Short Term Psychodynamic Therapy Effective for Bipolar and Depression

Intensive Short-Term Dynamic Psychotherapy (ISTDP) was found to be effective for treating major depression, bipolar disorder, and so-called treatment-resistant affective disorders.

José G. Luiggi-Hernández
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A recent publication by the Journal of Affective Disorders provided evidence for the efficacy of psychodynamic therapy. More specifically, the study investigated whether or not Intensive Short-Term Dynamic Psychotherapy (ISTDP) effectively reduced the symptoms associated with ‘Major Depressive Disorder’ and ‘Bipolar Disorder.’

“The results of the included studies suggest ISTDP is effective for the treatment of mood disorders,” the researchers, led by Alice Caldiroli in Italy, write. “These preliminary findings are in line with growing evidence for the efficacy of Short-Term Psychodynamic Psychotherapy for depressive disorders.”
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The effectiveness and efficacy of cognitive-behavioral therapies (CBT) have been widely researched in comparison to other psychotherapeutic modalities. As a result, CBT has been considered (almost exclusively) the evidence-based practice to be used by psychotherapists in the United States.

More recently, there has been increased research on the therapeutic outcomes of psychodynamic therapies. In general, psychodynamic therapies are as efficacious as CBT. When elements of CBT and psychodynamic therapies are integrated, their effectiveness improves.

There are different forms of psychodynamic therapy. ISTDP focuses on emotions and feelings that are being avoided and the ways that people avoid these feelings (defenses). By avoiding uncomfortable feelings and experiences, people become unaware or unconscious of the patterns of thinking, feeling, and acting that they regularly engage in.

ISTDP was developed in the ’70s and modified for the treatment of depression in the ’80s. Through ISTDP, the ability to tolerate the anxiety about these avoided emotions is increased through capacity building.

Feelings are usually explored through bodily experiences or sensations, including (but not limited to) stomach aches, headaches, hand clenching, and confusion. The therapeutic relationship allows people to identify the emotions and how they avoid them, experience and express them, and increasingly tolerate these feelings, which are the key features of this treatment’s effectiveness.

The purpose of the study was to review the available findings of the effectiveness of ISTDP in the treatment of ‘Major Depression’ and ‘Bipolar Disorder.’

The researchers found that five sessions of ISTDP could help reduce depressive symptoms in patients diagnosed with bipolar disorder and reduce their healthcare use. They also found that 14-sessions of ISTDP reduced depressive, dysthymic, and hypomanic symptoms.

When assessed 14 months after treatment, their symptoms had reduced further, providing evidence of long-term effectiveness. Patients with “treatment-resistant” affective disorders not only benefited from treatment, but over half of them also reduced their medication use after eight weeks of treatment and were more occupationally active, and reduced their healthcare use.

This provides further evidence against the problematic “treatment-resistant” label (mostly used to label patients whose symptoms are not reduced through medication), as patients improved through their experience of psychotherapy. ISTDP was also effective in patients who were simultaneously medicated for their mood disorder and those who were not.

This study contributes to the emerging evidence for the effectiveness of psychodynamic therapy. The study challenges the notion of “treatment-resistant” disorders, as patients who underwent a combined treatment of ISTDP and medication experienced a reduction of symptoms. Other patients reduced their use of drugs throughout therapy while maintaining their psychological health.

 

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Caldiroli, A., Capuzzi, E., Riva, I., Russo, S., Clerici, M., Roustaya, C., Abbass, A. & Buoli, M. (2020).   Efficacy of Intensive Short-Term Dynamic Psychotherapy in Mood Disorders: A Critical Review.     Journal of Affective Disorders, 273(1), p.375-379 (Link)

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José G. Luiggi-Hernández
José G. Luiggi-Hernández
José G. Luiggi-Hernández is a Clinical Psychology PhD student at Duquesne University with a background in public health. His current research and clinical interests involve understanding the lived experience of colonization using phenomenological, psychoanalytic, and decolonial frameworks. He has previously worked on research related to LGBTQ issues, health behaviors, mindfulness for chronic pain, CBT for diabetes and depression, among other projects.

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5 COMMENTS

  2. “The effectiveness and efficacy of cognitive-behavioral therapies (CBT) have been widely researched in comparison to other psychotherapeutic modalities.”

    Not true. The vast majority of CBT studies compare it to waitlists, that is, no treatment at all or “treatment as usual” (for example, seeing your doctor or community mental health nurse). Also, effectiveness and efficacy in CBT world is short-term “symptom reduction” based on a statistical measure and have nothing to do with the quality of life, a sense of meaning and purpose, satisfying relationships, rewarding employment or fulfilled needs, the lack of which was the reason most people came to therapy in the first place.

    So-called evidence-based treatments have little to do with guiding and informing treatment decisions, but there to protect psychologists and manage their own anxieties dealing with the complex lives of their clients. That complexity is shoehorned into a specific diagnosis and when the client being given the-best-there-is-proven-to-work-on-others but without the desired outcome, then the problem must lie with the client. Terms like resistant, lacking insight, unmotivated and not psychologically minded will then be used and the psychologist can avoid self-reflection and scrutiny.

    • My picture of CBT is that it’s the same as traditional psychotherapy but in straight forward terms.

      When I “catastrophise”, and recognise that I’m “catastophising” I can definitely do something about it. But I don’t see CBT as an instant ‘cure’.

      The “Catastrophisation” I suffered from, had followed my withdrawal from a Long Acting Modecate Depot Injection (“suitable” for “Schizophrenia”).

  3. I don’t know anything about these “therapies,” but I can imagine they might be similar to what I got, which basically consisted of giving me suggestions for changing my approach to life that made sense to me and that I was willing to try. If they are like that, even though they may “improve outcomes,” they don’t address basic cause at all. This is actually the “medical model” of treatment. You make the symptoms go away by patching up whatever got broken or killing some bugs, then you call it a “cure” and send the patient on his way.

    The problem with psychiatry (and more often now with regular MDs) is that they want to keep that income stream going as long as possible. This is done, ordinarily, by purposely ignoring basic (or “root”) cause, treating symptoms only, and when symptoms persist, just continue treating symptoms. So, if the choice is between some maintenance dose of some drug and a diet change or some other handling that would actually make the patient permanently more healthy, they are tending to choose the former over the latter.

    Thus we see this “treatment modality” (I hate that “speak”) being used WITH drugs. And we see the study focusing mainly on symptoms, though “therapy” should be capable of addressing root cause. The study bows to “long-term effectiveness” (14 months) but where are the 3-5-10 year follow-ups? How long ago was it that Freud started all this? Why do we have so meager results in all those years? I don’t think their hearts are really in it.

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