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Intervention Review

Short-term psychodynamic psychotherapies for common mental disorders

  1. Allan A Abbass1,*,
  2. Jeffrey T Hancock2,
  3. Julie Henderson1,
  4. Steve R Kisely3

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 18 OCT 2006

Assessed as up-to-date: 20 AUG 2006

DOI: 10.1002/14651858.CD004687.pub3


How to Cite

Abbass AA, Hancock JT, Henderson J, Kisely SR. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.: CD004687. DOI: 10.1002/14651858.CD004687.pub3.

Author Information

  1. 1

    Dalhousie University, Department of Psychiatry, Halifax, NS, Canada

  2. 2

    Cornell University, Department of Psychology, New York, USA

  3. 3

    Logan Campus, Griffith University, School of Medicine, Meadowbrook, Australia

*Allan A Abbass, Department of Psychiatry, Dalhousie University, Suite 9215, 8203 - 5909 Veterans Memorial Lane, Halifax, NS, B3H 2E2, Canada. Allan.Abbass@cdha.nshealth.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 OCT 2006

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Over the past 40 years, short-term psychodynamic psychotherapies (STPP) for a broad range of psychological and somatic disorders have been developed and studied. Four published meta-analyses of STPP, using different methods and samples, have found conflicting results.

Objectives

This review evaluated the efficacy of STPP relative to minimal treatment and non-treatment controls for adults with common mental disorders.

Search methods

We searched CCDANCTR-Studies and CCDANCTR-References on 25/4/2005, CENTRAL, MEDLINE, CINAHL, EMBASE, PsycINFO, DARE and Biological Abstracts were also searched. We contacted triallists and checked references from papers retrieved.

Selection criteria

All randomised controlled trials (RCT) of adults with common mental disorders, in which a brief psychodynamic therapy lasting less than 40 hours in total, and provided in individual format, were included.

Data collection and analysis

Three reviewers working in pairs evaluated studies. Studies were selected only if pairs of reviewers agreed they met inclusion criteria. A third reviewer was consulted if two reviewers could not reach consensus. Data were collected and entered into Review Manager. Study quality was assessed and scored by pairs of raters. Publication bias was assessed using a funnel plot. Sensitivity analyses were also conducted.

Main results

23 studies of 1431 randomised patients with common mental disorders were included. These studies evaluated STPP for general, somatic, anxiety, and depressive symptom reduction, as well as social adjustment. Outcomes for most categories of disorder suggested significantly greater improvement in the treatment versus the control groups, which were generally maintained in medium and long term follow-up. However, only a small number of studies contributed data for each category of disorder, there was significant heterogeneity between studies, and results were not always maintained in sensitivity analyses.

Authors' conclusions

STPP shows promise, with modest to moderate, often sustained gains for a variety of patients. However, given the limited data and heterogeneity between studies, these findings should be interpreted with caution. Furthermore, variability in treatment delivery and treatment quality may limit the reliability of estimates of effect for STPP. Larger studies of higher quality and with specific diagnoses are warranted.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Short-term psychodynamic psychotherapies for common mental disorders

Short-term psychodynamic psychotherapies have been subjected to randomised controlled trials for a range of common mental disorders, including anxiety disorders, depression, stress-related physical conditions, certain behaviour disorders and interpersonal or personality problems mixed with symptom disorders. Previous meta-analyses have yielded conflicting results. This review included all RCTs of STPP for common mental disorders, and found modest treatment benefits that were generally maintained in medium and long term follow-up. However, variability in study design means that our conclusions are tentative, and need confirmation with further research.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

一般心理疾病的短期動力取向心理治療

在過去40年來,針對心理和身體疾患的短期的動力取向心理治療已廣泛地發展和進行研究。有四篇已發表的統合分析,以不同的研究方法和族群,得到不一致的結果。

目標

這篇文獻回顧評估了一般心理疾患接受短期動力取向心理治療的效用,與接受輕微治療及沒有接受治療的控制組做比較。

搜尋策略

我們搜尋了25/4/2005的CCDANCTRStudies 與CCDANCTRReferences,也搜尋CENTRAL, MEDLINE, CINAHL, EMBASE, PsycINFO, DARE 及Biological Abstracts。我們與試驗者聯繫,並檢視論文的參考文獻

選擇標準

選擇標準涵括所有一般成人心理疾患的隨機對照試驗,不過是以個別治療的形式,而且接受短期動力取向心理治療總時數要少於40小時。

資料收集與分析

三位評論者進行配對評估研究。只有經兩位評論三位文獻回顧者以配對的方式來評估研究. 只有兩位都同意其條件符合納入準則的研究才會被挑選進來。若兩位的意見不一致時,將會照會第三位的意見。所有的資料收集後就進入回顧處理. 計分者會評估研究的品質並計分。發表的偏差以漏斗圖來評估。同時也做敏感度分析

主要結論

23個研究,共1431位隨機處理的一般精神疾患被包括進來。這些研究評估了短期動力取向心理治療對整體,身體,焦慮,和憂鬱症狀的減輕程度,也包含社會調適。與維持在中長期追蹤的控制組相較,結果為大部分的症狀類型都有顯著改善。然而,只有少部分的研究對不同類型的症狀提供資料,其結果顯示不同研究間有很大的異質性,而且經過敏感度分析後不見得還能維持同樣的結果

作者結論

短期動力取向心理治療對不同類型患者的效果顯示為樂觀,且經常有輕度到中度的持續助益。然而,考慮到資料的有限及研究結果彼此的異質性,這些發現的詮釋必須要謹慎。再者,治療施行與治療品質的差異可能會限制短期動力取向心理治療效果的可信度。針對特定診斷的更大型高品質研究並是必要的。

翻譯人

本摘要由彰化基督教醫院李冠瑩翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

短期動力取向心理治療使用在各種不同的一般心理疾患,包括焦慮症、憂鬱症、壓力相關的生理狀態、特定行為疾患以及混和症狀疾患的人際間或是人格問題等已經有一些隨機對照試驗。先前的統合分析顯示了不一致的結論。此篇文獻回顧囊括了所有一般心理疾患短期動力取向心理治療的隨機對照試驗,結果發現在中長期追蹤下,是會有適度的益處。然而,在研究設計上的差異性使得我們的結論是只是暫時性的,還需要更進一步的研究來加以確認。