Efficacy of high-intensity versus low-intensity psychoanalytically oriented long-term treatments and determinants of outcome: individual participant data Meta-analysis of Long-term Analytic treatment Studies (MeLAS).

INTRODUCTION: Long-term psychodynamic/psychoanalytic psychotherapy (LTPP) is a prevalent treatment option for complex mental disorders. Yet, little is known about the role of treatment intensity in LTPP. We present a study protocol for a systematic review and individual participant data (IPD) meta-analysis aggregating and analysing individual data from randomised and quasi-experimental trials by meta-analysis. The purpose is to (1) determine the treatment effectiveness of LTPP with low versus high intensity (up to 2 weekly sessions vs three or more), (2) compare their joint effectiveness to shorter therapies and treatments as usual, (3) identify predictors and moderators of treatment outcomes and (4) determine reciprocal relationships between different outcome domains (symptomatic and structural/personality change) over the courses of LTPP. METHODS AND ANALYSIS: We include studies from (randomised controlled trial, RCT) and quasi-experimental trials, where at least one condition was LTPP of high or low frequency. Long-term treatment is defined as ≥1 year or ≥50 sessions. To be eligible studies must include a standardised outcome measure of symptoms (global or disorder specific) with at least one proof of reliability. The primary outcome is symptom reduction (global or specific), secondary outcome criteria are reliable change, remission, functional capacities, personality, personality functioning and interpersonal pathology. Relevant studies will mainly be identified by searching relevant databases: PubMed, PsycINFO (via EBSCO), Web of Science (via Elsevier), Chochrane's Central Register of Controlled Trials (via Wiley). Risk of bias will be evaluated in line with the Cochrane assessments tools for quasi-experimental trials and RCTs, respectively. ETHICS AND DISSEMINATION: Aggregation of data from primary trials collected based on ethics votes. Dissemination into clinical practice via open access publications of findings. PROSPERO REGISTRATION NUMBER: CRD42022304982; Pre-results.

[Results of the pilot project of the Techniker-Krankenkasse "quality monitoring in outpatient psychotherapy" - a commentary by the project's scientific advisory board]. / Zu den Ergebnissen des Modellprojektes der Techniker-Krankenkasse zum Qualitätsmonitoring in der ambulanten Psychotherapie - eine Replik des wissenschaftlichen Beirats.

In order to objectify the discussion about a project of the TK, a German health insurance company, which aimed to analyse the effects of a specific quality monitoring system on psychotherapy outcomes, the scientific advisory board summarized the main results of the study. The main results were cited from the final report which confirms the confirmatory character of the study design that aimed to test the hypothesis of the superiority of the quality monitoring system compared to the system of peer review-based approval of therapies. The quality monitoring system represents a complex intervention which is composed of several single intervention elements. Thus, the study results allow only the conclusion that the overall complex interven-tion did not prove to be superior. Further studies are needed with regard to the effectiveness of single components. Finally, the issues of representativeness and selectivity of the study and the sample are discussed and their importance is -underlined by reference to the literature.

[The project of the Techniker-Krankenkasse: some comments on the results by the project's scientific advisory board]. / Das Modellprojekt der Techniker-Krankenkasse: Eine Kommentierung der Ergebnisse aus der Sicht des wissenschaftlichen Projektbeirates.

The Project of the Techniker Krankenkasse compared 2 systems of quality assurance in outpatient psychotherapy, the established peer review system based on qualitative individual case reports and a new model based on psychometric assessment and feed-back systems. In this publication the members of the project advisory board comment on the results and limitations of the study. 400 psychotherapists in private practice participated in a cluster-randomized comparison study, 200 were allocated to the intervention group, and 200 to the control group. In both groups assessments were performed at 3 points in time, one at the beginning of treatment, one at the end of treatment and one at follow-up 12 months post-treatment. No significant differences in psychotherapeutic outcome were observed in the 2 groups. The hypothesis of a better outcome associated with the psychometric assessment and benchmarking procedure was not confirmed.

[Dimensions of the therapeutic alliance from patients' view--development of the "Skala Therapeutische Allianz-Revised STA-R"]. / Dimensionen der therapeutischen Beziehung aus Patienten-Perspektive--Entwicklung der "Skala Therapeutische Allianz-Revised STA-R".

Studies on the dimensionality of the therapeutic alliance had been conducted by Hatcher et al. factor-analyzing three widely used alliance measures (Helping Alliance Questionnaire, Working Alliance Inventory, California Psychotherapy Alliance Scales) and proposing two additional dimensions (on affects and interpersonal aspects). The present study intended to construct an economic German patient questionnaire on the basis of this preliminary work, which represents relevant dimensions of the therapeutic alliance in an economic way. 36 items, purposed by Hatcher et al. were translated into German. They have been examined by confirmative factor analysis (sample 1: N=301 psychotherapy patients). As a result of further factor analysis, the "Skala Therapeutische Allianz - Revised STA-R" was developed. The 17-items questionnaire has 4 scales: "Confident Collaboration", "Bond", "Patient Fear" and "Therapist Interference", which correspond to Hatcher et al. The latter scales have not yet been considered in German questionnaires. A confirmatory factor analysis with sample 2 (N=427 patients) showed a good model fit with these factors, too. Correlations of the therapeutic alliance at the end of the treatment with change in symptom load (SCL-90-R) proved to be significant (rSTA-R, GSI=0.43**).

Patterns of interpersonal problems and their improvement in depressive and anxious patients treated with psychoanalytic therapy.

Interpersonal problems were studied in 121 patients treated with psychoanalytic therapy using the Inventory of Interpersonal Problems. Four characteristic subtypes were identified, which differed in the quality and flexibility of their interpersonal behavior. Independent of the predominant type of interpersonal problems, the psychotherapy treatment led to strong decreases in interpersonal distress and increases in interpersonal differentiation. Psychoanalytic therapy was highly effective for all identified interpersonal subtypes and seems to help patients achieve more satisfactory relationships.

[Results of psychoanalytic long-term therapy in specific diagnostic groups: improvement in symptoms and interpersonal relationships]. / Ergebnisse analytischer Langzeitpsychotherapien bei spezifischen psychischen Störungen: Verbesserungen in der Symptomatik und in interpersonellen Beziehungen.

OBJECTIVES: In the present paper, data from four German studies on the efficacy of outpatient psychoanalytic long-term psychotherapy were examined for symptom reduction (SCL-90-R) and reduction of interpersonal problems (IIP-D). Specifically, the research question addressed the efficacy of long-term therapy in specific diagnostic groups and was was compared with that of a parallel group who underwent shorter-term psychodynamic therapy. METHODS: Data from four German studies addressing the efficacy of outpatient psychoanalytic long-term therapy were collected. Evaluation of these data was carried for specific diagnostic groups allowing for comorbid diagnoses. The effects of psychoanalytic therapy were assessed by pre-post and pre-follow-up comparisons using paired t-tests. Additionally, effect sizes were calculated. Psychoanalytic long-term psychotherapy and shorter-term psychodynamic therapy were compared by using a repeated measure ANOVA: Pretreatment vs. posttreatment/follow-up (two-levels) with the between subject factor "therapy conditions" (two levels). RESULTS: The results showed that in terms of improvement of symptoms and interpersonal problems, psychoanalytic long-term therapy was at least as effective as shorter term psychodynamic therapy with regard to the following ICD-10 diagnostic groups: affective disorders (F3), anxiety disorders (F40; F41; F42), personality disorders (F60; F61; F62), and a group of mixed neurotic disorders (F43; F50; F51; F1; F55). Effect sizes were large and remained stable at follow-up. CONCLUSIONS: The authors emphasize the clinical relevance of the examined diagnostic groups and relatively large effects achieved by the psychoanalytic treatment. Furthermore, the occurrence of comorbid diagnoses and their consequences are discussed. The authors stress that the specific effects of psychoanalytic therapy can only be very insufficiently tapped by the outcome measures referring to symptoms and interpersonal problems.

[Therapy goals, change of goals and goal attainment in the process of psychoanalytically oriented and behavior long-term therapy--a comparative study from the private practices of insurance-registered psychotherapists]. / Therapieziele, Zieländerungen und Zielerreichung im Verlauf psychoanalytisch orientierter und verhaltenstherapeutischer Langzeittherapie--Eine vergleichende Untersuchung aus der Praxis niedergelassener Psychotherapeuten.

In a prospective naturalistic design 31 patients with long-term behavior therapy (average 63 treatment hours) and 31 patients with psychoanalytically-oriented long-term therapy (average 185 treatment hours) were compared. All patients were examined by extern interviewers with the Structured Clinical Interview for Diagnosis (SCID) before they were included in the study. Only patients that showed DSM-III-R criteria of a depressive or anxiety disorder were included. At four times the patient goals in therapy and the actual state was examined: At the beginning of treatment, after 1, after 2,5 and after 3,5 years. At all times the patients could formulate new goals and release old ones. The symptoms were registered by SCL-90-R and the interpersonal problems were recorded by IIP-D. After 3,5 years a follow-up interview was conducted. Although all patients were comparable in their diagnoses the patients in behavior therapy and those in psychoanalytically-oriented therapy differed in a number of characteristics, for example by the way they gained access to therapy (doctors' subscription versus personal initiative for an appointment), the education, the consuming of psychotropic medication and the strain of symptoms. The patients did not differ remarkably in their goals in therapy. The symptoms as a goal did not have the highest priority in both groups, but the category "self-worth-problems" was found in both groups with a high priority. About one third of therapy goals were redefined by the patients in both groups within one year. After 2,5 years the number of goals in the category "interpersonal conflicts" increases remarkably in both treatment groups. For both groups we found the extent of reaching aimed goals in therapy (recorded by GAS) was significant over time. The results seem to prove that psychotherapy under naturalistic conditions aims more at improving the general level of functioning than at reducing the symptoms.