Update of Empirical Evidence Mental ... - Clínica...

This article was downloaded by: [Aston University]On: 27 August 2014, At: 23:39Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH,UK

Contemporary PsychoanalysisPublication details, including instructions forauthors and subscription information:http://www.tandfonline.com/loi/uucp20

The Efficacy of PsychodynamicPsychotherapy in SpecificMental Disorders: A 2013Update of Empirical EvidenceFalk Leichsenring D.Sc., Susanne Klein M.Sc. &Simone Salzer D.Sc.Published online: 16 Apr 2014.

To cite this article: Falk Leichsenring D.Sc., Susanne Klein M.Sc. & Simone SalzerD.Sc. (2014) The Efficacy of Psychodynamic Psychotherapy in Specific MentalDisorders: A 2013 Update of Empirical Evidence, Contemporary Psychoanalysis,50:1-2, 89-130, DOI: 10.1080/00107530.2014.880310

To link to this article: http://dx.doi.org/10.1080/00107530.2014.880310

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all theinformation (the “Content”) contained in the publications on our platform.However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness,or suitability for any purpose of the Content. Any opinions and viewsexpressed in this publication are the opinions and views of the authors, andare not the views of or endorsed by Taylor & Francis. The accuracy of theContent should not be relied upon and should be independently verified withprimary sources of information. Taylor and Francis shall not be liable for anylosses, actions, claims, proceedings, demands, costs, expenses, damages,and other liabilities whatsoever or howsoever caused arising directly orindirectly in connection with, in relation to or arising out of the use of theContent.

http://www.tandfonline.com/loi/uucp20

http://www.tandfonline.com/action/showCitFormats?doi=10.1080/00107530.2014.880310

http://dx.doi.org/10.1080/00107530.2014.880310

This article may be used for research, teaching, and private study purposes.Any substantial or systematic reproduction, redistribution, reselling, loan,sub-licensing, systematic supply, or distribution in any form to anyone isexpressly forbidden. Terms & Conditions of access and use can be found athttp://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4

http://www.tandfonline.com/page/terms-and-conditions

Contemporary Psychoanalysis, 2014, Vol. 50, Nos. 1–2: 89–130.C© William Alanson White Institute of Psychiatry, Psychoanalysis & Psychology andthe William Alanson White Psychoanalytic SocietyISSN: 0010-7530 print / 2330-9091 onlineDOI: 10.1080/00107530.2014.880310

FALK LEICHSENRING, D.Sc., SUSANNE KLEIN, M.Sc.,AND SIMONE SALZER, D.Sc.

THE EFFICACY OF PSYCHODYNAMIC

PSYCHOTHERAPY IN SPECIFIC MENTAL

DISORDERS:A 2013 UPDATE OF EMPIRICAL EVIDENCE

Abstract. This article reviews the empirical evidence for psychodynamic therapyfor specific mental disorders in adults. The focus is on randomized controlled tri-als (RCTs). However, this does not imply that RCTs are uncritically accepted as thegold standard for demonstrating that a treatment works. According to the resultspresented here, there is evidence from RCTs that psychodynamic therapy is effi-cacious in common mental disorders, that is, depressive disorders, anxiety disor-ders, somatic symptom disorders, personality disorders, eating disorders, compli-cated grief, posttraumatic stress disorder (PTSD), and substance-related disorder.These results clearly contradict assertions repeatedly made by representatives ofother psychotherapeutic approaches claiming psychodynamic psychotherapy isnot empirically supported. However, further research is needed, both on outcomeand processes of psychodynamic psychotherapy. There is a need, for example,for RCTs of psychodynamic psychotherapy of PTSD. Furthermore, research onlong-term psychotherapy for specific mental disorders is required.

Keywords: psychodynamic psychotherapy, empirically supported treatments, psy-chotherapy outcome research, evidence-based medicine

There is a need for empirical outcome research in psychodynamicand psychoanalytic therapy (Gunderson & Gabbard, 1999). In this

article, the available evidence for psychodynamic psychotherapy in adults

Address correspondence to Falk Leichsenring, D.Sc., Clinic of Psychosomatics and Psy-chotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen, Germany. E-mail:[email protected]

89

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4

90 FALK LEICHSENRING, D.Sc. ET AL.

is reviewed. The focus will be on randomized controlled trials (RCTs),which are regarded as the “gold standard” for demonstrating treatmentefficacy in clinical psychology and medicine.

Evidence for Psychodynamic Psychotherapy in Specific Mental Disorders

The aim of this review is to identify those mental disorders for whichRCTs provide evidence for the efficacy of psychodynamic psychother-apy (PDT). Here, the criteria proposed by the Task Force on Promotionand Dissemination of Psychological Procedures of the American Psy-chological Association, modified by Chambless and Hollon (1998) todefine efficacious treatments, were applied. Only RCTs were includedin which psychodynamic psychotherapy was compared to (a) no treat-ment (waiting list, minimal contact), placebo, or treatment as usual, or to(b) pharmacotherapy or other (nonpsychodynamic) forms of psychother-apy. Studies examining the combination of psychodynamic therapy andmedication were not included; concomitant medication in both treatmentarms, however, was allowed. Previous reviews were given, for example,by Fonagy, Roth, and Higgitt (2005), Leichsenring (2005), Shedler (2010),and Gerber et al. (2011). In psychotherapy outcome research, RCTs areregarded as the “gold standard” because they control for known andunknown differences between subjects before treatment. For a criticaldiscussion of the role of RCTs, see Roth and Parry, 1997; Leichsenring,2004; Westen, Novotny, and Thompson-Brenner, 2004; and Rothwell,2005. As Roth and Parry (1997) put it, “ . . . their results are best seen asone part of a research cycle. . . . ” (p. 370).

Definition of Psychodynamic Psychotherapy

Psychodynamic psychotherapy operates on an interpretive-supportivecontinuum (Wallerstein, 1989; Gunderson & Gabbard, 1999). Interpre-tive interventions enhance the patient’s insight about repetitive conflictssustaining his or her problems (Luborsky, 1984; Gabbard, 2004). Sup-portive interventions aim to strengthen abilities (“ego-functions”) that aretemporarily not accessible to a patient due to acute stress (e.g., traumaticevents) or ones that have not been sufficiently developed (e.g., impulsecontrol in borderline personality disorder). Thus, supportive interventionsmaintain or build ego functions (Wallerstein, 1989). Supportive interven-tions include, for example, fostering a therapeutic alliance, setting of

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4

EFFICACY OF PSYCHODYNAMIC PSYCHOTHERAPY 91

goals, or strengthening of ego functions such as reality testing or impulsecontrol (Luborsky, 1984). The use of more supportive or more interpre-tive (insight-enhancing) interventions depends on the patient’s needs.The more severely disturbed a patient is, or the more acute his or hercondition, the more supportive and the less interpretive interventions arerequired and vice versa (Luborsky, 1984; Wallerstein, 1989). Borderlinepatients, as well as healthy subjects in an acute crisis or after a trau-matic event, may need more supportive interventions (e.g., stabilization,providing a safe and supportive environment). Thus, a broad spectrumof psychiatric problems and disorders can be treated with psychody-namic psychotherapy, ranging from milder adjustment disorders or stressreactions to severe personality disorders such as borderline personalitydisorder or psychotic conditions.

Efficacy Studies of Psychodynamic Psychotherapy in Specific MentalDisorders

Forty-four RCTs providing evidence for the efficacy of psychodynamicpsychotherapy in specific mental disorders were identified and includedin this review. These studies are presented in Table 1.

Models of Psychodynamic Psychotherapy

In the studies identified, different forms of psychodynamic psychother-apy were applied (Table 1). The models developed by Luborsky (1984),Shapiro and Firth (1985), or Malan (1976) were used most frequently.

Evidence for the Efficacy of Psychodynamic Psychotherapy in SpecificMental Disorders

The studies of psychodynamic psychotherapy included in this reviewwill be presented for the different mental disorders. However, from apsychodynamic perspective, the results of a therapy for a specific psy-chiatric disorder (e.g., depression, agoraphobia) are influenced by theunderlying psychodynamic features (e.g., conflicts, defenses, personal-ity organization), which may vary considerably within one category ofpsychiatric disorder (Kernberg, 1996). These psychodynamic factors mayaffect treatment outcome and may have a greater impact on outcome than

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


Tab

le1

Ran

dom

ized

Controlle

dSt

udie

sofPsy

chodyn

amic

Psy

choth

erap

y(P

P)

inSp

ecifi

cM

enta

lD

isord

ers

Dis

ord

erSt

udy

N(P

P)

Com

par

ison

Gro

up

Conce

ptofPP

Tre

atm

ent

Dura

tion

Dep

ress

ive

dis

ord

ers

Maj

or

dep

ress

ion

Bar

ber

etal

.,20

1251

Phar

mac

oth

erap

y:n

=55

;pla

cebo:

n=

50

Lubors

ky20

sess

ions,

16w

eeks

Maj

or

dep

ress

ion

Bar

kham

etal

.,19

9618

CBT:n

=18

Shap

iro

&Fi

rth

8vs

.16

sess

ions

Maj

or,

min

or,

or

inte

rmitt

ent

dep

ress

ion

Gal

lagh

er-

Thom

pso

n&

Stef

fen,19

94

30CBT:n

=36

Man

n;Rose

&D

elM

aest

ro16

–20

sess

ions

Maj

or

dep

ress

ion

Johan

sson

etal

.,20

1246

Stru

cture

dsu

pport:

n=

46In

tern

et-g

uid

edse

lf-h

elp;

Silv

erber

g

10w

eeks

Dys

thym

icdis

ord

erM

aina

etal

.,20

0510

Supportiv

eth

erap

y:n

=10

;w

aitlis

t:n

=10

Mal

an15

–30

(M=

19.6

)

Maj

or

dep

ress

ion

Salm

inen

etal

.,20

0826

Fluoxe

tine,

n=

25M

ann,M

alan

16se

ssio

ns

Maj

or

dep

ress

ion

Shap

iro

etal

.,19

9458

CBT:n

=59

Shap

iro

&Fi

rth

8vs

.16

sess

ions

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


Maj

or

dep

ress

ion

Thom

pso

net

al.,

1987

24BT:n

=25

;CBT:n

=27

;w

aitin

glis

t:n

=19

Horo

witz

&K

altrei

der

16–2

0se

ssio

ns

Anxi

ety

dis

ord

ers

Soci

alphobia

Boge

lset

al.,

2003

22CBT:n

=27

Mal

an36

Gen

eral

ized

anxi

ety

dis

ord

erCrits

-Christ

oph

etal

.,20

0515

Supportiv

eth

erap

y:n

=16

Lubors

ky;

Crits

-Christ

oph

etal

.

16se

ssio

ns

Soci

alphobia

Knijn

iket

al.,

2004

15Cre

dib

lePla

cebo

ControlG

roup:n

=15

Knijn

iket

al.

12se

ssio

ns

Gen

eral

ized

anxi

ety

dis

ord

erLe

ichse

nring

etal

.,20

0928

CBT:n

=29

Lubors

ky;

Crits

-Christ

oph

etal

.

30

Soci

alphobia

Leic

hse

nring,

Salz

er,et

al.,

2013

207

Cogn

itive

ther

apy:

n=

209;

wai

ting

listn

=79

Lubors

ky;

Leic

hse

nring,

Beu

tel,

Leib

ing

30

Pan

icdis

ord

erM

ilrod

etal

.,20

0726

CBT

(applie

dre

laxa

tion):

n=

23M

ilrod

etal

.24

sess

ions

(Contin

ued

on

nex

tpag

e)

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4

94 FALK LEICHSENRING, D.Sc. ET AL.T

able

1

(Contin

ued

)

Dis

ord

erSt

udy

N(P

P)

Com

par

ison

Gro

up

Conce

ptofPP

Tre

atm

ent

Dura

tion

Mix

edsa

mple

sof

dep

ress

ive

and

anxi

ety

dis

ord

ers

Dep

ress

ive

and

anxi

ety

dis

ord

ers

Bre

ssiet

al.,

2010

30TAU

:n

=30

Mal

an40

sess

ions,

1ye

ar

Dep

ress

ive

and

anxi

ety

dis

ord

ers

Knek

t,Li

ndfo

rs,

Laak

sonen

,et

al.,

2008

128,

101

Solu

tion-focu

sed

ther

apy,

n=

97M

alan

,Si

fneo

s;G

abbar

d23

5;49

.9;29

.9

PTSD

Bro

met

al.,

1989

29des

ensi

tizat

ion:n

=31

;hyp

noth

erap

y:n

=29

Horo

witz

18.8

sess

ions

Som

atic

sym

pto

mdis

ord

ers

Irrita

ble

bow

elCre

edet

al.,

2003

59Par

oxe

tine:

n=

43;

trea

tmen

tas

usu

al:

n=

86

Hobso

n;Sh

apiro

&Fi

rth

8se

ssio

ns

Irrita

ble

bow

elG

uth

rie

etal

.,19

9150

supportiv

elis

tenin

g:n

=46

Hobso

n;Sh

apiro

&Fi

rth

8se

ssio

ns

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4

EFFICACY OF PSYCHODYNAMIC PSYCHOTHERAPY 95Fu

nct

ional

dys

pep

sia

Ham

ilton

etal

.,20

0037

Supportiv

eth

erap

y:n

=36

Shap

iro

&Fi

rth

7se

ssio

ns

Som

atofo

rmpai

ndis

ord

erM

onse

n&

Monse

n,20

0020

trea

tmen

tas

usu

al/n

oth

erap

y:n

=20

Monse

n&

Monse

n33

sess

ions

Multi

-som

atofo

rmdis

ord

erSa

ttel

etal

.,20

1210

7en

han

ced

med

ical

care

:n

=10

4H

ardy,

Bar

kham

etal

.12

sess

ions

Eat

ing

dis

ord

ers

Anore

xia

ner

vosa

,bulim

ianer

vosa

Bac

har

etal

.,19

9917

CT:n

=17

;nutriti

onal

counse

ling:

n=

10B

arth

;G

oodsi

tt;

Gei

st46

sess

ions

Anore

xia

ner

vosa

Dar

eet

al.,

2001

21Cogn

itive

-anal

ytic

ther

apy

(Ryl

e):n

=22

;fa

mily

ther

apy:

n=

22;ro

utin

etrea

tmen

t:n

=19

Mal

an;D

are

M=

24.9

sess

ions

Bulim

ianer

vosa

Fairburn

etal

.,19

8611

CBT:n

=11

Rose

n;St

unka

rd;

Bru

ch19

sess

ions

Bulim

ianer

vosa

Gar

ner

etal

.,19

9325

CBT:n

=25

Lubors

ky19

sess

ions

Anore

xia

ner

vosa

Gow

ers

etal

.,19

9420

trea

tmen

tas

usu

al:n

=20

Crisp

12se

ssio

ns

Bin

geea

ting

dis

ord

erTas

caet

al.,

2006

48G

roup

CBT:n

=47

;w

aitin

glis

t:n

=40

Tas

caet

al.

16se

ssio

ns

(Contin

ued

on

nex

tpag

e)

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


Tab

le1

(Contin

ued

)

Dis

ord

erSt

udy

N(P

P)

Com

par

ison

Gro

up

Conce

ptofPP

Tre

atm

ent

Dura

tion

Subst

ance

-rel

ated

dis

ord

ers

Coca

ine

dep

enden

ceCrits

-Christ

oph

etal

.,19

99,

2001

124

CBT

+gr

oup

dru

gco

unse

ling

(DC):

n=

97,in

div

idual

DC:

n=

92,in

div

idual

DC

+gr

oup

DC:n

=96

Mar

k&

Lubors

ky+

group

DC

Up

to36

indiv

idual

and

24gr

oup

sess

ions;

4m

onth

s

Alc

ohol

dep

enden

ceSa

ndah

let

al.,

1998

25CBT:n

=24

Foulk

es15

sess

ions

(M=

8.9)

Opia

tedep

enden

ceW

oody

etal

.,19

83,19

9031

Dru

gco

unse

ling

(DC):

n=

35;CBT

+D

C:n

=34

Lubors

ky+

dru

gco

unse

ling

12se

ssio

ns

Opia

tedep

enden

ceW

oody

etal

.,19

9557

Dru

gco

unse

ling:

n=

27Lu

bors

ky+

dru

gco

unse

ling

26se

ssio

ns

Bord

erlin

eper

sonal

itydis

ord

er

Bat

eman

&Fo

nag

y,19

99,

2001

19Tre

atm

entas

usu

al:n

=19

Bat

eman

&Fo

nag

y18

month

s

Bord

erlin

eper

sonal

itydis

ord

er

Bat

eman

&Fo

nag

y,20

0971

Stru

cture

dcl

inic

alm

anag

emen

t,n

=63

Bat

eman

&Fo

nag

y18

month

s

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4

EFFICACY OF PSYCHODYNAMIC PSYCHOTHERAPY 97Bord

erlin

eper

sonal

itydis

ord

er

Cla

rkin

etal

.,20

0730

Dia

lect

ical

beh

avio

ral

ther

apy:

n=

30;

supportiv

eth

erap

y:n

=30

Ker

nber

g,Cla

rkin

etal

.12

month

s

Bord

erlin

eper

sonal

itydis

ord

er

Doer

ing

etal

.,20

1043

Tre

atm

entby

exper

ience

dco

mm

unity

ther

apis

ts,n

=29

Cla

rkin

etal

.Ass

essm

entaf

ter

1ye

ar

Bord

erlin

eper

sonal

itydis

ord

er

Gie

sen-B

loo

etal

.,20

0642

CBT:n

=44

Ker

nber

g,Cla

rkin

etal

.3

year

sw

ithse

ssio

ns

twic

ea

wee

k

Bord

erlin

eper

sonal

itydis

ord

er

Gre

gory

etal

.,20

0815

Tre

atm

entas

usu

al:n

=15

Gre

gory

&Rem

en24

.9se

ssio

ns

Bord

erlin

eper

sonal

itydis

ord

er

Munro

e-B

lum

&M

arzi

ali,

1995

31In

terp

erso

nal

group

ther

apy:

n=

25K

ernber

g17

sess

ions

Clu

ster

Cper

sonal

itydis

ord

ers

Mura

net

al.,

2005

22Brief

rela

tional

ther

apy:

n=

33;

CBT:n

=29

Polla

cket

al.

30se

ssio

ns

Clu

ster

Cper

sonal

itydis

ord

ers

Svar

tber

get

al.,

2004

25CBT:n

=25

Mal

an,

McC

ullo

ugh

Vai

llant

40se

ssio

ns

(Contin

ued

on

nex

tpag

e)

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4

98 FALK LEICHSENRING, D.Sc. ET AL.T

able

1

(Contin

ued

)

Dis

ord

erSt

udy

N(P

P)

Com

par

ison

Gro

up

Conce

ptofPP

Tre

atm

ent

Dura

tion

Avo

idan

tper

sonal

itydis

ord

er

Em

mel

kam

pet

al.,

2006

23CBT:n

=21

;w

aitin

glis

t:n

=18

Mal

an;Lu

bors

ky;

Lubors

ky&

Mar

k;Pin

sker

etal

.

20se

ssio

ns

Sam

ple

sofm

ixed

per

sonal

itydis

ord

ers

Het

eroge

neo

us

per

sonal

itydis

ord

ers

Abbas

set

al.,

2008

14M

inim

alco

nta

ct:n

=14

Dav

enlo

o27

.7se

ssio

ns

(mea

n)

Prim

arily

Clu

ster

Cper

sonal

itydis

ord

ers

Hel

lers

tein

etal

.,19

9825

Brief

supportiv

epsy

choth

erap

y:n

=24

Dav

enlo

o40

sess

ions

Het

eroge

neo

us

per

sonal

itydis

ord

ers

Win

ston

etal

.,199

425

Brief

adap

tive

psy

choth

erap

y:n

=30

;w

aitin

glis

t:n

=26

Dav

enlo

o40

wee

ks,M

=40

.3se

ssio

ns

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


the phenomenological DSM categories (Piper, McCallum, Joyce, Rosie, &Ogrodniczuk, 2001).

Depressive Disorders

Cognitive-behavioral therapists encourage the patient to become moreactive and work through depressive cognitions. Psychodynamic ther-apists focus on the conflicts or ego-functions associated with depres-sive symptoms. At present, several RCTs are available that provide ev-idence for the efficacy of psychodynamic psychotherapy compared tocognitive-behavioral therapy (CBT) in major depressive disorder (Thomp-son, Gallagher, & Breckenridge, 1987; Gallagher-Thompson & Steffen,1994; Shapiro et al., 1994; Barkham et al., 1996). Different models of psy-chodynamic psychotherapy were applied (Table 1). For these studies, ameta-analysis (Leichsenring, 2001) found psychodynamic psychotherapyand CBT to be equally effective with regard to depressive symptoms, gen-eral psychiatric symptoms, and social functioning. In this meta-analysis,psychodynamic psychotherapy achieved large pre-post effect sizes indepressive symptoms, general psychiatric symptoms, and social func-tioning. The results proved to be stable in follow-up studies (Gallagher-Thompson, Hanley-Peterson, & Thompson, 1990; Shapiro et al., 1995).These results are consistent with the findings of the meta-analysis byWampold, Minami, Baskin, and Tierney (2002) who did not find signifi-cant differences between CBT and “other therapies” in the treatment ofdepression. In an RCT by Salminen et al. (2008), psychodynamic psy-chotherapy was found to be equally efficacious as fluoxetine in reducingsymptoms of depression and improving functional ability. However, withsample sizes of n1 = 26 and n2 = 25, statistical power may have not beensufficient to detect possible differences between treatments. In a smallRCT, Maina, Forner, and Bogetto (2005) examined the efficacy of psycho-dynamic psychotherapy and brief supportive therapy in the treatment ofminor depressive disorders (dysthymic disorder, depressive disorder nototherwise specified, or adjustment disorder with depressed mood). Bothtreatments were superior to a wait list condition at the end of treatment.At six-month follow-up, psychodynamic psychotherapy was superior tobrief supportive therapy.

A recent meta-analysis that examined the effects of CBT, psychody-namic psychotherapy, interpersonal therapy and other forms of psy-chotherapy in adult depression did not find one treatment significantly

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


superior to others, with the exception of interpersonal therapy (Cui-jpers, van Straten, Andersson, & van Oppen, 2008). Another recent meta-analysis examined the effects of psychodynamic psychotherapy in de-pression (Driessen et al., 2010). The authors found psychodynamic psy-chotherapy significantly superior to control conditions. If group therapywas included, PDT was less efficacious compared to other treatments atthe end of therapy. If only individual therapy was included, there wereno significant differences between PDT and other treatments (Abbass &Driessen, 2010). In three-month and nine-month follow-ups, no signifi-cant differences between treatments were found. In a recent study by Bar-ber, Barrett, Gallop, Rynn, and Rickels (2012), PDT and pharmacotherapywere equally effective in the treatment of depression. However, neitherPDT nor pharmacotherapy was superior to placebo.

Meanwhile, Internet-guided self-help is also available for psychody-namic psychotherapy. In an RCT, Johansson et al. (2012) found Internet-guided self-help based on psychodynamic psychotherapy significantlymore efficacious than a structured support intervention (psychoeduca-tion and scheduled weekly contacts online) in patients with MDD. Treat-ment effects were maintained at 10-month follow-up. Psychodynamicallyoriented self-help was based on the concept by Silverberg (2005). Silver-berg’s Internet-guided self-help based on psychodynamic psychotherapyis a promising approach, especially for patients who do not receive psy-chotherapy. Further studies should be carried out.

In sum, several RCTs provide evidence for the efficacy of psycho-dynamic psychotherapy in depressive disorders. Nevertheless, furtherstudies are required to broaden the evidence base for psychodynamicpsychotherapy. In particular, RCTs on long-term treatments should becarried out.

Pathological Grief

In two RCTs by McCallum and Piper (1990) and Piper et al. (2001) thetreatment of prolonged or complicated grief by short-term psychody-namic group therapy was studied. In the first study, short-term psycho-dynamic group therapy was significantly superior to a wait list (McCallum& Piper, 1990). In the second study, a significant interaction was found.With regard to grief symptoms, high quality of object relations patientsimproved more in interpretive therapy, and low quality of object relationspatients improved more in supportive therapy. For general symptoms,

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


clinical significance favored interpretive therapy over supportive therapy(Piper et al., 2001).

Anxiety Disorders

For anxiety disorders, several RCTs are presently available (Table 1).With regard to panic disorder (with or without agoraphobia), Milrodet al. (2007) showed in a recent RCT that psychodynamic psychotherapywas more successful than applied relaxation. For social phobia, two RCTsof psychodynamic therapy exist: In the first study, short-term psychody-namic group treatment for generalized social phobia was superior to acredible placebo control (Knijnik, Kapczinski, Chachamovich, Margis, &Eizirik, 2004).

In a study by Bogels, Wijts, Oort, and Sallerts (2014), psychodynamicpsychotherapy proved to be as effective as CBT in the treatment of(generalized) social phobia.

In a large-scale multicenter RCT, the efficacy of psychodynamic psy-chotherapy and cognitive therapy (CT) in the treatment of social phobiawas studied (Leichsenring et al., 2013). In an outpatient setting, 495 pa-tients with a primary diagnosis of social phobia were randomly assignedto CBT, psychodynamic psychotherapy, or to waiting list. Treatmentswere carried out according to manuals and treatment fidelity was care-fully controlled for. Both treatments were significantly superior to thewaiting list. Thus, this trial provides evidence that psychodynamic psy-chotherapy is effective in the treatment of social phobia according to thecriteria proposed by Chambless and Hollon (1998). There were no differ-ences between PDT and CT with regard to response rates (52% vs. 60%)and reduction of depression. There were significant differences betweenCT and PDT in favor of CT, however, with regard to remission rates(36% vs. 26%), self-reported symptoms of social phobia, and reductionof interpersonal problems. Differences in terms of between-group effectsizes, however, were small (Leichsenring et al., 2013).

In a randomized controlled feasibility study of generalized anxiety dis-order, psychodynamic psychotherapy was equally effective as a support-ive therapy with regard to continuous measures of anxiety, but signifi-cantly superior on symptomatic remission rates (Crits-Christoph, ConnollyGibbons, Narducci, Schamberger, & Gallop, 2005). However, the samplesizes of that study were relatively small (n = 15 vs. n = 16), and thestudy was not sufficiently powered to detect more possible differences

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


between treatments. In another RCT of generalized anxiety disorder, psy-chodynamic psychotherapy was compared to CBT (Leichsenring et al.,2009). Psychodynamic psychotherapy and CBT were equally effectivewith regard to the primary outcome measure. However, in some sec-ondary outcome measures, CBT was found to be superior, both at theend of therapy and at the six-month follow-up. Other differences mayexist that were not detected due to the limited sample size and power(CBT: n = 29; psychodynamic psychotherapy: n = 28). At the one-yearfollow-up, results proved to be stable (Salzer, Winkelbach, Leweke, Leib-ing, & Leichsenring, 2011). Contrary to short-term psychodynamic psy-chotherapy, a core element in the applied method of CBT consisted of amodification of worrying. This specific difference between the treatmentsmay explain the superiority of CBT in the Penn State Worry Questionnaireand, in part, also in the State-Trait-Anxiety Inventory (trait measure)—the latter also contains several items related to worrying. The results ofthat study may suggest that the outcome of short-term psychodynamicpsychotherapy in generalized anxiety disorder may be further optimizedby employing a stronger focus on the process of worrying. In psychody-namic psychotherapy, worrying can be conceptualized as a mechanismof defense that protects the subject from fantasies or feelings that are evenmore threatening than the contents of his or her worries (Crits-Christoph,Wolf-Palacio, Ficher, & Rudick, 1995).

According to the available RCTs, psychodynamic psychotherapy is effi-cacious in anxiety disorders. If there were differences between psychody-namic psychotherapy and CBT, they were found in secondary outcomemeasures or corresponded to small differences in effect size. This is con-sistent with a recent meta-analysis by Baardseth et al. (2013), who didnot find significant differences in favor of CBT compared to bona fidetreatments.

Mixed Samples of Depressive and Anxiety Disorders

Knekt, Lindfors, Harkanen, et al. (2008) and Knekt, Lindfors, Laaksonen,et al. (2008) compared short-term psychodynamic psychotherapy (STPP),long-term psychodynamic psychotherapy (LTPP), and solution-focusedtherapy (SFT) in patients with depressive or anxiety disorders. STPP wasmore effective than LTPP during the first year. During the second yearof follow-up, no significant differences were found between long-termand short-term treatments. In the three-year follow-up, LTPP was moreeffective; no significant differences were found between the short-termtreatments. With regard to specific mental disorders, it is of note that after

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


three years, significantly more patients recovered from anxiety disordersin LTPP (90%) compared to STPP (67%) and SFT (65%). For depressivedisorders, no such differences occurred. In an RCT by Bressi, Porcellana,Marinaccio, Nocito, and Magri (2010), PDT was superior to Treatment asUsual (TAU) in a sample of patients with depressive or anxiety disorders.

Posttraumatic Stress Disorder

In an RCT by Brom, Kleber, and Defares (1989), the effects of psychody-namic psychotherapy, behavioral therapy and hypnotherapy in patientswith posttraumatic stress disorder (PTSD) were studied. All of the treat-ments proved to be equally effective. The results reported by Brom et al.(1989) are consistent with that of a more recent meta-analysis by Ben-ish, Imel, and Wampold (2008), which found no significant differencesbetween bona fide treatments for the treatment of PTSD. In a responseto the meta-analysis by Benish et al., Ehlers et al. (2010) critically re-viewed the study by Brom et al. (1989). A comprehensive discussionand convincing reply to the critique by Ehlers et al. (2010) was givenby Wampold et al. (2010). In the present context, we only shall addressthe critique put forward by Ehlers et al. (2010) against the study byBrom et al. (1989). Ehlers et al. (2010) reviewed the study by Brom et al.(1989) in the following way: “In this study, neither hypnotherapy norpsychodynamic therapy was consistently more effective than the waitinglist control condition across the analyses used. . . . In addition, Bromet al. (1989) pointed out that patients in psychodynamic therapy showedslower overall change than those in the other two treatment conditions,and did not improve in intrusive symptoms significantly. . . .” (p. 273).

Results are different for different outcome measures. For the avoidancescale and the total score of the Impact of Event Scale, psychodynamic psy-chotherapy was significantly superior to the waiting list condition, bothafter therapy and at follow-up (Brom et al., 1989, pp. 610). Althougheffect sizes for psychodynamic psychotherapy were somewhat smaller atposttreatment (avoidance: 0.66, total: 1.10), psychodynamic psychother-apy achieved the largest effect sizes at follow-up (avoidance: 0.92, total:1.56) as compared to CBT (0.73, 1.30) and hypnotherapy (0.88, 1.54).1

With regard to the Intrusion scale of the Impact of Event Scale, theprimary outcome measure, it is true that psychodynamic psychother-apy was not superior to waiting list, both at posttest and at three-month

1Effect sizes assessed by Falk Leichsenring and Simone Salzer.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


follow-up. Intrusion is one of the core symptoms of PTSD. Pre-post differ-ences of psychodynamic psychotherapy, however, were significant andthe pre-post and pre-follow-up effect sizes were large (0.95 and 1.55,respectively). In contrast, the pre-post effect size for the waiting list wassmall (0.34). For the CBT condition (trauma desensitization), the pre-postand pre-follow-up effect sizes were 1.66 and 1.43, respectively. Thus, atfollow-up psychodynamic psychotherapy achieved a larger effect sizethan CBT. Although the effect size of CBT tended to decrease at follow-up, it tended to increase for psychodynamic psychotherapy; as will beshown below, this is true for the avoidance scale and the total score ofthe Impact of Event Scale.2 For this reason, it is strange that the differ-ence between psychodynamic psychotherapy and the control conditionwas reported by Brom et al. (1989) to be not significant at follow-up.For intrusion, psychodynamic psychotherapy achieved the lowest scoreof all conditions at follow-up. These results, however, were not reportedby Ehlers et al. (2010). The figure presented by Ehlers et al. (2010, p.273) included only the pre-post effect sizes, but not the pre-follow-upeffect sizes, for which psychodynamic psychotherapy achieved larger ef-fect sizes, as shown above. In a critical review, results of all analysesshould be presented, not only the results that support one’s own per-spective. Furthermore, for general symptoms Brom et al. (1989) wrotethat psychodynamic psychotherapy “seems to withstand the comparison[with waiting list] best” (p. 610). Thus, after all, it seems to take (a little bit,i.e., three months!) longer for psychodynamic psychotherapy to achieveits effects, but these effects are at least as large as those of CBT.

Apart from that discussion, further studies of psychodynamic psy-chotherapy in PTSD are required. Only one RCT of psychodynamic psy-chotherapy in PTSD is presently available.

Somatic Symptom Disorders

At present, five RCTs of psychodynamic psychotherapy in somatic symp-tom disorders that fulfill the inclusion criteria are available (Table 1). Inthe RCT by Guthrie, Creed, Dawson, and Tomenson (1991), patients withirritable bowel syndrome, who had not responded to standard medical

2Brom et al. (1989) did not report means and standard deviation for the waiting list condi-

tion at follow-up, only for posttreatment. For this reason, no effect sizes for follow-up canbe calculated.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


treatment over the previous six months, were treated with psychody-namic psychotherapy in addition to standard medical treatment. Thistreatment was compared to standard medical treatment alone. Accordingto the results, psychodynamic psychotherapy was effective in two thirdsof the patients. In another RCT, psychodynamic psychotherapy was sig-nificantly more effective than routine care, and as effective as medication(paroxetine) in the treatment of severe irritable bowel syndrome (Creedet al., 2003). During the follow-up period, however, psychodynamic psy-chotherapy, but not paroxetine, was associated with a significant reduc-tion in health care costs compared with treatment as usual. In an RCT byHamilton et al. (2000) psychodynamic psychotherapy was compared tosupportive therapy in the treatment of patients with chronic intractablefunctional dyspepsia, who had failed to respond to conventional pharma-cological treatments. At the end of treatment, psychodynamic psychother-apy was significantly superior to the control condition. The effects werestable in the 12-month follow-up. Monsen and Monsen (2000) comparedpsychodynamic psychotherapy of 33 sessions with a control condition(no treatment or treatment as usual) in the treatment of patients withchronic pain. Psychodynamic psychotherapy was significantly superiorto the control group on measures of pain, psychiatric symptoms, inter-personal problems, and affect consciousness. The results remained stableor even improved in the 12-month follow-up. In a recent study, Sattelet al. (2012) compared PDT with enhanced medical care in patients withmulti somatic symptom disorders. At follow-up PDT was superior to en-hanced medical care with regard to improvements in patients’ physicalquality of life.

Abbass, Kisely, and Kroenke (2009) carried out a review and meta-analysis on the effects of psychodynamic psychotherapy in somatic dis-orders. They included both RCTs and controlled before and after studies.Meta-analysis was possible for 14 studies. It revealed significant effects onphysical symptoms, psychiatric symptoms and social adjustment, whichwere maintained in long- term follow-up. Thus, specific forms of psy-chodynamic psychotherapy can be recommended for the treatment ofsomatic symptom disorders.

Bulimia Nervosa

For the treatment of bulimia nervosa, three RCTs of psychodynamicpsychotherapy are available (Table 1). Significant and stable improve-ments in bulimia nervosa after psychodynamic psychotherapy were

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


demonstrated in the RCTs by Fairburn, Kirk, O’Connor, and Cooper(1986), Garner et al. (1993), and Fairburn et al. (1995). In the pri-mary disorder-specific measures (bulimic episodes, self-induced vomit-ing), psychodynamic psychotherapy was as effective as CBT (Fairburnet al., 1986, 1995; Garner et al., 1993). Again, however, the studieswere not sufficiently powered to detect possible differences (see Ta-ble 1 for sample sizes). Apart from this, CBT was superior to psycho-dynamic psychotherapy in some specific measures of psychopathol-ogy (Fairburn et al., 1986). However, in a follow-up (Fairburn et al.,1995) of the Fairburn et al. (1986) study using a longer follow-up pe-riod, both forms of therapy proved to be equally effective and werepartly superior to a behavioral form of therapy. Accordingly, for avalid evaluation of the efficacy of psychodynamic psychotherapy inbulimia nervosa, longer-term follow-up studies are necessary. In an-other RCT, psychodynamic psychotherapy was significantly superiorto both a nutritional counseling group and CT (Bachar, Latzer, Kre-itler, & Berry, 1999). This was true of patients with bulimia nervosaand a mixed sample of patients with bulimia nervosa or anorexianervosa.

Anorexia Nervosa

For the treatment of anorexia nervosa, however, evidence-based treat-ments are barely available (Fairburn, 2005). This applies to both psy-chodynamic psychotherapy and CBT. In an RCT by Gowers, Norton,Halek, and Crisp (1994), psychodynamic psychotherapy combined withfour sessions of nutritional advice yielded significant improvements inpatients with anorexia nervosa (Table 1). Weight and BMI changes weresignificantly more improved than in a control condition (treatment asusual). Dare, Eisler, Russell, Treasure, and Dodge (2001) compared psy-chodynamic psychotherapy with a mean duration of 24.9 sessions tocognitive-analytic therapy, family therapy, and routine treatment in thetreatment of anorexia nervosa (Table 1). Psychodynamic psychotherapyyielded significant symptomatic improvements and psychodynamic psy-chotherapy and family therapy were significantly superior to the routinetreatment with regard to weight gain. However, the improvements weremodest—several patients were undernourished at the follow-up. Thus,the treatment of anorexia nervosa remains a challenge and more effectivetreatment models are required.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


Binge Eating Disorder

In an RCT by Tasca et al. (2006) a psychodynamic group treatment wasas efficacious as CBT and superior to a waiting list condition in bingeeating disorder (e.g., days binged, interpersonal problems). For the com-parison of psychodynamic psychotherapy with CBT, again the questionof statistical power arises (n1 = 48, n2 = 47, n3 = 40).

Several RCTs provide evidence that psychodynamic psychotherapy isefficacious in eating disorders. However, outcome, especially for anorexianervosa, is not yet satisfactory. This is true for CBT as well. Thus, furtherstudies are required.

Substance-Related Disorders

Woody et al. (1983) and Woody, Luborsky, McLellan, and O’Brien (1990)studied the effects of psychodynamic psychotherapy and CBT, both ofwhich were given in addition to drug counseling, in the treatment ofopiate dependence (Table 1). Psychodynamic psychotherapy plus drugcounseling yielded significant improvements on measures of drug-relatedsymptoms and general psychiatric symptoms. At a seven-month follow-up, psychodynamic psychotherapy and CBT, plus drug counseling, wereequally effective, and both conditions were superior to drug counsel-ing alone. In another RCT, psychodynamic psychotherapy of 26 ses-sions given in addition to drug counseling was also superior to drugcounseling alone in the treatment of opiate dependence (Woody, McLel-lan, Luborsky, & O’Brien, 1995). At a six-month follow-up, most of thegains made by the patients who had received psychodynamic therapy re-mained. In an RCT conducted by Crits-Christoph et al. (1999, 2001), psy-chodynamic psychotherapy of up to 36 individual sessions was combinedwith 24 sessions of group drug counseling in the treatment of cocainedependence. The combined treatment yielded significant improvementsand was as effective as CBT, which was combined with group drug coun-seling as well. However, both CBT and psychodynamic psychotherapyplus group drug counseling were not more effective than group drugcounseling alone. Furthermore, individual drug counseling was signifi-cantly superior to both forms of therapy concerning measures of drugabuse. With regard to psychological and social outcome variables, alltreatments were equally effective (Crits-Christoph et al., 1999, 2001). Inan RCT by Sandahl, Herlitz, Ahlin, and Ronnberg (1998), psychodynamicpsychotherapy and CBT were compared concerning their efficacy in the

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


treatment of alcohol abuse. Psychodynamic psychotherapy yielded sig-nificant improvements on measures of alcohol abuse, which were stableat a 15-month follow-up. Psychodynamic psychotherapy was significantlysuperior to CBT in the number of abstinent days and in the improvementof general psychiatric symptoms.

Borderline Personality Disorder

At present, seven RCTs are available for psychodynamic psychotherapy inborderline personality disorder (Munroe-Blum & Marziali, 1995; Bateman& Fonagy, 1999, 2009; Giesen-Bloo et al., 2006; Clarkin, Levy, Lenzen-weger, & Kernberg, 2007; Gregory et al., 2008; Doering et al., 2010). Ofthese studies, several RCTs showed that psychodynamic psychotherapywas superior to Treatment As Usual (Bateman & Fonagy, 1999; Gregoryet al., 2008; Doering et al., 2010). Bateman and Fonagy (1999, 2001)studied psychoanalytically oriented partial hospitalization treatment forpatients with borderline personality disorder. The major difference be-tween the treatment group and the control group was the provision ofindividual and group psychotherapy in the former. The treatment lasted amaximum of 18 months. Psychodynamic psychotherapy was significantlysuperior to standard psychiatric care, both at the end of therapy and at the18-month follow-up. In a recent RCT, Transference-Focused Psychother-apy (TFP) based on Kernberg’s model (Clarkin, Yeomans, & Kernberg,1999) was compared to a treatment carried out by experienced com-munity psychotherapists in borderline outpatients (Doering et al., 2010).TFP was superior with regard to borderline psychopathology, psychoso-cial functioning, personality organization, inpatient admission, and drop-outs. Another RCT compared psychodynamic psychotherapy (“dynamicdeconstructive psychotherapy”) with TAU in the treatment of patientswith BPD and co-occurring alcohol use disorder (Gregory et al., 2008).In this study, psychodynamic psychotherapy, but not TAU, achievedsignificant improvements in outcome measures of parasuicide, alcoholmisuse, and institutional care (Gregory et al., 2008). Furthermore, psy-chodynamic psychotherapy was superior with regard to improvements inborderline psychopathology, depression, and social support. No differ-ence was found in dissociation. This was true although TAU participantsreceived higher average treatment intensity. Another recent RCT foundmentalization-based treatment (MBT) to be superior to manual-drivenstructured clinical management with regard to the primary (suicidal and

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


self-injurious behaviors, hospitalization) and secondary outcome mea-sures (e.g., depression, general symptom distress, interpersonal function-ing [Bateman & Fonagy, 2009]).

With regard to the comparison of psychodynamic psychotherapy tospecific forms of psychotherapy, one RCT reported psychodynamicpsychotherapy as equally effective as an interpersonal group therapy(Munroe-Blum & Marziali, 1995). Psychodynamic psychotherapy yieldedsignificant improvements on measures of borderline-related symptoms,general psychiatric symptoms and depression, and was as effective as aninterpersonal group therapy. Power, however, may have been insufficientto detect differences between treatments (n1 = 22, n2 = 26). Giesen-Blooet al. (2006) compared psychodynamic psychotherapy (transference-focused psychotherapy [TFP]) with schema-focused therapy (SFT), a formof CBT. Treatment duration was three years with two sessions a week.The authors reported statistically and clinically significant improvementsfor both treatments. However, SFT was found to be superior to TFP inseveral outcome measures. Furthermore, a significantly higher dropoutrisk for TFP was reported. This study, however, has serious methodolog-ical flaws. The authors used scales for adherence and competence forboth treatments, for which they adopted an identical cut-off score of 60indicating competent application. According to the data published by theauthors (p. 651), the median competence level for applying SFT methodswas 85.67. For TFP, a value of 65.6 was reported. Although the compe-tence level for SFT clearly exceeded the cut-off, the competence levelfor TFP just surpassed it. Furthermore, the competence level for SFT isclearly higher than that for TFP. Accordingly, both treatments were notequally applied in terms of therapist competence. Thus, the results of thatstudy are questionable. The difference in competence was not taken intoaccount by the authors, neither with regard to the analysis of resultingdata nor in the discussion of the results. Thus, this study raises seriousconcerns about an investigator allegiance effect (Luborsky et al., 1999).Another RCT compared psychodynamic psychotherapy (TFP), DialecticalBehavior Therapy (DBT), and psychodynamic supportive psychotherapy(Clarkin et al., 2007). Patients treated with all three modalities showedgeneral improvement in the study. However, TFP was shown to produceimprovements not demonstrated by either DBT or supportive therapy.Those participants who received TFP were more likely to move from aninsecure attachment classification to a secure one. They also showedsignificantly greater changes in mentalizing capacity and narrative

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


coherence compared to the other two groups. TFP was associated withsignificant improvement in 10 of the 12 variables across the six symp-tomatic domains, compared to six in supportive therapy and five for DBT.Only TFP made significant changes in impulsivity, irritability, verbal as-sault, and direct assault. TFP and DBT reduced suicidality to the sameextent. Here as well, power may have been insufficient to detect furtherpossible differences (n1 = 23, n2 = 17, n3 = 22).

In sum, there is clear evidence that specific forms of manual-guidedpsychodynamic psychotherapy are efficacious in borderline personalitydisorder (Leichsenring, Leibing, Kruse, New, & Leweke, 2011). For TFPand MBT, two RCTs carried out in independent research settings provideevidence that both MBT and TFP are efficacious and specific treatmentsof BPD, according to the criteria of empirically supported treatments pro-posed by Chambless and Hollon (1998). Studies of both psychotherapyand pharmacotherapy in BPD were recently reviewed by Leichsenring,Leibing, et al. (2011). For active forms of psychotherapy, including MBT,TFP, DBT, and schema-focused therapy (SFT), there is no evidence thatone form of psychotherapy is superior to another (Leichsenring, Leibing,et al., 2011).

Cluster C Personality Disorders

There is also evidence for the efficacy of psychodynamic psychother-apy in the treatment of Cluster C personality disorders (i.e., avoidant,compulsive or dependent personality disorder). In an RCT conducted bySvartberg, Stiles, and Seltzer (2004), psychodynamic psychotherapy of 40sessions in length was compared to CBT (Table 1). Both psychodynamicpsychotherapy and CBT yielded significant improvements in patients withDSM-IV Cluster C personality disorders. The improvements refer to symp-toms, interpersonal problems, and core personality pathology. The resultswere stable at 24 months follow-up. No significant differences were foundbetween psychodynamic psychotherapy and CBT with regard to efficacy.However, this study was also not sufficiently powered to detect possibledifferences (n1 = 25, n2 = 25). Muran, Safran, Samstag, and Winston(2005) compared the efficacy of psychodynamic therapy, brief relationaltherapy, and CBT in the treatment of Cluster C personality disorders andpersonality disorders not otherwise specified. Treatments lasted for 30sessions. With regard to mean changes in outcome measures, no signif-icant differences were found between the treatment conditions, neither

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


at termination nor at follow-up. Furthermore, there were no significantdifferences between the treatments with regard to the patients achievingclinically significant change in symptoms, interpersonal problems, fea-tures of personality disorders, or therapist ratings of target complaints.At termination, CBT and brief relational therapy were superior to psy-chodynamic psychotherapy in one outcome measure (patient ratings oftarget complaints). However, this difference did not persist at follow-up.With regard to the percentage of patients showing change, no significantdifferences were found, either at termination or at the follow-up, exceptin one comparison: At termination, CBT was superior to psychodynamicpsychotherapy on the Inventory of Interpersonal Problems (Horowitz,Alden, Wiggins, & Pincus, 2000). Again, this difference did not persist atthe follow-up. The conclusion is that only a few significant differenceswere found between the treatments but these differences did not persistat follow-up.

Avoidant Personality Disorder

Avoidant personality disorder (AVPD) is among the above mentionedCluster C personality disorders. In a recent RCT, Emmelkamp et al. (2006)compared CBT to psychodynamic psychotherapy and a waitlist conditionin the treatment of AVPD. The authors reported CBT as more effectivethan waiting-list control and psychodynamic psychotherapy. However,the study suffers from several methodological shortcomings (Leichsen-ring & Leibing, 2007). In contrast to CBT, for example, no disorder-specific manual was used for PDT. Some outcome measures applied byEmmelkamp et al. (2006) were specifically tailored to effects for CBT(e.g., to beliefs). Furthermore an arbitrary level of significance (p = 0.10)was set by the authors so that a usually not significant difference (p =0.09) achieved significance in favor of CBT. At follow-up, no differencesbetween CBT and PDT were found in primary outcome measures. Inaddition, Emmelkamp et al. reported that PDT was not superior to thewaiting list group. This was true, but may be attributed to the small sam-ple size and low power of the study. Furthermore, CBT was superiorto the waiting list group in only two of six measures (Leichsenring &Leibing, 2007). Thus, design, statistical analyses and reporting of resultsraise serious concerns about an investigator allegiance effect (Luborskyet al., 1999).

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


Heterogeneous Samples of Patients with Personality Disorders

Winston et al. (1994) compared psychodynamic psychotherapy with briefadaptive psychotherapy or waiting list patients in a heterogeneous groupof patients with personality disorders. Most of the patients showed aCluster C personality disorder. Patients with paranoid, schizoid, schizo-typal, borderline, narcissistic personality disorders were excluded. Meantreatment duration was 40 weeks. In both treatment groups, patientsshowed significantly more improvements than the patients on the wait-ing list. No differences in outcome were found between the two forms ofpsychotherapy. Hellerstein et al. (1998) compared psychodynamic psy-chotherapy to brief supportive therapy in a heterogeneous sample ofpatients with personality disorders. Again, most of the patients showeda Cluster C personality disorder. The authors reported similar degrees ofimprovement both at termination and at six-month follow-up. However,the studies by Winston et al. (1994) and Hellerstein et al. (1998) werenot sufficiently powered to detect possible differences (see Table 1 forsample sizes). Abbass, Sheldon, Gyra, and Kalpin (2008) compared psy-chodynamic psychotherapy (intensive short-term dynamic psychotherapy[ISTDP]) with a minimal contact group in a heterogeneous group of pa-tients with personality disorders. The most common Axis II diagnoseswere borderline (44%), obsessive compulsive (37%) and avoidant per-sonality disorder (33%). Average treatment duration was 27.7 sessions.Psychodynamic psychotherapy was significantly superior to the controlcondition in all primary outcome measures. When control patients weretreated, they experienced benefits similar to the initial treatment group. Inthe long-term follow-up, two years after the end of treatment, the wholegroup maintained their gains and had an 83% reduction of personalitydisorder diagnoses. In addition, treatment costs were thrice offset by re-ductions in medication and disability payments. This preliminary studyof ISTDP suggests it is efficacious and cost-effective in the treatment ofpersonality disorders.

At present, two meta-analyses on the effects of psychodynamic psy-chotherapy in personality disorders are available (Leichsenring & Leibing,2003; Town, Abbass, & Hardy, 2011). A meta-analysis addressing the ef-fects of psychodynamic psychotherapy and CBT in personality disordersreported that psychodynamic psychotherapy yielded large effects sizesnot only for comorbid symptoms, but also for core personality pathology(Leichsenring & Leibing, 2003). This was true especially for BPD. A more

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


recent meta-analysis by Town et al. (2011) included seven RCTs on short-term psychodynamic psychotherapy in personality disorders. The authorsdrew the preliminary conclusion that psychodynamic psychotherapy maybe considered an efficacious empirically supported treatment option fora wide range of personality disorders, producing significant and mediumto long-term improvements for a large percentage of patients.

Complex Mental Disorders

The majority of available RCTs addressing the efficacy of psychodynamicpsychotherapy are focusing on short-term treatments. Evidence, how-ever, demonstrates that short-term treatments are not sufficiently helpfulfor a considerable proportion of patients with more complex mentaldisorders, such as personality disorders or other chronic mental disor-ders (Kopta, Howard, Lowry, & Beutler, 1994). Some studies suggest thatlonger-term psychotherapy may be helpful for these patients (Linehan,Tutek, Heard, & Armstrong, 1994; Bateman & Fonagy, 1999; Linehanet al., 2006; Clarkin et al., 2007). A meta-analysis of long-term psycho-dynamic psychotherapy (LTPP) included 11 randomized controlled trialsand 12 observational studies (Leichsenring & Rabung, 2008). Accordingto the results, LTPP (defined as lasting at least one year or 50 sessions)yielded large and stable effects in patients with complex mental disor-ders (defined as personality disorders, multiple mental disorders, andchronic mental disorders). For overall outcome, the effect sizes even in-creased significantly between termination of treatment and follow-up.The comparison of RCTs vs. observational studies revealed no signifi-cant differences in outcome, suggesting that the outcome data of theRCTs included in this meta-analysis were representative for clinical prac-tice. On the other hand, the results also showed that the data of theobservational studies did not systematically over- or underestimate theeffects of LTPP. When LTPP was compared to other methods of psy-chotherapy that were predominantly less intensive or shorter-term, itproved to be significantly superior with regard to overall outcome, targetproblems, and personality functioning. This meta-analysis was criticallydiscussed by CBT researchers (Bhar et al., 2010). In a detailed response,the authors of that meta-analysis addressed the critique (Leichsenring &Rabung, 2011a). In order to consider some of the critiques of the 2008meta-analysis (Leichsenring & Rabung, 2008), an update of that meta-analysis was carried out (Leichsenring & Rabung, 2011b). In this update,only controlled studies were included and only between-group effect

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


sizes were reported. Furthermore, only active treatments were permittedas control conditions. The updated meta-analysis corroborated the re-sults of the 2008 meta-analysis (Leichsenring & Rabung, 2008). LTPP wassuperior to shorter forms of interventions in complex mental disorders(Leichsenring & Rabung, 2011b). However, it seems to be hard for rep-resentatives of other therapeutic approaches to accept this result. In anattempt to test whether the results of the above mentioned meta-analyseson LTPP can be replicated, Smit et al. (2012) reported that they couldnot confirm the results. The meta-analysis by Smit et al., however, usedinclusion criteria that deviated from that of the previous meta-analyseson LTPP (Leichsenring & Rabung, 2008). As a result, they in fact com-pared LTPP to other forms of long-term psychotherapy (Leichsenring,Abbass, Luyten, Hilsenroth, & Rabung, 2012). Smit et al. (2012) did notfind significant differences in efficacy between LTPP and other formsof long-term psychotherapy. This result, however, does not contradictthe results of the previous meta-analyses (Leichsenring & Rabung, 2008,2011b), which compared LTPP to shorter forms of therapy. In addition,the meta-analysis by Smit et al. (2012) showed severe methodologicalflaws. Some of the studies included by Smit et al., for example, do notfulfill the inclusion criteria used by the authors themselves (Leichsenringet al., 2012). In addition, two studies included by Smit et al. (2012) asrepresenting LTPP did not, in fact, examine (long-term) psychodynamicpsychotherapy (Leichsenring et al., 2012). Furthermore, the meta-analysisby Smit et al. (2012) is characterized by several additional methodologicalflaws—for a detailed review see Leichsenring et al. (2012). In sum, themeta-analysis by Smit et al. (2012) seems to be highly biased against psy-chodynamic psychotherapy. Nevertheless, further studies are required toallow for more refined analyses addressing the effects of LTPP in spe-cific complex disorders, including comparisons to other specific forms oftherapies.

Meta-analytic Results for Psychodynamic Psychotherapyacross Mental Disorders

In a meta-analysis of psychodynamic psychotherapy across mental dis-orders we found psychodynamic psychotherapy was superior to wait listor treatment as usual, and it was equally effective to other psychother-apies (Leichsenring, Rabung, & Leibing, 2004). We found large effect

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


sizes for psychodynamic psychotherapy in target problems, general psy-chiatric problems, and social functioning. These effects were stable atfollow-up and tended to increase. This meta-analysis was criticized bysome CBT proponents as well (Bhar & Beck, 2009) We have respondedto this critique showing that it is not supported by any data (Leichsenring,Salzer, et al., 2011). In addition, this critique itself suffered from seriousmethodological shortcomings. Tolin (2010) presented a meta-analysis thataddressed the efficacy of cognitive behavior therapy compared to otherforms of psychotherapy. He reported CBT to be superior to psychody-namic psychotherapy. This meta-analysis, however, suffers from severalmethodological shortcomings.

• Some recent meta-analyses did not find superiority of CBT to otherforms of psychotherapy, including psychodynamic psychotherapy(e.g., Leichsenring et al., 2004; Cuijpers et al., 2008). Tolin (2010)did not mention these results. Tolin should have discussed why hisresults clearly deviated from that of these previous meta-analyses.One reason could be that only high quality studies were includedin those meta-analyses that did not find CBT to be superior to otherforms of psychotherapy (Leichsenring et al., 2004).

• Several RCT’s of psychodynamic psychotherapy were not included,e.g., the studies by Garner et al. (1993), Crits-Christoph et al. (1999,2001), Dare et al. (2001), Muran et al. (2005), Clarkin et al. (2007),Milrod et al. (2007), and Leichsenring et al. (2009). It is not clear whythe author did not include these studies. Thus, it is questionablewhether the results are representative of the available studies ofpsychodynamic psychotherapy.

• Contrary to Tolin’s (2010) own intention to only include bona fidetreatments, this meta-analysis included studies in which the non-CBTcomparison conditions represented “intent to fail” conditions (i.e.,poorly implemented conditions over which the favored therapy isintended to prevail), e.g., the study by Durham et al. (1994) com-paring CBT with short term psychodynamic psychotherapy. Froma methodological point of view, studies like this represent an “iso-lated evaluation” described by Scriven (1991) as not a “comparativeevaluation.” As Tolin correctly points out (p. 711) “intent to fail”conditions (isolated evaluations) only control for the common orunspecific treatment effects.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


• For post-therapy data, the superiority of CBT over alternative treat-ments corresponded only to small between-group effects sizes ofd = 0.22 (Table 3, p. 715). For the comparison of CBT and PDT,Tolin (2010) reported a d of 0.28. It is not clear what the clinicalsignificance of these small differences is. For different areas of out-come, all the differences in favor of CBT (Table 5, p. 716) were small(0.11–0.27).

• According to Tolin’s own analysis, most of the results in favor ofCBT compared to psychodynamic psychotherapy were not robustagainst file drawer effects (p. 713).3 This is true for all post-therapycomparisons and one-year follow-up comparisons. Only for the six-month comparisons were the results robust (p. 715).

• In presenting and discussing the results the author did not take intoaccount the small effect sizes in favor of CBT and the fact that onlysome of the results were robust against file drawer effects.

• Tolin attempted to take investigator allegiance effects into account.However, the procedures applied are not convincing.◦ It is not clear whether the data that he received about the investi-

gator allegiance are representative of the studies he included.◦ The author asked the principal investigators to self-rate their inves-

tigator allegiance. It is unclear whether this self-rated assessmentis reliable and valid. Self-ratings of investigator allegiance can beexpected to be biased.

◦ For this reason the results based on this self-report measure arequestionable. Thus, an effect of the investigator allegiance on theresults cannot really be ruled out by the procedures applied bythe author.

◦ The author did find a significant correlation between outcomeeffect sizes and the principal investigators’ investigator allegiancerating (for the therapists and the research team, the correlationswere not significant).

◦ The author used the investigator allegiance self-ratings as covari-ates in a regression analysis and found the effect sizes unchanged.However, the effects of the therapist and team allegiance self-ratings may conceal the effects of the investigator allegiance. Itwould be interesting to see the effect sizes if only the principal

3File drawer effect: unpublished studies that may change the results of a meta-analysis.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


investigators’ allegiance is controlled for. Tolin did not presentthese results.

• The methodological quality of studies was rated using criteria pro-posed by Jadad et al. (1996) and by Foa and Meadows (1997).However, the author did not report who rated the methodologi-cal quality. Were the raters trained? Was the reliability of the ratingsassessed? What was the reliability of the ratings? In addition, it wouldbe interesting to see the quality ratings for studies comparing CBTwith interpersonal therapy, psychodynamic psychotherapy, support-ive therapy, and others separately. Were there significant differences,for example, between studies comparing CBT with interpersonaltherapy, compared to studies comparing CBT with psychodynamicpsychotherapy?

• Tolin (2010) assessed the relative efficacy of CBT for several condi-tions, i.e., for different mental disorders (Table 4 in his article). Whydid he carry out statistical analysis lumping depressive and anxietydisorders together? Thus, it is unclear if these results refer to de-pressive disorders, to anxiety disorders, or to both of them. In Table4, results for anxiety and depressive disorders are listed separately.As stated by Tolin (p. 715), these results are not robust against filedrawer effects.

• With regard to the statistical analysis carried out by Tolin, severalissues may be critically discussed.◦ Tolin transformed results of dichotomous variables into odds ra-

tios, which he converted into Cohen’s d. Which procedures wereapplied here (formulas for converting)?

◦ As a measure of effect size, the author calculated Cohen’s d statis-tic. Apparently, the results presented in Tables 3, 4, and 5 in hisarticle represent Cohen’s d. Thus, these effect sizes seem to benot based on the random effects model. What are the results if theeffect sizes are based on the random effects model? They can beexpected to deviate from Cohen’s d.

◦ It is not clear how Tolin carried out tests of significance for Cohen’sd. Do the tests of significance reported refer to Cohen’s d, or toeffect sizes assessed by the random effects model?

◦ Tolin carried out a number of tests of significance. Did he adjustfor type I error inflation, or did they carry out power analysisaccording to the procedures described, for example, by Cohen?Some of the significant results may be due to chance. What is thestatistical power of the results the author reported?

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


◦ Tolin assessed the heterogeneity by use of the Q-statistic. In addi-tion to Q, the author should have calculated the I2 statistic (Huedo-Medina, Sanchez-Meca, Marin-Martinez, & Botella, 2006).4

To sum up, this meta-analysis is affected by several methodologicalflaws making the results questionable. The shortcomings described aboveraise serious questions of an investigator allegiance effect. A serious biasin favor of CBT cannot be ruled out.

In a recent review, Shedler (2010) came to the conclusion that effectsizes of PDT are as large as those reported for other forms of psychother-apy that are regarded as “empirically supported.” In addition, he foundthat effects of PDT were stable or tended to improve after the end oftreatment.

In a quality-based review of randomized controlled trials, Gerber et al.(2011) found PDT to be at least as efficacious as another active treatmentin 34 of 39 studies (87%). In comparison, with inactive conditions, PDTwas superior in 18 of 24 adequate comparisons (75%).

In another quality-based review of randomized controlled trials, Thomaet al. (2012) examined the methodological quality of RCTs of CBT in de-pression. Contrary to their expectation, the authors found no significantdifferences in methodological quality between RCTs of CBT in depres-sion and RCTs of PDT. Taking the frequently put forward criticism ofthe methodological quality of studies of PDT into account (e.g., Bharet al., 2010), the result reported by Thoma et al. (2012) is of some impor-tance. In another context, we showed that often double standards wereapplied when studies of PDT were criticized by representatives of otherapproaches (Leichsenring & Rabung, 2011a).

Discussion

Under the requirements of the criteria proposed by the Task Force modi-fied by Chambless and Hollon (1998), several RCTs are presently available

4The Q statistic is defined as the sum of the squared deviations of each study’s effect

estimate, weighting the contribution of each by its inverse variance. The Q statistic followsa chi-square distribution. The I2 statistic indicates the extent of true heterogeneity, dividingthe difference between the result of the Q test and its degrees of freedom by the Q valueitself and multiplying it by 100.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


that provide evidence for the efficacy of psychodynamic psychotherapyin specific mental disorders. There is evidence for the efficacy of PDT indepressive disorders, prolonged or complicated grief, anxiety disorders,posttraumatic stress disorder, eating disorders, somatic symptom disor-ders, substance related disorders, and personality disorders, includingboth less severe (Cluster C) and severe personality disorders (borderlinepersonality disorder). For posttraumatic stress disorder, only one RCT ex-ists (Brom et al., 1989). Thus, we urgently need further studies showingthat PDT is effective in complex posttraumatic stress disorders, i.e., inpatients suffering from childhood abuse. With regard to personality dis-orders, no RCTs exist for Cluster A personality disorders (e.g., paranoid,schizoid) and for some relevant Cluster B personality disorders (e.g.,narcissistic). This is true, however, for CBT as well. In addition furtherRCTs of long-term psychodynamic psychotherapy, especially in complexmental disorders, are required.

In the studies reviewed here, psychodynamic psychotherapy was eithermore effective than placebo therapy, supportive therapy, or treatmentas-usual, or no differences between psychodynamic psychotherapy andCBT, or between psychodynamic psychotherapy and pharmacotherapy,were found. These results are consistent with one of our meta-analysesof psychodynamic psychotherapy cited above (Leichsenring et al.,2004).

In a few studies, psychodynamic psychotherapy was superior to amethod of CBT (Milrod et al., 2007); in another study psychodynamicpsychotherapy was superior to CBT in some outcome measures (Clarkinet al., 2007). However, most of the studies that found no differencesin efficacy between psychodynamic psychotherapy and another bonafide treatment were not sufficiently powered. As reported above, test-ing for non-inferiority (i.e., equivalence) requires n1 = n2 = 86 patientsto detect an at least medium differences (effect size d = 0.5) betweentwo treatments with a sufficient power (α = 0.05, two tailed test, 1-β =0.90; Cohen, 1988). At present, only three RCT comparing psychody-namic psychotherapy with a bona fide treatment fulfill this criterion(Crits-Christoph et al., 1999; Knekt, Lindfors, Harkanen, et al., 2008; Le-ichsenring et al., 2013). The issue of small sample size studies, however,is not specific to studies of psychodynamic psychotherapy, since manystudies of CBT are also not sufficiently powered (Leichsenring & Rabung,2011a).

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


For comparisons of psychodynamic psychotherapy with bona fide ther-apies, the between-group effect sizes were found to be small (Leichsen-ring et al., 2004; Leichsenring, Salzer, et al., 2011, 2013). Thus, it is anopen question of research whether more highly powered studies wouldfind significant differences. Furthermore, the question has to be addressedwhether these (possibly small) differences are clinically relevant or sig-nificant (Jacobson & Truax, 1991).

It is important, however, to realize which mental disorders lack anyRCTs of psychodynamic psychotherapy. This is true, for example, fordissociative disorders and for some specific forms of personality disorders(e.g., narcissistic). For PTSD, only one RCT is presently available (Bromet al., 1989).

Some studies reported differences, at least in some measures, in favorof CBT. This is true, for example, for the studies on bulimia nervosaby Fairburn et al. (1986) and Garner et al. (1993), and for the studieson generalized anxiety disorder (Leichsenring et al., 2009) and socialphobia (Leichsenring, Salzer, et al., 2013). For the study on generalizedanxiety disorder (Leichsenring et al., 2009), we discussed above whethera stronger focus on the process of worrying would possibly improvethe results of psychodynamic psychotherapy. In general, more researchshould address the question whether the efficacy of psychodynamic psy-chotherapy can be improved by putting a stronger focus on the specificmechanisms that maintain the psychopathology of the respective disor-der. Mentalization-based therapy (MBT) or TFP may serve as good exam-ples for psychodynamic treatments that focus on the assumed processesor deficits maintaining a disorder.

According to the results of this review, further research of psychody-namic psychotherapy in specific mental disorders is necessary, includingstudies of both the outcome and the active ingredients of psychodynamicpsychotherapy in these disorders. Not only measures on symptoms andDSM criteria of a disorder should be applied, but also measures morespecific to psychodynamic psychotherapy. Future studies should alsoexamine if there are specific gains achieved only by psychodynamicpsychotherapy, i.e., the question of “added value.” Furthermore, thosemethods of therapy that have proved to work under experimental con-ditions of RCTs need to be studied for their effectiveness in the field(effectiveness studies). The perception that PDT lacks empirical supportis not consistent with available empirical evidence and may reflect selec-tive dissemination of research findings (Shedler, 2010).

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


REFERENCES

Abbass, A., & Driessen, E. (2010). The efficacy of short-term psychodynamicpsychotherapy for depression: A summary of recent findings. Acta PsychiatricaScandinavica, 121(5), 398–399.

Abbass, A., Kisely, S., & Kroenke, K. (2009). Short-term psychodynamic psy-chotherapy for somatic disorders. Systematic review and meta-analysis of clin-ical trials. Psychotherapy & Psychosomatics, 78(5), 265–274.

Abbass, A., Sheldon, A., Gyra, J., & Kalpin, A. (2008). Intensive short-term dy-namic psychotherapy for DSM-IV personality disorders: A randomized con-trolled trial. Journal of Nervous & Mental Diseases, 196(3), 211–216.

Baardseth, T, Goldberg, S. B., Pace, B. T., Wislocki, A. P., Frost, N. D., Siddiqui,J. R., . . . Wampold, B. E. (2013). Cognitive-behavioral therapy versus othertherapies: Redux. Clinical Psychology Review, 33, 395–405.

Bachar, E., Latzer, Y., Kreitler, S., & Berry, E. M. (1999). Empirical comparisonof two psychological therapies. Self psychology and cognitive orientation inthe treatment of anorexia and bulimia. Journal of Psychotherapy Practice &Research, 8(2), 115–128.

Barber, J. P., Barrett, M. S., Gallop, R., Rynn, M. A., & Rickels, K. (2012). Short-termdynamic psychotherapy versus pharmacotherapy for major depressive disorder:A randomized, placebo-controlled trial. Journal of Clinical Psychiatry, 73(1),66–73.

Barkham, M., Rees, A., Shapiro, D. A., Stiles, W. B., Agnew, R. M., Halstead, J., . . .

Harrington, V. M. (1996). Outcomes of time-limited psychotherapy in appliedsettings: replicating the Second Sheffield Psychotherapy Project. Journal ofConsulting & Clinical Psychology, 64(5), 1079–1085.

Bateman, A., & Fonagy, P. (1999). Effectiveness of partial hospitalization in thetreatment of borderline personality disorder: a randomized controlled trial.American Journal of Psychiatry, 156(10), 1563–1569.

Bateman, A., & Fonagy, P. (2001). Treatment of borderline personality disorderwith psychoanalytically oriented partial hospitalization: An 18-month follow-up. American Journal of Psychiatry, 158(1), 36–42.

Bateman, A., & Fonagy, P. (2009). Randomized controlled trial of outpatientmentalization-based treatment versus structured clinical management for bor-derline personality disorder. American Journal of Psychiatry, 166(12), 1355–1364.

Benish, S. G., Imel, Z. E., & Wampold, B. E. (2008). The relative efficacy of bonafide psychotherapies for treating post-traumatic stress disorder: A meta-analysisof direct comparisons. Clinical Psychology Review, 28(5), 746–758.

Bhar, S. S., & Beck, A. T. (2009). Treatment integrity of studies that compare short-term psychodynamic psychotherapy with cognitive-behavior therapy. ClinicalPsychology: Science & Practice, 16(3), 370–378.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


Bhar, S. S., Thombs, B. D., Pignotti, M., Bassel, M., Jewett, L., Coyne, J. C., & Beck,A. T. (2010). Is longer-term psychodynamic psychotherapy more effective thanshorter-term therapies? Review and critique of the evidence. Psychotherapy &Psychosomatics, 79(4), 208–216.

Bogels, S. M., Wijts, P., Oort, F. J., & Sallaerts, S. J. (2014). Psychodynamic psy-chotherapy versus cognitive behavior therapy for social anxiety disorders: Anefficacy and partial effectiveness trial. Depression and Anxiety. Advance onlinepublication.

Bressi, C., Porcellana, M., Marinaccio, P. M., Nocito, E. P., & Magri, L. (2010).Short-term psychodynamic psychotherapy versus treatment as usual for de-pressive and anxiety disorders: A randomized clinical trial of efficacy. Journalof Nervous & Mental Diseases, 198(9), 647–652.

Brom, D., Kleber, R. J., & Defares, P. B. (1989). Brief psychotherapy for post-traumatic stress disorders. Journal of Consulting & Clinical Psychology, 57(5),607–612.

Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported thera-pies. Journal of Consulting & Clinical Psychology, 66(1), 7–18.

Clarkin, J. F., Levy, K. N., Lenzenweger, M. F., & Kernberg, O. F. (2007). Evalu-ating three treatments for borderline personality disorder: a multiwave study.American Journal of Psychiatry, 164(6), 922–928.

Clarkin, J. F., Yeomans, F. E., & Kernberg, O. F. (1999). Psychotherapy ofborderline-personality. New York, NY: Wiley.

Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale,NJ: Lawrence Erlbaum Associates.

Creed, F., Fernandes, L., Guthrie, E., Palmer, S., Ratcliffe, J., Read, N., . . . Tomen-son, B. (2003). The cost-effectiveness of psychotherapy and paroxetine forsevere irritable bowel syndrome. Gastroenterology, 124(2), 303–317.

Crits-Christoph, P., Connolly Gibbons, M. B., Narducci, J., Schamberger, M., &Gallop, R. (2005). Interpersonal problems and the outcome of interpersonallyoriented psychodynamic treatment of GAD. Psychotherapy: Theory, Research,Practice, Training, 42, 211–224.

Crits-Christoph, P., Siqueland, L., Blaine, J., Frank, A., Luborsky, L., Onken, L. S.,. . . Beck, A. T. (1999). Psychosocial treatments for cocaine dependence: Na-tional Institute on Drug Abuse Collaborative Cocaine Treatment Study. Archivesof General Psychiatry, 56(6), 493–502.

Crits-Christoph, P., Siqueland, L., McCalmont, E., Weiss, R. D., Gastfriend, D.R., Frank, A., . . . Thase, M. E. (2001). Impact of psychosocial treatments onassociated problems of cocaine-dependent patients. Journal of Consulting &Clinical Psychology, 69(5), 825–830.

Crits-Christoph, P., Wolf-Palacio, D., Ficher, M., & Rudick, D. (1995). Briefsupportive-expressive psychodynamic therapy for generalized anxiety disorder.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


In J. Barber & P. Crits-Christoph (Eds.), Dynamic therapies for psychiatric dis-orders (Axis I) (pp. 43–83). New York, NY: Basic Books.

Cuijpers, P., van Straten, A., Andersson, G., & van Oppen, P. (2008). Psychother-apy for depression in adults: A meta-analysis of comparative outcome studies.Journal of Consulting & Clinical Psychology, 76(6), 909–922.

Dare, C., Eisler, I., Russell, G., Treasure, J., & Dodge, L. (2001). Psychologicaltherapies for adults with anorexia nervosa: Randomised controlled trial of out-patient treatments. British Journal of Psychiatry, 178, 216–221.

Doering, S., Horz, S., Rentrop, M., Fischer-Kern, M., Schuster, P., Benecke, C.,. . . Buchheim, P. (2010). Transference-focused psychotherapy v. treatment bycommunity psychotherapists for borderline personality disorder: randomisedcontrolled trial. Brithish Journal of Psychiatry, 196(5), 389–395.

Driessen, E., Cuijpers, P., de Maat, S. C., Abbass, A. A., de Jonghe, F., & Dekker,J. J. (2010). The efficacy of short-term psychodynamic psychotherapy for de-pression: A meta-analysis. Clinical Psychology Review, 30(1), 25–36.

Durham, R. C., Murphy, T., Allan, T., Richard, K., Treliving, L. R., & Fenton, G.W. (1994). Cognitive therapy, analytic psychotherapy and anxiety managementtraining for generalised anxiety disorder. British Journal of Psychiatry, 165(3),315–323.

Ehlers, A., Bisson, J., Clark, D. M., Creamer, M., Pilling, S., Richards, D., . . . Yule,W. (2010). Do all psychological treatments really work the same in posttrau-matic stress disorder? Clinical Psychology Review, 30(2), 269–276.

Emmelkamp, P. M., Benner, A., Kuipers, A., Feiertag, G. A., Koster, H. C., & vanApeldoorn, F. J. (2006). Comparison of brief dynamic and cognitive-behaviouraltherapies in avoidant personality disorder. British Journal of Psychiatry, 189,60–64.

Fairburn, C. G. (2005). Evidence-based treatment of anorexia nervosa. Interna-tional Journal of Eating Disorders, 37(Suppl.), S26–S30.

Fairburn, C. G., Kirk, J., O’Connor, M., & Cooper, P. J. (1986). A comparisonof two psychological treatments for bulimia nervosa. Behaviour Research &Therapy, 24(6), 629–643.

Fairburn, C. G., Norman, P. A., Welch, S. L., O’Connor, M. E., Doll, H. A., &Peveler, R. C. (1995). A prospective study of outcome in bulimia nervosa andthe long-term effects of three psychological treatments. Archives of GeneralPsychiatry, 52(4), 304–312.

Foa, E. B., & Meadows, E. A. (1997). Psychosocial treatments for posttraumaticstress disorder: a critical review. Annual Review of Psychology, 48, 449–480.

Fonagy, P., Roth, A., & Higgitt, A. (2005). Psychodynamic psychotherapies:evidence-based practice and clinical wisdom. Bulletin of the Menninger Clinic,69(1), 1–58.

Gabbard, G. O. (2004). Long-term psychodynamic psychotherapy. Washington,DC: American Psychiatric Publishing.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


Gallagher-Thompson, D., Hanley-Peterson, P., & Thompson, L. W. (1990). Main-tenance of gains versus relapse following brief psychotherapy for depression.Journal of Consulting & Clinical Psychology, 58(3), 371–374.

Gallagher-Thompson, D., & Steffen, A. M. (1994). Comparative effects ofcognitive-behavioral and brief psychodynamic psychotherapies for depressedfamily caregivers. Journal of Consulting & Clinical Psychology, 62(3), 543–549.

Garner, D. M., Rockert, W., Davis, R., Garner, M. V., Olmsted, M. P., & Eagle, M.(1993). Comparison of cognitive-behavioral and supportive-expressive therapyfor bulimia nervosa. American Journal of Psychiatry, 150(1), 37–46.

Gerber, A. J., Kocsis, J. H., Milrod, B. L., Roose, S. P., Barber, J. P., Thase, M. E.,. . . Leon, A. C. (2011). A quality-based review of randomized controlled trials ofpsychodynamic psychotherapy. American Journal of Psychiatry, 168(1), 19–28.

Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., vanAsselt, T., . . . Arntz, A. (2006). Outpatient psychotherapy for borderline per-sonality disorder: Randomized trial of schema-focused therapy vs. transference-focused psychotherapy. Archives of General Psychiatry, 63(6), 649–658.

Gowers, S., Norton, K., Halek, C., & Crisp, A. H. (1994). Outcome of outpatientpsychotherapy in a random allocation treatment study of anorexia nervosa.International Journal of Eating Disorders, 15(2), 165–177.

Gregory, R. J., Chlebowski, S., Kang, D., Remen, A. L., Soderberg, M. G., Step-kovitch, J., & Virk, S. (2008). A controlled trial of psychodynamic psychother-apy for co-occurring borderline personality disorder and alcohol use disorder.Psychotherapy: Theory, Research, Practice, Training, 45(1), 28–41.

Gunderson, J. G., & Gabbard, G. O. (1999). Making the case for psychoana-lytic therapies in the current psychiatric environment. Journal of the AmericanPsychoanalytic Association, 47(3), 679–704.

Guthrie, E., Creed, F., Dawson, D., & Tomenson, B. (1991). A controlled trialof psychological treatment for the irritable bowel syndrome. Gastroenterology,100(2), 450–457.

Hamilton, J., Guthrie, E., Creed, F., Thompson, D., Tomenson, B., Bennett, R., . . .

Liston, R. (2000). A randomized controlled trial of psychotherapy in patientswith chronic functional dyspepsia. Gastroenterology, 119(3), 661–669.

Hellerstein, D. J., Rosenthal, R. N., Pinsker, H., Samstag, L. W., Muran, J. C., &Winston, A. (1998). A randomized prospective study comparing supportive anddynamic therapies: Outcome and alliance. Journal of Psychotherapy Practice &Research, 7(4), 261–271.

Horowitz, L. M., Alden, L. E., Wiggins, J. S., & Pincus, A. L. (2000). Inventory ofInterpersonal Problems: Manual. Odessa, FL: Psychological Corp.

Huedo-Medina, T. B., Sanchez-Meca, J., Marin-Martinez, F., & Botella, J. (2006).Assessing heterogeneity in meta-analysis: Q statistic or I2 index? PsychologicalMethods, 11(2), 193–206.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach todefining meaningful change in psychotherapy research. Journal of Consulting& Clinical Psychology, 59(1), 12–19.

Jadad, A. R., Moore, R. A., Carroll, D., Jenkinson, C., Reynolds, D. J., Gavaghan,D. J., & McQuay, H. J. (1996). Assessing the quality of reports of randomizedclinical trials: Is blinding necessary? Controlled Clinical Trials, 17(1), 1–12.

Johansson, R., Ekbladh, S., Hebert, A., Lindstrom, M., Moller, S., Petitt, E., . . .

Andersson, G. (2012). Psychodynamic guided self-help for adult depressionthrough the Internet: A randomised controlled trial. PLoS One, e38021.

Kernberg, O. F. (1996). A psychoanalytic model for the classification of person-ality disorders. In M. Achenheil, B. Bondy, R. Engel, M. Ermann, & N. Nedopil(Eds.), Implications of psychopharmacology to psychiatry (pp. 66–78). NewYork, NY: Springer.

Knekt, P., Lindfors, O., Harkanen, T., Valikoski, M., Virtala, E., Laaksonen, M.A., . . . Renlund, C. (2008). Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapyon psychiatric symptoms during a 3-year follow-up. Psychological Medicine,38(5), 689–703.

Knekt, P., Lindfors, O., Laaksonen, M. A., Raitasalo, R., Haaramo, P., & Jarvikoski,A. (2008). Effectiveness of short-term and long-term psychotherapy on workability and functional capacity: A randomized clinical trial on depressive andanxiety disorders. Journal of Affective Disorders, 107(1–3), 95–106.

Knijnik, D. Z., Kapczinski, F., Chachamovich, E., Margis, R., & Eizirik, C. L. (2004).Psicoterapia psicodinamica em grupo para fobia social generalizada [Psycho-dynamic group treatment for generalized social phobia]. Revista Brasileira dePsiquiatria, 26(2), 77–81.

Kopta, S. M., Howard, K. I., Lowry, J. L., & Beutler, L. E. (1994). Patterns ofsymptomatic recovery in psychotherapy. Journal of Consulting & Clinical Psy-chology, 62(5), 1009–1016.

Leichsenring, F. (2001). Comparative effects of short-term psychodynamic psy-chotherapy and cognitive-behavioral therapy in depression: A meta-analyticapproach. Clinical Psychology Review, 21(3), 401–419.

Leichsenring, F. (2004). Randomized controlled versus naturalistic studies: A newresearch agenda. Bulletin of the Menninger Clinic, 68(2), 137–151.

Leichsenring, F. (2005). Are psychodynamic and psychoanalytic therapies effec-tive?: A review of empirical data. International Journal of Psychoanalysis, 86(3),841–868.

Leichsenring, F., Abbass, A., Luyten, P., Hilsenroth, P., & Rabung, S. (2012).The emerging evidence for long-term psychodynamic therapy. Unpublishedmanuscript.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


Leichsenring, F., & Leibing, E. (2003). The effectiveness of psychodynamic ther-apy and cognitive behavior therapy in the treatment of personality disorders:A meta-analysis. American Journal of Psychiatry, 160(7), 1223–1232.

Leichsenring, F., & Leibing, E. (2007). Cognitive-behavioural therapy for avoidantpersonality disorder. British Journal of Psychiatry, 190, 80.

Leichsenring, F., Leibing, E., Kruse, J., New, A., & Leweke, F. (2011). Borderlinepersonality disorder. Lancet, 377(9759), 74–84.

Leichsenring, F., & Rabung, S. (2008). Effectiveness of long-term psychodynamicpsychotherapy: A meta-analysis. Journal of the American Medical Association,300(13), 1551–1565.

Leichsenring, F., & Rabung, S. (2011a). Double standards in psychotherapy re-search. Psychotherapy & Psychosomatics, 80(1), 48–51.

Leichsenring, F., & Rabung, S. (2011b). Long-term psychodynamic psychotherapyin complex mental disorders: Update of a meta-analysis. British Journal ofPsychiatry, 199(1), 15–22.

Leichsenring, F., Rabung, S., & Leibing, E. (2004). The efficacy of short-term psy-chodynamic psychotherapy in specific psychiatric disorders: A meta-analysis.Archives of General Psychiatry, 61(12), 1208–1216.

Leichsenring, F., Salzer, S., Hilsenroth, M., Leibing, E., Leweke, F., & Rabung,S. (2011). Treatment integrity: An unresolved issue in psychotherapy research.Current Psychiatry Reviews, 7, 313–321.

Leichsenring, F., Salzer, S., Jaeger, U., Kachele, H., Kreische, R., Leweke, F., . . .

Leibing, E. (2009). Short-term psychodynamic psychotherapy and cognitive-behavioral therapy in generalized anxiety disorder: A randomized, controlledtrial. American Journal of Psychiatry, 166(8), 875–881.

Leichsenring, F., Salzer, S., Beutel, M. E., Herpertz, S., Hiller, W., Hoyer, J., . . .

Leibing, E. (2013). Psychodynamic therapy and cognitive therapy in socialanxiety disorder : A multicenter randomized controlled trial. American Journalof Psychiatry, 170(7), 759–767.

Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard,H. L., . . . Lindenboim, N. (2006). Two-year randomized controlled trial andfollow-up of dialectical behavior therapy vs. therapy by experts for suicidalbehaviors and borderline personality disorder. Archives of General Psychiatry,63(7), 757–766.

Linehan, M. M., Tutek, D. A., Heard, H. L., & Armstrong, H. E. (1994). Inter-personal outcome of cognitive behavioral treatment for chronically suicidalborderline patients. American Journal of Psychiatry, 151(12), 1771–1776.

Luborsky, L. (1984). Principles of psychoanalytic psychotherapy: Manual forsupportive-expressive treatment. New York, NY: Basic Books.

Luborsky, L., Diguer, L., Seligman, D., Rosenthal, R., Krause, E. D., Johnson, S.,. . . Schweizer, E. (1999). The researcher’s own therapy llegiances: A “wild card”

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


in comparisons of treatment efficacy. Clinical Psychology: Science & Practice,6(1), 95–106.

Maina, G., Forner, F., & Bogetto, F. (2005). Randomized controlled trial comparingbrief dynamic and supportive therapy with waiting list condition in minordepressive disorders. Psychother Psychosom, 74(1), 43–50.

Malan, D. H. (1976). Toward the validation of dynamic psychotherapy. New York,NY: Plenum.

McCallum, M., & Piper, W. E. (1990). A controlled study of effectiveness andpatient suitability for short-term group psychotherapy. International Journal ofGroup Psychotherapy, 40(4), 431–452.

Milrod, B., Leon, A. C., Busch, F., Rudden, M., Schwalberg, M., Clarkin, J., . . .

Shear, M. K. (2007). A randomized controlled clinical trial of psychoanalyticpsychotherapy for panic disorder. American Journal of Psychiatry, 164(2),265–272.

Monsen, K., & Monsen, T. J. (2000). Chronic pain and psychodynamic bodytherapy. Psychotherapy: Theory, Research, Practice, Training, 37, 257–269.

Munroe-Blum, H., & Marziali, E. (1995). A controlled trial of short-term grouptreatment for borderline personality disorder. Journal of Personality Disorders,9, 190–198.

Muran, J. C., Safran, J. D., Samstag, L. W., & Winston, A. (2005). Evaluatingan alliance-focused treatment for personality disorders. Psychotherapy: Theory,Research, Practice, Training, 42, 532–545.

Piper, W. E., McCallum, M., Joyce, A. S., Rosie, J. S., & Ogrodniczuk, J. S. (2001).Patient personality and time-limited group psychotherapy for complicated grief.International Journal of Group Psychotherapy, 51(4), 525–552.

Roth, A. D., & Parry, G. (1997). The implications of psychotherapy research forclinical practice and service development: Lessons and limitations. Journal ofMental Health, 6, 367–380.

Rothwell, P. M. (2005). External validity of randomised controlled trials: “Towhom do the results of this trial apply?” Lancet, 365(9453), 82–93.

Salminen, J. K., Karlsson, H., Hietala, J., Kajander, J., Aalto, S., Markkula, J., . . .

Toikka, T. (2008). Short-term psychodynamic psychotherapy and fluoxetine inmajor depressive disorder: A randomized comparative study. Psychotherapy &Psychosomatics, 77(6), 351–357.

Salzer, S., Winkelbach, C., Leweke, F., Leibing, E., & Leichsenring, F. (2011).Long-term effects of short-term psychodynamic psychotherapy and cognitive-behavioural therapy in generalized anxiety disorder: 12-month follow-up.Canadian Journal of Psychiatry, 56(8), 503–508.

Sandahl, C., Herlitz, K., Ahlin, G., & Ronnberg, S. (1998). Time-limited grouppsychotherapy for moderately alcohol dependent patients: A randomized con-trolled clinical trial. Psychotherapy Research, 8, 361–378.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


Sattel, H., Lahmann, C., Gundel, H., Guthrie, E., Kruse, J., Noll-Hussong, M., . . .

Henningsen, P. (2012). Brief psychodynamic interpersonal psychotherapy forpatients with multisomatoform disorder: randomised controlled trial. BritishJournal of Psychiatry, 200(1), 60–67.

Scriven, M. (1991). Evaluation thesaurus. Newbury Park, CA: Sage.Shapiro, D. A., Barkham, M., Rees, A., Hardy, G. E., Reynolds, S., & Startup, M.

(1994). Effects of treatment duration and severity of depression on the effective-ness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy.Journal of Consulting & Clinical Psychology, 62(3), 522–534.

Shapiro, D. A., & Firth, J. A. (1985). Exploratory therapy manual for the SheffieldPsychotherapy Project (SAPU Memo 733). Sheffield, UK: University of Sheffield.

Shapiro, D. A., Rees, A., Barkham, M., Hardy, G., Reynolds, S., & Startup, M.(1995). Effects of treatment duration and severity of depression on the main-tenance of gains after cognitive-behavioral and psychodynamic-interpersonalpsychotherapy. Journal of Consulting & Clinical Psychology, 63(3), 378–387.

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psy-chologist, 65(2), 98–109.

Silverberg, F. (2005). Make the leap: A practical guide to breaking the patternsthat hold you back. New York, NY: Marlowe & Co.

Smit, Y., Huibers, M. J., Ioannidis, J. P., van Dyck, R., van Tilburg, W., & Arntz, A.(2012). The effectiveness of long-term psychoanalytic psychotherapy: A meta-analysis of randomized controlled trials. Clinical Psychology Review, 32(2),81–92.

Svartberg, M., Stiles, T. C., & Seltzer, M. H. (2004). Randomized, controlled trial ofthe effectiveness of short-term dynamic psychotherapy and cognitive therapyfor cluster C personality disorders. American Journal of Psychiatry, 161(5),810–817.

Tasca, G. A., Ritchie, K., Conrad, G., Balfour, L., Gayton, J., Lybanon, V., &Bissadac, H. (2006). Attachment scales predict outcome in a randomized con-trolled trial of two group therapies for binge eating disorder: An aptitude bytreatment interaction. Psychotherapy Research, 16(1), 106–121.

Thoma, N. C., McKay, D., Gerber, A. J., Milrod, B. L., Edwards, A. R., & Koc-sis, J. H. (2012). A quality-based review of randomized controlled trials ofcognitive-behavioral therapy for depression: An assessment and metaregres-sion. American Journal of Psychiatry, 169(1), 22–30.

Thompson, L. W., Gallagher, D., & Breckenridge, J. S. (1987). Comparative ef-fectiveness of psychotherapies for depressed elders. Journal of Consulting &Clinical Psychology, 55(3), 385–390.

Tolin, D. F. (2010). Is cognitive-behavioral therapy more effective than othertherapies? A meta-analytic review. Clinical Psychology Review, 30(6), 710–720.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


Town, J. M., Abbass, A., & Hardy, G. (2011). Short-term psychodynamic psy-chotherapy for personality disorders: A critical review of randomized controlledtrials. Journal of Personality Disorders, 25, 723–740.

Wallerstein, R. S. (1989). The Psychotherapy Research Project of the MenningerFoundation: An overview. Journal of Consulting & Clinical Psychology, 57(2),195–205.

Wampold, B. E., Imel, Z. E., Laska, K. M., Benish, S., Miller, S. D., Fluckiger,C., . . . Budge, C. (2010). Determining what works in the treatment of PTSD.Clinical Psychology Review, 30(8), 923–933.

Wampold, B. E., Minami, T., Baskin, T. W., & Callen Tierney, S. (2002). A meta-(re)analysis of the effects of cognitive therapy versus “other therapies” fordepression. Journal of Affective Disorders, 68(2–3), 159–165.

Westen, D., Novotny, C. M., & Thompson-Brenner, H. (2004). The empiri-cal status of empirically supported psychotherapies: Assumptions, findings,and reporting in controlled clinical trials. Psychological Bulletin, 130(4), 631–663.

Winston, A., Laikin, M., Pollack, J., Samstag, L. W., McCullough, L., & Muran, J. C.(1994). Short-term psychotherapy of personality disorders. American Journalof Psychiatry, 151(2), 190–194.

Woody, G., Luborsky, L., McLellan, A. T., & O’Brien, C. P. (1990). Correctionsand revised analyses for psychotherapy in methadone maintenance patients.Archives of General Psychiatry, 47(8), 788–789.

Woody, G. E., Luborsky, L., McLellan, A. T., O’Brien, C. P., Beck, A. T., Blaine,J., . . . Hole, A. (1983). Psychotherapy for opiate addicts. Does it help? Archivesof General Psychiatry, 40(6), 639–645.

Woody, G. E., McLellan, A. T., Luborsky, L., & O’Brien, C. P. (1995). Psychother-apy in community methadone programs: A validation study. American Journalof Psychiatry, 152(9), 1302–1308.

Falk Leichsenring, D.Sc., is a professor for psychotherapy research at the Uni-versity of Giessen. He is psychologist, psychoanalyst, and training analyst. Hehas published extensively on psychotherapy research, including questions ofmethodology and philosophy of science.

Susanne Klein, M.Sc., earned her master’s in psychology at the University ofInnsbruck, Austria (2010). In 2011, she joined the team of psychotherapy researchat the Department of Psychosomatics and Psychotherapy at the University ofGiessen, Germany. She has been working as a research assistant on the socialphobia psychotherapy research network (SOPHO-NET).

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4


Simone Salzer, D.Sc., is a post-doc researcher at the Clinic of PsychosomaticMedicine and Psychotherapy, University of Goettingen, Germany. She is a psy-chologist, currently in psychoanalytic training, and her research focuses on theefficacy and effectiveness of psychodynamic therapies.

Dow

nloa

ded

by [

Ast

on U

nive

rsity

] at

23:

39 2

7 A

ugus

t 201

4

Update of Empirical Evidence Mental ... - Clínica...

Documents

Transcript of Update of Empirical Evidence Mental ... - Clínica...