LAUSR

Because depression is a recurrent disorder, the therapeutic aim for it should be the prevention of relapse or recurrence. Practitioners of psychoanalytic (PA), psychodynamic (PD) and cognitive–behavioral therapy (CBT) claim to achieve stable results by improving patients’ personality functioning (e.g., self- and object representations, capacity to regulate affect and self-esteem). This hypothesis was tested using data from a subsample of 67 patients of the Munich Psychotherapy Study. In addition, we tested a diathesis–stress model, assuming that a failure to improve personality functioning during therapy may represent a vulnerability factor, especially for people confronted with adverse life events after therapy. Depressive symptoms and general psychiatric distress were assessed using the German versions of the Beck Depression Inventory (Hautzinger, Bailer, Worall, & Keller, 1995) and the Global Severity Index of the Symptom Checklist 90–Revised (Franke, 1995) at pretreatment, posttreatment, and 3-year follow-up. Personality functioning was assessed pre- and posttreatment using the Scales of Psychological Capacities (Wallerstein, 1991; Wallerstein, DeWitt, Hartley, Rosenberg, & Zilberg, 1989). Patients were interviewed at 1-year follow-up to detect negative life events in the intervening time. Regression analyses revealed that depressive symptoms and general psychiatric distress at 3-year follow-up were significantly predicted by pre- to posttreatment changes in personality functioning. When controlling for pre- to posttreatment changes in outcome measures, the effects of change in personality functioning were no longer significant. However, we found evidence for an interaction effect between pre- to posttreatment changes in personality functioning and the number of negative life events on general psychiatric symptoms, partially supporting the assumed diathesis–stress model. This suggests that, irrespective of treatment modality, therapists should focus on changes in personality functioning to obtain stable benefits.