Insight as a mechanism of change in dynamic therapy for major depressive disorder.

Abstract

This study aimed to investigate change in insight into maladaptive interpersonal patterns over the course of psychotherapy, as well as the specificity of insight as a change mechanism in dynamic treatments. A total of 100 patients received up to 16 sessions of either cognitive or dynamic therapy for major depressive disorder in a randomized clinical trial. Assessments of insight (Insight into Conflictual Relationship Patterns scale) and depression severity (Hamilton Depression Inventory) took place at the beginning of treatment, at month 2, and month 5. Patient insight significantly improved over the course of dynamic treatments. Gains in insight from the beginning to month 2 of treatment were a significant predictor of decreases of depressive symptoms from month 2 to month 5 of treatment in the dynamic, but not in the cognitive treatment group, despite a nonsignificant interaction. Results provide support for insight as a change factor in dynamic therapies. Better self-understanding of dysfunctional interaction patterns could help patients to find more adaptive ways of behaving, to form more satisfying relationships, and to improve their depression. Public Significance StatementThis study suggests that insight is a potential change factor in dynamic psychotherapy for depression. Understanding problematic relationship patterns may lead to better symptom improvement for patients.

The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders – an umbrella review based on updated criteria

“…Our systematic search yielded one recent meta-analysis reporting a significant moderate correlation (r=0.31) between insight and outcome across a variety of psychotherapeutic approaches, including PDT 46 . Studies in depressive disorders, anxiety disorders and Cluster C personality disorders found that gains in insight preceded improvements in outcome of PDT [80][81][82] . These effects were found to be specific to PDT [80][81][82] .…”

“…Studies in depressive disorders, anxiety disorders and Cluster C personality disorders found that gains in insight preceded improvements in outcome of PDT [80][81][82] . These effects were found to be specific to PDT [80][81][82] . In personality disorders, the effect of transference work in patients with more severe interpersonal difficulties was found to be mediated by both improvements in insight and affect awareness 83 .…”

Precision Medicine: Neuropsychodynamic Psychiatry Model of Major Depressive Disorder

“…While the efficacy of psychodynamic therapy (PDT) is debatable, [25] demonstrates the noninferiority of PDT in treating MDD among other psychotherapies. Intensive short-term PDT (ISPDT) has shown significant [26] and sustained [27] improvement in MDD; long-term (LTDP) is superior to other therapies in treating chronic depression in terms of personality and social functioning [28].…”

Systematic review of machine learning utilization within outpatient psychodynamic psychotherapy research

“…Further positive effects include a reduced number of sick leaves, a reduction of health care utilization, less psychiatric hospitalizations after therapy, and a reduced relapse rates for depression ( 4 – 6 ). A number of factors that predict successful therapy are also known, such as improving the working alliance ( 7 , 8 ), therapeutic agency ( 7 , 9 , 10 ) or the patient's ability to perceive emotions ( 11 , 12 ) which lead to a reduction in symptom burden. However, as Leichsenring et al ( 13 ) point out, recent substantial improvements in treatment success have been scarce.…”