The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders - an umbrella review based on updated criteria

Falk Leichsenring; Allan Abbass; Nikolas Heim; John R Keefe; Steve Kisely; Patrick Luyten; Sven Rabung; Christiane Steinert

doi:10.1002/wps.21104

The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders - an umbrella review based on updated criteria

World Psychiatry. 2023 Jun;22(2):286-304. doi: 10.1002/wps.21104.

Authors

Falk Leichsenring^{1

2}, Allan Abbass³, Nikolas Heim⁴, John R Keefe⁵, Steve Kisely⁶, Patrick Luyten^{7

8}, Sven Rabung⁹, Christiane Steinert^{1

4}

Affiliations

¹ Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany.
² Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany.
³ Dalhousie University, Halifax, NS, Canada.
⁴ International Psychoanalytic University, Berlin, Germany.
⁵ Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, NY, USA.
⁶ School of Medicine, University of Queensland, Brisbane, QLD, Australia.
⁷ Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.
⁸ Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
⁹ Department of Psychology, University of Klagenfurt, Klagenfurt, Austria.

Abstract

To assess the current status of psychodynamic therapy (PDT) as an empirically supported treatment (EST), we carried out a pre-registered systematic umbrella review addressing the evidence for PDT in common mental disorders in adults, based on an updated model for ESTs. Following this model, we focused on meta-analyses of randomized controlled trials (RCTs) published in the past two years to assess efficacy. In addition, we reviewed the evidence on effectiveness, cost-effectiveness and mechanisms of change. Meta-analyses were evaluated by at least two raters using the proposed updated criteria, i.e. effect sizes, risk of bias, inconsistency, indirectness, imprecision, publication bias, treatment fidelity, and their quality as well as that of primary studies. To assess the quality of evidence we applied the GRADE system. A systematic search identified recent meta-analyses on the efficacy of PDT in depressive, anxiety, personality and somatic symptom disorders. High quality evidence in depressive and somatic symptom disorders and moderate quality evidence in anxiety and personality disorders showed that PDT is superior to (inactive and active) control conditions in reducing target symptoms with clinically meaningful effect sizes. Moderate quality evidence suggests that PDT is as efficacious as other active therapies in these disorders. The benefits of PDT outweigh its costs and harms. Furthermore, evidence was found for long-term effects, improving functioning, effectiveness, cost-effectiveness and mechanisms of change in the aforementioned disorders. Some limitations in specific research areas exist, such as risk of bias and imprecision, which are, however, comparable to those of other evidence-based psychotherapies. Thus, according to the updated EST model, PDT proved to be an empirically-supported treatment for common mental disorders. Of the three options for recommendation provided by the updated model (i.e., "very strong", "strong" or "weak"), the new EST criteria suggest that a strong recommendation for treating the aforementioned mental disorders with PDT is the most appropriate option. In conclusion, PDT represents an evidence-based psychotherapy. This is clinically important since no single therapeutic approach fits all psychiatric patients, as shown by the limited success rates across all evidence-based treatments.

Keywords: Psychodynamic therapy; anxiety disorders; depressive disorders; empirically supported treatments; evidence-based medicine; personality disorders; psychotherapies; somatic symptom disorders.