Case Control Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Aug 19, 2022; 12(8): 1016-1030
Published online Aug 19, 2022. doi: 10.5498/wjp.v12.i8.1016
Antidepressants combined with psychodrama improve the coping style and cognitive control network in patients with childhood trauma-associated major depressive disorder
Ren-Qiang Yu, Huan Tan, Er-Dong Wang, Jie Huang, Pei-Jia Wang, Xiao-Mei Li, Han-Han Zheng, Fa-Jin Lv, Hua Hu
Ren-Qiang Yu, Huan Tan, Fa-Jin Lv, Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
Er-Dong Wang, College of Art, Soochow University, Suzhou 215006, Jiangsu Province, China
Jie Huang, Pei-Jia Wang, Xiao-Mei Li, Han-Han Zheng, Hua Hu, Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 40016, China
Author contributions: All authors have materially participated in the research and article preparation; Yu RQ and Tan H participated in data collection, analysis, paper writing, and have equally contributed to this work; Wang ED implemented psychodrama intervention; Huang J, Wang PJ, Li XM, Zheng HH, and Lv FJ participated in data collection and analysis; Hu H, in charge of the research, was responsible for project application, implementation, and article writing; All authors approved the final manuscript.
Institutional review board statement: All patients provided written informed consent, and the study was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua Hu, PhD, Doctor, Professor, Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400016, China. huhuateam@126.com
Received: March 22, 2022
Peer-review started: March 22, 2022
First decision: June 11, 2022
Revised: July 27, 2022
Accepted: July 27, 2022
Article in press: July 27, 2022
Published online: August 19, 2022
Processing time: 148 Days and 22 Hours
Abstract
BACKGROUND

The use of antidepressant therapy alone has a limited efficacy in patients with childhood trauma-associated major depressive disorder (MDD). However, the effectiveness of antidepressant treatment combined with psychodrama in these patients is unclear.

AIM

To evaluate the effectiveness of antidepressant treatment combined with psychodrama.

METHODS

Patients with childhood trauma-associated MDD treated with antidepressants were randomly assigned to either the psychodrama intervention (observation group) or the general health education intervention (control group) and received combination treatment for 6 mo. The observation group received general health education given by the investigator together with the “semi-structured group intervention model” of Yi Shu psychodrama. A total of 46 patients were recruited, including 29 cases in the observation group and 17 cases in the control group. Symptoms of depression and anxiety as well as coping style and resting-state functional magnetic resonance imaging were assessed before and after the intervention.

RESULTS

Symptoms of depression and anxiety, measured by the Hamilton Depression Scale, Beck Depression Inventory, and Beck Anxiety Inventory, were reduced after the intervention in both groups of patients. The coping style of the observation group improved significantly in contrast to the control group, which did not. In addition, an interaction between treatment and time in the right superior parietal gyrus node was found. Furthermore, functional connectivity between the right superior parietal gyrus and left inferior frontal gyrus in the observation group increased after the intervention, while in the control group the connectivity decreased.

CONCLUSION

This study supports the use of combined treatment with antidepressants and psychodrama to improve the coping style of patients with childhood trauma-associated MDD. Functional connectivity between the superior parietal gyrus and inferior frontal gyrus was increased after this combined treatment. We speculate that psychodrama enhances the internal connectivity of the cognitive control network and corrects the negative attention bias of patients with childhood trauma-associated MDD. Elucidating the neurobiological features of patients with childhood trauma-associated MDD is important for the development of methods that can assist in early diagnosis and intervention.

Keywords: Major depressive disorder; Childhood trauma; Yi Shu psychodrama; Cognitive control network; Coping style

Core Tip: Antidepressant therapy alone has limited efficacy in patients with childhood trauma-associated major depressive disorder. In our study, we treated patients with childhood trauma-associated major depressive disorder with antidepressants combined with psychodrama. After treatment, the internal connectivity of the cognitive control network increased in patients with childhood trauma-associated depression. Antidepressants combined with psychodrama were more effective in improving patients’ coping styles and cognitive control network than combined with a general health education intervention.