The Effectiveness of Psychodynamic Therapy and Cognitive Behavior Therapy in the Treatment of Personality Disorders: A Meta-Analysis. By Falk Leichsenring, D.Sc. Eric Leibing, D.Sc. (Am J Psychiatry 2003; 160:1223-1232)

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The Effectiveness of Psychodynamic Therapy and
Cognitive Behavior Therapy in the Treatment of
Personality Disorders A Meta-Analysis. By
Falk Leichsenring, D.Sc. Eric Leibing,
D.Sc. (Am J Psychiatry 2003 1601223-1232)

• Presented By Lauren Coe

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Purpose

• There is a considerable lack of empirical
  research on treatment of personality disorders
  with psychotherapy, with only a few randomized
  controlled studies.
• To address concerns about costs of mental health
  services, empirical data about the efficacy of
  psychotherapy in the treatment of personality
  disorders are needed.

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Method

• Studies published between 1974 and 2001 were
  collected.
• MEDLINE
• PsycINFO
• Current Contents
• 14 of psychodynamic therapy and
• 11 studies of cognitive behavior therapy were
  included.

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Literature Review Questions

• What is the evidence of improvement in symptoms,
  social functioning, or core psychopathology after
  either type of therapy?
• Is there evidence of improvement in specific
  types of personality disorders after either type
  of therapy?
• Do individuals with personality disorders recover
  after either type of therapy?

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Literature Review Questions

• Are there differences between self-report and
  observational measures?
• Are there differences between outcome and
  duration of treatment?
• What other factors are connected with outcome
  (gender, inpatient vs. outpatient status, use of
  therapy manuals, experience of therapists)?

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Correlations

• Calculate correlations between outcome and the
  following factors
• Length of therapy
• Patient gender
• Inpatient vs. outpatient status
• Use of therapy manuals
• Clinical experience of therapists
• Study design (randomized vs. naturalistic)

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Issues To Consider

• Small number of studies
• Many variables
• Grouped personality disorders
• Effect sizes (statistics) not comparable
• This is preliminary

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Included Studies

• Studies focusing on
• Either psychodynamic or cognitive therapy
• Men and women
• Personality disorders
• Inpatients, outpatients
• Sufficient length of time
• Randomized and naturalistic designs

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Results
Therapy Type Mean Length Number of Sessions
Psychodynamic Therapy 37.18 6
Cognitive Therapy 16.36 7
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Results - Psychodynamic
Improvement Effect Size Number of Studies Mean (D) SD Range
Overall 15 1.46 0.73 0.34 - 2.70
Self-Report 12 1.08 0.36 0.65 - 1.67
Observer Report 12 1.79 1.07 0.34 - 4.02
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Results Cognitive
Improvement Effect Size Number of Studies Mean (D) SD Range
Overall 10 1.00 0.48 0.34 - 2.13
Self-Report 8 1.20 0.38 0.81 - 1.85
Observer Report 8 0.87 0.71 0.19 - 2.40
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Effectiveness of Therapy on Treatment Beck
Depression Scale
Psychodynamic studies Mean SD
PD 6 1.44 0.51
No PD 2 2.39 0.54
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Effectiveness of Therapy on Treatment Beck
Depression Scale
Cognitive studies Mean SD
PD 3 1.49 0.28
No PD 1 2.04 --
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Other Conclusions

• For cognitive behavioral therapy, the largest
  effect sizes were found with the Beck Depression
  Inventory.
• A calculated recovery rate from personality
  disorders of 59 after a mean of 15 months of
  treatment (psychodynamic therapy).
• 47 of the patients were no longer diagnosed with
  avoidant personality disorder (cognitive
  behavioral therapy).

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More random conclusions

• Dropout rates are relevant
• Mean dropout rates
• Psychodynamic therapy 15
• Cognitive therapy 17.
• Total number treated
• Psychodynamic therapy 417
• Cognitive therapy 231.

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Limitations of the Study

• Small number of studies that could be included
  (25 total)
• The small number of studies reduces both the
  results potential generalization and the
  statistical power.
• Thus, the conclusions that can be drawn are only
  preliminary.

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Limitations of the Study

• Effect sizes cannot be compared directly between
  cognitive behavior therapy and psychodynamic
  therapy because the data do not come from the
  same experimental comparisons.
• Within-group effect sizes may be an overestimate
  of the true change because of unspecific
  therapeutic factors, spontaneous remission, or
  regression to the mean.

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Limitations of the Study

• Significant fluctuations over time may occur that
  may be state dependent rather than showing
  lasting remission of the personality disorder in
  question.
• Several studies reported more improvement in
  personality disorder patients after longer
  treatment durations.

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Meta-Analysis Conclusions

• There is evidence that both psychodynamic therapy
  and cognitive behavior therapy are effective
  treatments of personality disorders.
• There is evidence that treatment with
  psychotherapy in personality disorder patients is
  relevant to the cost of health care utilization.

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Further Conclusions

• Further studies are necessary.
• Both longer treatments and follow-up studies
  should be included.
• Further research should examine specific forms of
  psychotherapy for specific types of personality
  disorder.
• Data on health economics should be included.