Leichsenring F
University of Göttingen, Department of Psychosomatics and Psychotherapy, Von Sieboldstr. 5, D-37075 Göttingen, Germany.
Clin Psychol Rev. 2001 Apr;21(3):401-19. doi: 10.1016/s0272-7358(99)00057-4.
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 > or = 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.
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: phi = 0.08, follow-up assessment: phi = 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.
本文回顾了短期心理动力心理治疗（STPP）与认知行为疗法（CBT）或行为疗法（BT）相比在治疗抑郁症方面的疗效。在本综述中，仅纳入了至少进行13次治疗疗程的研究，且每组治疗了足够数量的患者（N≥20）。关于疗效标准，对抑郁症状、一般精神症状和社会功能的改善情况进行了结果回顾。六项研究符合纳入标准。
在六项研究及其随访中进行的60项比较中的58项（97%）中，STPP与CBT/BT在抑郁症状、一般精神症状学和社会功能的影响方面未检测到显著差异。此外，在被判定为缓解或改善的患者方面，STPP和CBT/BT也没有显著差异。根据R. 罗森塔尔（1991年）描述的荟萃分析程序，在用STPP或CBT/BT治疗后被判定为缓解或改善的患者方面，这些研究没有显著差异。STPP与CBT/BT在被判定为缓解或改善的患者数量方面的平均差异对应于一个小的效应量（评估后：φ = 0.08，随访评估：φ = 0.12）。因此，STPP和CBT/BT在治疗抑郁症方面似乎是同样有效的方法。然而，由于符合纳入标准的研究数量较少，这一结果只能是初步的。此外，它仅适用于所选研究中所检查的特定形式的STPP，不能推广到其他形式的STPP。需要进一步的研究来检查特定形式的STPP在对照和自然环境中的效果。此外，有研究结果表明，对于大多数患者来说，16 - 20次的STPP和CBT/BT治疗不足以实现持久缓解。未来的研究应该探讨更长疗程治疗抑郁症的效果。
