Abstract
Data on the comparative effect of short- and long-term psychotherapy in anxiety disorders is scarce.
The study compared outcomes of two short-term therapies and one long-term psychotherapy in the treatment of patients with anxiety disorders in secondary analyses of a large randomized trial. Altogether 50 outpatients with anxiety disorders as the only axis I diagnosis were randomized to long-term psychodynamic psychotherapy (LPP), short-term psychodynamic psychotherapy (SPP), and solution-focused therapy (SFT) and were followed for 5 years. The outcome measures were psychiatric symptoms, work ability, need for psychiatric treatment, remission, and cost-effectiveness. During the first year of follow-up, no significant outcome differences were noted. During the following 3 years, LPP and SFT more effectively reduced symptoms, improved work ability, and elevated the remission rate than SPP. No significant differences between LPP and SFT were seen. At the end of the follow-up, the use of auxiliary treatment was lowest in SFT, whereas no other outcome differences were noted. The average total direct costs were about three times higher in LPP than in the short-term therapy groups. In conclusion, the resource-oriented SFT may be a cost-effective option in this patient group, while unconsidered allocation of patients to LPP does not appear to be cost-effective.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders DSM-IV (4th ed.). Washington, DC: APA.
Anderson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014). Guided Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: A systematic review and meta-analysis. World Psychiatry, 13, 288–295.
Andrews, G., Slade, T., & Issakidis, C. (2002). Deconstructing current comorbidity: Data from the Australian National Survey of mental health and well-being. British Journal of Psychiatry, 181, 306–314.
Bandelow, B., Lichte, T., Rudolf, S., Wiltink, J., & Beutel, M. E. (2014). The diagnosis and treatment recommendations for anxiety disorders. Deutsches Ärzteblatt International, 111, 473–480.
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988). Psychometric properties of the beck depression inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8, 77–100.
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.
Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110, 585–599.
Busch, F. N., Milrod, B. L., Singer, M. B., & Aronson, A. B. (2011). Manual of panic focused psychodynamic psychotherapy – extended range (1st ed.). New York: Routledge.
Cuijpers, P., Gentili, C., Banos, R. M., Garcia-Campayo, J., Botella, C., & Cristea, I. A. (2016). Relative effects of cognitive and behavioral therapies on generalized anxiety disorder, social anxiety disorder and panic disorder: A meta-analysis. Journal of Anxiety Disorders, 43, 79–89.
de Shazer, S., 1985. Keys to solution in brief therapy. W. W. Norton & Company, New York.
de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar, A., Gingerich, W., & Weiner-Davis, M. (1986). Brief therapy: Focused solution development. Family Process, 25, 207–221.
Derogatis, L. R., Lipman, R. S., & Covi, L. (1973). SCL-90: An outpatient psychiatric rating scale--preliminary report. Psychopharmacology Bulletin, 9, 13–28.
Falkenstrom, F., Grant, J., Broberg, J., & Sandell, R. (2007). Self-analysis and post-termination improvement after psychoanalysis and long-term psychotherapy. Journal of the American Psychoanalytic Association, 55, 629–674.
Gabbard, G. O. (1992). Psychodynamics of panic disorder and social phobia. Bulletin of the Menninger Clinic, 56, A3–A13.
Gabbard, G. O. (2004). Long-term psychodynamic psychotherapy: A basic text (1st ed.). Arlington, VA: American Psychiatric Publishing.
Gabbard, G. O., Gunderson, J. G., & Fonagy, P. (2002). The place of psychoanalytic treatments within psychiatry. Archives of General Psychiatry, 59, 505–510.
Gibbons, M. B., Crits-Christoph, P., Barber, J. P., Wiltsey Stirman, S., Gallop, R., Goldstein, L. A., … Ring-Kurtz, S. (2009). Unique and common mechanisms of change across cognitive and dynamic psychotherapies. Journal of Consulting and Clinical Psychology, 77, 801–813.
Graubard, B. I., & Korn, E. L. (1999). Predictive margins with survey data. Biometrics, 55, 652–659.
Härkänen, T., Arjas, E., Laaksonen, M. A., Lindfors, O., Haukka, J., & Knekt, P. (2016). Estimating efficacy in the presence of non-ignorable non-trial interventions in the Helsinki Psychotherapy Study. Statistical Methods in Medical Research, 25, 885–901.
Härkänen, T., Knekt, P., Virtala, E., & Lindfors, O. (2005). A case study in comparing therapies involving informative drop-out, non-ignorable non-compliance and repeated measurements. Statistics in Medicine, 24, 3773–3787.
Holi, M. M., Marttunen, M., & Aalberg, V. (2003). Comparison of the GHQ-36, the GHQ-12 and the SCL-90 as psychiatric screening instruments in the Finnish population. Nordic Journal of Psychiatry, 57, 233–238.
Holmqvist, R., Strom, T., & Foldemo, A. (2014). The effects of psychological treatment in primary care in Sweden--a practice-based study. Nordic Journal of Psychiatry, 68, 204–212.
Ilmarinen, J., Tuomi, K., & Klockars, M. (1997). Changes in the work ability of active employees over an 11-year period. Scandinavian Journal of Work, Environment & Health, 23(Suppl 1), 49–57.
Keefe, J. R., McCarthy, K. S., Dinger, U., Zilcha-Mano, S., & Barber, J. P. (2014). A meta-analytic review of psychodynamic therapies for anxiety disorders. Clinical Psychology Review, 34, 309–323.
Knekt, P., Heinonen, E., Härkäpää, K., Järvikoski, A., Virtala, E., Rissanen, J., et al. (2015). Randomized trial on the effectiveness of long- and short-term psychotherapy on psychosocial functioning and quality of life during a 5-year follow-up. Psychiatry Research, 229, 381–388.
Knekt, P., Lindfors, O., (2004). A randomized trial of the effect of four forms of psychotherapy on depressive and anxiety disorders: Design, methods, and results on the effectiveness of short-term psychodynamic psychotherapy and solution-focused therapy during a one-year follow-up, studies in social security and health; 77. Helsinki, Finland: Social Insurance Institution.
Knekt, P., Lindfors, O., Härkänen, T., Välikoski, M., Virtala, E., Laaksonen, M. A., et al. (2008). Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up. Psychological Medicine, 38, 689–703.
Knekt, P., Lindfors, O., Laaksonen, M. A., Raitasalo, R., Haaramo, P., Järvikoski, A., et al. (2008). Effectiveness of short-term and long-term psychotherapy on work ability and functional capacity--a randomized clinical trial on depressive and anxiety disorders. Journal of Affective Disorders, 107, 95–106.
Knekt, P., Lindfors, O., Renlund, C., Sares-Jäske, L., Laaksonen, M. A., & Virtala, E. (2011). Use of auxiliary psychiatric treatment during a 5-year follow-up among patients receiving short- or long-term psychotherapy. Journal of Affective Disorders, 135, 221–230.
Knekt, P., Lindfors, O., Sares-Jäske, L., Virtala, E., & Härkänen, T. (2013). Randomized trial on the effectiveness of long- and short-term psychotherapy on psychiatric symptoms and working ability during a 5-year follow-up. Nordic Journal of Psychiatry, 67, 59–68.
Knekt, P., Virtala, E., Härkänen, T., Vaarama, M., Lehtonen, J., & Lindfors, O. (2016). The outcome of short- and long-term psychotherapy 10 years after start of treatment. Psychological Medicine, 46, 1175–1188.
Laaksonen, M. A., Lindfors, O., Knekt, P., & Aalberg, V. (2012). Suitability for psychotherapy scale (SPS) and its reliability, validity, and prediction. British Journal of Clinical Psychology, 51, 351–375.
Lee, J. (1981). Covariance adjustment of rates based on the multiple logistic regression model. Journal of Chronic Diseases, 34, 415–426.
Lehtinen, V., Joukamaa, M., Jyrkinen, T., Lahtela, K., Raitasalo, R., & Aromaa, A. (1991). Suomalaisten aikuisten mielenterveys ja mielenterveyden häiriöt. (In Finnish with an English summary: Mental health and mental disorders in Finnish adults). Helsinki and Turku: Kansaneläkelaitoksen julkaisuja AL:33.
Leichsenring, F., Beutel, M., & Leibing, E. (2007). Psychodynamic psychotherapy for social phobia: A treatment manual based on supportive-expressive therapy. Bulletin of the Menninger Clinic, 71, 56–83.
Leichsenring, F., & Rabung, S. (2011). Long-term psychodynamic psychotherapy in complex mental disorders: Update of a meta-analysis. British Journal of Psychiatry, 199, 15–22.
Leichsenring, F., Salzer, S., Beutel, M. E., Herpertz, S., Hiller, W., Hoyer, J., … Leibing, E. (2014). Long-term outcome of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder. American Journal of Psychiatry, 171, 1074–1082.
Lindfors, O., Knekt, P., Heinonen, E., Härkänen, T., Virtala, E., & Helsinki Psychotherapy Study Group. (2015). The effectiveness of short- and long-term psychotherapy on personality functioning during a 5-year follow-up. Journal of Affective Disorders, 173, 31–38.
Luborsky, L. (1984). Principles of psychoanalytic psychotherapy: A manual for supportive-expressive treatment. New York: Basic Books.
Malan, D. (1976). The frontier of brief psychotherapy: An example of the convergence of research and clinical practice. New York: Plenum Medical Book Co.
Maljanen, T., Knekt, P., Lindfors, O., Virtala, E., Tillman, P., Härkänen, T., & Helsinki Psychotherapy Study Group (2016). The cost-effectiveness of short-term and long-term psychotherapy in the treatment of depressive and anxiety disorders during a 5-year follow-up. Journal of Affective Disorders, 190, 254–263.
Migon, H., & Gamerman, D. (1999). Statistical inference: An integrated approach. London: Arnold.
Moffitt, T. E., Harrington, H., Caspi, A., Kim-Cohen, J., Goldberg, D., Gregory, A. M., & Poulton, R. (2007). Depression and generalized anxiety disorder: Cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Archives of General Psychiatry, 64, 651–660.
National Institute for Health and Care Excellence (NICE). (2011). NICE guidelines: Generalised anxiety disorder and panic disorder in adults: management.
Newby, J. M., McKinnon, A., Kuyken, W., Gilbody, S., & Dalgleish, T. (2015). Systematic review and meta-analysis of transdiagnostic psychological treatments for anxiety and depressive disorders in adulthood. Clinical Psychology Review, 40, 91–110.
Penninx, B. W., Nolen, W. A., Lamers, F., Zitman, F. G., Smit, J. H., Spinhoven, P., … Beekman, A. T. (2011). Two-year course of depressive and anxiety disorders: Results from the Netherlands Study of Depression and Anxiety (NESDA). Journal of Affective Disorders, 133, 76–85.
Perry, J. C., & Bond, M. (2009). The sequence of recovery in long-term dynamic psychotherapy. Journal of Nervous and Mental Disease, 197, 930–937.
Priebe, S., Omer, S., Giacco, D., & Slade, M. (2014). Resource-oriented therapeutic models in psychiatry: Conceptual review. British Journal of Psychiatry, 204, 256–261.
Rakowska, J. M. (2011). Brief strategic therapy in patients with social phobia with or without personality disorder. Psychotherapy Research, 21, 462–471.
Sandell, R., Blomberg, J., Lazar, A., Carlsson, J., Broberg, J., & Schubert, J. (2000). Varieties of long-term outcome among patients in psychoanalysis and long-term psychotherapy. A review of findings in the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPP). International Journal of Psychoanalysis, 81, 921–942.
SAS Institute Inc (Ed.). (2011). SAS/STAT ® 9.3: User’s guide (2nd ed.). Cary, NC: SAS Institute Inc..
Trepper, T. S., McCollum, E. E., De Jong, P., Korman, H., Gingerich, W., & Franklin, C. (2014). Solution-focused therapy treatment manual for working with individuals. In: Kim, J. S. (Ed.) Solution-focused brief therapy: a multicultural approach (pp. 14–31). Los Angeles: Sage.
Tuomi, K., Ilmarinen, J., Jahkola, A., Katajarinne, L., & Tulkki, A. (1998). Work ability index (2nd ed.). Helsinki, Finland: Finnish Institute of Occupational Health.
Verbeke, G., & Molenberghs, G. (1997). Linear mixed models in practice: A SAS-oriented approach, lecture notes in statistics. New York: Springer.
Weissman, M. M., & Bothwell, S. (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry, 33, 1111–1115.
Willutzki, U., Neumann, B., Haas, H., & Schulte, D. (2004). Zur Psychotherapie sozialer Ängste: Kognitive Verhaltenstherapie im Vergleich zu einem kombiniert resourceorientierten Vorgehen. Zeitschrift für Klinische Psychologie und Psychotherapie, 33, 42–50.
Willutzki, U., Teismann, T., & Schulte, D. (2012). Psychotherapy for social anxiety disorder: Long-term effectiveness of resource-oriented cognitive-behavioral therapy and cognitive therapy in social anxiety disorder. Journal of Clinical Psychology, 68, 581–591.
Wiltink, J., Hoyer, J., Beutel, M. E., Ruckes, C., Herpertz, S., Joraschky, P., … Leichsenring, F. (2016). Do patient characteristics predict outcome of psychodynamic psychotherapy for social anxiety disorder? PLoS One, 11, e0147165.
Acknowledgements
This study was supported by a grant from the Academy of Finland (grant no. 138876); the Finnish Cultural Foundation; the Deutsche Gesellschaft für Systemische Therapie, Betratung und Familietherapie (DGSF); and the Systemische Gesellschaft (SG). The foundations had no role in the design, analysis or writing of this article.
The statistical analyses were carried out by Mr. Julius Rissanen.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Knekt, P., Lindfors, O., Heinonen, E., Maljanen, T., Virtala, E., Härkänen, T. (2020). The Effectiveness of Three Psychotherapies of Different Type and Length in the Treatment of Patients Suffering from Anxiety Disorders. In: Ochs, M., Borcsa, M., Schweitzer, J. (eds) Systemic Research in Individual, Couple, and Family Therapy and Counseling. European Family Therapy Association Series. Springer, Cham. https://doi.org/10.1007/978-3-030-36560-8_19
Download citation
DOI: https://doi.org/10.1007/978-3-030-36560-8_19
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-36559-2
Online ISBN: 978-3-030-36560-8
eBook Packages: Behavioral Science and PsychologyBehavioral Science and Psychology (R0)