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Bundesaesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008 Apr;51(4):422-9
Psychotherapy of Depression [Article in German] Hautzinger, M. Psychologisches Institut, Abteilung Klinische und Entwicklungspsychologie, Eberhard Karls Universität Tübingen, Christophstrasse 2, Tübingen, BRD. hautzinger@uni-tuebingen.de
A large number of controlled randomised trials have been conducted to establish scientific evidence for psychological treatments' in the short- and long-term. Depending on severity of symptomatology (suicidality) as well as the range of individual problems, supportive counselling or specific psychotherapy is indicated. Specific psychotherapies for depression are in particular cognitive behaviour therapy (CBT) and interpersonal psychotherapy (IPT), to a less extent short-term psychodynamic psychotherapy (STPP) and client centred psychotherapy (CCPT). For these specific psychotherapies, empirical evidence is available about short-term (successful symptom reduction) and long-term (relapse prevention) outcome as monotherapy or in combination with antidepressive medication.
Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2007 Jul 18;(3):CD003388. Update of: Cochrane Database Syst Rev. 2005;(2):CD003388.
Cardiff University, Department of Psychological Medicine, Monmouth House, University Hospital of Wales, Heath Park, Cardiff, UK, CF14 4XW. bissonji@cardiff.ac.uk
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BACKGROUND:
Psychological interventions are widely used in the treatment of post-traumatic stress disorder (PTSD). OBJECTIVES: To perform a systematic review of randomised controlled trials of all psychological treatments following the guidelines of The Cochrane Collaboration. Including any randomised controlled trial of a psychological treatment.
Types of participants - Adults suffering from traumatic stress symptoms for three months or more. Types of interventions - Trauma-focused cognitive behavioural therapy /exposure therapy (TFCBT); stress management (SM); other therapies (supportive therapy, non-directive counselling, psychodynamic therapy and hypnotherapy); group cognitive behavioural therapy (group CBT); eye movement desensitisation and reprocessing (EMDR).
MAIN RESULTS: Thirty-three studies were included in the review. With regards to reduction of clinician assessed PTSD symptoms measured immediately after treatment TFCBT did significantly better than waitlist/usual care (standardised mean difference (SMD) = -1.40; 95% CI, -1.89 to -0.91; 14 studies; n = 649). There was no significant difference between TFCBT and SM (SMD = -0.27; 95% CI, -0.71 to 0.16; 6 studies; n = 239). TFCBT did significantly better than other therapies (SMD = -0.81; 95% CI, -1.19 to -0.42; 3 studies; n = 120). Stress management did significantly better than waitlist/usual care (SMD = -1.14; 95% CI, -1.62 to -0.67; 3 studies; n = 86) and than other therapies (SMD = -1.22; 95% CI, -2.09 to -0.35; 1 study; n = 25). There was no significant difference between other therapies and waitlist/usual care control (SMD = -0.43; 95% CI, -0.90 to 0.04; 2 studies; n = 72). Group TFCBT was significantly better than waitlist/usual care (SMD = -0.72; 95% CI, -1.14 to -0.31). EMDR did significantly better than waitlist/usual care (SMD = -1.51; 95% CI, -1.87 to -1.15; 5 studies; n = 162). There was no significant difference between EMDR and TFCBT (SMD = 0.02; 95% CI, -0.28 to 0.31; 6 studies; n = 187). There was no significant difference between EMDR and SM (SMD = -0.35; 95% CI, -0.90 to 0.19; 2 studies; n = 53). EMDR did significantly better than other therapies (self-report) (SMD = -0.84; 95% CI, -1.21 to -0.47; 2 studies; n = 124).
AUTHORS' CONCLUSIONS: There was evidence individual TFCBT, EMDR, stress management and group TFCBT are effective in the treatment of PTSD. Other non-trauma focused psychological treatments did not reduce PTSD symptoms as significantly. There was some evidence that individual TFCBT and EMDR are superior to stress management in the treatment of PTSD at between 2 and 5 months following treatment, and also that TFCBT, EMDR and stress management were more effective than other therapies. Post-traumatic stress disorder. Cardiff and Vale NHS Trust, Cardiff, UK. Clin Evid (Online). 2007 Aug 1;2007. pii: 1005.
INTRODUCTION: Post-traumatic stress disorder (PTSD) may affect 10% of women and 5% of men at some stage, and symptoms may persist for several years. Risk factors include major trauma, lack of social support, peritraumatic dissociation, and psychiatric or personality factors. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent; and to treat PTSD? We searched: Medline, Embase, The Cochrane Library and other important databases up to December RESULTS: We found 36 systematic reviews, RCTs, or observational studies that met our inclusion criteria. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: affect management, antiepileptic drugs, antihypertensive drugs, benzodiazepines, brofaromine, carbamazepine, CBT, drama therapy, eye movement desensitisation and reprocessing, fluoxetine, group therapy, hydrocortisone, hypnotherapy, inpatient treatment programmes, internet-based psychotherapy, mirtazepine, multiple-session CBT, multiple-session collaborative trauma support, multiple-session education, nefazodone, olanzapine, paroxetine, phenelzine, propranolol, psychodynamic psychotherapy, risperidone, SSRIss, sertraline, single-session group debriefing, single-session individual debriefing, supportive psychotherapy, supportive counselling, temazepam, tricyclic antidepressants, venlafaxine.
The evaluation of mental health outcome at a community-based psychodynamic psychotherapy service for young people: a 12-month follow-up based on self-report data.
Brandon Centre for Counselling and Psychotherapy for Young People, UK. Psychol Psychother. 2002 Sep;75(Pt 3):261-78. Links
The present study focuses on the evaluation of mental health outcome of 151 young people who received psychodynamic psychotherapy at the Brandon Centre, a community-based psychodynamic psychotherapy centre; for young people. Participants aged 12-18 years completed either the Youth Self Report form or, if they were aged over 18, the Young Adult Self Report form at intake, 3 months, 6 months, and 1 year. The domains evaluated included young people's externalizing problems, internalizing problems, and total problems. Outcome was measured in three different ways: the change in mean scores; the change in numbers from the clinical to the non-clinical range; and categorizing cases according to the presence of statistically reliable change in the level of adaptation. These approaches showed improvement among participants in all three domains. Although there was a high general tendency to improve, the rate of improvement dropped significantly over time. The paper discusses how the results from systematic monitoring of effectiveness at the Brandon Centre have formed an empirical basis that has led to changes in service delivery with the aim of optimizing provision for troubled young people.
A randomised controlled trial to evaluate the effectiveness and cost-effectiveness of counselling patients with chronic depression.
Simpson S, Corney R, Fitzgerald P, Beecham J.
Department of Psychology, University of Greenwich, UK.
Health Technol Assess. 2000;4(36):1-83. Links
OBJECTIVES: To examine the effectiveness and cost-effectiveness of short-term counselling in general practice for patients with chronic depression or combined depression and anxiety, compared with general practitioner (GP) care alone. DESIGN: A randomised controlled trial and economic evaluation with an initial assessment at randomisation and follow-ups at 6 and 12 months.
SETTING: Nine general practices that were well-established participants of the Derbyshire counselling in general practice scheme, and already had a counsellor in the practice team. SUBJECTS: Patients were screened at GP practices, and asked to participate if they scored >/= 14 on the Beck Depression Inventory (BDI), had suffered depression or depression/anxiety for 6 months or more, were aged 18-70 and had no history of drug or alcohol abuse, psychoses or suicidal tendencies.
INTERVENTIONS: The experimental group received usual GP treatment and were also referred to an experienced, well-qualified counsellor attached to their general practice. Of the eight counsellors, two practiced cognitive behavioural therapy (CBT) and six had a psychodynamic approach. The controls were referred back to their GP for routine treatment. There were no restrictions regarding the treatment that could be used, except that GPs could not refer controls to practice counsellors.
OUTCOME MEASURES: The main outcome measure was the BDI. Others included the Brief Symptom Inventory, the Inventory of Interpersonal Problems and the Social Adjustment Scale. All tests were given at initial, 6- and 12-month assessments. Comprehensive costs were also estimated, and combined with changes in outcomes to examine between-group differences and whether counselling was more cost-effective than standard GP care.
RESULTS: The trial recruited 181 patients. There was an overall significant improvement in the actual scores over time but no difference between groups or between CBT and psychodynamic counselling approaches at either 6 or 12 months. This difference was statistically significant at 12 months and neared significance at 6 months. In addition, most patients were very positive about the counselling and considered it helpful. Visual inspection of the outcomes suggested that more patients with mild or moderate depression at study entry had improved and ceased to be cases, and that more of these patients had become 'non-cases' in the experimental than the control group. CONCLUSIONS: Stricter referral criteria to exclude the severely depressed may have yielded more conclusive results. The results indicated that there were similar improvements for both CBT and psychodynamic counselling, |
