1,721,050 research outputs found
Change norms: A complementary approach to the issue of control groups in psychotherapy outcome research
No full textControl groups are widely regarded as a sine qua non of psychotherapy outcome research. However, they produce high costs and are not applicable to long-term studies. The authors address the issue of control groups in psychotherapy research in a novel way: They systematically study the changes occurring in psychiatric patients who did not receive any specific treatment. Such data may serve as reference data for further outcome studies. It would then no longer be necessary to collect reference data repeatedly in each and every new study. The authors evaluated the changes that occurred in the control groups of available randomized controlled studies (RCTs) of psychodynamic psychotherapy in a first and preliminary trial. Twenty-six RCTs of psychodynamic psychotherapy, in which reliable and valid outcome measures were applied and which provided the necessary data to calculate effect sizes, were included in a meta-analysis. Effect sizes were calculated for the mean changes occurring in the control groups. The mean effect size of 0.12 (95% confidence interval [CI]: 0.05-0.28) corresponds to a small effect. To demonstrate its possible use, the upper limit of the 95% CI (d = 0.28), considered a very conservative estimate of the average control group effect size, was compared with that of selected studies of psychodynamic psychotherapy. The average change in psychiatric patients included in RCTs of psychotherapy who did not receive specific treatment may serve as a preliminary control group estimate (change norm) for open trials of psychotherapy. Future research should assess the mean expected change in more sophisticated controls (e.g., for specific psychiatric disorders, outcome measures, or patient variables)
Psychodynamic psychotherapy: A systematic review of techniques, indications and empirical evidence
No full textPurpose. Psychodynamic psychotherapy is one of the most frequently applied methods of psychotherapy in clinical practice. However, it is the subject of controversial discussion, especially with regard to empirical evidence. In this article we aim to give an up-to-date description of the treatment and to review the available empirical evidence. Evidence is reviewed for both efficacy and mechanisms of change of short- and moderate-term psychodynamic psychotherapy. Furthermore, results of effectiveness studies of long-term psychoanalytic therapy are reviewed. Methods. With regard to efficacy, a protocol for a Cochrane review for (short-term) psychodynamic psychotherapy is available specifying inclusion criteria for efficacy studies. Results. Twenty-three randomized controlled trials of manual-guided psychodynamic psychotherapy applied in specific psychiatric disorders provided evidence that psychodynamic psychotherapy is superior to control conditions (treatment-as-usual or wait list) and, on the whole, as effective as already established treatments (e.g. cognitive-behavioural therapy) in specific psychiatric disorders. With regard to process research, central assumptions of psychodynamic psychotherapy were confirmed by empirical studies. Conclusions. Further research should include both efficacy studies (on specific forms of psychodynamic psychotherapy in specific mental disorders) and effectiveness studies complementing the results from experimental research settings. Future process research should address the complex interactions among interventions, patient's level of functioning, helping alliance and outcome
A Unified Protocol for the Transdiagnostic Psychodynamic Treatment of Anxiety Disorders: An Evidence-Based Approach
No full textAlthough there is evidence for the efficacy of psychodynamic therapy (PDT) in anxiety disorders, results are not yet satisfactory, for example, if rates of remission and response are considered. To address this problem, a unified psychodynamic protocol for anxiety disorders (UPP-ANXIETY) is proposed that integrates the treatment principles of those methods of PDT that have proven to be efficacious in anxiety disorders. In addition, this protocol is transdiagnostic, implying that is it is applicable to various forms of anxiety disorders and related disorders (generalized anxiety disorder, social phobia, panic disorders, avoidant personality disorder). Based on supportive-expressive therapy, the UPP-ANXIETY represents an integrated form of psychodynamic therapy that allows for a flexible use of empirically supported treatment principles. UPP-ANXIETY encompasses the following 9 treatment principles (modules): (1) socializing the patient for psychotherapy, (2) motivating and setting treatment goals, (3) establishing a secure helping alliance, (4) identifying the core conflict underlying anxiety, (5) focusing on the warded-off wish/affect, (6) modifying underlying internalized object relations, (7) changing underlying defenses and avoidance, (8) modifying underlying response of self, and (9) termination and relapse prevention. Some principles are regarded as core components to be used in every treatment (principles 3-8). A unified protocol for the psychodynamic treatment of anxiety disorders has several advantages, that is (1) integrating the most effective treatment principles of empirically supported psychodynamic treatments for anxiety disorders can be expected to further improve the efficacy of PDT; (2) using a unified protocol in efficacy studies has the potential to enhance the evidence-based status of PDT by aggregating the evidence; (3) a unified protocol will facilitate both training in PDT and transfer of research to clinical practice; and (4) thus, a unified protocol can be expected to have a significant impact on the health care system. We are planning to test the UPP-ANXIETY in a multicenter randomized controlled trial
Treatments for Social Anxiety Disorder: Considerations Regarding Psychodynamic Therapy Findings Response
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Psychodynamic psychotherapy for social phobia: A treatment manual based on supportive-expressive therapy
No full textSocial phobia is a very frequent mental disorder characterized by an early onset, a chronic unremitting course, severe psychosocial impairments and high socioeconomic costs. To date, no manual for the psychodynamic treatment of social phobia exists. After a brief description of the disorder, a manual for a short-term psychodynamic treatment of social phobia is presented. The treatment is based on Luborsky's supportive-expressive (SE) therapy, which is complemented by treatment elements specific to social phobia. The treatment includes the characteristic elements of SE therapy, that is, setting goals, focus on the Core Conflictual Relationship Theme (CCRT) associated with the patient's symptoms, interpretive interventions to enhance insight into the CCRT, and supportive interventions, in particular fostering a helping alliance. In order to tailor the treatment more specifically to social phobia., treatment elements have been added, for example informing the patient about the disorder and the treatment, a specific focus on shame and on unrealistic demands, and encouraging the patient to confront anxiety-producing situations. More directive interventions are included as well, such as specific Prescriptions to stop Persisting self-devaluations. The treatment manual is presently being used in a large-scale randomized controlled multicenter study comparing short-term psychodynamic psychotherapy and cognitive-behavioral therapy in the treatment of social phobia
THE EFFICACY OF PSYCHODYNAMIC PSYCHOTHERAPY IN SPECIFIC MENTAL DISORDERS: A 2013 UPDATE OF EMPIRICAL EVIDENCE
No full textThis article reviews the empirical evidence for psychodynamic therapy for specific mental disorders in adults. The focus is on randomized controlled trials (RCTs). However, this does not imply that RCTs are uncritically accepted as the gold standard for demonstrating that a treatment works. According to the results presented here, there is evidence from RCTs that psychodynamic therapy is efficacious in common mental disorders, that is, depressive disorders, anxiety disorders, somatic symptom disorders, personality disorders, eating disorders, complicated grief, posttraumatic stress disorder (PTSD), and substance-related disorder. These results clearly contradict assertions repeatedly made by representatives of other psychotherapeutic approaches claiming psychodynamic psychotherapy is not empirically supported. However, further research is needed, both on outcome and processes of psychodynamic psychotherapy. There is a need, for example, for RCTs of psychodynamic psychotherapy of PTSD. Furthermore, research on long-term psychotherapy for specific mental disorders is required
The effectiveness of psychoanalytic-interactional therapy in borderline personality disorder - A study of clinical data
No full textObjectives: Different methods are available for the psychotherapeutic treatment of patients with severe structural mental disorders. Psychoanalytic-interactional therapy is among those methods which have been clinically proven to be effective for many years. Psychoanalytic- interactional therapy was derived from analytic psychotherapy specifically to allow for the treatment of severely disturbed patients, e.g. patients with borderline personality disorders, prepsychotic disorders, addictions and perversions. Methods: In a naturalistic study, the effectiveness of psychoanalytic-interactional therapy was tested in a sample of patients with borderline personality disorders (N = 132). The patients were treated at the Clinic Tiefenbrunn near Goettingen, Germany. Standardized, reliable and valid diagnostic instruments were used to study the treatment effects. Results:Psychoanatytic- interactional therapy was found to significantly improve target symptoms, general symptoms, interpersonal problems and life satisfaction. Discussion: The results are discussed with regard to the treatment of severely disturbed patients
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