Short-Term Dynamic Therapy Gets Boost in New Efficacy Study

To answer the first question—whether intensive short-term dynamic psychotherapy is clinically effective—Abbass and his coworkers had the subjects complete self-report questionnaires before and after therapy. The questionnaires consisted of the Brief Symptom Inventory, a general symptom measurement scale that encompasses depression and anxiety; the Inventory of Interpersonal Problems, a scale that assesses a wide range of interpersonal functioning difficulties; and the Beck Depression Inventory and the Beck Anxiety Inventory, well-established measurement scales of depression and anxiety, respectively.

Abbass and his colleagues then compared the results of the questionnaires completed by the subjects before and after therapy to see whether intensive short-term dynamic psychotherapy had helped them. On each self-report measure, after-therapy levels were lower than pretherapy ones, and the differences in each case were statistically significant. In fact, average scores on each measure decreased from pathological levels before therapy to within normal ranges after therapy.

Thus, intensive short-term dynamic psychotherapy given by a psychiatrist in a private office setting appears to be clinically effective, Abbass and his team concluded.

Abbass and his colleagues then set out to answer their second question—whether intensive short-term dynamic psychotherapy given by a psychiatrist in a private office setting is cost-effective.

The researchers collected data about subjects’ health care costs, unemployment rates, and disability insurance use and costs before therapy as well as after. Then the researchers compared subjects’ before and after therapy levels of health care use, unemployment rates, and disability insurance use. They found, for example, that the average length of stay in the hospital for the subjects went from 10 days during the 12-month period two years before treatment to three days during the 12-month period after treatment. Of the 22 subjects who had been unemployed and out of work on average 60 weeks before therapy, 18 (82 percent) returned to work after therapy (or even before therapy ended). Seventeen of the 18 subjects had been on disability insurance.

Finally, the investigators compared the costs of subjects’ health care and disability insurance use during the 12-month period two years before therapy to the costs of their health care and disability insurance use in the 12-month period after therapy to see whether they could find any differences. The researchers found that the total cost, in Canadian dollars, after therapy was $551,954 less than what it had been before therapy. They then deducted the cost of giving intensive short-term dynamic psychotherapy to the 89 subjects, which was $149,431, leaving a net savings of $402,523.

“This is a remarkable study,” Robert Neborsky, M.D., a clinical professor of psychiatry at the University of California at San Diego, told Psychiatric News. “One of its key points is its naturalistic design. Abbass and his coworkers studied the effect of the treatment on 89 consecutive referrals to a general psychiatry outpatient practice in Vancouver. Although not a perfect design, they have eliminated all criticism of ‘cherry-picking’—that is, only reporting the responses of highly motivated, low-resistance cases. Theirs was a markedly disturbed population, and their results show evidence of substantial change in symptom measures, character measures, and health care and disability costs, using the patient’s retrospective health care demographic compared with their prospective utilization.”

What still needs to be learned, of course, Neborsky pointed out, is whether certain types of patients respond better to intensive short-term dynamic psychotherapy than others do.

“Clearly, there were some patients in the study who showed greater benefit than others,” he said, “and it would be of interest to determine whether they demonstrated the greatest part of the therapeutic variance, and if so, what were their characteristics as opposed to the relative nonresponders.”