A systematic review of controlled trials of the effectiveness and cost effectiveness of brief psychological treatments of depression

Institute of Psychiatry, King's College London, UK.
Health technology assessment (Winchester, England) (Impact Factor: 5.03). 02/2001; 5(35):1-173. DOI: 10.3310/hta5350
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    • "Each of these metaanalyses suggests good evidence for the efficacy of psychodynamic psychotherapy and CBT (Crits-Christoph, 1992; Leichenring, 2001). A number of these studies compared effect sizes in PDT with that of CBT (Churchill et al., 2002; Gloaguen et al., 1998; Svartberg & Stiles, 1991). In the Churchill et al. review, the authors found no significant differences between groups post-treatment with regard to symptoms, symptom reduction , or dropout. "
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    ABSTRACT: Abstract The growing number of individuals seeking treatment for mental disorders calls for intelligent and responsible decisions in health care politics. However, the current relative decrease in reimbursement of effective psychotherapy approaches occurring in the context of an increase in prescription of psychotropic medication lacks a scientific base. Using psychodynamic psychotherapy as an example, we review the literature on meta-analyses and recent outcome studies of effective treatment approaches. Psychodynamic psychotherapy is an effective treatment for a wide variety of mental disorders. Adding to the known effectiveness of other shorter treatments, the results indicate lasting change in many cases, especially for complex and difficult to treat patients, ultimately reducing health-care utilization. Research-informed health care decisions that take into account the solid evidence for the effectiveness of psychotherapy, including psychodynamic psychotherapy, have the potential to promote choice, increase mental health, and reduce society's burden of disease in the long run.
    Psychodynamic Psychiatry 09/2014; 42(3):377-421. DOI:10.1521/pdps.2014.42.3.377
    • "The first meta-analysis (Leichsenring, 2001) included six studies comparing PT with CBT and found that both psychotherapies were equally effective in the treatment of depression, a result the author suggested should be regarded as preliminary, due to the small number of included studies. The second meta-analysis (Churchill et al., 2001) compared PT to CBT and found that patients receiving CBT were more likely to recover than those receiving PT, but found no differences in posttreatment symptoms, symptom reduction, or drop-out. The third meta-analysis of our own research group (Driessen et al., 2007) was the most extensive study, and included many more trials than the first two meta-analyses. "
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    ABSTRACT: Psychodynamic therapy (PT) for depression is the least examined treatment method for depression, compared to cognitive-behavioral therapy (CBT) and interpersonal therapy. This article, consisting of five randomized clinical trials of short psychodynamic supportive psychotherapy (SPSP) conducted over the last 25 years in Amsterdam, will review the trial results to provide answers to the question about which role SPSP can play in the treatment of depression. The researchers conclude that it is justified to qualify SPSP an empirically supported therapy form of PT for depression. In particular, adding SPSP to pharmacotherapy yields better results than pharmacotherapy by itself. Adding medication to SPSP may have a significant added value, but it is not as large as in the first comparison. The results also confirm no difference in efficacy between CBT and SPSP.
    Contemporary psychoanalysis 04/2014; 50(1-2):131-155. DOI:10.1080/00107530.2014.880312 · 0.33 Impact Factor
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    • "The evidence for clinical effectiveness of brief talking therapies in depressive and anxiety disorders is strongest for cognitive behaviour therapy (CBT). Despite this consensus, not all patients given CBT improve (Churchill et al. 2001) and some may do better with, or prefer, other forms of talking therapy such as psychodynamic psychotherapy, non-directive counselling (NDC) and interpersonal psychotherapy. Less evidence for the effectiveness of these therapies has been published than for CBT. "
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    ABSTRACT: Most evidence in the UK on the effectiveness of brief therapy for depression concerns cognitive behaviour therapy (CBT). In a trial published in 2000, we showed that non-directive counselling and CBT were equally effective in general practice for patients with depression and mixed anxiety and depression. Our results were criticized for including patients not meeting diagnostic criteria for a depressive disorder. In this reanalysis we aimed to compare the effectiveness of the two therapies for patients with an ICD-10 depressive episode. Patients with an ICD-10 depressive episode or mixed anxiety and depression were randomized to counselling, CBT or usual general practitioner (GP) care. Counsellors provided nondirective, interpersonal counselling following a manual that we developed based on the work of Carl Rogers. Cognitive behaviour therapists provided CBT also guided by a manual. Modelling was carried out using generalized estimating equations with the multiply imputed datasets. Outcomes were mean scores on the Beck Depression Inventory, Brief Symptom Inventory, and Social Adjustment Scale at 4 and 12 months. A total of 134 participants were randomized to CBT, 126 to counselling and 67 to usual GP care. We undertook (1) an interaction analysis using all 316 patients who were assigned a diagnosis and (2) a head-to-head comparison using only those 130 (41%) participants who had an ICD-10 depressive episode at baseline. CBT and counselling were both superior to GP care at 4 months but not at 12 months. There was no difference in the effectiveness of the two psychological therapies. We recommend that national clinical guidelines take our findings into consideration in recommending effective alternatives to CBT.
    Psychological Medicine 10/2013; 44(9):1-10. DOI:10.1017/S0033291713002377 · 5.94 Impact Factor
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