Childhood trauma and treatment outcomes in short-term psychodynamic and cognitive behavioral therapy for adult depression

Anders Malkomsen^1*Randi Ulberg^1,2Toril Dammen^1,2Julie Horgen Evensen³Benjamin Hummelen¹André Løvgren¹Kåre Osnes⁴Theresa Wilberg^1,2Jan Ivar Røssberg^1,2

• ¹Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
• ²Institute of Clinical Medicine, University of Oslo, Oslo, Norway
• ³Division of Mental Health and Addiction, Nydalen DPS, Oslo universitetssykehus, Oslo, Norway
• ⁴Division of Mental Health and Substance Abuse, Diakonhjemmet Hospital, Oslo, Norway

Childhood trauma (CT) is a known risk factor for major depressive disorder (MDD), yet its implications for treatment selection remain unclear. This exploratory randomized controlled trial (N = 100) compared short-term psychodynamic psychotherapy (STPP) and cognitive behavioral therapy (CBT) in adults with MDD treated in outpatient clinics. CT was assessed with the Childhood Trauma Questionnaire–Short Form (CTQ-SF), and depressive symptoms were measured using the Beck Depression Inventory-II (BDI-II) and the Hamilton Depression Rating Scale (HDRS) at baseline and after 28 weeks of therapy. Linear mixed-model analyses showed that CT was associated with higher depression severity at the start of treatment. No significant predictive effects of CT were found for treatment outcome or for moderation of the comparative effectiveness of CBT and STPP. Emotional abuse was initially associated with greater improvement in STPP compared to CBT on the HDRS, but the effect did not remain significant after correction for multiple testing. These findings suggest that both CBT and STPP are suitable options for patients with MDD and a history of CT.