Leichsenring Falk, Abbass Allan, Heim Nikolas, Keefe John R, Kisely Steve, Luyten Patrick, Rabung Sven, Steinert Christiane
Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany.
Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany.
World Psychiatry. 2023 Jun;22(2):286-304. doi: 10.1002/wps.21104.
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.
为评估心理动力疗法（PDT）作为一种循证治疗（EST）的当前状况，我们基于EST的更新模型，针对成人常见精神障碍中PDT的证据进行了一项预先注册的系统伞状综述。按照该模型，我们重点关注过去两年发表的随机对照试验（RCT）的荟萃分析以评估疗效。此外，我们还审查了关于有效性、成本效益和改变机制的证据。至少两名评估者使用提议的更新标准，即效应量、偏倚风险、不一致性、间接性、不精确性、发表偏倚、治疗保真度及其质量以及原始研究的质量，对荟萃分析进行评估。为评估证据质量，我们应用了GRADE系统。一项系统检索确定了近期关于PDT在抑郁、焦虑、人格和躯体症状障碍疗效的荟萃分析。抑郁和躯体症状障碍的高质量证据以及焦虑和人格障碍的中等质量证据表明，PDT在以具有临床意义的效应量减轻目标症状方面优于（无活性和活性）对照条件。中等质量证据表明，PDT在这些障碍中与其他活性疗法一样有效。PDT的益处超过其成本和危害。此外，还发现了关于上述障碍的长期效果、功能改善、有效性、成本效益和改变机制的证据。特定研究领域存在一些局限性，如偏倚风险和不精确性，但这些与其他循证心理治疗的局限性相当。因此，根据更新的EST模型，PDT被证明是一种针对常见精神障碍的循证治疗。更新模型提供的三种推荐选项（即“非常强”、“强”或“弱”）中，新的EST标准表明，对使用PDT治疗上述精神障碍给予强烈推荐是最合适的选择。总之，PDT是一种循证心理治疗。这在临床上很重要，因为正如所有循证治疗的成功率有限所表明的那样，没有一种单一的治疗方法适用于所有精神科患者。
