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A 12-month comparison of brief psychodynamic psychotherapy and pharmacotherapy treatment in subjects with generalised anxiety disorders in a community setting

Published online by Cambridge University Press:  16 April 2020

Andrea Ferrero ,
Andrea Pierò ,
Simona Fassina ,
Tiziana Massola ,
Antonello Lanteri ,
Giovanni Abbate Daga  and
Secondo Fassino
Andrea Ferrero
Affiliation:
Mental Health Department, ASL 7 of Chivasso, V. Don Paviolo 5, 10036Settimo T.se (TO), Italy Unit of Psychotherapy, Department of Mental Health, ASL 7 of Chivasso, V. Don Paviolo 5, 10036Settimo T.se (TO), Italy SAIGA Institute of Research, v. Principe Amedeo 16, 10123Torino, Italy
Andrea Pierò*
Affiliation:
Mental Health Department, ASL 7 of Chivasso, V. Don Paviolo 5, 10036Settimo T.se (TO), Italy Neurosciences Department, Psychiatry Section, Turin University, via Cherasco 11, CAP10124, Italy
Simona Fassina
Affiliation:
Unit of Psychotherapy, Department of Mental Health, ASL 7 of Chivasso, V. Don Paviolo 5, 10036Settimo T.se (TO), Italy SAIGA Institute of Research, v. Principe Amedeo 16, 10123Torino, Italy
Tiziana Massola
Affiliation:
Mental Health Department, ASL 7 of Chivasso, V. Don Paviolo 5, 10036Settimo T.se (TO), Italy
Antonello Lanteri
Affiliation:
Mental Health Department, ASL 7 of Chivasso, V. Don Paviolo 5, 10036Settimo T.se (TO), Italy
Giovanni Abbate Daga
Affiliation:
Neurosciences Department, Psychiatry Section, Turin University, via Cherasco 11, CAP10124, Italy
Secondo Fassino
Affiliation:
Neurosciences Department, Psychiatry Section, Turin University, via Cherasco 11, CAP10124, Italy
*
*Corresponding author at: Neurosciences Department, Turin University, Via Cherasco 15, CAP 10126, Italy. Tel.: +39 011 6336201; fax: +39 011 673473. E-mail address: andrea.piero@unito.it (A. Pierò).
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Abstract

Little information is available on the use of brief psychotherapy among subjects with generalised anxiety disorder (GAD) within community mental health services. This study compared results among subjects treated with brief Adlerian psychodynamic psychotherapy (B-APP), those treated with medication (MED), or those who experienced combined treatment (COM). Symptomatology and occupational functioning were assessed using the Hamilton Anxiety and Depression scales (HAM-A; HAM-D), Clinical Global Impression (CGI), and Social and Occupational Functioning Assessment Scale (SOFAS) at intake (T1) and at 3, 6, and 12 months later (T3, T6, T12). The study sample included 87 patients with GAD (B-APP 34; MED 33; COM 20), and an ANOVA was applied for analysing repeated measures while controlling for personality disorder. After 6 months, CGI, HAM-A, HAM-D, and SOFAS scores significantly improved independently from the type of treatment. Subjects with personality disorders treated with B-APP exhibited superior results to those treated using other methods only in SOFAS scores at T6. These results were generally maintained at T12. Remission rates among subjects (HAM-A scores <7) varied between 55% (MED) and 74% (B-APP) at T6 and between 63% (MED) and 78% (COM) at T12; no significant differences appeared between the three treatment groups. A logistic regression model predicted anxiety remission only by CGI at T1. This paper discusses these results in relation to the use of brief psychotherapy within community mental health services.

Keywords

Anxiety disordersBrief psychotherapyMedicationMental healthTreatmentAgoraphobiaDrugFollow-upOutcomePanicPersonality disorders
Type
Original article
Information
European Psychiatry , Volume 22 , Issue 8 , November 2007 , pp. 530 - 539
Copyright
Copyright © Elsevier Masson SAS 2007

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References

Addis, M.E., Hatgis, C., Cardemil, E., Jacob, K., Krasnow, A.D., Mansfield, A.Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting. J Consult Clin Psychol 2004;72:625–635.CrossRefGoogle Scholar
American Psychiatric Association. Practice guidelines for the treatment of patients with panic disorder. Am J Psychiatry 1998;155(5):1–34.Google Scholar
American Psychiatric Association. DSM-IV: diagnostic and statistical manual of mental disorders 4th ed.Washington, DC: American Psychiatric Association; 2000.Google Scholar
American Psychiatric Association. Guideline watch: practice guideline for the treatment of patients with panic disorder. New York: Oxford University Press; 2006.Google Scholar
Bacaltchuk, J., Hay, P., Trefiglio, R.Antidepressants versus psychological treatments and their combination for bulimia nervosa. Cochrane Database Syst Rev 2001;4 CD003385.Google Scholar
Baldwin, D.S., Anderson, I.M., Nutt, D.J., Bandelow, B., Bond, A., Davidson, J.R.British Association for Psychopharmacology. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2005;19(6):567–596.CrossRefGoogle ScholarPubMed
Ballenger, J.C.Clinical guidelines for establishing remission in patients with depression and anxiety. J Clin Psychiatry 1999;60(22):29–34.Google ScholarPubMed
Balon, R.Developments in treatment of anxiety disorders: psychotherapy, pharmacotherapy, and psychosurgery. Depress Anxiety 2004;19(2):63–76.CrossRefGoogle ScholarPubMed
Bandelow, B., Zohar, J., Hollander, E., Kasper, S., Moller, H.J.World Federation of Societies of Biological Psychiatry Task Force on Treatment Guidelines for Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders. World J Biol Psychiatry 2002;3(4):171–199.CrossRefGoogle ScholarPubMed
Black, D.W.Efficacy of combined pharmacotherapy and psychotherapy versus monotherapy in the treatment of anxiety disorders. CNS Spectr 2006;11:29–33.CrossRefGoogle ScholarPubMed
Connor, K.M., Davidson, J.R., Chung, H., Yang, R., Clary, C.M.Multidimensional effects of sertraline in social anxiety disorder. Depress Anxiety 2006;23(1):6–10.CrossRefGoogle ScholarPubMed
Craske, M.G., Golinelli, D., Stein, M.B., Roy-Byrne, P., Bystritsky, A., Sherbourne, C.Does the addition of cognitive behavioral therapy improve panic disorder treatment outcome relative to medication alone in the primary-care setting?. Psychol Med 2005;35(11):1645–1654.CrossRefGoogle ScholarPubMed
Davidson, J.R., Foa, E.B., Huppert, J.D., Keefe, F.J., Franklin, M.E., Compton, J.S.et al.Fluoxetine, comprehensive cognitive behavioral therapy, and placebo in generalized social phobia. Arch Gen Psychiatry 2004;61:1005–1013.CrossRefGoogle ScholarPubMed
Dewan, M.J., Steenbarger, B.N., Greenberg, R.P.Art and science of brief psychotherapies. Washington, DC: American Psychiatric Press; 2004.Google Scholar
Fassino, S., Abbate-Daga, G., Delsedime, N., Busso, F., Pierò, A., Rovera, G.G.Baseline personality characteristics of responders to 6-month psychotherapy in eating disorders: preliminary data. Eat Weight Disord 2005;10(1):40–50.CrossRefGoogle ScholarPubMed
Fassino, S., Abbate-Daga, G., Pierò, A., Leombruni, P., Rovera, G.G.Dropout from brief psychotherapy within a combination treatment in bulimia nervosa: role of personality and anger. Psychother Psychosom 2003;72:203–210.CrossRefGoogle ScholarPubMed
Fassino, S., Abbate-Daga, G., Pierò, A., Rovera, G.G.Dropout from brief psychotherapy in anorexia nervosa. Psychother Psychosom 2002;71:200–206.CrossRefGoogle ScholarPubMed
Fassino, S., Ferrero, A., Pierò, A., Mongelli, E., Caviglia, M.L., Delsedime, N.et al.Rehabilitative residential treatment in patients with severe mental disorders: factors associated with short term outcome. Am J Orthopsychiatry 2004;74:33–42.CrossRefGoogle Scholar
Fassino, S., Pierò, A., Mongelli, E., Caviglia, M.L., Delsedime, N., Busso, F.et al.Baseline personality functioning correlates with 6 month outcome in schizophrenia. Eur Psychiatry 2003;18:93–100.CrossRefGoogle Scholar
Fava, G.A., Ruini, C., Rafanelli, C., Finos, L., Salmaso, L., Mangelli, L.et al.Well-being therapy of generalized anxiety disorder. Psychother Psychosom 2005;74(1):26–30.CrossRefGoogle ScholarPubMed
First, M.B., Gibbon, M., Spitzer, R.L., Williams, J.B.W., Benjamin, L.S.SCID II personality questionnaire. Washington, DC: American Psychiatric Press; 1997.Google Scholar
First, M.B., Spitzer, R.L., Gibbon, M., Williams, J.B.W.Structured Clinical Interview for DSM-IV Axis I Disorders: outpatient edition (SCID-O/P, version 2.0). New York: Biometric Research, New York State Psychiatric Institute; 1996.Google Scholar
Gabbard, G.O., Freedman, R.Psychotherapy in the journal: what's missing?. Am J Psychiatry 2006;163(2):182–184.CrossRefGoogle ScholarPubMed
Hamilton, M.The assessment of anxiety states by rating. Br J Med Psychol 1959;32:50–55.CrossRefGoogle ScholarPubMed
Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56.CrossRefGoogle ScholarPubMed
Hilsenroth, M.J., Ackerman, S.J., Blagys, M.D.Reliability and validity of DSM IV Axis V. Am J Psychiatry 2000;157:1858–1863.CrossRefGoogle ScholarPubMed
Hilsenroth, M.J., Peters, E.J., Ackerman, S.J.The development of therapeutic alliance during psychological assessment: patient and therapist perspectives across treatment. J Pers Assess 2004;83:332–344.CrossRefGoogle ScholarPubMed
Hollifield, M., Thompson, P.M., Ruiz, J.E., Uhlenhuth, E.H.Potential effectiveness and safety of olanzapine in refractory panic disorder. Depress Anxiety 2005;21(1):33–40.CrossRefGoogle ScholarPubMed
Hunot, V., Churchill, R., Teixeira, V., Silva de Lima, M.Psychological therapies for generalized anxiety disorder. Cochrane Database Syst Rev 2007;1:CD001848.Google Scholar
Issakidis, C., Andrews, G.Pretreatment attrition and dropout in an outpatient clinic for anxiety disorders. Acta Psychiatr Scand 2004;109(6):426–433.CrossRefGoogle Scholar
Kessing, L.V., Hansen, H.V., Ruggeri, M., Bech, P.Satisfaction with treatment among patients with depressive and bipolar disorders. Soc Psychiatry Psychiatr Epidemiol 2006;41(2):148–155.CrossRefGoogle ScholarPubMed
Lee, H.J., Lee, M.S., Kang, R.H., Kim, H., Kim, S.D., Kee, B.S.et al.Influence of the serotonin transporter promoter gene polymorphism on susceptibility to posttraumatic stress disorder. Depress Anxiety 2005;21(3):135–139.CrossRefGoogle ScholarPubMed
Leichsenring, F.Are psychodynamic and psychoanalytic therapies effective? A review of empirical data. Int J Psychoanal 2005;86(3):841–868.CrossRefGoogle ScholarPubMed
Leichsenring, F., Rabung, S., Leibing, E.The efficacy of short-term psychodynamic psychotherapy in specific psychiatric disorders: a meta-analysis. Arch Gen Psychiatry 2004;61(12):1208–1216.CrossRefGoogle ScholarPubMed
Leichsenring, F., Ruger, U.Psychotherapy and evidence-based medicine (EBM)-randomized controlled vs. naturalistic studies: is there only one gold standard?. Z Psychosom Med Psychother 2004;50(2):203–217.Google ScholarPubMed
Linden, M., Zubraegel, D., Baer, T., Franke, U., Schlattmann, P.Efficacy of cognitive behaviour therapy in generalized anxiety disorders: results of a controlled clinical trial (Berlin CBT-GAD Study). Psychother Psychosom 2005;74:36–42.CrossRefGoogle Scholar
Marciniak, M.D., Lage, M.J., Dunayevich, E., Russell, J.M., Bowman, L., Landbloom, R.P.et al.The cost of treating anxiety: the medical and demographic correlates that impact total medical costs. Depress Anxiety 2005;21(4):178–184.CrossRefGoogle ScholarPubMed
Milrod, B., Busch, F., Leon, A.C., Aronson, A., Roiphe, J., Rudden, M.et al.A pilot open trial of brief psychodynamic psychotherapy for panic disorder. J Psychother Pract Res 2001;10(4):239–245.Google ScholarPubMed
Milrod, B., Busch, F., Leon, A.C., Shapiro, T., Aronson, A., Roiphe, J.et al.Open trial of psychodynamic psychotherapy for panic disorder: a pilot study. Am J Psychiatry 2000;157(11):1878–1880.CrossRefGoogle ScholarPubMed
Mitte, K.Meta-analysis of cognitive-behavioral treatments for generalized anxiety disorder: a comparison with pharmacotherapy. Psychol Bull 2005;131(5):785–795.CrossRefGoogle ScholarPubMed
Mosak, H.Adlerian psychotherapy In: Corsini, R., Wedding, D. editors. Current psychotherapies. Itasca, IL: Peacock; 1989. p. 65–118.Google Scholar
Prasko, J., Houbova, P., Novak, T., Zalesky, R., Espa-Cervena, K., Paskova, B.et al.Influence of personality disorder on the treatment of panic disorder: comparison study. Neuroendocrinol Lett 2005;26(6):667–674.Google ScholarPubMed
Roy-Byrne, P.P., Craske, M.G., Stein, M.B., Sullivan, G., Bystritsky, A., Katon, W.et al.A randomized effectiveness trial of cognitive-behavioral therapy and medication for primary care panic disorder. Arch Gen Psychiatry 2005;62:290–298.CrossRefGoogle ScholarPubMed
Roy-Byrne, P., Russo, J., Pollack, M., Stewart, R., Bystrisky, A., Bell, J.et al.Personality and symptom sensitivity predictors of alprazolam withdrawal in panic disorder. Psychol Med 2003;33(3):511–518.CrossRefGoogle ScholarPubMed
Rubio, G., Lopez-Ibor, J.J. Jr.What can be learnt from the natural history of anxiety disorders?. Eur Psychiatry 2007;22(2):80–86.CrossRefGoogle ScholarPubMed
Ruggeri, M., Salvi, G., Perwanger, V., Phelan, M., Pellegrini, N., Parabiaghi, A.Satisfaction with community and hospital-based emergency services amongst severely mentally ill service users: a comparison study in south Verona and south London. Soc Psychiatry Psychiatr Epidemiol 2006;41(4):302–309.CrossRefGoogle ScholarPubMed
Sihvo, S., Hämäläinen, J., Kiviruusu, O., Pirkola, S., Isometsä, E.Treatment of anxiety disorders in the Finnish general population. J Affect Dis 2006;96(1–2):31–38.CrossRefGoogle ScholarPubMed
SPSS Base 11.0. Application guide. Chicago, IL: SPSS; 2000.Google Scholar
Starcevic, V.Anxiety states: a review of conceptual and treatment issues. Curr Opin Psychiatry 2006;19:79–83.CrossRefGoogle ScholarPubMed
Stein, D.J., Kasper, S., Andersen, E.W., Nil, R., Lader, M.Escitalopram in the treatment of social anxiety disorder: analysis of efficacy for different clinical subgroups and symptom dimensions. Depress Anxiety 2004;20(4):175–181.CrossRefGoogle ScholarPubMed
Svartberg, M., Stiles, T.C., Seltzer, M.H.Randomized, controlled trial of the effectiveness of short-term dynamic psychotherapy and cognitive therapy for cluster C personality disorders. Am J Psychiatry 2004;161(5):810–817.CrossRefGoogle ScholarPubMed
Tenbrink, D.Zur Theorie und Praxis der Psychodinamischen Kerzpsychoterapie. Z Individual Psychol 1997;1:3–31 (in German).Google Scholar
Vinnars, B., Barber, J.P., Noren, K., Gallop, R., Weinryb, R.M.Manualized supportive-expressive psychotherapy versus nonmanualized community-delivered psychodynamic therapy for patients with personality disorders: bridging efficacy and effectiveness. Am J Psychiatry 2005;162(10):1933–1940.CrossRefGoogle ScholarPubMed
Westen, D., Novotny, C.M., Thompson-Brenner, H.The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials. Psychol Bull 2004;130(4):631–633.CrossRefGoogle ScholarPubMed
Wittchen, H.U.Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety 2002;16(4):162–171.CrossRefGoogle ScholarPubMed
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