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Short-Term Psychodynamic Psychotherapy for Personality Disorders: A Critical Review of Randomized Controlled Trials
Abstract
The research evidence for Short-Term Psychodynamic Psychotherapy (STPP) in the treatment of personality disorders (PD) was examined through consideration of studies utilizing randomized controlled designs. An extensive literature search revealed eight published Randomized Controlled Trials (RCT) of moderate study quality. A critical review of this literature is offered to provide an evidence-based guidance for clinicians and implications for treatments are discussed. Preliminary conclusions suggest STPP may be considered an efficacious empirically-supported treatment option for a range of PDs, producing significant and medium to long-term improvements for a large percentage of patients. Further research is recommended to allow comparisons with alternative evidence-based approaches.
... A series of studies have found manualized short-term PDT to be efficacious and effective for treating different PDs [10][11][12][13][14], whereas the evidence for long-term PDT, often being less structured and eclectic, is very limited and conflicting [7,13,15,16]. A reason for this may be that it is complicated, if not impossible, to design appropriate trials. ...
... Manualized PDT and MBT treatments have been found to be effective in clinical efficacy and effectiveness studies [10][11][12][13][14]18,19]. However, patients with PD do not in general receive this treatment, but rather more traditional and nonmanualized approaches of PDT combined with MBT [8,14,[22][23][24]. ...
... Furthermore, several early studies have shown that manualized PDT treatment is more effective than non-manualized treatment [10]. Also, most contemporary clinical trials examining manualized PDT have been implemented under 'realworld' clinical conditions (heterogeneous patient populations, routine care therapists, and the training, delivery and monitoring of the intervention) and do not typically exceed that which the setting currently affords [7,[10][11][12][13]15,18,19]. Hence, in the efficacy versus effectiveness continuum, these studies may be regarded as effectiveness studies and are therefore applicable in routine care settings. ...
Objectives: Patients with personality disorders (PDs) are often treated with non-manualized psychodynamic group therapy (PDT) lasting for several years. Non-manualized PDT often combine a variety of therapeutic approaches from different PDT traditions, including mentalization-based therapy. Currently, little is known about the effect of this long-term, costly treatment. This study investigated the extent to which patient groups with different PDs benefit from mentalization-oriented PDT as it is implemented in clinical practice in terms of symptom severity, interpersonal problems, and general functioning.
Methods: The design was a naturalistic, prospective cohort study. A total sample of 75 consecutive PD patients were assessed before treatment with the Symptom Checklist-90 Revised (SCL-90-R) as the primary outcome measure and the Inventory of Interpersonal Problems (IIP) and Global Assessment of Functioning (GAF) as secondary outcome measures. The sample repeatedly assessed every 12 months for up to 36 months. Paired t-tests were applied to examine the effectiveness of the intervention.
Results: Fifty-six percent (n= 42) of the patients completed treatment. Among completers, improvement was observed on the SCL-90-R Global Severity Index (mean change= -0.45, 95% CI=(-0.72)-(-0.19), Cohen’s d=-0.55), Positive Symptom Distress Index (mean change=-0.40, 95%CI=(-0.63)-(-0.17), Cohen’s d=-0.56) and Positive Symptoms Total (mean change=-10.70, 95%CI=(-17.31)-(-4.09), Cohen’s d=-0.52). Secondary outcome measures also improved: IIP-total (mean change=-0.50, 95%CI=(-0.74)-(-0.25), Cohen’s d=-0.66), GAF-Functioning (mean change=8.79, 95%CI=6.32-11.27, Cohen’s d=1.15) and GAF-Symptoms (mean change=10.67, 95%CI=8.09-13.25, Cohen’s d=1.34).
Conclusions: Patients completing mentalization-oriented PDT group therapy improved on symptom severity, interpersonal problems, and general functioning, with within-group effect sizes ranging from medium to large. Approximately half the sample dropped out, suggesting that PDT spanning several years may be unrealistic for many patients with PD.
... There is growing empirical support for the efficacy of shortterm psychodynamic psychotherapy (STPP) in common psychiatric conditions among adults. For example, meta-analytic reviews suggest that STPP outperforms inactive controls (e.g., wait list, treatment as usual) in the treatment of depression (Driessen et al., 2010), anxiety disorders (Keefe, McCarthy, Dinger, Zilcha-Mano, & Barber, 2014), personality disorders (Town, Abbass, & Hardy, 2011) and somatic disorders (Abbass, Kisely, & Kroenke, 2009). In a recent Cochrane Library review update, Abbass et al. (2014) concluded that STPP "may be effective for a very broad range of common mental disorders . . ...
... Overall, our results mirror those of recently published reviews of psychodynamic therapies (Abbass et al., 2014;Barber et al., 2013;de Maat et al., 2009;Leichsenring & Rabung, 2008;Town et al., 2011. For example, similar to our results, Abbass et al. (2014) found moderate between-groups effects (ds ϭ 0.42-0.71) ...
Experiential dynamic therapy (EDT) is a subgroup of short-term psychodynamic psychotherapy (STPP) that emphasizes patients’ in-session affective processing. To evaluate the efficacy of EDT for psychiatric conditions, we conducted a meta-analysis of randomized controlled trials. Twenty-eight studies published between 1978 and 2014 were included, encompassing 1,782 adult patients with mood, anxiety, personality, or mixed disorders. Across targeted outcome domains, medium-size between-groups effects (Cohen’s ds ranging from 0.39 to 0.65) favored EDT over inactive controls at posttreatment and in symptom measures at follow-up. We found no differences between EDT and active treatments (e.g., medication, cognitive–behavioral therapy, manualized supportive therapy) at posttreatment, but EDT outperformed supportive therapy at follow-up (d = 0.75). In terms of within-group effect sizes, EDT was associated with large improvements in general psychiatric symptoms (d = 1.11), depression (d = 1.33), and anxiety (d = 1.09) and with small to moderate gains in the areas of interpersonal problems (d = 0.55) and global functioning (d = 0.86). Small but significant effects suggested continued improvement between posttreatment and follow-up. Heterogeneity in pre–post effects was explored in subgroup analyses, which indicated that EDT might be most effective in depressive disorders and that individual EDT had larger effects compared with group treatment. In addition, EDT performed better in higher quality studies. We conclude that EDT is a promising treatment for psychiatric conditions in adults. Further high-quality studies evaluating contemporary versions of EDT in specific psychiatric conditions are warranted.
... At present, two meta-analyses on the effects of psychodynamic psychotherapy in personality disorders are available (Leichsenring & Leibing, 2003;Town, Abbass, & Hardy, 2011). A meta-analysis addressing the effects of psychodynamic psychotherapy and CBT in personality disorders reported that psychodynamic psychotherapy yielded large effects sizes not only for comorbid symptoms, but also for core personality pathology (Leichsenring & Leibing, 2003). ...
... This was true especially for BPD. A more Downloaded by [Falk Leichsenring] at 03:29 23 April 2014 recent meta-analysis by Town et al. (2011) included seven RCTs on shortterm psychodynamic psychotherapy in personality disorders. The authors drew the preliminary conclusion that psychodynamic psychotherapy may be considered an efficacious empirically supported treatment option for a wide range of personality disorders, producing significant and medium to long-term improvements for a large percentage of patients. ...
This article reviews the empirical evidence for psychodynamic therapy for specific mental disorders in adults. The focus is on randomized controlled trials (RCTs). However, this does not imply that RCTs are uncritically accepted as the gold standard for demonstrating that a treatment works. According to the results presented here, there is evidence from RCTs that psychodynamic therapy is efficacious in common mental disorders, that is, depressive disorders, anxiety disorders, somatic symptom disorders, personality disorders, eating disorders, complicated grief, posttraumatic stress disorder (PTSD), and substance-related disorder. These results clearly contradict assertions repeatedly made by representatives of other psychotherapeutic approaches claiming psychodynamic psychotherapy is not empirically supported. However, further research is needed, both on outcome and processes of psychodynamic psychotherapy. There is a need, for example, for RCTs of psychodynamic psychotherapy of PTSD. Furthermore, research on long-term psychotherapy for specific mental disorders is required.
... Leibing 2003) belegte, dass psychodynamische Therapien wirksam in der Behandlung von Persönlichkeitsstörungen sind und es hierbei keine Wirksamkeitsunterschiede zur Verhaltenstherapie gibt. Dies wird auch durch später publizierte RCT zur übertragungsfokussierten Psychotherapie (TFP; Clarkin et al. 2007; Doering et al. 2010 ) oder mentalisierungsbasierten Therapie (MBT; Fonagy et al. 2009; Jørgensen et al. 2012) sowie durch eine aktuelle Metaanalyse zu psychodynamischen Kurzzeittherapien gestützt (Town et al. 2011 ). Ein aus Sicht der Objektbeziehungstheorie interessanter Befund ist, dass es in der New Yorker Vergleichsstudie (Clarkin et al. 2007) nur bei Patienten in Behandlung mit TFP zu einer Veränderung des Bindungsstatus von unsicher zu sicher kam, nicht jedoch in den anderen Therapiebedingungen (auch: Levy et al. 2012). ...
... Ein aus Sicht der Objektbeziehungstheorie interessanter Befund ist, dass es in der New Yorker Vergleichsstudie (Clarkin et al. 2007) nur bei Patienten in Behandlung mit TFP zu einer Veränderung des Bindungsstatus von unsicher zu sicher kam, nicht jedoch in den anderen Therapiebedingungen (auch: Levy et al. 2012). In der Behandlung der in der Praxis wichtigen Gruppe von depressiven Patienten mit komorbider Persönlichkeitsstörung waren psychodynamische Psychotherapien ebenfalls hoch wirksam (Abbass et al. 2011). Eine besondere Stellung nimmt eine kanadische Studie zur Behandlung von Borderline-Persönlichkeitsstörungen ein. ...
Die Frage nach der Wirksamkeit psychodynamischer Behandlungsverfahren hat in berufspolitischen und wissenschaftlichen Debatten der letzten Jahre einen hohen Stellenwert eingenommen. In diese Zeit fällt eine Vielzahl weiterer Studienergebnisse mit neuen Effektivitätsnachweisen. Ziel des vorliegenden Beitrags ist es, einen überblick über aktuelle Ergebnisse der psychodynamischen Psychotherapieforschung zu geben, mit einem Schwerpunkt auf Metaanalysen und randomisierten Vergleichsstudien. Die Ergebnisse zeigen, dass es für eine große Anzahl von Störungsbildern mittlerweile Effektivitätsnachweise auf einer robusten Datengrundlage gibt. Die methodische Qualität der aktuellen Studien ist gut; auch der Vergleich mit anderen Therapieverfahren braucht nicht gescheut zu werden. Gleichzeitig sind weitere Studien notwendig, sowohl in Bezug auf Störungsbilder als auch Praxisstudien zur Abbildung der Wirksamkeit in der Breite der Anwendung im Alltag.
Abstract
The effectiveness of psychodynamic psychotherapy has been a “hot topic” in scientific and healthcare related debates in recent years. During this time a significant amount of new evidence supporting the effectiveness of psychodynamic psychotherapy has been published. The paper provides an overview on current psychodynamic psychotherapy research, with a focus on meta-analytic findings and randomized effectiveness trials. The results in the literature show robust evidence for the effectiveness of psychodynamic therapies for a wide range of psychiatric disorders. The methodological quality of current studies is good and comparative trials with other forms of psychotherapy yield mostly equivalent results. However, further studies are needed with regard to different mental disorders as well as effectiveness studies in everyday practice.
... At present, two meta-analyses on the effects of PDT in personality disorders are available (Leichsenring & Leibing, 2003;Town, Abbass, & Hardy, 2011). A meta-analysis addressing the effects of PDT and CBT in personality disorders Psychoanalytic Psychotherapy 23 ...
... This was true especially for BPD. A more recent meta-analysis by Town et al. (2011) included seven RCTs on STPP in personality disorders. The authors drew the preliminary conclusion that PDT may be considered an efficacious empirically supported treatment option for a wide range of personality disorders, producing significant and medium to long-term improvements for a large percentage of patients. ...
This article reviews the empirical evidence for psychodynamic therapy for specific mental disorders in adults. According to the results presented here, there is evidence from randomized controlled trials (RCTs) that psychodynamic therapy is efficacious in common mental disorders, including depressive disorders, anxiety disorders, somatoform disorders, personality disorders, eating disorders, complicated grief, posttraumatic stress disorder (PTSD), and substance-related disorders. These results clearly contradict assertions repeatedly made by representatives of other psychotherapeutic approaches claiming that psychodynamic psychotherapy is not empirically supported. However, further research is required, both on outcome and processes of psychodynamic psychotherapy. There is a need, for example, for RCTs of psychodynamic psychotherapy of PTSD. Furthermore, research on long-term psychotherapy for specific mental disorders is required.
... Psychodynamic psychotherapy (PDT) has recently undergone extensive study, meta-analysis and review [1] . The clinical benefits of this therapeutic approach are now supported by meta-analyses of randomized controlled trials across mood [1] , somatoform [2] , personality [3] and mixed disorders [4] . The outcome literature, therefore, demonstrates an empirical foundation for the clinical efficacy of PDT. ...
... As the posttreatment changes in baseline measures of brain function correlated with improvement in clinical presentation, these neurobiological changes appear indicative of improvement on a biological level [12-19, 21, 22] . Such improvements in neuroimaging measures might reflect neural correlates of the changes effected by PDT and expressed clinically as symptom reduction [1][2][3][4] . ...
The clinical efficacy of psychodynamic psychotherapy (PDT) has undergone extensive study and review. Recently, researchers have studied the effects of this treatment on brain metabolic or synaptic activity, but the collective findings have never been reviewed. The objective of this review was to describe the findings of all neuroimaging studies of any form of PDT treatment. An extensive literature search through databases along with surveying of research groups were undertaken to acquire all available published studies. Eleven series were included in the final sample, consisting of 2 randomized controlled trials, 5 controlled trials and 4 case series, altogether involving 210 people: 94 healthy controls and 116 people with mood disorders, panic disorder, somatoform disorders and borderline personality disorder. A variety of neuroimaging techniques were used to examine regional metabolic activity and synaptic neurotransmission before and after treatment. The common finding was normalization of synaptic or metabolic activity in limbic, midbrain and prefrontal regions, occurring in association with improved clinical outcomes. PDT has demonstrable effects on brain function in diverse clinical populations as evidenced by a modest group of mixed neuroimaging studies. © 2014 S. Karger AG, Basel.
... ST helps individuals identify and restructure cognitive schemas associated with unhelpful beliefs, thoughts, emotions, and actions [84]. Additionally, PD is a therapy derived from psychoanalysis that is insight-oriented and invites clients to explore emotional distress through developing skills in selfexploration and self-reflection [85,86] PD in its short-term iteration has also been indicated for successful treatment for individuals living with ASPD, as it encourages individuals to explore and challenge motivations for tasks associated with aggressive behavior [86,87]. Either of these interventions might provide some beneficial results for individuals living with psychopathy who seek treatment. ...
Misunderstanding, stigmatization, and fascination abound in western culture concerning the concepts of psychopathy and sociopathy. These concepts are often used interchangeably-and erroneously-to describe violent or aggressive behavior in humans. These concepts tend also to be hurled as insults at individuals assumed to exhibit a lack empathy, impulsive decision making, and violent behavior. Psychopathy and sociopathy, however, are two concepts that describe different etiologies of the same mental health condition: antisocial personality disorder. This chapter bifurcates between the neurobiological origins of psychopathy and sociopathy, contributing to the destigmatization of a broadly misunderstood mental health condition. This chapter also explores recent findings from functional magnetic resonance imagery studies that analyze neurophysiological activity germane to psychopathy and sociopa-thy. Using these terms, students, clinicians, and researchers have access to a language that outlines correlations in neural substrate activity between genetic antisocial personality disorder (psychopathy) and epigenetic antisocial personality disorder (sociopathy). These terms might also serve to enhance treatment outcomes, as they implicate discrete neural substrates that have the potential to be treated using psycho-therapeutic and psychopharmacological interventions.
... • mild personality disorders -which include, in part, the "neuroses," in the psychoanalytic sense of the term [72][73][74][75]; • anxiety disorders [76]; ...
Objective
Since the 2000s, “mental health” policies in France have to be based on evidence. A report on various forms of psychotherapy, published by the INSERM (the French National Institute of Health and Medical Research) in 2004, and whose conclusion was that there is no evidence of effectiveness for psychoanalysis, remains an important reference. The aim of this article is to re-examine its scientific value, fifteen years later.
Method
After returning to the context in which this report was written and the controversies surrounding its publication, we propose a review of the efficacy studies that have since evaluated psychoanalysis. This recent literature, mostly international, remains relatively little known in France.
Results
The INSERM's expert report – whose status could in part be promoted at the time of its publication – now appears to be relatively dated, both in terms of methodology and in its conclusions. The majority of current efficacy studies show that psychoanalytical and cognitive-behavioral therapies do not show any significant differences in efficacy for all known disorders.
Discussion
These results give rise to debate. Some scientists believe that they are only due to a lack of rigor in the experimental protocols. Others, on the contrary, maintain that the search for specific factors of efficacy is a dead end and promote studies in natural conditions, in order to assess the cumulative contextual factors of therapeutic effectiveness.
Conclusions
Without prejudging future research orientations and results, it nevertheless appears that the INSERM report can no longer be the dominant reference in France today for recommending psychotherapeutic “good practices.” Research has progressed considerably. In view of the international scientific literature available today, psychoanalysis is one offer of care to be advocated among others – a position to which many countries subscribe.
... The efficacy of STPP has been studied in over 250 randomized controlled trials (RCTs) (Lilliengren, 2019), and reviews and meta-analyses of these trials conclude that STPP improves numerous conditions, including depression (Driessen et al., 2015), anxiety (Keefe et al., 2014), personality disorders (Town et al., 2011), and common mental disorders (Abbass et al., 2014). ...
Objective
A recent meta-analysis of 17 randomized, controlled trials (RCTs) showed that Short-term Psychodynamic Psychotherapy (STPP) for functional somatic disorders (FSD) reduced somatic symptoms compared to wait list, minimal treatment, and treatment-as-usual controls. A clinically important yet unanswered question is how much improvement patients experience within STPP treatment.
Methods
Following a systematic search, we identified STPP trials presenting data at baseline and post-treatment/follow-up. Meta-analyses determined the magnitude of changes in somatic symptoms and other outcomes from before to after STPP, and analyses examined effect sizes as a function of study, therapy, and patient variables.
Results
We identified 37 trials (22 pre-post studies and 15 RCTs) totaling 2094 patients treated an average of 13.34 sessions for a range of FSD. Across all studies, somatic symptoms improved significantly from pre-treatment to short-term follow-up with a large effect size (SMD = −1.07), which was maintained at long-term follow-up (SMD = −0.90). After excluding two outlier studies, effects at short- and medium-term follow-up remained significant but were somewhat reduced in magnitude (e.g., short-term SMD = −0.73). Secondary outcomes including anxiety, depression, disability, and interpersonal problems had medium to large effects. Effects were larger for studies of STPP that were longer than 12 sessions or used an emotion-focused type of STPP, and for chronic pain or gastrointestinal conditions than for functional neurological disorders.
Conclusions
STPP results in moderate to large improvements in multiple outcome domains that are sustained in long-term follow-up. STPP is an effective treatment option for FSD and should be included in treatment guidelines.
... Meta-analyses uniformly demonstrate that individual short-term psychodynamic psychotherapy is as effective as CBT for the spectrum of common mental disorders (Abbass et al., 2014). Brief PDT has been demonstrated effective for anxiety disorders (Keefe et al., 2014), depression (Driessen et al., 2015), personality disorders (Town et al., 2011), and somatic symptoms disorders (Abbass et al., 2009, in press). One variety of brief PDT called experiential dynamic therapy and that focuses on feelings related to attachment disruption, outperforms bona fide treatment comparisons as a collective when treating those with a broad range of common mental disorders (Lilliengren et al., 2016). ...
In this article, Canadian psychotherapy researchers and teachers review the state of psychodynamic therapy (PDT) in Canada. We review the ways in which PDT has been implemented, developed and researched within the public and private sector, and how psychoanalytic and psychodynamic practitioners regionally have responded to the challenges of evidence-based practice and the emphasis on empirically supported treatments (EST) as it is defined today. We note that neglect and misrepresentation of the scientific evidence behind PDT has resulted in its marginalization. There is also a dearth of evidence collected to measure the effectiveness of implementing EST. Based on its empirical standing, we propose a model of care that incorporates PDT as an effective, evidence-based model for first line treatment, and also as an alternative for those patients who do not respond to other treatments or who express a preference for PDT or insight-oriented therapy.
... Évaluation des TP brèves d'une durée inférieure à un an L'effet d'une psychothérapie peut être mesuré en comparant l'intensité des symptômes avant et à la fin du traitement (effet « prépost »). La taille de cet effet peut être présentée, soit telle quelle [4][5][6][7][8][9][10][11], soit en comparant avec un traitement contrôle réputé inactif (e.g. un traitement placebo) [3,12,13]. ...
Résumé
Objectif
Le rapport de l’Inserm, évaluant les psychothérapies, date de février 2004. Notre article propose, à un lectorat francophone, une revue systématique des travaux publiés, depuis 2003, et concernant l’efficacité des psychothérapies psychanalytiques sur les troubles mentaux.
Méthodes
Une recherche systématique sur le site PubMed a identifié 71 articles de méta-analyses, publiés entre 2004 et 2019, inclus. Parmi eux, 25 articles ont été jugés pertinents et sont présentés en détail. Nous avons aussi recherché des études de long terme, publiées depuis 2013 et non inclues dans les méta-analyses. Trois études contrôlées et randomisées, comparant une thérapie psychanalytique à des traitements actifs, ont été identifiées.
Résultats
Onze articles de méta-analyses ont évalué l’amélioration des symptômes à l’issue du traitement. Ils concluent tous que l’effet des psychothérapies psychanalytiques est robuste. Dix articles de méta-analyses ont comparé une psychothérapie psychanalytique à un traitement actif (e.g. autre psychothérapie, médication). Un seul rapporte une infériorité cliniquement significative des psychothérapies psychanalytiques par rapport aux psychothérapies cognitivo-comportementales. Cinq articles de méta-analyse et trois études randomisées ont comparé des psychothérapies psychanalytiques de long terme (plus d’un an) à divers traitements actifs. Tous ont conclu à une efficacité des psychothérapies psychanalytiques égale ou supérieure à celle des traitements actifs de comparaison.
Conclusion
Les études concernant les psychothérapies psychanalytiques se sont multipliées depuis 2003 dans les revues biomédicales. Elles montrent que, pour la plupart des troubles mentaux fréquents, les psychothérapies psychanalytiques sont aussi efficaces que les psychothérapies cognitivo-comportementales. Cette absence de différence est discutée.
... The use of experiential interventions in order to acquire insight into the underlying patterns related to patients' complaints from an interpersonal and intrapersonal perspective is prominent in the psychodynamic-and to the psychodynamic psychotherapy related schema-focusedpsychotherapy [6]. Meta-analysis on psychodynamic psychotherapy [7] suggests equal efficacy to other psychotherapies, in addition Town et al. [8] found STPP had robust and persistent effects in patients with personality disorders. ...
The growing field of equine-assisted psychotherapy (EAP), a subfield of animal-assisted psychotherapy (AAP), needs theoretically-based clinical studies. This systematic review examines the existing clinical studies in adult populations on psychodynamic psychotherapy combined with equine-assisted psychotherapy. An electronic database search was divided in two studies to identify publications on 1) EAP combined with psychodynamic psychotherapy and 2) EAP combined to personality problems and traumatization in order to compile studies by population, intervention, outcome and therapeutic assets. Study 1 revealed no relevant clinical studies on EAP with a psychodynamic background with an adult population. Study 2 revealed 12 publications to review predominantly addressing veterans with PTSD. The methodological limitations of most of the studies restrain the overall findings on outcome. However, overall positive effects for EAP, specifically on its experiential features and on finding interpersonal trust for patients, can be discerned. There is an apparent need for clinical studies meeting methodological standards on psychodynamic underpinned EAP methodologies in adults with intertwined personality problems and traumatization.
... There are currently over 250 published randomised controlled trials (Lilliengren, 2020) supporting the use of STPP with several mental health presentations including personality and somatic disorders, anxiety, post-traumatic stress disorder (PTSD) and depression among others (Abbass et al., 2014). In fact, several meta-analyses examining the efficacy of STPP have shown large effect sizes that persist at follow-up (Abbass & Driessen, 2010;Abbass et al., 2009Abbass et al., , 2011Driessen et al., 2015;Leichsenring et al., 2004;Lilliengren et al., 2016;Town et al., 2011). Furthermore, STPP is included in the NICE guidelines for depression (National Institute for Healthcare and Excellence, 2018) and eating disorders (National Institute for Healthcare and Excellence, 2017). ...
Purpose: Short Term Psychodynamic Psychotherapy (STPP) has been demon- 10 strated as an effective treatment for several mental health difficulties. However, its implementation in secondary mental health services in the
National Health Service (NHS) is scarce. The aim of this study was to bridge
the gap between controlled trials and practice-based evidence, by exploring an
initial estimate of the therapeutic effects of this intervention as well as its 15 safety in a secondary care NHS community mental health setting. Method:
The study followed a quantitative case series design. Eight clients with com-
plex, enduring mental health difficulties, supported by a community secondary
mental health service received a course of STPP. They completed outcome measures at the start, at the end and eight-weeks following completion of 20 therapy. Results: All participants but one completed the therapy and atten-
dance rates were high (>75%). No adverse effects were reported. All partici-
pants but two reported improvement in the CORE-OM, BSI and the PHQ-9
and these were maintained at follow-up. Conclusions: The results suggested
that STPP was a safe and acceptable intervention, that may have contributed to 25 clinical and reliable improvement for 4 participants, non-reliable improvement
for 2 and non-reliable deterioration for one participant who finished the treatment.
... • les troubles légers de la personnalité -recoupant en partie les « névroses » au sens psychanalytique [72][73][74][75] On pourrait discuter point par point la nature précise des thérapies analytiques testées dans ces études (plusieurs sous-courants existent) et également quels types de TCC y participent (elles sont nombreuses), ou différencier plus finement que cela n'est fait ici les types de troubles, les types de résultats -voire mieux, examiner les méthodologies utilisées pour chacune de ces études. ...
Objectif
Depuis les années 2000, en France, les politiques de « santé mentale » s’appuient sur des données probantes. Concernant les psychothérapies, l’expertise de l’Inserm, publiée en 2004 et concluant à l’absence de preuve d’efficacité pour la psychanalyse, reste une référence importante. L’objectif de cet article est d’en réinterroger la valeur scientifique, quinze ans après.
Méthode
Après avoir fait retour au contexte de rédaction du rapport et aux controverses ayant entouré sa publication, nous proposons une revue des études d’efficacité ayant depuis évalué la psychanalyse. Cette littérature récente, principalement internationale, reste assez méconnue en France.
Résultats
Le rapport d’expertise de l’Inserm, pour part recevable à sa parution, apparaît aujourd’hui relativement daté, tant au plan méthodologique que dans ses conclusions. Les plus récentes études d’efficacité démontrent en effet que les thérapies psychanalytiques et cognitivo-comportementales ne présentent pas de différences notables d’efficacité, pour la quasi-totalité des troubles connus.
Discussion
Ces résultats donnent lieu à débat. Une partie des scientifiques croit qu’ils sont l’effet d’un manque de rigueur dans les protocoles expérimentaux. D’autres soutiennent au contraire que la recherche des facteurs spécifiques de l’efficacité est une impasse, et promeuvent des études en conditions naturelles pour apprécier les facteurs contextuels cumulés de l’efficience thérapeutique.
Conclusions
Sans préjuger des orientations et résultats futurs de la recherche, il apparaît néanmoins que le rapport d’expertise de l’Inserm ne peut plus être aujourd’hui la référence dominante, en France, pour recommander les « bonnes pratiques » psychothérapiques. Au vu de la littérature scientifique aujourd’hui disponible, la psychanalyse est une offre de soin à préconiser parmi d’autres – position à laquelle souscrivent les systèmes de santé de nombreux pays.
--
Objective. – Since the 2000s, in France, « mental health » policies have to be based on evidence. Concerning psychotherapies, the INSERM’s expertise, published in 2004 and concluding that there is no evidence of effectiveness for psychoanalysis, remains an important reference. The aim of this article is to re-examine its scientific value, fifteen years later.
Method. – After returning to the context in which this report was written and the controversies surrounding its publication, we propose a review of the efficacy studies that have since evaluated psychoanalysis. This recent littérature, mostly international, remains relatively little known in France.
Results. – The INSERM’s expert report – whose status could in part be promoted at the time of its publication – now appears to be relatively dated, both in terms of methodology and in its conclusions. The majority of current efficacy studies show that psychoanalytical and cognitive-behavioural therapies do not show any significant differences in efficacy for almost known disorders.
Discussion. – These results give rise to debate. Some scientists believe that they are only due to a lack of rigour in the experimental protocols. Others, on the contrary, maintain that the search for specific factors of efficacy is a dead end and promote studies in natural conditions, to assess the cumulative contextual factors of therapeutic effectiveness.
Conclusions. – Without prejudging future research orientations and results, it nevertheless appears that the INSERM expert report can no longer be the dominant reference in France today for recommending psychotherapeutic « good practices ». Research has progressed considerably. In view of the international scientific littérature available today, psychoanalysis is one offer of care to be advocated among others – a position to which many countries subscribe.
... STPP methods have been studied in over 250 random ized controlled trials (RCTs) for a wide range of condi tions [15]. STPP has been found efficacious for depres sion [16], anxiety [17], personality disorders [18], and common mental disorders in general [8]. In 2009, we re ported on 23 trials of STPP for mixed somatic conditions and found it to be effective and superior to controls, with moderate to large treatment effects that tended to be sus tained or increased at followup [19]. ...
Introduction:
Functionalsomatic disorders (FSD) are common and costly, thereby driving the need for the development of effective brief treatment options. Short-term psychodynamic psychotherapy (STPP) is one candidate treatment method.
Objective:
To review and meta-analyze, where possible, randomized controlled trials (RCTs) of STPP for FSD.
Methods:
Following a systematic search of the literature, we performed a meta-analysis of available RCT groups to determine the effects of STPP on a range of outcomes after treatment, and medium- and long-term follow-ups.
Results:
In meta-analyses of 17 RCTs, STPP significantly outperformed minimal treatment, treatment as usual, or waiting list controls on somatic symptom measures at all time frames, with small to large magnitude effect sizes. Descriptive reviews of 5 RCTs suggest that STPP performed at least as well as other bona fide psychological therapies. Limitations of this meta-analysis include small samples of studies and possible publication bias.
Conclusions:
STPP is a valid treatment option for diverse FSD conditions resulting in somatic symptom reductions that persist over time. STPP should be included in FSD treatment guidelines.
... Whether this is also the case in DIT is ultimately an empirical question. Over the past decades, evidence for both more traditional intrapersonal and more interpersonal brief and long-term treatments in depression with and without comorbid personality pathology has been accumulating [158][159][160][161][162]. In line with these findings, a recent small pilot trial showed that DIT was associated with a significant reduction in symptoms in all but one case, to below clinical levels in 70% of the patients studied [63]. ...
Borderline personality disorder (BPD) and mood disorders are highly comorbid, and both disorders share important developmental pathways and underlying neurobiological features. This chapter reviews evidence for the overlap between BPD and mood disorders and presents an attachment and mentalizing approach to the conceptualization and treatment of depressed patients and without marked BPD features. We propose that patients with BPD and mood disorders can be situated on a continuum, with four related features distinguishing individuals with depression with, versus without, marked BPD features: (a) the nature of their depressive experiences; (b) the nature of their mentalizing impairments; (c) the presence of insecure, but organized, attachment in response to stress and arousal versus disorganized attachment; and (d) problems with epistemic trust versus epistemic hypervigilance. We outline the therapeutic implications of these views, arguing that treatments that combine a mental representation and mental process (i.e., mentalizing) focus may be most appropriate for patients with mood problems without marked BPD features. Yet, for patients with more marked BPD features, these treatments may be iatrogenic, as these patients may have serious problems in establishing a therapeutic alliance and lack the reflective capacities needed for such treatments. For these patients, a mental process approach that focuses on restoring the capacity for mentalizing might be more appropriate. Preliminary empirical evidence supporting these assumptions is presented.
... Borderline personality pathology has proven to be particularly challenging to treat because of patients' associated chronic and severe psychosocial impairment (Town, Abbass, & Hardy, 2011;Skodol et al., 2002), high risk of selfharm (Panos, Jackson, Hasan, & Panos, 2014;American Psychiatric Association, 2001), wearing interpersonal dynamics (Gunderson, 2003), and high rates of comorbidity, that is, depressive disorders and other personality pathology (Gunderson, 2003;Zanarini, Frankenburg, Hennen, Reich, & Silk, 2004;Zimmerman, Rothschild, & Chelminski, 2005). Although several effective treatments for borderline personality disorder exist (i.e., Bateman & Fonagy, 2011;Carsky, 2013;Hobson, 1985;Jørgensen et al., 2013;McMain et al., 2009;Linehan, 1993;Rockland, 1992;Ryle, 1997;Stevenson, Meares, & D'Angelo, 2004;Yeomans, Selzer, & Clarkin, 1992), patients with BPD continue to prematurely drop-out of treatment at high levels (Bennett et al., 2006), highlighting a critical gap between empirically supported treatments and effective clinical practice. ...
The present study sought to investigate the impact of psychotherapy integration, incorporating some cognitive–behavioral (CB) techniques with psychodynamic–interpersonal (PI) techniques, with the moderating impact of borderline personality pathology on short-term psychodynamic psychotherapy treatment outcomes in a sample of 75 outpatients. PI and CB techniques were assessed using independent videotape ratings of therapy sessions and aspects of the alliance were determined using patient-rated scores. Axis II borderline personality pathology was measured using the Borderline Pathology Index (BPI). Treatment outcomes were measured using patients’ estimates of their broadband functioning (PEI) and change in global symptom index of the brief symptom inventory (BSI-GSI-RCI). Findings of preliminary analyses were nonsignificant; the direct relationship between patient pretreatment borderline pathology with the flexible integration of CB and PI techniques was not significant. In addition, PI and CB techniques derived from the CPPS each demonstrated nonsignificant relationships with the BPI, respectively. Multilevel model analyses indicated that when controlling for therapist effects, pretreatment borderline pathology did not moderate symptom change (improvement or deterioration) or patient estimates of their broadband functioning. Post hoc analyses demonstrated some significant findings, indicating that therapist, but not patient, confident collaboration scores were negatively related to borderline personality pathology, although this did not significantly impact treatment outcomes. Taken together, findings from the present study suggest that the interaction between borderline personality pathology and the integration of some cognitive-behavioral techniques within psychodynamic psychotherapy do not affect statistically significant change in treatment outcome. Implications are discussed for clinical research and practice.
... Research has underlined the potential, effectiveness and efficacy of ISTDP, most notably from AllanAbbass and colleagues in Halifax, Nova Scotia (Ab bass, 2015;Abbass, Town, & Driessen, 2012 ;Town, Abbass, & Hardy, 2011;Town, Abbass, Stride, & Bernier, 2017).However, we now have a significant publication from Dr Catherine Hickey, significant particularly because she has worked closely at the centre ofDavanloo's group in Montreal for twelve years during the period when publications have been all but absent. Th is is an insider's view. ...
It is possible to consider that a silence which fell on Davanloo and his group in the last two decades, following such a creative and productive output in the previous two decades, has been broken by Dr Hickey. This is a significant step. It can appear that the silence reflected a form of isolation, indeed perhaps even insulation, which we might consider similar to the first decade of Davanloo’s work in the 60s and 70s. It is perhaps a surprise that developments in the wider world of psychoanalytic and psychodynamic theory and practice that may have influence are not apparent in this book, and in Davanloo’s more recent developments. Object relations theory, and particularly developments in Kernberg’s group with structural object relations and transference focused psychotherapy (TFP) (Clarkin, Yeomans, & Kernberg, 2015; Kernberg, 1979), would seem to have a significant interaction with Davanloo’s understanding of metapsychology and practice. Similarly Fonagy’s work with attachment theory, and with mentalisation and mentalisation-based treatments, would seem to speak to Davaloo’s approach to the effects of trauma and building of ego capacity (Fonagy, 2001; Fonagy & Bateman, 2006; Fonagy & Target, 2006).
... Midgley and Kennedy (2011) document 34 studies supporting psychodynamic psychotherapy for children and adolescents. Town et al. (2011) have provided evidence supporting Davanloo's use of "unlocking the unconscious" in Intensive Short-Term Psychodynamic Psychotherapy as more effective than not accessing unconscious material. Attachment-based therapies have been utilized successfully in many diagnostic categories including autism, borderline personality disorder, and treatment-resistant anxiety (Milrod et al. 2016), as well as receiving support from neuroscientific research. ...
... 8 In terms of treatment, a limited body of research has investigated interventions for NPD using randomized controlled trials or other methodologically rigorous approaches. One systematic review published by Town and colleagues 11 found eight studies of "moderate" scientific rigor that demonstrated the positive effect of shortterm psychodynamic psychotherapy (STPP). Several researchers have examined the impact of NPD on the psychotherapeutic relationship. ...
Narcissistic Personality Disorder (NPD) is characterized by a persistent pattern of grandiosity, fantasies of unlimited power or importance, and the need for admiration or special treatment. Individuals with NPD may experience significant psychological distress related to interpersonal conflict and functional impairment. Research suggests core features of the disorder are associated with poor prognosis in therapy, including slow progress to behavioral change, premature patient-initiated termination, and negative therapeutic alliance. The current manuscript will explore challenges of working with NPD within the context of life-limiting illness for two psychotherapy patients seen in a behavioral health clinic at a large academic health science center. The ways in which their personality disorder affected their illness-experience shared significant overlap characterized by resistance to psychotherapeutic change, inconsistent adherence to medical recommendations, and volatile relationships with providers. In this manuscript we will (1) explore the ways in which aspects of narcissistic personality disorder impacted the patients' physical health, emotional well-being, and healthcare utilization; (2) describe psychotherapeutic methods that may be useful for optimizing psychosocial, behavioral, and physical well-being in individuals with co-morbid NPD and life-limiting disease; and (3) review conceptualizations of NPD from the DSM-5 alternative model for assessing personality function via trait domains.
... personality disorders. That being said, two meta-analyses(Barber et al., 2013;Town, Abbass, & Hardy, 2011) have indicated PDP was more effective than controls in general outcome and no difference between other treatments in both general and secondary outcome. Further, medium-term PDP treatments created specifically to treat borderline personality disorder have been designated by the APA Division 12 (2012) as a wellestablished treatment (transference focused psychotherapy [TFP]; Clarkin,Levy, Lenzenweger, & Kernberg, 2007) and probably efficacious (mentalization-based treatment[MBT]; Bateman & Fonagy, 2016). ...
Psychodynamic psychotherapies (PDP) is an umbrella term for a variety of therapeutic modalities that have evolved out of the psychoanalytic/psychodynamic tradition, each theorizing a trajectory of human development that includes an etiology of and treatment for psychopathology. PDPs have in common the belief that people have an unconscious mind that influences thoughts and behaviors outside of the individual’s awareness. These processes operate from birth till death and are responsible for adaptive and maladaptive functioning at the level of interpersonal relationships and daily living.
The psychodynamic therapist creates a case formulation for the individual seeking treatment, which incorporates a formal diagnosis with an understanding of the underlying dynamic factors contributing to the individual’s suffering. From this case formulation a treatment plan is created specific to the individual. During treatment, the therapist develops a strong working alliance while utilizing psychodynamic-specific techniques targeted at bringing insight into these unconscious thoughts and behaviors. Greater self-understanding enables greater choice ability and flexibility in functioning.
In contrast to prevalent views, empirical research has found support for the efficacy of PDP in the treatment of mental disorders, including but not limited to: depression, anxiety disorders, somatic disorders, and personality disorders. In general, PDP was found more effective than control conditions and not different from active treatments. PDP effects have been shown to remain stable post treatment.
... personality disorders. That being said, two meta-analyses(Barber et al., 2013;Town, Abbass, & Hardy, 2011) have indicated PDP was more effective than controls in general outcome and no difference between other treatments in both general and secondary outcome. Further, medium-term PDP treatments created specifically to treat borderline personality disorder have been designated by the APA Division 12 (2012) as a wellestablished treatment (transference focused psychotherapy [TFP]; Clarkin,Levy, Lenzenweger, & Kernberg, 2007) and probably efficacious (mentalization-based treatment[MBT]; Bateman & Fonagy, 2016). ...
Short-term dynamic therapy (STDP) comprises a group of interventions based on psychoanalytic principles that have been adapted for use in treatments of limited duration. The prototypic definition of STPD includes the following aspects: the theory of psychopathology explaining the disorder and treatment techniques employed (e.g., clarification, interpretation, and confrontation) that are psychoanalytic in origin; the selection of patients on the basis of their ability to withstand intensive psychotherapy; treatment that is time-limited and focused on a specific issue or conflict; and treatment aimed to provide symptom relief or limited personality or character change. STPD was developed by a subgroup of psychoanalysts who were trying to increase the efficiency of psychodynamic therapy, to bring its power to short-term settings (seeing patients once or twice a week, sitting up), and therefore to make the treatment available to a potentially broader group of patients. Subsequent changes in health care financing and reimbursement and increased awareness of data supporting its efficacy have driven increased interest in STDP.
... The most recent and comprehensive meta-analysis on PDs (Budge et al., 2013) analyzed 30 studies that compared an active psychotherapeutic treatment with treatment as usual, finding that active psychotherapeutic treatments were more efficient than treatment-as-usual comparisons, with medium effect size (d = .40). In addition, the effectiveness of PDT for individuals with PDs is supported by two more recent meta-analytic studies for shortterm PDT (Town, Abbass, & Hardy, 2011) and for the treatment of depression with comorbid PDs . ...
Personality disorders are a heterogeneous group of mental disorders which arise when an individual’s personality is considered impaired and maladaptive. As will be discussed in greater detail below, personality disorders (PDs) are highly prevalent in the general population (up to 18%) and much higher in patient populations (up to 75%). In addition to being prevalent, PDs are often underappreciated sources of social cost, family burden, and morbidity and mortality (Hueston, Mainous, & Schilling, 1996).
In this chapter, we first define personality and personality disorders, differentiating them from related constructs such as temperament. We outline current classification and diagnostic frameworks for PDs, grounded in a historical perspective. We then provide data as well as implications of the high prevalence and comorbidity of PDs with other conditions, followed by an overview of assessment techniques, with their respective advantages and disadvantages. Next, we summarize recent meta-analytic data regarding the efficacy of treatments for PDs. Finally, we conclude the chapter by providing a look back at major accomplishments in the field of PD research and treatment, and a look forward towards the likely progress the field will make in the next decade.
... Results from two meta-analyses 98,99 showed PDT to be effi cacious in the treatment of personality disorders. ...
Psychodynamic therapy (PDT) is an umbrella concept for treatments that operate on an interpretive-supportive continuum and is frequently used in clinical practice. The use of any form of psychotherapy should be supported by sufficient evidence. Efficacy research has been neglected in PDT for a long time. In this review, we describe methodological requirements for proofs of efficacy and summarise the evidence for use of PDT to treat mental health disorders. After specifying the requirements for superiority, non-inferiority, and equivalence trials, we did a systematic search using the following criteria: randomised controlled trial of PDT; use of treatment manuals or manual-like guidelines; use of reliable and valid measures for diagnosis and outcome; adults treated for specific mental problems. We identified 64 randomised controlled trials that provide evidence for the efficacy of PDT in common mental health disorders. Studies sufficiently powered to test for equivalence to established treatments did not find substantial differences in efficacy. These results were corroborated by several meta-analyses that suggest PDT is as efficacious as treatments established in efficacy. More randomised controlled trials are needed for some mental health disorders such as obsessive-compulsive disorder and post-traumatic stress disorder. Furthermore, more adequately powered equivalence trials are needed.
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... For example, Abbass and colleagues (Abbass et al., 2006;Abbass et al., 2009) conducted a series of meta-analyses of controlled trials of short-term dynamic therapy (STDT) and found that STDT was superior to various types of no-treatment or minimal treatment controls on a variety of outcome measures and that the effects were sustained or grew over time. A number of other meta-analyses have substantiated the enduring effects of psychodynamic treatments (Abbass, Town, & Driessen, 2011;Driessen et al., 2010;Town, Abbass, & Hardy, 2011) and some have claimed that the benefits of psychodynamic treatments increase over time (e.g., Leichsenring et al., 2004;Town et al., 2012). ...
... Knowledge about patients at risk for non-response to treatment also comes from studies on personality disorders (see e.g. Abbass et al., 2008;Monsen et al., 1995;Giesen-Bloo et al., 2006;Town et al., 2011). Generally these studies indicate that treatment efforts need to be tailored to the specific needs of these patients to be effective. ...
... Driessen 2010;Cuijpers et al. 2008;Driessen et al. 2010;Leichsenring 2001), Depression im Rahmen von Persönlichkeitsstörungen , somatische Störungen (Abbass et al. 2009) und Persönlichkeitsstörungen (Leichsenring u. Leibing 2003;Town et al. 2011). ...
... Although only two randomized, controlled trials were included in that analysis, since then, additional efficacy trials have been conducted, reporting equally large treatment effects. 17 More recently, Barber and colleagues 18 selected only well-conducted studies for inclusion in their meta-analysis of the effectiveness of psychodynamic psychotherapies. The controlled effects, based on the analysis of post-treatment outcomes in seven studies, revealed that psychodynamic psychotherapy was more effective than control treatments (g = 0.59). ...
CME EducationaL Objectives 1. Review the outcome evidence of prior meta-analytic reviews of intensive short-term dynamic psychotherapy (ISTDP). 2. Provide an additional meta-analysis of ISTDP for the treatment of personality and somatic disorders. 3. Suggest areas for future study in the use of psychodynamic psychotherapy for personality and somatic disorders. The literature reviewing studies of psychodynamic psychotherapy clearly demonstrates evidence for the efficacy of both short-term and long-term models. Meta-analytic reviews synthesizing effects across different psychodynamic psychotherapy formats have been conducted for common mental disorders, depression, depression in the setting of personality disorder, personality disorders, and somatic disorders. Psychodynamic psychotherapy demonstrates superiority to control condition, and no significant difference to other formal psychotherapies, including cognitive behavioral therapies. Building upon a recently published systematic review and meta-analysis,11 the aim of this article is to further examine the evidence for a contemporary psychodynamic psychotherapy treatment protocol, intensive short-term dynamic psychotherapy (ISTDP), in the treatment of personality and somatic disorders.
... In the past 10 years, several reviews were done on the effectiveness of psychotherapeutic treatments with general PD patients. Positive results were reported for time-limited psychodynamic psychotherapy and cognitive-behavioral therapy (Leichsenring & Leibing, 2003;Matusiewicz, Hopwood, Banducci, & Lejuez, 2010;Town, Abbass, & Hardy, 2011;Verheul & Herbrink, 2007), whereas rather limited and conflicting evidence was reported concerning long-term psychoanalytic psychotherapy (Smit et al., 2012). ...
Controlled studies on the effectiveness of inpatient psychotherapy with patients with personality disorders (PD) are rare. This study aims to compare 3-month short-term inpatient psychotherapy based on transactional analysis (STIP-TA) with other psychotherapies (OP) up to 36-month follow-up. PD patients treated with STIP-TA were matched with OP patients using the propensity score. The primary outcome measure was general psychiatric symptomatology; secondary outcomes were psychosocial functioning and quality of life. In 67 pairs of patients, both STIP-TA and OP showed large symptomatic and functional improvements. However, STIP-TA patients showed more symptomatic improvement at all time points compared to OP patients. At 36 months, 68% of STIP-TA patients were symptomatically recovered compared to 48% of OP patients. STIP-TA outperformed OP in terms of improvements in general psychiatric symptomatology and quality of life. Superiority of STIP-TA was most pronounced at 12-month follow-up, but remained intact over the course of the 3-year follow-up.
... They found that active psychotherapeutic treatments were more efficient than treatment as usual comparisons, with medium effect size (d = .40). In addition, the effectiveness of PDT for individuals with personality disorders is supported by two more recent meta-analytic studies for short-term PDT (Town, Abbass, & Hardy, 2011) and for the treatment of depression with comorbid personality disorders (Abbass, Town, & Driessen, 2011). ...
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.
... Numerous literature reviews have summarised the favourable outcomes of psychodynamic psychotherapy for PD (Bateman & Tyrer, 2004;Fonagy, Roth, & Higgitt, 2005;Leichsenring & Leibing, 2003;Leichsenring, Leibing, Kruse, New, D. Haskayne et al. 2 & Leweke, 2011;Leichsenring & Rabung, 2011). Town, Abbass, and Hardy (2011) and Abbass, Town, and Driessen (2011) reviewed short-term psychodynamic psychotherapy for PD with positive findings. Anestis, Anestis, and Lilienfeld (2011) criticised some of these reviews for including mainly naturalistic psychodynamic studies, lacking a validated therapy as a comparison group. ...
This review aimed to explore the evidence base of psychodynamic therapy for personality disorder (PD). A systematic approach was applied to the literature search with the use of a clear inclusion/exclusion criteria and a quality assessment checklist. Nineteen studies investigating the use of psychodynamic therapy for PD were reviewed. Four randomised controlled trials (RCT) demonstrated superior results for psychodynamic therapy compared with another type of therapy, two RCTs found that cognitive-based therapies were superior and one RCT found no difference between therapies for PD. Another seven RCTs found positive results for psychodynamic therapies compared with a treatment as usual condition (n = 3) or another dynamic therapy (n = 4). Five non-RCTs were included with mixed findings for treating PD with psychodynamic therapy. Many of the included studies focusing on psychodynamic-based therapies with borderline personality disorder had positive outcomes, and concentrated on mentalisation-based therapy and transference-focused therapy. There were good outcomes for short- and long-term psychodynamic therapies with individuals with PD. Implications for developing services for treating PD are discussed. Research that addresses methodological issues and increases understanding of the ingredients of change in psychodynamic therapy for PD is also recommended.
The purpose of this research was to determine the effectiveness of psychodynamic psychotherapy, both generally and in Australian settings. A systematic review of recent (last five years) and Australian (last 10 years) papers using MEDLINE Complete and PsycINFO was performed. For the review of recent literature, 59 papers (56 studies) met the inclusion criteria. The search for Australian literature identified four papers on one quasi-experimental study. Research supports the use of psychodynamic psychotherapy for the treatment of depressive disorders, some anxiety disorders (especially generalised anxiety disorder), somatic symptoms and some somatoform disorders (e.g., hypochondriasis), and some personality disorders (primarily borderline and Cluster C personality disorders). Improvements made through psychodynamic psychotherapy typically endure beyond the completion of treatment. Psychodynamic psychotherapy is generally superior to treatment as usual and equivalent to other psychotherapies.
Background:
People diagnosed with borderline personality disorder (BPD) frequently present to healthcare services in crisis, often with suicidal thoughts or actions. Despite this, little is known about what constitutes effective management of acute crises in this population and what type of interventions are helpful at times of crisis. In this review, we will examine the efficacy of crisis interventions, defined as an immediate response by one or more individuals to the acute distress experienced by another individual, designed to ensure safety and recovery and lasting no longer than one month. This review is an update of a previous Cochrane Review examining the evidence for the effects of crisis interventions in adults diagnosed with BPD.
Objectives:
To assess the effects of crisis interventions in adults diagnosed with BPD in any setting.
Search methods:
We searched CENTRAL, MEDLINE, Embase, nine other databases and three trials registers up to January 2022. We also checked reference lists, handsearched relevant journal archives and contacted experts in the field to identify any unpublished or ongoing studies.
Selection criteria:
Randomised controlled trials (RCTs) comparing crisis interventions with usual care, no intervention or waiting list, in adults of any age diagnosed with BPD.
Data collection and analysis:
We used standard methodological procedures expected by Cochrane.
Main results:
We included two studies with 213 participants. One study (88 participants) was a feasibility RCT conducted in the UK that examined the effects of joint crisis plans (JCPs) plus treatment as usual (TAU) compared to TAU alone in people diagnosed with BPD. The primary outcome was self-harm. Participants had an average age of 36 years, and 81% were women. Government research councils funded the study. Risk of bias was unclear for blinding, but low in the other domains assessed. Evidence from this study suggested that there may be no difference between JCPs and TAU on deaths (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.06 to 14.14; 88 participants; low-certainty evidence); mean number of self-harm episodes (mean difference (MD) 0.30, 95% CI -36.27 to 36.87; 72 participants; low-certainty evidence), number of inpatient mental health nights (MD 1.80, 95% CI -5.06 to 8.66; 73 participants; low-certainty evidence), or quality of life measured using the EuroQol five-dimension questionnaire (EQ-5D; MD -6.10, 95% CI -15.52 to 3.32; 72 participants; very low-certainty evidence). The study authors calculated an Incremental Cost Effectiveness Ratio of GBP -32,358 per quality-adjusted life year (QALY), favouring JCPs, but they described this result as "hypothesis-generating only" and we rated this as very low-certainty evidence. The other study (125 participants) was an RCT conducted in Sweden of brief admission to psychiatric hospital by self-referral (BA) compared to TAU, in people with self-harm or suicidal behaviour and three or more diagnostic criteria for BPD. The primary outcome was use of inpatient mental health services. Participants had an average age of 32 years, and 85% were women. Government research councils and non-profit foundations funded the study. Risk of bias was unclear for blinding and baseline imbalances, but low in the other domains assessed. The evidence suggested that there is no clear difference between BA and TAU on deaths (RR 0.49, 95% CI 0.05 to 5.29; 125 participants; low-certainty evidence), mean number of self-harm episodes (MD -0.03, 95% CI -2.26 to 2.20; 125 participants; low-certainty evidence), violence perpetration (RR 2.95, 95% CI 0.12 to 71.13; 125 participants; low-certainty evidence), or days of inpatient mental health care (MD 0.70, 95% CI -14.32 to 15.72; 125 participants; low-certainty evidence). The study suggested that BA may have little or no effect on the mean number of suicide attempts (MD 0.00, 95% CI -0.06 to 0.06; 125 participants; very low-certainty evidence). We also identified three ongoing RCTs that met our inclusion criteria. The results will be incorporated into future updates of this review.
Authors' conclusions:
A comprehensive search of the literature revealed very little RCT-based evidence to inform the management of acute crises in people diagnosed with BPD. We included two studies of two very different types of intervention (JCP and BA). We found no clear evidence of a benefit over TAU in any of our main outcomes. We are very uncertain about the true effects of either intervention, as the evidence was judged low- and very low-certainty, and there was only a single study of each intervention. There is an urgent need for high-quality, large-scale, adequately powered RCTs on crisis interventions for people diagnosed with BPD, in addition to development of new crisis interventions.
ÖZET
Çocukluk çağında başlayan birçok ruhsal hastalık ergenlik ve erişkinlik döneminde yineleyebilmekte, kronikleşebilmekte veya farklı görüntülerle sürebilmektedir. Bu nedenle erken dönemde uygulanacak tedavi girişimleri son derece önemlidir. Psikodinamik Psikoterapiler ergenlikteki ruhsal bozuklukların tedavisinde kullanılmaktadır. Ergenlerin tedavisinde, psikodinamik terapinin görevi, onların gelişimsel hedeflerinin tamamlanmasına yardımcı olmak ve desteklemektir. Kısa Süreli ya da diğer adıyla Süresi Sınırlı Psikodinamik Terapiler?in (SSPT), çocuk ve ergenlerde sık karşılaşılan psikiyatrik rahatsızlıklarda (depresyon, anksiyete bozuklukları, anoreksiya nervoza, borderline kişilik örgütlenmesi) etkili olabileceği gösterilmiştir. Bu makalede ergenlerde psikodinamik terapi uygulamalarının temel özellikleri ve ergenler için geliştirilen Süresi Sınırlı Ergen Psikodinamik Terapi (SSEPT) modeli tanıtılacaktır.
Anahtar Kelimeler: Adölesan; psikodinamik terapi; süresi sınırılı psikodinamik terapiler
ABSTRACT
Many mental illnesses that begin in childhood can recur in adolescence and adulthood, become chronic, or persist with different appearances. For this reason, early treatment interventions are very important. Psychodynamic Psychotherapies are used in the treatment of mental disorders in adolescents. In the treatment of adolescents, the task of psychodynamic therapy is to help and support the completion of their developmental goals. Short Time or Time Limited Psychodynamic Therapies (SSPT) have been shown to be effective in psychiatric disorders (depression, anxiety disorders, anorexia nervosa, borderline personality organization) that are common in children and adolescents. In this article, basic characteristics of psychodynamic therapy applications in adolescents and the Model of Time Limited Adolescent Psychodynamic Therapy (SSEPT) developed for adolescents will be introduced in more detail.
Keywords: Adolescence; psychodynamic therapy; time-limited psychodynamic therapies
This study examines the experiences of patients in treatment with psychodynamic psychiatrists on an intermittent basis following an initial brief period of intensive psychotherapy and stabilization. Patients with non-psychotic disorders who received intermittent treatment answered a web-based questionnaire describing the usefulness of various supportive, cognitive-behavioral, and psychodynamic interventions. Forty-eight out of 58 patients invited to participate completed the survey (83% response rate). The majority (75%) of respondents welcomed the intermittent treatment frame. Therapeutic factors deemed to be most helpful included supportive interventions such as ability to relate to the clinician, ability of clinician to listen empathically, and feeling supported by a non-judgemental therapist when talking about private matters. The majority of respondents also endorsed as highly beneficial various cognitive-behavioral interventions such as understanding how thinking patterns impact behavior and feelings and discussing alternative coping skills. Also highly rated were psychodynamic interventions, including understanding how the present is modeled from past experiences and expression and regulation of affect. In the open-ended qualitative feedback, therapeutic factors including collaboration, forming an alliance, and empathic attunement emerged as important. Our preliminary findings suggest that the intermittent psychodynamic treatment frame is well received by patients. Patients welcome integration of different psychotherapeutic approaches to individualize treatment. The common factors in psychotherapy are important patient-reported therapeutic factors in the intermittent treatment approach.
The aim of this thesis has been to analyze the official definitions of mental disorder (i.e. those routinely used in the Health System to make diagnosis), to demonstrate that they are biological and individual-based. A mental disorder is essentially conceived and measured as a biological phenomenon embedded in an individual.
Thanks to a logical and conceptual process rooted in empirical evidences, though, I suggest here to reconsider psychopathology as a fundamentally social phenomenon: sociality could be the “proprium” or even the “definiens” of what we call mental disorders.
This operation would present many difficulties, both practical and theoretical, which I tried to take into account.
Background: Considering the importance of assessing the range of phenomena that can change in psychodynamic therapy, and lack of appropriate assessment scale in Persian language, the present study assessed the reliability of the Persian mastery scale. The mastery scale is a comprehensive research tool for assessing a patient's mastery of transference-related interpersonal conflicts during the treatment process. Objectives: The aim of this research was to examine the psychometric properties of the Persian version of the Mastery Scale. Methods: After preparing the Persian version of the mastery scale through the forward-backward translation process, a sample of 36 relationship episodes was rated by three independent judges. Data were collected in Mashhad, Iran in 2015. The psychometric properties of the instrument, including inter-rater reliability and test-retest analysis were assessed. Results: The test-retest correlations of the 3 judges were (0.80, 0.91 and 0.95), highly significant at P < 0.0001 and the inter-rater reliability indicated a good level of agreement (The ICC (3, 3) 0.84, 95% CI [0.72, 0.90]). Conclusions: The current study has provided evidence that the Persian mastery scale is a reliable instrument for assessing changes in inner capacities and resources through psychodynamic treatments. However, further studies are required to investigate the validity of this scale.
Background: Considering the importance of assessing the range of phenomena that can change in psychodynamic therapy, and
lack of appropriate assessment scale in Persian language, the present study assessed the reliability of the Persian mastery scale.
The mastery scale is a comprehensive research tool for assessing a patient’s mastery of transference-related interpersonal conflicts
during the treatment process.
Objective: The aim of this research was to examine the psychometric properties of the Persian version of the Mastery Scale.
Methods: After preparing the Persian version of the mastery scale through the forward-backward translation process, a sample of
36 relationship episodes was rated by three independent judges. Data were collected in Mashhad, Iran in 2015. The psychometric
properties of the instrument, including inter-rater reliability and test-retest analysis were assessed.
Results: The test-retest correlations of the 3 judges were (0.80, 0.91 and 0.95), highly significant at P < 0.0001 and the inter-rater
reliability indicated a good level of agreement (The ICC (3, 3) 0.84, 95% CI [0.72, 0.90]).
Conclusions: The current study has provided evidence that the Persian mastery scale is a reliable instrument for assessing changes
in inner capacities and resources through psychodynamic treatments. However, further studies are required to investigate the validity
of this scale.
Keywords: Interpersonal Relations, Iran, Mastery Scale, Psychometrics, Supportive-Expressive Psychodynamic Psychotherapy
Psychodynamic psychotherapy is an evidence-based treatment. The results of randomized controlled trials (RCTs) support the efficacy of psychodynamic psychotherapy in many psychiatric disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM), including major depressive disorder (MDD), social anxiety disorder, and Cluster C personality disorders. Psychodynamic psychotherapy is indicated when our formulation suggests that our patient's problems are linked to unconscious factors and acute or persistent problems in domains of function. Interpersonal difficulties, distorted self-perceptions, and maladaptive ways of dealing with stress are undoubtedly the complicated end products of myriad factors. One of the most common chief complaints that psychodynamic psychotherapists hear from their patients is that, in some way, they feel stuck. Patients whose problems stem from acute or persistent difficulties in the five domains of function are likely to benefit from psychodynamic psychotherapy with a supporting stance.
Objectives: The discussion about the effectivity of psychodynamic,psychotherapy is being renewed by recent meta-analyses. Although some well-designed studies have been presented, there is still a dearth of research in this field. Methods: In a controlled prospective field study we investigated the outcome of outpatient psychodynamic psychotherapy in a pre-post design. This evaluation includes data from the symptom inventories VDS90, VDS30, and HEALTH for 90 patients with different mental disorders before therapy and after the regular end of therapy, compared to a waiting list control group. Results: We found a significant improvement in symptoms, dysfunctional personality features, and quality of life. Rates of statistically and clinically significant improvement were markedly higher after therapy than in the waiting list condition. Conclusions: Psychodynamic psychotherapy shows an effect on symptoms, dysfunctional personality features, and quality of life.
Borderline personality disorder (BPD) and mood disorders are highly comorbid, and both disorders share important developmental pathways and underlying neurobiological features. This chapter reviews evidence for the overlap between BPD and mood disorders and presents an attachment and mentalizing approach to the conceptualization and treatment of depressed patients and without marked BPD features. We propose that patients with BPD and mood disorders can be situated on a continuum, with four related features distinguishing individuals with depression with, versus without, marked BPD features: (a) the nature of their depressive experiences; (b) the nature of their mentalizing impairments; (c) the presence of insecure, but organized, attachment in response to stress and arousal versus disorganized attachment; and (d) problems with epistemic trust versus epistemic hypervigilance. We outline the therapeutic implications of these views, arguing that treatments that combine a mental representation and mental process (i.e., mentalizing) focus may be most appropriate for patients with mood problems without marked BPD features. Yet, for patients with more marked BPD features, these treatments may be iatrogenic, as these patients may have serious problems in establishing a therapeutic alliance and lack the reflective capacities needed for such treatments. For these patients, a mental process approach that focuses on restoring the capacity for mentalizing might be more appropriate. Preliminary empirical evidence supporting these assumptions is presented.
Aim. Analysis of associations between changes in neurotic personality profile and reduction of suicidal ideation (SI) – or lack of such reduction – defined as its elimination or reduction of its intensity in patients who underwent a course of intensive psychotherapy conducted in integrative approach with predominance of psychodynamic approach.
Material and method. Symptom Checklist KO“O”, Neurotic Personality Questionnaire KON-2006 and Life Inventory completed by 473 women and 207 men treated due to neurotic, behavioral or personality disorders in a day hospital between 2005–2013. During the qualification for the therapy 134 women and 80 men reported SI, of whom 84.3% and 77.5% respectively improved.
Results. Patients who improved in terms of SI obtained significantly greater reduction of global neurotic personality disintegration (neuroticism) than others (p<0.0005 in women and p=0.015 in men). Associations were found between improvement in terms of SI and greater reduction of many neurotic personality traits (p<0.05) in both genders: Negative self-esteem, Impulsiveness, Sense of alienation, Demobilization, Difficulties in emotional relations, Lack of vitality, Sense of lack of control, Sense of guilt, Difficulties in interpersonal relations, Sense of being in danger, Exaltation, Ponderings; and only in women: Feeling of being dependent on the Environment, Asthenia, Difficulties with decision making, Conviction of own resourcelessness in life, Deficit in internal locus of control and Imagination. indulging in fiction.
Conclusions. The results confirm effectiveness of intensive psychotherapy as a treatment method that leads to comprehensive improvement encompassing reduction of neurotic personality disorders (neuroticism) and of majority of neurotic personality traits, as well as SI reduction. The revealed associations weigh in favor of hypothesis on neuroticism as SI-predisposing factor in patients with neurotic, behavioral and personality disorders.
Background:
Since the mid-1970s, short-term psychodynamic psychotherapies (STPP) for a broad range of psychological and somatic disorders have been developed and studied. Early published meta-analyses of STPP, using different methods and samples, have yielded conflicting results, although some meta-analyses have consistently supported an empirical basis for STPP. This is an update of a review that was last updated in 2006.
Objectives:
To evaluate the efficacy of STPP for adults with common mental disorders compared with wait-list controls, treatments as usual and minimal contact controls in randomised controlled trials (RCTs). To specify the differential effects of STPP for people with different disorders (e.g. depressive disorders, anxiety disorders, somatoform disorders, mixed disorders and personality disorder) and treatment characteristics (e.g. manualised versus non-manualised therapies).
Search methods:
The Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR) was searched to February 2014, this register includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also conducted searches on CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, DARE and Biological Abstracts (all years to July 2012) and all relevant studies (identified to 2012) were fully incorporated in this review update. We checked references from papers retrieved. We contacted a large group of psychodynamic researchers in an attempt to find new studies.
Selection criteria:
We included all RCTs of adults with common mental disorders, in which a brief psychodynamic therapy lasting 40 or fewer hours in total was provided in individual format.
Data collection and analysis:
Eight review authors working in pairs evaluated studies. We selected studies only if pairs of review authors agreed that the studies met inclusion criteria. We consulted a third review author if two review authors could not reach consensus. Two review authors collected data and entered it into Review Manager software. Two review authors assessed and scored risk of bias. We assessed publication bias using a funnel plot. Two review authors conducted and reviewed subgroup analyses.
Main results:
We included 33 studies of STPP involving 2173 randomised participants with common mental disorders. Studies were of diverse conditions in which problems with emotional regulation were purported to play a causative role albeit through a range of symptom presentations. These studies evaluated STPP for this review's primary outcomes (general, somatic, anxiety and depressive symptom reduction), as well as interpersonal problems and social adjustment. Except for somatic measures in the short-term, all outcome categories suggested significantly greater improvement in the treatment versus the control groups in the short-term and medium-term. Effect sizes increased in long-term follow-up, but some of these effects did not reach statistical significance. A relatively small number of studies (N < 20) contributed data for the outcome categories. There was also significant heterogeneity between studies in most categories, possibly due to observed differences between manualised versus non-manualised treatments, short versus longer treatments, studies with observer-rated versus self report outcomes, and studies employing different treatment models.
Authors' conclusions:
There has been further study of STPP and it continues to show promise, with modest to large gains for a wide variety of people. However, given the limited data, loss of significance in some measures at long-term follow-up and heterogeneity between studies, these findings should be interpreted with caution. Furthermore, variability in treatment delivery and treatment quality may limit the reliability of estimates of effect for STPP. Larger studies of higher quality and with specific diagnoses are warranted.
Es wird zunächst ein kursorischer Überblick über die Outcome-Forschung im Bereich der Psychotherapie von Persönlichkeitsstörungen gegeben. Dagegen gibt es relativ wenig Wissen und Studien über Prozessforschung und Prozess-Outcome-Beziehungen. Es wird dann auf relevante Patienten- und Therapeutenvariabeln eingegangen, und wichtige Kontroversen in der Behandlungstechnik von Persönlichkeitsstörungen werden beleuchtet. Während anfangs Studien dafür zu sprechen schienen, dass Übertragungsdeutungen generell mit schlechterem Therapieerfolg verbunden sein könnten, finden sich in neueren Studien Hinweise auf differenziertere Zusammenhänge. Es gibt zunehmend Evidenz, dass insbesondere bei schwereren Persönlichkeitsstörungen vom B-Cluster gerade eine moderate Zahl von Übertragungsdeutungen und vielleicht sogar ein nicht zu gutes therapeutisches Bündnis, das ein Indikator für eine innere Auseinandersetzung auf der Beziehungsebene mit dem Therapeuten sein könnte, sich als günstig erweisen könnten. Ein Zusammenhang, der bei Cluster-C-Persönlichkeitsstörungen so möglicherweise nicht besteht. Ein Problem der Studienlage liegt allerdings darin, dass oft klare Definitionen fehlen, was die Vergleichbarkeit der Studien erschwert, und der Einfluss anderer Mediatorvariabeln unklar bleibt.
Three interacting challenges are facing all aspects of health care in the United Kingdom: financial restraint in the context of a global economic downturn; a move to services being commissioned and decommissioned by primary care Clinical Commissioning Groups; and a need to provide evidence based practice through ‘payment by results’. Psychoanalytic psychotherapy faces more difficulty than most services in mental health, with long and frequent criticisms of it being expensive and under-researched; and it is not as well understood by GPs as cognitive behavioural therapy, with which it is frequently unfavourably compared. This review provides an overview of the existing evidence for psychoanalytic psychotherapy, identifying strengths and areas that are under explored. We also argue that psychoanalytic psychotherapy has a unique clinical role but this will need to be clearly stated in the future, and promoted by clinicians to encourage future commissioning in the UK.
There is encouraging evidence that some patients with personality disorder are treatable. Psychotherapeutic interventions show promise, although interpretation of the literature is problematic: the number of patients in most trials is small, outcome measures are questionable, follow-up is limited, and treatments are multifaceted, complex interventions in which the effective components are unclear. The evidence base can be assessed according to efficacy and generalisability, and when both are taken into account the best verification is for psychodynamic therapy. However, there is inadequate evidence to make specific recommendations for any particular therapy.
Service usage of 24 patients with a personality disorder was established for one year pre-treatment and one year post-treatment via a prospective survey of the patients, their original referrer and their general practitioner. The average annual cost of psychiatric and prison services (calculated from extra-contractual referrals (ECR) tariffs and Home Office data) was Σ13 966 pre-treatment compared to Σ1308 post-treatment, representing a cost-offset of Σ12 658 per patient per year. The average cost of the specialist admission was Σ25 641. Thus the cost to the Nation for treating these personality disordered patients in a tertiary treatment resource would be recouped within two years and represent a saving thereafter.
In this volume, different approaches to Psychodynamic/Object Relations approaches are examined. It covers the important issues in the field, with topics ranging from "psychodynamic psychotherapy with undergraduate and graduate students" to "a relational feminist psychodynamic approach to sexual desire" to "psychodynamic/object relations group therapy with shizophrenic patients."
24 patients with avoidant personality disorder (AVPD) and 14 patients with obsessive-compulsive personality disorder (OCPD; all Ss 20–65 yrs old) were assigned to 52 sessions of time-limited Supportive-Expressive dynamic psychotherapy. At intake, most Ss had least 1 concurrent depressive and/or anxiety disorder. OCPD Ss lost their personality disorder diagnoses significantly faster than did AVPD Ss. By the end of treatment, 39% of AVPD Ss still retained their diagnosis while only 15% of OCPD did so. Using hierarchical linear modeling, both patient groups improved significantly across time on measures of personality disorders, depression, anxiety, general functioning, and interpersonal problems. OCPD Ss remained in treatment significantly longer and tended to improve more than did AVPD Ss. Alliance ratings from both Ss and therapists increased significantly over time, expect for those OCPD Ss who remained constant. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Short-term dynamic psychotherapy is a group of well-researched brief treatments with over 50 published controlled trials testing its effectiveness against a range of treatment and nontreatment controls. Studied samples are often high users of medical services, hospital services, mental health services and disability insurance. If short-term dynamic psychotherapy is effective, it should translate into demonstrable reductions in medical and social system costs. This review examines whether or not short-term dynamic psychotherapy is a cost-effective treatment.
Somatic symptom disorders are common, disabling and costly. Individually provided short-term psychodynamic psychotherapies (STPP) have shown promising results. However, the effectiveness of STPP for somatic symptom disorders has not been reviewed.
We undertook a systematic review of randomized controlled trials and controlled before and after studies. The outcomes included psychological symptoms, physical symptoms, social-occupational function, healthcare utilization and treatment continuation.
A total of 23 studies met the inclusion criteria and covered a broad range of somatic disorders. Thirteen were RCTs and 10 were case series with pre-post outcome assessment. Of the included studies, 21/23 (91.3%), 11/12 (91.6%), 16/19 (76.2%) and 7/9 (77.8%) reported significant or possible effects on physical symptoms, psychological symptoms, social-occupational function and healthcare utilization respectively. Meta-analysis was possible for 14 studies and revealed significant effects on physical symptoms, psychiatric symptoms and social adjustment which were maintained in long-term follow-up. Random-effect modeling attenuated some of these relationships. There was a 54% greater treatment retention in the STPP group versus controls.
STPP may be effective for a range of medical and physical conditions underscoring the role of patients' emotional adjustment in overall health. Future research should include high-quality randomized and clinical effectiveness studies with attention to healthcare use and costs.
• Current emphasis on early case finding, outpatient care, and on longitudinal studies of asymptomatic patients has focused attention on the community adjustment of psychiatric patients. Thus, simple and inexpensive methods such as self-report scales, which allow the routine assessment of patient adjustment, are potentially useful.
The derivation and testing of such a method, the Social Adjustment Scale Self-Report, is described. This scale covers the patient's role performance, interpersonal relationships, friction, feelings and satisfaction in work, and social and leisure activities with the extended family, as a spouse, parent, and member of a family unit. Self-report results based on 76 depressed outpatients were comparable to those obtained from relatives as well as by a rater who interviewed the patient directly.
The authors investigated the relationship between personality disorders and treatment outcome in the National Institute of Mental Health Treatment of Depression Collaborative Research Program, which involved 239 outpatients with major depressive disorder randomly assigned to one of four 16-week treatment conditions. Patients with personality disorders (74% of the sample) had a significantly worse outcome in social functioning than patients without personality disorders and were significantly more likely to have residual symptoms of depression. There were no significant differences in work functioning or in mean depression scores at treatment termination. Outcome was similar for patients in the different clusters of personality disorders.
The efficacy of short-term psychotherapy has become an area of increasing interest. The primary objective of this study was to assess the results of two forms of short-term psychotherapy in patients with personality disorders.
Eighty-one patients with personality disorders were randomly assigned to brief adaptive psychotherapy, short-term dynamic psychotherapy, or a waiting list for therapy. Outcome at termination of therapy for the treatment groups and at the end of the waiting period for the waiting list group was evaluated by means of ratings of target complaints and scores on the SCL-90 and the Social Adjustment Scale. In addition, for 38 of the treated patients, target complaints were reevaluated an average of 1.5 years after treatment ended.
Patients in the two therapy conditions improved significantly on all measures in comparison with the patients on the waiting list. There was no significant difference between the results in the two therapy conditions. The waiting list period averaged approximately 15 weeks; treatment averaged 40 weeks. At follow-up, after an average of 1.5 years, target complaint ratings were not significantly different from those at the termination of therapy.
These data indicate that brief adaptive psychotherapy and short-term dynamic psychotherapy are effective for patients with certain types of personality disorder and that the two therapy approaches do not differ in overall outcome.
In a group of 25 patients with major depression, the authors investigated the relationships among having a comorbid personality disorder, the severity of psychiatric disorder, and the outcome of dynamic psychotherapy. They found that 1) depressed patients with a comorbid diagnosis of personality disorder had more severe psychiatric disturbance at intake and at termination of therapy as well as at follow-up and 2) although all patients improved and maintained their gains at follow-up, those with a comorbid personality disorder diagnosis did not improve as much as those without a personality disorder.
Twenty-seven of 114 depressed clients, stratified for severity of depression, obtained a Diagnostic and Statistical Manual of Mental Disorders (3rd ed.; DSM-III; American Psychiatric Association, 1980) diagnosis of Cluster C personality disorder--that is, avoidant, obsessive-compulsive or dependent personality disorder (PD clients)--whereas the remaining 87 did not (non-personality-disorder [NPD] clients). All clients completed either 8 or 16 sessions of cognitive-behavioral (CB) or psychodynamic-interpersonal (PI) psychotherapy. On most measures, PD clients began with more severe symptomatology than NPD clients. Among those who received PI therapy, PD clients maintained this difference posttreatment and at 1-year follow-up. Among those who received CB therapy, posttreatment differences between PD and NPD groups were not significant. Treatment length did not influence outcome for PD clients. PD clients whose depression was also relatively severe showed significantly less improvement after treatment than either PD clients with less severe depression or NPD clients.
The authors report preliminary results of Brief Supportive Psychotherapy (BSP) in the Beth Israel Brief Psychotherapy Program for a sample with primarily Cluster C Axis II disorders. This study compares 24 patients treated with BSP with 25 patients treated with Short-Term Dynamic Psychotherapy (STDP). STDP was chosen because its confrontational methods contrast dramatically to BSP, which emphasizes building self-esteem, reducing anxiety, and enhancing coping mechanisms. Videotaped therapies were based on manualized 40-session protocols. Similar degrees of improvement were seen in BSP and STDP at termination and at 6-month follow-up. A study of therapeutic alliance in BSP showed stable and high levels of alliance in good-outcome cases and more variability in poor-outcome cases. These preliminary findings are consistent with other studies and suggest supportive psychotherapy may be effective for many patients, leading to significant and lasting change.
A randomized, controlled trial was conducted on 110 subjects who scored positive on the Diagnostic Interview for Borderlines to assess the merits of an experimental, time-limited group treatment for borderline personality disorder (BPD) in comparison with the control condition, individual dynamic psychotherapy. Seventy-nine subjects received treatment. Analyses at 12- and 24-month follow-ups on 84% of the treated subjects (N = 66), demonstrated no statistically significant differences in outcome on the major dependent variables. Outpatient referrals to the study complied with the treatments at twice the rate of inpatient referrals. The total study cohort showed significant improvements on all major outcomes at follow-up. The cost effectiveness of the group approach, in tandem with its potential for application in a range of community services by multidisciplinary practitioners, speaks to the promise of this treatment as an innovative service approach for BPD.
Time-limited psychodynamic therapies in an outpatient setting are offered for a broad spectrum of psychogenic disorders. Chiefly, meta-analyses have proved their effectiveness where neurotic disorders have been concerned. The Cyclic Maladaptive Pattern/Structural Analysis of Social Behavior (CMP/SASB) model (Tress et al., 1996) of short-term dynamic psychotherapy (STDP) in this study was applied to patients with somatoform and personality disorders. Using a naturalistic design, 41 therapists treated 75 patients with personality (n = 24), somatoform (n = 24), and neurotic (n = 27) disorders. Relevant research instruments were Beeintrachtigungsschwere Score (BSS; an impairment score), Global Assessment of Functioning Scale (GAF), CMP, Symptom Checklist (SCL-90-R), and Intrex Introject Questionnaire based on the SASB. The treatments lasted for 25 sessions, and follow-up examinations were performed after 6 months and 1, 2, and 5 years. Effect sizes for the entire sample by BSS and GAF are reported. Somatoform...
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
The objective is to study the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) trial therapies. In a tertiary psychotherapy service, Brief Symptom Inventory (BSI), Inventory of Interpersonal Problems (IIP) medication use, and need for further treatment were evaluated before versus 1-month post trial therapy in a sequential series of 30 clients. Trial therapies were interviews with active focus on emotions and how they are experienced. The interviews resulted in statistically significant improvements on all BSI subscales and one of the IIP subscales. One-third of clients required no further treatment, seven stopped medications, and two returned to work following trial therapy. The ISTDP trial therapy appeared tobe clinicallyeffectiveandcosteffective. Future researchdirections arediscussed. (Brief Treatment and Crisis Intervention 8:164-170 (2008))
Time-limited psychodynamic therapies in an outpatient setting are offered for a broad spectrum of psychogenic disorders. Chiefly, meta-analyses have proved their effectiveness where neurotic disorders have been concerned. The Cyclic Maladaptive Pattern/Structural Analysis of Social Behavior (CMP/SASB) model (Tress et al., 1996) of short-term dynamic psychotherapy (STDP) in this study was applied to patients with somatoform and personality disorders. Using a naturalistic design, 41 therapists treated 75 patients with personality (n = 24), somatoform (n = 24), and neurotic (n = 27) disorders. Relevant research instruments were Beeinträchtigungsschwere Score (BSS; an impairment score), Global Assessment of Functioning Scale (GAF), CMP, Symptom Checklist (SCL-90-R), and Intrex Introject Questionnaire based on the SASB. The treatments lasted for 25 sessions, and follow-up examinations were performed after 6 months and 1, 2, and 5 years. Effect sizes for the entire sample by BSS and GAF are reported. Somatoform patients benefited the most, but those with personality disorders also profited. Effect sizes of self-ratings (SCL-90-R and Intrex) were not as high. Thus, the CMP/SASB model of STDP is suited not only for neuroses but is especially appropriate for somatoform disorders as well.
A meta-analysis was conducted of 125 studies on psychotherapy dropout. Mean dropout rate was 46.86%. Dropout rate was unrelated to most of the variables that were examined but differed significantly as a function of definition of dropout. Lower dropout rates occurred when dropout was defined by termination because of failure to attend a scheduled session than by either therapist judgment or number of sessions attended. Significant effect sizes were observed for 3 client demographic variables: racial status, education, and income. Dropout rates increased for African-American (and other minority), less-educated, and lower income groups. Recommendations for future psychotherapy dropout research are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Describes a new instrument, the Inventory of Interpersonal Problems (IIP), which measures distress arising from interpersonal sources. The IIP meets the need for an easily administered self-report inventory that describes the types of interpersonal problems that people experience and the level of distress associated with them before, during, and after psychotherapy. In Study 1, psychometric data are presented for 103 patients who were tested at the beginning and end of a waiting period before they began brief dynamic psychotherapy. On both occasions, a factor analysis yielded the same six subscales; these scales showed high internal consistency and high test–retest reliability. Study 2 demonstrated the instrument's sensitivity to clinical change. In this study, a subset of patients was tested before, during, and after 20 sessions of psychotherapy. Their improvement on the IIP agreed well with all other measures of their improvement, including those generated by the therapist and by an independent evaluator. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
A detailed study of 20 patients treated in brief psychoanalytic therapy. Surveying the literature, hypotheses as to selection criteria, technique, and outcome are proposed. The clinical data on the patients' course of treatment is organized into rationally derived categories. Results are evaluated both qualitatively and quantitatively. Findings support the "radical" view that brief therapy can achieve far reaching improvements in neurotic patients independent of the severity or chronicity of their psychopathology. Favorable prognosis is related to the following conditions: "The patient has a high motivation; the therapist has a high enthusiasim; transference arises early and becomes a major feature of therapy; grief and anger at termination are imporatnt issues." (92 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The major purpose of the Millon Clinical Multiaxial Inventory (MCMI) is to provide information to psychologists, counselors, psychiatrists, and social workers who must make assessments and treatment decisions about persons with emotional and interpersonal difficulties. Each of its 22 scales is designed to be an operational measure of a syndrome derived from a theory of personality and psychopathology (T. Millon, 1969, 1981, 1990). Both uses and limitations of the instrument are recorded. Steps to be followed in making configural interpretations are recommended, and results of evaluative research are reported. The MCMI-II is viewed as an evolving assessment instrument, upgraded and refined to reflect substantive advances in knowledge. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper presents a study with the aim of evaluating the relative efficacy of an alliance-focused treatment, brief relational therapy, in comparison to a short-term dynamic therapy and a cognitive-behavioral therapy on a sample of highly comorbid personality disordered patients. Results indicated that the three treatments were equally effective on standard statistical analyses of change, including those conducted on repeated measures and residual gain scores. Some significant differences were indicated regarding clinically significant change and reliable change, favoring the brief relational and cognitive-behavioral models. There was also a significant difference regarding dropout rates, favoring brief relational therapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
There is evidence that the quality of controlled clinical trials affects the results that are obtained. A systematic approach to the assessment of quality is required for psychiatric research. This study set out to develop an instrument for the assessment of the quality of controlled trials of interventions for depressive and non-psychotic conditions. A pilot study led to the development of a scale containing 23 items covering a wide range of aspects of quality including objective formulation, design, presentation of results, analysis and quality of conclusions. Scoring criteria were devised and the scale was then subjected to reliability testing using a random sample of trials of treatment for depression and ‘neurosis’. The scale showed moderate inter-rater reliability and results were comparable to those obtained with shorter instruments. It was quick and easy to use. There were significant correlations between year of publication and overall quality score with later studies showing higher quality. The instrument developed here provides a systematic approach to the assessment of quality for use in critical appraisal of individual studies and meta-analysis. However, the scoring process should be used cautiously since inter-rater agreement was only moderate. Copyright © 2001 Whurr Publishers Ltd.
Twenty-six studies of the effectiveness of short-term dynamic therapy (STDT) were subjected to two meta-analyses. Effect sizes (ES) obtained by each method were similar. STDT attained average ESs of 71 and 34, relative to waitlist and minimal treatment groups, respectively. When studies using psychosomatic patients were excluded, STDT achieved an ES of 85, relative to waitlist groups. We found no evidence that STDT is superior or inferior to other forms of psychotherapy at posttreatment, although it evidenced a slight superiority at long-term followup assessment. There was, in addition, evidence that studies employing manuals or therapists trained in STDT produced larger ESs than those that did not.
The presence of comorbid personality disorder (PD) is one of the factors that can make the treatment of depression unsuccessful. Short-term Psychodynamic Psychotherapy (STPP) has been shown efficacious in the treatment of personality and depressive disorders (DD). However, the efficacy of STPP for comorbid DD and PD has not been systematically evaluated. In this study, data from patients meeting criteria for both DD and PD participating from randomized controlled trials of STPP was collected, systematically reviewed, and meta-analyzed where possible. Eight studies were included, 6 with major depression and 2 with minor depressive disorders. Pre- to post- treatment effects sizes were large (d = 1.00-1.27), suggesting symptom improvement during STPP, and these gains were maintained in follow-ups averaging over 1.5 years. For major depression, no differences were found comparing STPP to other psychotherapies, and STPP was found superior to a wait-list condition in one study. STPP may have had an advantage over other therapy controls in treating minor depression as noted in ratings of general psychopathology. Patients with Cluster A/B and C PD were responsive to STPP, with the majority of all studied patients showing clinically significant change on self-report measures. Within the limits of this study, these findings suggest that STPP warrants consideration as a first line treatment for combined personality disorder and depression. Future research directions are proposed.
It remains largely unclear, firstly whether short-term psychodynamic psychotherapy (STPP) is an effective treatment for depression, and secondly, which study, participant, or intervention characteristics may moderate treatment effects. The purpose of this study is to assess the efficacy of STPP for depression and to identify treatment moderators.
After a thorough literature search, 23 studies totaling 1365 subjects were included. STPP was found to be significantly more effective than control conditions at post-treatment (d=0.69). STPP pre-treatment to post-treatment changes in depression level were large (d=1.34), and these changes were maintained until 1-year follow-up. Compared to other psychotherapies, a small but significant effect size (d=-0.30) was found, indicating the superiority of other treatments immediately post-treatment, but no significant differences were found at 3-month (d=-0.05) and 12-month (d=-0.29) follow-up. Studies employing STPP in groups (d=0.83) found significantly lower pre-treatment to post-treatment effect sizes than studies using an individual format (d=1.48). Supportive and expressive STPP modes were found to be equally efficacious (d=1.36 and d=1.30, respectively).
We found clear indications that STPP is effective in the treatment of depression in adults. Although more high-quality RCTs are necessary to assess the efficacy of the STPP variants, the current findings add to the evidence-base of STPP for depression.
Thirty-two patients with personality disorder diagnoses were randomly assigned to two treatment conditions that vary on several techniques of brief dynamic psychotherapy. Seventeen patients constituted a waiting list control group. The two brief psychotherapies showed significant improvement on target complaints, SCL-90, and Social Adjustment Scale-SR compared with the control subjects. The two therapy groups were similar in overall outcome but showed interesting differences on several subscale measures. Process measurements of videotaped sessions revealed significant variations in frequencies of therapist interventions across the two treatment conditions, which validated planned differences in the treatment techniques.
This study examines the relationship between borderline personality disorder (BPD) and the use of psychiatric services in a naturalistic follow-up comparison with antisocial personality disorder and bipolar type II affective disorder. In the first follow-up series, borderline psychopathology was associated with higher levels of psychiatric service use (emergency, daycare, and inpatient). Markov analyses indicated that the transition between levels of psychiatric service use followed a stationary, second order process (i.e. the immediate past and current service use, predicted use on the next follow-up, and the relationship did not depend on the point in time examined in the follow-up series). Further, the transition probabilities generated from this model did not depend significantly on diagnosis. Predictions from the Markov model about the cumulative probability that subjects would use the highest level of psychiatric services were tested on a second series of follow-ups on the same subjects 20 months later. The model-based predictions (starting from the observed levels in the first two follow-ups of the second series) clustered into three groups, of high, middle, and low predicted probabilities. The subject group with the lowest predicted likelihood had a cumulative probability of 0.19 for using emergency, daycare, or inpatient hospitalization by 22 months of follow-up, whereas the group with the highest likelihood (containing a disproportionate number of BPD subjects) had a cumulative observed probability of 0.80. The Markov model generated from this second series supported the stationarity of the transition process. BPD subjects began using high levels of psychiatric services, but their transition from one level to another over time followed a process similar to that of non-BPD subjects.
Synopsis
This is an introductory report for the Brief Symptom Inventory (BSI), a brief psychological self-report symptom scale. The BSI was developed from its longer parent instrument, the SCL-90-R, and psychometric evaluation reveals it to be an acceptable short alternative to the complete scale. Both test-retest and internal consistency reliabilities are shown to be very good for the primary symptom dimensions of the BSI, and its correlations with the comparable dimensions of the SCL-90-R are quite high. In terms of validation, high convergence between BSI scales and like dimensions of the MMPI provide good evidence of convergent validity, and factor analytic studies of the internal structure of the scale contribute evidence of construct validity. Several criterion-oriented validity studies have also been completed with this instrument
In our study of 43 neurotic outpatients treated with brief dynamic psychotherapy, a significant inverse relationship was found between frequency of transference interpretations and long-term outcome for the subsample of 21 patients with a history of high quality of interpersonal relationships. At four-year follow-up, only one of four such patients achieved successful dynamic change when the interpretive focus had been on the transference relationship, whereas three of four patients achieved successful dynamic change when the interpretive focus had been on extratransference relationships. Contrary to what we expected, the subsample of 22 patients with a history of low quality of interpersonal relationships were more able to tolerate high numbers of transference interpretations from early on in treatment. Interpretive work on the transference is ancillary to work outside the transference. This, indeed, was Freud's theoretical position.
Comorbidity between major psychiatric disorders (Axis I) and personality disorders (Axis II) is widespread, often extremely strong, and invariably confusing. The strongest associations are found between substance use and the cluster B (flamboyant) personality disorders, anxiety disorders and the anxious/fearful personality group (cluster C), and between somatisation and both cluster B and C disorders. The significance of these associations is far from clear, and almost certainly include more than one type of relationship. Empirical studies of patients with and without Axis I and II comorbidity show that the presence of a personality disorder can affect the outcome of treatment, both positively and negatively, in a way that currently appears unpredictable. One useful way of interpreting this comorbidity is by postulating personality dispositions that make some people prone to certain mental state disorders.