Higher intensity of psychotherapy might improve treatment outcome in depression, especially in those with comorbid personality disorder.

To compare the effects of 25 individual sessions (weekly) of two forms of psychotherapy – short-term psychoanalytic supportive psychotherapy (SPSP) and schema therapy – with the same treatments given for 50 sessions (twice weekly) in people with depression and personality disorder. Trial registration: NTR5941.

We conducted a pragmatic, double-randomised clinical trial and, over 37 months, recruited 246 adult out-patients with comorbid depression/dysthymia and personality disorder. A 2 × 2 factorial design randomised participants to 25 or 50 sessions of SPSP or schema therapy. The primary outcome was change in depression severity over 1 year on the Beck Depression Inventory II (BDI-II). Secondary outcomes were remission both of depression and personality disorder.

Compared with 25 sessions, participants who received 50 sessions showed a significantly greater decrease in depressive symptoms over time (time × session dosage, P < 0.001), with a mean difference of 5.6 BDI points after 1 year (d = −0.53, 95% CI −0.18 to 0.882, P = 0.003). Remission from depression was also greater in the 50-session group (74% v. 58%, P = 0.025), as was remission of personality disorder (74% v. 56%, P = 0.010).

Greater intensity of psychotherapy leads to better outcomes of both depression and personality status in people with comorbid depression and personality disorder.

更高强度的心理治疗可能会改善抑郁症的治疗结果，特别是对于患有共病人格障碍的患者。

比较两种形式的心理治疗（短期精神分析支持性心理治疗 (SPSP) 和图式治疗）的 25 次单独疗程（每周）与抑郁症和人格障碍患者进行 50 次疗程（每周两次）的相同治疗效果。试用注册：NTR5941。

我们进行了一项务实的双随机临床试验，历时 37 个月，招募了 246 名患有抑郁症/心境恶劣和人格障碍的成人门诊患者。 2 × 2 析因设计将参与者随机分配至 25 或 50 次 SPSP 或图式治疗。主要结果是贝克抑郁量表 II (BDI-II) 一年内抑郁严重程度的变化。次要结果是抑郁症和人格障碍的缓解。

与 25 次疗程相比，接受 50 次疗程的参与者随着时间的推移，抑郁症状明显减轻（时间 × 疗程剂量，P < 0.001），1 年后平均差异为 5.6 BDI 点（d = -0.53，95%） CI -0.18 至 0.882，P = 0.003）。 50 次疗程组中抑郁症的缓解率也较高（74% vs. 58%，P = 0.025），人格障碍的缓解率也较高（74% vs. 56%，P = 0.010）。

对于患有抑郁症和人格障碍的人来说，更大强度的心理治疗可以使抑郁症和人格状态得到更好的结果。