Psychodynamic Therapy: As Efficacious as Other Empirically Supported Treatments? A Meta-Analysis Testing Equivalence of Outcomes

Abstract

Results suggest equivalence of psychodynamic therapy to treatments established in efficacy. Further research should examine who benefits most from which treatment.

Equivalence and non-inferiority testing in psychotherapy research

“…This margin corresponds to differences, for example, in the Hamilton Rating Scale for Depression and the Hamilton Anxiety Rating Scale of 0.28 and 0.35 scale points which can hardly be considered clinically relevant. As shown above, most researchers agree on larger margins (Lange and Freitag, 2005;Gladstone and Vach, 2014;Steinert et al, 2017) (b) Sample size Furthermore, Rief and Hofmann´s proposal for demonstrating non-inferiority with a power of 0.80 using a margin of d = 0.05 and applying one one-sided test at α = 0.025 (Lesaffre, 2008), would require 2 × 6281 subjects. In psychotherapy research, sample sizes like this can hardly be realized, rendering non-inferiority trials in this field virtually impossible 2.…”

“…Steinert et al, 2017, p. 944). In a meta-analysis of psychodynamic therapy (PDT) including different mental disorders, Steinert et al (2017) chose a margin of g = 0.25, which is among the smallest margins ever used in psychotherapy and medical research (Gladstone andVach, 2014, Figure 2, Steinert et al, 2017, p. 944). This margin is very close to both (a) the threshold for a minimally important difference specifically suggested for depression (0.24, Cuijpers et al, 2014), and (b) the margin recommended by Gladstone and Vach (2014) to protect against degradation of treatment effects in non-inferiority trials (d = −0.23).…”

“…The meta-analysis by Steinert et al (2017) discussed by Rief and Hofmann in this regard included only studies in which the efficacy of the comparator was established in previous studies and in which the treatments and the comparators were adequately implemented in the included studies by use of treatment manuals and treatment fidelity measures (e.g. training, supervision, and/or treatment integrity checks).…”

“…For this reason, Cuijpers et al (2016, p. 245) concluded that the effects of CBT are 'uncertain and should be considered with caution', implying less confidence in the effects of CBT than suggested by Rief and Hofmann (2018) (g) (Deductive) hypothesis testing v. inductive conclusions Steinert et al (2017) tested the hypothesis that psychodynamic therapy is as efficacious as treatments with established efficacy. This hypothesis was corroborated in a strict test that included a small margin, a control of researcher allegiance, and adequately implemented comparators established in efficacy (Steinert et al, 2017). Steinert et al (2017) have never claimed that their results may be inductively generalized to conditions for which no studies of PDT exist such as insomnia as suggested by Rief and Hofmann (2018) Equivalence v. non-inferiority testing…”

On Mechanisms of Change in Psychodynamic Therapy

“…There is growing evidence for the efficacy of psychodynamic therapy (Abbass et al 2014;Leichsenring et al 2015a;Leichsenring et al 2015b;Steinert et al 2017). However, several biases or "myths" towards psychodynamic therapy (PDT) are kept alive, including, for example, a distorted depiction of psychodynamic theory based on caricatured versions of early psychoanalytic assumptions (e.g., repressed libido as the only dynamic force) while ignoring contemporary psychodynamic approaches (Abbass et al 2017).…”