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Effectiveness of systematic treatment selection for psychodynamic and cognitive-behavioural therapy: randomised
Birgit Watzke1, Heinz Rüddel, Ralph Jürgensen
1Research Group for Mental Health Care Research, Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52 (Building W26), Hamburg 20246, Germany. watzke@uke.uni-hamburg.de
Background:
Although cognitive-behavioural therapy (CBT) and psychodynamic therapy (PDT) are both effective treatments for mental disorders, they show clear dissimilarities concerning their therapeutic models and treatment rationales.
Aims:
To determine the effectiveness of systematic treatment selection (STS) to CBT or PDT in a mental healthcare setting compared with a control procedure of random treatment selection (RTS).
Method:
A randomised controlled trial in a consecutive sample of 291 in-patients with at least one ICD-10 mental disorder was performed. The primary outcome was symptom severity (General Severity Index of the Symptom Checklist-14) at 6-month follow-up. Health-related quality of life was the secondary outcome, determined using the Short Form-8.
Results:
Analyses revealed no general effect for systematic treatment selection. However, there was a differential effect: systematic selection resulted in a better longer-term outcome for PDT, but not for CBT; STS-PDT patients showed a significantly larger reduction in symptom severity than RTS-PDT patients. This difference was not observed in CBT.
Conclusions:
Since systematic treatment selection seems to be able to optimise treatment outcome, at least for PDT, pursuing systematic treatment assignment strategies in mental healthcare settings is a worthwhile endeavour.
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