Quasi-experimental study on the effectiveness of psychoanalysis, long-term and short-term psychotherapy on psychiatric symptoms, work ability and functional capacity during a 5-year follow-up

Abstract

Background

Psychotherapy is apparently an insufficient treatment for some patients with mood or anxiety disorder. In this study the effectiveness of short-term and long-term psychotherapies was compared with that of psychoanalysis.

Methods

A total of 326 psychiatric outpatients with mood or anxiety disorder were randomly assigned to solution-focused therapy, short-term psychodynamic and long-term psychodynamic psychotherapies. Additionally, 41 patients suitable for psychoanalysis were included in the study. The patients were followed from the start of the treatment and assessed 9 times during a 5-year follow-up. The primary outcome measures on symptoms were the Beck Depression Inventory, the Hamilton Depression and Anxiety Rating Scales, and the Symptom Check List, anxiety scale. Primary work ability and functional capacity measures were the Work Ability Index, the Work-subscale of the Social Adjustment Scale, and the Perceived Psychological Functioning Scale.

Results

A reduction in psychiatric symptoms and improvement in work ability and functional capacity was noted in all treatment groups during the 5-year follow-up. The short-term therapies were more effective than psychoanalysis during the first year, whereas the long-term therapy was more effective after 3 years of follow-up. Psychoanalysis was most effective at the 5-year follow-up, which also marked the end of the psychoanalysis.

Conclusions

Psychotherapy gives faster benefits than psychoanalysis, but in the long run psychoanalysis seems to be more effective. Results from trials, among patients suitable for psychoanalysis and with longer follow-up, are needed before firm conclusions about the relative effectiveness of psychoanalysis and psychotherapy in the treatment of mood and anxiety disorders can be drawn.

Introduction

Psychotherapies of different forms and duration, including psychoanalysis can be applied in the treatment of mood and anxiety disorders (American Psychiatric Association, 1985). Clinical trials have demonstrated that short-term psychodynamic psychotherapy is effective in the treatment of these disorders and that the effects are stable during follow-up (Leichsenring et al., 2004). Solution-focused therapy has been reported to be effective as well (Gingerich and Eisengart, 2000). Long-term psychodynamic psychotherapy has been shown to be more effective than short-term psychodynamic psychotherapy and solution-focused therapy in reducing psychiatric symptoms and improving work ability and functional capacity (Knekt et al., 2008a, Knekt et al., 2008b). Most of the few naturalistic studies comparing the outcome of psychoanalysis and long-term psychodynamic psychotherapy have suggested that psychoanalysis might be more effective in reducing psychiatric symptoms (Grande et al., 2006, Rudolf et al., 1999, Sandell et al., 2000). Studies on changes in work ability and functional capacity in psychoanalysis compared to long-term psychotherapy, are scarce and the findings inconsistent, indicating no additional decrease in work absenteeism and equal or more benefits in perceived work capacity (Lazar et al., 2006, Sandell et al., 2000). Thus, although these findings suggest that the more intensive the therapy the better the results with respect to symptoms, work ability and functional capacity, as far as we know, despite the obvious need (Fonagy et al., 2002, Gabbard et al., 2002), there are no clinical trials on this topic.

To address the important question of whether psychoanalysis is more effective than less intensive psychotherapies in the treatment of patients suffering from mood or anxiety disorder we conducted a quasi-experimental clinical trial comparing the effectiveness of psychoanalysis with one long-term psychotherapy and two short-term therapies on psychiatric symptoms, work ability and functional capacity during a 5-year follow-up.