Leichsenring Falk, Leibing Eric
Department of Psychosomatics, University of Göttingen, Germany.
Am J Psychiatry. 2003 Jul;160(7):1223-32. doi: 10.1176/appi.ajp.160.7.1223.
The authors conducted a meta-analysis to address the effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders.
Studies of psychodynamic therapy and cognitive behavior therapy that were published between 1974 and 2001 were collected. Only studies that 1) used standardized methods to diagnose personality disorders, 2) applied reliable and valid instruments for the assessment of outcome, and 3) reported data that allowed calculation of within-group effect sizes or assessment of personality disorder recovery rates were included. Fourteen studies of psychodynamic therapy and 11 studies of cognitive behavior therapy were included.
Psychodynamic therapy yielded a large overall effect size (1.46), with effect sizes of 1.08 found for self-report measures and 1.79 for observer-rated measures. For cognitive behavior therapy, the corresponding values were 1.00, 1.20, and 0.87. For more specific measures of personality disorder pathology, a large overall effect size (1.56) was seen for psychodynamic therapy. Two cognitive behavior therapy studies reported significant effects for more specific measures of personality disorder pathology. For psychodynamic therapy, the effect sizes indicate long-term rather than short-term change in personality disorders.
There is evidence that both psychodynamic therapy and cognitive behavior therapy are effective treatments of personality disorders. Since the number of studies that could be included in this meta-analysis was limited, the conclusions that can be drawn are only preliminary. Further studies are necessary that examine specific forms of psychotherapy for specific types of personality disorders and that use measures of core psychopathology. Both longer treatments and follow-up studies should be included.
作者进行了一项荟萃分析，以探讨心理动力疗法和认知行为疗法在治疗人格障碍方面的有效性。
收集了1974年至2001年间发表的关于心理动力疗法和认知行为疗法的研究。仅纳入了以下研究：1）使用标准化方法诊断人格障碍；2）应用可靠且有效的工具评估治疗结果；3）报告的数据允许计算组内效应量或评估人格障碍康复率。纳入了14项心理动力疗法研究和11项认知行为疗法研究。
心理动力疗法产生了较大的总体效应量（1.46），自我报告测量的效应量为1.08，观察者评定测量的效应量为1.79。对于认知行为疗法，相应的值分别为1.00、1.20和0.87。对于人格障碍病理学的更具体测量，心理动力疗法的总体效应量较大（1.56）。两项认知行为疗法研究报告了人格障碍病理学更具体测量的显著效果。对于心理动力疗法，效应量表明人格障碍的是长期而非短期变化。
有证据表明心理动力疗法和认知行为疗法都是治疗人格障碍的有效方法。由于本荟萃分析中可纳入的研究数量有限，得出的结论仅为初步结论。有必要进行进一步研究，以考察针对特定类型人格障碍的特定心理治疗形式，并使用核心精神病理学测量方法。应纳入更长疗程的治疗和随访研究。
