Transcript The Effectiveness of Psychodynamic Therapy and Cognitive

The Effectiveness of Psychodynamic
Therapy and Cognitive Behavior Therapy
in the Treatment of Personality
Disorders: A Meta-Analysis.
By Falk Leichsenring, D.Sc.
Eric Leibing, D.Sc.
(Am J Psychiatry 2003; 160:12231232)
Presented By: Lauren Coe
Purpose
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There is a considerable lack of empirical
research on treatment of personality
disorders with psychotherapy, with only a few
randomized controlled studies.
To address concerns about costs of mental
health services, empirical data about the
efficacy of psychotherapy in the treatment of
personality disorders are needed.
Method
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Studies published between 1974 and 2001
were collected.
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MEDLINE
PsycINFO
Current Contents
14 of psychodynamic therapy and
11 studies of cognitive behavior therapy were
included.
Literature Review Questions:
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What is the evidence of improvement in
symptoms, social functioning, or core
psychopathology after either type of therapy?
Is there evidence of improvement in specific
types of personality disorders after either type
of therapy?
Do individuals with personality disorders
recover after either type of therapy?
Literature Review Questions:
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Are there differences between self-report and
observational measures?
Are there differences between outcome and
duration of treatment?
What other factors are connected with
outcome (gender, inpatient vs. outpatient
status, use of therapy manuals, experience of
therapists)?
Correlations
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Calculate correlations between outcome and
the following factors:
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Length of therapy
Patient gender
Inpatient vs. outpatient status
Use of therapy manuals
Clinical experience of therapists
Study design (randomized vs. naturalistic)
Issues To Consider
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Small number of studies
Many variables
Grouped personality disorders
Effect sizes (statistics) not comparable
This is “preliminary”
Included Studies
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Studies focusing on:
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Either psychodynamic or cognitive therapy
Men and women
Personality disorders
Inpatients, outpatients
Sufficient length of time
Randomized and naturalistic designs
Results
Therapy Type
Mean
Length
Number of
Sessions
Psychodynamic Therapy
37.18
6
Cognitive Therapy
16.36
7
Results - Psychodynamic
Improvement
Effect Size
Number of
Studies
Mean (D)
SD
Range
Overall
15
1.46
0.73
0.34 - 2.70
Self-Report
12
1.08
0.36
0.65 - 1.67
Observer Report
12
1.79
1.07
0.34 - 4.02
Results – Cognitive
Improvement
Effect Size
Number of
Studies
Mean (D)
SD
Range
10
1.00
0.48
0.34 - 2.13
Self-Report
8
1.20
0.38
0.81 - 1.85
Observer Report
8
0.87
0.71
0.19 - 2.40
Overall
Effectiveness of Therapy on Treatment
– Beck Depression Scale
Psychodynamic
PD
No PD
# studies
Mean
SD
6
1.44
0.51
2
2.39
0.54
Effectiveness of Therapy on Treatment
– Beck Depression Scale
Cognitive
# studies
Mean
SD
PD
3
1.49
0.28
No PD
1
2.04
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Other Conclusions
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For cognitive behavioral therapy, the largest
effect sizes were found with the Beck
Depression Inventory.
A calculated recovery rate from personality
disorders of 59% after a mean of 15 months
of treatment (psychodynamic therapy).
47% of the patients were no longer
diagnosed with avoidant personality disorder
(cognitive behavioral therapy).
More random conclusions
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Dropout rates are relevant:
 Mean dropout rates
 Psychodynamic therapy = 15%
 Cognitive therapy = 17%.
 Total number treated
 Psychodynamic therapy = 417
 Cognitive therapy = 231.
Limitations of the Study
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Small number of studies that could be
included (25 total)
The small number of studies reduces both
the results’ potential generalization and the
statistical power.
Thus, the conclusions that can be drawn are
only preliminary.
Limitations of the Study
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Effect sizes cannot be compared directly
between cognitive behavior therapy and
psychodynamic therapy because the data do
not come from the same experimental
comparisons.
Within-group effect sizes may be an
overestimate of the true change because of
unspecific therapeutic factors, spontaneous
remission, or regression to the mean.
Limitations of the Study
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Significant fluctuations over time may occur
that may be state dependent rather than
showing lasting remission of the personality
disorder in question.
Several studies reported more improvement
in personality disorder patients after longer
treatment durations.
Meta-Analysis Conclusions
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There is evidence that both psychodynamic
therapy and cognitive behavior therapy are
effective treatments of personality disorders.
There is evidence that treatment with
psychotherapy in personality disorder
patients is relevant to the cost of health care
utilization.
Further Conclusions
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Further studies are necessary.
Both longer treatments and follow-up studies
should be included.
Further research should examine specific
forms of psychotherapy for specific types of
personality disorder.
Data on health economics should be
included.