Hostname: page-component-669899f699-qzcqf Total loading time: 0 Render date: 2025-05-05T19:54:31.726Z Has data issue: false hasContentIssue false
  • English
  • Français

Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up

Published online by Cambridge University Press:  16 November 2007

P. Knekt ,
O. Lindfors ,
T. Härkänen ,
M. Välikoski ,
E. Virtala ,
M. A. Laaksonen ,
M. Marttunen ,
M. Kaipainen  and
C. Renlund
P. Knekt*
Affiliation:
Social Insurance Institution, Helsinki, Finland Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland
O. Lindfors
Affiliation:
Biomedicum Helsinki, Helsinki, Finland
T. Härkänen
Affiliation:
Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland
M. Välikoski
Affiliation:
Biomedicum Helsinki, Helsinki, Finland
E. Virtala
Affiliation:
Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland
M. A. Laaksonen
Affiliation:
Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland
M. Marttunen
Affiliation:
Biomedicum Helsinki, Helsinki, Finland
M. Kaipainen
Affiliation:
Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
C. Renlund
Affiliation:
Biomedicum Helsinki, Helsinki, Finland
*
*Address for correspondence: Dr P. Knekt, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. (Email: paul.knekt@ktl.fi)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Insufficient evidence exists for a viable choice between long- and short-term psychotherapies in the treatment of psychiatric disorders. The present trial compares the effectiveness of one long-term therapy and two short-term therapies in the treatment of mood and anxiety disorders.

Method

In the Helsinki Psychotherapy Study, 326 out-patients with mood (84.7%) or anxiety disorder (43.6%) were randomly assigned to three treatment groups (long-term psychodynamic psychotherapy, short-term psychodynamic psychotherapy, and solution-focused therapy) and were followed up for 3 years from start of treatment. Primary outcome measures were depressive symptoms measured by self-report Beck Depression Inventory (BDI) and observer-rated Hamilton Depression Rating Scale (HAMD), and anxiety symptoms measured by self-report Symptom Check List Anxiety Scale (SCL-90-Anx) and observer-rated Hamilton Anxiety Rating Scale (HAMA).

Results

A statistically significant reduction of symptoms was noted for BDI (51%), HAMD (36%), SCL-90-Anx (41%) and HAMA (38%) during the 3-year follow-up. Short-term psychodynamic psychotherapy was more effective than long-term psychodynamic psychotherapy during the first year, showing 15–27% lower scores for the four outcome measures. During the second year of follow-up no significant differences were found between the short-term and long-term therapies, and after 3 years of follow-up long-term psychodynamic psychotherapy was more effective with 14–37% lower scores for the outcome variables. No statistically significant differences were found in the effectiveness of the short-term therapies.

Conclusions

Short-term therapies produce benefits more quickly than long-term psychodynamic psychotherapy but in the long run long-term psychodynamic psychotherapy is superior to short-term therapies. However, more research is needed to determine which patients should be given long-term psychotherapy for the treatment of mood or anxiety disorders.

Keywords

Anxietydepressionlong-termpsychotherapyrandomized trial
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 5 , May 2008 , pp. 689 - 703
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Anderson, EM, Lambert, MJ (1995). Short-term dynamically oriented psychotherapy: a review and meta-analysis. Clinical Psychology Review 15, 503–514.CrossRefGoogle Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association: Washington, DC.Google Scholar
Barber, JP, Ellman, J (1996). Advances in short-term dynamic psychotherapy. Current Opinion in Psychiatry 9, 188–192.CrossRefGoogle Scholar
Beck, AT, Steer, RA, Garbin, MG (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review 8, 77–100.CrossRefGoogle Scholar
Beck, AT, Ward, CH, Mendelson, M, Mock, J, Erbaugh, J (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561–571.CrossRefGoogle ScholarPubMed
Bond, M, Perry, JC (2006). Psychotropic medication use, personality disorder and improvement in long-term dynamic psychotherapy. Journal of Nervous and Mental Disease 194, 21–26.CrossRefGoogle ScholarPubMed
Brockman, B, Poynton, A, Ryle, A, Watson, JP (1987). Effectiveness of time-limited therapy carried out by trainees. Comparison of two methods. British Journal of Psychiatry 151, 602–610.CrossRefGoogle ScholarPubMed
Busch, FN, Milrod, BL, Singer, MB (1999). Theory and technique in psychodynamic treatment of panic disorder. Journal of Psychotherapy Practice and Research 8, 234–242.Google ScholarPubMed
Busch, FN, Rudden, M, Shapiro, T (2004). Psychodynamic Treatment of Depression. American Psychiatric Publishing: Washington, DC.Google Scholar
Carey, V, Zeger, SL, Diggle, P (1993). Modelling multivariate binary data with alternating logistic regressions. Biometrika 80, 517–526.CrossRefGoogle Scholar
Castonguay, LG, Arnow, BA, Blatt, SJ, Jones, EE, Pilkonis, PA, Segal, ZV (1999). Psychotherapy for depression: current and future directions in research, theory, practice and public policy. Journal of Clinical Psychology 55, 1347–1370.3.0.CO;2-L>CrossRefGoogle ScholarPubMed
Crits-Christoph, P (1992). The efficacy of brief dynamic psychotherapy: a meta-analysis. American Journal of Psychiatry 149, 151–158.Google ScholarPubMed
de Shazer, S (1991). Putting Difference to Work. W. W. Norton & Company: New York, NY.Google Scholar
de Shazer, S, Berg, IK, Lipchik, E, Nunnally, E, Molnar, A, Gingerich, W, Weiner-Davis, M (1986). Brief therapy: focused solution development. Family Process 25, 207–221.CrossRefGoogle ScholarPubMed
Derogatis, LR, Lipman, RS, Covi, L (1973). SCL-90: an outpatient psychiatric rating scale – preliminary report. Psychopharmacology Bulletin 9, 13–28.Google ScholarPubMed
Durham, RC, Murphy, T, Allan, T, Richard, K, Treliving, LR, Fenton, GW (1994). Cognitive therapy, analytic psychotherapy and anxiety management training for generalised anxiety disorder. British Journal of Psychiatry 165, 315–323.CrossRefGoogle ScholarPubMed
Gabbard, GO (2004). Long-term Psychodynamic Psychotherapy. A Basic Text. American Psychiatric Publishing: Washington, DC.Google Scholar
Gabbard, GO, Gunderson, JG, Fonagy, P (2002). The place of psychoanalytic treatments within psychiatry. Archives of General Psychiatry 59, 505–510.CrossRefGoogle ScholarPubMed
Gallagher-Thompson, D, Hanley-Peterson, P, Thompson, LW (1990). Maintenance of gains versus relapse following brief psychotherapy for depression. Journal of Consulting and Clinical Psychology 58, 371–374.CrossRefGoogle ScholarPubMed
Gallagher-Thompson, D, Steffen, AM (1994). Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers. Journal of Consulting and Clinical Psychology 62, 543–549.CrossRefGoogle ScholarPubMed
Gingerich, WJ, Eisengart, S (2000). Solution-focused brief therapy: a review of the outcome research. Family Process 39, 477–498.CrossRefGoogle ScholarPubMed
Hamilton, M (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology 32, 50–55.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Härkänen, T, Knekt, P, Virtala, E, Lindfors, O (2005). A case study in comparing therapies involving informative drop-out, non-ignorable non-compliance and repeated measurements. Statistics in Medicine 24, 3773–3787.CrossRefGoogle ScholarPubMed
Hersen, M, Bellack, AS, Himmelhoch, JM, Thase, ME (1984). Effects of social skill training, amitriptyline, and psychotherapy in unipolar depressed women. Behavior Therapy 15, 21–40.CrossRefGoogle Scholar
Hoglend, P, Perry, JC (1998). Defensive functioning predicts improvement in major depressive episodes. Journal of Nervous and Mental Disease 186, 238–243.CrossRefGoogle ScholarPubMed
Johnson, LD, Miller, SD (1994). Modification of depression risk factors: a solution-focused approach. Psychotherapy: Theory, Research, Practice, Training 31, 244–253.CrossRefGoogle Scholar
Keller, MB (2003). Past, present, and future directions for defining optimal treatment outcome in depression: remission and beyond. Journal of the American Medical Association 289, 3152–3160.CrossRefGoogle ScholarPubMed
Kernberg, OF (1996). A psychoanalytic theory of personality disorders. In Major Theories of Personality Disorder (ed. Clarkin, J. F. and Lenzenweger, M. F.), pp. 106–140. The Guilford Press: New York, NY.Google Scholar
Knekt, P, Lindfors, O (2004). A randomized trial of the effect of four forms of psychotherapy on depressive and anxiety disorders. Design, methods, and results on the effectiveness of short-term psychodynamic psychotherapy and solution-focused therapy during a one-year follow-up. Studies in social security and health 77. The Social Insurance Institution: Helsinki (http://www.ktl.fi/hps/pdf/effectiveness.pdf). Accessed 16 June 2006.Google Scholar
Lambert, MJ, Okiishi, JC, Finch, AE, Johnson, LD (1998). Outcome assessment: from conceptualization to implementation. Professional Psychology: Research and Practice 29, 63–70.CrossRefGoogle Scholar
Lee, J (1981). Covariance adjustment of rates based on the multiple logistic regression model. Journal of Chronic Diseases 34, 415–426.CrossRefGoogle ScholarPubMed
Leichsenring, F (2001). Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: a meta-analytic approach. Clinical Psychology Review 21, 401–419.CrossRefGoogle ScholarPubMed
Leichsenring, F, Rabung, S, Leibing, E (2004). The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. Archives of General Psychiatry 61, 1208–1216.CrossRefGoogle ScholarPubMed
Liang, K-Y, Zeger, SL (1986). Longitudinal data analysis using generalized linear models. Biometrika 73, 13–22.CrossRefGoogle Scholar
Malan, DH (1976). The Frontier of Brief Psychotherapy: An Example of the Convergence of Research and Clinical Practice. Plenum Medical Books: New York, NY.CrossRefGoogle Scholar
McKeel, AJ (1996). A clinician's guide to research on solution-focused brief therapy. In Handbook of Solution-Focused Brief Therapy (ed. Miller, S. D., Hubble, M. and Duncan, B. L.), pp. 251–271. Jossey-Bass Publishers: San Francisco, CA.Google Scholar
McLean, PD, Hakstian, AR (1979). Clinical depression: comparative efficacy of outpatient treatments. Journal of Consulting and Clinical Psychology 47, 818–836.CrossRefGoogle ScholarPubMed
Migon, HdS, Gamerman, D (1999). Statistical Inference: An Integrated Approach. Arnold: London.Google Scholar
Piper, WE, Debbane, EG, Bienvenu, JP, Garant, J (1984). A comparative study of four forms of psychotherapy. Journal of Consulting and Clinical Psychology 52, 268–279.CrossRefGoogle ScholarPubMed
Piper, WE, McCallum, M, Joyce, AS, Azim, HF, Ogrodniczuk, JS (1999). Follow-up findings for interpretive and supportive forms of psychotherapy and patient personality variables. Journal of Consulting and Clinical Psychology 67, 267–273.CrossRefGoogle ScholarPubMed
Rosenthal, R, Rosnow, RL (1991). Essentials of Behavioral Research: Methods and Data Analysis, 2nd edn. McGraw Hill: New York, NY.Google Scholar
SAS Institute Inc. (1999). SAS Online Doc. SAS/STAT User's Guide, Version 8. SAS Institute Inc: Cary, NC.Google Scholar
Schaefer, BA, Koeter, MW, Wouters, L, Emmelkamp, PM, Schene, AH (2003). What patient characteristics make clinicians recommend brief treatment? Acta Psychiatrica Scandinavica 107, 188–196.CrossRefGoogle ScholarPubMed
Sifneos, PE (1978). Short-term anxiety provoking psychotherapy. In Short-term Dynamic Psychotherapy (ed. Davanloo, H.), pp. 35–42. Spectrum: New York, NY.Google Scholar
Svartberg, M, Stiles, TC (1991). Comparative effects of short-term psychodynamic psychotherapy: a meta-analysis. Journal of Consulting and Clinical Psychology 59, 704–714.CrossRefGoogle ScholarPubMed
Wampold, BE, Minami, T, Baskin, TW, Callen, Tierney S (2002). A meta-(re)analysis of the effects of cognitive therapy versus ‘other therapies’ for depression. Journal of Affective Disorders 68, 159–165.CrossRefGoogle ScholarPubMed
Wampold, BE, Mondin, GW, Moody, M, Stich, F, Benson, K, Ahn, H (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: empirically, ‘all must have prizes’. Psychological Bulletin 122, 203–215.CrossRefGoogle Scholar
Verbeke, G, Molenberghs, G (1997). Linear Mixed Models in Practice: A SAS-oriented Approach. Springer: New York, NY.CrossRefGoogle Scholar
WHO (2000). Cross-national comparisons of the prevalences and correlates of mental disorders. WHO International Consortium in Psychiatric Epidemiology. Bulletin of the World Health Organization 78, 413–426.Google Scholar
Wiborg, IM, Dahl, AA (1996). Does brief dynamic psychotherapy reduce the relapse rate of panic disorder? Archives of General Psychiatry 53, 689–694.CrossRefGoogle ScholarPubMed
Wilczek, A, Barber, JP, Gustavsson, JP, Asberg, M, Weinryb, RM (2004). Change after long-term psychoanalytic psychotherapy. Journal of the American Psychoanalytic Association 52, 1163–1184.Google ScholarPubMed