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Quinze ans après le rapport de l’Inserm. L’efficacité de la psychanalyse ré-évaluée. EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Fifteen years after the INSERM report. Psychoanalysis's efficacy reevaluated. EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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3
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Abstract
There is encouraging evidence that some patients with personality disorder are treatable. Psychotherapeutic interventions show promise, although interpretation of the literature is problematic: the number of patients in most trials is small, outcome measures are questionable, follow-up is limited, and treatments are multifaceted, complex interventions in which the effective components are unclear. The evidence base can be assessed according to efficacy and generalisability, and when both are taken into account the best verification is for psychodynamic therapy. However, there is inadequate evidence to make specific recommendations for any particular therapy.
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Abstract
Target complaints measures have been used frequently as measures of psychotherapy outcome, but lack adequate concurrent validity data and suffer a number of methodological problems. In the present study, a simplified written version of a client- and therapist-rated target complaints measure was completed along with a variety of other commonly used outcome measures on 138 clients at the beginning of psychotherapy and then at 2 months' follow-up. Although client and therapist severity ratings were positively correlated, there was some inconsistency between the content of client and therapist complaints. Strong support was found for the concurrent validity of the target complaints measures. Both client and therapist ratings of target complaints significantly correlated with measures of anxiety, psychological distress, symptom severity, and client satisfaction. However, the magnitude of the correlations suggested that target complaints measures offered unique problem information in addition to the other outcome measures and were an economical adjunct.
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Affiliation(s)
| | - John Spicer
- Massey University, Palmerston North, New Zealand
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Gumz A, Treese B, Marx C, Strauss B, Wendt H. Measuring Verbal Psychotherapeutic Techniques-A Systematic Review of Intervention Characteristics and Measures. Front Psychol 2015; 6:1705. [PMID: 26617543 PMCID: PMC4639607 DOI: 10.3389/fpsyg.2015.01705] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/22/2015] [Indexed: 11/13/2022] Open
Abstract
Language is one of the most important “tools” of psychotherapists. The working mechanisms of verbal therapeutic techniques, however, are still marginally understood. In part, this is due to the lack of a generally acknowledged typology as well as a gold standard for the assessment of verbal techniques, which limits the possibility of conducting studies focusing this topic. The present study reviews measures used in clinical research which assess directly observable dimensions of verbal interventions in a reliable manner. All measures were evaluated with respect to their theoretical foundation, research goals, assessment modes, and various psychometric properties. A systematic search in databases (PubMed, PsycInfo, PsycArticles, PSYNDEX, Web of Science, Embase) followed by an additional “snowballing” search covering the years 1940–2013 yielded n = 179 publications eligible for review. Within these publications, 34 measures were identified showing great heterogeneity regarding the aspects under study. Only two measures reached the highest psychometric standards and can be recommended for clinical use without any reservation. Central problems include deficiencies in the systematization of techniques as well as their partly ambiguous and inconsistent definitions. To promote this field of research, it will be important to achieve a consensus concerning the terminology, conceptions and measures of verbal interventions.
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Affiliation(s)
- Antje Gumz
- Berlin University of Psychology Berlin, Germany ; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf Hamburg, Germany
| | - Barbara Treese
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena Jena, Germany
| | | | - Bernhard Strauss
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena Jena, Germany
| | - Hanna Wendt
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf Hamburg, Germany
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Levy KN, Ehrenthal JC, Yeomans FE, Caligor E. The efficacy of psychotherapy: focus on psychodynamic psychotherapy as an example. Psychodyn Psychiatry 2015; 42:377-421. [PMID: 25211431 DOI: 10.1521/pdps.2014.42.3.377] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The growing number of individuals seeking treatment for mental disorders calls for intelligent and responsible decisions in health care politics. However, the current relative decrease in reimbursement of effective psychotherapy approaches occurring in the context of an increase in prescription of psychotropic medication lacks a scientific base. Using psychodynamic psychotherapy as an example, we review the literature on meta-analyses and recent outcome studies of effective treatment approaches. Psychodynamic psychotherapy is an effective treatment for a wide variety of mental disorders. Adding to the known effectiveness of other shorter treatments, the results indicate lasting change in many cases, especially for complex and difficult to treat patients, ultimately reducing health-care utilization. Research-informed health care decisions that take into account the solid evidence for the effectiveness of psychotherapy, including psychodynamic psychotherapy, have the potential to promote choice, increase mental health, and reduce society's burden of disease in the long run.
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Abbass AA, Kisely SR, Town JM, Leichsenring F, Driessen E, De Maat S, Gerber A, Dekker J, Rabung S, Rusalovska S, Crowe E. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Syst Rev 2014; 2014:CD004687. [PMID: 24984083 PMCID: PMC11129844 DOI: 10.1002/14651858.cd004687.pub4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Since the mid-1970s, short-term psychodynamic psychotherapies (STPP) for a broad range of psychological and somatic disorders have been developed and studied. Early published meta-analyses of STPP, using different methods and samples, have yielded conflicting results, although some meta-analyses have consistently supported an empirical basis for STPP. This is an update of a review that was last updated in 2006. OBJECTIVES To evaluate the efficacy of STPP for adults with common mental disorders compared with wait-list controls, treatments as usual and minimal contact controls in randomised controlled trials (RCTs). To specify the differential effects of STPP for people with different disorders (e.g. depressive disorders, anxiety disorders, somatoform disorders, mixed disorders and personality disorder) and treatment characteristics (e.g. manualised versus non-manualised therapies). SEARCH METHODS The Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR) was searched to February 2014, this register includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also conducted searches on CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, DARE and Biological Abstracts (all years to July 2012) and all relevant studies (identified to 2012) were fully incorporated in this review update. We checked references from papers retrieved. We contacted a large group of psychodynamic researchers in an attempt to find new studies. SELECTION CRITERIA We included all RCTs of adults with common mental disorders, in which a brief psychodynamic therapy lasting 40 or fewer hours in total was provided in individual format. DATA COLLECTION AND ANALYSIS Eight review authors working in pairs evaluated studies. We selected studies only if pairs of review authors agreed that the studies met inclusion criteria. We consulted a third review author if two review authors could not reach consensus. Two review authors collected data and entered it into Review Manager software. Two review authors assessed and scored risk of bias. We assessed publication bias using a funnel plot. Two review authors conducted and reviewed subgroup analyses. MAIN RESULTS We included 33 studies of STPP involving 2173 randomised participants with common mental disorders. Studies were of diverse conditions in which problems with emotional regulation were purported to play a causative role albeit through a range of symptom presentations. These studies evaluated STPP for this review's primary outcomes (general, somatic, anxiety and depressive symptom reduction), as well as interpersonal problems and social adjustment. Except for somatic measures in the short-term, all outcome categories suggested significantly greater improvement in the treatment versus the control groups in the short-term and medium-term. Effect sizes increased in long-term follow-up, but some of these effects did not reach statistical significance. A relatively small number of studies (N < 20) contributed data for the outcome categories. There was also significant heterogeneity between studies in most categories, possibly due to observed differences between manualised versus non-manualised treatments, short versus longer treatments, studies with observer-rated versus self report outcomes, and studies employing different treatment models. AUTHORS' CONCLUSIONS There has been further study of STPP and it continues to show promise, with modest to large gains for a wide variety of people. However, given the limited data, loss of significance in some measures at long-term follow-up and heterogeneity between studies, these findings should be interpreted with caution. Furthermore, variability in treatment delivery and treatment quality may limit the reliability of estimates of effect for STPP. Larger studies of higher quality and with specific diagnoses are warranted.
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Affiliation(s)
- Allan A Abbass
- Dalhousie UniversityDepartment of Psychiatry8203 ‐ 5909 Veterans Memorial LaneHalifaxNSCanadaB3H 2E2
| | - Steve R Kisely
- The University of QueenslandSchool of MedicinePrincess Alexandra HospitalIpswich RoadWoolloongabbaQueenslandAustraliaQLD 4102
| | - Joel M Town
- Dalhousie UniversityCentre for Emotions & Health5909 Veterans' Memorial LaneHalifaxCanadaB3H 2E2
| | - Falk Leichsenring
- University of GiessenKlinik für Psychosomatik und PsychotherapieLudwigstr. 76GiessenGermany35392
| | - Ellen Driessen
- VU University AmsterdamFaculty of Psychology and Education, Department of Clinical PsychologyVan der Boechorststraat 1Transitorium 2B‐57AmsterdamNetherlands1081 BT
| | - Saskia De Maat
- Dutch Psychoanalytic Institute (NPI)Olympiaplein 4AmsterdamNetherlands1076 AB
| | - Andrew Gerber
- New York State Psychiatric InstitutePsychiatry1051 Riverside Drive, Unit 74New YorkNew YorkUSA10032
| | - Jack Dekker
- Arkin Mental Health InstituteResearch DepartmentKlaprozenweg 111AmsterdamNetherlands1033 NN
| | - Sven Rabung
- Alpen‐Adria‐Universität KlagenfurtDepartment of PsychologyUniversitätsstr. 65‐67KlagenfurtAustria9020
- University Medical Center Hamburg‐EppendorfDepartment of Medical PsychologyMartinistr. 52, W26HamburgGermany20246
| | | | - Elizabeth Crowe
- University of QueenslandSchool of Population HealthHerston RoadBrisbaneQueenslandAustralia4006
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Treatment duration and premature termination of psychotherapy in personality disorders: predictive performance of psychodynamic personality functioning. J Psychiatr Pract 2012; 18:172-86. [PMID: 22617082 DOI: 10.1097/01.pra.0000415074.43744.29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Little is known about predictors of treatment duration and premature termination of psychotherapy. METHOD Sociodemographic variables, descriptive DSM-IV psychiatric diagnoses, general symptom severity, and psychodynamic personality functioning were assessed in 148 inpatients with personality disorders who were receiving psychotherapy. Psychodynamic personality functioning was assessed using the Developmental Profile (DP). Predictive performance and incremental value over and beyond demographics and descriptive diagnoses were determined. RESULTS In contrast to DSM-IV diagnoses and symptom severity, psychodynamic variables and the level of personality functioning significantly predicted treatment duration and premature treatment termination. Longer treatment duration was predicted by adaptive DP levels of personality functioning, whereas shorter treatment duration was associated with maladaptive personality functioning (primitive DP levels, including fragmentation and self-centeredness). DP variables independently explained 6% of the variance. CONCLUSION In contrast to DSM-IV diagnoses and general symptom severity, psychodynamic personality variables significantly predicted treatment duration and premature discharge. These findings support the relevance of psycho-dynamic assessments in clinical practice, the DSM-5 proposals for the definition of personality functioning, and the predictive validity of the DP.
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Abbass A, Town J, Driessen E. Intensive short-term dynamic psychotherapy: a systematic review and meta-analysis of outcome research. Harv Rev Psychiatry 2012; 20:97-108. [PMID: 22512743 DOI: 10.3109/10673229.2012.677347] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Habib Davanloo has spent his career developing and teaching methods to accelerate dynamic psychotherapy, including his technique of intensive short-term dynamic psychotherapy (ISTDP). Over the past 20 years, outcome studies using this treatment have been conducted and published. We performed a systematic review of the literature to obtain studies presenting ISTDP outcome data. We found 21 studies (10 controlled, and 11 uncontrolled) reporting the effects of ISTDP in patients with mood, anxiety, personality, and somatic disorders. Using the random-effects model, we performed meta-analyses including 13 of these studies and found pre- to post-treatment effect sizes (Cohen's d) ranging from 0.84 (interpersonal problems) to 1.51 (depression). Post-treatment to follow-up effect sizes suggested that these gains were maintained at follow-up. Based on post-treatment effect sizes, ISTDP was significantly more efficacious than control conditions (d = 1.18; general psychopathology measures). Study quality was highly variable, and there was significant heterogeneity in some analyses. Eight studies using various measures suggested ISTDP was cost-effective. Within limitations of study methodologies, this evidence supports the application of ISTDP across a broad range of populations. Further rigorous and targeted research into this method is warranted.
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Affiliation(s)
- Allan Abbass
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Centre for Emotions and Health, Dalhousie, Nova Scotia, Canada.
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Smith JD. A tapestry of red thread and emotional blueprints: Poetic feeling in brief dynamic therapy. PSYCHODYNAMIC PRACTICE 2012. [DOI: 10.1080/14753634.2012.640162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Town JM, Abbass A, Hardy G. Short-Term Psychodynamic Psychotherapy for personality disorders: a critical review of randomized controlled trials. J Pers Disord 2011; 25:723-40. [PMID: 22217220 DOI: 10.1521/pedi.2011.25.6.723] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The research evidence for Short-Term Psychodynamic Psychotherapy (STPP) in the treatment of personality disorders (PD) was examined through consideration of studies utilizing randomized controlled designs. An extensive literature search revealed eight published Randomized Controlled Trials (RCT) of moderate study quality. A critical review of this literature is offered to provide an evidence-based guidance for clinicians and implications for treatments are discussed. Preliminary conclusions suggest STPP may be considered an efficacious empirically-supported treatment option for a range of PDs, producing significant and medium to long-term improvements for a large percentage of patients. Further research is recommended to allow comparisons with alternative evidence-based approaches.
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Affiliation(s)
- Joel M Town
- Dalhousie University Department of Psychiatry, Canada.
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Bradshaw W, Roseborough D, Pahwa R, Jordan J. Evaluation of psychodynamic psychotherapy in a community mental health center. ACTA ACUST UNITED AC 2009; 37:665-81. [PMID: 20001199 DOI: 10.1521/jaap.2009.37.4.665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study describes an evaluation of the effectiveness of psychodynamic psychotherapy provided in an outpatient community mental health clinic. The study used a single group pretest-posttest design involving 78 clients. Clinical outcomes included overall psychosocial functioning and quality of life, level of subjective distress, interpersonal functioning and role functioning, measured by the Outcome Questionnaire (Lambert, Hansen, Umpress, Lunnen Okilshi, & Burlingame, 2000). Clients showed statistically significant improvement from pretest (first sessions) to completion of treatment in overall functioning, and quality of life, level of subjective distress, interpersonal functioning and role functioning. Eighty-five percent of clients made statistically and clinically significant change. Calculation of effect sizes for each outcome found moderate to strong change effects ranging from d = .4 to .9. The study illustrates a method of intervention research that therapists and agencies can use to integrate practical evaluation methods into their clinical services in order to improve mental health service to clients, to demonstrate the effectiveness of interventions, and to provide data to support coverage for needed services for clients.
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Affiliation(s)
- William Bradshaw
- College of Social Work, University of Tennessee Knoxville, Knoxville, TN 37966-3333, USA.
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Abstract
The goal of the current review is to examine the evidence for the efficacy of dynamic psychotherapy, primarily focusing on studies that meet the rigorous criteria proposed by Chambless & Hollon (1998). We examine whether any progress has been made over the past decade in evaluating the efficacy of dynamic psychotherapy using well-controlled randomized designs. Over the past decade, multiple studies have been published supporting the efficacy of dynamic psychotherapy for the treatment of specific mental disorders. Dynamic psychotherapy should now be included as a possibly efficacious treatment for panic disorder and borderline personality disorder, as well as the original designation of possibly efficacious in the treatment of opiate dependence. In the context of medication usage, dynamic psychotherapy should be considered efficacious in the treatment of major depressive disorder (MDD). Studies suggest that dynamic psychotherapy has great promise as a monotherapy for MDD and alcohol dependence and thus should be evaluated further.
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Intensive short-term dynamic psychotherapy for DSM-IV personality disorders: a randomized controlled trial. J Nerv Ment Dis 2008; 196:211-6. [PMID: 18340256 DOI: 10.1097/nmd.0b013e3181662ff0] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study evaluated the efficacy and long-term effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with DSM-IV personality disorders (PD). Twenty-seven patients with PD were randomized to treatment with ISTDP or a minimal-contact, delayed-treatment control condition. ISTDP-treated patients improved significantly more than controls on all primary outcome indices, reaching the normal ranges on both the brief symptom inventory (1.51-0.51, p < 0.001) and inventory of interpersonal problems (1.56-0.67, p < 0.001). When control patients were treated, they experienced benefits similar to the initial treatment group. In long-term follow-up, the whole group maintained their gains and had an 83.3% reduction of personality disorder diagnoses. Treatment costs were thrice offset by reductions in medication and disability payments. This preliminary study of ISTDP suggests it is efficacious and cost-effective in the treatment of PD. Limitations of this study and suggestions for future research are discussed.
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Rickinson B. Evaluating the effectiveness of counselling intervention with final year undergraduates. COUNSELLING PSYCHOLOGY QUARTERLY 2007. [DOI: 10.1080/09515079708254179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abbass AA. Intensive Short-Term Dynamic Psychotherapy of treatment-resistant depression: a pilot study. Depress Anxiety 2007; 23:449-52. [PMID: 16845654 DOI: 10.1002/da.20203] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This pilot study examined the effectiveness of Intensive Short-term Dynamic Psychotherapy (ISTDP) in treatment-resistant depression (TRD). Ten patients with TRD were provided a course of ISTDP. Clinician and patient symptom and interpersonal measures were completed every 4 weeks, at termination, and in follow-up. Medication, disability, and hospital costs were compared before and after treatment. After an average of 13.6 sessions of therapy, all mean measures reached the normal range, with effect sizes ranging from 0.87 to 3.3. Gains were maintained in follow-up assessments. Treatment costs were offset by cost reductions elsewhere in the system. This open study suggests that ISTDP may be effective with this challenging patient group. A randomized, controlled trial and qualitative research are warranted to evaluate this treatment further and to examine its possible therapeutic elements.
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Verheul R, Herbrink M. The efficacy of various modalities of psychotherapy for personality disorders: a systematic review of the evidence and clinical recommendations. Int Rev Psychiatry 2007; 19:25-38. [PMID: 17365156 DOI: 10.1080/09540260601095399] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The aim of this paper is to review the level of empirical evidence for four different formats and settings that are available for psychotherapy delivery, i.e., group psychotherapy, out-patient individual psychotherapy, day hospital psychotherapy, and in-patient psychotherapy. The focus is on studies which include a wide range of DSM-IV-TR Axis II personality disorders. The results show that various psychotherapeutic treatments have proven to be efficacious with respect to reducing symptomatology and personality pathology, and improving social functioning in patients with Cluster A, B, C, or not-otherwise-specified personality disorders. This is especially true for cognitive-behaviorally or psychodynamically oriented out-patient individual psychotherapies. However, some evidence indicates that this also applies to (1) long-term, psychodynamically oriented group psychotherapy, (2) short-term, psychodynamically oriented psychotherapy in a day hospital setting, and (3) various duration variants of psychodynamically oriented, in-patient psychotherapy programmes. The available evidence mostly applies to borderline, dependent, avoidant and not-otherwise-specified personality disorder, and perhaps also paranoid, obsessive-compulsive, and schizotypal personality disorder. It is unknown whether these conclusions also apply to schizoid, antisocial, narcissistic, and histrionic personality disorder.
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Affiliation(s)
- Roel Verheul
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
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Abbass AA, Hancock JT, Henderson J, Kisely S. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Syst Rev 2006:CD004687. [PMID: 17054212 DOI: 10.1002/14651858.cd004687.pub3] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Over the past 40 years, short-term psychodynamic psychotherapies (STPP) for a broad range of psychological and somatic disorders have been developed and studied. Four published meta-analyses of STPP, using different methods and samples, have found conflicting results. OBJECTIVES This review evaluated the efficacy of STPP relative to minimal treatment and non-treatment controls for adults with common mental disorders. SEARCH STRATEGY We searched CCDANCTR-Studies and CCDANCTR-References on 25/4/2005, CENTRAL, MEDLINE, CINAHL, EMBASE, PsycINFO, DARE and Biological Abstracts were also searched. We contacted triallists and checked references from papers retrieved. SELECTION CRITERIA All randomised controlled trials (RCT) of adults with common mental disorders, in which a brief psychodynamic therapy lasting less than 40 hours in total, and provided in individual format, were included. DATA COLLECTION AND ANALYSIS Three reviewers working in pairs evaluated studies. Studies were selected only if pairs of reviewers agreed they met inclusion criteria. A third reviewer was consulted if two reviewers could not reach consensus. Data were collected and entered into Review Manager. Study quality was assessed and scored by pairs of raters. Publication bias was assessed using a funnel plot. Sensitivity analyses were also conducted. MAIN RESULTS 23 studies of 1431 randomised patients with common mental disorders were included. These studies evaluated STPP for general, somatic, anxiety, and depressive symptom reduction, as well as social adjustment. Outcomes for most categories of disorder suggested significantly greater improvement in the treatment versus the control groups, which were generally maintained in medium and long term follow-up. However, only a small number of studies contributed data for each category of disorder, there was significant heterogeneity between studies, and results were not always maintained in sensitivity analyses. AUTHORS' CONCLUSIONS STPP shows promise, with modest to moderate, often sustained gains for a variety of patients. However, given the limited data and heterogeneity between studies, these findings should be interpreted with caution. Furthermore, variability in treatment delivery and treatment quality may limit the reliability of estimates of effect for STPP. Larger studies of higher quality and with specific diagnoses are warranted.
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Affiliation(s)
- A A Abbass
- Dalhousie University, Psychiatry, Suite 9215, 5909 Veterans Memorial Lane, Halifax, NS, Canada.
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Leichsenring F, Rabung S. CHANGE NORMS: A COMPLEMENTARY APPROACH TO THE ISSUE OF CONTROL GROUPS IN PSYCHOTHERAPY OUTCOME RESEARCH. Psychother Res 2006. [DOI: 10.1080/10503300600805217] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Emmelkamp PMG, Benner A, Kuipers A, Feiertag GA, Koster HC, van Apeldoorn FJ. Comparison of brief dynamic and cognitive-behavioural therapies in avoidant personality disorder. Br J Psychiatry 2006; 189:60-4. [PMID: 16816307 DOI: 10.1192/bjp.bp.105.012153] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is a paucity of controlled trials examining the effectiveness of individual psychotherapy in personality disorders, especially in patients with cluster C disorders. AIMS To compare the effectiveness of brief dynamic therapy and cognitive-behavioural therapy as out-patient treatment for people with avoidant personality disorder. METHOD Patients who met the criteria for avoidant personality disorder (n=62) were randomly assigned to 20 weekly sessions of either brief dynamic therapy (n = 23) or cognitive-behavioural therapy (n=21), or they were assigned to the waiting-list control group (n = 18). After the waiting period, patients in the control group were randomly assigned to one of the two therapies. RESULTS Patients who received cognitive-behavioural therapy showed significantly more improvements on a number of measures in comparison with those who had brief dynamic psychotherapy or were in the waiting-list control group. Results were maintained at follow-up. CONCLUSIONS Cognitive-behavioural therapy is more effective than waiting-list control and brief dynamic therapy. Brief dynamic therapy was no better than the waiting-list control condition.
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Affiliation(s)
- Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, Roetersstraat 15, 1018 WB Amsterdam, The Netherlands.
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Greenberg LS, Pascual-Leone A. Emotion in psychotherapy: A practice-friendly research review. J Clin Psychol 2006; 62:611-30. [PMID: 16523500 DOI: 10.1002/jclp.20252] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This article reviews the process and outcome research on emotion in psychotherapy. Four distinct types of emotion processes are identified in the literature as useful in therapy, depending on a client's presenting concerns: emotional awareness and arousal; emotional regulation, active reflection on emotion (meaning making), and emotional transformation. Research findings are summarized to highlight the practical implications of these different emotion processes to psychotherapy. A range of selected treatments from different therapeutic orientations are addressed collectively as different types of emotion-focused, experiential therapies and are compared on the basis of how they work with emotion in session.
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Abstract
There is an extensive body of research that documents the importance of social support as an independent factor in physical health and longevity. This article reviews published research that addresses the effects of psychotherapy on social connection and social support. The assumption of most psychotherapists that psychotherapy generally improves social connection is unsupported by research data except in very specific diagnostic categories. Evidence that otherwise beneficial psychotherapy can inadvertently damage social connections is also considered. The implications of these findings for further research and current practice are discussed.
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Affiliation(s)
- Richard S Schwartz
- Department of Psychiatry, Harvard Medical School; McLean Hospital, Belmont, MA 02140, USA.
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Fonagy P, Roth A, Higgitt A. The outcome of psychodynamic psychotherapy for psychological disorders. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.cnr.2005.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
This article is based on an exhaustive review of the psychotherapy outcomes literature, undertaken originally at the instigation of the UK Department of Health by Roth and Fonagy (Department of Health, 1995). We have recently updated this review (Fonagy, Target, Cottrell, Phillips, & Kurtz, 2002; Roth & Fonagy, 2004) and extended it to identify all studies of psychoanalytic psychotherapy. The usual methods for identifying studies were employed (Fonagy, Target, et al., 2002; Roth & Fonagy, in press). The key questions that should be asked of this literature given the current state of research in this area (also see Westen, Morrison, & Thompson-Brenner, 2004) are: Are there any disorders for which short-term psychodynamic psychotherapy (STPP) can be considered evidence-based, Are there any disorders for which STPP is uniquely effective as either the only evidence-based treatment or as a treatment that is more effective than alternatives, and Is there any evidence base for long-term psychodynamic psychotherapy (LTPP) either in terms of achieving effects not normally associated with short-term treatment or addressing problems that have not been addressed by STPP? In this context, short-term therapy is conceived of as a treatment of around 20 sessions delivered usually once weekly.
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Affiliation(s)
- Peter Fonagy
- Psychoanalysis, University College London; The Anna Freud Centre, London, UK.
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McCullough L, Osborn KAR. Short term dynamic psychotherapy goes to Hollywood: The treatment of performance anxiety in cinema. J Clin Psychol 2004; 60:841-52. [PMID: 15241812 DOI: 10.1002/jclp.20042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This article uses characters in popular films to demonstrate the theory and application of short term dynamic psychotherapy (STDP) in the treatment of performance anxiety. The reader is taught to identify affect phobias that are hypothesized to underlie performance anxiety. Similar in function to external phobias, affect phobias or internal phobias involve the avoidance of feelings (e.g., fear about feeling anger, shame about showing grief, pain about closeness), which thwarts adaptive responding and generates numerous behavioral problems. STDP treatment focuses on the restructuring of defenses, conflicted affects, and attachments. The resolution of the affect phobia requires systematic desensitization of affective responses (i.e., exposure and desensitization of underlying conflicted feelings). When patients learn to access adaptive forms of feelings, performance anxiety can often be resolved.
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Barker-Collo SL. Culture and validity of the Symptom Checklist-90-Revised and Profile of Mood States in a New Zealand student sample. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2003; 9:185-96. [PMID: 12760329 DOI: 10.1037/1099-9809.9.2.185] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
New Zealand students' performance was examined on assessments of psychopathology and mood as compared to normative data from the United States. New Zealand university students (N = 137) completed the Symptom Checklist-90-Revised (SCL-90-R) and Profile of Mood States (POMS). Mean performances differed significantly from normative data for each SCL-90-R scale. No significant differences were found for the POMS scales. Within the sample, European (n = 82), Maori (n = 24), and Asian (n = 24) participants differed significantly on SCL-90-R obsessive-compulsive, phobic anxiety, and anxiety scales and POMS scales of tension and confusion. Implications for assessment of New Zealand samples are discussed.
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Affiliation(s)
- Suzanne L Barker-Collo
- Department of Psychology, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Leichsenring F. [The effectiveness of psychodynamic therapy. A review using criteria of evidence-based medicine]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2002; 48:139-62. [PMID: 11992325 DOI: 10.13109/zptm.2002.48.2.139] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The existing studies on the effectiveness of psychodynamic therapy are reviewed. All studies published between 1960 and 2001 were collected. In the first part of this survey, the focus is on short-term psychodynamic therapy, the second part focuses on longer-term psychoanalytic and psychodynamic therapy. The studies are reviewed with regard to forms of disorders. The methodological quality of the studies is judged according to criteria of evidence-based medicine. These criteria themselves are also critically discussed. Although they vary concerning their methodological quality, the studies reveal evidence of the effectiveness of both short-term and long-term psychodynamic therapy. In a meta-analytic evaluation performed by the author, substantial effects were found for psychodynamic therapy of personality disorders, i.e. 1.13 (self-report measures) and 1.57 (observer-rated measures) for short-term psychodynamic therapy and 1.05 (self-report measures) and 2.11 (observer-rated measures) for longer term psychodynamic therapy. Although there is evidence of the effectiveness of psychodynamic therapy, further research of specific forms of psychodynamic therapy in specific disorders is necessary.
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Affiliation(s)
- Falk Leichsenring
- Klinik für Psychosomatik und Psychotherapie, Von-Siebold-Str. 5, D-37075 Göttingen, Germany.
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Bernier A, Dozier M. The client-counselor match and the corrective emotional experience: Evidence from interpersonal and attachment research. ACTA ACUST UNITED AC 2002. [DOI: 10.1037/0033-3204.39.1.32] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
The authors argue for an integrated model of brief psychotherapy that includes psychoanalytic and cognitive-behavioral approaches, as well as pharmacotherapy when necessary. The use of such a model gives the clinician the opportunity to tailor the treatment to the individual patient using differential therapeutics. In implementing a differential therapeutic approach, dynamic psychotherapy can be conceptualized using a health-sickness or psychopathology continuum, which is then superimposed upon a psychotherapy continuum ranging from expressive to supportive interventions. The use of such a psychotherapy continuum helps clinicians tailor the treatment approach to the specific patient. The authors first review psychotherapy outcome studies from the last two decades that suggest that an integrated approach may be advantageous. They then present findings from process studies that highlight the importance of the patient/therapist relationship. In the final sections of the article, the authors discuss how to use an integrated approach to brief psychotherapy, including the use of medication when appropriate. The authors also discuss the use of trial therapy during the initial session to help the therapist determine whether a supportive or expressive approach will be most appropriate for the individual patient and present two case vignettes illustrating the expressive and supportive approaches to trial therapy.
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Affiliation(s)
- A Winston
- Department of Psychiatry, Beth Israel Medical Center and Albert Einstein College of Medicine, New York, NY 10003, USA
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McCullough L, Andrews S. Assimilative integration: Short-term dynamic psychotherapy for treating affect phobias. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2001. [DOI: 10.1093/clipsy.8.1.82] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Shadish WR, Matt GE, Navarro AM, Phillips G. The effects of psychological therapies under clinically representative conditions: a meta-analysis. Psychol Bull 2000; 126:512-29. [PMID: 10900994 DOI: 10.1037/0033-2909.126.4.512] [Citation(s) in RCA: 165] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recently, concern has arisen that meta-analyses overestimate the effects of psychological therapies and that those therapies may not work under clinically representative conditions. This meta-analysis of 90 studies found that therapies are effective over a range of clinical representativeness. The projected effects of an ideal study of clinically representative therapy are similar to effect sizes in past meta-analyses. Effects increase with larger dose and when outcome measures are specific to treatment. Some clinically representative studies used self-selected treatment clients who were more distressed than available controls, and these quasi-experiments underestimated therapy effects. This study illustrates the joint use of fixed and random effects models, use of pretest effect sizes to study selection bias in quasi-experiments, and use of regression analysis to project results to an ideal study in the spirit of response surface modeling.
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Affiliation(s)
- W R Shadish
- Department of Psychology, University of Memphis, Tennessee 38152-6400, USA.
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Langfitt JT, Wood BL, Brand KL, Brand J, Erba G. Family Interactions as Targets for Intervention to Improve Social Adjustment After Epilepsy Surgery. Epilepsia 1999; 40:735-44. [PMID: 10368071 DOI: 10.1111/j.1528-1157.1999.tb00771.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To identify family interactions associated with psychosocial outcome of epilepsy surgery, to design interventions to improve patient outcome. METHODS A cross-sectional, case series study of relations among observed family behavior and psychosocial outcome of 43 patients after temporal lobectomy. Videotaped family behavior during family discussion tasks was rated for predominant family affect, affective range, and support of patient autonomy. Multiple regression analyses tested the relation of observed family characteristics to outcomes, controlling for seizure control and other psychological and disease characteristics. RESULTS Predominant family affect predicted patients' social adjustment independent of postoperative seizure status and other disease characteristics. The relation between predominant affect and social adjustment was stronger among patients with persisting complex partial seizures (CPSs; r = -0.91), versus patients with auras (r = -0.38) and seizure-free patients (r = -0.28; multiple R = 0.71; p < 0.05). Families with a positive affective climate supported patients' autonomy. CONCLUSIONS Two potential targets were identified for family intervention to improve postsurgical social adjustment: (a) family interactions that support a predominantly positive affective climate, and (b) family interactions that support patient autonomy. These findings are consistent with findings in normal and other clinical populations. They identify specific interactions that give rise to positive versus negative affective climate and support versus undermining of autonomy. These results lay the groundwork for intervention studies targeting these specific family interactions. Such intervention studies would clarify the direction of effect of the observed relationships and would test the efficacy of family intervention for improving psychosocial outcomes for patients with epilepsy.
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Affiliation(s)
- J T Langfitt
- Department of Neurology, University of Rochester School of Medicine, New York 14642, USA
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Sanislow CA, McGlashan TH. Treatment outcome of personality disorders. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1998; 43:237-50. [PMID: 9561312 DOI: 10.1177/070674379804300302] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the treatment outcome of personality disorders. METHOD A literature search of studies pertaining to personality disorder and outcome was conducted, and studies that focused primarily on Axis II were retained. Of these, naturalistic outcome studies were distinguished from those that addressed treatment outcome specifically. The treatment outcome studies were examined in terms of type of treatment intervention, dependent variables, and outcome. RESULTS Contrary to contemporary assumptions about Axis II, a substantial number of treatment outcome studies were identified. Trends in the assumptions underlying psychosocial and pharmacologic approaches were identified on the basis of dependent variables. CONCLUSION There is evidence that effective treatments exist to alleviate symptoms and reduce symptomatic behaviours that accompany personality disorders. What these results hold for the idea of remission from personality disorder is considered.
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Affiliation(s)
- C A Sanislow
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06520-8038, USA.
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Abstract
O presente estudo visou levantar a produção científica referente à Psicoterapia do idoso, classificando-a em 06 dimensões de análise: países relacionados à pesquisa na área, os periódicos de indexação, os temas estudados, a abordagem utilizada, a modalidade de produção cientifica e os objetivos visados pelas pesquisas. O material analisado foi composto de 108 resumos de artigos de periódicos indexados ao PSYCHOLOGICAL ABSTRACTS (1990-1996), utilizando-se a base de dados PSYCLIT, com os verbetes de acesso: psychotherapy, brief psychotherapy, and: elderly, aging, geriatric, gerontology. Os resultados são discutidos em termos das dimensões propostas, levantando-se as tendências mais marcantes da produção nesse período e fazendo-se sugestões para o acúmulo de conhecimentos na área.
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Diversification and consultation: Designing a private group psychological practice in the age of health care reform. COGNITIVE AND BEHAVIORAL PRACTICE 1995. [DOI: 10.1016/s1077-7229(95)80018-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Monsen J, Odland T, Faugli A, Daae E, Eilertsen DE. Personality disorders and psychosocial changes after intensive psychotherapy: a prospective follow-up study of an outpatient psychotherapy project, 5 years after end of treatment. Scand J Psychol 1995; 36:256-68. [PMID: 7481598 DOI: 10.1111/j.1467-9450.1995.tb00985.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This report presents the results of a 7-year prospective outcome study designed to examine the psychosocial changes during and after therapy among 25 outpatients suffering from personality disorders and psychoses. The therapeutic approach was based mainly on object relations theory and psychodynamic self-psychology, and focused in particular on affect consciousness, parental images, self-image and interpersonal relations. Twenty patients completed the form which measured psychosocial changes during therapy, and 21 persons participated at follow-up. The data show statistically significant changes in the capacity to tolerate intimate relationships and actually establish such relationships, improved quality of contact in relationships with friends, a general raising of socioeconomic status and reduced use of ordinary health and social services. Both the global psychosocial outcome at follow-up as measured by HSRS and the general level of symptoms measured by SCL-90 suggest that 76% of the sample had reached a level of psychosocial functioning and adaptation that can be defined as "no-caseness".
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Affiliation(s)
- J Monsen
- Department of Psychology, University of Oslo, Norway
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Winston A, Pollack J. Brief Adaptive Psychotherapy. Psychiatr Ann 1991. [DOI: 10.3928/0048-5713-19910701-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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