Psychodynamic Psychotherapy in the Treatment of Mood Disorders
Purpose of Review: This article summarizes recent studies of psychodynamic psychotherapy for mood disorders. It is important to note whether the therapy studied is adhering to the principles of psychodynamic psychotherapy, whether it is manual based or flexibly responsive to patient developments, whether it is short term or long term and whether it is combined with pharmacotherapy.
Recent Findings: A review of recently published studies has found that all studies show a significant improvement in symptoms in patients who were depressed before treatment with psychodynamic psychotherapy. It is rare, however, for a study to meet the criteria of randomized clinical trials: use of treatment manuals and assured adherence, a sample of patients specifically diagnosed with depression and relevant measures. In one metaanalysis of studies meeting the above criteria, two of 17 studies included a sample with a diagnosis of depression, and short-term psychodynamic psychotherapy achieved similar results as other psychotherapies. Naturalistic studies show improvement with dynamic psychotherapy over time in both symptoms and dynamic measures, such as defense styles and frustration tolerance.
Summary: In the last year there were few randomized controlled studies specifically examining psychodynamic psychotherapy for mood disorders. Most evidence from naturalistic and various efficacy studies indicates that dynamic psychotherapy, with or without pharmacotherapy, is associated with improvement in symptoms and some character features. Longer follow-ups provide useful data for what can be a chronic or recurring illness. There are no data showing that psychodynamic therapy is more or less effective than other forms of psychotherapy.
Psychodynamic psychotherapy is an established option for the treatment of depression. There is more research on cognitive-behavioral therapy (CBT) for this disorder, however the small but regular flow of studies of dynamic psychotherapy is worth examining. Psychodynamic psychotherapists have been slower to respond to the pressure to demonstrate efficacy and effectiveness empirically, perhaps because of a less structured and more spontaneous culture among psychoanalytically oriented therapists. Although empirical studies have been emerging and standardized measures have been developed, psychodynamic psychotherapy does not have the 'empirically supported' cachet that CBT has earned and this, in turn, has led to an underrepresentation of dynamically oriented reviewers on granting agencies. This may make it more difficult to obtain funding for studies of psychodynamic psychotherapy.
In assessing the empirical literature on psychodynamic psychotherapy in the treatment of mood disorders, many issues must be taken into account. Are the studies efficacy or effectiveness studies? Efficacy studies tend to be randomized clinical trials, focusing on a single diagnosis in a homogeneous sample, treated with a manualized therapy over a relatively short period of time, e.g. 20 weeks with a follow-up evaluation period of 6-12 months. Effectiveness studies tend to be naturalistic, without control groups, with therapists modifying techniques based on patient response and the sample is more heterogeneous with co-morbidity. The follow-ups tend to be longer, taking into account that mood disorders are often recurrent over time.
Another important question is, what is psychodynamic psychotherapy? Psychodynamic psychotherapy generally involves developing a therapeutic alliance and addressing defense mechanisms and intrapsychic conflicts in an attempt to show the multiple conscious and unconscious factors which influence a patient's symptoms and behaviors. Psychodynamic psychotherapies, however, can range in length and depth from psychoanalysis to short-term dynamic psychotherapy. Dynamic psychotherapy for mood disorders is sometimes combined with pharmacotherapy. We will include studies in which combined therapy was used as well as studies of different durations of treatment and follow-up. Psychodynamic psychotherapy should be distinguished from interpersonal psychotherapy and cognitive therapy, but the distinctions are not always that clear, even when manuals are used.
In addition to the issues of efficacy versus effectiveness studies, psychotherapy versus combined therapy, short term versus long term, one must consider the nature of the sample - homogeneous diagnosis versus co-morbidity. The approach to a depressed patient with a personality disorder can be different from one with an 'uncomplicated' axis I disorder. Personality disorder pathology may act as a moderator of outcome leading to different results compared with the therapy of depression in a person without this 'co-morbidity'.
We will examine studies of shorter-term and longer-term dynamic psychotherapy, homogeneous and heterogeneous diagnosis, with and without pharmacotherapy, and randomized controlled trials as well as naturalistic research.
Abstract and Introduction
Abstract
Purpose of Review: This article summarizes recent studies of psychodynamic psychotherapy for mood disorders. It is important to note whether the therapy studied is adhering to the principles of psychodynamic psychotherapy, whether it is manual based or flexibly responsive to patient developments, whether it is short term or long term and whether it is combined with pharmacotherapy.
Recent Findings: A review of recently published studies has found that all studies show a significant improvement in symptoms in patients who were depressed before treatment with psychodynamic psychotherapy. It is rare, however, for a study to meet the criteria of randomized clinical trials: use of treatment manuals and assured adherence, a sample of patients specifically diagnosed with depression and relevant measures. In one metaanalysis of studies meeting the above criteria, two of 17 studies included a sample with a diagnosis of depression, and short-term psychodynamic psychotherapy achieved similar results as other psychotherapies. Naturalistic studies show improvement with dynamic psychotherapy over time in both symptoms and dynamic measures, such as defense styles and frustration tolerance.
Summary: In the last year there were few randomized controlled studies specifically examining psychodynamic psychotherapy for mood disorders. Most evidence from naturalistic and various efficacy studies indicates that dynamic psychotherapy, with or without pharmacotherapy, is associated with improvement in symptoms and some character features. Longer follow-ups provide useful data for what can be a chronic or recurring illness. There are no data showing that psychodynamic therapy is more or less effective than other forms of psychotherapy.
Introduction
Psychodynamic psychotherapy is an established option for the treatment of depression. There is more research on cognitive-behavioral therapy (CBT) for this disorder, however the small but regular flow of studies of dynamic psychotherapy is worth examining. Psychodynamic psychotherapists have been slower to respond to the pressure to demonstrate efficacy and effectiveness empirically, perhaps because of a less structured and more spontaneous culture among psychoanalytically oriented therapists. Although empirical studies have been emerging and standardized measures have been developed, psychodynamic psychotherapy does not have the 'empirically supported' cachet that CBT has earned and this, in turn, has led to an underrepresentation of dynamically oriented reviewers on granting agencies. This may make it more difficult to obtain funding for studies of psychodynamic psychotherapy.
In assessing the empirical literature on psychodynamic psychotherapy in the treatment of mood disorders, many issues must be taken into account. Are the studies efficacy or effectiveness studies? Efficacy studies tend to be randomized clinical trials, focusing on a single diagnosis in a homogeneous sample, treated with a manualized therapy over a relatively short period of time, e.g. 20 weeks with a follow-up evaluation period of 6-12 months. Effectiveness studies tend to be naturalistic, without control groups, with therapists modifying techniques based on patient response and the sample is more heterogeneous with co-morbidity. The follow-ups tend to be longer, taking into account that mood disorders are often recurrent over time.
Another important question is, what is psychodynamic psychotherapy? Psychodynamic psychotherapy generally involves developing a therapeutic alliance and addressing defense mechanisms and intrapsychic conflicts in an attempt to show the multiple conscious and unconscious factors which influence a patient's symptoms and behaviors. Psychodynamic psychotherapies, however, can range in length and depth from psychoanalysis to short-term dynamic psychotherapy. Dynamic psychotherapy for mood disorders is sometimes combined with pharmacotherapy. We will include studies in which combined therapy was used as well as studies of different durations of treatment and follow-up. Psychodynamic psychotherapy should be distinguished from interpersonal psychotherapy and cognitive therapy, but the distinctions are not always that clear, even when manuals are used.
In addition to the issues of efficacy versus effectiveness studies, psychotherapy versus combined therapy, short term versus long term, one must consider the nature of the sample - homogeneous diagnosis versus co-morbidity. The approach to a depressed patient with a personality disorder can be different from one with an 'uncomplicated' axis I disorder. Personality disorder pathology may act as a moderator of outcome leading to different results compared with the therapy of depression in a person without this 'co-morbidity'.
We will examine studies of shorter-term and longer-term dynamic psychotherapy, homogeneous and heterogeneous diagnosis, with and without pharmacotherapy, and randomized controlled trials as well as naturalistic research.
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