A cost-utility analysis of psychoanalysis versus psychoanalytic psychotherapy

Berghout, Casper; Zevalkink, Jolien; Roijen, Leona Hakkaart-van

doi:10.1017/s0266462309990791

Cited by 26 publications

(14 citation statements)

References 18 publications

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“…The vast majority of studies included by Margraf (2009) investigated cognitive behavioral therapy und short-term psychodynamic psychotherapy (see Puschner & Kraft 2008). Cost-benefit studies are also available for PT showing considerable reduction of absenteeism and of inpatient hospital stays after treatment (Dührssen & Jorswieck 1965;Breyer et al 1997;DeMaat et al 2008;Berghout et al 2010); however, these were mostly retrospective studies.…”

Section: Cost-benefit Analysis In Psychotherapymentioning

confidence: 99%

A Comparison of Psychoanalytic Therapy and Cognitive Behavioral Therapy for Anxiety (Panic/Agoraphobia) and Personality Disorders (APD Study): Presentation of the RCT Study Design

Benecke

Huber

Schmitz

et al. 2016

Zeitschrift für Psychosomatische Medizin und Psychotherapie

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Fragestellung: Angststörungen, insbesondere Panikstörungen und Agoraphobie, sind weitverbreitete psychische Störungen, die eine hohe Komorbidität mit Persönlichkeitsstörungen aufweisen. Randomisierte kontrollierte Studien, die sich mit dieser sehr relevanten Gruppe von Patienten befassen, fehlen bisher. Methode: Die multizentrisch durchgeführte Studie zu Angst-und Persönlichkeitsstörungen (APS) untersucht 200 Patienten mit Panikstörung und/oder Agoraphobie mit komorbiden Persönlichkeitsstörungen in einer randomisierten, kontrollierten Vergleichsstudie zwischen Analytischer Psychotherapie (psychoanalytic therapy, PT) und Kognitiver Verhaltenstherapie (cognitive behavioral therapy, CBT), wobei jede Gruppe 100 Patienten enthält. Jeder Patient wird über einen Zeitraum von sechs Jahren untersucht, unabhängig von der Dauer der individuellen Behandlung. Die wesentlichen Fragestellungen dieser Studie beziehen sich auf den Vergleich der Effektivität von PT und CBT in dieser speziellen Patientenpopulation, auf den Vergleich der Nachhaltigkeit der Effekte von PT und CBT, den Vergleich der langfristigen Kosten-Nutzen-Relation von PT und CBT, sowie die Untersuchung von prädiktiven Patientenmerkmalen für individuelle Therapieempfehlungen (Differenzielle Indikationsstellung). Diskussion: Die APS-Studie vergleicht Effektivität, Nachhaltigkeit und Kosten-Nutzen-Relation von PT und CBT für Angst-plus Persönlichkeitsstörungen in einem randomisierten, kontrollierten Design. Das Studiendesign erfüllt damit die Anforderungen an eine Effektivitätsstudie für PT, die unlängst definiert wurden. Studienregistrierung: Current Controlled Trials ISRCTN12449681.

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Section: Cost-benefit Analysis In Psychotherapymentioning

confidence: 99%

A Comparison of Psychoanalytic Therapy and Cognitive Behavioral Therapy for Anxiety (Panic/Agoraphobia) and Personality Disorders (APD Study): Presentation of the RCT Study Design

Benecke

Huber

Schmitz

et al. 2016

Zeitschrift für Psychosomatische Medizin und Psychotherapie

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“…The ethical dilemma is akin to a situation where there is a limited supply of penicillin in the midst of an epidemic of pneumonia: does one give half the recommended dose to everybody or a full recommended dose to half? Fortunately, limited services and medication are sufficient for some, but many others are recurrently and chronically ill and need more intensive and/or extended psychotherapy, to include those with chronic depression (Blatt, Quinlan, Pilkonis, & Shea, 1995;Buchheim et al, 2012;Fava, Ruini, & Belaise, 2007;Huber, Zimmerman, Henrich, & Klug, 2012) and those with borderline personality disorder (Bateman & Fonagy, 2008;Stevenson & Meares, 1999) as well as other patient groups (Berghout, Zevalkink, & Hakkaart-vanRojen, 2010a, 2010bBeutel, Rasting, Stuhr, Rüger, & Leuzinger-Bohleber, 2004;De Maat, de Jonghe, Schoevers, & Dekker, 2009;De Maat, Philipszoon, Schoevers, Dekker, & De Jonghe, 2007;Howard, Kopta, Krause, & Olinski, 1986;Leichsenring & Rabung, 2008, 2011Sandell et al, 2000).…”

Section: How Will Ecps Make Their Choices?mentioning

confidence: 99%

Obstacles to Early Career Psychiatrists Practicing Psychotherapy

Clemens¹,

Plakun²,

Lazar³

et al. 2014

Psychodynamic Psychiatry

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Though psychiatric residents are expected to be competent psychotherapists on graduation, further growth in skill and versatility requires continued experience in their ongoing career. Maturity as a psychotherapist is essential because a psychiatrist is the only mental health provider who, as a physician, can assume full responsibility for biopsychosocial patient care and roles as supervisor, consultant, and team leader. Graduating residents face an environment in which surveys show a steady and alarming decline in practice of psychotherapy by psychiatrists, along with a decline in job satisfaction. High educational debts, practice structures, intrusive management, and reimbursement policies that devalue psychotherapy discourage early career psychiatrists from a practice style that enables providing it. For the early-career psychiatrist there is thus the serious risk of being unable to develop a critical mass of experience or a secure identity as a psychiatric psychotherapist. Implementation of parity laws and the Affordable Care Act (ACA) will affect the situation in unpredictable ways that call for vigilance and active response. Additional service and administrative demands may result from the ACA, creating ethical dilemmas about meeting urgent patient needs versus biopsychosocial standards of care. The authors recommend 1) vigorous advocacy for better payment levels for psychotherapy and freedom from disruptive management; 2) aggressive action against violations of the parity act, 3) active preparation of psychiatric residents for dealing with career choices and the environment for providing psychotherapy in their practice, and 4) post-graduate training in psychotherapy through supervision/consultation, continuing education courses, computer instruction, and distance learning.

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“…The effect of psychodynamic psychotherapy seems to maximize the capacity to focus on work and personal relationships. The benefits of LTPP not only persist following therapy termination but continue to grow (Berghout et al, 2010a). CBT seems to benefit by a similar process, namely that the medications facilitate learning or reduce the barriers wORKPLACE EFFECTIvENESS AND PSYCHOTHERAPY 525 to learning and the incorporation of the skills into daily life.…”

Section: Policy Implications and Future Directionsmentioning

confidence: 99%

Workplace Effectiveness and Psychotherapy for Mental, Substance Abuse, and Subsyndromal Conditions

Sledge¹,

Lazar²

2014

Psychodynamic Psychiatry

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While it is known that psychiatric illness and subclinical psychiatric illness can be very disabling, their impact on workers' productivity has been little appreciated or appropriately addressed. Complex variables are involved in fashioning an appropriate policy to ameliorate the impact of mental illness on productivity including the identification of effective treatments and potential negative effects of controlling patients' access to them. The cost-effectiveness of such treatments is considered from the differing perspectives and goals of the various stakeholders involved, including employers, insurers, and workers with psychiatric illness. Depression in workers leads to significant absenteeism, "presenteeism" (diminished capacity due to illness while still present at work), and significantly increased medical expenses in addition to the costs of psychiatric care. In addition to the specific usefulness of psychotropic medication, there are a variety of studies on the cost-effectiveness of different psychotherapeutic treatments that improve health and productivity in psychiatrically ill workers. Research indicates the usefulness of approaches including employee assistance programs, specialized cognitive-behavioral treatments, and brief and longer term psychodynamic interventions. It is clear that substance abuse disorders and especially depression and subsyndromal depression have a profound negative effect on work productivity and increases in medical visits and expenses. The current system of mental health care suffers from ignorance of the negative effects of psychiatric illness in workers, from a lack of subtle awareness of which treatments are most appropriate for which diagnoses and from the reluctance by payers to invest in them. Access to evidence-based appropriate treatment can improve the negative impact on productivity as well as workers' health. This article considers these issues and argues for a role of psychotherapy in the treatment of mental illness and substance abuse from the perspective of worker productivity.

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A cost-utility analysis of psychoanalysis versus psychoanalytic psychotherapy

Cited by 26 publications

References 18 publications

A Comparison of Psychoanalytic Therapy and Cognitive Behavioral Therapy for Anxiety (Panic/Agoraphobia) and Personality Disorders (APD Study): Presentation of the RCT Study Design

A Comparison of Psychoanalytic Therapy and Cognitive Behavioral Therapy for Anxiety (Panic/Agoraphobia) and Personality Disorders (APD Study): Presentation of the RCT Study Design

Obstacles to Early Career Psychiatrists Practicing Psychotherapy

Workplace Effectiveness and Psychotherapy for Mental, Substance Abuse, and Subsyndromal Conditions

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