OBJECTIVE Many active treatments exist for major depressive disorder (MDD), but little is known about their differential effects for various subpopulations of patients to guide precision medicine. This is the first randomized controlled trial (RCT) designed to identify differential treatment effects based on patients' attachment orientations. We tested an a priori preregistered hypothesis of the potential moderating effect of patients' attachment orientation on the outcome of supportive therapy (ST) versus supportive-expressive therapy (SET). METHODS The RCT was conducted between 2015 and 2021. Individuals with MDD were randomly assigned to 16-week ST or SET. The predefined primary outcome measure was the Hamilton Rating Scale for Depression. Hypotheses were formulated and preregistered before data collection. RESULTS One hundred patients with MDD were enrolled, 57% women, average age 31.2 (SD = 8.25). Data were analyzed using the intention-to-treat approach. Our hypothesis that attachment anxiety is a significant moderator of treatment outcome was supported (B = -0.09, p = .016): Patients with higher levels of attachment anxiety showed greater treatment efficacy following SET than ST. Although the hypothesis regarding a potential moderating effect of avoidant attachment was not supported, sensitivity analyses revealed that individuals with disorganized attachment orientation (higher scores on both anxious and avoidant attachment) benefited more from SET than from ST (B = -0.07, p = .04). CONCLUSION The findings support the clinical utility of patients' attachment orientation in selecting the most suitable treatment for individuals and demonstrate the methodological utility of RCTs predesigned to test theoretically based models of personalized treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

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一项随机对照试验，用于根据患者的依恋取向确定最适合抑郁症的治疗方法。

目标 重度抑郁症 (MDD) 存在许多积极的治疗方法，但对于它们对不同患者亚群指导精准医疗的不同效果知之甚少。这是第一个旨在根据患者依恋方向确定不同治疗效果的随机对照试验 (RCT)。我们测试了一个预先注册的假设，即患者依恋取向对支持性治疗 (ST) 与支持性表达治疗 (SET) 结果的潜在调节作用。方法 RCT 在 2015 年至 2021 年间进行。患有 MDD 的个体被随机分配到 16 周的 ST 或 SET。预定义的主要结果测量是汉密尔顿抑郁量表。假设是在数据收集之前制定和预注册的。结果 100 名 MDD 患者入组，其中 57% 为女性，平均年龄 31.2 岁（SD = 8.25）。使用意向治疗方法分析数据。我们关于依恋焦虑是治疗结果的重要调节因素的假设得到支持（B = -0.09，p = .016）：依恋焦虑水平较高的患者在 SET 后显示出比 ST 更高的治疗效果。尽管关于回避依恋的潜在调节作用的假设没有得到支持，但敏感性分析显示，依恋取向混乱（焦虑和回避依恋得分较高）的个体从 SET 中受益比从 ST 中获益更多（B = -0.07，p = . 04)。结论 研究结果支持患者的临床效用 依恋取向为个人选择最合适的治疗方法，并展示预先设计的随机对照试验的方法效用，以测试基于理论的个性化治疗模型。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。