The effectiveness of psychodynamic psychotherapies: An update

Summary & key facts

This paper reviewed many studies to see how well psychodynamic therapy works for common mental health problems. The review found that, compared to inactive options like being on a waiting list or getting usual care, psychodynamic therapy often helps with depression, some anxiety problems, some eating disorders, and some physical symptom disorders. But it did not find good evidence that this therapy helps for post-traumatic stress disorder, obsessive-compulsive disorder, bulimia, cocaine dependence, or psychosis. The strongest support was for longer psychodynamic therapy for some personality problems, especially borderline personality disorder. The authors also say we should stop lumping many therapies and diagnoses together and instead use biology and computer-based methods to test specific treatment parts for individual patients.

Key facts:

• Psychodynamic therapy is a kind of talking therapy that focuses on emotions, patterns in relationships, and past experiences.
• When studies compared psychodynamic therapy to inactive options like waiting lists or usual care, it generally helped with depression.
• Those same comparisons generally showed benefits for some anxiety disorders, some eating disorders, and some bodily symptom disorders.
• There was little or no good evidence that psychodynamic therapy helps for post-traumatic stress disorder, obsessive-compulsive disorder, bulimia nervosa, cocaine dependence, or psychosis.
• The strongest evidence supports relatively long-term psychodynamic therapy for some personality disorders, especially borderline personality disorder.
• When psychodynamic therapy was compared with other active treatments, it rarely came out clearly better, and the studies were often not set up to show that treatments are equally effective.
• A few studies found psychodynamic therapy to be worse than other treatments, but those studies are small in number and often have problems in how they were designed.
• The authors warn that reviews can be biased by researchers' loyalties and recommend testing specific therapy components using biological data and computer methods rather than comparing broad groups of therapies over broad diagnostic lists.

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

Substances

Other

Conditions & symptoms

Anxiety Chronic Pain Depression Eating Disorder Obsessive-Compulsive Disorder PTSD Substance abuse disorder Anxiety or worry Chronic pain Poor appetite or overeating Sadness or low mood