CBT and STPP Reduce Avoidant Traits in Major Depressive Disorder

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Personality and mental health Published May 6, 2026 Medically reviewed May 8, 2026 Study authors: de Bruin Saskia, Herrmann Pauline L, Dekker Jack J M, Peen Jaap, Van Henricus L, Don Frank, Driessen… PubMed ↗ DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Consider both CBT and STPP for MDD patients with avoidant traits; neither treatment was superior based on these traits.

This randomized controlled trial included 265 adult patients with major depressive disorder and compared cognitive-behavioral therapy (CBT) with short-term psychodynamic psychotherapy (STPP) over 16 weeks. The primary outcome was depressive symptom change on the Hamilton Depression Rating Scale, and secondary outcomes included avoidant personality traits and avoidant coping.

The study found that neither avoidant personality traits nor avoidant coping significantly moderated treatment efficacy. Both treatments led to a significant reduction in avoidant personality traits, but no significant change in avoidant coping was observed. Effect sizes and confidence intervals were not reported.

Safety and tolerability data were not reported, and limitations were not specified. The study is a single RCT without reported p-values or confidence intervals for main outcomes, so results should be interpreted cautiously.

For clinical practice, both CBT and STPP can be offered to patients with avoidant personality traits and avoidant coping, and both may reduce avoidant personality traits. However, the lack of significant moderation does not prove equivalence between treatments.

Study Details

Study typeRct

Sample sizen = 265

EvidenceLevel 2

Follow-up3.7 mo

PublishedMay 2026

PMID42070779

View Original Abstract ↓

Research on the significance of comorbid personality disorders (PD) on the outcome of depression treatment has shown inconsistent findings. In addition, it is still unclear whether treatment choice based on personality traits and coping can enhance the efficacy of depression treatment. Aiming to deliver clinically representative results, we use dimensional measures to examine avoidant personality and coping as moderators for the efficacy of cognitive-behavioral therapy (CBT) versus short-term psychodynamic psychotherapy (STPP) for depression. Furthermore, we explored whether these depression treatments reduced avoidant personality traits and coping. Included were 265 patients with major depressive disorder who received 16-week CBT or STPP in a randomized clinical trial. Depression, avoidant personality traits, and avoidant coping were measured with, respectively, the Hamilton Depression Rating Scale, NEO Five Factor Inventory (extraversion and neuroticism subscales), and Utrecht Coping List (avoidance subscale). Multilevel regression analyses estimated the moderating effects of avoidant personality traits and avoidant coping on the relationship between treatment type and depressive symptom change, as well as changes in avoidant personality traits and avoidant coping in CBT and STPP. Avoidant personality traits and avoidant coping did not moderate the efficacy of CBT and STPP. Both treatments resulted in significant reductions in avoidant personality traits, but not in coping. Both CBT and STPP can be offered to patients with avoidant personality traits and avoidant coping and can reduce avoidant personality traits. Trial Registration: ISRCTN31263312 (http://www.controlled-trials.com).