of drug intake and health economic variables are carried out.

The LAC study is of high external validity since it reflects well the treatment practice of chronically depressed patients undergoing long-term therapies. The therapies were performed by experienced, state-approved therapists and were financed by health insurance companies.
Duration: since 2007
Funding: German Society for Psychoanalysis , Psychotherapy, Psychosomatics and Psychodynamics (DGPT), German Psychoanalytic Association (DPV); International Psychoanalytical Association (IPA), Heidehof Foundation, German Research Foundation (DFG) (support of conferences on the LAC study); Dr. M. von der Tann (support of the OPD) and other private sponsors.

Recent publications

  • Beutel, M. E., Leuzinger-Bohleber, M., Rüger, B., Bahrke, U., Negele, A., Haselbacher, A., … & Hautzinger, M. (2012). Psychoanalytic and cognitive-behavior therapy of chronic depression: Study protocol for a randomized controlled trial. Trials, 13(1), 117. https://doi.org/10.1186/1745-6215-13-117
  • Kaufhold, J., Bahrke, U., Kallenbach, L., Negele, A., Ernst, M., Keller, W., … & Beutel, M. (2019). Wie können nachhaltige Veränderungen in Langzeittherapien untersucht werden?: Symptomatische versus strukturelle Veränderungen in der LAC-Depressionsstudie. PSYCHE, 73(02), 106–133. https://doi.org/10.21706/ps-73-2-106
  • Leuzinger-Bohleber, M., Hautzinger, M., Fiedler, G., Keller, W., Bahrke, U., Kallenbach, L., … & Beutel, M. (2019). Outcome of Psychoanalytic and Cognitive-Behavioural Long-Term Therapy with Chronically Depressed Patients: A Controlled Trial with Preferential and Randomized Allocation. The Canadian Journal of Psychiatry, 64(1), 47–58. https://doi.org/10.1177/0706743718780340
  • Leuzinger-Bohleber, M., Hautzinger, M., Keller, W., Fiedler, G., Bahrke, U., Kallenbach, L., … & Beutel, M. (2019). Psychoanalytische und kognitiv-behaviorale Langzeitbehandlung chronisch depressiver Patienten bei randomisierter oder präferierter Zuweisung: Ergebnisse der LAC-Studie. PSYCHE, 73(02), 77–105. https://doi.org/10.21706/ps-73-2-77
  • Leuzinger-Bohleber, M., Kaufhold, J., Kallenbach, L., Negele, A., Ernst, M., Keller, W., … & Beutel, M. (2019). How to measure sustained psychic transformations in long-term treatments of chronically depressed patients: Symptomatic and structural changes in the LAC Depression Study of the outcome of cognitive-behavioural and psychoanalytic long-term treatments. The International Journal of Psychoanalysis, 100(1), 99–127. https://doi.org/10.1080/00207578.2018.1533377
  • Leuzinger-Bohleber, M., Kallenbach-Kaminski, L., Bahrke, U., Kaufhold, J., Negele, A., Ernst, M., … & Beutel, M. (2020). The LAC Study a comparative outcome study of psychoanalytic and cognitive-behavioral long-term tehrapies of chronic depressed patients. In M. Leuzinger-Bohleber, M. Solms & S. Arnold (Eds.), Outcome Research and the Future of Psychoanalysis: Clinicians and Researchers in Dialogue (1st ed.). Routledge. https://doi.org/10.4324/9780429281112
  • Leuzinger-Bohleber, M., Negele, A., Bahrke, U.: „Was nur erzählt und nicht gemessen werden kann“. Einblicke in psychoanalytische Behandlungen der LAC Studie. Erscheint beim Psychosozial Verlag, Giessen im Herbst 2020