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[The effectiveness of psychotherapy on depression in the long term].

https://arctichealth.org/en/permalink/ahliterature126056
Source
Duodecim. 2012;128(3):267-74
Publication Type
Article
Date
2012
Author
Paul Knekt
Olavi Lindfors
Laura Sares-Jäske
Maarit Laaksonen
Author Affiliation
Terveyden ja hyvinvoinnin laitos, Väestön terveydentila -yksikkö.
Source
Duodecim. 2012;128(3):267-74
Date
2012
Language
Finnish
Publication Type
Article
Keywords
Depression - psychology - therapy
Finland
Humans
Psychotherapy - methods
Randomized Controlled Trials as Topic
Recovery of Function
Abstract
Different short-term therapies, mainly with short follow-ups, seem equally effective treatments of mood disorders. The Helsinki Psychotherapy Study is the only published randomized trial on the effectiveness of short-term and long-term therapies during a longer follow-up. During a 5-year follow-up, patients' recovery from symptoms and improvement in work ability were greater in long-term therapy than in two, equally effective, short-term therapies. The short-term therapies were, however, more cost-effective, but many patients in them did not recover. More randomized clinical trials and cohort studies with long follow-ups on the efficacy, sufficiency and suitability of short- and long-term therapy are thus needed.
PubMed ID
22428380 View in PubMed
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Therapists' professional and personal characteristics as predictors of working alliance in short-term and long-term psychotherapies.

https://arctichealth.org/en/permalink/ahliterature265503
Source
Clin Psychol Psychother. 2014 Nov-Dec;21(6):475-94
Publication Type
Article
Author
Erkki Heinonen
Olavi Lindfors
Tommi Härkänen
Esa Virtala
Tuija Jääskeläinen
Paul Knekt
Source
Clin Psychol Psychother. 2014 Nov-Dec;21(6):475-94
Language
English
Publication Type
Article
Keywords
Adult
Anxiety Disorders - therapy
Clinical Competence - statistics & numerical data
Cooperative Behavior
Depressive Disorder - therapy
Female
Finland
Follow-Up Studies
Health Personnel - psychology
Humans
Male
Mental Disorders - therapy
Middle Aged
Personality
Professional-Patient Relations
Psychotherapy - methods
Psychotherapy, Brief - methods
Questionnaires
Young Adult
Abstract
To investigate the determinants of the therapeutic working relationship and better understand its intrapersonal and interpersonal nature, this study investigated therapist characteristics as predictors of the formation and development of patient-rated and therapist-rated working alliances within a clinical trial of short-term versus long-term therapies. Short-term (solution-focused and short-term psychodynamic) and long-term (long-term psychodynamic therapy and psychoanalysis) therapies were provided by 70 volunteering, experienced therapists to 333 patients suffering from depressive and/or anxiety disorders. Therapists' professional and personal characteristics, measured prior to the start of the treatments, were assessed with the comprehensive self-report instrument, Development of Psychotherapists Common Core Questionnaire. The Working Alliance Inventory was rated by both therapists and patients at the third session and at the 7?months' follow-up point from the initiation of therapy. Therapists' self-rated basic interpersonal skills were found to predict the formation of better patient-rated alliances in both short-term and long-term therapies. Engaging, encouraging relational style fostered improvement of patients' working alliances especially in the course of short-term therapies. However, it led to patient alliance deterioration in long-term therapies, where constructive coping techniques proved more beneficial. Therapists' professional self-confidence and work enjoyment, along with their self-experiences in personal life, consistently predicted their alliances, but were less salient for patient ratings of alliance. The divergence of therapist and patient viewpoints has implications for therapist training and supervision, as characteristics found detrimental or helpful for the working relationship rated from the perspective of one party may not be predictive of the other therapy participant's experience.
PubMed ID
23813617 View in PubMed
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Effectiveness of short-term and long-term psychotherapy on work ability and functional capacity--a randomized clinical trial on depressive and anxiety disorders.

https://arctichealth.org/en/permalink/ahliterature161532
Source
J Affect Disord. 2008 Apr;107(1-3):95-106
Publication Type
Article
Date
Apr-2008
Author
Paul Knekt
Olavi Lindfors
Maarit A Laaksonen
Raimo Raitasalo
Peija Haaramo
Aila Järvikoski
Author Affiliation
Social Insurance Institution, Helsinki, Finland. paul.knekt@ktl.fi
Source
J Affect Disord. 2008 Apr;107(1-3):95-106
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Adult
Ambulatory Care
Anxiety Disorders - psychology - therapy
Depressive Disorder - psychology - therapy
Employment - statistics & numerical data
Female
Finland
Follow-Up Studies
Humans
Longitudinal Studies
Male
Outcome Assessment (Health Care)
Patient Dropouts
Psychotherapy - methods
Psychotherapy, Brief - methods
Self-Evaluation Programs
Sick Leave - statistics & numerical data
Social Adjustment
Treatment Outcome
Work - physiology - psychology
Work Capacity Evaluation
Abstract
Insufficient evidence exists about the effect of different therapies on work ability for patients with psychiatric disorders. The present study compares improvements in work ability in two short-term therapies and one long-term therapy.
In the Helsinki Psychotherapy Study, 326 outpatients with depressive or anxiety disorder were randomly assigned to long-term and short-term psychodynamic psychotherapy, and solution-focused therapy. The patients were followed for 3 years from the start of treatment. Primary outcome measures were the Work Ability Index (WAI), the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR), Perceived Psychological Functioning Scale, the prevalence of patients employed or studying, and the number of sick-leave days.
Work ability was statistically significantly improved according to WAI (15%), SAS-Work (17%), and Perceived Psychological Functioning Scale (21%) during the 3-year follow-up. No differences in the work ability scores were found between two short-term therapies. The short-term therapies showed 4-11% more improved work ability scores than long-term therapy at the 7 month follow-up point. During the second year of follow-up, no significant differences were found between therapies. After 3 years of follow-up, long-term therapy was more effective than the short-term therapies with 5-12% more improved scores. No differences in the prevalence of individuals employed or studying or in the number of sick-leave days were found between therapies during follow-up.
Short-term therapies give benefits more quickly than long-term therapy on work ability but in the long run long-term therapy is more effective than short-term therapies. More research is needed to confirm these findings.
Notes
Comment In: Evid Based Ment Health. 2008 Nov;11(4):10918952958
PubMed ID
17804079 View in PubMed
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The cost-effectiveness of short-term psychodynamic psychotherapy and solution-focused therapy in the treatment of depressive and anxiety disorders during a one-year follow-up.

https://arctichealth.org/en/permalink/ahliterature124220
Source
J Ment Health Policy Econ. 2012 Mar;15(1):13-23
Publication Type
Article
Date
Mar-2012
Author
Timo Maljanen
Paivi Paltta
Tommi Harkanen
Esa Virtala
Olavi Lindfors
Maarit A Laaksonen
Paul Knekt
Author Affiliation
Social Insurance Institution, PO Box 450, 00101 Helsinki, Finland. timo.maljanen@kela.fi
Source
J Ment Health Policy Econ. 2012 Mar;15(1):13-23
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adult
Anxiety Disorders - economics - epidemiology - therapy
Behavior Therapy - economics
Combined Modality Therapy
Cost of Illness
Cost-Benefit Analysis
Cross-Sectional Studies
Depressive Disorder, Major - economics - epidemiology - therapy
Female
Finland
Humans
Male
Problem Solving
Psychoanalytic Therapy - economics
Psychotherapy, Brief - economics
Transference (Psychology)
Abstract
Mood and anxiety disorders are characterized by a high and increasing prevalence, they cause a lot of costs and human suffering and there are many treatment options with differing costs. The benefits of identifying the treatments with the most favourable cost-effectiveness ratios can be substantial. However, the number of randomized trials where psychological treatments are compared with each other and where economic aspects, too, are taken into account is still relatively small.
To compare the cost-effectiveness of two short-term psychotherapies in the treatment of depressive and anxiety disorders during a one-year follow-up.
In the Helsinki Psychotherapy Study, 198 patients, who were 20--45 years of age and met DSM-IV criteria for anxiety or mood disorder, were randomized to short-term psychodynamic psychotherapy (SPP) or solution-focused therapy (SFT). Psychiatric symptoms were assessed at baseline and 4 times during the one-year follow-up from the start of therapy using the Beck Depression Inventory and the Symptom Check List Anxiety Scale, and 2 times using the Hamilton Depression Rating Scales and Hamilton Anxiety Rating Scales. Both direct costs (therapy sessions, outpatient visits, medication, inpatient care) and indirect costs (production losses due to work absenteeism, value of neglected household work, lost leisure time and unpaid help received) due to mental disorders were measured. Mean total costs were compared and incremental cost-effectiveness ratios analyzed.
According to all 4 psychiatric outcome measures, symptoms of depression and anxiety were reduced statistically significantly in both therapy groups during the one-year follow-up. The relative changes were about the same size according to all four outcome measures. In both groups the reductions took place mainly in the first half of the follow-up. The reductions were somewhat greater with SPP, but the differences between the two groups were small and not statistically significant at any measurement point. The mean total direct costs were 1791 euros in the SPP group, being 346 euros (16%) lower than those of the SFT group, but this difference was not statistically significant either. Also the incremental cost-effectiveness ratio points calculated by 500 bootstrap iterations favoured SPP. The total indirect costs in the SPP group were, in contrast to direct costs, higher than those in the SFT group, but, again, the difference was not statistically significant.
The generalization of our results may be weakened by the fact that the patients included in our study were relatively young, and the follow-up period was restricted to one year.
This study suggests that there are no notable differences in cost-effectiveness between SPP and SFT. If one were obliged to choose between these two therapies our results would support the choice of SPP. However, more research with extensive data about both costs and effectiveness, compiled over a period longer than one year, are needed before any firm conclusions can be drawn about the cost-effectiveness of the two therapies compared in this study.
PubMed ID
22611089 View in PubMed
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