The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update

Driessen, Ellen; Hegelmaier, Lisa Mira; Abbass, Allan; Barber, Jacques P.; Dekker, Jack; Van, Henricus L.; Jansma, Elise P.; Cuijpers, Pim

doi:10.1016/j.cpr.2015.07.004

Cited by 228 publications

(129 citation statements)

References 34 publications

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“…Contrary to the assertions of many EBT advocates, there exists a substantial literature that demonstrates the effectiveness of idiographic psychotherapies (Driessen et al, 2015, Leichsenring, 2005Leichsenring & Leibing, 2003;Leichsenring & Rabung, 2008;Leichsenring, Rabungm, & Leibing, 2004;Leichsenring & Scheauenburg, 2014;Leichsenring, Leweke, Klein, & Steinaart, 2015;Shedler, 2010;Wampold, 2007;Westen & Harnden-Fischer, 2001). This literature is too large to be reviewed in this article however, contrary to statements that idiographic approaches to psychotherapy are "ineffective" and "unscientific," psychotherapy effectiveness research indicates the opposite (Clarkin, Levy, Lenzenweger, & Kernberg, 2007;Leichsenring & Leibing, 2003;Leichsenring & Rabung, 2008;Leichsenring et al, 2004;Levy & Ablon, 2008;Lewis, Dennerstein, & Gibbs, 2008;Seligman, 1996;Shedler, 2010;Wampold, 2007).…”

Section: Effectiveness Studiesmentioning

confidence: 99%

“…The assumption that psychotherapy can be formulated as a relatively standardized set of procedures that can be applied across carefully matched individuals without significant variation or concern for differences between both therapists and patients runs counter to the perspective of most idiographic therapists with the exception of short-term psychodynamic therapy for anxiety disorders and depression (Driessen et al, 2015). There is logic in attempting to describe as systematically as possible the principles and strategies involved in a therapeutic approach whenever possible, but it should be recognized that this requirement also limits the scope and range of problems that can be treated as well as the types of therapy that can be applied.…”

Section: Therapy Manualsmentioning

confidence: 99%

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Psychotherapy Outcome Research: Issues and Questions

Shean

2016

Psychodynamic Psychiatry

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Emphasis on identifying evidence-based therapies (EBTs) has increased markedly. Lists of EBTs are the rationale for recommendations for how psychotherapy provider training programs should be evaluated, professional competence assessed, and licensure and reimbursement policies structured. There are however methodological concerns that limit the external validity of EBTs. Among the most salient is the circularity inherent in randomized control trials (RCTs) of psychotherapy that constrains the manner in which the psychological problems are defined, psychotherapy can be practiced, and change evaluated. RCT studies favor therapies that focus of specific symptoms and can be described in a manual, administered reliably across patients, completed in relatively few sessions, and involve short-term evaluations of outcome. The epistemological assumptions of a natural science approach to psychotherapy research limit how studies are conducted and assessed in ways that that advantage symptom-focused approaches and disadvantage those approaches that seek to bring broad recovery-based changes. Research methods that are not limited to RCTs and include methodology to minimize the effects of "therapist allegiance" are necessary for valid evaluations of therapeutic approaches that seek to facilitate changes that are broader than symptom reduction. Recent proposals to adopt policies that dictate training, credentialing, and reimbursement based on lists of EBTs unduly limit how psychotherapy can be conceptualized and practiced, and are not in the best interests of the profession or of individuals seeking psychotherapy services.

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Section: Effectiveness Studiesmentioning

confidence: 99%

Section: Therapy Manualsmentioning

confidence: 99%

Psychotherapy Outcome Research: Issues and Questions

Shean

2016

Psychodynamic Psychiatry

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“…Town et al cite various subanalyses from the Driessen et al 8 meta-analysis, but the issues of multiple divergent findings in that article and the use of many small and methodologically challenged studies do not allow for a clear, unequivocal conclusion as would be needed for a first-line treatment recommendation. Additionally, they state that other therapies may use different treatment manuals.…”

Section: Dear Editormentioning

confidence: 99%

Rating Short-Term Psychodynamic Therapy for the Canadian Network for Mood and Anxiety Treatments Depression Guidelines

et al. 2017

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Dear Editor:We thank the authors of 2 letters inquiring how ratings were established with regards to short-term psychodynamic psychotherapy (STPP) for major depressive disorder in the Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines.1 The second-line treatment recommendation for STPP captures the emerging nature of the evidence and clinical utility of STPP. Briefly, evidence from meta-analyses can result in the highest level of evidence, but we did not rely on abstracts for conclusions. 2 We examined key factors of each study from any meta-analysis, including whether at least 2 studies used the same manual, choice of control conditions, replication by another research group, overall sample size, and finally the multiple subanalyses conducted. When there are multiple outcomes, divergent findings weaken conclusions. Good scientists, and good clinicians, may reasonably disagree both on which subanalyses should have primacy, as well as the relative importance of study characteristics.Leichsenring and Steinert rightly mention that there are 2 studies of the de Jonghe et al.3 model of STPP-but one is a study designed to compare STPP alone to STPP with pharmacotherapy. 4 There was no control group for the psychotherapy, and in the results, the authors state, ''The advantage of combining antidepressants with STPP were equivocal. Neither the treating clinicians nor the independent observers were able to ascertain them.'' The second de Jonghe et al. model of STPP study, conducted by Driessen et al., 5 was a noninferiority trial comparing STPP to cognitive-behavioural therapy (CBT), and its authors conclude that noninferiority was demonstrated at posttreatment but could not be demonstrated for remission rates and follow-up measures. Both trials lend support but together fail to establish level 1 evidence for efficacy of that model of STPP. They subsequently cite the Connolly Gibbons et al.6 study, published after the review period of the CAN-MAT article, invoking the Luborsky 7 model of STPP. This, too, is a noninferiority trial without a control condition. As a single trial from a single research group, it does not satisfy the criterion of level 1 evidence. Furthermore, noninferiority was demonstrated on a primary outcome but not on 4 secondary outcomes, and both treatments had low remission rates.Town et al. cite various subanalyses from the Driessen et al. meta-analysis, but the issues of multiple divergent findings in that article and the use of many small and methodologically challenged studies do not allow for a clear, unequivocal conclusion as would be needed for a first-line treatment recommendation. Additionally, they state that other therapies may use different treatment manuals. While this is true, each of the other first-line treatments had evidence from at least 2 studies using the same specific type of therapy. Behavioural activation and mindfulness-based CBT each share many features with CBT, but each therapy has its own trials and evidence. Randomised controlled trials are needed in whic...

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“…Randomized clinical trials (RCTs) and metaanalyses have shown that STDP is as effective as medication (Barber et al 2012), more effective than control conditions, and as effective as alternative treatments at termination and follow-up assessments (Driessen et al 2010, 2013, 2015a, b, Gibbons et al 2012Abbass et al 2014;Fonagy, 2015;Leichsenring et al 2015). Furthermore, combined treatment of STDP and medication was found to be more effective than medication alone (Barber et al 2013;Fonagy, 2015;Leichsenring et al 2015).…”

Section: Short-term Dynamic Psychotherapy (Stdp)mentioning

confidence: 99%

What we know, what we do not know, and where are we heading? Efficacy and acceptability of psychological interventions for depression

Solomonov

Barber

2015

Epidemiol Psychiatr Sci

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In the past several decades, increasing evidence supports the efficacy of psychotherapies for depression. The vast majority of findings from meta-analyses, randomized clinical trials (RCTs) and naturalistic studies have demonstrated that well-established psychotherapies (behavioural activation, problem-solving therapy, psychodynamic therapy, cognitive-behavioural therapy, interpersonal therapy and emotion-focused therapy) are superior to no-treatment and control conditions, and are in most cases equally effective in treating depression. However, despite this abundant support for psychotherapies, studies have also consistently shown high drop-out rates, high percentages of non-respondent patients who experience treatment failures, and mixed findings regarding the enduring effects of psychotherapy. Thus, there is a need to develop more personalised treatment models tailored to patients' needs. A new integrative sequential stepwise approach to the treatment of depression is suggested. Key words: Behaviour therapy, cognitive therapy, depression, evidence-based psychiatry, psychoanalysis and psychodynamic therapies. What do we know about the efficacy of psychotherapies for depression?Depression is a pervasive mental condition which interferes with all domains of one's functioning and it is one of the most common problems leading people to seek treatment (e.g. Summers & Barber, 2010). Recent studies have shown that the approximated cumulative incidence of depression diagnosis from childhood to adulthood is between 32.54 and 51% (Rohde et al. 2012;Angst et al. 2015).In the past several decades, over 400 randomised clinical trials have investigated the efficacy of psychotherapy for depression (Cuijpers, 2015). Despite the heated debate regarding the superiority of one treatment over others, there is fairly wide acceptance of the 'Dodo Bird Verdict ' (Luborsky et al. 1975), at least in the case of depression, suggesting that all treatments are more or less equally effective (Cuijpers et al. 2008;Barth et al. 2013). Furthermore, research in the past two decades has taught us that psychotherapeutic treatments of depression are superior to waitlist and other control conditions (Barth et al. 2013;Lambert, 2013), and that psychotherapy combined with anti-depressant medication is more effective than medication alone (Barber et al. 2013;Köhler et al. 2013;Hollon et al. 2014;Fonagy, 2015;Leichsenring et al. 2015). There is also evidence suggesting that some types of psychotherapies are not only as effective as medication, but also have higher long-term enduring effects (Hollon & Ponniah, 2010;Cuijpers et al. 2013b). We begin by briefly reviewing some of the major findings that have arisen from the literature on treatments of depression, focusing only on the best-known and more widely researched. Behavioural activation (BA)BA is one of the most accepted and widely used behavioural treatments. Meta analyses found BA to be as effective as cognitive-behavioural therapy, and superior to control conditions (Cuijpers et al. 2007;Mazzuc...

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The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update

Cited by 228 publications

References 34 publications

Psychotherapy Outcome Research: Issues and Questions

Psychotherapy Outcome Research: Issues and Questions

Rating Short-Term Psychodynamic Therapy for the Canadian Network for Mood and Anxiety Treatments Depression Guidelines

What we know, what we do not know, and where are we heading? Efficacy and acceptability of psychological interventions for depression

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