Major depression is one of the most common psychiatric disorders among patients seeking treatment. Over the years, there has been the development and refinement of an array of treatment modalities for depression. Although research has demonstrated the effectiveness of pharmacological and psychosocial treatments for depression, a substantial number of depressed patients do not respond fully to available treatments. Recent theory and research suggest that depressed individuals with histories of childhood sexual abuse constitute, in part, those who respond poorly to available treatments and/or suffer from chronic depression. Despite the high prevalence of childhood sexual abuse in depressed populations, and the poor prognostic outcome of this subgroup of depressed patients, no treatments for depression that address the specific clinical needs of depressed patients with histories of sexual abuse have been developed or systematically evaluated. Based on an integration of the literature on the treatment of depression and childhood sexual abuse, it is proposed to develop a 24-week treatment, Schema-Focused Therapy, for this subgroup of depressed patients, which may improve treatment retention and efficacy for this challenging population of patients.
The aims of this treatment development proposal are to: 1) modify and expand a schema-focused treatment manual for depressed patients with histories of childhood sexual abuse; 2) develop and implement a therapist training program for the proposed treatment; 3) develop and test competence and adherence rating scales for the proposed treatment; 4) expand the clinical management component of the control condition, pharmacotherapy plus clinical management; 5) conduct a pilot study of the treatment program, which will evaluate the initial efficacy, feasibility, and acceptability of the proposed treatment in conjunction with expanded pharmacotherapy-plus-clinical-management compared to a control condition (expanded pharmacotherapy-plus-clinical management) in a sample of 24 female patients with major depression and histories of childhood sexual abuse. Primary treatment outcomes will be: a) treatment retention; and b) depressive symptoms; 6) test the feasibility and acceptability of the control condition for depressed patients with histories of childhood sexual abuse.
