Short-Term Psychodynamic Psychotherapy and Cognitive-Behavioral Therapy in Generalized Anxiety Disorder: A Randomized, Controlled Trial

Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany.
American Journal of Psychiatry (Impact Factor: 12.3). 08/2009; 166(8):875-81. DOI: 10.1176/appi.ajp.2009.09030441
Source: PubMed


While several studies have shown that cognitive-behavioral therapy (CBT) is an efficacious treatment for generalized anxiety disorder, few studies have addressed the outcome of short-term psychodynamic psychotherapy, even though this treatment is widely used. The aim of this study was to compare short-term psychodynamic psychotherapy and CBT with regard to treatment outcome in generalized anxiety disorder.
Patients with generalized anxiety disorder according to DSM-IV were randomly assigned to receive either CBT (N=29) or short-term psychodynamic psychotherapy (N=28). Treatments were carried out according to treatment manuals and included up to 30 weekly sessions. The primary outcome measure was the Hamilton Anxiety Rating Scale, which was applied by trained raters blind to the treatment conditions. Assessments were carried out at the completion of treatment and 6 months afterward.
Both CBT and short-term psychodynamic psychotherapy yielded significant, large, and stable improvements with regard to symptoms of anxiety and depression. No significant differences in outcome were found between treatments in regard to the primary outcome measure. These results were corroborated by two self-report measures of anxiety. In measures of trait anxiety, worry, and depression, however, CBT was found to be superior.
The results suggest that CBT and short-term psychodynamic psychotherapy are beneficial for patients with generalized anxiety disorder. In future research, large-scale multicenter studies should examine more subtle differences between treatments, including differences in the patients who benefit most from each form of therapy.

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    • "Results showed a significant reduction in worry and anxiety symptoms. In the most recent trial comparing CBT and short-term psychodynamic therapy, both treatments were mostly equally effective, however CBT was superior regarding measures of trait anxiety, worry and reduction of comorbid depression (Leichsenring et al., 2009). "
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    ABSTRACT: Five types of intervention may be of special relevance and in consequence have been included in treatments targeting generalized anxiety disorder (GAD) symptomology: metacognitive therapy targeting both negative and positive metacognitions concerning worrying; fear imagery exposure, based on the avoidance theory of worrying; interventions developed to increase tolerance of uncertainty; relaxation exercises; and finally, treatment modules focusing on negative problem orientation. This chapter first describes the diagnostic procedures most helpful for the preparation of treatment and then the treatment modules. All these modules have been included in manualized treatments, which have been evaluated with regard to their efficacy in a number of RCTs. The chapter presents an overview of the evidence for the efficacy of variations of this cognitive-behavioral treatment (CBT). Applied relaxation is one of the most regularly used components within standard CBTs for GAD. Besides cognitive-behavioral therapy and psychodynamic psychotherapy, pharmacotherapy offers another evidence-based treatment option for GAD.
    The Wiley Handbook of Anxiety Disorders, 04/2014: pages 1003-1037; , ISBN: 9781118775356
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    • "Psychodynamic psychotherapy is a psychological treatment approach that has a growing empirical base (Town et al., 2012), with research support for e.g., depression (Driessen et al., 2010), social anxiety disorder (Leichsenring et al., 2013), panic disorder (Milrod et al., 2007), and generalized anxiety disorder (Leichsenring et al., 2009). There is a variation among the psychodynamic therapies in the degree to which they focus on expression and experience of affect. "
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    ABSTRACT: Background. Psychodynamic psychotherapy is a psychological treatment approach that has a growing empirical base. Research has indicated an association between therapist-facilitated affective experience and outcome in psychodynamic therapy. Affect-phobia therapy (APT), as outlined by McCullough et al., is a psychodynamic treatment that emphasizes a strong focus on expression and experience of affect. This model has neither been evaluated for depression nor anxiety disorders in a randomized controlled trial. While Internet-delivered psychodynamic treatments for depression and generalized anxiety disorder exist, they have not been based on APT. The aim of this randomized controlled trial was to investigate the efficacy of an Internet-based, psychodynamic, guided self-help treatment based on APT for depression and anxiety disorders.Methods. One hundred participants with diagnoses of mood and anxiety disorders participated in a randomized (1:1 ratio) controlled trial of an active group versus a control condition. The treatment group received a 10-week, psychodynamic, guided self-help treatment based on APT that was delivered through the Internet. The treatment consisted of eight text-based treatment modules and included therapist contact (9.5 min per client and week, on average) in a secure online environment. Participants in the control group also received online therapist support and clinical monitoring of symptoms, but received no treatment modules. Outcome measures were the 9-item Patient Health Questionnaire Depression Scale (PHQ-9) and the 7-item Generalized Anxiety Disorder Scale (GAD-7). Process measures were also included. All measures were administered weekly during the treatment period and at a 7-month follow-up.Results. Mixed models analyses using the full intention-to-treat sample revealed significant interaction effects of group and time on all outcome measures, when comparing treatment to the control group. A large between-group effect size of Cohen’s d = 0.77 (95% CI: 0.37–1.18) was found on the PHQ-9 and a moderately large between-group effect size d = 0.48 (95% CI: 0.08–0.87) was found on the GAD-7. The number of patients who recovered (had no diagnoses of depression and anxiety, and had less than 10 on both the PHQ-9 and the GAD-7) were at post-treatment 52% in the treatment group and 24% in the control group. This difference was significant, χ2(N = 100, d f = 1) = 8.3, p < .01. From post-treatment to follow-up, treatment gains were maintained on the PHQ-9, and significant improvements were seen on the GAD-7.Conclusion. This study provides initial support for the efficacy of Internet-delivered psychodynamic therapy based on the affect-phobia model in the treatment of depression and anxiety disorders. The results support the conclusion that psychodynamic treatment approaches may be transferred to the guided self-help format and delivered via the Internet.
    PeerJ 07/2013; 1(Suppl 2):e102. DOI:10.7717/peerj.102 · 2.11 Impact Factor
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    • "A convergence of findings from RCTs, metaanalyses , and effectiveness studies in aggregate indicates a value to these approaches, and the value appears to be equivalent to that of CBT. In terms of RCTs, there are now a number of studies suggesting the efficacy of psychodynamic and humanistic existential psychotherapies for a range of disorders, including depression (Cooper, Murray, Wilson, & Romaniuk, 2003; de Jonghe et al., 2004; Watson, Gordon, Stermac, Kalogerakos , & Steckley, 2003), anxiety disorders (Leichsenring et al., 2009; Milrod, Leon, Busch, et al., 2007), and borderline personality disorder (Bateman & Fonagy, 1999, 2008; Clarkin, Levy, Lenzenweger, & Kernberg, 2007; Doering et al., 2010), as well as marital discord therapy (Snyder, Wills, & Grady-Fletcher, 1991). One particularly important example is the work of Milrod, Leon, Busch, et al. (2007), who in an RCT compared a short-term PDT for panic disorder with applied relaxation therapy. "
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    ABSTRACT: Longitudinal data of psychotherapy theoretical orientations (PTO) for faculty from within clinical psychology programs were analyzed for a period of over two decades. Results from multilevel modeling demonstrated that clinical psychology has moved from a field that was relatively balanced in percentages of faculty from cognitive-behavioral (CBT), psychodynamic, humanistic, behavioral, and family PTOs to one that has shown highly significant linear growth for a single PTO: CBT. All other PTOs (except family) showed significant linear decline. To some extent, important research findings from other PTOs have been co-opted into CBT, but essential aspects of this work have been stripped down, muddied, or lost in a conflation with CBT treatments. We suggest that the field has lost significant intellectual diversity during the past two decades and identify how intellectual monocultures have been damaging to the success of other scientific disciplines and research groups. Tangible solutions are offered to correct this trend, including the establishment of an intellectual diversity task force, the APA's dissuasion of the establishment of monocultures within its evaluation of training, increased support for research investigation of more diverse approaches to psychotherapy, organizing of minority PTOs in order to lobby for larger research and professional training goals, and increased mentoring opportunities from minority PTO faculty.
    Clinical Psychology Science and Practice 06/2013; 20(2):211-220. DOI:10.1111/cpsp.12035 · 2.92 Impact Factor
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