Dynamic Psychotherapy Meta-analyses
This month we include two recent meta-analyses of short-term dynamic psychotherapies.
The first comes from a group based in Stockholm Sweden reporting on the efficacy of Experiential Dynamic Psychotherapies- EDT.
EDTs operate within the basic psychodynamic framework but focus particular attention on the experience and exploration of emotions during therapy sessions.
The second article comes from Allan Abbass in Halifax and co-authors from Amsterdam.
They undertook an analysis of 33 randomized controlled trials of Short-Term Psychodynamic Psychotherapy (STPP).
Lilliengren P. et al. Efficacy of experiential dynamic therapy for psychiatric conditions:
a meta-analysis of randomized controlled trials.
Psychotherapy 2016 Mar 90-104.
Experiential dynamic therapy (EDT) is a subgroup of short-term psychodynamic
psychotherapy (STPP) that emphasizes patients’ in-session affective processing.
To evaluate the efficacy of EDT for psychiatric conditions, we conducted a
meta-analysis of randomized controlled trials. Twenty-eight studies published
between 1978 and 2014 were included, encompassing 1,782 adult patients with mood,
anxiety, personality, or mixed disorders. Across targeted outcome domains,
medium-size between-groups effects (Cohen’s ds ranging from 0.39 to 0.65) favored
EDT over inactive controls at post treatment and in symptom measures at follow-up.
We found no differences between EDT and active treatments (e.g., medication,
cognitive-behavioral therapy, manualized supportive therapy) at post treatment,
but EDT outperformed supportive therapy at follow-up (d = 0.75). In terms of
within-group effect sizes, EDT was associated with large improvements in general
psychiatric symptoms (d = 1.11), depression (d = 1.33), and anxiety (d = 1.09)
and with small to moderate gains in the areas of interpersonal problems (d =
0.55) and global functioning (d = 0.86).
Small but significant effects suggested continued improvement between post treatment and follow-up. Heterogeneity in pre-post effects was explored in subgroup analyses, which indicated that EDT might be most effective in depressive disorders and that individual EDT had larger effects compared with group treatment. In addition, EDT performed better in higher quality studies. We conclude that EDT is a promising treatment for psychiatric conditions in adults. Further high-quality studies evaluating
contemporary versions of EDT in specific psychiatric conditions are warranted.
Driessen E, Hegelmaier LM, Abbass A et al. The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update. Clin Psychol Rev. 2015 Dec1-15.
The efficacy of short-term psychodynamic psychotherapy (STPP) for
depression is debated. Recently, a number of large-scale and high-quality studies
have been conducted. We examined the efficacy of STPP by updating our 2010
RESULTS: After a thorough literature search, 54 studies (33 randomized clinical
trials) totaling 3946 subjects were included. STPP was significantly more
effective than control conditions at post-treatment on depression, general
psychopathology and quality of life measures (d=0.49 to 0.69). STPP pre-treatment
to post-treatment changes (d=0.57 to 1.18) indicated significant improvements on
all outcome measures, which either significantly improved further (d=0.20 to
1.04) or were maintained from post-treatment to follow-up. No significant
differences were found between individual STPP and other psychotherapies at
post-treatment (d=-0.14) and follow-up (d=-0.06) in analyses that were adequately
powered to detect a clinically relevant difference. STPP was significantly more
efficacious than other psychotherapies on anxiety measures at both post-treatment
(d=0.35) and follow-up (d=0.76).
CONCLUSION: We found clear indications that STPP is effective in the treatment of
depression in adults. Although more high-quality studies are needed, particularly
to assess the efficacy of STPP compared to control conditions at follow-up and to
antidepressants, these findings add to the evidence-base of STPP for depression.