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Falk Leichsenring - One of the best experts on this subject based on the ideXlab platform.
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trauma focused Psychodynamic Therapy and stair narrative Therapy of post traumatic stress disorder related to childhood maltreatment trial protocol of a multicentre randomised controlled trial assessing psychological neurobiological and health econom
BMJ Open, 2020Co-Authors: Falk Leichsenring, Christiane Steinert, Manfred E Beutel, Lila Feix, Harald Gundel, Andrea Hermann, Alexander Karabatsiakis, Christine Knaevelsrud, Hanshelmut KonigAbstract:Introduction Success rates of psychoTherapy in post-traumatic stress disorder related to childhood maltreatment (PTSD-CM) are limited. Methods and analysis Observer-blind multicentre randomised clinical trial (A-1) of 4-year duration comparing enhanced methods of STAIR Narrative Therapy (SNT) and of trauma-focused Psychodynamic Therapy (TF-PDT) each of up to 24 sessions with each other and a minimal attention waiting list in PTSD-CM. Primary outcome is severity of PTSD (Clinician-Administered PTSD Scale for DSM-5 total) assessed by masked raters. For SNT and TF-PDT, both superiority and non-inferiority will be tested. Intention-to-treat analysis (primary) and per-protocol analysis (secondary). Assessments at baseline, after 10 sessions, post-Therapy/waiting period and at 6 and 12 months of follow-up. Adult patients of all sexes between 18 and 65 years with PTSD-CM will be included. Continuing stable medication is permitted. To be excluded: psychotic disorders, risk of suicide, ongoing abuse, acute substance related disorder, borderline personality disorder, dissociative identity disorder, organic mental disorder, severe medical conditions and concurrent psychoTherapy. To be assessed for eligibility: n=600 patients, to be e randomly allocated to the study conditions: n=328. Data management, randomisation and monitoring will be performed by an independent European Clinical Research Infrastructure Network (ECRIN)-certified data coordinating centre for clinical trials (KKS Marburg). Report of AEs to a data monitoring and safety board. Complementing study A-1, four inter-related add-on projects, including subsamples of the treatment study A-1, will examine (1) treatment integrity (adherence and competence) and moderators and mediators of outcome (B-1); (2) biological parameters (B-2, eg, DNA damage, reactive oxygen species and telomere shortening); (3) structural and functional neural changes by neuroimaging (B-3) and (4) cost-effectiveness of the treatments (B-4, costs and utilities). Ethics and dissemination Approval by the institutional review board of the University of Giessen (AZ 168/19). Following the Consolidated Standards of Reporting Trials statement for non-pharmacological trials, results will be reported in peer-reviewed scientific journals and disseminated to patient organisations and media. Trial registration number DRKS 00021142.
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Changes in Personality Functioning After Inpatient Psychodynamic Therapy: A Dimensional Approach to Personality Disorders.
Psychodynamic Psychiatry, 2019Co-Authors: Falk Leichsenring, Ulrich Jaeger, Oliver Masuhr, Andreas Dally, Michael Dümpelmann, Christian Fricke-neef, Christiane Steinert, Carsten SpitzerAbstract:Objective Patients with mental disorders do not only show specific symptoms but also impairments in personality functioning, especially those with personality disorders. Recent developments in DSM-5 and ICD-11 suggest a dimensional approach to personality disorders. Few studies, however, have examined changes in personality functioning. Methods In a large sample of 2,596 patients treated by inpatient Psychodynamic Therapy, changes in personality functioning were studied. Two patient groups were examined, one with (N = 1152, BPO) and one without a presumptive diagnosis of a borderline personality organization (N = 1444, NBPO). For the assessment of personality functioning, the Borderline-Personality Inventory (BPI) was used. The BPI taps personality functioning as defined by Kernberg's structural criteria of personality organization. Symptom distress and interpersonal problems were examined with the Symptom Checklist SCL-90-R and the Inventory of Interpersonal Problems (IIP). Patients were assessed at admission and discharge. Results In the BPO sample significant and substantial pre-post effect sizes in overall personality functioning, identity integration, and defense mechanisms/object relations were found (d = 0.68, 0.60, 0.78). In addition, large improvements in symptoms (SCL-90-R) were achieved (d = 0.97). For interpersonal problems effect sizes were medium (0.56). At discharge 36% of the BPO patients scored below the BPI-Cut-Off score for a BPO (remission). Pre-post effect sizes in the NPBO sample (N = 1444) were significant but small for changes in personality functioning (d = 0.31-0.46) and substantial for improvements in symptoms (d = 0.77). Conclusions Both personality functioning and symptom distress can be substantially improved by inpatient Psychodynamic Therapy. Future research is recommended to study both improvements in symptoms and personality functioning.
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on mechanisms of change in Psychodynamic Therapy
Zeitschrift Fur Psychosomatische Medizin Und Psychotherapie, 2018Co-Authors: Falk Leichsenring, Christiane Steinert, Paul CritschristophAbstract:BACKGROUND There is a growing body of evidence for the efficacy of Psychodynamic Therapy. Some representatives of other approaches, however, have repeatedly questioned its efficacy. Recently, another line of argumentation emerged, claiming that Psychodynamic Therapy may work, but that the mechanisms of change underlying its effects were not clear or even could not be tested empirically at all. OBJECTIVE The present article critically reviews these allegations. RESULTS The allegations put forward were shown to be mostly untenable. Mechanisms of change of Psychodynamic Therapy are testable and have been tested empirically. CONCLUSIONS There is evidence for both the efficacy of Psychodynamic Therapy and for the assumed mechanisms of change. The repeatedly presented critique by representatives of other approaches seems to be motivated more by political than by scientific reasons. However, further research on both the outcome and process of Psychodynamic Therapy is required.
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cognitive behavioral and Psychodynamic Therapy in adolescents with social anxiety disorder a multicenter randomized controlled trial
Psychotherapy and Psychosomatics, 2018Co-Authors: Simone Salzer, Falk Leichsenring, Eric Leibing, Annette Stefini, Gunter Reich, Klausthomas Kronmuller, Peter Henningsen, Hamid Peseschkian, Rita Rosner, Uwe RuhlAbstract:Background: Although social anxiety disorder (SAD) has an early onset and is frequently found in adolescence, evidence for psychotherapeutic treatments of SAD in adolescents is rather scarce. Within the Social Phobia PsychoTherapy Research Network (SOPHO-NET), we examined the efficacy of cognitive-behavioral (CBT) and Psychodynamic Therapy (PDT) compared to a waiting list (WL) in these patients. Methods: In a multicenter randomized controlled superiority trial, 107 patients, aged 14–20 years, were randomized to CBT ( n = 34), PDT ( n = 34), or WL ( n = 39). Assessments were made at baseline, at the end of treatment, and 6 and 12 months after termination. The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) applied by raters masked to the treatment condition was used as the primary outcome. As secondary outcomes, rates of response and remission and the Social Phobia Anxiety Inventory (SPAI) were used. Results: Both treatments were superior to WL in the LSAS-CA (CBT: p = 0.0112, d = 0.61, 95% CI 0.14–1.08; PDT: p = 0.0261, d = 0.53, 95% CI 0.06–1.00). At the end of treatment, response rates were 66, 54, and 20% for CBT, PDT, and WL. The corresponding remission rates were 47, 34, and 6%, respectively. CBT and PDT were significantly superior to WL regarding remission (CBT: p = 0.0009, h = 1.0; PDT: p = 0.0135, h = 0.74), response (CBT: p = 0.0004, h = 0.97; PDT: p = 0.0056, h = 0.72), and the SPAI (CBT: p = 0.0021, d = 0.75, 95% CI 0.27–1.22; PDT: p = 0.0060, d = 0.66, 95% CI 0.19–1.13). Treatment effects were stable at 6- and 12-month follow-ups. Conclusions: These results are comparable to the large SOPHO-NET trial in adults ( n = 495). Early treatments for social anxiety are needed in order to prevent chronic manifestation of SAD.
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bias toward Psychodynamic Therapy framing the problem and working toward a solution
Journal of Psychiatric Practice, 2017Co-Authors: Allan Abbass, Patrick Luyten, Christiane Steinert, Falk LeichsenringAbstract:Although Psychodynamic Therapy (PDT) is an evidence-based intervention for a broad spectrum of psychiatric conditions, there is often notable bias in the way PDT is depicted both in the popular media and in the scientific literature. This has contributed to a negative view of PDT, which hampers both patient access to this treatment and researcher access to funding for further research on PDT. The adverse effects of these distortions and biases are detrimental not only to PDT but also to the overall field of psychoTherapy, raising questions about its credibility. Here we summarize current evidence for PDT, describe existing biases, and formulate a set of recommendations to foster a more balanced perspective on PDT.
Simone Salzer - One of the best experts on this subject based on the ideXlab platform.
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cognitive behavioral and Psychodynamic Therapy in adolescents with social anxiety disorder a multicenter randomized controlled trial
Psychotherapy and Psychosomatics, 2018Co-Authors: Simone Salzer, Falk Leichsenring, Eric Leibing, Annette Stefini, Gunter Reich, Klausthomas Kronmuller, Peter Henningsen, Hamid Peseschkian, Rita Rosner, Uwe RuhlAbstract:Background: Although social anxiety disorder (SAD) has an early onset and is frequently found in adolescence, evidence for psychotherapeutic treatments of SAD in adolescents is rather scarce. Within the Social Phobia PsychoTherapy Research Network (SOPHO-NET), we examined the efficacy of cognitive-behavioral (CBT) and Psychodynamic Therapy (PDT) compared to a waiting list (WL) in these patients. Methods: In a multicenter randomized controlled superiority trial, 107 patients, aged 14–20 years, were randomized to CBT ( n = 34), PDT ( n = 34), or WL ( n = 39). Assessments were made at baseline, at the end of treatment, and 6 and 12 months after termination. The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) applied by raters masked to the treatment condition was used as the primary outcome. As secondary outcomes, rates of response and remission and the Social Phobia Anxiety Inventory (SPAI) were used. Results: Both treatments were superior to WL in the LSAS-CA (CBT: p = 0.0112, d = 0.61, 95% CI 0.14–1.08; PDT: p = 0.0261, d = 0.53, 95% CI 0.06–1.00). At the end of treatment, response rates were 66, 54, and 20% for CBT, PDT, and WL. The corresponding remission rates were 47, 34, and 6%, respectively. CBT and PDT were significantly superior to WL regarding remission (CBT: p = 0.0009, h = 1.0; PDT: p = 0.0135, h = 0.74), response (CBT: p = 0.0004, h = 0.97; PDT: p = 0.0056, h = 0.72), and the SPAI (CBT: p = 0.0021, d = 0.75, 95% CI 0.27–1.22; PDT: p = 0.0060, d = 0.66, 95% CI 0.19–1.13). Treatment effects were stable at 6- and 12-month follow-ups. Conclusions: These results are comparable to the large SOPHO-NET trial in adults ( n = 495). Early treatments for social anxiety are needed in order to prevent chronic manifestation of SAD.
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cognitive behavioral and Psychodynamic Therapy in female adolescents with bulimia nervosa a randomized controlled trial
Journal of the American Academy of Child and Adolescent Psychiatry, 2017Co-Authors: Annette Stefini, Simone Salzer, Gunter Reich, Hildegard Horn, Klaus Winkelmann, Hinrich Bents, Ursula Rutz, Ulrike Frost, Antje Von Boetticher, Uwe RuhlAbstract:Objective The authors compared cognitive-behavioral Therapy (CBT) and Psychodynamic Therapy (PDT) for the treatment of bulimia nervosa (BN) in female adolescents. Method In this randomized controlled trial, 81 female adolescents with BN or partial BN according to the DSM-IV received a mean of 36.6 sessions of manualized disorder−oriented PDT or CBT. Trained psychologists blinded to treatment condition administered the outcome measures at baseline, during treatment, at the end of treatment, and 12 months after treatment. The primary outcome was the rate of remission, defined as a lack of DSM-IV diagnosis for BN or partial BN at the end of Therapy. Several secondary outcome measures were evaluated. Results The remission rates for CBT and PDT were 33.3% and 31.0%, respectively, with no significant differences between them (odds ratio [OR] = 0.90, 95% CI = 0.35−2.28, p = .82). The within-group effect sizes were h = 1.22 for CBT and h = 1.18 for PDT. Significant improvements in all secondary outcome measures were found for both CBT ( d = 0.51−0.82) and PDT ( d = 0.24−1.10). The improvements remained stable at the 12-month follow-up in both groups. There were small between-group effect sizes for binge eating ( d = 0.23) and purging ( d = 0.26) in favor of CBT and for eating concern ( d = −0.35) in favor of PDT. Conclusion CBT and PDT were effective in promoting recovery from BN in female adolescents. The rates of remission for both therapies were similar to those in other studies evaluating CBT. This trial identified differences with small effects in binge eating, purging, and eating concern. Clinical trial registration information— Treating Bulimia Nervosa in Female Adolescents With Either Cognitive-Behavioral Therapy (CBT) or Psychodynamic Therapy (PDT). http://isrctn.com/; ISRCTN14806095.
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long term cost effectiveness of cognitive behavioral Therapy versus Psychodynamic Therapy in social anxiety disorder
Depression and Anxiety, 2016Co-Authors: Nina Egger, Stephan Herpertz, Simone Salzer, Manfred E Beutel, Wolfgang Hiller, Juergen Hoyer, Alexander Konnopka, Ulrich Stangier, Bernhard Strauss, Ulrike WillutzkiAbstract:Background To determine the cost-effectiveness of cognitive behavioral Therapy (CBT) versus Psychodynamic Therapy (PDT) in the treatment of social anxiety disorder after a follow-up of 30 months from a societal perspective. Methods This analysis was conducted alongside the multicenter SOPHO-NET trial; adults with a primary diagnosis of social anxiety disorder received CBT (n = 209) or PDT (n = 207). Data on health care utilization and productivity loss were collected at baseline, after 6 months (posttreatment), and three further follow-ups to calculate direct and indirect costs. Anxiety-free days (AFDs) calculated based on remission and response were used as measure of effect. The incremental cost-effectiveness ratio (ICER) was determined. Net benefit regressions, adjusted for comorbidities and baseline differences, were applied to derive cost-effectiveness acceptability curves. Results In the descriptive analysis, the unadjusted ICER favored CBT over PDT and the adjusted analysis showed that CBT's cost-effectiveness relative to PDT depends on the willingness to pay (WTP) per AFD. As baseline costs differed substantially the unadjusted estimates might be deceptive. If additional WTPs for CBT of €0, €10, and €30 were assumed, the probability of CBT being cost-effective relative to PDT was 65, 83, and 96%. Direct costs increased compared to baseline across groups, whereas indirect costs did not change significantly. Results were sensitive to considered costs. Conclusions If the society is willing to pay ≥€30 per additional AFD, CBT can be considered cost-effective, relative to PDT, with certainty. To further increase the cost-effectiveness more knowledge regarding predictors of treatment outcome seems essential.
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short term cost effectiveness of Psychodynamic Therapy and cognitive behavioral Therapy in social anxiety disorder results from the sopho net trial
Journal of Affective Disorders, 2015Co-Authors: Nina Egger, Stephan Herpertz, Simone Salzer, Manfred E Beutel, Wolfgang Hiller, Juergen Hoyer, Alexander Konnopka, Ulrich Stangier, Bernhard Strauss, Ulrike WillutzkiAbstract:Abstract Background To investigate the short-term cost-effectiveness of cognitive-behavioral Therapy (CBT) and Psychodynamic Therapy (PDT) compared to waiting list (WL). Methods The analysis was conducted alongside the SOPHO-NET multi-center efficacy trial. Patients were randomly assigned to CBT ( n =209), PDT ( n =207), or WL ( n =79). Resource use was assessed prior and during treatment to determine direct and absenteeism costs. Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated based on remission and response rates. To visualize statistical uncertainty, cost-effectiveness acceptability curves (CEACs) were constructed based on adjusted net-benefit regression. Different values for the society׳s willingness to pay (WTP) were assumed. Results Both interventions were more efficacious than WL but were associated with increased direct costs besides intervention costs. Unadjusted ICERs per responder were €3615 for CBT and €4958 for PDT. Unadjusted ICERs per remitted patient were €5788 and €10,733. CEACs revealed a high degree of uncertainty: applying the 97.5% probability threshold, CBT proved cost-effective at a WTP ≥€16,100 per responder and ≥€26,605 per remitted patient. Regarding PDT cost-effectiveness only was certain for response at a WTP ≥€27,290. Limitations The WL condition is assumed to represent untreated patients, although the expectation to start treatment in the near future probably affects symptom severity and health care utilization. Conclusions At the end of treatment cost-effectiveness of CBT and PDT compared to WL is uncertain and depends on the societal WTP. The interventions may induce a more adequate utilization of other health care services – involving increased costs. Development of costs and effects in the long-run should be considered.
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long term outcome of Psychodynamic Therapy and cognitive behavioral Therapy in social anxiety disorder
American Journal of Psychiatry, 2014Co-Authors: Falk Leichsenring, Stephan Herpertz, Simone Salzer, Manfred E Beutel, Wolfgang Hiller, Juergen Hoyer, Johannes Huesing, Peter Joraschky, Bjoern Nolting, Karin PoehlmannAbstract:No long-term differences were found between CBT and Psychodynamic Therapy in treating social anxiety disorder, and both treatments were superior to no treatment, but CBT was slightly favored for self-reported symptoms and interpersonal problems in the short term.
Manfred E Beutel - One of the best experts on this subject based on the ideXlab platform.
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trauma focused Psychodynamic Therapy and stair narrative Therapy of post traumatic stress disorder related to childhood maltreatment trial protocol of a multicentre randomised controlled trial assessing psychological neurobiological and health econom
BMJ Open, 2020Co-Authors: Falk Leichsenring, Christiane Steinert, Manfred E Beutel, Lila Feix, Harald Gundel, Andrea Hermann, Alexander Karabatsiakis, Christine Knaevelsrud, Hanshelmut KonigAbstract:Introduction Success rates of psychoTherapy in post-traumatic stress disorder related to childhood maltreatment (PTSD-CM) are limited. Methods and analysis Observer-blind multicentre randomised clinical trial (A-1) of 4-year duration comparing enhanced methods of STAIR Narrative Therapy (SNT) and of trauma-focused Psychodynamic Therapy (TF-PDT) each of up to 24 sessions with each other and a minimal attention waiting list in PTSD-CM. Primary outcome is severity of PTSD (Clinician-Administered PTSD Scale for DSM-5 total) assessed by masked raters. For SNT and TF-PDT, both superiority and non-inferiority will be tested. Intention-to-treat analysis (primary) and per-protocol analysis (secondary). Assessments at baseline, after 10 sessions, post-Therapy/waiting period and at 6 and 12 months of follow-up. Adult patients of all sexes between 18 and 65 years with PTSD-CM will be included. Continuing stable medication is permitted. To be excluded: psychotic disorders, risk of suicide, ongoing abuse, acute substance related disorder, borderline personality disorder, dissociative identity disorder, organic mental disorder, severe medical conditions and concurrent psychoTherapy. To be assessed for eligibility: n=600 patients, to be e randomly allocated to the study conditions: n=328. Data management, randomisation and monitoring will be performed by an independent European Clinical Research Infrastructure Network (ECRIN)-certified data coordinating centre for clinical trials (KKS Marburg). Report of AEs to a data monitoring and safety board. Complementing study A-1, four inter-related add-on projects, including subsamples of the treatment study A-1, will examine (1) treatment integrity (adherence and competence) and moderators and mediators of outcome (B-1); (2) biological parameters (B-2, eg, DNA damage, reactive oxygen species and telomere shortening); (3) structural and functional neural changes by neuroimaging (B-3) and (4) cost-effectiveness of the treatments (B-4, costs and utilities). Ethics and dissemination Approval by the institutional review board of the University of Giessen (AZ 168/19). Following the Consolidated Standards of Reporting Trials statement for non-pharmacological trials, results will be reported in peer-reviewed scientific journals and disseminated to patient organisations and media. Trial registration number DRKS 00021142.
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partner related attachment as a moderator of outcome in patients with social anxiety disorder a comparison between short term cognitive behavioral and Psychodynamic Therapy
Psychotherapy, 2017Co-Authors: Bernhard Strauss, Stephan Herpertz, Manfred E Beutel, Wolfgang Hiller, Jurgen Hoyer, Susan Koranyi, Uwe Altmann, Tobias Nolte, Jorg Wiltink, Peter JoraschkyAbstract:This study investigated whether partner-related attachment characteristics differentially predict premature treatment termination as well as posttreatment and 1-year follow-up outcome in patients with social anxiety disorder treated with a manualized cognitive-behavioral Therapy (CBT) or short-term Psychodynamic Therapy (PDT) in the SOPHO-NET (Social Phobia PsychoTherapy Network) trial. Participants were 412 patients with social anxiety disorder (57% female) with a mean age of 35.4 years (SD = 12.1) who were randomized to either CBT or PDT. Partner-related attachment characteristics were measured using the revised Experiences in Close Relationships Questionnaire (ECR-R) at pretreatment. The Liebowitz Social Anxiety Scale was administered at pretreatment, posttreatment, and a 1-year follow-up. To address our research questions, linear regression models were applied. Furthermore, we compared CBT versus PDT patients within ECR-R quartiles. Treatment dropout did not differ between CBT and PDT and was not predicted by pretreatment attachment. In both treatment conditions, there was a trend for higher attachment anxiety to be associated with a more limited reduction in symptoms if controlling for pretreatment Liebowitz Social Anxiety Scale scores. Exploratory analyses showed that patients assigned to the highest quartile of the ECR-R-Avoidance distribution showed more benefit within the CBT condition posttreatment and at follow-up than the PDT condition. Our findings suggest that it may be useful to assess attachment characteristics in patients with social anxiety disorder before psychotherapeutic treatment. Patients characterized by very high pretreatment attachment avoidance (ECR-R-Avoidance >3.87) may specifically benefit more from CBT than from PDT. However, replication studies are needed that also should investigate nonlinear effects of pretreatment attachment. (PsycINFO Database Record
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long term cost effectiveness of cognitive behavioral Therapy versus Psychodynamic Therapy in social anxiety disorder
Depression and Anxiety, 2016Co-Authors: Nina Egger, Stephan Herpertz, Simone Salzer, Manfred E Beutel, Wolfgang Hiller, Juergen Hoyer, Alexander Konnopka, Ulrich Stangier, Bernhard Strauss, Ulrike WillutzkiAbstract:Background To determine the cost-effectiveness of cognitive behavioral Therapy (CBT) versus Psychodynamic Therapy (PDT) in the treatment of social anxiety disorder after a follow-up of 30 months from a societal perspective. Methods This analysis was conducted alongside the multicenter SOPHO-NET trial; adults with a primary diagnosis of social anxiety disorder received CBT (n = 209) or PDT (n = 207). Data on health care utilization and productivity loss were collected at baseline, after 6 months (posttreatment), and three further follow-ups to calculate direct and indirect costs. Anxiety-free days (AFDs) calculated based on remission and response were used as measure of effect. The incremental cost-effectiveness ratio (ICER) was determined. Net benefit regressions, adjusted for comorbidities and baseline differences, were applied to derive cost-effectiveness acceptability curves. Results In the descriptive analysis, the unadjusted ICER favored CBT over PDT and the adjusted analysis showed that CBT's cost-effectiveness relative to PDT depends on the willingness to pay (WTP) per AFD. As baseline costs differed substantially the unadjusted estimates might be deceptive. If additional WTPs for CBT of €0, €10, and €30 were assumed, the probability of CBT being cost-effective relative to PDT was 65, 83, and 96%. Direct costs increased compared to baseline across groups, whereas indirect costs did not change significantly. Results were sensitive to considered costs. Conclusions If the society is willing to pay ≥€30 per additional AFD, CBT can be considered cost-effective, relative to PDT, with certainty. To further increase the cost-effectiveness more knowledge regarding predictors of treatment outcome seems essential.
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developing a prototype for short term Psychodynamic supportive expressive Therapy an empirical study with the psychoTherapy process q set
Psychotherapy Research, 2016Co-Authors: Falk Leichsenring, Christiane Steinert, Jacques P. Barber, Paul Critschristoph, Manfred E Beutel, Frank Leweke, Mary Beth Connolly Gibbons, Stuart Ablon, Susanne Klein, Jorg WiltinkAbstract:AbstractObjective: A PsychoTherapy Process Q-set (PQS) prototype characteristic of short-term Psychodynamic Therapy (STPP) does not yet exist. Method: Experts in supportive-expressive (SE) Therapy used the 100-Item PQS questionnaire to rate an ideal short-term SE Therapy. Results: Agreement between raters was high (Cronbach's alpha = 0.94). The prototype for SE Therapy showed a significant correlation with the psychoanalytic prototype, but with 28% of variance explained, the majority of variance of the former was not explained by the latter or vice versa. Furthermore, the SE prototype showed significant correlations with the cognitive-behavioral prototype and the prototype of interpersonal Therapy by Ablon and Jones (r = 0.69, 0.43). Conclusions: We recommend using the PQS prototype presented here for future process research on STPP.
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short term cost effectiveness of Psychodynamic Therapy and cognitive behavioral Therapy in social anxiety disorder results from the sopho net trial
Journal of Affective Disorders, 2015Co-Authors: Nina Egger, Stephan Herpertz, Simone Salzer, Manfred E Beutel, Wolfgang Hiller, Juergen Hoyer, Alexander Konnopka, Ulrich Stangier, Bernhard Strauss, Ulrike WillutzkiAbstract:Abstract Background To investigate the short-term cost-effectiveness of cognitive-behavioral Therapy (CBT) and Psychodynamic Therapy (PDT) compared to waiting list (WL). Methods The analysis was conducted alongside the SOPHO-NET multi-center efficacy trial. Patients were randomly assigned to CBT ( n =209), PDT ( n =207), or WL ( n =79). Resource use was assessed prior and during treatment to determine direct and absenteeism costs. Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated based on remission and response rates. To visualize statistical uncertainty, cost-effectiveness acceptability curves (CEACs) were constructed based on adjusted net-benefit regression. Different values for the society׳s willingness to pay (WTP) were assumed. Results Both interventions were more efficacious than WL but were associated with increased direct costs besides intervention costs. Unadjusted ICERs per responder were €3615 for CBT and €4958 for PDT. Unadjusted ICERs per remitted patient were €5788 and €10,733. CEACs revealed a high degree of uncertainty: applying the 97.5% probability threshold, CBT proved cost-effective at a WTP ≥€16,100 per responder and ≥€26,605 per remitted patient. Regarding PDT cost-effectiveness only was certain for response at a WTP ≥€27,290. Limitations The WL condition is assumed to represent untreated patients, although the expectation to start treatment in the near future probably affects symptom severity and health care utilization. Conclusions At the end of treatment cost-effectiveness of CBT and PDT compared to WL is uncertain and depends on the societal WTP. The interventions may induce a more adequate utilization of other health care services – involving increased costs. Development of costs and effects in the long-run should be considered.
Ellen Driessen - One of the best experts on this subject based on the ideXlab platform.
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cognitive behavioral versus Psychodynamic Therapy for major depression secondary outcomes of a randomized clinical trial
Journal of Consulting and Clinical Psychology, 2017Co-Authors: Ellen Driessen, Henricus L Van, Jaap Peen, Frank J Don, Jos W R Twisk, Pim Cuijpers, Jack DekkerAbstract:Objective In a randomized clinical trial, we compared the efficacy of cognitive-behavioral Therapy (CBT) and Psychodynamic Therapy for adult outpatient depression on measures of psychopathology, interpersonal functioning, pain, and quality of life. Method There were 341 Dutch adults (70.1% female, mean age = 38.9, SD = 10.3) meeting Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) criteria for a major depressive episode and with a Hamilton Depression Rating Scale (HAM-D) score ≥14, who were randomized to 16 sessions of individual manualized CBT or short-term Psychodynamic supportive psychoTherapy. Severely depressed patients (HAM-D >24) received additional antidepressant medication according to a protocol. Outcome measures included the Brief Symptom Inventory, Beck Anxiety Inventory, Outcome Questionnaire, a visual analogue scale for pain, and EuroQol. Data were analyzed with mixed model analyses using intention-to-treat samples. Noninferiority margins were prespecified as Cohen's d = -0.30. Results Across treatment conditions, 45-60% of the patients who completed posttreatment assessment showed clinically meaningful change for most outcome measures. We found no significant differences between the treatment conditions on any of the outcome measures at both posttreatment and follow-up. Noninferiority of Psychodynamic Therapy to CBT was shown for posttreatment and follow-up anxiety measures as well as for posttreatment pain and quality of life measures, but could not be consistently demonstrated for the other outcomes. Conclusions This is the first study that shows that Psychodynamic Therapy can be at least as efficacious as CBT for depression on important aspects of patient functioning other than depressive symptom reduction. These findings extend the evidence-base of Psychodynamic Therapy for depression, but replication is needed by means of rigorously designed noninferiority trials. (PsycINFO Database Record
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The role of avoidant and obsessive-compulsive personality disorder traits in matching patients with major depression to cognitive behavioral and Psychodynamic Therapy: A replication study
Journal of affective disorders, 2016Co-Authors: Martijn J. Kikkert, Jacques P. Barber, Ellen Driessen, Jaap Peen, Claudi L.h. Bockting, Frans Schalkwijk, Jeff Dekker, Jack DekkerAbstract:Abstract Background Barber and Muenz (1996) reported that cognitive behavior Therapy (CBT) was more effective than interpersonal Therapy (IPT) for depressed patients with elevated levels of avoidant personality disorder, while IPT was more effective than CBT in patients with elevated levels of obsessive-compulsive personality disorder. These findings may have important clinical implications, but have not yet been replicated. Methods We conducted a study using data from a randomized clinical trial comparing the efficacy of CBT and short-term Psychodynamic supportive psychoTherapy in the outpatient treatment of depression. Results We found no evidence indicating that avoidant patients may benefit more from CBT compared to short-term Psychodynamic supportive Therapy (SPSP). Conclusions Our results indicate that treatment effect does not depend on the level of avoidance, or obsessive-compulsiveness personality disorders further examine the influence of personality disorders on the effectiveness of CBT or Psychodynamic Therapy in the treatment of depression.
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differential efficacy of cognitive behavioral Therapy and Psychodynamic Therapy for major depression a study of prescriptive factors
Psychological Medicine, 2016Co-Authors: Ellen Driessen, Jaap Peen, Frank J Don, Pim Cuijpers, Jack Dekker, Simone Kool, Dieuwertje Westra, Marielle Hendriksen, Niels Smits, Henricus L VanAbstract:Minimal efficacy differences have been found between cognitive behavioral Therapy (CBT) and Psychodynamic therapies for depression, but little is known about patient characteristics that might moderate differential treatment effects. We aimed to generate hypotheses regarding such potential prescriptive factors. We conducted post-hoc model-based recursive partitioning analyses alongside a randomized clinical trial comparing the efficacy of CBT and short-term Psychodynamic supportive psychoTherapy (SPSP). Severely depressed patients received additional antidepressant medication. We included 233 adults seeking treatment for a major depressive episode in psychiatric outpatient clinics, who completed post-treatment assessment. Post-treatment mean Hamilton Depression Rating Scale scores constituted the main outcome measure. While treatment differences (CBT v. SPSP) were minimal in the total sample of patients (d = 0.04), model-based recursive partitioning indicated differential treatment efficacy in certain subgroups of patients. SPSP was found more efficacious among moderately depressed patients receiving psychoTherapy only who showed low baseline co-morbid anxiety levels (d = −0.40) and among severely depressed patients receiving psychoTherapy and antidepressant medication who reported a duration of the depressive episode of ⩾1 year (d = −0.31), while CBT was found more efficacious for such patients reporting a duration <1 year (d = 0.83). Our findings are observational and need validation before they can be used to guide treatment selection, but suggest that knowledge of prescriptive factors can help improve the efficacy of psychoTherapy for depression. Depressive episode duration and co-morbid anxiety level should be included as stratification variables in future randomized clinical trials comparing CBT and Psychodynamic Therapy.
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therapist rated outcomes in a randomized clinical trial comparing cognitive behavioral Therapy and Psychodynamic Therapy for major depression
Journal of Affective Disorders, 2015Co-Authors: Ellen Driessen, Henricus L Van, Jaap Peen, Frank J Don, Pim Cuijpers, Simone Kool, Dieuwertje Westra, Marielle HendriksenAbstract:Abstract Background The efficacy of Psychodynamic Therapy (PDT) for depression is debated due to a paucity of high-quality studies. We compared short Psychodynamic supportive psychoTherapy (SPSP) to cognitive behavioral Therapy (CBT) in a randomized clinical trial. We used therapist-rated outcomes to examine how the course of change during treatment could be best represented and to compare treatment efficacy, hypothesizing non-significant differences. Methods Three hundred and forty-one adults meeting DSM-IV criteria for a depressive episode and with Hamilton Depression Rating Scale (HAM-D) scores ≥14 were randomized to 16 sessions of individual manualized CBT or SPSP. Severely depressed patients (HAM-D>24) received additional antidepressant medication. After each session, therapists rated the Clinical Global Impression Scale subscales ‘Severity of Illness’ (CGI-S) and ‘Global Improvement’ (CGI-I), and the DSM-IV Axis V Global Assessment of Functioning Scale (GAF). We fitted growth curves using mixed model analyses with intention-to-treat samples. Results CGI-S and GAF scores during treatment were best represented by a linear symptom decrease. CGI-I scores were best represented by an S-shaped curve with relative more improvement in the first and last phases than in the middle phase of treatment. No significant post-treatment treatment differences were found. A non-significant trend for a treatment effect on CGI-S scores vanished when controlling for therapist gender and profession. Limitations Therapists were not specifically trained for CGI and GAF assessments. Conclusions These findings add to the evidence-base of PDT for depression. Therapist characteristics and differences between severity and improvement measures might influence ratings and need to be taken into account when using therapist-rated outcome measures.
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the efficacy of cognitive behavioral Therapy and Psychodynamic Therapy in the outpatient treatment of major depression a randomized clinical trial
American Journal of Psychiatry, 2013Co-Authors: Ellen Driessen, Jaap Peen, Jos W R Twisk, Pim Cuijpers, Simone Kool, Dieuwertje Westra, Marielle Hendriksen, Robert A Schoevers, Jack DekkerAbstract:ObjectiveThe efficacy of Psychodynamic therapies for depression remains open to debate because of a paucity of high-quality studies. The authors compared the efficacy of Psychodynamic Therapy with that of cognitive-behavioral Therapy (CBT), hypothesizing nonsignificant differences and the noninferiority of Psychodynamic Therapy relative to CBT.MethodA total of 341 adults who met DSM-IV criteria for a major depressive episode and had Hamilton Depression Rating Scale (HAM-D) scores ≥14 were randomly assigned to 16 sessions of individual manualized CBT or short-term Psychodynamic supportive Therapy. Severely depressed patients (HAM-D score >24) also received antidepressant medication according to protocol. The primary outcome measure was posttreatment remission rate (HAM-D score ≤7). Secondary outcome measures included mean posttreatment HAM-D score and patient-rated depression score and 1-year follow-up outcomes. Data were analyzed with generalized estimating equations and mixed-model analyses using intent-...
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cognitive behavioral versus Psychodynamic Therapy for major depression secondary outcomes of a randomized clinical trial
Journal of Consulting and Clinical Psychology, 2017Co-Authors: Ellen Driessen, Henricus L Van, Jaap Peen, Frank J Don, Jos W R Twisk, Pim Cuijpers, Jack DekkerAbstract:Objective In a randomized clinical trial, we compared the efficacy of cognitive-behavioral Therapy (CBT) and Psychodynamic Therapy for adult outpatient depression on measures of psychopathology, interpersonal functioning, pain, and quality of life. Method There were 341 Dutch adults (70.1% female, mean age = 38.9, SD = 10.3) meeting Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) criteria for a major depressive episode and with a Hamilton Depression Rating Scale (HAM-D) score ≥14, who were randomized to 16 sessions of individual manualized CBT or short-term Psychodynamic supportive psychoTherapy. Severely depressed patients (HAM-D >24) received additional antidepressant medication according to a protocol. Outcome measures included the Brief Symptom Inventory, Beck Anxiety Inventory, Outcome Questionnaire, a visual analogue scale for pain, and EuroQol. Data were analyzed with mixed model analyses using intention-to-treat samples. Noninferiority margins were prespecified as Cohen's d = -0.30. Results Across treatment conditions, 45-60% of the patients who completed posttreatment assessment showed clinically meaningful change for most outcome measures. We found no significant differences between the treatment conditions on any of the outcome measures at both posttreatment and follow-up. Noninferiority of Psychodynamic Therapy to CBT was shown for posttreatment and follow-up anxiety measures as well as for posttreatment pain and quality of life measures, but could not be consistently demonstrated for the other outcomes. Conclusions This is the first study that shows that Psychodynamic Therapy can be at least as efficacious as CBT for depression on important aspects of patient functioning other than depressive symptom reduction. These findings extend the evidence-base of Psychodynamic Therapy for depression, but replication is needed by means of rigorously designed noninferiority trials. (PsycINFO Database Record
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The role of avoidant and obsessive-compulsive personality disorder traits in matching patients with major depression to cognitive behavioral and Psychodynamic Therapy: A replication study
Journal of affective disorders, 2016Co-Authors: Martijn J. Kikkert, Jacques P. Barber, Ellen Driessen, Jaap Peen, Claudi L.h. Bockting, Frans Schalkwijk, Jeff Dekker, Jack DekkerAbstract:Abstract Background Barber and Muenz (1996) reported that cognitive behavior Therapy (CBT) was more effective than interpersonal Therapy (IPT) for depressed patients with elevated levels of avoidant personality disorder, while IPT was more effective than CBT in patients with elevated levels of obsessive-compulsive personality disorder. These findings may have important clinical implications, but have not yet been replicated. Methods We conducted a study using data from a randomized clinical trial comparing the efficacy of CBT and short-term Psychodynamic supportive psychoTherapy in the outpatient treatment of depression. Results We found no evidence indicating that avoidant patients may benefit more from CBT compared to short-term Psychodynamic supportive Therapy (SPSP). Conclusions Our results indicate that treatment effect does not depend on the level of avoidance, or obsessive-compulsiveness personality disorders further examine the influence of personality disorders on the effectiveness of CBT or Psychodynamic Therapy in the treatment of depression.
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differential efficacy of cognitive behavioral Therapy and Psychodynamic Therapy for major depression a study of prescriptive factors
Psychological Medicine, 2016Co-Authors: Ellen Driessen, Jaap Peen, Frank J Don, Pim Cuijpers, Jack Dekker, Simone Kool, Dieuwertje Westra, Marielle Hendriksen, Niels Smits, Henricus L VanAbstract:Minimal efficacy differences have been found between cognitive behavioral Therapy (CBT) and Psychodynamic therapies for depression, but little is known about patient characteristics that might moderate differential treatment effects. We aimed to generate hypotheses regarding such potential prescriptive factors. We conducted post-hoc model-based recursive partitioning analyses alongside a randomized clinical trial comparing the efficacy of CBT and short-term Psychodynamic supportive psychoTherapy (SPSP). Severely depressed patients received additional antidepressant medication. We included 233 adults seeking treatment for a major depressive episode in psychiatric outpatient clinics, who completed post-treatment assessment. Post-treatment mean Hamilton Depression Rating Scale scores constituted the main outcome measure. While treatment differences (CBT v. SPSP) were minimal in the total sample of patients (d = 0.04), model-based recursive partitioning indicated differential treatment efficacy in certain subgroups of patients. SPSP was found more efficacious among moderately depressed patients receiving psychoTherapy only who showed low baseline co-morbid anxiety levels (d = −0.40) and among severely depressed patients receiving psychoTherapy and antidepressant medication who reported a duration of the depressive episode of ⩾1 year (d = −0.31), while CBT was found more efficacious for such patients reporting a duration <1 year (d = 0.83). Our findings are observational and need validation before they can be used to guide treatment selection, but suggest that knowledge of prescriptive factors can help improve the efficacy of psychoTherapy for depression. Depressive episode duration and co-morbid anxiety level should be included as stratification variables in future randomized clinical trials comparing CBT and Psychodynamic Therapy.
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the efficacy of cognitive behavioral Therapy and Psychodynamic Therapy in the outpatient treatment of major depression a randomized clinical trial
American Journal of Psychiatry, 2013Co-Authors: Ellen Driessen, Jaap Peen, Jos W R Twisk, Pim Cuijpers, Simone Kool, Dieuwertje Westra, Marielle Hendriksen, Robert A Schoevers, Jack DekkerAbstract:ObjectiveThe efficacy of Psychodynamic therapies for depression remains open to debate because of a paucity of high-quality studies. The authors compared the efficacy of Psychodynamic Therapy with that of cognitive-behavioral Therapy (CBT), hypothesizing nonsignificant differences and the noninferiority of Psychodynamic Therapy relative to CBT.MethodA total of 341 adults who met DSM-IV criteria for a major depressive episode and had Hamilton Depression Rating Scale (HAM-D) scores ≥14 were randomly assigned to 16 sessions of individual manualized CBT or short-term Psychodynamic supportive Therapy. Severely depressed patients (HAM-D score >24) also received antidepressant medication according to protocol. The primary outcome measure was posttreatment remission rate (HAM-D score ≤7). Secondary outcome measures included mean posttreatment HAM-D score and patient-rated depression score and 1-year follow-up outcomes. Data were analyzed with generalized estimating equations and mixed-model analyses using intent-...