The effectiveness of psychodynamic psychotherapies: an update
The effectiveness of psychodynamic psychotherapies:an updatePETER FONAGY
Research Department of Clinical, Educational and Health Psychology, University College London, and The Anna Freud Centre, London, UK
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 byno means invariably show PDT to be effective for depression, some anxiety disorders, eating disorders and somatic disorders. There is littleevidence to support its implementation for post-traumatic stress disorder, obsessive-compulsive disorder, bulimia nervosa, cocaine depen-dence 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 andstudies are generally not appropriately designed to provide tests of statistical equivalence. Studies that demonstrate inferiority of PDT toalternatives 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 het-erogeneous diagnostic groups. Instead, it advocates using the opportunities provided by bioscience and computational psychiatry to creative-ly explore and assess the value of protocol-directed combinations of specific treatment components to address the key problems of individualpatients.
Key words: Psychodynamic psychotherapy, psychoanalysis, depression, anxiety disorders, eating disorders, somatic disorders, personalitydisorders
(World Psychiatry 2015;14:137–150)
Psychodynamic therapy (PDT) is on the retreat around the
py as "evidence-based" (e.g., practice-based evidence) (23).
world in the face of critique of its scientific credibility. Empiri-
However, it is misguided to deny that RCTs are key to estab-
cally substantiated clinical judgement underpins professional
lishing the validity of a therapeutic modality.
accountability and transparency in health care and increas-
The history of medicine is littered with interventions that
ingly so in mental health (1). One would therefore expect em-
did remarkable duty as therapies and yet, when subjected to
pirically supported therapies to gradually replace treatment
RCT methodology, were shown either to have no benefit over
as usual in everyday clinical care (2-5). Many outside the
alternative treatments or even to prevent the patient from
cognitive-behavioural therapy (CBT) community have ob-
benefitting, in terms of effect size or speed, from a superior
jected to this, raising concerns about the generalizability of
intervention. Perhaps the most dramatic example is the RCT
findings from randomized controlled trials (RCTs) (6).
that ended 100 years of radical mastectomies for breast carci-
The issue of external validity of RCTs in the context of
noma only 30 years ago. The study showed that half a million
health care policy was recently exposed to philosophical
women who had been subjected to disabling, mutilating oper-
scrutiny (7), leading to the suggestion that the key issue may
ations, performed with the best of intentions on the basis of a
not be the theory-driven question of whether an intervention
fallacious theory about how carcinoma spreads, could have
works, but the implementation question "Will it work for
had equally good outcomes with lumpectomies (24).
us?". For example, multisystemic therapy for conduct disor-
Empirical knowledge in psychological therapies is multi-
der is supported by trials in the U.S. and Norway, but these
faceted and complex, and requires sophistication in the scru-
results were not replicated in Sweden and Canada (8-19).
tiny of research data. While critical reviews that summarize
Along with other researchers, we have argued that, in
or synthesize a body of research are not without value, they
order for a treatment to be considered as empirically sup-
also have major limitations. They rely on the statistical signif-
ported, evidence beyond that provided by RCTs is required
icance of a study to determine an intervention's efficacy, yet
(20,21). However, this does not imply, as many have as-
statistical significance is primarily determined by sample
sumed, that RCTs can be replaced by methods that do not
size. Meta-analyses can pool multiple studies where each
comply with Mill's "method of difference" maxim (stating
has low statistical power (a pervasive problem in psychother-
that where you have one situation that leads to an effect,
apy research), but are potentially misleading when the RCTs
and another which does not, and the only difference is the
being aggregated are not homogeneous in terms of the target
presence of a single factor in the first situation, you can infer
population, the treatment method and the outcome mea-
this factor as the cause of the effect) (22).
sures. This is often the case for trials of PDT.
Some have argued that not only are RCTs for psycho-
A recent meta-review of 61 meta-analyses covering 21
therapy flawed because of issues of generalizability, but also
psychiatric disorders containing 852 trials and 137,126 par-
that there are alternative ways of establishing psychothera-
ticipants yielded slightly larger effect sizes for psychotherapy
(0.58; 95% CI: 0.42 to 0.76) than pharmacotherapy (0.40;
fied by the work of those around the boundaries of both
95% CI: 0.28 to 0.52) studies (25), but the applicability of
domains (33-36). The common distinction between inter-
these figures is brought into question by the null results from
pretive and supportive approaches (37) speaks to a clinical
dichotomy that existed 30-40 years ago, but hardly applies
The limitations of meta-analyses have generated concern
today. Certain manualized treatments are labelled as psy-
among a number of reviewers (26,27) that undue weight is
chodynamic (38,39), but a thorough content analysis of
given to heterogeneous small-scale studies, which are con-
these remains to be done. The pragmatic approach adopted
sidered in preference to well-designed and well-conducted
in this review has been to use self-declared allegiance as the
RCTs that converge in their results. While hard-pressed
guiding principle as to what constitutes PDT.
readers may understandably wish to take an intellectual
This review focuses on effectiveness and ignores ques-
short-cut to a pooled effect size rather than considering
tions of mechanism and treatment process. This was, again,
individual investigations, it is important to remember that
a decision of expedience given the space limitations and the
meta-analyses lack individual patient data – they are based
wish to provide a comprehensive survey. The literature
on response rates and mean values. This masks important
search on which this contribution depends was based on
heterogeneity that is often revealed by careful scrutiny of
the methodology evolved for two previous large-scale sur-
veys (20,40) and involved a computer search of all major
This review has opted to prioritize individual studies. The
databases using 100 terms referring to different aspects of
key limitation of small studies is the so-called "file drawer"
mental health problems and 11 terms describing psycho-
problem. Insufficient patients are sampled in small studies. As
therapy (the search algorithm and full inclusion criteria are
a consequence, relying on underpowered studies means that
available on request). Studies were selected if they reported
there is a risk that the likely effectiveness of a therapy is over-
outcomes that were directly related to the disorder or to
stated simply because a study with the same sample size but
intermediate variables. The review is limited to experimental
chance negative findings is unlikely to have been published.
designs involving some degree of random assignment.
Further, it is important to recognize that the absence of a
significant difference between two conditions in a studyshould not be considered evidence for equivalence. The lat-
ter requires a different statistical procedure and a larger sam-ple size than the so-called "superiority trials" which most
psychotherapy trials are (28). Lack of significant differencedoes not mean that two interventions are equally effective,
Several studies have compared PDT to waitlist (41,42),
but only that it is impossible to rule out their equivalence
placebo (43-46) or usual care controls (47-50) in the short-
(29). A confident statement of superiority requires a trial
term treatment of depression. The results are mixed, with
with at least 50 individuals per arm for a medium effect size
some favouring PDT (41-43,47,49,51) while others report
(30). Equivalence trials are expected to have sample sizes
no superiority to controls (44-46,48,50).
several times larger. Sadly, few of the trials which are re-
A number of these studies are methodologically too weak
viewed here meet this elementary criterion.
to permit definitive conclusions, either due to small sample
Finally, how do we define psychodynamic psychotherapy?
size (41-43,50) or because their implementation of PDT fails
A recent meta-analysis likened the family of psychodynamic
to meet criteria (52) for a bona fide treatment (44,48).
therapies to an actual, if somewhat dysfunctional, family
Among the good studies, results are still mixed. Some stud-
whose many members hardly spoke to each other and some-
ies report medium effect sizes: 20.57 (95% CI: 20.99 to
times even spoke different languages (31). This review uses a
20.14) (47) and 20.53 (95% CI: 20.92 to 20.13) (49). Per-
broad definition of psychodynamic treatment as a stance tak-
haps the most rigorous study comparing supportive expres-
en to human subjectivity that is inclusive and aimed at a com-
sive therapy with placebo medication reported no superior
prehensive understanding of the interplay between aspects
effects at the end of treatment on either depression (45) or
of the individual's relationship with his/her environment,
quality of life (46). However, a recent well-conducted study
whether external or internal (32). It refers to the extraordi-
of women with depressive disorders and breast cancer found
nary human potential for dynamic self-alteration and self-
that significantly more of the PDT group achieved remission
correction. This definition incorporates a developmental
from depression than the usual care group (44% vs. 23%)
perspective, and assumes limitations on conscious influence,
(53). An RCT of a mixed anxiety and depression group also
ubiquity of conflict, internal representation of relationships,
reported favourable post-treatment results for PDT on clini-
mental defences, and that complex meanings can be attached
cian and self-report measures (54).
to experience (32).
An intriguing meta-analysis of studies carried out in China
The boundaries of PDT have become blurred over recent
lists six controlled trials that reported substantial treatment
decades by changes in both CBT approaches and psychody-
success from psychodynamic psychotherapy as an adjunct to
namic theory and technique, leading to increasing conver-
medication and conventional nursing in the treatment of
gence of both understanding and clinical methods, exempli-
depression in patients with Parkinson's disease (55).
World Psychiatry 14:2 - June 2015
Since in clinical practice psychological therapies for
reporting too limited to permit reliable inferences about
depression are mostly offered in combination with medi-
equivalence or even superiority (76-82). If CBT is superior
cation, the potential value added by brief dynamic thera-
to PDT, it is so only in very brief (8-session) implementa-
py is a key question for practitioners. A well-constructed,
tions (77). PDT and solution-focused therapy appear com-
appropriately powered RCT found combined treatment
parable in effectiveness (83).
to be more acceptable (reducing refusal and premature
A recently advanced innovative approach used the Inter-
termination of medication) and associated with higher
net to deliver PDT based on a self-help manual in a pro-
recovery rates (41% vs. 59%) (56). These findings were
gramme lasting 10 weeks. Compared to a structured support
confirmed for self-reported depression and quality of life
condition, recovery rates of 35% vs. 9% were reported, which
outcomes, but not for clinician-rated outcomes (57). A
were maintained at 10-month follow-up (84). A second trial
further smaller study comparing clomipramine with or
based on a different model also yielded good outcomes com-
without PDT reported reduced depression, lower hospi-
pared to online therapist support without treatment modules
talization rates, better work adjustment and better global
in a mixed mood and anxiety disorder population (85).
functioning in the combined treatment group (58). Acombined analysis of three RCTs (56,59,60), in whichdata were pooled to enable contrasts between pharmaco-
therapy alone and combination treatment, yielded betterobserver-rated and self-reported outcomes in terms of
In normal practice, PDT is often offered as a long-term
remission and response rates at treatment termination for
(50 sessions or more) treatment. However, only a handful of
combination treatments (61).
studies have explored the effectiveness of long-term PDT.
There may be moderators of the superior effect of com-
The Helsinki study showed long-term PDT to be inferior
bination treatments. So far, unreplicated findings suggest
to short-term PDT initially, but superior after 3-year follow-
that PDT may be particularly indicated if depression is
up (86-88). In an intriguing comparison between intensive
accompanied by personality disorder (62,63) or child-
long-term PDT (psychoanalysis), long-term PDT and short-
hood trauma (64), and findings are restricted to long-term
term PDT, psychoanalysis was initially inferior to both other
follow-ups (42,65,66). Dose-effect relations associated
therapies, but was more effective at 5-year follow-up (89).
with the length of therapy (8 vs. 16 sessions) have not
A large-scale naturalistic study randomized 272 depressed
been found for combination treatments (59).
patients to unmanualized long-term PDT, fluoxetine or their
When pharmacotherapy is contrasted head-to-head with
combination for 24 months (51). Long-term PDT on its own
PDT, studies fail to identify differential effects (45,46,67,68).
or in combination was more effective in reducing depression
Adding pharmacotherapy to PDT brings equivocal benefit
scores than fluoxetine alone, with a medium effect size.
(60), an important observation in the light of consistent find-
A study in which participants with major depressive dis-
ings of patient preference for PDT (69). A meta-analysis
order were randomized to psychoanalysis or long-term PDT
comparing psychotherapies to treatment with selective sero-
found significant superiority of psychoanalysis on self-rated
tonin reuptake inhibitors demonstrated that the former were
measures of depression at 3-year follow-up, but no differen-
comparable to medication and that PDT was as efficacious
ces at 1 and 2 years (90). A quasi-experimental comparison
as other therapies. However, psychotherapies that were not
found psychoanalysis but not long-term PDT to be superior
bona fide (i.e., those delivered by professionals without sub-
to CBT on measures of depression at 3 year follow-up (91).
stantial training in psychotherapy) had significantly worse
A recently completed study of 18 months of once-weekly
psychoanalytic psychotherapy for patients with two previous
Several high-quality trials reported comparisons between
documented treatment failures reported the psychotherapy
CBT and PDT. A well-powered equivalence trial (N5341)
to be superior to U.K. practice guidelines-based treatment,
reported no observer-rated, patient-rated or therapist-rated
but superiority was not apparent until 2 years after the end of
differences at treatment termination or follow-up, although
overall the remission rate was low at 22.7% (71-73). Anothertrial found PDT, but not counselling or CBT, to be superiorto a control in reducing the rate of postnatal depression at
termination (49), although the treatments were equivalent atshort-term and long-term follow-up. By contrast, an RCT of
Meta-analytic findings on the whole reveal large pre-post
291 inpatients reported that CBT was equally effective in
treatment effects (93,94) for PDT maintained at 1-year
those selected for CBT or PDT, while PDT benefitted only
follow-up, with medium effect sizes indicating superiority to
those who were specifically selected for that treatment (74).
inactive controls (31,95) but either no difference (31) or
Consequently, CBT was superior for the randomly rather
slight inferiority (94) in relation to alternative interventions
than systematically assigned group of patients (75).
post-treatment. Checking for publication bias revealed the
Earlier studies tended to show negligible differences
existence of "file drawer" studies favouring PDT, which abol-
between PDT and CBT, but the trials were too small and
ished the inferiority.
Effect sizes at follow-up relative to other treatments are
A health economics study reported that the end of treat-
insignificant overall (31,94,96), but PDT performed signifi-
ment cost-effectiveness of CBT and PDT compared to wait-
cantly worse against CBT (31) and in geriatric studies (31).
list was uncertain and depended on societal willingness to
PDT is comparable to alternative treatments at long-term
pay (WTP): CBT proved cost-effective at WTP e16,100
follow-up. It also increases the effect of antidepressant med-
per responder and PDT at WTP e27,290 (106).
There are no studies of PDT against inactive controls in
generalized anxiety disorder, except a study of Internet-based PDT, which yielded no evidence of superiority to
waitlist control on anxiety ratings (107). An early study of apoorly specified PDT showed it to be inferior to both anxiety
On the whole, evidence supports the use of PDT in the
management training and cognitive therapy at termination
treatment of depression, although its effects compared to
and short-term follow-up (108). A small study comparing
placebo and other inactive control treatments are moderate
PDT to supportive therapy failed to find superiority of PDT
rather than large. There is evidence that the effects are main-
for interpersonal problems (109). An RCT contrasting CBT
tained in both the short and long term. PDT may be a pre-
with PDT found the former to be superior on self-reported
ferred alternative to pharmacotherapy and certainly adds to
measures of anxiety, but this was not confirmed by indepen-
the effectiveness of medication. If CBT is more effective
dent observer ratings (110). At 12-month follow-up, signifi-
than PDT, this difference is neither large nor reliable. How-
cant differences favouring CBT remained on two of the
ever, there are too few large-scale trials to fully establish
Two small studies of panic disorder have been reported.
The dynamic therapies considered under the heading
In one study, panic-focused PDT was clearly superior to
"PDT" are probably quite similar in practice, but vary in the-
applied relaxation (73% vs. 39% response) (111), specifically
oretical orientation, content focus, and style of delivery
for those with comorbid personality disorders (112). A simi-
(supportive vs. confrontational), and no single type of PDT
lar study contrasted this treatment with CBT and found no
emerges as particularly efficacious. The literature on long-
significant differences, although a larger sample with the
term PDT, which is still in its infancy, suggests that this
same response ratios (47% PDT vs. 72% CBT) would lead to
approach may have value, perhaps particularly with more
statistical significance (H50.52) (113).
complex and chronic cases of depression. There is a ques-
There is no evidence that PDT is helpful for obsessive-
tion over the issue of cost-effectiveness of these therapies.
compulsive disorder (114). The single study adding PDT to
Both established and currently emerging Internet applica-
pharmacotherapy reported no significant clinical effect
tions of PDT are of particular interest, because of their
from this supplemental treatment (115).
potential for efficient dissemination.
There is only one study of PDT as an approach to post-
traumatic stress disorder (PTSD) (116), which shows a sig-nificant reduction of intrusion and avoidance compared to
waitlist, to about the same extent as hypnotherapy and trau-ma desensitization. Systematic reviews found insufficient
evidence in relation to PTSD to warrant comment (117-119), although strong theoretical and clinical arguments
Notwithstanding the high lifetime prevalence of anxiety
have been advanced for incorporating a psychodynamic
disorders (97), few studies have examined the effectiveness
approach into PTSD treatment programmes (120).
of PDT for these conditions.
PDT has been shown to be superior to enhanced waitlist
for social anxiety and social phobia (98-102). The most
recent study, with 207 PDT and 79 waitlist patients, yieldedlarge differences in remission rates (26% vs. 9%) (100). A
Meta-analyses have tended to combine different anxiety
smaller study showed that adding group PDT to medication
disorders when providing effect sizes (31,121). PDT is re-
(clonazepam) reduced social anxiety (103) and immature
ported to be significantly more effective than inactive control
defence styles (104).
conditions with a medium effect size, and to be overall insig-
Whilst short-term PDT outperformed applied relaxation,
nificantly different when compared with alternative treat-
it was equivalent or inferior to prolonged exposure in two
ments. However, substantial heterogeneity is reported in
small, early studies (98,99). More recent trials contrasting
both primary and secondary outcomes. These conclusions
PDT with CBT found small between-group differences
differ from those of other reviewers (122,123) who compared
in remission (100,102). Continuous measures of phobia
PDT only with CBT and claimed definite superiority for the
favoured CBT at termination. Between 6-month and 2-year
latter. This claim, however, has been questioned (121) and
follow-up, the differences between the two treatments dis-
significant errors may indeed have crept into one of the
above meta-analyses (122).
World Psychiatry 14:2 - June 2015
than routine treatment (21%) and achieved outcomes com-parable to family therapy (41%) and cognitive analytic thera-
The effectiveness of PDT for anxiety is crucial in the debate
py (32%) (131).
between those who argue for specific treatment approaches,
In a recent, exceptionally high-quality study (Anorexia
as in CBT, versus those who support a generic approach
Nervosa Treatment of OutPatients, ANTOP) (132,133), focal
seeking to identify similar unconscious content across diag-
dynamic psychotherapy was contrasted with enhanced CBT
and treatment as usual, which incorporated the same intensi-
In relation to social anxiety and perhaps generalized anx-
ty of psychotherapy, offered by community experts. Weight
iety disorder and panic disorder, promising emerging evi-
gains were comparable across the three groups over 12
dence supports the argument for a generic approach. The
months. With respect to global outcome measures, patients
case is weakened, however, by the absence of evidence for
allocated to PDT had higher recovery rates than the control
PTSD and the evidence of absence of effect for obsessive-
group; this was the first study to show superiority to CBT.
compulsive disorder. In general, the methodological weak-
Patients in the control group more frequently required inpa-
nesses of earlier studies call meta-analytic findings into
tient treatment (41%) than those receiving PDT (23%) or
CBT (35%). Although full syndrome anorexia nervosa per-
Overall, there is considerable potential for further sound
sisted in 21% of PDT patients (versus 28% of controls), the
research aiming to identify the anxiety conditions for which
findings, in association with other studies (134), suggest that
PDT may be particularly helpful.
a focus on intra- and interpersonal factors is beneficial forindividuals with this disorder (135).
PDT in the treatment of anorexia nervosa in 12-19-year
olds was found to be comparable to family-based treat-ment after 12-18 months of implementation in terms of
A small study showed self-psychology oriented PDT to be
achieving a target weight, but slightly inferior in terms of
superior to nutritional counselling in treating a combination
change in body mass index and more frequent hospitaliza-
of anorexia and bulimia nervosa. The comparison with an
tion (136,137). In an independent study of PDT versus
active treatment in the same study (cognitive orientation
family-based therapy, age appeared to be a significant
therapy) favoured PDT, particularly for bulimia nervosa
moderator, with older patients benefitting more from indi-
(124). By contrast, two studies focusing on bulimia nervosa
vidual therapy and younger patients from family-based
found both PDT and CBT to be effective in reducing eating
approaches in both short-term (138) and long-term fol-
disorder symptoms, but CBT was slightly superior on global
low-up (139). A definitive study with larger samples found
measures of clinical outcome, self-rated psychopathology
that, even for older adolescents, family-based treatment
and some indicators of social adjustment (125,126).
achieved higher rates of remission and larger treatment
A 16-week course of group psychodynamic psychothera-
effects than individual treatment (140).
py for binge eating disorder was superior to treatment asusual on all measures, and mostly equivalent to group CBTin reducing binge eating and overall improvement (79%
PDT vs. 73% CBT) (127). PDT resulted in lower depressionand more improvement in self-esteem, but greater suscepti-
There is strong evidence (two independent RCTs, one of
bility to hunger. There was some indication that patients
which is large) that PDT can contribute to recovery from
with higher attachment anxiety benefitted more from PDT.
anorexia nervosa. This is underscored by the fact that treat-
A recent report of an RCT of 70 patients with bulimia ner-
ment as usual in the ANTOP trial included psychotherapy,
vosa, contrasting 2 years of once-weekly PDT with 20 ses-
which, given the location of the study (Germany), was most
sions of CBT over 5 months, found CBT to be more effective
likely to have been non-manualized PDT.
in both the short (5 months) and long (2 years) term (128).
While available studies are small and conflicting, there is
Both treatments were effective in reducing eating disorder
sufficient uncertainty about the relevance of PDT for bulim-
symptoms and general psychopathology. On the face of it,
ia nervosa to warrant further research in which the imple-
this finding might be considered to have appropriately chal-
mentation of the therapy is more appropriately symptom-
lenged the value of PDT, except that, strangely, this manual-
ization of PDT precluded addressing bingeing and purgingunless the topic was volunteered by the patient (129). Thefindings drew attention to the importance of adapting PDT
to the patient's presenting problems (130).
An RCT comparing focal PDT with family therapy, cogni-
A number of studies have examined the usefulness of
tive analytic therapy and routine treatment of anorexia ner-
interpersonally oriented PDT for individuals presenting with
vosa found that PDT achieved more improvement (52%)
a range of pain symptoms.
A relatively large study of irritable bowel syndrome pa-
significant differences between groups for follow-up hospi-
tients, randomized to usual (medical) care or PDT (plus usual
tal costs (151).
care), reported substantial changes in somatic symptoms,abdominal pain and bowel dysfunction at 3 and 15 months inthe PDT group (141). A 12-week trial found that women pre-
senting with irritable bowel syndrome benefitted more fromPDT than from active listening in terms of self- and doctor-
No meta-analyses have been reported recently. A limited
rated symptoms (142). Those in the control group who ac-
review identified only 13 RCTs and a moderate effect size
cepted psychotherapy after the end of treatment improved,
for somatic symptoms (d520.59; 95% CI: 20.78 to 20.40),
and those who declined relapsed.
but the random effects model failed to reach significance
A further study with people with the same clinical prob-
(152). The effects are clearer for psychiatric symptoms and
lems contrasted eight sessions of PDT with pharmacological
social adjustment than somatic symptoms.
treatment (paroxetine) and treatment as usual (143). Bothactive treatments reduced physical distress but neither im-proved pain ratings. Psychotherapy reduced health care
costs during the follow-up year. Patients with a history ofsexual abuse particularly benefitted from PDT, but those
The evidence base for PDT in somatoform disorders com-
with depression did better with paroxetine treatment.
pared to control treatments is quite robust. Although there
A comparison of PDT with supportive psychotherapy in
are no adequate meta-analytic summaries, this narrative
patients with dyspepsia reported that at 1 year 54% felt
review clearly reveals that an interpersonal form of dynamic
physically much better with the former treatment, com-
therapy has substantial and relatively long-term effects, with
pared to 28% of those receiving the latter (144). The physi-
medium effect sizes compared to enhanced treatment as
cal improvements were in line with improvements in
usual, and that PDT may be able to reduce long-term health
psychological symptoms in the PDT group. These findings
care costs for somatic disorders.
were replicated in a small Iranian RCT, indicating cultural
Interestingly, there appear to have been no comparisons
with active symptom-focused psychosocial treatments such
A well-powered trial in patients with chronic pain symp-
as CBT. Yet, a comparison may be relatively easy, since in
toms, randomized to PDT or enhanced medical care, yielded
this context PDT is mostly offered as a particularly brief
medium between-group effects (d50.42) for physical quality
intervention (8-10 sessions).
of life at 9-month follow-up (146). An earlier study with a
The overall impression is that PDT may be more effective
smaller sample of patients with somatoform pain disorder
when somatoform disorders are associated with adverse
and a much longer (33 sessions) treatment also yielded sig-
social histories rather than manifest psychiatric problems.
nificant pain reductions, in addition to improvements insomatization, mood and social adjustment (147).
An evaluation of 25 sessions of PDT compared to four
consultations over 6 months for patients with fibromyalgiafound no evidence of superiority of PDT for symptoms spe-
RCTs suggest that the value of PDT in the treatment of
cific to this disorder or general psychiatric problems (148).
drug dependence is moderated by the substance involved.
However, the training offered to the therapists was brief
An early study of methadone-maintained opiate dependence
(4 hours) and focused on insight rather than interpersonal
found drug counselling plus either supportive-expressive
emotional awareness, which has been found to be more rel-
PDT or CBT to be beneficial relative to drug counselling
alone, but there were no differences between the two psy-
An imaginative study randomized general practitioners
chotherapies (153-155). Patients with psychiatric morbidity
to be trained to work jointly with psychodynamic psycho-
benefitted most from the psychotherapies (156). A replica-
therapists to deliver 10 weekly group therapy sessions
tion study of methadone users with psychiatric morbidity
in addition to the diagnosis and psychological management
contrasted only PDT with counselling and observed a reduc-
of medically unexplained symptoms (150). This large trial
tion of cocaine-positive but not opiate-positive urine sam-
found significant small to medium health benefits over
ples during the treatment period (157). Importantly, this
enhanced medical care from this psychodynamic group
study demonstrated better maintenance of abstinence at 6
months, lower-dose methadone use and a significant reduc-
A large quasi-experimental study compared pre- and
tion in psychiatric morbidity.
post-treatment health care costs for 890 patients treated
A study of cocaine dependence, contrasting CBT, PDT
with brief PDT for a broad range of somatic and psychiatric
and individual drug counselling based on the 12-step philos-
disorders with those of a control group (N5192) who were
ophy (all incorporating group drug counselling) with group
referred but never treated, and found an average cost reduc-
drug counselling alone, found individual drug counselling
tion per treated case of $12,628 over 3 follow-up years, with
to be most efficacious (158). Neither CBT nor PDT added
World Psychiatry 14:2 - June 2015
benefit to group drug counselling, and they did not differ
is limited even for CBT. The available evidence for PDT sug-
from each other in terms of effectiveness. Thirty-eight per-
gests some possible immediate benefit from dynamic ap-
cent of individual drug counselling patients compared to
proaches, but benefits are not sustained in the longer term.
18% of PDT patients maintained 3 months of consecutiveabstinence. However, individual drug counselling did notreduce psychiatric symptoms, unemployment, or medico-
legal, social, alcohol or interpersonal problems to a greaterextent than the other treatments (159).
A relatively wide range of dynamic therapies have been
evaluated for a number of personality disorders, against bothactive and inactive control treatments. A number of small tri-
als report intensive, relatively brief (25-40 sessions) PDT tobe superior to minimal contact (166), waitlist (167,168) and
It is unclear whether PDT should be recommended to
treatment as usual (169-172). Some studies demonstrated
supplement the treatment of opiate-dependent individuals.
the value of longer-term treatments for specific diagnoses,
Individual drug counselling clearly has benefit and, since
for example, borderline personality disorder (173,174).
contingency management has become a preferred treatment
Brief therapies do less well against active controls. In
for dependency problems (20,40), the role of PDT in the
mixed personality disorder populations, manualized PDT
treatment of drug dependence is currently doubtful.
was not superior to supportive psychotherapy (175), adap-tive psychotherapy (167) or non-manualized community-delivered PDT (176). In a comparison of non-manualized
PDT with CBT, the latter was more efficacious over a20-session treatment and follow-up for avoidant personality
A Cochrane review of individual PDT for schizophrenia
disorder (168). In contrast, a trial of manualized PDT versus
and severe mental illness, including four randomized trials
CBT for cluster C personality disorder patients reported no
with 528 participants, found that patients who had received
significant differences and a somewhat more rapid reduction
PDT used less medication, were no more or less likely to be
of symptom distress in the PDT group (177). A further com-
rehospitalized, but were less likely to be discharged (160).
parison between PDT, CBT and brief relational therapy
There was no clear evidence of any positive effect of PDT
(which focuses on ruptures in the therapeutic alliance) found
and adverse effects were not considered. Another meta-
that the latter two treatments were associated with a higher
analytic review (161), which identified 37 studies with 2,642
percentage of clinically significant and reliable change in the
patients, incorporated many studies from the 1950s to the
treatment of cluster C personality disorder, although the dif-
1970s, when treatment pathways and practices were quite
ferences were not significant (178).
different, which makes the pooled estimates impossible to
There have been larger trials with active treatment com-
parisons focused on borderline personality disorder. Trans-
In a partial RCT, the Danish National Schizophrenia
ference-focused psychotherapy was shown to be superior to
Project (162), patients with first episode psychosis received
supportive psychotherapy and dialectical behaviour thera-
one of three treatment packages: one including PDT, the
py on some symptom measures (improving irritability,
second multi-family treatment, and the third treatment as
anger and assault and impulsivity) (179) as well as a num-
usual. Only a small subgroup of patients was randomized.
ber of attachment-related measures (180). Similarly,
When controlled for drug and alcohol use, the 1-year com-
mentalization-based treatment was shown to be superior
parison revealed benefit from PDT (162). A further analysis
to structured clinical management of equal intensity (181),
after 2 years contrasted treatment as usual (N5150) with
particularly for patients with more than two personality
PDT (N5119) (only 72 patients had been randomly allocat-
disorder diagnoses (182). Mentalization-based treatment
ed). Patients receiving PDT had higher Global Assessment
was also found to be superior to supportive group therapy,
of Functioning scores (medium effect size) (163). Benefits
but only in terms of global assessment of functioning, at
were no longer evident at 5-year follow-up (164).
termination (183) and at 18-month follow-up (184). How-
A pilot study of psychodynamic art therapy vs. treatment
ever, an RCT comparing transference-focused psychother-
as usual with a small sample found a post-treatment reduc-
apy and CBT (schema-focused therapy) found CBT to be
tion in positive psychotic symptoms, which dissipated 6
more effective, particularly because early dropout rates
weeks later (165).
were higher for the former treatment (185). In this context,it is noteworthy that the introduction of mentalization-based treatment to a specialist unit for borderline personal-
ity disorder was historically associated with a substantialreduction of dropouts (from 15% to 2%) (186).
There is increasing optimism about the value of psycholog-
While the inclusion of general psychiatric management
ical therapy for psychosis, although the supporting evidence
in a review of PDT may perhaps be controversial, this
"dynamically informed" intervention, manualized by two
while mentalization-based treatment is deemed probably ef-
psychodynamic practitioners (187), owes much to dynamic
ficacious. In fact, a number of the comparator treatments
techniques and conceptualization of borderline personality
considered above also have strong claims to being empirical-
disorder. It has been shown to be comparable to dialectical
ly supported, notably relational psychotherapy for general
behaviour therapy at termination (188) and 2-year follow-
personality disorder (193), manualized dynamic supportive
therapy (194) and brief adaptive psychotherapy (195).
A review of the treatment of personality disorders (196)
summarizes the characteristics required for an effective treat-
ment as structured, focused on developing agency, integrativeof feelings and actions, active and validating, and incorporat-
There are few meta-analyses specific to PDT for personal-
ing supervision. Most dynamic therapies will incorporate
ity disorders, although a number of the meta-analyses focus-
these features. Their relative efficacy is thus hardly surprising.
ing on long-term psychotherapy capture many if not all ofthe relevant studies (190,191).
One meta-analysis of controlled and uncontrolled studies
for patients with comorbid depression reported large pre-post effect sizes (d51-1.27) and superiority to waitlist, but
What can be concluded about the efficacy of PDT? In-
no significant differences in efficacy compared to other
triguingly, different reviews of the same literature appear
treatments (63). The most comprehensive meta-analysis
sometimes to reach dramatically different conclusions (190,
reported medium effect sizes compared to inactive controls
191,197-201). There is a clear need for authors to declare
(31). Active treatment comparisons yield insignificant but
interests, since the conclusions of reviews often appear to
negative effect sizes (g520.15, 95% CI: 20.3 to 0.1) and no
reflect the authors' theoretical orientation, just as the out-
significant difference at follow-up.
comes of individual studies appear to be highly correlated
Breaking down outcomes to symptomatology, global func-
with the first author's affiliation (202). This tendency is
tioning, interpersonal problems, depression and suicidality
regrettable, because the lack of balance and the determina-
also revealed no significant differences between PDT and
tion to use statistics primarily for support leads to entrenched
other therapies on any of these dimensions, but medium
traditions and conflicts with the need to innovate through
effect sizes in relation to control treatments. A marginally sig-
the process of collaboration that is so characteristic of discov-
nificant association between the number of sessions and
effect size is reported.
The extension of the evidence-based movement to psycho-
However, it would be wrong to argue that complex disor-
therapy, which we strongly support, may have reinforced a
ders always require complex and long-term PDT interven-
conservatism by raising the bar for accepting innovative ap-
tions. Patients with chronic mental disorders (average 5-year
proaches. Could CBT be discovered and disseminated now
chronicity), who were frequent utilizers of mental health
under the empirically supported therapies paradigm (203)?
services, were randomized to treatment as usual or very brief
Complex combinations of techniques have been packaged as
(8-session) PDT (192). Six months post-treatment there were
empirically supported therapies. Increasingly, developers
significant benefits in terms of general psychiatric distress,
have prioritized the implementation of packages without
social functioning, quality of life, and resource utilization in
regard to the unique value of each component. These treat-
terms of outpatient attendance, general practitioner contacts,
ment packages evolve in relation to what many now consider
nurse contacts and medication. The cost of psychotherapy
a less-than-adequate system of diagnostic classification (204-
was recouped through reductions in resource use. The study
206). Transdiagnostic considerations will ultimately out-
underscores the absence of a simple linear relationship be-
weigh syndrome-specific treatment recommendations.
tween the length of a dynamic treatment and the severity of
Given all this, is it possible to make meaningful recom-
mendations about PDT based on the evidence? The follow-ing suggestions seem to be well grounded in data:
Treatment approaches generated from PDT principles
appear to benefit individuals who present with depres-
The evidence concerning personality disorders is rela-
sion, some forms of anxiety, eating disorders and so-
tively robust in highlighting the superiority of PDT over
controls across key clinical variables including suicidality,
Implementations of the same principles in long-term treat-
global and interpersonal functioning, as well as comorbid
ments (1 year and longer) appear to benefit individuals
with complex disorders where the severity manifests as a
The American Psychological Association (Division 12)
combination of syndromal and spectral-level problems (a
has designated transference-focused psychotherapy a well-
generally high level of vulnerability to psychopathology)
established treatment for borderline personality disorder,
World Psychiatry 14:2 - June 2015
There is little evidence to suggest that PDT is superior to
Gardner and Dr. A. Higgitt for assistance with the litera-
other therapeutic approaches. Its implementation in
ture review and drafting the manuscript, and Dr. P. Luyten
most instances will depend on the availability of appro-
for helpful discussions.
priately trained personnel and their willingness to ac-quire the specific techniques that have been shown to be
efficacious to a level of competence on a par with per-sonnel delivering treatments in RCTs.
1. Weisz JR, Kazdin AE (eds). Evidence-based psychotherapies for
The speed of recovery and cost-effectiveness of interven-
children and adolescents, 2nd ed. New York: Guilford Press, 2010.
tions is a crucial parameter, since there is little evidence
2. Clark DM. Implementing NICE guidelines for the psychological
that in the long term major differences exist between thera-
treatment of depression and anxiety disorders: the IAPT experi-
pies in terms of recovery or remission. Any apparent superi-
ence. Int Rev Psychiatry 2011;23:318-27.
ority of long-term PDT is attributable to the prolonged con-
3. Layard R, Clark D. Thrive: the power of evidence-based psycho-
logical therapies. London: Allen Lane, 2014.
tact between patient and therapist.
4. Holmes EA, Craske MG, Graybiel AM. Psychological treat-
ments: a call for mental-health science. Nature 2014;511:287-9.
Looking towards the future, the modularization of inter-
5. Beck JG, Castonguay LG, Chronis-Tuscano A et al. Principles
ventions and their combination to meet the needs of individ-
for training in evidence-based psychology: recommendations for
ual patients is the highest priority. Currently, there are very
the graduate curricula in clinical psychology. Clin Psychol SciPract 2014;21:410-24.
few systematic, empirically tested protocols for combining
6. Stratton P. Formulating research questions that are relevant to
treatments in either pharmacotherapy or psychotherapy. Yet,
psychotherapy. Ment Health Learning Disabilities Res Practice
the reality is that most patients receive empirically untested
combinations. In the newly established self-report system of
7. Cartwright N, Munro E. The limitations of randomized con-
the U.K.'s Children and Young People's Improving Access to
trolled trials in predicting effectiveness. J Eval Clin Pract 2010;16:260-6.
Psychological Therapies programme (CYP IAPT), the treat-
8. Borduin CM, Mann BJ, Cone LT et al. Multisystemic treatment
ment most commonly offered – almost twice as often as any-
of serious juvenile offenders: long-term prevention of criminality
thing else – is "other"; that is, not CBT, family therapy, PDT
and violence. J Consult Clin Psychol 1995;63:569-78.
9. Henggeler SW, Melton GB, Smith LA. Family preservation using
In developing new therapies, researchers have to aim to
multisystemic therapy: an effective alternative to incarcerating seri-ous juvenile offenders. J Consult Clin Psychol 1992;60:953-61.
innovate in the direction of directly addressing the deficits
10. Henggeler SW, Melton GB, Brondino MJ et al. Multisystemic
patients with mental disorder present with. The alignment
therapy with violent and chronic juvenile offenders and their
of PDT with such deficits is the most important priority. We
families: the role of treatment fidelity in successful dissemina-
may well be concerned that current PDT approaches are
tion. J Consult Clin Psychol 1997;65:821-33.
too deeply rooted in the technical preferences of developers
11. Henggeler SW, Pickrel SG, Brondino MJ. Multisystemic treat-
ment of substance-abusing and dependent delinquents: out-
(supportive vs. expressive, relational vs. ego-oriented, self-
comes, treatment fidelity, and transportability. Ment Health Serv
psychological vs. conflict-focused, etc.). This is the language
of professionals rather than patients. Each approach may
12. Henggeler SW, Halliday-Boykins CA, Cunningham PB et al. Juve-
have meaningful components in relation to particular indi-
nile drug court: enhancing outcomes by integrating evidence-
viduals, but how is a therapist to know which approach to
based treatments. J Consult Clin Psychol 2006;74:42-54.
13. Ogden T, Hagen KA. Multisystemic treatment of serious behav-
apply to whom? The evidence certainly does not speak to
iour problems in youth: sustainability of effectiveness two years
such a choice.
after intake. Child Adolesc Ment Health 2006;11:142-9.
If the field is to advance, we have to do more than talk
14. Rowland MD, Halliday-Boykins CA, Henggeler SW et al. A ran-
about the global effectiveness of a heterogeneous category of
domized trial of multisystemic therapy with Hawaii's Felix Class
approaches, such as PDT, in relation to a heterogeneous
Youths. J Emot Behav Disord 2005;13:13-23.
15. Timmons-Mitchell J, Bender MB, Kishna MA et al. An indepen-
group of patients, such as those who experience depression.
dent effectiveness trial of multisystemic therapy with juvenile
There have been some attempts to match particular presenta-
justice youth. J Clin Child Adolesc Psychol 2006;35:227-36.
tions to specific PDT techniques (e.g., work on introjective
16. Borduin CM, Schaeffer CM, Heiblum N. A randomized clinical
vs. anaclitic depression) (209-211). However, there is consid-
trial of multisystemic therapy with juvenile sexual offenders:
erably more to be achieved by "playful" experimentation,
effects on youth social ecology and criminal activity. J ConsultClin Psychol 2009;77:26-37.
probably driven by advances in bioscience and computation-
17. Schoenwald SK, Chapman JE, Sheidow AJ et al. Long-term
youth criminal outcomes in MST transport: the impact of thera-pist adherence and organizational climate and structure. J ClinChild Adolesc Psychol 2009;38:91-105.
18. Butler S, Baruch G, Hickey N et al. A randomized controlled tri-
al of multisystemic therapy and a statutory therapeutic interven-tion for young offenders. J Am Acad Child Adolesc Psychiatry
The author acknowledges funding from the National
Institute for Health Research (Senior Investigator Award
19. National Institute for Health and Clinical Excellence. Antisocial
NF-51-0514-10157). He wishes to thank Dr. E. Allison, T.
personality disorder: treatment, management and prevention.
London: The British Psychological Society and the Royal Col-
dynamic approaches to psychopathology. New York: Guilford (in
lege of Psychiatrists, 2010.
20. Fonagy P, Cottrell D, Phillips J et al. What works for whom? A
40. Roth A, Fonagy P. What works for whom? A critical review of
critical review of treatments for children and adolescents, 2nd
psychotherapy research, 2nd ed. New York: Guilford Press,
ed. New York: Guilford Press, 2014.
21. Kazdin AE. Understanding how and why psychotherapy leads
41. Carrington CH. A comparison of cognitive and analytically ori-
to change. Psychother Res 2009;19:418-28.
ented brief treatment approaches to depression in black women.
22. Mill JS. On the definition of political economy and on the meth-
Doctoral dissertation, University of Maryland, 1979.
od of philosophical investigation in that science. Reprinted in
42. Maina G, Forner F, Bogetto F. Randomized controlled trial
Collected Works of John Stuart Mill, Vol. IV. Toronto: Universi-
comparing brief dynamic and supportive therapy with waiting
ty of Toronto Press, 1836/1967.
list condition in minor depressive disorders. Psychother Psycho-
23. Mellor-Clark J, Cross S, Macdonald J et al. Leading horses to
water: lessons from a decade of helping psychological therapy
43. Lopez D, Cuevas P, Gomez A et al. Psicoterapia focalizada en la
services use routine outcome measurement to improve practice.
transferencia para el trastorno lımite de la personalidad. Un
Adm Policy Ment Health (in press).
estudio con pacientes femeninas. Salud Ment 2004;27:44-54.
24. Fisher B, Wolmark N, Redmond C et al. Findings from NSABP
44. McLean PD, Hakstian AR. Clinical depression: comparative effica-
Protocol No. B-04: comparison of radical mastectomy with al-
cy of outpatient treatments. J Consult Clin Psychol 1979;47:818-
ternative treatments. II. The clinical and biologic significance of
medial-central breast cancers. Cancer 1981;48:1863-72.
45. Barber JP, Barrett MS, Gallop R et al. Short-term dynamic psy-
25. Huhn M, Tardy M, Spineli LM et al. Efficacy of pharmacothera-
chotherapy versus pharmacotherapy for major depressive disor-
py and psychotherapy for adult psychiatric disorders: a system-
der: a randomized, placebo-controlled trial. J Clin Psychiatry
atic overview of meta-analyses. JAMA Psychiatry 2014;71:706-
46. Zilcha-Mano S, Dinger U, McCarthy KS et al. Changes in well-
26. Correll CU, Carbon M. Efficacy of pharmacologic and psycho-
being and quality of life in a randomized trial comparing dynam-
therapeutic interventions in psychiatry: to talk or to prescribe: is
ic psychotherapy and pharmacotherapy for major depressive
that the question? JAMA Psychiatry 2014;71:624-6.
disorder. J Affect Disord 2014;152-154:538-42.
27. Hennekens CH, Demets D. The need for large-scale randomized
47. Vitriol VG, Ballesteros ST, Florenzano RU et al. Evaluation of
evidence without undue emphasis on small trials, meta-analyses,
an outpatient intervention for women with severe depression
or subgroup analyses. JAMA 2009;302:2361-2.
and a history of childhood trauma. Psychiatr Serv 2009;60:936-42.
28. Barker LE, Luman ET, McCauley MM et al. Assessing equiva-
48. Simpson S, Corney R, Fitzgerald P et al. A randomized con-
lence: an alternative to the use of difference tests for measuring
trolled trial to evaluate the effectiveness and cost-effectiveness
disparities in vaccination coverage. Am J Epidemiol 2002;156:
of psychodynamic counselling for general practice patients with
chronic depression. Psychol Med 2003;33:229-39.
29. Walker E, Nowacki AS. Understanding equivalence and nonin-
49. Cooper PJ, Murray L, Wilson A et al. Controlled trial of the
feriority testing. J Gen Intern Med 2011;26:192-6.
short- and long-term effect of psychological treatment of post-
30. Cohen J. Statistical power analysis for the behavioral sciences,
partum depression. I. Impact on maternal mood. Br J Psychia-
2nd ed. Hillsdale: Lawrence Erlbaum Associates, 1988.
31. Barber JP, Muran JC, McCarthy KS et al. Research on dynamic
50. Gibbons MB, Thompson SM, Scott K et al. Supportive-expres-
therapies. In: Lambert M (ed). Bergin and Garfield's handbook of
sive dynamic psychotherapy in the community mental health
psychotherapy and behavior change. New York: Wiley, 2013:443-
system: a pilot effectiveness trial for the treatment of depression.
32. Fonagy P, Target M. Psychodynamic treatments. In: Rutter M,
51. Bastos AG, Guimaraes LS, Trentini CM. The efficacy of long-
Bishop D, Pine D et al (eds). Rutter's child and adolescent psy-
term psychodynamic psychotherapy, fluoxetine and their combi-
chiatry, 5th ed. Oxford: Blackwell, 2008:1079-91.
nation in the outpatient treatment of depression. Psychother Res
33. McCullough JP, Jr. Treatment for chronic depression using Cog-
nitive Behavioral Analysis System of Psychotherapy (CBASP).
52. Wampold BE, Mondin GW, Moody M et al. A meta-analysis of
J Clin Psychol 2003;59:833-46.
outcome studies comparing bona fide therapies: empirically, ‘All
34. Ryle A, Kerr IB. Introducing cognitive analytic therapy: princi-
must have prizes'. Psychol Bull 1997;122:203-15.
ples and practice. Chichester: Wiley, 2002.
53. Beutel ME, Weissflog G, Leuteritz K et al. Efficacy of short-term
35. Weissman MM, Markowitz JC, Klerman GL. Clinician's quick
psychodynamic psychotherapy (STPP) with depressed breast
guide to interpersonal psychotherapy. New York: Oxford Universi-
cancer patients: results of a randomized controlled multicenter
ty Press, 2007.
trial. Ann Oncol 2014;25:378-84.
36. Safran JD. The relational turn, the therapeutic alliance, and psy-
54. Bressi C, Porcellana M, Marinaccio PM et al. Short-term psy-
chotherapy research: strange bedfellows or postmodern mar-
chodynamic psychotherapy versus treatment as usual for depres-
riage? Contemporary Psychoanalysis 2003;39:449-75.
sive and anxiety disorders: a randomized clinical trial of efficacy.
37. Luborsky L. Principles of psychoanalytic psychotherapy: a manual
J Nerv Ment Dis 2010;198:647-52.
for supportive-expressive (SE) treatment. New York: Basic Books,
55. Xie CL, Wang XD, Chen J et al. A systematic review and meta-
analysis of cognitive behavioral and psychodynamic therapy for
38. Seybert C, Erhardt I, Levy R et al. Manualized treatments for
depression in Parkinson's disease patients. Neurol Sci (in press).
psychodynamic psychotherapy research. In: Levy RA, Ablon JS,
56. de Jonghe F, Kool S, van Aalst G et al. Combining psychothera-
Kaechele H (eds). Psychodynamic psychotherapy research: prac-
py and antidepressants in the treatment of depression. J Affect
tice based evidence and evidence based practice. New York:
Humana Press, 2011:395-402.
57. Molenaar PJ, Dekker J, Van R et al. Does adding psychothera-
39. Leichsenring F, Kruse J, Rabung S. Efficacy of psychodynamic psy-
py to pharmacotherapy improve social functioning in the
chotherapy in specific mental disorders: an update. In: Luyten P,
treatment of outpatient depression? Depress Anxiety 2007;24:
Mayes L, Fonagy P et al (eds). Handbook of contemporary psycho-
World Psychiatry 14:2 - June 2015
58. Burnand Y, Andreoli A, Kolatte E et al. Psychodynamic psycho-
77. Shapiro DA, Barkham M, Rees A et al. Effects of treatment dura-
therapy and clomipramine in the treatment of major depression.
tion and severity of depression on the effectiveness of cognitive-
Psychiatr Serv 2002;53:585-90.
behavioral and psychodynamic-interpersonal psychotherapy.
59. Dekker J, Molenaar PJ, Kool S et al. Dose-effect relations in
J Consult Clin Psychol 1994;62:522-34.
time-limited combined psycho-pharmacological treatment for
78. Gallagher-Thompson D, Steffen AM. Comparative effects of
depression. Psychol Med 2005;35:47-58.
cognitive-behavioral and brief psychodynamic psychotherapies
60. de Jonghe F, Hendrikson M, van Alst E et al. Psychotherapy
for depressed family caregivers. J Consult Clin Psychol 1994;62:
alone and combined with pharmacotherapy in the treatment of
depression. Br J Psychiatry 2004;185:37-45.
79. Thompson LW, Gallagher D, Breckenridge JS. Comparative
61. de Maat S, Dekker J, Schoevers R et al. Short psychodynamic sup-
effectiveness of psychotherapies for depressed elders. J Consult
portive psychotherapy, antidepressants, and their combination in
Clin Psychol 1987;55:385-90.
the treatment of major depression: a mega-analysis based on three
80. Gallagher DE, Thompson LW. Treatment of major depressive
randomized clinical trials. Depress Anxiety 2008;25:565-74.
disorder in older adult outpatients with brief psychotherapies.
62. Kool S, Dekker J, Duijsens IJ et al. Efficacy of combined therapy
Psychotherapy: Theory, Research and Practice 1982;19:482-90.
and pharmacotherapy for depressed patients with or without
81. LaPointe KA, Rimm DC. Cognitive, assertive, and insight-oriented
personality disorders. Harv Rev Psychiatry 2003;11:133-41.
group therapies in the treatment of reactive depression in women.
63. Abbass A, Town J, Driessen E. The efficacy of short-term psy-
Psychotherapy: Theory, Research and Practice 1980;17:312-21.
chodynamic psychotherapy for depressive disorders with co-
82. Thompson LW, Gallagher DE. Efficacy of psychotherapy in the
morbid personality disorder. Psychiatry 2011;74:58-71.
treatment of late-life depression. Adv Behav Res Ther 1984;6:
64. Nemeroff CB, Heim CM, Thase ME et al. Differential responses
to psychotherapy versus pharmacotherapy in patients with chronic
83. Knekt P, Lindfors O, Laaksonen MA et al. Effectiveness of
forms of major depression and childhood trauma. Proc Natl Acad
short-term and long-term psychotherapy on work ability and
Sci USA 2003;100:14293-6.
functional capacity – a randomized clinical trial on depressive
65. Maina G, Rosso G, Bogetto F. Brief dynamic therapy combined
and anxiety disorders. J Affect Disord 2008;107:95-106.
with pharmacotherapy in the treatment of major depressive dis-
84. Johansson R, Ekbladh S, Hebert A et al. Psychodynamic guided
order: long-term results. J Affect Disord 2009;114:200-7.
self-help for adult depression through the internet: a randomised
66. Rosso G, Martini B, Maina G. Brief dynamic therapy and de-
controlled trial. PLoS One 2012;7:e38021.
pression severity: a single-blind, randomized study. J Affect Dis-
85. Johansson R, Bjorklund M, Hornborg C et al. Affect-focused
psychodynamic psychotherapy for depression and anxiety
67. Salminen JK, Karlsson H, Hietala J et al. Short-term psychody-
through the Internet: a randomized controlled trial. Peer J 2013;
namic psychotherapy and fluoxetine in major depressive disor-
der: a randomized comparative study. Psychother Psychosom
86. Knekt P, Laaksonen MA, Raitasalo R et al. Changes in lifestyle
for psychiatric patients three years after the start of short- and
68. Bloch M, Meiboom H, Lorberblatt M et al. The effect of sertraline
long-term psychodynamic psychotherapy and solution-focused
add-on to brief dynamic psychotherapy for the treatment of post-
therapy. Eur Psychiatry 2010;25:1-7.
partum depression: a randomized, double-blind, placebo-control-
87. Knekt P, Lindfors O, Laaksonen MA. Review: long term psy-
led study. J Clin Psychiatry 2012;73:235-41.
chodynamic psychotherapy improves outcomes in people with
69. Raue PJ, Schulberg HC, Heo M et al. Patients' depression treat-
complex mental disorders. Evid Based Ment Health 2009;12:56.
ment preferences and initiation, adherence, and outcome: a ran-
88. Knekt P, Lindfors O, Harkanen T et al. Randomized trial on the
domized primary care study. Psychiatr Serv 2009;60:337-43.
effectiveness of long- and short-term psychodynamic psycho-
70. Spielmans GI, Berman MI, Usitalo AN. Psychotherapy versus
therapy and solution-focused therapy on psychiatric symptoms
second-generation antidepressants in the treatment of depres-
during a 3-year follow-up. Psychol Med 2008;38:689-703.
sion: a meta-analysis. J Nerv Ment Dis 2011;199:142-9.
89. Knekt P, Lindfors O, Laaksonen MA et al. Quasi-experimental
71. Driessen E, Van HL, Schoevers RA et al. Cognitive behavioral
study on the effectiveness of psychoanalysis, long-term and
therapy versus short psychodynamic supportive psychotherapy
short-term psychotherapy on psychiatric symptoms, work ability
in the outpatient treatment of depression: a randomized con-
and functional capacity during a 5-year follow-up. J Affect Dis-
trolled trial. BMC Psychiatry 2007;7:58.
72. Driessen E, Van HL, Don FJ et al. The efficacy of cognitive-
90. Huber D, Henrich G, Clarkin J et al. Psychoanalytic versus psy-
behavioral therapy and psychodynamic therapy in the outpa-
chodynamic therapy for depression: a three-year follow-up
tient treatment of major depression: a randomized clinical trial.
study. Psychiatry 2013;76:132-49.
Am J Psychiatry 2013;170:1041-50.
91. Huber D, Zimmermann J, Henrich G et al. Comparison of
73. Driessen E, Van Henricus L, Peen J et al. Therapist-rated out-
cognitive-behaviour therapy with psychoanalytic and psychody-
comes in a randomized clinical trial comparing cognitive behav-
namic therapy for depressed patients – a three-year follow-up
ioral therapy and psychodynamic therapy for major depression.
study. Z Psychosom Med Psychother 2012;58:299-316.
J Affect Disord 2015;170:112-8.
92. Fonagy P, Rost F, Carlyle J et al. Randomized controlled trial of
74. Watzke B, Ruddel H, Jurgensen R et al. Effectiveness of systematic
long-term psychoanalytic psychotherapy for chronic "treatment-
treatment selection for psychodynamic and cognitive-behavioural
resistant/treatment-refractory" depression: the Tavistock Adult
therapy: randomised controlled trial in routine mental healthcare.
Depression Study (TADS). Submitted for publication.
Br J Psychiatry 2010;197:96-105.
93. Abbass A, Driessen E. The efficacy of short-term psychodynamic
75. Watzke B, Ruddel H, Jurgensen R et al. Longer term outcome of
psychotherapy for depression: a summary of recent findings.
cognitive-behavioural and psychodynamic psychotherapy in rou-
Acta Psychiatr Scand 2010;121:398.
tine mental health care: randomised controlled trial. Behav Res
94. Driessen E, Cuijpers P, de Maat SCM et al. The efficacy of short-
term psychodynamic psychotherapy for depression: a meta-
76. Barkham M, Rees A, Shapiro DA et al. Outcomes of time-
analysis. Clin Psychol Rev 2010;30:25-36.
limited psychotherapy in applied settings: replicating the Second
95. Barth J, Munder T, Gerger H et al. Comparative efficacy of seven
Sheffield Psychotherapy Project. J Consult Clin Psychol 1996;
psychotherapeutic interventions for patients with depression: a
network meta-analysis. PLoS Med 2013;10:e1001454.
96. Cuijpers P, van Straten A, Andersson G et al. Psychotherapy for
115. Maina G, Rosso G, Rigardetto S et al. No effect of adding brief
depression in adults: a meta-analysis of comparative outcome
dynamic therapy to pharmacotherapy in the treatment of obsessive-
studies. J Consult Clin Psychol 2008;76:909-22.
compulsive disorder with concurrent major depression. Psychother
97. Somers JM, Goldner EM, Waraich P et al. Prevalence and inci-
dence studies of anxiety disorders: a systematic review of the lit-
116. Brom D, Kleber RJ, Defares PB. Brief psychotherapy for post-
erature. Can J Psychiatry 2006;51:100-13.
traumatic stress disorders. J Consult Clin Psychol 1989;57:
98. Alstrom JE, Nordlund CL, Persson G et al. Effects of four treat-
ment methods on agoraphobic women not suitable for insight-
117. Gillies D, Taylor F, Gray C et al. Psychological therapies for the
oriented psychotherapy. Acta Psychiatr Scand 1984;70:1-17.
treatment of post-traumatic stress disorder in children and ado-
99. Alstrom JE, Nordlund CL, Persson G et al. Effects of four treat-
lescents. Evid Based Child Health 2013;8:1004-116.
ment methods on social phobic patients not suitable for insight-
118. Ponniah K, Hollon SD. Empirically supported psychological
oriented psychotherapy. Acta Psychiatr Scand 1984;70:97-110.
treatments for adult acute stress disorder and posttraumatic
100. Leichsenring F, Salzer S, Beutel ME et al. Psychodynamic thera-
stress disorder: a review. Depress Anxiety 2009;26:1086-109.
py and cognitive-behavioral therapy in social anxiety disorder: a
119. Gerger H, Munder T, Gemperli A et al. Integrating fragmented
multicenter randomized controlled trial. Am J Psychiatry 2013;
evidence by network meta-analysis: relative effectiveness of psy-
chological interventions for adults with post-traumatic stress
101. Knijnik DZ, Kapczinski F, Chachamovich E et al. Psychody-
disorder. Psychol Med 2014;44:3151-64.
namic group treatment for generalized social phobia. Rev Bras
120. Schottenbauer MA, Glass CR, Arnkoff DB et al. Contributions
of psychodynamic approaches to treatment of PTSD and trau-
102. Bogels SM, Wijts P, Oort FJ et al. Psychodynamic psychotherapy
ma: a review of the empirical treatment and psychopathology lit-
versus cognitive behavior therapy for social anxiety disorder: an
erature. Psychiatry 2008;71:13-34.
efficacy and partial effectiveness trial. Depress Anxiety 2014;31:
121. Keefe JR, McCarthy KS, Dinger U et al. A meta-analytic review
of psychodynamic therapies for anxiety disorders. Clin Psychol
103. Knijnik DZ, Blanco C, Salum GA et al. A pilot study of clonaze-
pam versus psychodynamic group therapy plus clonazepam in
122. Tolin DF. Is cognitive-behavioral therapy more effective than
the treatment of generalized social anxiety disorder. Eur Psychi-
other therapies? A meta-analytic review. Clin Psychol Rev 2010;
104. Knijnik DZ, Salum GA, Jr., Blanco C et al. Defense style changes
123. Tolin DF. Beating a dead dodo bird: looking at signal vs. noise
with the addition of psychodynamic group therapy to clonazepam
in cognitive-behavioral therapy for anxiety disorders. Clin Psy-
in social anxiety disorder. J Nerv Ment Dis 2009;197:547-51.
chol Sci Pract 2014;21:351-62.
105. Leichsenring F, Salzer S, Beutel ME et al. Long-term outcome of
124. Bachar E, Latzer Y, Kreitler S et al. Empirical comparison of
psychodynamic therapy and cognitive-behavioral therapy in
two psychological therapies. Self psychology and cognitive ori-
social anxiety disorder. Am J Psychiatry 2014;171:1074-82.
entation in the treatment of anorexia and bulimia. J Psychother
106. Egger N, Konnopka A, Beutel ME et al. Short-term cost-effec-
Pract Res 1999;8:115-28.
tiveness of psychodynamic therapy and cognitive-behavioral ther-
125. Fairburn CG, Kirk J, O'Connor M et al. A comparison of two
apy in social anxiety disorder: results from the SOPHO-NET trial.
psychological treatments for bulimia nervosa. Behav Res Ther
J Affect Disord 2015;180:21-8.
107. Andersson G, Paxling B, Roch-Norlund P et al. Internet-based
126. Garner DM, Rockert W, Davis R et al. Comparison of cognitive-
psychodynamic versus cognitive behavioral guided self-help for
behavioral and supportive-expressive therapy for bulimia nervo-
generalized anxiety disorder: a randomized controlled trial. Psy-
sa. Am J Psychiatry 1993;150:37-46.
chother Psychosom 2012;81:344-55.
127. Tasca GA, Ritchie K, Conrad G et al. Attachment scales predict
108. Durham RC, Murphy T, Allan T et al. Cognitive therapy, analytic
outcome in a randomized controlled trial of two group therapies
psychotherapy and anxiety management training for generalized
for binge eating disorder: an aptitude by treatment interaction.
anxiety disorder. Br J Psychiatry 1994;165:315-23.
Psychother Res 2006;16:106-21.
109. Crits-Christoph P, Connolly Gibbons J, Schamberger M et al.
128. Poulsen S, Lunn S, Daniel SI et al. A randomized controlled trial
Interpersonal problems and the outcome of interpersonally ori-
of psychoanalytic psychotherapy or cognitive-behavioral thera-
ented psychodynamic treatment of GAD. Psychotherapy: Theo-
py for bulimia nervosa. Am J Psychiatry 2014;171:109-16.
ry, Research, Practice, Training 2005;42:211-24.
129. Lunn S, Poulsen S. Psychoanalytic psychotherapy for bulimia ner-
110. Leichsenring F, Salzer S, Jaeger U et al. Short-term psychody-
vosa: a manualized approach. Psychoanal Psychother 2012;26:
namic psychotherapy and cognitive-behavioral therapy in gener-
alized anxiety disorder: a randomized, controlled trial. Am J Psy-
130. Poulsen S, Lunn S. Response to Tasca et al. Am J Psychiatry
111. Milrod B, Leon AC, Busch F et al. A randomized controlled clin-
131. Dare C, Eisler I, Russell G et al. Psychological therapies for
ical trial of psychoanalytic psychotherapy for panic disorder.
adults with anorexia nervosa: randomised controlled trial of
Am J Psychiatry 2007;164:265-72.
out-patient treatments. Br J Psychiatry 2001;178:216-21.
112. Milrod BL, Leon AC, Barber JP et al. Do comorbid personality
132. Wild B, Friederich HC, Gross G et al. The ANTOP study: focal
disorders moderate panic-focused psychotherapy? An explor-
psychodynamic psychotherapy, cognitive-behavioural therapy,
atory examination of the American Psychiatric Association prac-
and treatment-as-usual in outpatients with anorexia nervosa – a
tice guideline. J Clin Psychiatry 2007;68:885-91.
randomized controlled trial. Trials 2009;10:23.
113. Beutel ME, Scheurich V, Knebel A et al. Implementing panic-
133. Zipfel S, Wild B, Gross G et al. Focal psychodynamic therapy,
focused psychodynamic psychotherapy into clinical practice.
cognitive behaviour therapy, and optimised treatment as usual
Can J Psychiatry 2013;58:326-34.
in outpatients with anorexia nervosa (ANTOP study): rando-
114. Ponniah K, Magiati I, Hollon SD. An update on the efficacy of
mised controlled trial. Lancet 2014;383:127-37.
psychological therapies in the treatment of obsessive-compulsive
134. McIntosh VV, Jordan J, Carter FA et al. Three psychotherapies
disorder in adults. J Obsessive Compuls Relat Disord 2013;2:
for anorexia nervosa: a randomized, controlled trial. Am J Psy-
World Psychiatry 14:2 - June 2015
135. Bulik CM. The challenges of treating anorexia nervosa. Lancet
156. Woody G, McLellan AT, Luborsky L et al. Psychiatric severity
as a predictor of benefits from psychotherapy: The Veterans
136. Robin AL, Siegel PT, Moye A. Family versus individual therapy
Administration - Penn Study. Am J Psychiatry 1984;141:1172-7.
for anorexia: impact on family conflict. Int J Eat Disord 1995;17:
157. Woody GE, McLellan AT, Luborsky L et al. Psychotherapy in
community methadone programs: a validation study. Am J Psy-
137. Robin AL, Siegel PT, Moye AW et al. A controlled comparison
of family versus individual therapy for adolescents with anorexia
158. Crits-Christoph P, Siqueland L, Blaine J et al. Psychosocial treat-
nervosa. J Am Acad Child Adolesc Psychiatry 1999;38:1482-9.
ments for cocaine dependence: National Institute on Drug Abuse
138. Crisp AH, Norton KRW, Gowers SG et al. A controlled study of
Collaborative Cocaine Treatment Study. Arch Gen Psychiatry
the effect of therapies aimed at adolescent and family psychopa-
thology in anorexia nervosa. Br J Psychiatry 1991;159:325-33.
159. Crits-Christoph P, Siqueland L, McCalmont E et al. Impact of
139. Eisler I, Dare C, Russell GF et al. Family and individual therapy
psychosocial treatments on associated problems of cocaine-
in anorexia nervosa. A 5-year follow-up. Arch Gen Psychiatry
dependent patients. J Consult Clin Psychol 2001;69:825-30.
160. Malmberg L, Fenton M. Individual psychodynamic psychothera-
140. Lock J, Le Grange D, Agras S et al. Randomized clinical trial
py and psychoanalysis for schizophrenia and severe mental ill-
comparing family-based treatment with adolescent-focused indi-
ness. Cochrane Database Syst Rev 2001:CD001360.
vidual therapy for adolescents with anorexia nervosa. Arch Gen
161. Gottdiener WH, Haslam N. The benefits of individual psychother-
apy for people diagnosed with schizophrenia: a meta-analytic
141. Svedlund J, Sjodin I, Ottosson JO et al. Controlled study of psy-
review. Ethical Hum Sci Services 2002;4:163-87.
chotherapy in irritable bowel syndrome. Lancet 1983;2:589-92.
162. Rosenbaum B, Valbak K, Harder S et al. The Danish National
142. Guthrie E, Creed F, Dawson D et al. A randomised controlled
Schizophrenia Project: prospective, comparative longitudinal
trial of psychotherapy in patients with refractory irritable bowel
treatment study of first-episode psychosis. Br J Psychiatry 2005;
syndrome. Br J Psychiatry 1993;163:315-21.
143. Creed F, Fernandes L, Guthrie E et al. The cost-effectiveness of
163. Rosenbaum B, Harder S, Knudsen P et al. Supportive psychody-
psychotherapy and paroxetine for severe irritable bowel syn-
namic psychotherapy versus treatment as usual for first-episode
drome. Gastroenterology 2003;124:303-17.
psychosis: two-year outcome. Psychiatry 2012;75:331-41.
144. Hamilton J, Guthrie E, Creed F et al. A randomized controlled
164. Harder S, Koester A, Valbak K et al. Five-year follow-up of sup-
trial of psychotherapy in patients with chronic functional dys-
portive psychodynamic psychotherapy in first-episode psycho-
pepsia. Gastroenterology 2000;119:661-9.
sis: long-term outcome in social functioning. Psychiatry 2014;
145. Faramarzi M, Azadfallah P, Book HE et al. A randomized con-
trolled trial of brief psychoanalytic psychotherapy in patients
165. Montag C, Haase L, Seidel D et al. A pilot RCT of psychodynam-
with functional dyspepsia. Asian J Psychiatry 2013;6:228-34.
ic group art therapy for patients in acute psychotic episodes: fea-
146. Sattel H, Lahmann C, Gundel H et al. Brief psychodynamic inter-
sibility, impact on symptoms and mentalising capacity. PLoS
personal psychotherapy for patients with multisomatoform disor-
der: randomised controlled trial. Br J Psychiatry 2012;200:60-7.
166. Abbass A, Sheldon A, Gyra J et al. Intensive short-term dynamic
147. Monsen K, Monsen JT. Chronic pain and psychodynamic body
psychotherapy for DSM-IV personality disorders: a randomized
therapy: a controlled outcome study. Psychotherapy 2000;37:
controlled trial. J Nerv Ment Dis 2008;196:211-6.
167. Winston A, Laikin M, Pollack J et al. Short-term psychotherapy
148. Scheidt CE, Waller E, Endorf K et al. Is brief psychodynamic
of personality disorders. Am J Psychiatry 1994;151:190-4.
psychotherapy in primary fibromyalgia syndrome with concur-
168. Emmelkamp PM, Benner A, Kuipers A et al. Comparison of brief
rent depression an effective treatment? A randomized con-
dynamic and cognitive-behavioural therapies in avoidant per-
trolled trial. Gen Hosp Psychiatry 2013;35:160-7.
sonality disorder. Br J Psychiatry 2006;189:60-4.
149. Luyten P, Abbass A. What is the evidence for specific factors in
169. Gregory RJ, DeLucia-Deranja E, Mogle JA. Dynamic deconstruc-
the psychotherapeutic treatment of fibromyalgia? Comment on "Is
tive psychotherapy versus optimized community care for border-
brief psychodynamic psychotherapy in primary fibromyalgia syn-
line personality disorder co-occurring with alcohol use disorders: a
drome with concurrent depression an effective treatment? A ran-
30-month follow-up. J Nerv Ment Dis 2010;198:292-8.
domized controlled trial". Gen Hosp Psychiatry 2013;35:675-6.
170. Gregory RJ, Chlebowski S, Kang D et al. A controlled trial of
150. Schaefert R, Kaufmann C, Wild B et al. Specific collaborative
psychodynamic psychotherapy for co-occurring borderline per-
group intervention for patients with medically unexplained
sonality disorder and alcohol use disorder. Psychotherapy 2008;
symptoms in general practice: a cluster randomized controlled
trial. Psychother Psychosom 2013;82:106-19.
171. Amianto F, Ferrero A, Piero A et al. Supervised team manage-
151. Abbass A, Kisely S, Rasic D et al. Long-term healthcare cost
ment, with or without structured psychotherapy, in heavy users
reduction with intensive short-term dynamic psychotherapy in a
of a mental health service with borderline personality disorder:
tertiary psychiatric service. J Psychiatr Res 2015;64:114-20.
a two-year follow-up preliminary randomized study. BMC Psy-
152. Abbass A, Kisely S, Kroenke K. Short-term psychodynamic
psychotherapy for somatic disorders. Systematic review and
172. Reneses B, Galian M, Serrano R et al. A new time limited psy-
meta-analysis of clinical trials. Psychother Psychosom 2009;78:
chotherapy for BPD: preliminary results of a randomized and
controlled trial. Actas Esp Psiquiatr 2013;41:139-48.
153. Woody GE, Luborsky L, McLellan AT et al. Psychotherapy for
173. Bateman AW, Fonagy P. Psychotherapy for severe personality
opiate addicts. Does it help? Arch Gen Psychiatry 1983;40:639-45.
disorder. Article did not do justice to available research data.
154. Woody GE, McLellan AT, Luborsky L et al. Twelve-month follow-
up of psychotherapy for opiate dependence. Am J Psychiatry 1987;
174. Doering S, Horz S, Rentrop M et al. Transference-focused psy-
chotherapy v. treatment by community psychotherapists for bor-
155. Luborsky L, McLellan AT, Woody GE et al. Therapist success
derline personality disorder: randomised controlled trial. Br J
and its determinants. Arch Gen Psychiatry 1985;42:602-11.
175. Hellerstein DJ, Rosenthal RN, Pinsker H et al. A randomized
192. Guthrie E, Moorey J, Margison F. Cost-effectiveness of brief
prospective study comparing supportive and dynamic therapies.
psychodynamic-interpersonal therapy in high utilizers of psychi-
Outcome and alliance. J Psychother Pract Res 1998;7:261-71.
atric services. Arch Gen Psychiatry 1999;56:519-26.
176. Vinnars B, Barber JP, Noren K et al. Manualized supportive-
193. Muran JC, Safran JD. A relational approach to psychotherapy.
expressive psychotherapy versus nonmanualized community-
In: Magnavita JJ (ed). Comprehensive handbook of psychother-
delivered psychodynamic therapy for patients with personality
apy: psychodynamic/object relations. Chichester: Wiley, 2002:
disorders: bridging efficacy and effectiveness. Am J Psychiatry
194. Clarkin JF, Levy KN, Lenzenweger MF et al. The Personality
177. Svartberg M, Stiles TC, Seltzer MH. Randomized, controlled tri-
Disorders Institute/Borderline Personality Disorder Research
al of the effectiveness of short-term dynamic psychotherapy and
Foundation randomized control trial for borderline personality
cognitive therapy for cluster C personality disorders. Am J Psy-
disorder: rationale, methods, and patient characteristics. J Pers
178. Muran JC, Samstag LW, Safran J et al. Evaluating an alliance-
195. Pollack J, Flegenheimer W, Winston A. Brief adaptive psychother-
focused treatment for personality disorders. Psychotherapy: Theo-
apy. In: Crits-Christoph P, Barber J (eds). Handbook of short-term
ry, Research, Practice, Training 2005;42:532-45.
dynamic psychotherapy. New York: Basic Books, 1991:199-219.
179. Clarkin J, Levy KN, Lenzenweger MF et al. Evaluating three treat-
196. Bateman AW, Gunderson J, Mulder R. Treatment of personality
ments for borderline personality disorder: a multiwave study. Am
disorder. Lancet 2015;385:735-43.
J Psychiatry 2007;164:922-8.
197. Bhar SS, Thombs BD, Pignotti M et al. Is longer-term psychody-
180. Levy KN, Meehan KB, Kelly KM et al. Change in attachment
namic psychotherapy more effective than shorter-term thera-
patterns and reflective function in a randomized control trial of
pies? Review and critique of the evidence. Psychother Psycho-
transference-focused psychotherapy for borderline personality
disorder. J Consult Clin Psychol 2006;74:1027-40.
198. Smit Y, Huibers MJ, Ioannidis JP et al. The effectiveness of long-
181. Bateman AW, Fonagy P. Randomized controlled trial of outpa-
term psychoanalytic psychotherapy – a meta-analysis of ran-
tient mentalization-based treatment versus structured clinical
domized controlled trials. Clin Psychol Rev 2012;32:81-92.
management for borderline personality disorder. Am J Psychia-
199. Levy KN, Ehrenthal JC, Yeomans FE et al. The efficacy of psy-
chotherapy: focus on psychodynamic psychotherapy as an exam-
182. Bateman A, Fonagy P. Impact of clinical severity on outcomes of
ple. Psychodyn Psychiatry 2014;42:377-421.
mentalisation-based treatment for borderline personality disor-
200. Jones C, Hacker D, Cormac I et al. Cognitive behaviour therapy
der. Br J Psychiatry 2013;203:221-7.
versus other psychosocial treatments for schizophrenia. Cochrane
183. Jørgensen CR, Freund C, Boye R et al. Outcome of mentalization-
Database Syst Rev 2012;4:CD008712.
based and supportive psychotherapy in patients with borderline
201. Shedler J. The efficacy of psychodynamic psychotherapy. Am
personality disorder: a randomized trial. Acta Psychiatr Scand
202. Luborsky L, Diguer L, Seligman DA et al. The researcher's own
184. Jørgensen CR, Bøye R, Andersen D et al. Eighteen months post-
therapy allegiances: a ‘wild card' in comparisons of treatment
treatment naturalistic follow-up study of mentalization-based
efficacy. Clin Psychol Sci Pract 1999;6:95-106.
therapy and supportive group treatment of borderline personali-
203. Chambless DL, Hollon SD. Defining empirically supported ther-
ty disorder: clinical outcomes and functioning. Nord Psychol
apies. J Consult Clin Psychol 1998;66:7-18.
204. Cuthbert BN. The RDoC framework: facilitating transition from
185. Giesen-Bloo J, van Dyck R, Spinhoven P et al. Outpatient psy-
ICD/DSM to dimensional approaches that integrate neurosci-
chotherapy for borderline personality disorder: randomized trial
ence and psychopathology. World Psychiatry 2014;13:28-35.
of schema-focused therapy vs transference-focused psychothera-
205. Fulford KW, Bortolotti L, Broome M. Taking the long view: an
py. Arch Gen Psychiatry 2006;63:649-58.
emerging framework for translational psychiatric science. World
186. Kvarstein EH, Pedersen G, Urnes O et al. Changing from a tradi-
tional psychodynamic treatment programme to mentalization-
206. Keshavan MS, Ongur D. The journey from RDC/DSM diagno-
based treatment for patients with borderline personality disorder
ses toward RDoC dimensions. World Psychiatry 2014;13:44-6.
– does it make a difference? Psychol Psychother 2015;88:71-86.
207. Caspi A, Houts RM, Belsky DW et al. The p factor: one general
187. Gunderson J, Links PL. Handbook of good psychiatric manage-
psychopathology factor in the structure of psychiatric disorders?
ment (GPM) for borderline patients. Washington: American Psy-
Clin Psychol Sci 2013;2:119-37.
chiatric Press, 2014.
208. Patalay P, Fonagy P, Deighton J et al. A general psychopathology
188. McMain SF, Links PS, Gnam WH et al. A randomized trial of
factor in early adolescence. Br J Psychiatry (in press).
dialectical behavior therapy versus general psychiatric manage-
209. Blatt SJ, Luyten P. A structural-developmental psychodynamic
ment for borderline personality disorder. Am J Psychiatry 2009;
approach to psychopathology: two polarities of experience
across the life span. Dev Psychopathol 2009;21:793-814.
189. McMain SF, Guimond T, Streiner DL et al. Dialectical behavior
210. Luyten P, Blatt SJ. Interpersonal relatedness and self-definition
therapy compared with general psychiatric management for bor-
in normal and disrupted personality development: retrospect
derline personality disorder: clinical outcomes and functioning
and prospect. Am Psychol 2013;68:172-83.
over a 2-year follow-up. Am J Psychiatry 2012;169:650-61.
211. Luyten P, Blatt SJ, Fonagy P. Impairments in self structures in
190. Leichsenring F, Abbass A, Luyten P et al. The emerging evidence
depression and suicide in psychodynamic and cognitive behav-
for long-term psychodynamic therapy. Psychodyn Psychiatry
ioral approaches: implications for clinical practice and research.
Int J Cogn Ther 2013;6:265-79.
191. Leichsenring F, Rabung S. Long-term psychodynamic psycho-
therapy in complex mental disorders: update of a meta-analysis.
Br J Psychiatry 2011;199:15-22.
World Psychiatry 14:2 - June 2015
TABLE OF CONTENTS *Perspectives from Biogen leadership For the fourth consecutive year, our global colleagues participated in ON THE COVER Biogen's Care Deeply Volunteer Day, which shattered last year's record Inspired by the new Biogen turnout with a 54-percent increase in employee participation. This worldwide logo, the front cover graphic
Predicción de complicaciones cardiacas utilizando Minería de Datos: Estado del Arte Norka Gómez López, René Iván González Fernández, Alejandro Rosete Suárez Resumen. El electrocardiograma (ECG) ha sido ampliamente supervivencia y la calidad de vida del paciente afectado de aplicado en el diagnóstico de enfermedades cardiovasculares. El