Challenging the role of challenge in intensive short‐term dynamic psychotherapy for social anxiety disorder: A randomized controlled trial

Abstract

Objectives Intensive short‐term dynamic psychotherapy (ISTDP) requires the technique of challenge to defenses when treating resistant patients. As the technique of challenge is difficult for some therapists to practice, it leads us to question whether challenge can be replaced by clarification of defenses without losing treatment effectiveness. This study compared ISTDP with two different technical emphases while treating social anxiety disorder (SAD). Method Forty‐two subjects with DSM‐5 SAD were randomly assigned to either a waitlist control, 10 sessions of ISTDP with the use of challenge or 10 sessions of ISTDP without the use of challenge. Results ISTDP led to significant, sustained symptom reduction on the Liebowitz Social Anxiety Scale (LSAS‐SR) compared with the control group. There were no significant outcome differences between standard ISTDP and ISTDP where challenge was restricted. Conclusion ISTDP is efficacious for SAD. ISTDP may be effective for SAD without the use of challenge elements.

Intensive short-term dynamic psychotherapy provided by novice psychotherapists: effects on symptomatology and psychological structure in patients with anxiety disorders

“…All these data show that beneficial effects of ISTDP when provided by experienced clinicians are also achievable by novice psychotherapists during training. This appears true not only for changes at level of symptom remission (Rahmani, et al, 2020a;2020b), but also at the level of structural/personality change (Abbass et al, 2012;Abbass et al, 2013b;Lilliengren et al, 2020). Our findings provide information about role of limited clinical experience on clinical effectiveness and suggest that factors beyond clinical experience may contribute to outcomes.…”

“…Recent studies of ISTDP show that it is effective with depression, panic disorder, somatic symptom disorders and personality disorders (Abbass, Town, & Driessen, 2012, 2013Lilliengren, Cooper, Town, Kisely, & Abbass, 2020). A recent study found ISTDP effective and cost-effective with generalized anxiety disorder and 2 recent randomized controlled trials found ISTDP to be efficacious for social anxiety disorder (Rahmani, Abbass, Hemmati, Ghaffari, & Rezaei Mirghaed, 2020a;Abbass, Hemmati, Mirghaed, & Ghaffari, 2020b).…”