Psychoanalytic therapy shows significantly longer-lasting effects compared to cognitive-behaviour therapy three years after termination of treatment, which is discussed as a dose-effect.

The aim of this study was to investigate the effectiveness of long-term psychoanalytic and psychodynamic psychotherapies. In a prospective, randomized outcome study, psychoanalytic (mean duration: 39 months, mean dose: 234 sessions) and psychodynamic (mean duration: 34 months, mean dose: 88 sessions) therapy were compared at post-treatment and at one-, two-, and three-year follow-up in the treatment of patients with a primary diagnosis of unipolar depression. All treatments were carried out by experienced psychotherapists. Primary outcome measures were the Beck Depression Inventory and the Scales of Psychological Capacities, and secondary outcome measures were the Global Severity Index of the Symptom Checklist 90-R, the Inventory of Interpersonal Problems, the Social Support Questionnaire, and the INTREX Introject Questionnaire. Interviewers at pre- and post-treatment and at one-year follow-up were blinded; at two- and three-year follow-up, all self-report instruments were mailed to the patients. Analyses of covariance, effect sizes, and clinical significances were calculated to contrast the groups. We found significant outcome differences between treatments in terms of depressive and global psychiatric symptoms, personality functioning, and social relations at three-year follow-up, with psychoanalytic therapy being more effective. No outcome differences were found in terms of interpersonal problems. We concluded that psychoanalytic therapy associated with its higher treatment dose shows longer-lasting effects.

Psychoanalytic therapy is an effective treatment for major depression, especially in the long run. The differential effectiveness of psychoanalytic therapy cannot be fully explained by its higher dose. Distinctive features of psychoanalytic technique (e.g., focusing on patients' dreams, fantasies, sexual experiences or childhood memories) may play an important role in establishing sustained therapeutic change.

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BackgroundAlthough aging is accompanied by diminished functioning, many elderly individuals preserve a sense of well-being. While the concept of "successful aging" has been popular for many decades, little is known about its psycho-physiologic and endocrine underpinnings. KORA-Age is a population-based, longitudinal study designed to determine the prevalence of successfully aged men and women between 65 and 94 years old in the MONICA/KORA Augsburg cohort of randomly selected inhabitants. Specifically, we aim to identify predictors of successful aging and to elucidate bio-psychosocial mechanisms that maintain mental health and successful adaptation despite adverse experiences of life and aging.Methods/DesignComponents of successful aging were assessed in a telephone survey of 4,127 participants (2008-2009) enrolled in the MONICA/KORA cohort, on average, 13 years earlier. Psychosocial, somatic and behavioural predictors are used to determine factors that contribute to successful aging. An age-stratified random sub-sample (n = 1,079) participated in a personal interview where further psychological mechanisms that may underlie successful adaptation (resilience, social support, attachment) were examined. The interactions among neuroendocrine systems in the aging process are investigated by studying the cortisol/dehydroepiandrosterone-sulfate ratio, the level of insulin-like growth factor I, and oxytocin.DiscussionLongitudinal determinants of successful aging can be assessed based on a follow-up of an average of 13 years. A comprehensive analysis of biological as well as physio-psychological information provides a unique opportunity to investigate relevant outcomes such as resilience and frailty in the elderly population.

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Because depression is a recurrent disorder, the therapeutic aim for it should be the prevention of relapse or recurrence. Practitioners of psychoanalytic (PA), psychodynamic (PD) and cognitive-behavioral therapy (CBT) claim to achieve stable results by improving patients' personality functioning (e.g., selfand object representations, capacity to regulate affect and self-esteem). This hypothesis was tested using data from a subsample of 67 patients of the Munich Psychotherapy Study. In addition, we tested a diathesis-stress model, assuming that a failure to improve personality functioning during therapy may represent a vulnerability factor, especially for people confronted with adverse life events after therapy. Depressive symptoms and general psychiatric distress were assessed using the German versions of the Beck Depression Inventory (Hautzinger, Bailer, Worall, & Keller, 1995) and the Global Severity Index of the Symptom Checklist 90 -Revised (Franke, 1995) at pretreatment, posttreatment, and 3-year follow-up. Personality functioning was assessed pre-and posttreatment using the Scales of Psychological Capacities (Wallerstein, 1991;Wallerstein, DeWitt, Hartley, Rosenberg, & Zilberg, 1989). Patients were interviewed at 1-year follow-up to detect negative life events in the intervening time. Regression analyses revealed that depressive symptoms and general psychiatric distress at 3-year follow-up were significantly predicted by pre-to posttreatment changes in personality functioning. When controlling for pre-to posttreatment changes in outcome measures, the effects of change in personality functioning were no longer significant. However, we found evidence for an interaction effect between pre-to posttreatment changes in personality functioning and the number of negative life events on general psychiatric symptoms, partially supporting the assumed diathesis-stress model. This suggests that, irrespective of treatment modality, therapists should focus on changes in personality functioning to obtain stable benefits.