Longer-duration psychotherapy appears more beneficial for treatment of complex mental disorders

September 30, 2008

Psychodynamic psychotherapy lasting for at least a year is effective and superior to shorter-term therapy for patients with complex mental disorders such as personality and chronic mental disorders, according to a meta-analysis published in the October 1 issue of JAMA.

Evidence indicates that short-term psychodynamic psychotherapy is insufficient for a considerable proportion of patients with complex mental disorders, i.e., patients with multiple or chronic mental disorders or personality disorders. Some studies suggest that long-term psychodynamic psychotherapy (LTPP) may be helpful for these patients, according to background information in the article. LTPP is therapy in which emphasis is placed on more interpretive or supportive interventions, depending on the patient's needs, and that involves careful attention to the therapist-patient interaction.

Falk Leichsenring, D.Sc., of the University of Giessen, Germany, and Sven Rabung, Ph.D., of the University Medical Center Hamburg-Eppendorf, Hamburg, Germany, conducted a meta-analysis to examine the effectiveness of LTPP (lasting for at least a year, or 50 sessions) and whether it is superior to shorter psychotherapeutic treatments for complex mental disorders, including personality disorders, chronic mental disorders (defined as lasting at least a year) and multiple mental disorders. The researchers identified and included 23 studies for the meta-analysis (11 randomized controlled trials and 12 observational studies), involving a total of 1,053 patients receiving LTPP.

The authors found: "In this meta-analysis, LTPP was significantly superior to shorter-term methods of psychotherapy with regard to overall outcome, target problems, and personality functioning. Long-term psychodynamic psychotherapy yielded large and stable effect sizes in the treatment of patients with personality disorders, multiple mental disorders, and chronic mental disorders. The effect sizes for overall outcome increased significantly between end of therapy and follow-up."

With regard to overall effectiveness, analysis indicated that after treatment with LTPP patients with complex mental disorders on average were better off than 96 percent of the patients in the comparison groups.

The authors add that further research should evaluate the cost-effectiveness of LTPP.

Citation: JAMA. 2008;300[13]:1551-1565.

Source: JAMA and Archives Journals

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