Advertisement

The Effectiveness of Three Psychotherapies of Different Type and Length in the Treatment of Patients Suffering from Anxiety Disorders

  • Paul KnektEmail author
  • Olavi Lindfors
  • Erkki Heinonen
  • Timo Maljanen
  • Esa Virtala
  • Tommi Härkänen
Chapter
  • 42 Downloads
Part of the European Family Therapy Association Series book series (EFTAS)

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.

Keywords

Anxiety Effectiveness Long-term psychotherapy Psychodynamic Randomized trial Short-term psychotherapy Solution-focused 

Notes

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.

References

  1. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders DSM-IV (4th ed.). Washington, DC: APA.Google Scholar
  2. 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.CrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. 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.PubMedPubMedCentralGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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.Google Scholar
  9. 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.CrossRefGoogle Scholar
  10. de Shazer, S., 1985. Keys to solution in brief therapy. W. W. Norton & Company, New York.Google Scholar
  11. 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.Google Scholar
  12. Derogatis, L. R., Lipman, R. S., & Covi, L. (1973). SCL-90: An outpatient psychiatric rating scale--preliminary report. Psychopharmacology Bulletin, 9, 13–28.PubMedGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. Gabbard, G. O. (1992). Psychodynamics of panic disorder and social phobia. Bulletin of the Menninger Clinic, 56, A3–A13.PubMedGoogle Scholar
  15. Gabbard, G. O. (2004). Long-term psychodynamic psychotherapy: A basic text (1st ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
  16. Gabbard, G. O., Gunderson, J. G., & Fonagy, P. (2002). The place of psychoanalytic treatments within psychiatry. Archives of General Psychiatry, 59, 505–510.CrossRefGoogle Scholar
  17. 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.Google Scholar
  18. Graubard, B. I., & Korn, E. L. (1999). Predictive margins with survey data. Biometrics, 55, 652–659.CrossRefGoogle Scholar
  19. 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.CrossRefGoogle Scholar
  20. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 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.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 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.Google Scholar
  24. 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.CrossRefGoogle Scholar
  25. 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.CrossRefGoogle Scholar
  26. 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.Google Scholar
  27. 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.CrossRefGoogle Scholar
  28. 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.CrossRefGoogle Scholar
  29. 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.CrossRefGoogle Scholar
  30. 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.CrossRefGoogle Scholar
  31. 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.CrossRefGoogle Scholar
  32. 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.CrossRefGoogle Scholar
  33. Lee, J. (1981). Covariance adjustment of rates based on the multiple logistic regression model. Journal of Chronic Diseases, 34, 415–426.CrossRefGoogle Scholar
  34. 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.Google Scholar
  35. 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.CrossRefGoogle Scholar
  36. 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.CrossRefGoogle Scholar
  37. 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.Google Scholar
  38. 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.CrossRefGoogle Scholar
  39. Luborsky, L. (1984). Principles of psychoanalytic psychotherapy: A manual for supportive-expressive treatment. New York: Basic Books.Google Scholar
  40. Malan, D. (1976). The frontier of brief psychotherapy: An example of the convergence of research and clinical practice. New York: Plenum Medical Book Co.CrossRefGoogle Scholar
  41. 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.Google Scholar
  42. Migon, H., & Gamerman, D. (1999). Statistical inference: An integrated approach. London: Arnold.Google Scholar
  43. 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.Google Scholar
  44. National Institute for Health and Care Excellence (NICE). (2011). NICE guidelines: Generalised anxiety disorder and panic disorder in adults: management.Google Scholar
  45. 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.CrossRefGoogle Scholar
  46. 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.Google Scholar
  47. Perry, J. C., & Bond, M. (2009). The sequence of recovery in long-term dynamic psychotherapy. Journal of Nervous and Mental Disease, 197, 930–937.CrossRefGoogle Scholar
  48. Priebe, S., Omer, S., Giacco, D., & Slade, M. (2014). Resource-oriented therapeutic models in psychiatry: Conceptual review. British Journal of Psychiatry, 204, 256–261.CrossRefGoogle Scholar
  49. Rakowska, J. M. (2011). Brief strategic therapy in patients with social phobia with or without personality disorder. Psychotherapy Research, 21, 462–471.CrossRefGoogle Scholar
  50. 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.CrossRefGoogle Scholar
  51. SAS Institute Inc (Ed.). (2011). SAS/STAT ® 9.3: User’s guide (2nd ed.). Cary, NC: SAS Institute Inc..Google Scholar
  52. 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.Google Scholar
  53. Tuomi, K., Ilmarinen, J., Jahkola, A., Katajarinne, L., & Tulkki, A. (1998). Work ability index (2nd ed.). Helsinki, Finland: Finnish Institute of Occupational Health.Google Scholar
  54. Verbeke, G., & Molenberghs, G. (1997). Linear mixed models in practice: A SAS-oriented approach, lecture notes in statistics. New York: Springer.Google Scholar
  55. Weissman, M. M., & Bothwell, S. (1976). Assessment of social adjustment by patient self-report. Archives of General Psychiatry, 33, 1111–1115.CrossRefGoogle Scholar
  56. 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.CrossRefGoogle Scholar
  57. 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.CrossRefGoogle Scholar
  58. 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.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Paul Knekt
    • 1
    Email author
  • Olavi Lindfors
    • 1
  • Erkki Heinonen
    • 1
  • Timo Maljanen
    • 2
  • Esa Virtala
    • 1
  • Tommi Härkänen
    • 1
  1. 1.Finnish Institute for Health and WelfareHelsinkiFinland
  2. 2.Social Insurance InstitutionHelsinkiFinland

Personalised recommendations