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Dynamic psychotherapy comparable to cognitive therapy for MDD

Dynamic psychotherapy was comparable to cognitive therapy for treatment of major depressive disorder in a community mental health setting, according to recent findings.

“The effectiveness of cognitive therapy for major depressive disorder has been established in controlled efficacy trials and real-world effectiveness trials. However, substantial debate is ongoing as to whether short-term dynamic psychotherapy, which targets an individual’s impairing relationship conflicts, has the research base to support its dissemination as an intervention for MDD,” Mary Beth Connolly Gibbons, PhD, of Perelman School of Medicine, University of Pennsylvania, and colleagues wrote. “Although [dynamic psychotherapy] has been and is currently practiced worldwide, the research literature across mental disorders is flooded with reviews debating whether [dynamic psychotherapy] has adequate evidence of effectiveness.”

To compare efficacy of dynamic psychotherapy with cognitive therapy for MDD in a community mental health setting, researchers conducted a randomized clinical non-inferiority trial among 237 adult outpatients with MDD. Twenty therapists at a community mental health center were trained by experts in cognitive therapy and dynamic psychotherapy. Study participants received 16 sessions of cognitive therapy (n = 119) or dynamic psychotherapy (n = 118) across 5 months. The cohort had a mean age of 36.2 years.

Mean difference in change on Hamilton Rating Scale for Depression was 0.86 scale points (95% CI, –0.7 to 2.42), indicating that dynamic psychotherapy was statistically not inferior to cognitive therapy.

Researchers found a statistically significant main effect for time (P = .001).

Adherence to supportive techniques was not significantly higher among participants who received dynamic psychotherapy vs. cognitive therapy. However, competence in the use of psychodynamic supportive techniques (P = .02) and adherence (P = .001) and competence (P = .001) to expressive techniques were significantly higher among those who receive dynamic psychotherapy vs. cognitive therapy.

Patient ratings and treatment credibility did not significantly differ between treatment groups.

“These findings are in line with the American Psychological Association’s statement on the overall effectiveness of bona fide psychotherapies,” Allan A. Abbass, MD, FRCPC, and Joel M. Town, DClinPsy, of Dalhousie University, Halifax, Nova Scotia, Canada, wrote in an accompanying editorial. “Only time will tell whether these results represent a defining moment for the status of [short-term psychodynamic psychotherapy]; based on the breadth of evidence coupled with these definitive studies, it seems reasonable that changes in treatment guideline recommendations will increase the availability of [short-term psychodynamic psychotherapy] as a frontline option for MDD.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.