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Laurila M, Lindfors O, Knekt P, Heinonen E. The effect of individual short- and long-term psychotherapy on perceived social support: analysis of secondary outcomes of a randomized clinical trial. Nord J Psychiatry 2024; 78:230-237. [PMID: 38323800 DOI: 10.1080/08039488.2024.2306229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Social support is important for maintaining and restoring psychological well-being but the effects of individual psychotherapies on perceived social support are not well known. In this analysis of secondary outcomes from a randomized clinical study, we compared the effects of long-term psychotherapy and two short-term psychotherapies on social support during a 5-year follow-up. MATERIALS AND METHODS Altogether 326 adult outpatients suffering from depressive and/or anxiety disorders were randomly assigned to long-term psychodynamic psychotherapy (LPP, n = 126), short-term psychodynamic psychotherapy (SPP, n = 101) and solution-focused therapy (SFT, n = 97). Outcome was measured by the global index and six subscores of the self-reported Brief Inventory of Social Support and Integration scale (BISSI) at baseline and at 1, 2, 3, 4 and 5 years after the beginning of the therapy. RESULTS Social support improved in all therapy groups and the improvement was relatively stable, lasting several years after the end of therapy. Little difference in improvement was observed either between therapy orientations or durations. CONCLUSIONS While no major differences were observed between treatment groups, the slight differences call for further research to verify these findings and to better understand how different therapies may improve perceived social support.
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Affiliation(s)
- Matias Laurila
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Olavi Lindfors
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Paul Knekt
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Heinonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- University of Oslo, Oslo, Norway
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2
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Heinonen E, Knekt P, Lindfors O. What Works for Whom: Patients' Psychological Resources and Vulnerabilities as Common and Specific Predictors of Working Alliance in Different Psychotherapies. Front Psychiatry 2022; 13:848408. [PMID: 35865305 PMCID: PMC9294449 DOI: 10.3389/fpsyt.2022.848408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Across different types of psychotherapy, one of the most robust predictors of better therapeutic outcomes is a good working alliance between patient and therapist. Yet there is little comparative research on whether particular patients more likely achieve a better alliance in certain treatments which represent particular therapeutic approaches or durations. Methods 326 patients suffering from depressive and/or anxiety disorder were randomized into two short-term (solution-focused or psychodynamic) and one long-term (psychodynamic) therapy models. Treatments lasted ~7 and 36 months, respectively. Before randomization, patients were assessed with the interview-based Suitability for Psychotherapy Scale and filled Childhood Family Atmosphere and Life Orientation Test questionnaires. Patients filled Working Alliance Inventory after 3rd therapy session and at end of treatment; the long-term therapy patients, additionally, at 7 months' time point. Linear regression models were used. Results Greater psychological resources (e.g., capacity for self-reflection, affect regulation, flexible interaction) had little effect on alliance during the course of the short-term therapies. However, they did predict better working alliances at end of long-term as opposed to short-term therapy. Childhood adversities impacted alliances already at 7 months. Conclusions Although patients with certain qualities achieve better alliances in long-term as opposed to short-term therapies, apparently the theoretical orientation of therapy makes little difference. For patients with childhood adversities, differences between long-term (psychodynamic) treatment vs. various brief therapy models may be particularly salient.
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Affiliation(s)
- Erkki Heinonen
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Paul Knekt
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Olavi Lindfors
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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3
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Stenius J, Heinonen E, Lindfors O, Holma J, Knekt P. Ego Impairment Index (EII-2) as a predictor of outcome in short- and long-term psychotherapy during a 5-year follow-up. J Clin Psychol 2022; 78:1739-1751. [PMID: 35226756 PMCID: PMC9543424 DOI: 10.1002/jclp.23332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 01/19/2022] [Accepted: 02/11/2022] [Indexed: 11/22/2022]
Abstract
Objective This study examined the predictive ability of the Rorschach‐based Ego Impairment Index (EII‐2) on outcome of psychotherapy in different types and durations of therapy. Method A total of 326 outpatients suffering from depressive or anxiety disorders were randomized into receiving solution‐focused (n = 97), short‐term psychodynamic (n = 101), or long‐term psychodynamic psychotherapy (n = 128). Psychotherapy outcome assessments during the 5‐year follow‐up period covered psychiatric symptoms, social functioning, and work ability. Results Lower EII‐2 values, which indicate less problematic ego functioning, were found to predict faster improvement in both short‐term therapies as compared to long‐term psychotherapy. Conclusion The results provide preliminary support for the utility of EII‐2 as a complementary measure to interview‐based methods for selecting between short‐ and long‐term therapies.
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Affiliation(s)
- Jaakko Stenius
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.,Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Erkki Heinonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Olavi Lindfors
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Juha Holma
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Paul Knekt
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Lindfors O. What patient characteristics predict treatment success or failure in short- and long-term psychotherapies? Nord J Psychiatry 2021; 75:S2. [PMID: 35287540 DOI: 10.1080/08039488.2021.2019902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patient factors make a strong contribution to psychotherapy outcome. Pre-treatment patient characteristics - demographic, pathology and personal - may either facilitate achievement of recovery and lasting benefits or constitute a risk for different kinds of treatment failure. METHODS A narrative review focused on evaluating the role of pre-treatment patient characteristics on the success or failure of short- and long-term psychotherapy for mood and anxiety disorders. Success was conceptualized as significant improvement or recovery and failure as non-improvement, deterioration, or non-attendance/dropout. RESULTS There is no consistent evidence of demographic variables as predictors of treatment failure, except for lower socioeconomic status, being male and ethnic minority status for therapy non-attendance. Patients' pathology, i.e. severity of psychiatric symptoms, greater functional impairment, personality disorder and other comorbidities, have been shown to be mostly associated with lesser recovery across different types of disorders, especially in short-term therapies, but it does not consistently predict treatment failure. Some pre-treatment personal characteristics (e.g. secure attachment style) and capacities (e.g. motivation, self-observing capacity and good overall psychological suitability) mostly increase the likelihood of therapy success whereas some vulnerabilities and poor psychological suitability, or overall complexity (i.e. combination of demographic, clinical and personality factors), increase the risk of poor outcome mostly in short-term but not in long-term therapy, or moderate dropout. Likewise, the subsequent match between therapy type and patient's pre-treatment expectations and preferences may account for different aspects of treatment failure. CONCLUSIONS The relative importance of pre-treatment patient characteristics on treatment failure is not known. Meta-analyses on this issue are needed.
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Knekt P, Grandell L, Sares-Jäske L, Lindfors O. Poor suitability for psychotherapy - a risk factor for treatment non-attendance? J Affect Disord 2021; 295:1432-1439. [PMID: 34583841 DOI: 10.1016/j.jad.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/30/2021] [Accepted: 09/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Patient suitability has been suggested to predict treatment non-attendance but information on its effect is limited. AIM To study the prediction of the Suitability for Psychotherapy Scale (SPS), on occurrence of treatment non-attendance. METHODS Altogether 326 outpatients, with depressive or anxiety disorder, were randomized to short-term psychodynamic psychotherapy (SPP), long-term psychodynamic psychotherapy (LPP), and solution-focused therapy (SFT). SPS was based on seven components from three suitability domains: nature of problems, ego strength, and self-observing capacity. Treatment non-attendance was defined as refusal of engaging therapy and of premature termination. The Cox model and logistic regression were used. RESULTS Treatment non-attendance was significantly more common in LPP patients with poor SPS (RR = 2.76, 95% CI = 1.45-5.26). This was mainly due to poor flexibility of interaction, poor self-concept, and poor reflective ability. Premature termination in SFT showed a similar trend but due to other SPS components: absence of a circumscribed problem, poor modulation of affects, and poor response to trial interpretation. On the contrary, individuals with good values of SPS were more prone to premature termination in SPP. LIMITATIONS The prediction of suitability on refusal could only be studied in the LPP group due to few refusals in the short-term therapy groups. The sample consisted of patients who participated in a trial. Thus the findings may not be directly generalized to unselected patients in the public mental health setting. CONCLUSIONS Poor suitability, apparently, predicts non-attendance in LPP and SFT, but not in SPP. More studies on large cohorts are needed.
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Affiliation(s)
- Paul Knekt
- Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Leena Grandell
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Olavi Lindfors
- Finnish Institute for Health and Welfare, Helsinki, Finland; University of Helsinki, Department of Psychology and Logopedics, Helsinki, Finland
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Alanne C, Heinonen E, Knekt P, Rissanen J, Virtala E, Lindfors O. Predicting improvement of work ability in modalities of short- and long-term psychotherapy: The differential impact of reflective ability and other aspects of patient suitability. J Clin Psychol 2021; 77:1905-1920. [PMID: 33638220 DOI: 10.1002/jclp.23128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 01/27/2021] [Accepted: 02/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We investigated how patients' psychological capacities to engage in psychotherapy predict changes in work ability in short- and long-term psychotherapy. METHODS A cohort study of 326 patients, aged 20-46 years and suffering from mood and anxiety disorders, treated by short-term solution-focused, short-term psychodynamic, or long-term psychodynamic psychotherapy, followed-up for 5 years. The Suitability for Psychotherapy Scale, assessed at baseline, was the predictor. Outcomes were assessed at baseline and at six follow-up occasions using the Work Ability Index as the primary indicator. RESULTS Patients with good pretreatment psychological suitability for psychotherapy, good reflective ability in particular, improved more than patients with poor suitability in short-term psychodynamic psychotherapy. Comparisons between therapy groups showed poorer suitability to predict more improvement in solution-focused and in long-term psychodynamic psychotherapy than in short-term psychodynamic psychotherapy. CONCLUSION Patients' psychological suitability for psychotherapy has a different impact on work ability in different therapy modalities and durations.
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Affiliation(s)
- Carita Alanne
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Heinonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Knekt
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Julius Rissanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Esa Virtala
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Olavi Lindfors
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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7
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Stenius J, Knekt P, Heinonen E, Holma J, Antikainen R, Lindfors O. Predicting the working alliance over the course of long-term psychodynamic psychotherapy with the Rorschach Ego Impairment Index, self-reported defense style, and performance-based intelligence: An evaluation of three methodological approaches. Psychoanalytic Psychology 2021. [DOI: 10.1037/pap0000318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lindfors O, Keinänen M. Psychoanalytic psychotherapy in Finland. Psychoanalytic Psychotherapy 2020. [DOI: 10.1080/02668734.2020.1836675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Olavi Lindfors
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychology and Logopedia, University of Helsinki, Helsinki, Finland
| | - Matti Keinänen
- Department of Psychiatry, University of Turku, Turku, Finland
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
- Policlinic Toivola, Turku, Finland
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Knekt P, Laaksonen M, Raitasalo R, Haaramo P, Lindfors O. Changes in lifestyle for psychiatric patients three years after the start of short- and long-term psychodynamic psychotherapy and solution-focused therapy. Eur Psychiatry 2020; 25:1-7. [DOI: 10.1016/j.eurpsy.2009.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 03/21/2009] [Indexed: 10/20/2022] Open
Abstract
AbstractObjectivesLifestyle is less favourable among individuals suffering from psychiatric disorders. We studied whether psychotherapy brings along changes in lifestyle and whether these changes differ between short-term and long-term psychodynamic psychotherapy (SPP and LPP) and solution-focused therapy (SFT).MethodsA total of 326 outpatients, 20–46 years of age, with mood or anxiety disorder were randomly assigned to LPP, SPP and SFT. The lifestyle variables considered were alcohol consumption, smoking, body mass index (BMI), leisure time exercise and serum cholesterol. The patients were monitored for three years from the start of treatment.ResultsDuring the three-year follow-up, BMI and serum cholesterol rose statistically significantly although no statistically significant trends were shown for alcohol consumption, smoking or exercise. SPP showed a disadvantage of increased alcohol consumption and serum cholesterol level when compared with LPP. SFT showed an advantage of reduced smoking in comparison with SPP.DiscussionSmall therapy-specific changes in lifestyle may be a result from psychotherapy treatment. These lifestyle changes are apparently more common in short-term therapy. More studies are needed to verify these findings.
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10
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Sares-Jäske L, Knekt P, Männistö S, Lindfors O, Heliövaara M. Self-Report Dieters: Who Are They? Nutrients 2019; 11:nu11081789. [PMID: 31382439 PMCID: PMC6723801 DOI: 10.3390/nu11081789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/31/2022] Open
Abstract
Dieting attempts have become popular worldwide. Dieting, however, seems to have both positive and negative health-related consequences. So far, only a few studies have focused on the determinants of dieting in detail. This study explores the association between self-report dieting attempts and intentional weight loss (IWL) during the previous year and several demographic, lifestyle, health, and psychological factors in a cross-sectional study design using data from the representative Finnish Health 2000 Survey. The sample comprised 2147 men and 2378 women, aged 30–69. Information for potential determinants was assembled via health examinations, interviews, and questionnaires. Approximately 24% of the men and 39% of the women reported dieting attempts and 10% of the men and 15% of the women reported IWL. Dieting attempts were associated with younger age, education, BMI, formerly smoking, more favourable values in lifestyle variables, and unfavorable values in serum HDL and triglycerides, a worse sense of coherence, concerns about one’s appearance, and concerns about one’s health. Among men, diabetics and those sleeping ≤6 h a night more frequently reported dieting attempts and those with osteoarthritis reported IWL. Moreover, the gradient between BMI and dieting attempts was significantly stronger in men than in women. Men seem to attempt dieting when they have actual health-related reasons, while such reasons are not so strongly associated with dieting in women. These findings can be used for determining subpopulations with obesity and real weight-loss needs and, alternatively, subpopulations with normal weight unnecessarily attempting dieting.
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Affiliation(s)
- Laura Sares-Jäske
- Department of Public Health Solutions, National Institute for Health and Welfare, 00271 Helsinki, Finland.
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland.
| | - Paul Knekt
- Department of Public Health Solutions, National Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Satu Männistö
- Department of Public Health Solutions, National Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Olavi Lindfors
- Department of Public Health Solutions, National Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Markku Heliövaara
- Department of Public Health Solutions, National Institute for Health and Welfare, 00271 Helsinki, Finland
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Sares‐Jäske L, Knekt P, Männistö S, Lindfors O, Heliövaara M. Self-report dieting and long-term changes in body mass index and waist circumference. Obes Sci Pract 2019; 5:291-303. [PMID: 31452914 PMCID: PMC6700513 DOI: 10.1002/osp4.336] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE This prospective study explores whether dieting attempts and previous changes in weight predict changes in body mass index (BMI) and waist circumference (WC). METHODS The study was based on the representative Finnish Health 2000 Survey and on its follow-up examination 11 years later. The sample included 2,785 participants, aged 30-69. BMI and WC were determined at health examinations. Information on dieting attempts and previous changes in weight was collected using a questionnaire including questions on whether participant had tried to lose weight (no/yes), gained weight (no/yes) or lost weight (no/yes) during the previous year. RESULTS At baseline, 32.8% were dieters. Of these, 28.4% had lost weight during the previous year. Dieters had higher BMI and WC than non-dieters. During the follow-up, the measures increased more in dieters and in persons with previous weight loss. The mean BMI changes in non-dieters versus dieters were 0.74 (standard deviation [SD] 2.13) kg/m2 and 1.06 (SD 2.77) kg/m2 (P = 0.002), respectively. The corresponding numbers for those with no previous weight change versus those who had lost weight were 0.65 (SD 2.07) kg/m2 and 1.52 (SD 2.61) kg/m2. The increases in BMI and WC were most notable in dieters with initially normal weight. CONCLUSIONS The increases in BMI and WC were greater in dieters than in non-dieters, suggesting dieting attempts to be non-functional in the long term in the general population.
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Affiliation(s)
- L. Sares‐Jäske
- Department of Public Health SolutionsNational Institute for Health and WelfareHelsinkiFinland
- Department of Public HealthUniversity of HelsinkiHelsinkiFinland
| | - P. Knekt
- Department of Public Health SolutionsNational Institute for Health and WelfareHelsinkiFinland
| | - S. Männistö
- Department of Public Health SolutionsNational Institute for Health and WelfareHelsinkiFinland
| | - O. Lindfors
- Department of Public Health SolutionsNational Institute for Health and WelfareHelsinkiFinland
| | - M. Heliövaara
- Department of Public Health SolutionsNational Institute for Health and WelfareHelsinkiFinland
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Lindfors O, Knekt P, Lehtonen J, Virtala E, Maljanen T, Härkänen T. Effectiveness of psychoanalysis and long-term psychodynamic psychotherapy on personality and social functioning 10 years after start of treatment. Psychiatry Res 2019; 272:774-783. [PMID: 30832198 DOI: 10.1016/j.psychres.2018.12.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/30/2018] [Accepted: 12/16/2018] [Indexed: 11/18/2022]
Abstract
The evidence on potentially greater benefits of psychoanalysis (PA) vs. long-term psychodynamic psychotherapy (LPP) is scarce. This study compared the effectiveness of PA and LPP on personality and social functioning during a 10-year follow-up from the beginning of the treatments. The eligible patients, 41 self-selected for PA and 128 assigned to LPP, were 20-45 years of age and had anxiety or mood disorder. Outcomes were analyzed using ten standard measures of personality and social functioning, carried out 5-9 times during the follow-up. Different change patterns by time in PA and LPP emerged, suggesting less benefit of PA during the first years of follow-up and more benefit in most outcomes thereafter. Greater post-treatment improvement in PA than in LPP was seen up to 1-2 years after PA had ended in more mature defense style (DSQ), level of personality organization (LPO), more positive self-concept (SASB), more improved social adjustment (SAS-SR) and sense of coherence (SOC). However, at the 10-year follow-up the differences were non-significant. In conclusion, PA may give some additional benefits when long-term aims are linked to personality and social functioning. The relatively small differences and higher costs in comparison to LPP may restrict the feasibility of PA.
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Affiliation(s)
- Olavi Lindfors
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland; University of Helsinki, Helsinki, Finland.
| | - Paul Knekt
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland
| | - Johannes Lehtonen
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland; University of Eastern Finland, Kuopio, Finland
| | - Esa Virtala
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland
| | - Timo Maljanen
- The Social Insurance Institution, Helsinki, Finland; National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland
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13
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Sares-Jäske L, Knekt P, Männistö S, Lindfors O, Heliövaara M. Self-report dieters – who are they? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- L Sares-Jäske
- National Institute for Health and Welfare, Finland, Helsinki, Finland
| | - P Knekt
- National Institute for Health and Welfare, Finland, Helsinki, Finland
| | - S Männistö
- National Institute for Health and Welfare, Finland, Helsinki, Finland
| | - O Lindfors
- National Institute for Health and Welfare, Finland, Helsinki, Finland
| | - M Heliövaara
- National Institute for Health and Welfare, Finland, Helsinki, Finland
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14
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Heinonen E, Knekt P, Härkänen T, Virtala E, Lindfors O. Childhood adversities as predictors of improvement in psychiatric symptoms and global functioning in solution-focused and short- and long-term psychodynamic psychotherapy during a 5-year follow-up. J Affect Disord 2018; 235:525-534. [PMID: 29689505 DOI: 10.1016/j.jad.2018.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/15/2018] [Accepted: 04/04/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Childhood adversities are frequent among adults who seek treatment for depression or anxiety. These disorders are commonly treated by psychotherapy. Yet it is not known if specific types or durations of psychotherapy are particularly suited for patients who have suffered various early adversities. METHODS 221 depressed and anxious adult outpatients from community, student, occupational, and private healthcare services filled the Childhood Family Atmosphere Questionnaire. They were randomly assigned to short- (solution-focused or psychodynamic) or long-term (psychodynamic) psychotherapy. Outcome was assessed via patient questionnaires and clinician interviews of psychiatric symptoms and global functioning during a 5-year follow-up. Linear regression analyses were conducted. RESULTS Less separations from caregivers expectedly predicted better outcomes in all therapies; unexpectedly, so did greater abuse. Family unhappiness and parental problems predicted faster or greater improvement when patients were assigned to a short- or long-term psychodynamic therapy model. LIMITATIONS As patients with psychotic, substance abuse, and severe personality disorders were screened out, findings might not generalize to these patient groups. CONCLUSIONS Patients with certain childhood adversities appear to respond with faster or greater improvement when the psychotherapy model is explicitly focused on working through the potential connections between past and current problems. If confirmed by in-depth studies, the findings may help match psychotherapeutic models with given patient complaints, as well as fine-tune different psychosocial interventions to individual needs for optimizing treatment outcomes.
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Affiliation(s)
| | - Paul Knekt
- National Institute for Health and Welfare, Finland
| | | | - Esa Virtala
- National Institute for Health and Welfare, Finland
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15
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Heinonen E, Knekt P, Härkänen T, Virtala E, Lindfors O. Associations of early childhood adversities with mental disorders, psychological functioning, and suitability for psychotherapy in adulthood. Psychiatry Res 2018; 264:366-373. [PMID: 29677619 DOI: 10.1016/j.psychres.2018.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 04/01/2018] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
Abstract
Childhood adversities frequently precede adulthood depression and anxiety. Yet, how they impact needed treatment duration, type or focus in these common disorders, is unclear. For developing more individualized and precise interventions, we investigated whether specific early adversities associate with patients' distinct psychiatric problems, psychological vulnerabilities, and suitability for psychotherapy. A total of 221 depressed and anxious adult outpatients (excluding psychotic, severe personality, bipolar, and substance abuse disorders) referred from community, student, occupational, and private healthcare services filled the Childhood Family Atmosphere Questionnaire (CFAQ). They also filled self-reports on interpersonal behavior and problems, perceived competence, dispositional optimism, sense of coherence, defenses, and psychiatric history. Clinicians assessed the patients' symptomatology, personality, object relations, cognitive performance, and psychotherapy suitability. Regression analyses were conducted. Childhood adversities predicted both worse current psychological functioning (e.g., interpersonal problems), and better clinician-rated capacities for benefiting from psychotherapy (e.g. self-reflection, capacity for interaction). Parental problems had the most numerous negative associations to psychological functioning. Best capacities for psychotherapy were predicted by recollected family unhappiness. Associations with psychiatric criteria were, however, largely non-significant. In conclusion, for psychosocial treatment planning, patients' early adversities may indicate both vulnerability and resources. As childhood adversities are frequent among treatment-seekers, further studies examining how early adversities predict psychotherapy outcome are needed.
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Affiliation(s)
| | - Paul Knekt
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
| | - Esa Virtala
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
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Heinonen E, Heiskanen T, Lindfors O, Härkäpää K, Knekt P. Dispositional optimism as predictor of outcome in short- and long-term psychotherapy. Psychol Psychother 2017; 90:279-298. [PMID: 27743465 DOI: 10.1111/papt.12109] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/29/2016] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Dispositional optimism predicts various beneficial outcomes in somatic health and treatment, but has been little studied in psychotherapy. This study investigated whether an optimistic disposition differentially predicts patients' ability to benefit from short-term versus long-term psychotherapy. DESIGN A total of 326 adult outpatients with mood and/or anxiety disorder were randomized into short-term (solution-focused or short-term psychodynamic) or long-term psychodynamic therapy and followed up for 3 years. METHODS Dispositional optimism was assessed by patients at baseline with the self-rated Life Orientation Test (LOT) questionnaire. Outcome was assessed at baseline and seven times during the follow-up, in terms of depressive (BDI, HDRS), anxiety (SCL-90-ANX, HARS), and general psychiatric symptoms (SCL-90-GSI), all seven follow-up points including patients' self-reports and three including interview-based measures. RESULTS Lower dispositional optimism predicted faster symptom reduction in short-term than in long-term psychotherapy. Higher optimism predicted equally rapid and eventually greater benefits in long-term, as compared to short-term, psychotherapy. CONCLUSIONS Weaker optimism appeared to predict sustenance of problems early in long-term therapy. Stronger optimism seems to best facilitate engaging in and benefiting from a long-term therapy process. Closer research might clarify the psychological processes responsible for these effects and help fine-tune both briefer and longer interventions to optimize treatment effectiveness for particular patients and their psychological qualities. PRACTITIONER POINTS Weaker dispositional optimism does not appear to inhibit brief therapy from effecting symptomatic recovery. Patients with weaker optimism do not seem to gain added benefits from long-term therapy, but instead may be susceptible to prolonged psychiatric symptoms in the early stages of long-term therapy.
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Affiliation(s)
- Erkki Heinonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Tiia Heiskanen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland.,Biomedicum Helsinki, Finland
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17
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Knekt P, Lindfors O, Keinänen M, Heinonen E, Virtala E, Härkänen T. The prediction of the level of personality organization on reduction of psychiatric symptoms and improvement of work ability in short- versus long-term psychotherapies during a 5-year follow-up. Psychol Psychother 2017; 90:353-376. [PMID: 28035751 DOI: 10.1111/papt.12115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 09/08/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES How level of personality organization (LPO) predicts psychiatric symptoms and work ability in short- versus long-term psychotherapies is poorly known. We investigated the importance of the LPO on the benefits of short-term versus long-term psychotherapies. DESIGN A cohort study based on 326 outpatients with mood or anxiety disorder was allocated to long-term (LPP) and short-term (SPP) psychodynamic psychotherapy, and solution-focused therapy (SFT). METHODS The LPO was assessed by interview at baseline and categorized into neuroses and higher level borderline. Outcome was assessed at baseline and 4-9 times during a 5-year follow-up, using self-report and interview-based measures of symptoms and work ability. RESULTS For patients receiving SPP, improvement in work ability, symptom reduction, and the remission rate were more considerable in patients with neuroses than in higher level borderline patients, whereas LPP or SFT showed no notable differences in effectiveness in the two LPO groups. In patients with neuroses, improvement was more considerable in the short-term therapy groups during the first year of follow-up, and in higher level borderline patients LPP was more effective after 3 years of follow-up. The remission rate, defined as both symptom reduction and lack of auxiliary treatment, was higher in LPP than in SPP for both the LPO groups considered. CONCLUSIONS In neuroses, short-term psychotherapy was associated with a more rapid reduction of symptoms and increase in work ability, whereas LPP was more effective for longer follow-ups in both LPO groups. Further large-scale studies are needed. PRACTITIONER POINTS Level of personality organization is relevant for selection between short- and long-term psychotherapies. Short-term therapy gives faster benefits for neurotic patients but not for patients with higher level borderline personality organization. Sustained remission from symptoms is more probable after long-term than short-term therapy.
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Affiliation(s)
- Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland.,Biomedicum Helsinki, Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Erkki Heinonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Esa Virtala
- National Institute for Health and Welfare, Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, Helsinki, Finland
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18
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Knekt P, Lindfors O, Maljanen T. The Effectiveness of Three Psychotherapies of Different type and Length in the Treatment of Patients Suffering from Anxiety Disorder. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
IntroductionData on the comparative effect of short and long-term psychotherapy in anxiety disorder is scarce.AimTo compare the effectiveness of two short-term therapies and one long-term psychotherapy in the treatment of patients with anxiety disorder.MethodsAltogether 50 outpatients with anxiety disorder as the only axis I diagnosis, were randomly assigned to long-term psychodynamic psychotherapy (LPP), short-term psychodynamic psychotherapy (SPP), and solution-focused therapy (SFT) and were followed for 5 years. The outcome measures were psychiatric symptoms, working ability, need for psychiatric treatment, remission, and cost-effectiveness.ResultsDuring the first year of follow-up, no significant differences in the effectiveness between the therapies were noted. During the following 3 years, LPP and SFT more effectively reduced symptoms, improved work ability, and elevated the remission rate than SPP. No significant differences between LPP and SFT were seen. At the end of the follow-up, the use of auxiliary treatment was lowest in the SFT group whereas remission rates or changes in psychiatric symptom or work ability did not differ between the groups. The average total direct costs were about three times higher in the LPP group than in the short-term therapy groups.ConclusionsThe difference in effectiveness of LPP and SFT was negligible, whereas SPP appeared less effective. Thus, the resource-oriented SFT may be a cost-effective option in this selected patient group, while unconsidered allocation of patients to LPP does not appear to be cost-effective. Given the small number of patients, no firm conclusions should, however be drawn based on this study.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Abstract
BACKGROUND Empirical evidence on whether patients' mental health and functioning will be more improved after long-term than short-term therapy is scarce. We addressed this question in a clinical trial with a long follow-up. METHOD In the Helsinki Psychotherapy Study, 326 out-patients with mood or anxiety disorder were randomly assigned to long-term psychodynamic psychotherapy (LPP), short-term psychodynamic psychotherapy (SPP) or solution-focused therapy (SFT) and were followed for 10 years. The outcome measures were psychiatric symptoms, work ability, personality and social functioning, need for treatment, and remission. RESULTS At the end of the follow-up, altogether 74% of the patients were free from clinically elevated psychiatric symptoms. Compared with SPP, LPP showed greater reductions in symptoms, greater improvement in work ability and higher remission rates. A similar difference in symptoms and work ability was observed in comparison with SFT after adjustment for violations of treatment standards. No notable differences in effectiveness between SFT and SPP were observed. The prevalence of auxiliary treatment was relatively high, 47% in SFT, 58% in SPP and 33% in LPP, and, accordingly, the remission rates for general symptoms were 55, 45 and 62%, respectively. CONCLUSIONS After 10 years of follow-up, the benefits of LPP in comparison with the short-term therapies are rather small, though significant in symptoms and work ability, possibly due to more frequent use of auxiliary therapy in the short-term therapy groups. Further studies should focus on the choice of optimal length of therapy and the selection of factors predicting outcome of short- v. long-term therapy.
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Affiliation(s)
- P Knekt
- National Institute for Health and Welfare,Helsinki,Finland
| | - E Virtala
- National Institute for Health and Welfare,Helsinki,Finland
| | - T Härkänen
- National Institute for Health and Welfare,Helsinki,Finland
| | - M Vaarama
- National Institute for Health and Welfare,Helsinki,Finland
| | - J Lehtonen
- National Institute for Health and Welfare,Helsinki,Finland
| | - O Lindfors
- National Institute for Health and Welfare,Helsinki,Finland
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Abstract
OBJECTIVE The aim of this study was to investigate the influence of psychotherapy treatments of different lengths, number of sessions, and type on health behaviour. METHOD A total of 367 patients were monitored for their health behaviour (alcohol consumption, body mass index), serum cholesterol (total and HDL), smoking and exercise) for five years from the start of the therapy. The effectiveness of solution-focused therapy, short-term psychodynamic psychotherapy, and long-term psychodynamic psychotherapy (LPP) was examined in a randomized clinical trial, while the LPP group and the non-randomized psychoanalysis (PA) group were compared in a naturalistic design. RESULTS During the follow-up, an improvement was seen with regard to alcohol consumption, serum HDL cholesterol, and smoking in the LPP and PA groups. No notable differences in health behaviour between the two groups were found, however. During the last two years of the follow-up, changes towards higher alcohol consumption and higher total serum cholesterol levels were observed in the short-term therapy groups. CONCLUSIONS The impact of PA and LPP on health behaviour did not differ, whereas the changes were less health promoting in short-term psychotherapy. Large-scale studies are needed to confirm these findings.
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Affiliation(s)
- Kaisa Jyrä
- a National Institute for Health and Welfare , Helsinki , Finland
| | - Paul Knekt
- a National Institute for Health and Welfare , Helsinki , Finland
| | - Olavi Lindfors
- a National Institute for Health and Welfare , Helsinki , Finland
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21
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Maljanen T, Knekt P, Lindfors O, Virtala E, Tillman P, Härkänen T. The cost-effectiveness of short-term and long-term psychotherapy in the treatment of depressive and anxiety disorders during a 5-year follow-up. J Affect Disord 2016; 190:254-263. [PMID: 26540079 DOI: 10.1016/j.jad.2015.09.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
Both short-term and long-term psychotherapies are used extensively in treating different mental disorders, but there have been practically no attempts to compare their cost-effectiveness. The aim of this study, which is part of the Helsinki Psychotherapy Study, is to assess the cost-effectiveness of two short-term therapies compared to that of a long-term therapy. In this study 326 outpatients suffering from mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP) or to long-term psychodynamic psychotherapy (LPP). Psychiatric symptoms and working ability were assessed at baseline and then 4-9 times during a 5-year follow-up using eight widely used measures including e.g. Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), Symptom Check List, anxiety scale (SCL-90-Anx), Hamilton Anxiety Rating Scale (HARS), Symptom Check List, Global Severity Index (SCL-90-GSI), and the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR). Both direct and indirect costs were measured. During the 5-year follow-up period statistically significant improvements were observed in all health indicators in all therapy groups. At first the recovery was faster in the short-term therapy groups than in the LPP group, but taking the whole follow-up period into account, the effectiveness of the LPP was somewhat greater than that of the short-term therapies. Especially the direct costs were, however, much higher in the LPP group than in the short-term therapy groups. Thus the long-term therapy can hardly be regarded as cost-effective compared to short-term therapies when patients are randomized to the therapy groups.
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Affiliation(s)
- Timo Maljanen
- Social Insurance Institution, P.O. Box 450, FI-00101 Helsinki, Finland.
| | - Paul Knekt
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Esa Virtala
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Päivi Tillman
- Social Insurance Institution, P.O. Box 450, FI-00101 Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
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- Social Insurance Institution, P.O. Box 450, FI-00101 Helsinki, Finland; National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland; Rehabilitation Foundation, Helsinki, Finland
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22
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Joensuu M, Ahola P, Knekt P, Lindfors O, Saarinen P, Tolmunen T, Valkonen-Korhonen M, Vanninen R, Jääskeläinen T, Virtala E, Kuikka J, Tiihonen J, Lehtonen J. Baseline symptom severity predicts serotonin transporter change during psychotherapy in patients with major depression. Psychiatry Clin Neurosci 2016; 70:34-41. [PMID: 26311446 DOI: 10.1111/pcn.12335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 06/16/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022]
Abstract
AIMS The role of the serotonin transporter (SERT) in the pathophysiology of depression is unclear and only a few follow-up studies exist. Our aim was to measure changes in SERT availability during psychodynamic psychotherapy in patients with major depression over a follow-up time of 12 or 18 months. METHODS The patients were studied with iodine-123 labelled 2β-carbomethoxy-3β-(4-iodophenyl) serial single-photon emission tomography imaging and clinical rating scales of symptoms. RESULTS Changes in SERT availability had no correlation with the change of symptoms, but the change of SERT availability during psychotherapy in the midbrain was predicted by the baseline severity of the clinical symptoms measured by the Symptom Checklist Depression Scale and the Symptom Checklist Global Severity Index. With cut-off values applied, it was found that SERT availabilities increased in patients with high baseline symptoms, and decreased in patients with low baseline symptoms. CONCLUSIONS Together with our earlier finding of decreased SERT in patients with depression, these results indicate a state-dependent and possibly a compensatory role of decreased SERT availability in depression.
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Affiliation(s)
- Mikko Joensuu
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland
| | - Pasi Ahola
- University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland
| | - Pirjo Saarinen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.,Kuopio Psychiatric Center, Kuopio, Finland
| | - Tommi Tolmunen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Minna Valkonen-Korhonen
- University of Eastern Finland, Kuopio, Finland.,Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | | | - Esa Virtala
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jyrki Kuikka
- Department of Clinical Physiology and Nuclear Medicine, University of Kuopio, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland.,National Institute for Health and Welfare, Helsinki, Finland.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Johannes Lehtonen
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland.,National Institute for Health and Welfare, Helsinki, Finland
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23
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Knekt P, Heinonen E, Härkäpää K, Järvikoski A, Virtala E, Rissanen J, Lindfors O, Helsinki Psychotherapy Study Group. Randomized trial on the effectiveness of long- and short-term psychotherapy on psychosocial functioning and quality of life during a 5-year follow-up. Psychiatry Res 2015; 229:381-8. [PMID: 26162657 DOI: 10.1016/j.psychres.2015.05.113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 05/09/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Abstract
Knowledge is incomplete on whether long-term psychotherapy is more effective than short-term therapy in treating mood and anxiety disorder, when measured by improvements in psychosocial functioning and life quality. In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP), or long-term psychodynamic psychotherapy (LPP), and followed up for 5 years from the start of treatment. The outcome measures comprised 4 questionnaires on psychosocial functioning, assessing global social functioning (Social Adjustment Scale (SAS-SR), sense of coherence (Sense of Coherence Scale (SOC)), perceived competence (Self-Performance Survey), dispositional optimism (Life Orientation Test (LOT)), and 1 questionnaire assessing quality of life (Life Situation Survey (LSS)). Short-term therapies improved psychosocial functioning and quality of life more than LPP during the first year. The only exceptions were LOT and perceived competence, which did not differ between SPP and LPP. Later in the follow-up, SOC and perceived competence showed significantly more improvement in LPP than in the short-term therapy groups. No direct differences between SFT and SPP were noted. Short-term therapy has consistently more short-term effects on psychosocial functioning and quality of life than LPP, whereas LPP has some additional long-term benefits on psychosocial functioning.
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Affiliation(s)
- Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland.
| | - Erkki Heinonen
- National Institute for Health and Welfare, Helsinki, Finland
| | | | | | - Esa Virtala
- National Institute for Health and Welfare, Helsinki, Finland
| | - Julius Rissanen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland
| | - Helsinki Psychotherapy Study Group
- National Institute for Health and Welfare, Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland; University of Lapland, Rovaniemi, Finland; Rehabilitation Foundation, Helsinki, Finland; Social Insurance Institution, Finland
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24
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Rosenström T, Elovainio M, Jokela M, Pirkola S, Koskinen S, Lindfors O, Keltikangas-Järvinen L. Concordance between Composite International Diagnostic Interview and self-reports of depressive symptoms: a re-analysis. Int J Methods Psychiatr Res 2015; 24:213-25. [PMID: 26140369 PMCID: PMC6878410 DOI: 10.1002/mpr.1478] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/27/2015] [Accepted: 03/18/2015] [Indexed: 11/07/2022] Open
Abstract
Concordance between sum scores of self-reported depressive symptoms and structured interview diagnoses has been studied extensively, but are these the best attainable self-report-based predictions for interview diagnoses? We maximized the cross-validated concordance between World Health Organization's Composite International Diagnostic Interview (CIDI) diagnosis and Beck's Depression Inventory (BDI), and General Health Questionnaire (GHQ), from the viewpoint of exploratory statistics, re-analysing Health 2000 general-population sample of adults over 30 years in mainland Finland (N = 5200-5435). BDI sum-score prediction of CIDI diagnosis could be superseded by using (1) weighted sums of items, (2) classification trees constructed from items, or (3) a single item. Best solution (2) yielded cross-validated Youden's Index 0.757 [standard error (SE) = 0.001, sensitivity = 0.907, specificity = 0.851], improving the concordance to 1.07-fold (1.18-fold for 12-month diagnosis). A single-item solution was best for the GHQ. All positive predictive values remained low (0.09-0.31). Thus, CIDI-to-questionnaire concordance can be improved by using all information in the questionnaires instead of just sum scores, but latent-trait theory for questionnaires is incompatible with interview diagnoses (single item achieved better concordance than summing all). Self-reports have low predictive value for CIDI diagnoses in the general population, but better in settings with higher major depressive disorder (MDD) base rates. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Tom Rosenström
- Institute of Behavioural Sciences, University of Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Marko Elovainio
- Institute of Behavioural Sciences, University of Helsinki, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Markus Jokela
- Institute of Behavioural Sciences, University of Helsinki, Finland
| | - Sami Pirkola
- National Institute for Health and Welfare, Helsinki, Finland.,School of Health Sciences, University of Tampere, Tampere, Finland
| | - Seppo Koskinen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland
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Lindfors O, Knekt P, Heinonen E, Härkänen T, Virtala E. The effectiveness of short- and long-term psychotherapy on personality functioning during a 5-year follow-up. J Affect Disord 2015; 173:31-8. [PMID: 25462393 DOI: 10.1016/j.jad.2014.10.039] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/21/2014] [Accepted: 10/22/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Only few randomized trials comparing sustained effects of short- and long-term psychotherapies in personality functioning are available. In this study we compared the effects of two short-term therapies and long-term psychodynamic psychotherapy on patients' personality functioning during a 5-year follow-up. METHODS Altogether 326 patients of the Helsinki Psychotherapy Study, with anxiety or mood disorder, were randomly assigned to either short-term psychotherapy of about six months (solution-focused therapy (SFT, n=97) or short-term psychodynamic psychotherapy (SPP, n=101)), or to long-term psychodynamic psychotherapy (LPP, n=128), lasting on average three years. Outcomes in personality functioning (i.e., self-concept, defense style, interpersonal problems, and level of personality organization) were assessed five to seven times using, respectively, questionnaires (SASB, DSQ, IIP) and interview (LPO) during the 5-year follow-up from randomization. RESULTS Personality functioning improved in all therapy groups. Both short-term therapies fared better than LPP during the first year of follow-up, by faster improvement in self-concept and decrease in immature defense style. SFT also showed more early reduction of interpersonal problems. However, LPP thereafter showed larger and more sustained benefits than SFT and SPP, through greater changes in self-concept. Additionally, LPP outperformed SFT at the end of the follow-up in IIP and LPO, after adjustment for auxiliary treatment. No differences were noted between the short-term therapies at any measurement point. LIMITATIONS Auxiliary treatment was used relatively widely which limits generalization to exclusive use of short- or long-term therapy. CONCLUSIONS LPP seems to be somewhat more effective than short-term therapies in facilitating longterm changes in personality functioning.
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Affiliation(s)
- Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland.
| | - Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland
| | - Erkki Heinonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Esa Virtala
- National Institute for Health and Welfare, Helsinki, Finland
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- National Institute for Health and Welfare, Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland; Rehabilitation Foundation, Helsinki, Finland; Social Insurance Institution, Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
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26
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Isometsä E, Kinnunen E, Kivekäs T, Koponen H, Lappalainen J, Lindfors O, Marttunen M, Pirkola S, Jousilahti P, Tuunainen A. [Update on Current Care Guideline: Depression]. Duodecim 2015; 131:280-281. [PMID: 26245079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Treatment of depression is based on comprehensive diagnostic, clinical and psychosocial evaluation. Brief psychotherapies (cognitive, interpersonal, psychodynamic or problem-solving) are effective in mild to moderate depression; antidepressants in mild to severe, and electroconvulsive therapy in severe or psychotic. Combining antidepressants and psychotherapy is more effective than either alone. After the acute phase, antidepressants should be continued for six months to prevent relapses, and maintenance treatment considered after three lifetime episodes. Primary care is responsible for treatment of mild to moderate depressions; developing psychiatric consultation services and use of nurse case managers are recommended.
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27
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Knekt P, Saari T, Lindfors O. Intelligence as a predictor of outcome in short- and long-term psychotherapy. Psychiatry Res 2014; 220:1019-27. [PMID: 25454120 DOI: 10.1016/j.psychres.2014.10.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 02/02/2014] [Accepted: 10/05/2014] [Indexed: 10/24/2022]
Abstract
Intelligence has been suggested as a suitability factor for short-term therapy whereas its possible effect on short-term versus long-term therapy still is unknown. The aim of this study was to compare the prediction of intelligence on the level of psychiatric symptoms and psychosocial functioning in psychotherapies of different lengths. A total of 251 outpatients from the Helsinki Psychotherapy Study, aged 20–46 years, and suffering from mood or anxiety disorders were allocated to two long-term and two short-term therapies. Intelligence was assessed at baseline with the Wechsler Adult Intelligence Scale (WAIS-R). Psychiatric symptoms and psychosocial functioning were assessed 5–10 times during a 5-year follow-up using two primary symptom measures (HDRS and HARS) and one primary measure of psychosocial functioning (GAF). Short-term therapy was more effective than long-term therapy during the first year of follow-up. During the second to fourth follow-up year no differences between short- and long-term therapies or the intelligence groups were found. At the fifth follow-up year, however, long-term psychotherapy showed a statistically significantly larger change in all three primary measures compared to short-term therapy among those with higher intelligence. No differences between therapy groups were noted in those with lower intelligence. People with higher intelligence may benefit more from long-term than from short-term psychotherapy. These findings should be confirmed.
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Laaksonen MA, Sirkiä C, Knekt P, Lindfors O. Self-reported immature defense style as a predictor of outcome in short-term and long-term psychotherapy. Brain Behav 2014; 4:495-503. [PMID: 25161816 PMCID: PMC4075638 DOI: 10.1002/brb3.190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 09/12/2013] [Accepted: 10/15/2013] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Identification of pretreatment patient characteristics predictive of psychotherapy outcome could help to guide treatment choices. This study evaluates patients' initial level of immature defense style as a predictor of the outcome of short-term versus long-term psychotherapy. METHOD In the Helsinki Psychotherapy Study, 326 adult outpatients with mood or anxiety disorder were randomized to individual short-term (psychodynamic or solution-focused) or long-term (psychodynamic) psychotherapy. Their defense style was assessed at baseline using the 88-item Defense Style Questionnaire and classified as low or high around the median value of the respective score. Both specific (Beck Depression Inventory [BDI], Hamilton Depression Rating Scale [HDRS], Symptom Check List Anxiety Scale [SCL-90-Anx], Hamilton Anxiety Rating Scale [HARS]) and global (Symptom Check List Global Severity Index [SCL-90-GSI], Global Assessment of Functioning Scale [GAF]) psychiatric symptoms were measured at baseline and 3-7 times during a 3-year follow-up. RESULTS Patients with high use of immature defense style experienced greater symptom reduction in long-term than in short-term psychotherapy by the end of the 3-year follow-up (50% vs. 34%). Patients with low use of immature defense style experienced faster symptom reduction in short-term than in long-term psychotherapy during the first year of follow-up (34% vs. 19%). CONCLUSION Knowledge of patients' initial level of immature defense style may potentially be utilized in tailoring treatments. Further research on defense styles as outcome predictors in psychotherapies of different types is needed.
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Affiliation(s)
- Maarit A Laaksonen
- Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare (THL) Helsinki, Finland
| | - Carlos Sirkiä
- Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare (THL) Helsinki, Finland
| | - Paul Knekt
- Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare (THL) Helsinki, Finland ; Biomedicum Helsinki Helsinki, Finland ; Social Insurance Institution Helsinki, Finland
| | - Olavi Lindfors
- Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare (THL) Helsinki, Finland
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Lindfors O, Ojanen S, Jääskeläinen T, Knekt P. Social support as a predictor of the outcome of depressive and anxiety disorder in short-term and long-term psychotherapy. Psychiatry Res 2014; 216:44-51. [PMID: 24508367 DOI: 10.1016/j.psychres.2013.12.050] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 08/16/2013] [Accepted: 12/28/2013] [Indexed: 10/25/2022]
Abstract
Social support is known to be important for well-being of individuals, but it is not clear how it predicts psychotherapy outcome in patients suffering from depressive or anxiety disorders. The aim of the present study was to study the prediction of social support on the outcome of short-term and long-term psychotherapy. In the Helsinki Psychotherapy Study, 326 psychiatric outpatients, aged 20-46 years, and suffering from depressive or anxiety disorders, were randomly assigned to short-term psychotherapy (short-term psychodynamic or solution-focused) or long-term psychodynamic psychotherapy. The level of social support at baseline was assessed using the Brief Inventory of Social Support and Integration (BISSI). Psychiatric symptoms were assessed with the Symptom Check List, Global Severity Index (SCL-90-GSI) at baseline and four times during a 3-year follow-up. Patients with a high level of social support before treatment benefitted more from long-term than short-term therapy at the 3-year follow-up, whereas patients with a low level of social support experienced no such benefit. Pretreatment social support seems to predict differentially short- and long-term psychotherapy and thus needs to be acknowledged when evaluating patient's resources and treatment options. More research is needed to verify these findings.
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Affiliation(s)
- Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland
| | - Sakari Ojanen
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland.
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Härkäpää K, Junttila O, Lindfors O, Järvikoski A. Changes in studying abilities as perceived by students attending psychotherapy. British Journal of Guidance & Counselling 2013. [DOI: 10.1080/03069885.2013.857759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Heinonen E, Knekt P, Jääskeläinen T, Lindfors O. Therapists' professional and personal characteristics as predictors of outcome in long-term psychodynamic psychotherapy and psychoanalysis. Eur Psychiatry 2013; 29:265-74. [PMID: 24060629 DOI: 10.1016/j.eurpsy.2013.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 07/14/2013] [Accepted: 07/22/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Whether long-term psychodynamic therapy (LPP) and psychoanalysis (PA) differ from each other and require different therapist qualities has been debated extensively, but rarely investigated empirically. METHODS In a quasi-experimental design, LPP was provided for 128 and PA for 41 outpatients, aged 20-46 years and suffering from mood or anxiety disorder, with a 5-year follow-up from start of treatment. Therapies were provided by 58 experienced therapists. Therapist characteristics, measured pre-treatment, were assessed with the Development of Psychotherapists Common Core Questionnaire (DPCCQ). General psychiatric symptoms were assessed as the main outcome measure at baseline and yearly after start of treatment with the Symptom Check List, Global Severity Index (SCL-90-GSI). RESULTS Professionally less affirming and personally more forceful and less aloof therapists predicted less symptoms in PA than in LPP at the end of the follow-up. A faster symptom reduction in LPP was predicted by a more moderate relational style and work experiences of both skillfulness and difficulties, indicating differences between PA and LPP in the therapy process. CONCLUSIONS Results challenge the benefit of a classically "neutral" psychoanalyst in PA. They also indicate closer examinations of therapy processes within and between the two treatments, which may benefit training and supervision of therapists.
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Affiliation(s)
- E Heinonen
- National Institute for Health and Welfare, Finland
| | - P Knekt
- National Institute for Health and Welfare, Finland; Social Insurance Institution, Finland.
| | | | - O Lindfors
- National Institute for Health and Welfare, Finland
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Laaksonen MA, Knekt P, Lindfors O. Psychological predictors of the recovery from mood or anxiety disorder in short-term and long-term psychotherapy during a 3-year follow-up. Psychiatry Res 2013; 208:162-73. [PMID: 23123046 DOI: 10.1016/j.psychres.2012.09.053] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 08/13/2012] [Accepted: 09/27/2012] [Indexed: 11/25/2022]
Abstract
Choice of optimal treatment length for psychiatric patients requires knowledge about the patients' pre-treatment suitability. This study compares the prediction of seven psychological suitability measures on changes in psychiatric symptoms in short- and long-term psychotherapy over a 3-year follow-up. The psychological suitability of 326 outpatients from the Helsinki Psychotherapy Study, aged 20-46 years, and suffering from mood or anxiety disorders, was assessed at baseline using the Suitability for Psychotherapy Scale (SPS) before randomly assigning them to solution-focused therapy, short-term or long-term psychodynamic psychotherapy. Psychiatric symptoms (Symptom Checklist-90 Global Severity Index) were assessed at baseline and seven times during follow-up. Three patient groups with different prognosis were found when a cumulative SPS score, summing up the values of the seven single suitability measures, was used to predict symptom development: patients with more good (4 or more) than poor values benefited more from short-term therapy, patients with more poor (4-6) than good values benefited more from long-term therapy, and patients with all seven values poor failed to benefit from either short- or long-term therapy. The SPS can apparently be applied before the start of treatment to predict the amount of therapy patients need to recover, although its suitability in therapies of different types needs to be confirmed.
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Affiliation(s)
- Maarit A Laaksonen
- National Institute for Health and Welfare (THL), Department of Health, Functional Capacity and Welfare, Helsinki, Finland
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Heinonen E, Lindfors O, Härkänen T, Virtala E, Jääskeläinen T, Knekt P. Therapists' Professional and Personal Characteristics as Predictors of Working Alliance in Short-Term and Long-Term Psychotherapies. Clin Psychol Psychother 2013; 21:475-94. [DOI: 10.1002/cpp.1852] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 04/19/2013] [Accepted: 05/24/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Erkki Heinonen
- National Institute for Health and Welfare; Helsinki; Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare; Helsinki; Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare; Helsinki; Finland
| | - Esa Virtala
- National Institute for Health and Welfare; Helsinki; Finland
| | | | - Paul Knekt
- National Institute for Health and Welfare; Helsinki; Finland
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Härkänen T, Maljanen T, Lindfors O, Virtala E, Knekt P. Confounding and missing data in cost-effectiveness analysis: comparing different methods. Health Econ Rev 2013; 3:8. [PMID: 23537421 PMCID: PMC3695850 DOI: 10.1186/2191-1991-3-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 03/19/2013] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Common approaches in cost-effectiveness analyses do not adjust for confounders. In nonrandomized studies this can result in biased results. Parametric models such as regression models are commonly applied to adjust for confounding, but there are several issues which need to be accounted for. The distribution of costs is often skewed and there can be a considerable proportion of observations of zero costs, which cannot be well handled using simple linear models. Associations between costs and effectiveness cannot usually be explained using observed background information alone, which also requires special attention in parametric modeling. Furthermore, in longitudinal panel data, missing observations are a growing problem also with nonparametric methods when cumulative outcome measures are used. METHODS We compare two methods, which can handle the aforementioned issues, in addition to the standard unadjusted bootstrap techniques for assessing cost-effectiveness in the Helsinki Psychotherapy Study based on five repeated measurements of the Global Severity Index (SCL-90-GSI) and direct costs during one year of follow-up in two groups defined by the Defence Style Questionnaire (DSQ) at baseline. The first method models cumulative costs and effectiveness using generalized linear models, multiple imputation and bootstrap techniques. The second method deals with repeated measurement data directly using a hierarchical two-part logistic and gamma regression model for costs, a hierarchical linear model for effectiveness, and Bayesian inference. RESULTS The adjustment for confounders mitigated the differences of the DSQ groups. Our method, based on Bayesian inference, revealed the unexplained association of costs and effectiveness. Furthermore, the method also demonstrated strong heteroscedasticity in positive costs. CONCLUSIONS Confounders should be accounted for in cost-effectiveness analyses, if the comparison groups are not randomized. JEL CLASSIFICATION C1; C3; I1.
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Affiliation(s)
- Tommi Härkänen
- National Institute of Health and Welfare, Mannerheimintie 166, P.O.Box 30, FIN-00271 Helsinki, Finland
| | | | - Olavi Lindfors
- National Institute of Health and Welfare, Mannerheimintie 166, P.O.Box 30, FIN-00271 Helsinki, Finland
| | - Esa Virtala
- National Institute of Health and Welfare, Mannerheimintie 166, P.O.Box 30, FIN-00271 Helsinki, Finland
| | - Paul Knekt
- National Institute of Health and Welfare, Mannerheimintie 166, P.O.Box 30, FIN-00271 Helsinki, Finland
- Social Insurance Institution, Helsinki, Finland
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Knekt P, Lindfors O, Sares-Jäske L, Virtala E, Härkänen T. Randomized trial on the effectiveness of long- and short-term psychotherapy on psychiatric symptoms and working ability during a 5-year follow-up. Nord J Psychiatry 2013; 67:59-68. [PMID: 22563790 DOI: 10.3109/08039488.2012.680910] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The information on whether long-term psychotherapy is superior in comparison with short-term therapies during a long time-perspective in the treatment of mood and anxiety disorder is incomplete. AIMS The present study addresses this question in a clinical trial with an exceptionally long follow-up. METHODS In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomly assigned to long-term psychodynamic psychotherapy and two types of short-term psychotherapy (short-term psychodynamic psychotherapy and solution-focused therapy) and were followed up for 5 years from the start of treatment. The outcome measures were psychiatric symptoms measured by Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), Symptom Check List, anxiety scale (SCL-90-Anx), Hamilton Anxiety Rating Scale (HARS) and Symptom Check List, Global Severity Index (SCL-90-GSI), and working ability measured by the Work Ability Index (WAI), the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR) and the Perceived Psychological Functioning Scale (PPF). Furthermore, remission variables based on changes in psychiatric symptoms and use of auxiliary treatment, were used. RESULTS After the 5-year follow-up, the rate of recovery from psychiatric symptoms and the work ability improvement rate remained higher in the long-term therapy group, whereas no differences in the effectiveness of the two short-term therapies of different modalities were found. CONCLUSIONS Long-term psychotherapy is more effective than short-term therapy during a long follow-up, suggesting the need for a careful evaluation of suitability to short-term therapy. More research on the long-term effects of psychotherapy in large-scale studies is still needed, however.
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Affiliation(s)
- Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland.
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Härkänen T, Arjas E, Laaksonen MA, Lindfors O, Haukka J, Knekt P. Estimating efficacy in the presence of non-ignorable non-trial interventions in the Helsinki Psychotherapy Study. Stat Methods Med Res 2013; 25:885-901. [DOI: 10.1177/0962280212473348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In a randomised clinical trial with a longitudinal outcome, analyses of the efficacy of the study treatments may be complicated by both non-trial interventions, which have not been administered by the researcher, and sparsely measured outcome values. The delay between the change in outcome and the starting of the non-trial intervention may be much shorter than the time intervals between the actual measurements. We propose a model that accounts for the possible dynamic interdependence between the longitudinal outcome and time-to-event data. The model is based on discretising time into short intervals. This results in a missing data problem, which we tackle using Bayesian inference and data augmentation. The method is based on the assumption that decisions to initiate non-trial interventions are not confounded by unobservable factors. The Helsinki Psychotherapy Study data are used as an illustration. Different psychotherapies were compared, and possible episodes of psychotropic medication were viewed as non-trial interventions. Simulation studies suggest that our method provides reasonable estimates of the effects of both the study treatment and the non-trial intervention also showing some robustness against possible latent background factors. An application of marginal structural modelling, however, appeared to underestimate the differences between the treatments.
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Affiliation(s)
- Tommi Härkänen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Elja Arjas
- National Institute for Health and Welfare, Helsinki, Finland
- Department of Mathematics and statistics, University of Helsinki, Finland
| | | | - Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Haukka
- Hjelt Institute, University of Helsinki, Finland
| | - Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland
- Social Insurance Institute, Helsinki, Finland
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Lindfors O, Knekt P, Virtala E, Haaramo P. Concurrent validity of the Quality of Object Relations Scale (QORS) in relation to proxy assessment of the theoretical scale constituents. Psychopathology 2013; 46:111-9. [PMID: 22906923 DOI: 10.1159/000339385] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 04/29/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIMS Clinical assessment of object relations is essential when evaluating treatability by different types of psychotherapy. The Quality of Object Relations Scale (QORS) is an established interview measure used for assessing object relations, but the validity of the QORS in relation to its theoretical constituents has not been examined. Our aim was to study the concurrent validity of the QORS. METHODS Trained interviewers assessed 263 outpatients seeking psychotherapy due to mood or anxiety disorder, with the QORS and with selected proxy criterion measures representing constituents of object-relational maturity. RESULTS Discontinuity in relationships and the use of devaluation in relationships were the main determinants of low Quality of Object Relations (low-QOR). Patients with discontinuity in relationships had a four-fold and patients with devaluation in relationships a three-fold risk of belonging to the low-QOR group (p = 0.001) in comparison to those without these relational characteristics. Also poor self-confidence and major separations in childhood predicted the low- versus high-QOR category. CONCLUSION The results indicate adequate concurrent validity of the QORS and support its credibility in assessing personality pathology, beyond axis II diagnosis, by trained clinicians.
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Affiliation(s)
- Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland.
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Lindfors O, Knekt P, Virtala E. Quality of object relations modifies the effectiveness of short- and long-term psychotherapy on self-concept. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/ojpsych.2013.34036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Valkonen H, Lindfors O, Knekt P. Association between the Rorschach Ego Impairment Index and the Level of Personality Organization interview assessment in depressive and anxiety disorder patients. Psychiatry Res 2012; 200:849-56. [PMID: 22633010 DOI: 10.1016/j.psychres.2012.05.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Revised: 05/10/2012] [Accepted: 05/11/2012] [Indexed: 10/28/2022]
Abstract
The level of personality functioning, relevant for treatment planning, can be evaluated by the Rorschach Comprehensive System (CS) Ego Impairment Index-2 (EII-2) and by interview assessment of the severity of personality pathology. However, few studies on the association between these assessment methods have been reported. This study examines the strength of association between the EII-2 and its subcomponents with the interview-based Level of Personality Organization (LPO) assessment scale, and investigates their mutual associations with psychiatric symptoms, diagnoses, and history. Altogether, 315 mood or anxiety disorder outpatients without severe personality pathology were assessed with the LPO and tested with the CS, on which the EII-2 and its subcomponents (FQ-, WSum6, Critical contents, M-, PHR, GHR, and R) were calculated. Significant, but weak association between the EII-2 and the LPO was found. The WSum6, a measure of thought disorder, was the only EII-2 subcomponent significantly associated with the LPO. Both measures were consistently associated with psychiatric symptoms, diagnoses and history. The findings partially support the EII-2 and the LPO as consistently associated, relatively independent measures of the severity of personality pathology. More research on the incremental benefits of the measures is needed in clinical populations, covering non-severe and complex psychopathology.
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Joutsenniemi K, Laaksonen MA, Knekt P, Haaramo P, Lindfors O. Prediction of the outcome of short- and long-term psychotherapy based on socio-demographic factors. J Affect Disord 2012; 141:331-42. [PMID: 22520738 DOI: 10.1016/j.jad.2012.03.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 03/14/2012] [Accepted: 03/14/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Socio-demographic factors predict the outcome of short-term psychotherapy (STT) in the treatment of mood and anxiety disorders, but information on the prediction for long long-term therapy (LPP) is lacking. We aimed to compare the prediction of changes in psychiatric symptoms afforded by socio-demographic factors across two treatment conditions, short- versus long-term psychotherapy. METHODS In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorders, aged 20-46 years, were randomly assigned to STT or LPP. Socio-demographic factors (i.e. age, gender, education, employment status, marital status, and living arrangement) were self-reported. Psychiatric symptoms were measured by the Symptom Check List, Global Severity Index (SCL-90-GSI) and Anxiety scale (SCL-90-Anx), and the Beck Depression Inventory (BDI) at baseline and seven times during a three-year follow-up period. RESULTS Socio-demographic factors were found to predict symptom development during follow-up irrespective of the baseline symptom level. Patients in a relatively good position, i.e. married and highly educated patients benefited from STT, whereas patients in less advantaged positions, i.e. homemakers, lone parents, and divorced patients needed LPP or did not benefit from either therapy. In several categories of socio-demographic factors, the extent to which a patient's background predicted the outcome of the psychotherapy varied according to whether general, anxiety or depressive symptoms were studied. LIMITATIONS We were unable to assess widows and pensioners. For ethical reasons, a no-treatment control group with a long follow-up could not be included in the study design. CONCLUSIONS Socio-demographic factors may need to be considered in the selection of patients for short- and long-term therapy.
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Affiliation(s)
- K Joutsenniemi
- National Institute for Health and Welfare (THL), Finland.
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Laaksonen M, Knekt P, Sares-Jäske L, Lindfors O. Psychological Predictors on the Outcome of Short-Term Psychodynamic Psychotherapy and Solution-Focused Therapy in the Treatment of Mood and Anxiety Disorder. Eur Psychiatry 2012; 28:117-24. [DOI: 10.1016/j.eurpsy.2011.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 12/15/2011] [Accepted: 12/17/2011] [Indexed: 11/25/2022] Open
Abstract
AbstractObjectivePatient's pre-treatment suitability for short-term psychodynamic psychotherapy (STPP) and solution-focused therapy (SFT) has not been compared. The aim of this study was to compare the prediction of psychological suitability measures on outcome of STPP vs. SFT.MethodAltogether 198 patients with mood or anxiety disorder were randomized to STPP or SFT. A 7-item Suitability for Psychotherapy Scale (SPS) was assessed at baseline and a cumulative SPS score was formed. Psychiatric symptoms were measured using SCL-90-GSI at baseline and seven times during a 3-year follow-up.ResultsThe SPS score predicted the outcome of both short-term psychotherapies; for patients with a good score short-term therapies seemed beneficial, whereas for patients with a poor score they did not seem sufficient. There was no difference between STPP and SFT in the prediction of the SPS score.ConclusionsPsychological suitability measures may apparently be useful in the prediction of overall short-term psychotherapy outcomes.
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Heinonen E, Lindfors O, Laaksonen MA, Knekt P. Therapists' professional and personal characteristics as predictors of outcome in short- and long-term psychotherapy. J Affect Disord 2012; 138:301-12. [PMID: 22335889 DOI: 10.1016/j.jad.2012.01.023] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 10/14/2022]
Abstract
BACKGROUND Short- and long-term psychotherapies have been found effective for treating mood and anxiety disorders. Although psychotherapists differ in their effectiveness, virtually no comparative research exists on the therapist characteristics beneficial to short- or long-term therapy. METHODS Altogether 326 outpatients, aged 20-46 years, and suffering from mood or anxiety disorder, were randomly assigned to either short-term (solution-focused or psychodynamic therapy, combined) or long-term (psychodynamic) psychotherapy, and were followed up for 3 years. Therapies were provided by 55 volunteering therapists with at least 2 years of work experience in the given form of therapy. Therapists' professional and personal characteristics, measured before randomization, were assessed with the Development of Psychotherapists Common Core Questionnaire (DPCCQ). Patients' general psychiatric symptoms were assessed as the main outcome measure at baseline and 3, 7, 9, 12, 18, 24 and 36 months after start of treatment with the Symptom Check List, Global Severity Index (SCL-90-GSI). RESULTS Active, engaging, and extroverted therapists produced a faster symptom reduction in short-term therapy than in long-term therapy. More cautious, non-intrusive therapists generated greater benefits in long-term therapy during the 3-year follow-up. Therapists' lower confidence and enjoyment in therapeutic work predicted poorer outcomes in short-term therapy in the long run. LIMITATIONS Generalizability may be limited due to relatively experienced therapists. CONCLUSIONS Therapist characteristics apparently are important determinants of effectiveness of short- and long-term psychotherapy. If confirmed in future studies, results may be applied in training and supervision of therapists as well as in fitting therapy forms with therapist dispositions to maximize treatment benefits.
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Affiliation(s)
- Erkki Heinonen
- National Institute for Health and Welfare, Helsinki, Finland
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Laaksonen MA, Lindfors O, Knekt P, Aalberg V. Suitability for Psychotherapy Scale (SPS) and its reliability, validity, and prediction. British Journal of Clinical Psychology 2012; 51:351-75. [DOI: 10.1111/j.2044-8260.2012.02033.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maljanen T, Paltta P, Harkanen T, Virtala E, Lindfors O, Laaksonen MA, Knekt P. The cost-effectiveness of short-term psychodynamic psychotherapy and solution-focused therapy in the treatment of depressive and anxiety disorders during a one-year follow-up. J Ment Health Policy Econ 2012; 15:13-23. [PMID: 22611089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 02/18/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Mood and anxiety disorders are characterized by a high and increasing prevalence, they cause a lot of costs and human suffering and there are many treatment options with differing costs. The benefits of identifying the treatments with the most favourable cost-effectiveness ratios can be substantial. However, the number of randomized trials where psychological treatments are compared with each other and where economic aspects, too, are taken into account is still relatively small. AIM To compare the cost-effectiveness of two short-term psychotherapies in the treatment of depressive and anxiety disorders during a one-year follow-up. METHODS In the Helsinki Psychotherapy Study, 198 patients, who were 20--45 years of age and met DSM-IV criteria for anxiety or mood disorder, were randomized to short-term psychodynamic psychotherapy (SPP) or solution-focused therapy (SFT). Psychiatric symptoms were assessed at baseline and 4 times during the one-year follow-up from the start of therapy using the Beck Depression Inventory and the Symptom Check List Anxiety Scale, and 2 times using the Hamilton Depression Rating Scales and Hamilton Anxiety Rating Scales. Both direct costs (therapy sessions, outpatient visits, medication, inpatient care) and indirect costs (production losses due to work absenteeism, value of neglected household work, lost leisure time and unpaid help received) due to mental disorders were measured. Mean total costs were compared and incremental cost-effectiveness ratios analyzed. RESULTS According to all 4 psychiatric outcome measures, symptoms of depression and anxiety were reduced statistically significantly in both therapy groups during the one-year follow-up. The relative changes were about the same size according to all four outcome measures. In both groups the reductions took place mainly in the first half of the follow-up. The reductions were somewhat greater with SPP, but the differences between the two groups were small and not statistically significant at any measurement point. The mean total direct costs were 1791 euros in the SPP group, being 346 euros (16%) lower than those of the SFT group, but this difference was not statistically significant either. Also the incremental cost-effectiveness ratio points calculated by 500 bootstrap iterations favoured SPP. The total indirect costs in the SPP group were, in contrast to direct costs, higher than those in the SFT group, but, again, the difference was not statistically significant. LIMITATIONS The generalization of our results may be weakened by the fact that the patients included in our study were relatively young, and the follow-up period was restricted to one year. IMPLICATIONS This study suggests that there are no notable differences in cost-effectiveness between SPP and SFT. If one were obliged to choose between these two therapies our results would support the choice of SPP. However, more research with extensive data about both costs and effectiveness, compiled over a period longer than one year, are needed before any firm conclusions can be drawn about the cost-effectiveness of the two therapies compared in this study.
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Affiliation(s)
- Timo Maljanen
- Social Insurance Institution, PO Box 450, 00101 Helsinki, Finland.
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Knekt P, Lindfors O, Virtala E, Härkänen T, Sares-Jäske L, Laaksonen M. P-1153 - The effectiveness of short- and long-term psychotherapy during a 7-year follow-up. Eur Psychiatry 2012. [DOI: 10.1016/s0924-9338(12)75320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Knekt P, Lindfors O, Sares-Jäske L, Laaksonen M. [The effectiveness of psychotherapy on depression in the long term]. Duodecim 2012; 128:267-274. [PMID: 22428380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Different short-term therapies, mainly with short follow-ups, seem equally effective treatments of mood disorders. The Helsinki Psychotherapy Study is the only published randomized trial on the effectiveness of short-term and long-term therapies during a longer follow-up. During a 5-year follow-up, patients' recovery from symptoms and improvement in work ability were greater in long-term therapy than in two, equally effective, short-term therapies. The short-term therapies were, however, more cost-effective, but many patients in them did not recover. More randomized clinical trials and cohort studies with long follow-ups on the efficacy, sufficiency and suitability of short- and long-term therapy are thus needed.
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Affiliation(s)
- Paul Knekt
- Terveyden ja hyvinvoinnin laitos, Väestön terveydentila -yksikkö
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Knekt P, Lindfors O, Renlund C, Sares-Jäske L, Laaksonen MA, Virtala E. Use of auxiliary psychiatric treatment during a 5-year follow-up among patients receiving short- or long-term psychotherapy. J Affect Disord 2011; 135:221-30. [PMID: 21871667 DOI: 10.1016/j.jad.2011.07.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 07/28/2011] [Accepted: 07/28/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND The need for treatment is, despite of its obvious usefulness, a scarcely used measure of effectiveness in psychotherapy trials. This study considers changes in the need for auxiliary psychiatric treatment after starting short- and long-term psychotherapy and psychoanalysis. METHODS Altogether 326 psychiatric outpatients with mood or anxiety disorder were randomly assigned to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP), or long-term psychodynamic psychotherapy (LPP) while 41 self-selected patients were allocated to psychoanalysis (PA). The patients were followed for 5 years from start of treatment. Outcome measures were use of auxiliary psychotherapy, psychotropic medication, and hospitalization for mental reasons. RESULTS About 60% of the patients used auxiliary treatment during the follow-up. It was most common in the short-term therapy groups and its incidence was highest during the first year after the start of therapy. The average numbers of all therapy sessions among patients starting the therapy were 60, 70, 240, and 670 in SFT, SPP, LPP, and PA, respectively, whereas the corresponding average numbers of study therapy sessions alone were 10, 19, 232, and 646. Over 50% of the patients receiving short-term therapy received on average 4-6 times more therapy sessions than initially assigned. LIMITATIONS Post-randomization withdrawal was uneven. CONCLUSIONS Auxiliary treatment is usual among patients receiving short- and long-term therapies, and apparently becomes common shortly after the start of treatment. Auxiliary treatment can be used as an outcome measure indicating the need for treatment, should be monitored clinically and considered when interpreting the results of effectiveness studies.
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Affiliation(s)
- Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland.
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Abstract
Psychotherapy is widely held to be an effective means to decrease depression. It seems, however, that not everyone benefits from every kind of therapy, and the relevant outcomes vary from person to person. In this article, the pre-therapy views and post-therapy experiences of 14 users of either long-term psychodynamic psychotherapy or short-term solution-focused therapy are analyzed. The interviewees' personal views about their depression and therapy are approached with the concept of inner narrative. Three "basic stories" or orientations were found: life historical, situational and moral. These offered people different contexts from which to evaluate the outcomes of their therapy. The findings suggest that a person's expectations, hopes and values are worth taking into account to ensure positive therapy outcomes.
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Affiliation(s)
- Jukka Valkonen
- University of Eastern Finland, Department of Social Sciences, Kuopio, Finland.
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Knekt P, Lindfors O, Laaksonen MA, Renlund C, Haaramo P, Härkänen T, Virtala E. Quasi-experimental study on the effectiveness of psychoanalysis, long-term and short-term psychotherapy on psychiatric symptoms, work ability and functional capacity during a 5-year follow-up. J Affect Disord 2011; 132:37-47. [PMID: 21316768 DOI: 10.1016/j.jad.2011.01.014] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 01/17/2011] [Accepted: 01/17/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychotherapy is apparently an insufficient treatment for some patients with mood or anxiety disorder. In this study the effectiveness of short-term and long-term psychotherapies was compared with that of psychoanalysis. METHODS A total of 326 psychiatric outpatients with mood or anxiety disorder were randomly assigned to solution-focused therapy, short-term psychodynamic and long-term psychodynamic psychotherapies. Additionally, 41 patients suitable for psychoanalysis were included in the study. The patients were followed from the start of the treatment and assessed 9 times during a 5-year follow-up. The primary outcome measures on symptoms were the Beck Depression Inventory, the Hamilton Depression and Anxiety Rating Scales, and the Symptom Check List, anxiety scale. Primary work ability and functional capacity measures were the Work Ability Index, the Work-subscale of the Social Adjustment Scale, and the Perceived Psychological Functioning Scale. RESULTS A reduction in psychiatric symptoms and improvement in work ability and functional capacity was noted in all treatment groups during the 5-year follow-up. The short-term therapies were more effective than psychoanalysis during the first year, whereas the long-term therapy was more effective after 3years of follow-up. Psychoanalysis was most effective at the 5-year follow-up, which also marked the end of the psychoanalysis. CONCLUSIONS Psychotherapy gives faster benefits than psychoanalysis, but in the long run psychoanalysis seems to be more effective. Results from trials, among patients suitable for psychoanalysis and with longer follow-up, are needed before firm conclusions about the relative effectiveness of psychoanalysis and psychotherapy in the treatment of mood and anxiety disorders can be drawn.
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Affiliation(s)
- Paul Knekt
- Social Insurance Institution, Helsinki, Finland.
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Knekt P, Lindfors O, Laaksonen MA. Review: long term psychodynamic psychotherapy improves outcomes in people with complex mental disorders. Evid Based Ment Health 2009; 12:56. [PMID: 19395615 DOI: 10.1136/ebmh.12.2.56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland
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