Psychodynamic Treatment of Depression

摘要

Meta-analyses have identified very few, if any, differences in the efficacy of bona fide psychotherapies for a number of conditions, including depression.5-6 This may be because the effects of these treatments are only in part related to specific techniques. Other factors may account for a larger portion of the variance in treatment outcome; it has been estimated that only 15% is predicted by specific techniques, 30% by common factors (eg, providing support), 15% by expectancy and placebo effects, and 35% to 40% by extratherapeutic effects (eg, spontaneous remission, positive events or changes).7 Moreover, it has been difficult to find differences among treatments because most studies have focused on symptom remission in brief, highly structured, and manualized interventions. Furthermore, most randomized, controlled trials (RCTs) have only had power to investigate noninferiority compared with other active treatments and thus may be unable to detect meaningful differences between treatments. Research focusing on outcomes broader than symptom remission, as well as long-term effects, may be more promising as discussed below.