Short-Term Psychodynamic Psychotherapies for Common Mental Disorders

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and inconsistency (heterogeneity in patients and interventions).

A Cochrane review [Abstract] 1 included 33 studies with a total of 2173 subjects. Primary problems were diverse and included somatoform disorders (8 studies), mixed conditions (8 studies), anxiety disorders (7 studies), depressive disorders (5 studies), personality disorders (3 studies), self induced poisoning and eating disorders (one study each). Over one-third of these studies included challenging-to-treat populations. A range of brief psychodynamic-based psychotherapy methods were represented in these studies. Nineteen studies reported on general psychiatric symptoms, 18 studies used measures of depression, 18 studies used measures of anxiety, 8 studies used somatic symptom measures, 6 studies used interpersonal problem measures and 9 studies used measures of social adjustment. A range of controls was employed: treatment as usual (18 studies), wait-list controls (10 studies) and minimal psychological interventions (5 studies).

• General psychiatric symptoms: in the STPP group significant improvements were found relative to controls in the short-term (less than 3 months after treatment: SMD -0.71, 95% CI -1.00 to -0.41; 19 studies, n=1424) and medium-term (3 to 9 months after treatment: SMD -0.27, 95% CI -0.46 to -0.08; 5 studies, n=437). In the case of long-term follow-up (more than 9 months after treatment), the effects marginally did not reach significance (SMD -1.51, 95% CI -3.14 to 0.12, p=0.07; 4 studies, n=344).
• Somatic measures: there was no significant treatment effect relative to controls in the short-term (SMD -0.63, 95% CI -1.29 to 0.04, p=0.07; 8 studies, n=744) and long-term (SMD -2.21, 95% CI -5.49 to 1.07; 3 studies, n=280), but the effects were significant in the medium-term (SMD -1.39, 95% CI -2.75 to -0.02; 4 studies, n=359).
• Anxiety ratings: moderate treatment effects were seen relative to controls in the short-term (SMD -0.64, 95% CI -1.02 to -0.26; 18 studies, n=1102) and medium-term (SMD -0.46, 95% CI -0.77 to -0.16; 7 studies, n=506). In the long-term follow-up, the effects marginally did not reach significance (SMD -1.10, 95% CI -2.24 to 0.04, p=0.06; 5 studies, n=293).
• Depression measures: moderate treatment effects were seen relative to controls in the short-term (SMD -0.50, 95% CI -0.61 to -0.39; 18 studies, n=1415) and medium-term (SMD -0.34, 95% CI -0.60 to -0.09; 7 studies, n=601). The effects did not reach significance in long-term follow-up (SMD -1.00, 95% CI -2.22 to 0.21; 5 studies, n=321).
• Social adjustment: significant effects were seen in the short term (SMD -0.51, 95% CI -0.66 to -0.36; 9 studies, n=720) and long-term (SMD -0.58, 95% CI -0.86 to -0.29; 3 studies, n=199).

References

• Abbass AA, Kisely SR, Town JM et al. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Syst Rev 2014;7():CD004687. [PubMed]