Psychodynamic Research
Anxiety and post-traumatic stress disorders
At present, 17+X randomized controlled trials (RCTs) for psychodynamic therapy (PDT) in anxiety disorders exist (Barber et al., 2021). The quality of studies is sufficient for most studies (Barber et al., 2021), especially for comparisons with active treatments, but more high quality studies for comparison with control conditions are required (Barber et al., 2021; Leichsenring et al., 2023).
Efficacy (PDT vs controls): PDT was found to be superior to control conditions with a clinically meaningful effect size in reducing anxiety symptoms (g= -0.72, 95% CI -1.06, - 0.37, k=6, I2=43%).(Barber et al., 2021; Leichsenring et al., 2023). The width of the confidence intervals (CI) is wide but comparable to other treatments such as CBT compared to treatment as usual (TAU) . .
Comparative efficacy: Compared to other active treatments, outcome of PDT was not significantly different in anxiety outcomes (g= 0.06, 95% CI -0.11, 0.23, k=14, I2=45%) %).(Barber et al., 2021; Leichsenring et al., 2023), with no differences between type of anxiety disorder. Remission rates for anxiety diagnoses did not differ significantly between PDT and other treatments (log odds ratio= 0.12, 95% CI -0.76, 0.99, p=0.761)(Barber et al., 2021).
Stability of effects: At short-term and long-term follow-ups the outcome of PDT did not differ from those of other active treatments (Barber et al., 2021; Leichsenring et al., 2023)
Interpersonal Functioning: There are no differences between PDT and other psychotherapies in improving interpersonal functioning (g=-0.03, 95% CI -1.19, 1.14, k=3, N=512)(Keefe, 2022; Keefe et al., 2014).
Effectiveness under real world conditions: A recent meta-analysis on effectiveness of routinely delivered psychotherapies (Gaskell et al., 2022) found large pre-post effect sizes in anxiety outcomes (d=0.80, 95% CI: 00.71-0.90), with no differences between CBT and PDT (d=–0.00).
Adverse events: No or only a few adverse events were reported in studies of PDT in anxiety or disorders post-traumatic stress disorder, with no differences to other bona fide therapies (Leichsenring et al., 2013; Milrod et al., 2015; Milrod et al., 2007; Steinert et al., 2017).
Mechanisms of change: In addition, there is evidence for mechanisms of change of PDT in anxiety disorders (Leichsenring et al., 2023)
Summing up, in anxiety disorders PDT achieves clinically significant effects in comparison to controls and is as efficacious as other active treatments. In addition, PDT achieves clinically significant effects in improving interpersonal functioning. Effects are stable in follow-ups. Furthermore PDT is efficacious under real world conditions and there is evidence for mechanisms of change of PDT.
As a result, PDT fulfils the updated criteria of the American Psychological Association for empirically supported therapies (Tolin et al., 2015), warranting a strong recommendation for the treatment of anxiety disorders (Leichsenring et al., 2023)
References
Barber, J. P., Muran, J. C., McCarthy, K. S., Keefe R.J., & Zilcha-Mano, S. (2021). Research on psychodynamic therapies In Barkham; M., L. G. Castonguay, ,, & W. Lutz (Eds.), Bergin and Garfield's Handbook of Psychotherapy and Behavior Change (7th ed.) (pp. 387-419). Wiley.
Gaskell, C., Simmonds-Buckley, M., Kellett, S., Stockton, C., Somerville, E., Rogerson, E., & Delgadillo, J. (2022). The Effectiveness of Psychological Interventions Delivered in Routine Practice: Systematic Review and Meta-analysis. Administration and Policy in Mental Health. https://doi.org/10.1007/s10488-022-01225-y
Keefe, J. R. (2022). Jack Keefe, personal comunication, 26/10/2022.
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(4), 309-323. https://doi.org/10.1016/j.cpr.2014.03.004
Leichsenring, F., Abbass, A., Heim, N., Keefe, J. R., Kisely, S., Luyten, P., Rabung, S., & Steinert, C. (2023). The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders - an umbrella review based on updated criteria. World Psychiatry, 22(2), 286-304. https://doi.org/10.1002/wps.21104
Leichsenring, F., Salzer, S., Beutel, M. E., Herpertz, S., Hiller, W., Hoyer, J., Huesing, J., Joraschky, P., Nolting, B., Poehlmann, K., Ritter, V., Stangier, U., Strauss, B., Stuhldreher, N., Tefikow, S., Teismann, T., Willutzki, U., Wiltink, J., & Leibing, E. (2013). Psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: a multicenter randomized controlled trial. American Journal of Psychiatry, 170(7), 759-767. https://doi.org/10.1176/appi.ajp.2013.12081125
Milrod, B., Chambless, D. L., Gallop, R., Busch, F. N., Schwalberg, M., McCarthy, K. S., Gross, C., Sharpless, B. A., Leon, A. C., & Barber, J. P. (2015). Psychotherapies for panic disorder: a tale of two sites. Journal of Clinical Psychiatry. https://doi.org/10.4088/JCP.14m09507
Milrod, B., Leon, A. C., Busch, F., Rudden, M., Schwalberg, M., Clarkin, J., Aronson, A., Singer, M., Turchin, W., Klass, E. T., Graf, E., Teres, J. J., & Shear, M. K. (2007). A randomized controlled clinical trial of psychoanalytic psychotherapy for panic disorder. American Journal of Psychiatry, 164(2), 265-272. https://doi.org/10.1176/ajp.2007.164.2.265
Steinert, C., Bumke, P. J., Hollekamp, R. L., Larisch, A., Leichsenring, F., Matthess, H., Sek, S., Sodemann, U., Stingl, M., Ret, T., Vojtova, H., Woller, W., & Kruse, J. (2017). Resource activation for treating post-traumatic stress disorder, co-morbid symptoms and impaired functioning: a randomized controlled trial in Cambodia. Psychological Medicine, 47(3), 553-564. https://doi.org/10.1017/S0033291716002592
Tolin, D., McKay, D., Forman, E. M., Klonsky, E. D., & Thombs, B. D. (2015). Empirically supported treatments: recommendations for a new model. Clinical Psychology Science and Practice https://doi.org/10.1111.cpsp.12122