Skip to main content Accesibility Help
×
×
Home

Effectiveness of systematic treatment selection for psychodynamic and cognitive–behavioural therapy: randomised controlled trial in routine mental healthcare

  • Birgit Watzke (a1), Heinz Rüddel (a2), Ralph Jürgensen (a2), Uwe Koch (a1), Levente Kriston (a1), Barbara Grothgar (a2) and Holger Schulz (a3)...
Abstract
Background

Although cognitive–behavioural therapy (CBT) and psychodynamic therapy (PDT) are both effective treatments for mental disorders, they show clear dissimilarities concerning their therapeutic models and treatment rationales.

Aims

To determine the effectiveness of systematic treatment selection (STS) to CBT or PDT in a mental healthcare setting compared with a control procedure of random treatment selection (RTS).

Method

A randomised controlled trial in a consecutive sample of 291 in-patients with at least one ICD–10 mental disorder was performed. The primary outcome was symptom severity (General Severity Index of the Symptom Checklist–14) at 6-month follow-up. Health-related quality of life was the secondary outcome, determined using the Short Form–8.

Results

Analyses revealed no general effect for systematic treatment selection. However, there was a differential effect: systematic selection resulted in a better longer-term outcome for PDT, but not for CBT; STS–PDT patients showed a significantly larger reduction in symptom severity than RTS–PDT patients. This difference was not observed in CBT.

Conclusions

Since systematic treatment selection seems to be able to optimise treatment outcome, at least for PDT, pursuing systematic treatment assignment strategies in mental healthcare settings is a worthwhile endeavour.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Effectiveness of systematic treatment selection for psychodynamic and cognitive–behavioural therapy: randomised controlled trial in routine mental healthcare
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Effectiveness of systematic treatment selection for psychodynamic and cognitive–behavioural therapy: randomised controlled trial in routine mental healthcare
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Effectiveness of systematic treatment selection for psychodynamic and cognitive–behavioural therapy: randomised controlled trial in routine mental healthcare
      Available formats
      ×
Copyright
Corresponding author
Birgit Watzke, Research Group for Mental Health Care Research Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52 (Building W26), Hamburg 20246, Germany. Email: watzke@uke.uni-hamburg.de
Footnotes
Hide All

See editorial pp. 83–85, this issue.

Funded by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG). Grant No. SCHU 1513/1-1 to H.S.

Declaration of interest

None.

Footnotes
References
Hide All
1 Shadish, WR, Matt, GE, Navarro, AM, Phillips, G. The effects of psychological therapies under clinically representative conditions – a meta-analysis. Psychol Bull 2000; 126: 512–29.
2 Luty, SE, Carter, JD, McKenzie, JM, Rae, AM, Frampton, CMA, Mulder, RT, et al. Randomised controlled trial of interpersonal psychotherapy and cognitive–behavioural therapy for depression. Br J Psychiatry 2007; 190: 496502.
3 Lambert, MJ, Ogles, BM. The efficacy and effectiveness of psychotherapy. In Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (ed Lambert, MJ): 139–93. John Wiley, 2003.
4 Tillett, R. Psychotherapy assessment and treatment selection. Br J Psychiatry 1996; 168: 10–5.
5 Paul, GL. Strategy of outcome research in psychotherapy. J Consult Psychol 1967; 31: 109–18.
6 Roth, A, Fonagy, P. What Works for Whom? A Critical Review of Psychotherapy Research. Guilford Press, 1996.
7 Beutler, LE, Harwood, TM. Systematic treatment selection and prescriptive therapy. In A Casebook of Psychotherapy Integration (eds G Stricker, J Gold): 2941. American Psychological Association, 2006.
8 Chambless, DL, Ollendick, TH. Empirically supported psychological interventions: Controversies and evidence. Annu Rev Psychol 2001; 52: 685716.
9 Barghaan, D, Schulz, H, Koch, U, Watzke, B. Versorgungsstrukturen im stationären Setting in Deutschland: Verteilung von Einzel- und Gruppentherapie und deren psychotherapeutischen Ausrichtungen [Structure of inpatient mental health care in Germany: distribution of individual and group therapy and their treatment approaches]. Gruppenpsychother Gr 2009; 45: 83103.
10 Emmelkamp, PMG. Behavior therapy with adults. In Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (ed Lambert, MJ): 393446. John Wiley, 2003.
11 Hollon, SD, Beck, AT. Cognitive and cognitive behavioral therapies. In Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (ed Lambert, MJ): 447–92. John Wiley, 2003.
12 Leichsenring, F, Rabung, S, Leibing, E. The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. Arch Gen Psychiat 2004; 61: 1208–16.
13 Goldfried, MR, Castonguay, LG. A comparative analysis of the therapeutic focus in cognitive-behavioral and psychodynamic-interpersonal sessions. J Consult Clin Psychol 1997; 65: 740–8.
14 Watzke, B, Rueddel, H, Koch, U, Rudolph, M, Schulz, H. Comparison of therapeutic action, style and content in cognitive-behavioural and psychodynamic group therapy under clinically representative conditions. Clin Psychol Psychother 2008; 15: 404–17.
15 Keller, MB, McCullough, JP, Klein, DN, Arnow, BA, Rush, AJ, Nemeroff, CB, et al. A comparison of nefazadone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. N Engl J Med 2000; 322: 1462–70.
16 Feixas, G, Botella, L. Psychotherapy Integration: reflections and contributions from a constructivist epistemology. J Psychother Integrat 2004; 14: 192222.
17 Grawe, K. Psychological Therapy. Hogrefe & Huber Publishers, 2002.
18 Harwood, TM, Williams, OB. Identifying treatment relevant assessment: the STS. In Integrative Assessment of Adult Personality (eds Beutler, LE, Groth-Marnat, G): 6581. Guilford Press, 2003.
19 Schulte, D, Kunzel, R. Tailor-made versus standardized therapy of phobic patients. Adv Behav Res Ther 1992; 14: 6792.
20 Valbak, K. Suitability for psychoanalytic psychotherapy: a review. Acta Psychiatr Scand 2004; 109: 164–78.
21 World Health Organization. The ICD–10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
22 Schulz, H, Barghaan, D, Harfst, T, Koch, U. Gesundheitsberichterstattung des Bundes: Psychotherapeutische Versorgung [Federal Health Reporting: Mental Health Care]. Robert-Koch-Institut, 2008.
23 Sackett, DL, Rosenberg, WM. Evidence based medicine: what it is and what it isn't. BMC 1996; 312: 71–2.
24 Ambühl, H, Orlinsky, DE. Zum Einfluss der theoretischen Orientierung auf die psychotherapeutische Praxis [How does the theoretical orientation influence the psychotherapeutic work?]. Psychotherapeut 1997; 42: 290–8.
25 Heigl-Evers, A, Ott, J. Die Bedeutung der psychoanalytisch-interaktionellen Grundeinstellungen für die Gruppentherapie [Relevance of psychoanalytic-interactional attitude for group psychotherapy]. Gruppenpsychother Gr 1997; 33: 5573.
26 Fiedler, P. Verhaltenstherapie in und mit Gruppen [Cognitive-behavioural therapy in the group setting]. In Praxis der Gruppenpsychotherapie (ed Tschuschke, V): 343–8. Thieme, 2001.
27 Waltz, J, Addis, ME, Koerner, K, Jacobsen, N. Testing the integrity of a psychotherapeutic protocol: Assessment of adherence and competence. J Consult Clin Psych 1993; 61: 620–30.
28 Derogatis, LR. SCL-90-R. Administration, Scoring and Procedures Manual-I for the R(evised) Version. John Hopkins University School Medicine, 1977.
29 Harfst, T, Koch, U, Kurtz von Aschoff, C, Nutzinger, DO, Rüddel, H, Schulz, H. Entwicklung und Validierung einer Kurzform der Symptom Checklist-90-R [Development and validation of a short evrsion of the symptom checklist-90-R]. DRV-Schriften 2002; 33: 71–3.
30 Ware, JE. SF-36 Health survey update. Spine 2000; 25: 3130–9.
31 Cohen, J. Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum, 1988.
32 Begg, C, Cho, M, Eastwood, S, Horton, R, Moher, D, Olkin, I, et al. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA 1996; 276: 637–9.
33 Taylor, GJ. Psychoanalysis and empirical research: the example of patients who lack psychological mindedness. J Am Acad Psychoanal 1995; 23: 263–81.
34 Grand, S. A classic revisited: clinical and theoretical reflections on Stone's Widening scope of indications for psychoanalysis. J Am Psychoanal Ass 1995; 43: 741–64.
35 Spinhoven, P, Giesen-Bloo, J. Can assessors and therapists predict the outcome of long-term psychotherapy in borderline personality disorder. J Clin Psychol 2008; 64: 667–86.
36 First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID–CV). American Psychiatric Press, 1996.
37 Shear, MK, Greeno, C, Kang, J, Ludewig, D, Frank, E, Swartz, HA, et al. Diagnosis of nonpsychotic patients in community clinics. Am J Psychiatry 2000; 157: 581–7.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Effectiveness of systematic treatment selection for psychodynamic and cognitive–behavioural therapy: randomised controlled trial in routine mental healthcare

  • Birgit Watzke (a1), Heinz Rüddel (a2), Ralph Jürgensen (a2), Uwe Koch (a1), Levente Kriston (a1), Barbara Grothgar (a2) and Holger Schulz (a3)...
Submit a response

eLetters

Dodo-bird -- still alive (just)

jeremy a holmes, Professor of psychological Therapies
11 August 2010

Dodo-bird: still alive (just)

At first sight, Watske et al’s ingenious head-to-head of CBT and PDT (psychodynamic therapy) for unselected neurotic patients might strike terror into the heart of psychoanalytic therapists. The straight line between symptom severity at the start and end of psychodynamic treatment appears to bode ill for those aiming to establish PDT as part of routine psychological care.

But drawing general conclusions from this study, as does Fonagy , might be premature. It was conducted in the probably unique psychotherapy conditions that hold sway in Germany : in-patient admission for disorders that would have been treated as out-patients, if at all, elsewhere;, and consisting of six weeks of 3-4 times a week group therapy for 6 weeks total. The lack of manualisation of PDT meant that symptom-focus may well have been ignored if out-moded ‘classical’ non-directive psychoanalytic techniques were used. The evidence base for group PDT in anxiety disorders

is virtually non-existent, while, individual psychodynamic therapy is an established evidence-based treatment . Also, the lack of a no-treatment control group meant that the interaction between the inevitable non-specific impact of hospital admission itself with the specific treatments could notbe explored. Finally, as conceded by the authors , the baseline for the contrasting groups was very different: the final scores for the ‘successful’ treatments, both cognitive and psychodynamic, were no less than the starting conditions for the randomized PDT group.

Nevertheless, the study gives no grounds for complacency in the PDT comunity. Specifying psychodynamic technique, making symptom-focus a key issue, and introducing a far greater degree of quality-control in training, as Fonagy suggests, are major challenges for those trying to rethink and update psychodynamic concepts in the light of contemporary theory and research .

The Dodo bird is not extinct (incidentally, it was Luborsky et al who first coined the term, not Wampold), but remains on the endangered list.

Watske, B.Ruddel, H, JUrgenson, R., Koch, U., Kriston, L., Grothgar, B., & Schiltz, H. Effectiveness of systematic treatment selection for psychodynamic and cognitive-behavioural therapy: randomized control trial in routine mental healthcare. British Journal of Psychiatry 2010; 197; 96-105

Fonagy, P. Psychotherapy research: do we know what works for whom?. British Journal of Psychiatry; 197; 83-85

Shear M., Cooper, A., Klerman, G., Busch, F. & Shapiro, T. A psychodynamic model of panic disorder. American Journal of Psychiatry 1993 150 859-866

Holmes, J. Exploring In Security: Towards an Attachment-informed Psychoanalytic Psychotherapy.. London: Routledge. 2009.

Luborsky, L., Singer, B. & Luborsky, L. Comparative psychotherapies: is it true that ’everybody has won and all shall have prizes’? Arch. Gen. Psychiat. 1995, 32, 995-1008.

Jeremy Holmes, School of Psychology, University of Exeter, UK. Email:j.a. holmes@btinternet.com
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *