Research Behind ISTDP

ISTDP (Intensive-Short Term Dynamic Psychotherapy) is effective where most therapies are not. Below is the research base that supports this claim.

Although psychotherapy works for those who engage and stay with the process, between 40-50% of people drop out before any benefit is realized (Wierzbicki & Pekarik, 1993). Even when treatment is effective at first, research shows these changes are not permanent in between 35-70% of clients (Wiborg & Dahl, 1996). Since psychotherapists are failing to benefit almost half of people who come to them for help, more successful interventions were needed.

Therapeutic Approaches

Cognitive behavioral therapy (CBT), in which the focus is on the client's conscious thoughts, has been a popular approach. However, the belief that one's emotional disturbance is the result of faulty thinking has little scientific evidence to support it (Barlow, 2000). One large research study into CBT found no therapeutic effect in cases of high levels of anxiety and depression (Homquist, Strom, & Foldemo, 2014). Even worse, was the significant number of patients in this study who were functional at the start of therapy and became disabled after treatment due to an increase of their symptoms. New models of CBT incorporate emotional awareness and regulation which should be more promising.

Pharmacology is another common approach to managing mental health disturbances. This approach is built on the belief that there are chemical imbalances in the brain although no scientific evidence supports this view (Angell, 2011). Medication alone, without the addition of psychotherapy, has a relatively low rate of success. In fact, the largest population-based study on the effectiveness of antidepressants showed that those on medication experienced longer and more frequent depressive episodes (Patten, 2004).

Another favored approach is client-centered therapy in which the focus is on the therapeutic relationship as the curative factor. However, the relationship has been shown to be responsible for only 11% of the difference (Horvath, Del Re, Fluckiger, & Symmonds, 2011). A solid working alliance between the client and therapist is a necessary factor but alone is insufficient to cause long-term change in the client.

In contrast to the above, ISTDP is effective where most therapies are not, especially in cases of:

• Treatment resistant depression (Abbass, Hancok, Henderson, & Kisely, 2006)

• Panic disorder (Wiborg & Dahl, 1996)

• Social anxiety disorder (Rahmani, Abbass, Hemmati, Mirghaed, & Ghaffari, 2020)

• Personality disorders (Abbass, Joffres, & Ogrodniczuk, 2008)

• Somatic disorders (Abbass, Kisely, & Kroenke, 2009)

• Conversion disorders (Abbass et al, 2010)

• Medically unexplained symptoms (Abbass et al, 2010)

Follow-up studies on ISTDP show that those who obtain positive results by the end of treatment not only maintain therapeutic gains over time but continue to get better and better with no additional treatment (Shedler, 2010). These positive outcomes are possible because ISTDP clinicians are not content with simply reducing symptoms but work to restore the client's authentic sense of self. For more information on the approach, or for a free consultation, contact me.

Reference List:

Abbass, A., Campbell, S., Magee, K., Lenzer, I., Hann, G. & Tarzwell, R. (2010) Cost savings of treatment of medically unexplained symptoms using intensive short-term dynamic psychotherapy (ISTDP) by a hospital emergency department. Archives of Medical Psychology, 2, 34-44.

Abbass, A., Hancock, J.T., Henderson, J. & Kisely, S. (2006) Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Systematic Review, 4, CD004687.

Abbass, A., Joffres, M.R. & Ogrodniczuk, J.S. (2008) A naturalistic study of intensive short term dynamic psychotherapy trial therapy. Brief Treatment and Crisis Intervention, 8(2), 164-179.

Abbass, A., Kisely, S. & Kroenke, K. (2009) Short term psychodynamic psychotherapy for somatic symptom disorders: A systematic review and meta-analysis. Psychotherapy and Psychosomatics; 78, 265-274.

Angell, M. (2011) The epidemic of mental illness: Why? New York Review of Books, retrieved from http://www.nybooks.com/articles/2011/06/23/epidemic-mental-illness-why/.

Barlow, D.H. (2000) Unraveling the mysteries of anxiety and its disorders from the perspective of emotion theory. American Psychologist, 55, 1247-1263.

Homquist, R., Strom, P. & Foldemo, A. (2014) The effects of psychological treatment in primary care in Sweden. Nordic Journal of Psychiatry, 68, 204-212.

Horvath, A. O., Del Re, A.C., Fluckiger, C.& Symmonds, D. (2011) The alliance in adult psychotherapy. In J.C. Norcross (Ed.) Psychotherapy Relationships that Work (2nd ed., pp 25-69). New York: Oxford University Press.

Patten, S. B. (2004) The impact of antidepressant treatment on pupulation healthy: Synthesis of data from 2 national data csources in Canada. Population Health Metrics, 2(9). DOI: 10.1186/1478-7954-2-9.

Rahmani, F., Abbass, A., Hemmati, A., Mirghaed, S. & Ghaffari, N. (2020) The efficacy of intensive short-tern dynamic psychotherapy for social anxiety disorder. The Journal of Nervous and Mental Disease, 203(3), 245-251.

Wiborg, I.M. & Dahl, A.A. (1996) Does brief dynamic psychotherapy reduce relapse rate of panic disorder? Archives of General Psychiatry, 53, 689-694.

Wierzbicki, M. & Pekarik, G. (1993) A meta-analysis of psychotherapy drop out. Professional Psychology: Research and Practice, 24, 190-195.