Elsevier

Journal of Affective Disorders

Volume 181, 1 August 2015, Pages 67-77
Journal of Affective Disorders

Intensive short-term dynamic residential treatment program for patients with treatment-resistant disorders

https://doi.org/10.1016/j.jad.2015.04.003Get rights and content

Highlights

  • Patients (N=60)with repeated prior treatment failure, underwent an eight week intensive residential treatment program based on Intensive Short-Term Dynamic Psychotherapy (ISTDP).

  • Effects of treatment were compared to those of controls (N=30) receiving treatment as usual while on wait-list.

  • Outcome variables included overall levels of target complaints, general symptom distress, and overall interpersonal functioning.

  • Measures were administered repeatedly during and after treatment and analyzed by multilevel growth curve modeling.

  • Fourteen months after treatment50.0% of patients had recovered in terms ofof target complaints. 53.3% and 48.3%, respectively, had recovered in terms of general symptom distress and overall interpersonal functioning. By contrast changes in the wait-list condition were small or non-existent.

  • ISTDP-based residential treatmentappears to be effective for alleviating common and severe, treatment resistant mental disorders.

Abstract

Background

The study investigated the effectiveness of an Intensive Short-Term Dynamic (ISTDP) residential treatment program for patients with treatment resistant anxiety- and/or depressive disorders, with and without comorbid personality disorders.

Method

A non-randomized controlled trial examined the effects of an eight week intensive residential treatment program based on principles from ISTDP. Patients (N=60), who had repeated prior treatment failure for current mental disorder, sufficient dysfunction to warrant hospitalization, and evidencing capacity to take an intrapsychic perspective on own problems, were included. Outcome variables included measures of target complaints (depression/anxiety, social role dysfunction, and interpersonal distress), general symptom distress, and interpersonal functioning. Measures were administered throughout and after treatment. Change was assessed by multilevel growth curve modeling. Changes during and after treatment were compared to those reported by a sub-sample of wait-list controls taking treatment as usual (N=30).

Results

The treatment group evidenced significant improvements on all measures. By contrast, receiving treatment as usual while on the wait-list did not yield significant changes. Effect sizes in the treatment group were consistently large at both termination and follow-up. Fourteen months after treatment 50.0% of patients had recovered in terms of target complaints. Approximately 53.3% and 48.3%, respectively, had recovered in terms of general symptom distress and interpersonal functioning.

Limitations

Limitations included a relatively small sample size, inability to discern the effectiveness of separate components of the treatment program, and lack of randomization of patients to wait-list and treatment.

Conclusion

ISTDP-based residential treatment with an eight-week time-limit appears to be effective for alleviating common and severe, treatment resistant mental disorders. The treatment program was superior to receiving treatment as usual while on the wait-list. Participation in the program quickly reduced target complaints, symptoms and interpersonal problems for patients who, based on previous treatment experiences, were expected to fare poorly in treatment. Gains were consistently maintained or improved further at follow-up. Results are promising for patients with chronic debilitating problems who often do not profit from traditional psychiatric treatment.

Section snippets

Intensive short-term dynamic residential treatment program for patients with treatment‐resistant disorders

A large percentage of patients in psychiatric care respond inadequately to treatment (see e.g., STAR-D study (Trivedi et al., 2006)). In terms of effect sizes (Cohen, 1988) psychotherapy treatments tend to help about half of treated patients considerably or moderately. A further 20% to 25% are helped to some extent, while those remaining continue unchanged or are deteriorated (Lambert, 2013, Solbakken and Abbass, 2014). In terms of clinically significant change in symptom levels (Jacobson and

The treatment program and its components

Bearing in mind the long-standing and chronic disorders suffered by these patients and their tendency to fail treatment, the treatment program developed differed substantially from those of traditional routine treatment settings (Solbakken and Abbass, 2014, Solbakken and Abbass, 2013). First, patients were to be treated in a residential setting in order to reduce the risk of drop-out. Second, a pre-set, non-negotiable time limit of 8 weeks was provided. Third, a highly intensive treatment

Sample characteristics

A total of 60 patients consecutively admitted to the unit comprised the treatment sample for the present study. In the sample, the mean age was 39 years (SD: 10.8, range: 19–62), 65.6% were female. A total of 88.3% had diagnoses of affective disorders (recurrent major depressive episode: 56.7%, major depressive episode: 20.0%, dysthymia: 30.0%, bipolar disorder type II: 6.7%). Anxiety disorders were present in 71.7% (social phobia: 31.7%, agoraphobia: 28.3%, general anxiety disorder: 28.3%,

Discussion

This study indicates that an ISTDP-based in-patient treatment program can be highly effective in treating patients with highly comorbid, treatment resistant disorders. Treated patients reported considerable reductions in overall symptomatology, interpersonal problems, and target complaints (anxiety/depression, relational difficulties, and social role dysfunction). Effects were large, accrued quickly, and persisted more than a year after treatment. A total of 48.3% to 53.3% (depending on the

Limitations

Limitations of this study warrant clarification. The study included a relatively small sample size; even though large enough to give sufficient power to reliably identify at least medium effects. Also, there was no randomization of patients to wait-list or treatment. Thus, coincidental improvements cannot be completely ruled out, although patients׳ previous limited treatment effects make chance less likely as the cause of reported gains. The fact that these patients had been suffering for many

Conclusion

A treatment program based on principles from Intensive Short-term Dynamic Psychotherapy with an eight week time-limit appears to be effective in alleviating dysfunction, suffering and relational problems of severely suffering patients with a spectrum of common treatment resistant disorders. The treatment program quickly reduced target complaints, symptoms and interpersonal problems for patients who, based on their previous treatment experiences, were expected to fare poorly in treatment. Gains

Role of funding source

The present study received no external grants or funding and was financed as an integral part of day to day running at the hospital unit at which the treatments were given. Time for analyzing data and writing the article was allocated by the respective universities at which the authors are employed.

Conflict of interest

The authors acknowledge bias in favor of the Intensive Short-term Dynamic Psychotherapy treatment used in this article as they are practitioners and teachers of.

Acknowledgments

We would like to thank staff and patients at Unit E of the Residential Facility at DPS Drammen, Vestre Viken Health Trust for their patience and hard work during the collection of data for this study. We would also like to thank all other staff at the Residential Facility and at the DPS Drammen who have contributed in various ways. The study received no external grants or funding and was financed as an integral part of day to day running at the hospital unit at which the treatments were given.

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