The effectiveness of psychodynamic psychotherapies: An update

Summary & key facts

Researchers reviewed many outcome studies and meta-analyses of psychodynamic therapy, which is a type of talking therapy that explores feelings, relationships, and past experiences. They found that psychodynamic therapy often works better than doing nothing (for example being on a waitlist, getting only usual care, or a placebo) for depression, some kinds of anxiety, some eating problems, and some disorders that cause physical symptoms without a clear medical cause. There is little evidence that it helps post-traumatic stress disorder, obsessive-compulsive disorder, bulimia, cocaine dependence, or psychosis. The strongest support is for longer-term psychodynamic therapy for some personality problems, especially borderline personality disorder. The reviewers also said many studies are not well designed, comparisons with other active therapies rarely show psychodynamic therapy is better, and the field should move toward testing specific treatment parts and using biology and computer methods to tailor care to each person.

Key facts:

• The paper is a broad review of outcome studies and meta-analyses about psychodynamic therapy for major mental health diagnoses.
• Compared to inactive controls (like waitlists, usual care, or placebo), psychodynamic therapy generally shows benefit for depression.
• Psychodynamic therapy also generally shows benefit for some anxiety disorders, some eating disorders, and some somatic (physical) disorders without a clear medical cause.
• There is little evidence to support using psychodynamic therapy for post-traumatic stress disorder, obsessive-compulsive disorder, bulimia nervosa, cocaine dependence, or psychosis.
• The strongest current evidence supports longer-term psychodynamic therapy for certain personality problems, especially borderline personality disorder.
• When psychodynamic therapy is compared with other active treatments, it is rarely shown to be superior, and many studies were not designed to test whether different therapies are equally effective.
• Some reviews of psychodynamic therapy may be biased by the preferences of researchers or therapists, and a few studies have found psychodynamic therapy to be worse than alternatives, though those studies are few and often have design problems.
• The authors recommend stopping broad comparisons of mixed therapy types and instead testing specific, protocol-led combinations of treatment parts using advances from biology and computational psychiatry to better match treatments to individual patients.

Abstract

This paper provides a comprehensive review of outcome studies and meta-analyses of effectiveness studies of psychodynamic therapy (PDT) for the major categories of mental disorders. Comparisons with inactive controls (waitlist, treatment as usual and placebo) generally but by no means invariably show PDT to be effective for depression, some anxiety disorders, eating disorders and somatic disorders. There is little evidence to support its implementation for post-traumatic stress disorder, obsessive-compulsive disorder, bulimia nervosa, cocaine dependence or psychosis. The strongest current evidence base supports relatively long-term psychodynamic treatment of some personality disorders, particularly borderline personality disorder. Comparisons with active treatments rarely identify PDT as superior to control interventions and studies are generally not appropriately designed to provide tests of statistical equivalence. Studies that demonstrate inferiority of PDT to alternatives exist, but are small in number and often questionable in design. Reviews of the field appear to be subject to allegiance effects. The present review recommends abandoning the inherently conservative strategy of comparing heterogeneous "families" of therapies for heterogeneous diagnostic groups. Instead, it advocates using the opportunities provided by bioscience and computational psychiatry to creatively explore and assess the value of protocol-directed combinations of specific treatment components to address the key problems of individual patients.

Topics

Mental Health and Psychiatry Personality Disorders and Psychopathology Psychotherapy Techniques and Applications

Categories

Clinical Psychology Psychology Social Sciences

Tags

Law Medicine MEDLINE Political science Psychiatry Psychodynamics Psychology Psychotherapist

Conditions & symptoms

Anxiety Depression Eating Disorder Obsessive-Compulsive Disorder PTSD Substance abuse disorder Addiction or harmful habbits Anxiety or worry Poor appetite or overeating Sadness or low mood