Comparing the effect of supportive-expressive and cognitive-behavioral psychotherapies on depression and adherence to treatment in hemodialysis patients focusing on improving physician-patient relationship

The purpose of this study was to compare the effect of supportive-expressive and cognitive-behavioral psychotherapies on depression and adherence to treatment in hemodialysis patients with a focus on improving the physician-patient relationship.

This clinical trial was performed as pretest and posttest with randomized sampling control group. Participants were 45 hemodialysis patients, aged 20-50 years, in Imam Reza hospital of Mashhad and Taleghani hospital of Torbat Jam in 2018-2019 who completed these 3 questionnaires: Beck Depression II, Karami and Keyvanara Physician-Patient Relation Patterns and End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ). The patients with moderate to severe depression divided into 2 experimental groups and one control group (n=15). Data were analyzed using SPSS-23 software and repeated measures analysis of variance (ANOVA) and Bonferroni post hoc tests.

Findings in multivariable indicators showed a short-term effect (pretest-posttest) equal to 0.81 and a long-term effect (pretest-4 month follow-up) equal to 0.83 in supportive-expressive therapy group compared to the control group. In the cognitive-behavioral therapy with the same significance level, the short-term and long-term effects were 0.70 and 0.14. Finally, by using Bonferroni test and average comparison profiles, the short-term and long-term effects of supportive-expressive therapy were more than cognitive-behavioral therapy.

It seems that supportive-expressive therapy with focusing on improving the relationship has more significant effects to reduce depression and increase adherence to treatment than the other therapy.