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Division 29 TOPPs Report Literature Review

October 2010


Outcomes and factors related to efficacy of brief psychodynamic therapy.

Messer, S. B. & Kaplan, A. H. (2004) In: Core processes in brief psychodynamic psychotherapy: Advancing effective practice. Charman, D. P. (Ed.); Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers. pp. 103-118.

Reviews the evidence on outcome and the major factors contributing to progress and outcome in brief psychodynamic therapy (BPT). The first section addresses the question of whether BPT is an effective form of therapy. In doing so, two types of outcome studies are presented: meta-analysis, which aggregates the results of many studies that compare BPT to treated and untreated groups, and more recent individual studies that compare BPT to other brief therapies or long-term psychoanalytic therapy. In the second section, empirical literature on three salient factors related to therapeutic progress and outcome in BPT is presented. The first factor is the role of therapists' adherence to a psychodynamic formulated focus and its effect on progress and outcome. The second factor is patient suitability: Among diagnostic groups that have been studied empirically, who is best served by these methods? Diagnoses reviewed include depression, opiate dependency, bulimia, panic disorder, psychosomatic disorder, and personality disorder. The third area examined is "the dose-effect relationship," that is, the relationship of number of therapy sessions to percentage of patients improved. Areas for future investigation are suggested and questions are posed for the reader's reflection.  

Short-term psychodynamic psychotherapy for somatic disorders: Systematic review of meta-analysis of clinical trials.

 Abbass, A., Kisely, S. & Kroenke, K. (2009). Psychotherapy and Psychosomatics, 78(5), 265-274.

Somatic symptom disorders are common, disabling and costly. Individually provided short-term psychodynamic psychotherapies (STPP) have shown promising results. However, the effectiveness of STPP for somatic symptom disorders has not been reviewed. Methods: We undertook a systematic review of randomized controlled trials and controlled before and after studies. The outcomes included psychological symptoms, physical symptoms, social-occupational function, healthcare utilization and treatment continuation. Results: A total of 23 studies met the inclusion criteria and covered a broad range of somatic disorders. Thirteen were RCTs and 10 were case series with pre-post outcome assessment. Of the included studies, 21/23 (91.3%), 11/12 (91.6%), 16/19 (76.2%) and 7/9 (77.8%) reported significant or possible effects on physical symptoms, psychological symptoms, social-occupational function and healthcare utilization respectively. Meta-analysis was possible for 14 studies and revealed significant effects on physical symptoms, psychiatric symptoms and social adjustment which were maintained in long-term follow-up. Random-effect modeling attenuated some of these relationships. There was a 54% greater treatment retention in the STPP group versus controls. Conclusion: STPP may be effective for a range of medical and physical conditions underscoring the role of patients’ emotional adjustment in overall health. Future research should include high-quality randomized and clinical effectiveness studies with attention to healthcare use and cost.

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