Intensive Short-term Dynamic Psychotherapy Research Articles

Therapists’ experiences of negative effects in intensive short-term dynamic psychotherapy: A qualitative interview study

Objective: Negative effects of psychotherapy are a broad term that encompasses events such as non-response, deterioration, and novel symptoms. The aim of the present study was to explore experiences with negative effects among clinicians working within an intensive short-term dynamic psychotherapy (ISTDP) framework. Method: Eight ISTDP clinicians consented to participate and were interviewed using semi-structured video interviews. Data were transcribed and analyzed using a reflexive thematic analysis framework. Results: The thematic analysis resulted in five themes. Overall, the clinicians found it difficult to define negative effects, but that negative effects, regardless of cause, could be used therapeutically. Inaccurate assessment was seen as the main cause of negative effects. Other themes concerned the connection between dropout and negative effects, patient feedback, and the ISTDP community’s relationship to negative effects. Conclusions: The results are largely in line with qualitative studies of CBT clinicians’ views of negative effects although clinicians in the present study emphasized more strongly the therapeutic potential of these events. The research field could be further improved by using mixed-method designs while including both patients and therapists.

Halifax somatic symptom disorder trial: A pilot randomized controlled trial of intensive short-term dynamic psychotherapy in the emergency department

BackgroundPatients commonly present at hospital Emergency Departments (ED) with distress that meet criteria for a Somatic Symptom and Related Disorder (SSRD). Without access to effective treatment, risk of ongoing patient disability and further ED visits is high. MethodThis pilot trial used a randomized parallel group design to test the efficacy of Intensive Short-Term Dynamic Psychotherapy (ISTDP). ED patients who met criteria for SSRD were recruited. The effects of ISTDP plus medical care as usual (MCAU) were judged through comparison against 8 weeks of MCAU plus wait-list symptom monitoring (WL-SM). The primary outcome was somatic symptom at 8 weeks. Patients allocated to WL-SM could cross-over to receive ISTDP and 6-month follow-up data was collected. Baseline measures of patient attachment style and alexithymia were collected to examine vulnerabilities to somatic symptoms. ClinicalTrials.gov: NCT02076867. ResultsThirty-seven patients were randomized to 2 groups (ISTDP = 19 and WL-SM = 18). Multi-level modelling showed that change over time on somatic symptoms was significantly greater in the ISTDP group. Between-group differences were large at 8 weeks (Cohen's d = 0.94) and increased by end of treatment (Cohen's d = 1.54). Observed differences in symptoms of depression and illness anxiety were also large, favoring ISTDP, and effects were maintained at follow-up. Patients receiving ISTDP had reduced ED service utilization at 2-year follow-up. ConclusionsISTDP appears an efficacious treatment for SSRD and a larger randomized trial is justified.

Psychotherapy and Treatment-Resistant Depression

Treatment-resistant depression (TRD) describes those who have not responded to at least two other treatments for depression. These individuals require additional support to reach remission of their symptoms. Psychotherapy modalities can be a way to augment treatment of depression without additional medications. This article discusses the use of interpersonal therapy, dialectical behavioral therapy, radically open dialectical behavioral therapy, cognitive-behavioral therapy, and intensive short-term dynamic psychotherapy. All of these therapies can achieve increased rates of remission and improvement of depressive symptoms when compared to treatment as usual. No significant adverse events have noted in the studies that have looked at these various treatments. Areas for future research include delineation of which specific modalities are best suited to addressing the needs of individual patients. As part of a comprehensive treatment plan, psychotherapy should be considered when addressing TRD. [ Psychiatr Ann . 2024;54(6):e182–e185.]

Intensive short-term dynamic psychotherapy for irritable bowel syndrome: a randomized controlled trial examining improvements in emotion regulation, defense mechanisms, quality of life, and IBS symptoms.

Studies have provided evidence for the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in treating medically unexplained symptoms (MUS). This study aimed to examine the effectiveness of ISTDP on individuals living with irritable bowel syndrome (IBS) in terms of, emotion regulation (ER) abilities, defense mechanisms, quality of life (QOL), and IBS symptoms. A total of 30 patients diagnosed with IBS were recruited and randomly assigned to either the intervention (n = 15) or control (n = 15) group. Pre- and post-treatment assessments were conducted, along with a follow-up assessment after ten weeks. Repeated measures analyses of variance were employed to analyze the data. The findings revealed that ISTDP led to significant improvements in ER, defense mechanisms, and QOL, as well as a reduction in the severity and frequency of IBS symptoms. These results provide further support for the efficacy of ISTDP as a treatment modality for individuals with IBS.

Effectiveness of intensive short-term dynamic psychotherapy for Tension-Type Headache (TTH): A randomized controlled trial of effects on emotion regulation, anger, anxiety, and TTH symptom severity

Research has demonstrated the potential efficacy of intensive short-term dynamic psychotherapy (ISTDP) in addressing medically unexplained symptoms (MUS). However, the specific application of ISTDP for tension-type headache (TTH), a prevalent and common MUS, has not been extensively studied. In light of this gap in the literature, the current study investigated the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in treating TTH. The study assessed ISTDP's impact on emotion regulation (ER) capacities, levels of anxiety and anger, and TTH symptoms. 30 patients from the neurology clinic at Hazrat Rasool Hospital in Tehran were randomly assigned to either the intervention (n = 15) or control (n = 15) group. Pre- and post-treatment evaluations were conducted, followed by a ten-week follow-up assessment. Data were analyzed using repeated measures analyses of variance. The results indicated that ISTDP led to significant improvements in ER, reductions in anxiety and anger levels, and a significant decrease in TTH symptoms (ps < 0.001). Findings underscore the effectiveness of ISTDP as a valuable therapeutic approach for addressing TTH.

Effectiveness of Intensive Short-term Dynamic Psychotherapy on Attachment Styles, Somatization, and Health Anxiety in Patients with Chronic Pain

Effectiveness of Intensive Short-term Dynamic Psychotherapy on Attachment Styles, Somatization, and Health Anxiety in Patients with Chronic Pain

The effects of intensive short-term dynamic psychotherapy on depressive symptoms, negative affect, and emotional repression in single treatment-resistant depression: A randomized controlled trial.

Intensive short-term dynamic psychotherapy (ISTDP) is theorized to reduce negative affect by challenging patients' defense mechanisms so that they can experience and work through attachment-trauma-related emotions. While ISTDP has been shown to decrease depressive symptoms in single treatment-resistant depression (TRD), it has not been established whether negative affect and emotional repression are reduced, as theorized. Next to depressive symptoms, this retrospectively registered (https://osf.io/v46gy) randomized controlled trial, therefore, examined the effects of ISTDP on emotional repression and negative affect in adults with TRD. Eighty-six adults with major depressive disorder, who had not responded to at least one trial of antidepressants were randomized to 20 sessions of ISTDP (N = 43) or a waitlist control condition (N = 43). Mixed-effect models on the intention-to-treat sample showed that compared to the control condition, ISTDP resulted in significantly lower posttreatment levels of depressive symptoms (d = -1.73), emotional repression (d = -1.91), and negative affect (d = -1.45). Similarly, ISTDP resulted in significantly lower levels of depressive symptoms (d = -2.67), emotional repression (d = -2.69), and negative affect (d = -1.85) at the 3-month follow-up. These results support the evidence base of ISTDP by showing that it can decrease depressive symptoms, emotional repression, and negative affect in TRD. Future studies should assess whether these effects are specific to ISTDP. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Intensive Short-Term Dynamic Psychotherapy

Intensive Short-Term Dynamic Psychotherapy (ISTDP) is a transdiagnostic treatment method rooted in the psychodynamic tradition. A basic assumption is that many of our feelings, thoughts, desires and inner conflicts are inaccessible to our consciousness and thereby trigger and maintain psychological problems. In the 1960s, the Canadian psychoanalyst and psychiatrist Habib Davanloo began developing the original ‘standard format’ of ISTDP. After continuously studying video recordings of his treatment sessions, Davanloo systematised effective factors which he could use in subsequent treatment sessions. In the 1990s, he further developed a ‘graded format’ of ISTDP with interventions that could be adapted to patients who are easily overwhelmed by anxiety and other emotions. In this article, we take a closer look at how ISTDP operationalises ‘unconscious anxiety’ and ‘unconscious therapeutic alliance’ as observable markers that provide the therapist with information about the therapeutic process and about the choice of interventions, illustrated through the case of Nadine. Keywords: Intensive Short-Term Dynamic Psychotherapy, ISTDP, conflicting emotions, unconscious anxiety, unconscious therapeutic alliance

Comparison of the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) and existential therapy on the signs and symptoms of psychosomatic patients referred to Imam Khomeini Hospital in Tehran

Comparison of the effectiveness of intensive short-term dynamic psychotherapy (ISTDP) and existential therapy on the signs and symptoms of psychosomatic patients referred to Imam Khomeini Hospital in Tehran

Psilocybin-assisted psychotherapy for treatment-resistant depression: Which psychotherapy?

This perspective paper explores the choice of psychotherapy for psilocybin-assisted psychotherapy for treatment-resistant depression. There is evidence to support the use of some psychotherapies in treating 'treatment-resistant' depression, and emerging evidence for the efficacy of psilocybin. The next step which is the focus of this paper is to identify psychotherapies that are both effective and congruent with the psilocybin experience. The evidence for the efficacy of the psychotherapies is drawn from a Cochrane review and the analysis of their congruence with the psilocybin experience is drawn from a qualitative meta-synthesis of the experience of psilocybin. The paper will examine whether three one-to-one psychotherapies identified as effective in the treatment of treatment-resistant depression are compatible with the psilocybin experience. Each psychotherapy will be examined in relation to its congruence with the qualitative evidence that suggests the choice of psychotherapy needs to give priority to the subjective experience, facilitate emotional processing, support connectedness with others, acceptance of the self as emotional and support change based on the person's insights into their relationships with others and the world in which they live. We conclude that interpersonal psychotherapy and intensive short-term dynamic psychotherapy align with that experience, although others are currently being trialled.

Comparison of Effectiveness of Intensive Short-Term Dynamic Psychotherapy and Mindfulness-Based Stress Reduction in Depression and Severity of Symptoms in Women with Fibromyalgia

Background: In addition to pervasive pain, patients with fibromyalgia also complain about impaired cognitive functions, anxiety, and depression. Objectives: This study was conducted with the aim of comparing the effectiveness of mindfulness-based stress reduction (MBSR) and intensive short-term dynamic psychotherapy (ISTDP) in depression and the severity of symptoms in patients with fibromyalgia. Methods: This was an experimental study with a pretest-posttest design and a control group with a 3-month follow-up. The statistical population covered all female patients with fibromyalgia visiting the Rheumatology Clinic of Rasool Akram Hospital in Tehran, Iran. Based on inclusion criteria and the convenience sampling method, 36 individuals were selected and randomly assigned to 3 groups (2 experimental groups and a control group). Each experimental group received treatment (i.e., MBSR, eight 120-minute sessions, or ISTDP, eight 120-minute sessions). The research instruments included the Beck Depression Inventory-Second Edition and the Combined Index of Severity of Fibromyalgia. The results were analyzed using repeated measures analysis of variance (ANOVA). Results: The results showed that both interventions, namely MBSR and ISTDP, effectively reduced depression and the severity of symptoms in patients with fibromyalgia (P &lt; 0.001). Mindfulness-based stress reduction and ISTDP were also significantly different in terms of effectiveness, with ISTDP being more effective with a longer-term follow-up effect (P &lt; 0.001). Conclusions: Mindfulness-based stress reduction and ISTDP were effective and practical methods for reducing depression and the severity of fibromyalgia symptoms. It is recommended that psychotherapists and counselors adopt these approaches to reduce depression and the severity of fibromyalgia symptoms in patients and help improve and reduce their symptoms.

The Effectiveness of Intensive Short-Term Dynamic Psychotherapy on the Alexithymia, Defense Styles, and Ego Strength in Patients with Irritable Bowel Syndrome: A Quasi-Experimental Study

The Effectiveness of Intensive Short-Term Dynamic Psychotherapy on the Alexithymia, Defense Styles, and Ego Strength in Patients with Irritable Bowel Syndrome: A Quasi-Experimental Study

The Effectiveness of Intensive Short Term Dynamic Psychotherapy on Clinical Symptoms and Academic Performance in Adolescents with Oppositional Defiant Disorders

The Effectiveness of Intensive Short Term Dynamic Psychotherapy on Clinical Symptoms and Academic Performance in Adolescents with Oppositional Defiant Disorders

Intensive Short-Term Dynamic Psychotherapy (ISTDP) associated with healthcare reductions in patients with functional seizures

Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of Functional Neurological Disorders (FND) including functional seizures.This paper aimed to further examine the therapeutic effects of a 3-session course of this treatment focusing on its potential to maintain reduced healthcare utility within a group of patients with complex difficulties, across an extended time period, post-therapy.The original study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Seventeen participants completed the intervention and attendance rates were very high (95%). In this follow-up study, which was solely focused on the utilization of healthcare resources, results showed decreases when comparing 12 months prior and 12 months post three sessions of ISTDP.The results provide further support for the use of ISTDP in this group of participants with complex clinical presentations, specifically, its capacity to reduce healthcare usage over 12 months post-therapy. Further evidence from controlled and randomized studies with larger sample sizes is warranted.

Comparing the Effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) and Acceptance and Commitment Therapy Enriched with Compassion on the Components of Marital burnout in Women Seeking Divorce

Objective: This study aims to compare the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) and Acceptance and Commitment Therapy (ACT) enriched with compassion in altering marital burnout among women seeking divorce. Methods and Materials: Statistical population of this study consisted of all women seeking divorce in District 4 of Tehran city in the year 2021, who were selected from counseling centers supervised by the Organization of Psychology and Welfare through convenience sampling. Next, Pines’ (1996) Marital Burnout Questionnaire were distributed for completion, and 45 individuals who scored high on these scales were selected as the sample and randomly placed into two experimental groups and one control group (each group consisting of 15 individuals). For data analysis, descriptive statistical methods (frequency indices, mean, and standard deviation) and inferential statistics (multivariate repeated measures analysis of variance) using SPSS-24 were employed. Findings: Results indicated no significant difference between the ISTDP and ACT enriched with compassion in altering marital burnout. Both groups showed improvement compared to the control group, but no significant difference was noted between the two in terms of effectiveness. Conclusion: Both ISTDP and ACT enriched with compassion are effective in reducing marital burnout among women seeking divorce, with no significant difference in effectiveness between the two. This suggests that both therapeutic approaches can be beneficial in this context. Future research should consider broader and more diverse samples, longer follow-up periods, and comparisons to active control groups to further understand the sustained impact and efficacy of these therapies.

Intensive short-term dynamic psychotherapy (ISTDP) offers unique procedures for acceptance of emotion and may contribute to the process-based therapy movement

A variety of contemporary cognitive behavioral therapy (CBT) frameworks have collectively converged on acceptance of emotion as a therapeutic process central to producing positive outcomes. However, evidence shows that not all patients respond to these treatments, such as those with more severe and complicated symptomatology and more entrenched emotion avoidance tendencies. Intensive short-term dynamic psychotherapy (ISTDP) is a specific, highly active, emotion-focused model of therapy grounded in empirical research that was designed to treat complex patients with entrenched emotion avoidance behaviors. This paper presents the clinical techniques of ISTDP to illustrate its methods of facilitating acceptance of emotion, which is likely unfamiliar to many CBT therapists. Leaders of the field in CBT have recently made calls for psychotherapy, including CBT, to move toward a focus on process-based therapy (PBT), which seeks to highlight and investigate promising change processes and their related change procedures, no matter their original therapeutic framework. In introducing ISTDP techniques to CBT and PBT researchers and therapists, we seek to stimulate awareness, curiosity, and further collaboration in the study and use of these techniques in the hopes that ISTDP may contribute to the PBT movement.

The efficacy of intensive short-term dynamic psychotherapy (ISTDP) on self-esteem, emotion regulation, and defense mechanisms in men with social anxiety disorder

The efficacy of intensive short-term dynamic psychotherapy (ISTDP) on self-esteem, emotion regulation, and defense mechanisms in men with social anxiety disorder

The efficacy of intensive short-term dynamic psychotherapy on job stress coping strategies, health-related quality of life, and self-efficacy of iran air traffic controler staff

The efficacy of intensive short-term dynamic psychotherapy on job stress coping strategies, health-related quality of life, and self-efficacy of iran air traffic controler staff

The anger-depression mechanism in dynamic therapy: Experiencing previously avoided anger positively predicts reduction in depression via working alliance and insight.

A central tenet of psychodynamic theory of depression is the role of avoided anger. However empirical research has not yet addressed the question of for which patients and via what pathways experiencing anger in sessions can help. The therapeutic alliance and acquisition of patient insight are important change processes in dynamic therapy and may mediate the anger-depression association. This study was embedded into a randomized trial testing the efficacy of Intensive Short-Term Dynamic Psychotherapy (ISTDP) for treatment resistant depression. In-session patient affect experiencing (AE) was coded for every available session (475/481) by blinded observers in 27 patients randomized to ISTDP. Dynamic Structural Equation Modeling was used to examine within-person associations between variation in depression scores session-by-session and both patient ratings (alliance) and observer ratings (AE and insight) of the treatment process. Alliance and insight were independent mediators of the effect of anger on next-session depression. However, the relative importance of these two indirect effects of anger on depression was conditional on pretreatment patient personality pathology (PP). In patients with higher PP, in-session anger was negatively related to depressive symptoms next session, with this effect operating through higher alliance. In patients with low PP, in-session anger was negatively related to depressive symptoms next session, with this effect operating through enhanced patient insight. These findings highlight an anger-depression mechanism of change in dynamic therapy. Depending upon patient personality, either an "insight pathway" or a "relational pathway" may promote the effectiveness of facilitating arousal and expression of patients' in-session feelings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Three sessions of intensive short-term dynamic psychotherapy (ISTDP) for patients with dissociative seizures: a pilot study

Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of several Functional Neurological Disorders (FND) including dissociative seizures. However, its implementation in secondary mental health and specialist services within the English National Health Service (NHS) is scarce. The aim of this pilot study was to explore the estimates of the therapeutic effects of a 3-session course of this treatment as well as establish safety and acceptability for a complex patient group. The study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Participants completed self-report outcome measures at the start, at the end and 1 month following the completion of therapy. Three open-ended questions examined their therapy experiences qualitatively and these were analysed through thematic analysis. All participants who started the treatment (N = 17) completed the intervention and attendance rates were very high (95%). No serious adverse effects were observed and the CORE-OM and BSI showed improvements both at the end of the treatment and at follow-up. Healthcare utilisation was also reduced, including acute medications, A&E attendances and crisis-line usage. The results provide preliminary support for the safe use of ISTDP in this complex group of participants, but further evidence from controlled and randomized studies is warranted.