The Effectiveness of Three Psychotherapies of Different Type and Length in the Treatment of Patients Suffering from Anxiety Disorders
- 42 Downloads
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.
KeywordsAnxiety Effectiveness Long-term psychotherapy Psychodynamic Randomized trial Short-term psychotherapy Solution-focused
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.
- American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders DSM-IV (4th ed.). Washington, DC: APA.Google Scholar
- 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
- 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
- de Shazer, S., 1985. Keys to solution in brief therapy. W. W. Norton & Company, New York.Google Scholar
- 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
- Gabbard, G. O. (2004). Long-term psychodynamic psychotherapy: A basic text (1st ed.). Arlington, VA: American Psychiatric Publishing.Google Scholar
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- Luborsky, L. (1984). Principles of psychoanalytic psychotherapy: A manual for supportive-expressive treatment. New York: Basic Books.Google Scholar
- 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
- Migon, H., & Gamerman, D. (1999). Statistical inference: An integrated approach. London: Arnold.Google Scholar
- 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
- National Institute for Health and Care Excellence (NICE). (2011). NICE guidelines: Generalised anxiety disorder and panic disorder in adults: management.Google Scholar
- 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
- 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
- SAS Institute Inc (Ed.). (2011). SAS/STAT ® 9.3: User’s guide (2nd ed.). Cary, NC: SAS Institute Inc..Google Scholar
- 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
- 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
- Verbeke, G., & Molenberghs, G. (1997). Linear mixed models in practice: A SAS-oriented approach, lecture notes in statistics. New York: Springer.Google Scholar
- 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