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.
    Full-text · Article · Sep 2014 · Psychodynamic Psychiatry
    • "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.
    No preview · Article · Apr 2014 · Contemporary psychoanalysis
    • "Multivariate meta-regression analyses in which more than one predictor was entered simultaneously were conducted in STATA/MP 11.0 for Mac, because these analyses cannot be conducted in Comprehensive Meta-analysis. Publication bias was tested by inspecting the funnel plot on primary outcome measures and by Duval and Tweedie's trim and fill procedure (Borenstein et al., 2009), which yields an estimate of the outcomes after publication bias has been taken into account (as implemented in Comprehensive Meta-analysis, version 2.2.021). Fig. 1presents a flowchart describing the inclusion process. "
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    ABSTRACT: Background Standardised effect sizes have been criticized because they are difficult to interpret and offer little clinical information. This meta-analyses examine the extent of actual improvement, the absolute numbers of patients no longer meeting criteria for major depression, and absolute rates of response and remission. Methods We conducted a meta-analysis of 92 studies with 181 conditions (134 psychotherapy and 47 control conditions) with 6937 patients meeting criteria for major depressive disorder. Within these conditions, we calculated the absolute number of patients no longer meeting criteria for major depression, rates of response and remission, and the absolute reduction on the BDI, BDI-II, and HAM-D. Results After treatment, 62% of patients no longer met criteria for MDD in the psychotherapy conditions. However, 43% of participants in the control conditions and 48% of people in the care-as-usual conditions no longer met criteria for MDD, suggesting that the additional value of psychotherapy compared to care-as-usual would be 14%. For response and remission, comparable results were found, with less than half of the patients meeting criteria for response and remission after psychotherapy. Additionally, a considerable proportion of response and remission was also found in control conditions. In the psychotherapy conditions, scores on the BDI were reduced by 13.42 points, 15.12 points on the BDI-II, and 10.28 points on the HAM-D. In the control conditions, these reductions were 4.56, 4.68, and 5.29. Discussion Psychotherapy contributes to improvement in depressed patients, but improvement in control conditions is also considerable.
    No preview · Article · Apr 2014 · Journal of Affective Disorders
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