Original article
Comparative effects of short-term psychodynamic psychotherapy and cognitive-behavioral therapy in depression: A meta-analytic approach

https://doi.org/10.1016/S0272-7358(99)00057-4Get rights and content

Abstract

This article reviews the efficacy of short-term psychodynamic psychotherapy (STPP) in depression compared to cognitive-behavioral therapy (CBT) or behavioral therapy (BT). In this review, only studies in which at least 13 therapy sessions were performed have been included, and a sufficient number of patients per group were treated (N ≥ 20). With regard to outcome criteria, the results were reviewed for improvements in depressive symptoms, general psychiatric symptoms, and social functioning. Six studies met the inclusion criteria. Results: In 58 of the 60 comparisons (97%) performed in the six studies and their follow-ups, no significant difference could be detected between STPP and CBT/BT concerning the effects in depressive symptoms, general psychiatric symptomatology, and social functioning. Furthermore, STPP and CBT/BT did not differ significantly with regard to the patients that were judged as remitted or improved. According to a meta-analytic procedure described by R. Rosenthal (1991) the studies do not differ significantly with regard to the patients that were judged as remitted or improved after treatment with STPP or CBT/BT. The mean difference between STPP and CBT/BT concerning the number of patients that were judged as remitted or improved corresponds to a small effect size (post-assessment: φ = 0.08, follow-up assessment: φ = 0.12). Thus, STPP and CBT/BT seem to be equally effective methods in the treatment of depression. However, because of the small number of studies which met the inclusion criteria, this result can only be preliminary. Furthermore, it applies only to the specific forms of STPP that were examined in the selected studies and cannot be generalized to other forms of STPP. Further studies are needed to examine the effects of specific forms of STPP in both controlled and naturalistic settings. Furthermore, there are findings indicating that 16–20 sessions of both STPP and CBT/BT are insufficient for most patients to achieve lasting remission. Future studies should address the effects of longer treatments of depression.

Section snippets

Search for Studies

In addition to the usual search for studies via reviews, meta-analyses, and textbooks, a computerized search was carried out using Medline and PsycLIT with the following key words: Depression, psychotherapy, psychodynamic/psychoanalytic, study. The search was carried out for the following periods: 1966–12/1998 (Medline) and 1977–12/1998 (PsycLIT). Fifteen articles were identified describing empirical results of STPP compared to CBT and/or BT in depression Barkham et al. 1996, Covi & Lipman 1987

Results

This review is based on the results reported by the authors of the original studies, unless otherwise stated. The results of the studies were reviewed with regard to three aspects: statistically significant effects, effect sizes, and clinical significance (percentages of patients remitted or improved).

Meta-analytic evaluation: differences in effect sizes and mean success rates of stpp and cbt/bt

As already mentioned, only three of the six studies provided the data to assess effect sizes in form of Cohen's d (Cohen, 1988). However, the success rates reported can be used to assess an effect size estimator Rosenthal & Rubin 1982, Rosenthal 1995. These data were provided by all but one study (Barkham et al., 1996, see Table 1). As a measure of effect size I calculated the φ-correlation for the resulting 2 × 2 or 2 × 3 frequency tables. The φ-correlation is identical to the effect size

Discussion

This review is the first attempt to carry out a comparison of the efficacy of STPP and CBT/BT for a specific psychiatric disorder: (major) depression. Unfortunately, not more than six studies currently exist, which meet the applied inclusion criteria. In the six studies included in this review, the total number of patients treated with either STPP or CBT/BT is N = 416. This means about 200 patients were treated with STPP and about another 200 patients were treated with CBT/BT.

According to the

References (63)

  • M. Hersen et al.

    Effects of social skill training, Amitriptyline and psychotherapy in unipolar depressed women

    Behavior Therapy

    (1984)
  • M. Horowitz et al.

    Brief therapy of the stress response syndrome

    Psychiatric Clinics of North America

    (1979)
  • American Psychiatric Association (1980, 1983). Diagnostic and statistical manual of mental disorders. Third Edition....
  • M. Barkham et al.

    Outcomes of time-limited psychotherapy in applied settingsReplication of the second Sheffield psychotherapy Project

    Journal of Consulting and Clinical Psychology

    (1996)
  • A.T. Beck et al.

    Cognitive therapy of depression

    (1979)
  • D.L. Chambless et al.

    Defining empirically supported treatments

    Journal of Consulting and Clinical Psychology

    (1998)
  • J. Cohen

    Statistical power analysis for the behavioral sciences

    (1988)
  • L. Covi et al.

    Cognitive-behavioral group psychotherapy combined with Imipramine in major depression

    Psychopharmacology Bulletin

    (1987)
  • P. Crits-Christoph

    The efficacy of brief dynamic psychotherapyA meta-analysis

    American Journal of Psychiatry

    (1992)
  • Depression in primary careVol. 2. Treatment of major depression. Clinical practice guideline No. 5. (AHCPR publication No. 93-0551)

    (1993)
  • R.J. DeRubeis et al.

    Empirically supported individual and group psychological treatments for adult mental disorders

    Journal of Consulting and Clinical Psychology

    (1998)
  • K.S. Dobson

    A meta-analysis of the efficacy of cognitive therapy for depression

    Journal of Consulting and Clinical Psychology

    (1989)
  • I. Elkin et al.

    NIMH Treatment of Depression Collaborative Research Program

    Archives of General Psychiatry

    (1985)
  • I. Elkin et al.

    National Institutes of Mental Health Treatment of Depression Collaborative Research Program

    Archives of General Psychiatry

    (1989)
  • J.A. Firth et al.

    Prescriptive therapy manual for the Sheffield Psychotherapy Project (SAPU Memo 734)

    (1985)
  • D. Gallagher et al.

    Depression in the elderlyA behavioral treatment manual

    (1981)
  • D.E. Gallagher et al.

    Treatment of major depressive disorder in older adult outpatients with brief psychotherapies

    Psychotherapy: Theory, Research and Practice

    (1982)
  • D.E. Gallagher-Thompson et al.

    Maintenance of gains versus relapse following brief psychotherapy for depression

    Journal of Consulting and Clinical Psychology

    (1990)
  • D.E. Gallagher-Thompson et al.

    Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers

    Journal of Consulting and Clinical Psychology

    (1994)
  • R.M. Goldfried et al.

    The therapeutic focus in significant sessions of master therapistsA comparison of cognitive-behavioral and psychodynamic-interpersonal interventions

    Journal of Consulting and Clinical Psychology

    (1998)
  • K. Grawe et al.

    Psychotherapie im Wandel. Von der Konfession zur Profession

    (1994)
  • K.I. Howard et al.

    The dose-effect relationship in psychotherapy

    American Psychologist

    (1986)
  • L.M. Hsu

    Random sampling, randomization and equivalence of contrasted groups in psychotherapy outcome research

    Journal of Consulting and Clinical Psychology

    (1989)
  • A.E. Kazdin

    Methodology, design, and evaluation in psychotherapy research

  • A.E. Kazdin et al.

    Power to detect differences between alternative treatments in comparative psychotherapy outcome research

    Journal of Consulting and Clinical Psychology

    (1989)
  • G.L. Klerman et al.

    Interpersonal psychotherapy of depression

    (1984)
  • S.M. Kopta et al.

    Patterns of symptomatic recovery in psychotherapy

    Journal of Consulting and Clinical Psychology

    (1994)
  • S.J. Kornblith et al.

    The contribution of self-reinforcement training and behavior assignments to the efficacy of self-control therapy for depression

    Cognitive Therapy and Research

    (1983)
  • F. Leichsenring

    Zur Meta-Analyse von Grawe

    Gruppenpsychotherapie und Gruppendynamik

    (1996)
  • P. Lewinsohn

    A behavioral approach to depression

  • P. Lewinsohn et al.

    An integrative theory of depression

  • Cited by (0)

    View full text