Psychological Medicine

Original Articles

Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up

P. Knekta1a2 c1, O. Lindforsa3, T. Härkänena2, M. Välikoskia3, E. Virtalaa2, M. A. Laaksonena2, M. Marttunena3, M. Kaipainena4, C. Renlunda3 and the Helsinki Psychotherapy Study Groupa1a2a3a4a5

a1 Social Insurance Institution, Helsinki, Finland

a2 Department of Health and Functional Capacity, National Public Health Institute, Helsinki, Finland

a3 Biomedicum Helsinki, Helsinki, Finland

a4 Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland

a5 Rehabilitation Foundation, Helsinki, Finland

Abstract

Background Insufficient evidence exists for a viable choice between long- and short-term psychotherapies in the treatment of psychiatric disorders. The present trial compares the effectiveness of one long-term therapy and two short-term therapies in the treatment of mood and anxiety disorders.

Method In the Helsinki Psychotherapy Study, 326 out-patients with mood (84.7%) or anxiety disorder (43.6%) were randomly assigned to three treatment groups (long-term psychodynamic psychotherapy, short-term psychodynamic psychotherapy, and solution-focused therapy) and were followed up for 3 years from start of treatment. Primary outcome measures were depressive symptoms measured by self-report Beck Depression Inventory (BDI) and observer-rated Hamilton Depression Rating Scale (HAMD), and anxiety symptoms measured by self-report Symptom Check List Anxiety Scale (SCL-90-Anx) and observer-rated Hamilton Anxiety Rating Scale (HAMA).

Results A statistically significant reduction of symptoms was noted for BDI (51%), HAMD (36%), SCL-90-Anx (41%) and HAMA (38%) during the 3-year follow-up. Short-term psychodynamic psychotherapy was more effective than long-term psychodynamic psychotherapy during the first year, showing 15–27% lower scores for the four outcome measures. During the second year of follow-up no significant differences were found between the short-term and long-term therapies, and after 3 years of follow-up long-term psychodynamic psychotherapy was more effective with 14–37% lower scores for the outcome variables. No statistically significant differences were found in the effectiveness of the short-term therapies.

Conclusions Short-term therapies produce benefits more quickly than long-term psychodynamic psychotherapy but in the long run long-term psychodynamic psychotherapy is superior to short-term therapies. However, more research is needed to determine which patients should be given long-term psychotherapy for the treatment of mood or anxiety disorders.

(Received December 04 2006)

(Revised May 29 2007)

(Accepted July 12 2007)

(Online publication November 16 2007)

Correspondence

c1 Address for correspondence: Dr P. Knekt, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland. (Email: paul.knekt@ktl.fi)

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