Efficacy of short-term psychodynamic psychotherapy (STPP) in depressive disorders: A systematic review and meta-analysis
Introduction
Depression is one of the leading diseases globally. It can severely interfere with daily and occupational functioning of people affected. Both pharmacological interventions and psychotherapy are used for adult depression. The aim of the review is to evaluate the efficacy of short-term psychodynamic psychotherapy (STPP) by comparing STPP with different types of interventions.
Materials and methods A systematic review with meta-analysis on the efficacy of STPP in depressive disorders was performed.
Results Meta-analysis findings confirm the superiority of STPP versus no interventions. The average effect size of depressive symptoms severity at the end of the treatment is −0.91 (95% CI: −1.49 – −0.33) in favor of STPP, while for clinical improvement of depressive symptoms is −0.78 (95% CI: −1.56 – 0.01). Results confirm a clear superiority of STPP to usual treatments unstructured. A mild superiority of efficacy of STPP on support psychotherapy emerged. Comparison of the efficacy of STPP vs cognitive-behavioral psychotherapy (CBT) shows little superior in case of STPP. No substantial differences in efficacy in case of STPP than control interventions emerged. Antidepressant therapy is resulted to be slightly more effective to STPP.
Discussion
While all the other results confirm current literature, this review shows no superiority of combined treatment than STPP only.
Limitations
The review has some limitations such as the lack of moderation analysis and the high heterogenicity of the type of the studies.
Conclusions
The results confirm the efficacy of STPP in depressive disorders and endorse the guidelines of National Institute for Health and Clinical Excellence (NICE).
Introduction
Depressive disorders include different conditions characterized by persistent and pervasive low mood (World Health Organisation, 2018). Depression is a common illness worldwide with an estimated 3.8 % of the population affected. Depression is associated with risk of suicidal behavior which is considered the fourth leading cause of death in 15–29 years-old people (World Health Organisation, 2018; Institute of Health Metrics and Evaluation, n.d.). Depressive disorders can severely interfere with daily and work functioning (Krejtz et al., 2020). Moreover, depression has a huge impact on health services worldwide (Paul E. Greenberg et al., 2015) (Philip S Wang et al., 2003). Both pharmacological interventions and different form of psychotherapy are researched and used for adult depression (Ielmini et al., 2018; Callegari et al., 2019; Ielmini et al., 2021; Ostuzzi et al., 2020; Menchetti et al., 2014) although no firm evidence was found that one intervention was any more or less efficacious than another (Cuijpers et al., 2008; Spielmans et al., 2011; Cuijpers et al., 2013).
Several models of short-term psychotherapy have been developed by different authors starting with the second half of twentieth century (Malan, 1963; Mann, 1973; Sifneos, 1979; Davanloo, 1980; Strupp and Binder, 1984; Pollack and Horner, 1985; de Jonghe et al., 1994) up to present day (Wienicke and Driessen, 2021; Menchetti et al., 2015). They mainly differ for duration of treatment. In fact, STPP lasts 22 weeks with 16 session (Wienicke and Driessen, 2021), the Brief Adaptive Psychotherapy lasts maximum 40 sessions (Pollack and Horner, 1985), while the Short-term Supportive Psychotherapy includes 16 sessions in 6 month (de Jonghe et al., 1994; Tuynman-Qua and de Jonghe, 1992), finally the Interpersonal Counselling lasts 6 sessions (Menchetti et al., 2014). The different approaches have some relevant elements in common, such as drive theory, Ego Psychology, objects relations theory, Self Psychology, and attachment theory. All the different psychoanalytic perspectives consider unconscious personality as a determinant in the development and maintenance of symptoms and psychopathological features, including depression. Therefore, the objective of psychotherapy is to focus on internalized interpersonal relationships and emotions, unconscious desires, efforts and thoughts, in order to gain greater awareness and understanding of oneself and of the mechanisms responsible for one’s psychic suffering (APA, 2022). The main aims of short-term psychodynamic psychotherapy are to reduce symptoms and, as short as the treatment may be, to modify the personality traits improving individual vulnerability and resilience sources (APA, 2022). Unlike classical psychoanalysis, short-term psychodynamic psychotherapy has a limited duration. The number and frequency of sessions are agreed by therapist and by the patient at the beginning of the treatment, as well as the main theme to focus. The purpose is to build a new awareness and a new meaning about unconscious affects, ideas and behaviors responsible for symptoms and interpersonal difficulties (APA, 2022).
Recent studies did focus on the psychodynamic treatment of depression. Leichsenring and colleagues reviewed the efficacy short-term psychodynamic psychotherapy (STPP) in depression compared to cognitive-behavioral therapy (CBT) or behavioral therapy (BT) showing that STPP and CBT/BT seem to be equally methods in the treatment of depression (Leichsenring, 2001). Churchill et al. performed a systematic review and, where possible, a meta-analysis of all controlled clinical trials (CCTs) in which brief psychological treatments were compared with one another or treatment as usual in the treatment of depression was performed, but little can be said about the efficacy of different types of individual versus group therapy because all the trials comparing these formats used CT or BT (Churchill et al., 2001). Although Driessen and colleagues found clear indications that short-term psychodynamic psychotherapy is effective in the treatment of depression in adults (Driessen et al., 2015), specific comparisons between the efficacy of STPP and other types of interventions remains largely unclear. To our knowledge, few meta-analyses focused on the comparison between different types of treatment. Thus, the primary aim of the study is to evaluate the efficacy of STPP for the treatment of depressive disorder comparing different types of intervention, both pharmacological and psychotherapy. The secondary aim is to investigate the acceptability and the tolerability of STPP. Specifically, the meta-analysis compares STPP versus other interventions both in terms of efficacy (response rate; remission rate; severity) and in terms of tolerability (acceptability; tolerability).
Section snippets Inclusion criteria of studies and participants
A systematic review on the efficacy of short-term psychodynamic psychotherapy (STPP) in depressive disorders was conducted. Inclusions criteria of the systematic review with meta-analysis for the studies were the following: Randomized Controlled Trials (RCTs) with 10-subject samples or more; Cluster Randomized Controlled Trials with 10-subject samples or more; studies in which short-term psychodynamic psychotherapy programs were applied; STPP studies based on theories and psychoanalytical
Results
The PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) flowchart is shown in Fig. 1. A total of 4910 records was returned after the exclusion of duplicates. 254 studies were retrieved for full-text review. 63 studies met the eligibility criteria for revision; 32 studies were excluded for quantitative analysis (meta-analysis). Finally, 31 studies were included. References of studies included and the characteristics of the studies are contained in Appendix A. In all, 31
Discussion
An increased number of studies on the comparison between brief psychodynamic psychotherapy and other types of interventions for depression have been published in professional literature in recent years. As far as we know, few meta-analyses focused on the comparison between different types of treatment (Driessen et al., 2010). The systematic review with meta-analyses is aimed to evaluate the efficacy, acceptability and tolerability of STPP for the treatment of depressive disorder comparing
Conclusions
Short-term psychodynamic psychotherapy is currently considered as a proved effective intervention in the treatment of depressive disorders. The results confirm the efficacy of STPP in depressive disorders and endorse the guidelines of National Institute for Health and Clinical Excellence (NICE, 2018). The review showed a clear superiority of STPP compared to control conditions without the application of interventions or compared to usual interventions. A moderate superiority of STPP than
Depression is one of the leading diseases globally. It can severely interfere with daily and occupational functioning of people affected. Both pharmacological interventions and psychotherapy are used for adult depression. The aim of the review is to evaluate the efficacy of short-term psychodynamic psychotherapy (STPP) by comparing STPP with different types of interventions.
Materials and methods A systematic review with meta-analysis on the efficacy of STPP in depressive disorders was performed.
Results Meta-analysis findings confirm the superiority of STPP versus no interventions. The average effect size of depressive symptoms severity at the end of the treatment is −0.91 (95% CI: −1.49 – −0.33) in favor of STPP, while for clinical improvement of depressive symptoms is −0.78 (95% CI: −1.56 – 0.01). Results confirm a clear superiority of STPP to usual treatments unstructured. A mild superiority of efficacy of STPP on support psychotherapy emerged. Comparison of the efficacy of STPP vs cognitive-behavioral psychotherapy (CBT) shows little superior in case of STPP. No substantial differences in efficacy in case of STPP than control interventions emerged. Antidepressant therapy is resulted to be slightly more effective to STPP.
Discussion
While all the other results confirm current literature, this review shows no superiority of combined treatment than STPP only.
Limitations
The review has some limitations such as the lack of moderation analysis and the high heterogenicity of the type of the studies.
Conclusions
The results confirm the efficacy of STPP in depressive disorders and endorse the guidelines of National Institute for Health and Clinical Excellence (NICE).
Introduction
Depressive disorders include different conditions characterized by persistent and pervasive low mood (World Health Organisation, 2018). Depression is a common illness worldwide with an estimated 3.8 % of the population affected. Depression is associated with risk of suicidal behavior which is considered the fourth leading cause of death in 15–29 years-old people (World Health Organisation, 2018; Institute of Health Metrics and Evaluation, n.d.). Depressive disorders can severely interfere with daily and work functioning (Krejtz et al., 2020). Moreover, depression has a huge impact on health services worldwide (Paul E. Greenberg et al., 2015) (Philip S Wang et al., 2003). Both pharmacological interventions and different form of psychotherapy are researched and used for adult depression (Ielmini et al., 2018; Callegari et al., 2019; Ielmini et al., 2021; Ostuzzi et al., 2020; Menchetti et al., 2014) although no firm evidence was found that one intervention was any more or less efficacious than another (Cuijpers et al., 2008; Spielmans et al., 2011; Cuijpers et al., 2013).
Several models of short-term psychotherapy have been developed by different authors starting with the second half of twentieth century (Malan, 1963; Mann, 1973; Sifneos, 1979; Davanloo, 1980; Strupp and Binder, 1984; Pollack and Horner, 1985; de Jonghe et al., 1994) up to present day (Wienicke and Driessen, 2021; Menchetti et al., 2015). They mainly differ for duration of treatment. In fact, STPP lasts 22 weeks with 16 session (Wienicke and Driessen, 2021), the Brief Adaptive Psychotherapy lasts maximum 40 sessions (Pollack and Horner, 1985), while the Short-term Supportive Psychotherapy includes 16 sessions in 6 month (de Jonghe et al., 1994; Tuynman-Qua and de Jonghe, 1992), finally the Interpersonal Counselling lasts 6 sessions (Menchetti et al., 2014). The different approaches have some relevant elements in common, such as drive theory, Ego Psychology, objects relations theory, Self Psychology, and attachment theory. All the different psychoanalytic perspectives consider unconscious personality as a determinant in the development and maintenance of symptoms and psychopathological features, including depression. Therefore, the objective of psychotherapy is to focus on internalized interpersonal relationships and emotions, unconscious desires, efforts and thoughts, in order to gain greater awareness and understanding of oneself and of the mechanisms responsible for one’s psychic suffering (APA, 2022). The main aims of short-term psychodynamic psychotherapy are to reduce symptoms and, as short as the treatment may be, to modify the personality traits improving individual vulnerability and resilience sources (APA, 2022). Unlike classical psychoanalysis, short-term psychodynamic psychotherapy has a limited duration. The number and frequency of sessions are agreed by therapist and by the patient at the beginning of the treatment, as well as the main theme to focus. The purpose is to build a new awareness and a new meaning about unconscious affects, ideas and behaviors responsible for symptoms and interpersonal difficulties (APA, 2022).
Recent studies did focus on the psychodynamic treatment of depression. Leichsenring and colleagues reviewed the efficacy short-term psychodynamic psychotherapy (STPP) in depression compared to cognitive-behavioral therapy (CBT) or behavioral therapy (BT) showing that STPP and CBT/BT seem to be equally methods in the treatment of depression (Leichsenring, 2001). Churchill et al. performed a systematic review and, where possible, a meta-analysis of all controlled clinical trials (CCTs) in which brief psychological treatments were compared with one another or treatment as usual in the treatment of depression was performed, but little can be said about the efficacy of different types of individual versus group therapy because all the trials comparing these formats used CT or BT (Churchill et al., 2001). Although Driessen and colleagues found clear indications that short-term psychodynamic psychotherapy is effective in the treatment of depression in adults (Driessen et al., 2015), specific comparisons between the efficacy of STPP and other types of interventions remains largely unclear. To our knowledge, few meta-analyses focused on the comparison between different types of treatment. Thus, the primary aim of the study is to evaluate the efficacy of STPP for the treatment of depressive disorder comparing different types of intervention, both pharmacological and psychotherapy. The secondary aim is to investigate the acceptability and the tolerability of STPP. Specifically, the meta-analysis compares STPP versus other interventions both in terms of efficacy (response rate; remission rate; severity) and in terms of tolerability (acceptability; tolerability).
Section snippets Inclusion criteria of studies and participants
A systematic review on the efficacy of short-term psychodynamic psychotherapy (STPP) in depressive disorders was conducted. Inclusions criteria of the systematic review with meta-analysis for the studies were the following: Randomized Controlled Trials (RCTs) with 10-subject samples or more; Cluster Randomized Controlled Trials with 10-subject samples or more; studies in which short-term psychodynamic psychotherapy programs were applied; STPP studies based on theories and psychoanalytical
Results
The PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) flowchart is shown in Fig. 1. A total of 4910 records was returned after the exclusion of duplicates. 254 studies were retrieved for full-text review. 63 studies met the eligibility criteria for revision; 32 studies were excluded for quantitative analysis (meta-analysis). Finally, 31 studies were included. References of studies included and the characteristics of the studies are contained in Appendix A. In all, 31
Discussion
An increased number of studies on the comparison between brief psychodynamic psychotherapy and other types of interventions for depression have been published in professional literature in recent years. As far as we know, few meta-analyses focused on the comparison between different types of treatment (Driessen et al., 2010). The systematic review with meta-analyses is aimed to evaluate the efficacy, acceptability and tolerability of STPP for the treatment of depressive disorder comparing
Conclusions
Short-term psychodynamic psychotherapy is currently considered as a proved effective intervention in the treatment of depressive disorders. The results confirm the efficacy of STPP in depressive disorders and endorse the guidelines of National Institute for Health and Clinical Excellence (NICE, 2018). The review showed a clear superiority of STPP compared to control conditions without the application of interventions or compared to usual interventions. A moderate superiority of STPP than
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