Short-term psychodynamic psychotherapies for common mental disorders

Abbass AA, Hancock JT, Henderson J, Kisely SR

Published Online:

January 21, 2009

Short-term psychodynamic psychotherapies have been subjected to randomised controlled trials for a range of common mental disorders, including anxiety disorders, depression, stress-related physical conditions, certain behaviour disorders and interpersonal or personality problems mixed with symptom disorders. Previous meta-analyses have yielded conflicting results. This review included all RCTs of STPP for common mental disorders, and found modest treatment benefits that were generally maintained in medium and long term follow-up. However, variability in study design means that our conclusions are tentative, and need confirmation with further research.

Abstract (click to read)

Background:

Over the past 40 years, short-term psychodynamic psychotherapies (STPP) for a broad range of psychological and somatic disorders have been developed and studied. Four published meta-analyses of STPP, using different methods and samples, have found conflicting results.

Objectives:

This review evaluated the efficacy of STPP relative to minimal treatment and non-treatment controls for adults with common mental disorders.

Search strategy:

We searched CCDANCTR-Studies and CCDANCTR-References on 25/4/2005, CENTRAL, MEDLINE, CINAHL, EMBASE, PsycINFO, DARE and Biological Abstracts were also searched. We contacted triallists and checked references from papers retrieved.

Selection criteria:

All randomised controlled trials (RCT) of adults with common mental disorders, in which a brief psychodynamic therapy lasting less than 40 hours in total, and provided in individual format, were included.

Data collection and analysis:

Three reviewers working in pairs evaluated studies. Studies were selected only if pairs of reviewers agreed they met inclusion criteria. A third reviewer was consulted if two reviewers could not reach consensus. Data were collected and entered into Review Manager. Study quality was assessed and scored by pairs of raters. Publication bias was assessed using a funnel plot. Sensitivity analyses were also conducted.

Main results:

23 studies of 1431 randomised patients with common mental disorders were included. These studies evaluated STPP for general, somatic, anxiety, and depressive symptom reduction, as well as social adjustment. Outcomes for most categories of disorder suggested significantly greater improvement in the treatment versus the control groups, which were generally maintained in medium and long term follow-up. However, only a small number of studies contributed data for each category of disorder, there was significant heterogeneity between studies, and results were not always maintained in sensitivity analyses.

Authors' conclusions:

STPP shows promise, with modest to moderate, often sustained gains for a variety of patients. However, given the limited data and heterogeneity between studies, these findings should be interpreted with caution. Furthermore, variability in treatment delivery and treatment quality may limit the reliability of estimates of effect for STPP. Larger studies of higher quality and with specific diagnoses are warranted.

This record should be cited as:

Abbass AA, Hancock JT, Henderson J, Kisely SR. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004687. DOI: 10.1002/14651858.CD004687.pub3

Assessed as up to date:

August 21, 2006

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Primary Review Group:

Depression, Anxiety and Neurosis Group

Health topics:

Mental health > Anxiety disorders > Non-specific

Mental health > Depression > Depressive disorders & major depression

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Short-term psychodynamic psychotherapies for common mental disorders

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