Доказательства эффективности долгосрочной психодинамической психотерапии.

[Divisenko]

Отсюда: [Ссылки доступны только зарегистрированным пользователям ]

Effectiveness of Long-term Psychodynamic Psychotherapy

A Meta-analysis

Falk Leichsenring, DSc; Sven Rabung, PhD

JAMA. 2008;300(13):1551-1565.

Context The place of long-term psychodynamic psychotherapy (LTPP) within psychiatry is controversial. Convincing outcome research for LTPP has been lacking.

Objective To examine the effects of LTPP, especially in complex mental disorders, ie, patients with personality disorders, chronic mental disorders, multiple mental disorders, and complex depressive and anxiety disorders (ie, associated with chronic course and/or multiple mental disorders), by performing a meta-analysis.

Data Sources Studies of LTPP published between January 1, 1960, and May 31, 2008, were identified by a computerized search using MEDLINE, PsycINFO, and Current Contents, supplemented by contact with experts in the field.

Study Selection Only studies that used individual psychodynamic psychotherapy lasting for at least a year, or 50 sessions; had a prospective design; and reported reliable outcome measures were included. Randomized controlled trials (RCTs) and observational studies were considered. Twenty-three studies involving a total of 1053 patients were included (11 RCTs and 12 observational studies).

Data Extraction Information on study characteristics and treatment outcome was extracted by 2 independent raters. Effect sizes were calculated for overall effectiveness, target problems, general psychiatric symptoms, personality functioning, and social functioning. To examine the stability of outcome, effect sizes were calculated separately for end-of-therapy and follow-up assessment.

Results According to comparative analyses of controlled trials, LTPP showed significantly higher outcomes in overall effectiveness, target problems, and personality functioning than shorter forms of psychotherapy. With regard to overall effectiveness, a between-group effect size of 1.8 (95% confidence interval [CI], 0.7-3.4) indicated that after treatment with LTPP patients with complex mental disorders on average were better off than 96% of the patients in the comparison groups (P = .002). According to subgroup analyses, LTPP yielded significant, large, and stable within-group effect sizes across various and particularly complex mental disorders (range, 0.78-1.98).

Conclusions There is evidence that LTPP is an effective treatment for complex mental disorders. Further research should address the outcome of LTPP in specific mental disorders and should include cost-effectiveness analyses.


Author Affiliations: Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen (Dr Leichsenring); and Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg (Dr Rabung), Germany.

[Lyubimova]

Важно, что исследования продолжаются. Но доказательства ли это?

Актуальность: Изучалсиь в первую очередь тяжелые состояния у пациентов, сложные расстрйства

Цель: Меня очень заинтересовала цифра: результат улучшения жизни по сравнению с 96 % пациентов в группах сравнения.

Метод: попытка найти больше данных о данном исследовании в и-нете.
[Ссылки доступны только зарегистрированным пользователям ]
[Ссылки доступны только зарегистрированным пользователям ]

Результат: С чем таки сравнивали LTPP:
"Eight of the 11 RCTs included data from 257 patients receiving shorter forms of psychotherapies including active therapy, shorter-term psychodynamic psychotherapy, and treatment as usual, in which psychiatrists were free to use whatever treatment they would normally use.(с)"
Что такое "active therapy" я не знаю. Кто может, просветите пожалуйтса. Попытки просветиться самой успехом не увенчались.

Далее:
"The researchers found that long-term individual psychodynamic psychotherapy in patients with complex mental disorders resulted in better outcomes — including improved psychiatric symptoms and personality and social functioning — than shorter-term psychotherapy.(с)"
В общем год LTPP у тяжелых пациентов - это лучше, чем "active therapy", короткий курс psychodynamic psychotherapy и "обычное лечение".

И, конечно
"Limitations of this meta-analysis include its small number of studies, the methodological shortcomings of some of the included studies that were carried out in the 1980s, and some variance between the included studies regarding methodological quality.(с)"

Выводы:
На мой взгляд если данный метанализ что-то и доказывает, то это то, что у пациентов с тяжелыми расстрйоствами psychodynamic psychotherapy коротким курсом недопустима.
При этом данное исследование поднимает очень важную тему: о необходимости длительных психотерапевтических программ для пациентов со сложными психическими расстройствами, что в дальнейшем, возможно, позволит и увеличить финансирование на лечение для данной категории пациентов.
А что это будет за метод - еще предстоит определит, может быть LTPP, может быть КПТ или ....