Psychiatric News January 21, 2005
Volume 40 Number 2
© 2005 American Psychiatric Association
p. 53
Short-Term Psychodynamic Therapy Found Effective in Several Disorders
Mark Moran
Effect sizes were significant for a wide range of psychiatric conditions
including depression, substance abuse, eating disorders, and personality
disorders, among others.
A meta-analysis of more than 30 years of randomized controlled trials of
short-term psychodynamic psychotherapy (STPP) found it effective for treatment
of psychiatric disorders.
Short-term psychodynamic psychotherapy produced statistically significant
pretreatment-posttreatment effect sizes for target problems, general
psychiatric symptoms, and social functioning. The effect sizes were stable and
tended to increase at follow-up, according to a report of the study in the
December 2004 Archives of General Psychiatry.
The study was authored by Falk Leichsenring, D.Sc., of the department of
psychosomatics and psychotherapy at the University of Goettingen in Germany,
and colleagues.
They identified studies of STPP published between January 1, 1970 and
September 30, 2004, with a computerized search using MEDLINE, PsycINFO, and
Current Contents.
The following inclusion criteria were applied to their search:
- a randomized controlled design was used.
- a specific form of STPP represented in a treatment manual or manual-like
guide was applied, and treatment integrity was ensured.
- therapists were specifically trained or experienced in STPP.
- patients with specific psychiatric disorders were treated, and the patient
sample was clearly described.
- diagnostic procedures and outcome measures for which reliability and
validity have been demonstrated were used.
- data were reported that are necessary to calculate
pretreatment-posttreatment effects.
Seventeen studies were identified that fulfilled the criteria. Analysis
showed that STPP yielded large and significant effect sizes for target
problems (1.39), general psychiatric symptoms (0.90), and social functioning
(0.80).
Effect sizes were significantly greater for patients receiving STPP than
for those who were waiting-list control subjects in the studies and for
patients in the studies who received treatment as usual.
"According to these results, patients treated with STPP are better
off with regard to their target problems than 92 percent of the patients
before therapy," the authors stated. "At follow-up, which was on
average 13 months after termination of therapy, they were better off than 95
percent of the patients.... These results are highly relevant for clinical
practice." They added that this finding also holds for another result.
"Comparing the effect sizes yielded at the end of therapy and follow-up,
the effects of STPP proved to be stable and even tended to
increase."
The number of STPP sessions conducted in the studies ranged from seven to
40 and were performed in a face-to-face setting with one or two sessions per
week.
Psychiatric disorders treated by STPP included major depression (two
studies), maternal depression (one), posttraumatic stress disorder (one),
bulimia nervosa (two), anorexia nervosa (one), opiate dependence (two),
cocaine dependence (one), cluster C personality disorders (three), borderline
personality disorder (one), somatoform pain disorder (one), chronic functional
dyspepsia (one), and social phobia (one).
The authors believe the analysis is unique in the literature because of the
unusually rigorous inclusion criteria and because more than 75 percent of
studies included had not been included in other meta-analyses of STPP.
Moreover, the authors excluded studies of interpersonal psychotherapy, which
had been included in earlier analyses.
"According to the results of this and other meta-analyses, STPP is an
effective treatment of psychiatric disorders and yields stable results,"
the authors said. "Further research should study not only the effects of
STPP in specific psychiatric disorders but also the active ingredients of
STPP... .Furthermore, effectiveness studies should address whether the methods
of therapy that have proved to work in randomized control trials are effective
in the field."
An abstract of the article "The Efficacy of Short-Term
Psychodynamic Psychotherapy in Specific Psychiatric Disorders" is posted
online at
<http://archpsyc.ama-assn.org/cgi/content/abstract/61/12/1208>.
Arch Gen Psychiatry 2004 61 1208[Abstract/Free Full Text]
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