Falk Leichsenring, Allan Abbass, Nikolas Heim, John R Keefe, Steve Kisely, Patrick Luyten, Sven Rabung, Christiane Steinert
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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. 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引用次数: 0
摘要
为了评估心理动力学疗法(PDT)作为一种经验支持疗法(EST)的现状,我们根据最新的EST模型,对心理动力学疗法治疗成人常见精神障碍的证据进行了一次预先登记的系统性综述。按照这一模式,我们重点对过去两年中发表的随机对照试验(RCT)进行了荟萃分析,以评估其疗效。此外,我们还审查了有效性、成本效益和变化机制方面的证据。荟萃分析至少由两名评定员使用建议的最新标准进行评估,即效应大小、偏倚风险、不一致性、间接性、不精确性、发表偏倚、治疗忠实性、其质量以及主要研究的质量。为了评估证据的质量,我们采用了 GRADE 系统。通过系统性检索,我们发现了近期关于PDT对抑郁、焦虑、人格和躯体症状障碍疗效的荟萃分析。抑郁症和躯体症状障碍方面的高质量证据以及焦虑症和人格障碍方面的中等质量证据表明,PDT 在减少目标症状方面优于(非活动和活动)对照条件,且具有临床意义的效应大小。中等质量的证据表明,PDT 对这些障碍的疗效不亚于其他积极疗法。光动力疗法的益处大于其成本和危害。此外,研究还发现了上述疾病的长期疗效、功能改善、有效性、成本效益和改变机制等方面的证据。在特定研究领域存在一些局限性,如偏倚风险和不精确性,但这些局限性与其他循证心理疗法的局限性相当。因此,根据最新的 EST 模型,PDT 被证明是一种对常见精神障碍有实证支持的治疗方法。在更新模式提供的三个推荐选项(即 "非常强"、"强 "或 "弱")中,新的 EST 标准表明,强烈建议使用 PDT 治疗上述精神障碍是最合适的选择。总之,PDT 是一种循证心理疗法。这一点在临床上非常重要,因为没有一种治疗方法适合所有精神病患者,所有循证疗法的成功率都很有限。
The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders - an umbrella review based on updated criteria.
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.
期刊介绍:
World Psychiatry is the official journal of the World Psychiatric Association. It aims to disseminate information on significant clinical, service, and research developments in the mental health field.
World Psychiatry is published three times per year and is sent free of charge to psychiatrists.The recipient psychiatrists' names and addresses are provided by WPA member societies and sections.The language used in the journal is designed to be understandable by the majority of mental health professionals worldwide.