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The purpose of the current investigation was to conduct a treatment development study applying brief Supportive-Expressive psychodynamic psychotherapy to the treatment of generalized anxiety disorder (GAD). Background and rationale for the development of an interpersonallyoriented psychodynamic therapy for GAD are presented, followed by the methods and results of the treatment development project. The goals of the project were to develop a treatment manual, train therapists, assess the integrity of the treatment delivered, and collect preliminary efficacy data. Outcome data on 26 patients with a DSM-IV diagnosis of GAD indicate that the treatment appears to be promising. Patients revealed significant change in anxiety, as well as in depression, worry,

Twenty-four patients with a DSM-III-R diagnosis of Avoidant Personality Disorder (AVPD) and 14 patients with a diagnosis of Obsessive-CompulsivePersonality Disorder (OCPD) were assigned to 52 sessions of time-limited Supportive-Expressive (SE) dynamic psychotherapy. At intake, most patients had at least one concurrent Depressive and/or Anxiety disorder. OCPD patients lost their personality disorder diagnoses significantly faster than did AVPD patients. By the end of treatment, 39 percent of AVPD still retained their diagnosis while only 15 percent 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 patients remained in treatment significantly longer and tended to improve (nonsignificantly) more than did AVPD This study was supported in part by National Institute of Mental Health grants P50-MH45178 and RO1-MH49902. The authors thank Drs. Leigh McCullough Vaillant and Karla Moras for training and supervising the diagnosticians. We also thank the therapists and patients for their participation.

Importance Dynamic psychotherapy is widely practiced in the community, but few trials have established its effectiveness for specific mental health disorders relative to control conditions or other evidence-based psychotherapies. Objective To determine whether dynamic psychotherapy is not inferior to cognitive therapy in the treatment of major depressive disorder in a community mental health setting. Design From 2010 to 2014, community outpatients with major depressive disorder were randomized to treatment delivered by trained therapists. Setting Community mental health center in Pennsylvania. Participants Twenty therapists employed at a community mental health center were trained by experts in either cognitive therapy or dynamic psychotherapy. A total of 237 adult outpatients with major depressive disorder seeking services at this site were randomized to 16 sessions of either dynamic psychotherapy or cognitive therapy delivered across 5 months. Interventions Short-term dynamic psychotherapy or cognitive therapy. Main Outcome Measure Expert blind evaluations with the 17-item Hamilton Rating Scale for Depression. Results There was a mean difference between treatments in change on the Hamilton Rating Scale for Depression of 0.86 scale points (95% CI [−.70–2.42]; SD = 7.73; Cohen d = .11), indicating that dynamic psychotherapy was statistically not inferior to cognitive therapy. There was a statistically significant main effect for time (F1,198 = 75.92, P = .001). There were no statistically significant differences between treatments on patient ratings of treatment credibility. Dynamic therapy and cognitive therapy were discriminated from each other on competence in supportive techniques (t120 = 2.48, P = .02), competence in expressive techniques (t120 = 4.78, P = .001), adherence to cognitive therapy techniques (t115 = −7.07, P = .001), and competence in cognitive therapy (t115 = −7.07, P = .001). Conclusions and Relevance This study suggests that dynamic psychotherapy is not inferior to cognitive therapy on change in depression for the treatment of major depressive disorder in a community mental health setting. The CI suggests that the effects of dynamic psychotherapy are equivalent to cognitive therapy. Trial Registration ClinicalTrials.gov (A Comparison of Cognitive and Dynamic Therapy for Depression in Community Settings; NCT01207271).

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