Tuesday, May 30, 2017

Psychodynamic Therapy Is Equivalent to CBT, Meta-Analysis Finds

Psychodynamic therapy appears to be as effective at treating mental illness as other techniques with established efficacy, including cognitive-behavioral therapy (CBT), according to a meta-analysis in AJP in Advance

“This meta-analysis is the first in psychotherapy research to systematically investigate equivalence of a specific form of psychotherapy to established treatments by formally applying the logic of equivalence testing,” wrote Christiane Steinert, Ph.D., of the University of Giessen in Germany and colleagues. 

The meta-analysis included 23 randomized, controlled trials with 2,751 patients. Twenty-one of the trials compared psychodynamic therapy to other forms of psychotherapy, in most cases CBT. Two studies compared psychodynamic therapy with a selective serotonin reuptake inhibitor or with a serotonin-norepinephrine reuptake inhibitor in the treatment of depression. The majority of studies investigated participants with a depressive disorder (n=8), followed by anxiety disorders (n=4), eating disorders (n=4), personality disorders (n=4), substance dependence (n=2), and posttraumatic stress disorder (n=1).

The primary outcome was “target symptoms,” which included measures specific to the mental disorder under study (for example, measures of depressive symptoms in depressive disorders or of social anxiety in social anxiety disorder). General psychiatric symptoms and psychosocial functioning—including social, occupational, and personality functioning—were also examined.

Regardless of whether efficacy results in the individual trials favored psychodynamic therapy or the comparator treatment, the pooled between-group difference in outcome for target symptoms at post-treatment for all studies was statistically small, suggesting psychodynamic therapy is as efficacious as the other treatments. 

The authors noted that “therapist effects”—which refers to the effects of the skills or experience a therapist brings to treatment, as well as to the “fit” between patient and therapist—are known to be a determinant in the effectiveness of psychotherapy. “Because therapist effects seem to have a stronger impact on outcome than the treatments being compared and need to be taken into account, one promising strategy for improving treatments is enhancing therapist training and eventually therapist outcome,” they concluded. “Furthermore, different patients may benefit from different approaches, which is why a shift from one empirically supported treatment to another may be helpful in case of nonresponse.”

For related information, see the Psychiatric News article “Cost-Effectiveness and the Role of Psychodynamic Psychotherapies,” by Susan G. Lazar, M.D., a clinical professor of psychiatry at Georgetown University School of Medicine.

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