Zimmermann Johannes, Löffler-Stastka Henriette, Huber Dorothea, Klug Günther, Alhabbo Sarah, Bock Astrid, Benecke Cord
Department of Psychology, University of Kassel, Kassel, Germany.
Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria.
Clin Psychol Psychother. 2015 Nov-Dec;22(6):469-87. doi: 10.1002/cpp.1917. Epub 2014 Sep 4.
Empirical evidence for the effectiveness of long-term psychodynamic psychotherapy (LTPP) in patients with mood disorders is growing. However, it is unclear whether the effectiveness of LTPP is due to distinctive features of psychodynamic/psychoanalytic techniques or to a higher number of sessions. We tested these rival hypotheses in a quasi-experimental study comparing psychoanalytic therapy (i.e., high-dose LTPP) with psychodynamic therapy (i.e., low-dose LTPP) and cognitive-behavioural therapy (CBT) for depression. Analyses were based on a subsample of 77 subjects, with 27 receiving psychoanalytic therapy, 26 receiving psychodynamic therapy and 24 receiving CBT. Depressive symptoms, interpersonal problems and introject affiliation were assessed prior to treatment, after treatment and at the 1-, 2- and 3-year follow-ups. Psychoanalytic techniques were assessed from three audiotaped middle sessions per treatment using the Psychotherapy Process Q-Set. Subjects receiving psychoanalytic therapy reported having fewer interpersonal problems, treated themselves in a more affiliative way directly after treatment and tended to improve in depressive symptoms and interpersonal problems during follow-up as compared with patients receiving psychodynamic therapy and/or CBT. Multilevel mediation analyses suggested that post-treatment differences in interpersonal problems and introject affiliation were mediated by the higher number of sessions, and follow-up differences in depressive symptoms were mediated by the more pronounced application of psychoanalytic techniques. We also found some evidence for indirect treatment effects via psychoanalytic techniques on changes in introject affiliation during follow-up. These results provide support for the prediction that both a high dose and the application of psychoanalytic techniques facilitate therapeutic change in patients with major depression.
Psychoanalytic therapy is an effective treatment for major depression, especially in the long run. The differential effectiveness of psychoanalytic therapy cannot be fully explained by its higher dose. Distinctive features of psychoanalytic technique (e.g., focusing on patients' dreams, fantasies, sexual experiences or childhood memories) may play an important role in establishing sustained therapeutic change.
长期心理动力心理治疗（LTPP）对情绪障碍患者有效性的实证证据正在增加。然而，尚不清楚LTPP的有效性是由于心理动力/精神分析技术的独特特征还是由于疗程数量较多。我们在一项准实验研究中检验了这些相互竞争的假设，该研究将精神分析治疗（即高剂量LTPP）与心理动力治疗（即低剂量LTPP）以及认知行为疗法（CBT）用于治疗抑郁症进行比较。分析基于77名受试者的子样本，其中27人接受精神分析治疗，26人接受心理动力治疗，24人接受CBT。在治疗前、治疗后以及1年、2年和3年随访时评估抑郁症状、人际问题和内投认同。使用心理治疗过程Q集从每种治疗的三个录音中间疗程中评估精神分析技术。与接受心理动力治疗和/或CBT的患者相比，接受精神分析治疗的受试者报告人际问题较少，治疗后直接以更具亲和性的方式对待自己，并且在随访期间抑郁症状和人际问题倾向于改善。多层次中介分析表明，人际问题和内投认同的治疗后差异由疗程数量较多介导，抑郁症状的随访差异由精神分析技术的更显著应用介导。我们还发现了一些证据，表明通过精神分析技术对随访期间内投认同变化存在间接治疗效果。这些结果支持了这样的预测，即高剂量和精神分析技术的应用都有助于重度抑郁症患者的治疗改变。
精神分析治疗是治疗重度抑郁症的有效方法，尤其是从长远来看。精神分析治疗的差异有效性不能完全由其高剂量来解释。精神分析技术的独特特征（例如，关注患者的梦、幻想、性经历或童年记忆）可能在建立持续的治疗改变中起重要作用。
