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

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.

Efficacité de la psychothérapie comparativement à la pharmacothérapie dans le traitement des troubles anxieux et dépressifs chez l’adulte : une revue de la littérature

“…La revue de la littérature de référence, c'est-à-dire utilisée comme point de départ, est celle publiée par l'Australian Psychological Society (APS, 2010 (Ferrero et al, 2007). Les paramètres de résultats examinés ne sont pas présentés de façon détaillée et n'ont pas fait l'objet d'une méta-analyse.…”

“…En effet, dans la revue de la littérature de l'APS (basée sur 3 revues systématiques, 1 ECR et 1 essai clinique ou EC non randomisé), aucune différence statistiquement significative n'a été démontrée dans les paramètres de résultats entre la thérapie psychodynamique (TPD) et la pharmacothérapie. Un EC non randomisé d'une durée de 12 mois sur des patients souffrant d'un trouble d'anxiété généralisée (TAG) a permis de montrer les bénéfices de la psychothérapie en termes de soulagement de symptômes (Ferrero, et al, 2007). En ce qui a trait au trouble panique, aucune différence statistiquement significative n'a été établie concernant l'efficacité de la TCC comparée à celle de la pharmacothérapie, y compris les ATC et les ISRS (NICE, 2004) (Mitte, 2005 ;Van Apeldoorn, et al, 2008).…”

An open, non‐randomised comparison of escitalopram and duloxetine for the treatment of subjects with Generalized Anxiety Disorder

“…Improving the evidence about the effectiveness and safety of medications for GAD in ''real world'' settings seems therefore an important issue for psychiatrists working in community MHS: all treatments of psychiatric disorders offered by these services should in fact be effective but also efficient (Baldwin and Polkinghorn, 2005) and accepted (Ferrero et al, 2007). The settings and procedures of many randomized controlled trials are not comparable with community outpatient psychiatric services (Westen et al, 2004), because subjects referring to specialized centers are usually more motivated and more influenced by the treatment setting.…”

“…Although psychotherapy (Davidson, 2009) could be considered among the first-line interventions for several patients, both individually and combined with drug therapy (Ferrero et al, 2007), this kind of treatment is often not available in an useful timeframe for professionals who refer to community Mental Health Services (MHS).…”

Combined therapy versus usual care in the treatment of depressed cancer patients with pain

“…This technique has been described in a previous study [25] and has been used within a range of settings to treat various disorders [26][27][28] analysis. Cardinal variables were described by using the mean and standard deviation.…”