Papers by Falk Leichsenring
Zeitschrift Fur Psychosomatische Medizin Und Psychotherapie, Dec 3, 2019
Why the concept of distinct psychotherapeutic approaches is indispensableand why the tool box con... more Why the concept of distinct psychotherapeutic approaches is indispensableand why the tool box concept of psychotherapy cannot work Background: In Germany, the official psychotherapy guidelines are oriented towards the model of distinct psychotherapeutic approaches. Within the German health care system this also applies to the training in psychotherapy. Some critics, however, are presently pleading in favour of abolishing the model of distinct psychotherapeutic approaches, which also implies to abolish the concept of the so called "Richtlinienverfahren" in Germany-approaches of psychotherapy which proved to be efficacious and whose costs are reimbursed by the insurance companies. Objective: The arguments put forward such as the heterogeneity of the approaches as well as the proposed alternatives, for example, an "integrative" model of both mental disorders and psychotherapeutic treatment are critically discussed. Results: Both the arguments and proposed alternatives are found to be not convincing, neither from a scientific nor from a psychotherapeutic perspective. From a scientific perspective, there is no evidence for efficacy of a "general" or "integrative" model of psychotherapy-which is in contrast to the Richtlinienverfahren for which evidence for efficacy
The Lancet Psychiatry, 2015
Psychodynamic therapy (PDT) is an umbrella concept for treatments that operate on an interpretive... more Psychodynamic therapy (PDT) is an umbrella concept for treatments that operate on an interpretive-supportive continuum and is frequently used in clinical practice. The use of any form of psychotherapy should be supported by suffi cient evidence. Effi cacy research has been neglected in PDT for a long time. In this review, we describe methodological requirements for proofs of effi cacy and summarise the evidence for use of PDT to treat mental health disorders. After specifying the requirements for superiority, non-inferiority, and equivalence trials, we did a systematic search using the following criteria: randomised controlled trial of PDT; use of treatment manuals or manual-like guidelines; use of reliable and valid measures for diagnosis and outcome; adults treated for specifi c mental problems. We identifi ed 64 randomised controlled trials that provide evidence for the effi cacy of PDT in common mental health disorders. Studies suffi ciently powered to test for equivalence to established treatments did not fi nd substantial diff erences in effi cacy. These results were corroborated by several meta-analyses that suggest PDT is as effi cacious as treatments established in effi cacy. More randomised controlled trials are needed for some mental health disorders such as obsessive-compulsive disorder and post-traumatic stress disorder. Furthermore, more adequately powered equivalence trials are needed.
Psychotherapy, 2012
The aim of this research was to examine the extent to which the use of research-specific procedur... more The aim of this research was to examine the extent to which the use of research-specific procedures in psychodynamic psychotherapy impacts upon treatment effectiveness and which variables moderate this potential relationship. Effects of audio/video recording of sessions, use of treatment manuals, and checks of treatment fidelity were examined. A meta-analysis was conducted on randomized controlled trials of psychodynamic psychotherapy. Forty-six independent treatment samples totaling 1615 patients were included. The magnitude of change between pretreatment and posttreatment aggregated across all studies (45 treatment samples) for overall outcome was large (d ϭ 1.01), and further improvement was observed between posttreatment and an average 12.8-month follow-up (d ϭ 0.18). Subgroup analyses comparing studies that used research-specific procedures and those that did not revealed that for posttreatment data no differences in treatment effects were found. However, the use of treatment manuals and fidelity checks were significantly associated with improvement between the end of treatment and follow-up assessment. Within the limitations of analyses, this data offered preliminary evidence that use of research-specific procedures does not contribute in a negative manner to posttreatment outcomes in psychodynamic psychotherapy, and their use contributes to positive differences that emerge with time. These findings, although observational in nature, make a case for reconsidering how dimensions of clinical utility and experimental control may be integrated in psychodynamic psychotherapy to enable further elucidation of principles that evidently work.
World psychiatry : official journal of the World Psychiatric Association (WPA), 2016
American Journal of Psychiatry, 2009
While several studies have shown that cognitive-behavioral therapy (CBT) is an efficacious treatm... more While several studies have shown that cognitive-behavioral therapy (CBT) is an efficacious treatment for generalized anxiety disorder, few studies have addressed the outcome of short-term psychodynamic psychotherapy, even though this treatment is widely used. The aim of this study was to compare short-term psychodynamic psychotherapy and CBT with regard to treatment outcome in generalized anxiety disorder. Patients with generalized anxiety disorder according to DSM-IV were randomly assigned to receive either CBT (N=29) or short-term psychodynamic psychotherapy (N=28). Treatments were carried out according to treatment manuals and included up to 30 weekly sessions. The primary outcome measure was the Hamilton Anxiety Rating Scale, which was applied by trained raters blind to the treatment conditions. Assessments were carried out at the completion of treatment and 6 months afterward. Both CBT and short-term psychodynamic psychotherapy yielded significant, large, and stable improvements with regard to symptoms of anxiety and depression. No significant differences in outcome were found between treatments in regard to the primary outcome measure. These results were corroborated by two self-report measures of anxiety. In measures of trait anxiety, worry, and depression, however, CBT was found to be superior. The results suggest that CBT and short-term psychodynamic psychotherapy are beneficial for patients with generalized anxiety disorder. In future research, large-scale multicenter studies should examine more subtle differences between treatments, including differences in the patients who benefit most from each form of therapy.
PiD - Psychotherapie im Dialog, 2003
Context The place of long-term psychodynamic psychotherapy (LTPP) within psychiatry is controvers... more Context The place of long-term psychodynamic psychotherapy (LTPP) within psychiatry is controversial. Convincing outcome research for LTPP has been lacking.
We commend Malhi et al. (1) and this journal for publishing excellent clinical practice recommend... more We commend Malhi et al. (1) and this journal for publishing excellent clinical practice recommendations for depression. We write to highlight new findings supporting Short-Term Psychodynamic Psychotherapy (STPP) for depression which, using the authorsÕ criteria requiring a systematic review of randomized controlled trials (1), may result in increasing the level of evidence for this treatment.
Journal of Affective Disorders, 2015
Background: To investigate the short-term cost-effectiveness of cognitive-behavioral therapy (CBT... more Background: To investigate the short-term cost-effectiveness of cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) compared to waiting list (WL). Methods: The analysis was conducted alongside the SOPHO-NET multi-center efficacy trial. Patients were randomly assigned to CBT (n ¼209), PDT (n ¼ 207), or WL (n ¼ 79). Resource use was assessed prior and during treatment to determine direct and absenteeism costs. Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated based on remission and response rates. To visualize statistical uncertainty, cost-effectiveness acceptability curves (CEACs) were constructed based on adjusted net-benefit regression. Different values for the society's willingness to pay (WTP) were assumed. Results: Both interventions were more efficacious than WL but were associated with increased direct costs besides intervention costs. Unadjusted ICERs per responder were €3615 for CBT and €4958 for PDT. Unadjusted ICERs per remitted patient were €5788 and €10,733. CEACs revealed a high degree of uncertainty: applying the 97.5% probability threshold, CBT proved cost-effective at a WTP Z€16,100 per responder and Z €26,605 per remitted patient. Regarding PDT cost-effectiveness only was certain for response at a WTP Z €27,290. Limitations: The WL condition is assumed to represent untreated patients, although the expectation to start treatment in the near future probably affects symptom severity and health care utilization. Conclusions: At the end of treatment cost-effectiveness of CBT and PDT compared to WL is uncertain and depends on the societal WTP. The interventions may induce a more adequate utilization of other health care servicesinvolving increased costs. Development of costs and effects in the long-run should be considered.
Forum der Psychoanalyse
A statement of the professional umbrella society DGPT is presented that was formulated in coopera... more A statement of the professional umbrella society DGPT is presented that was formulated in cooperation with the various professional societies and with the German Society of Psychosomatic Medicine and Psychotherapy and the Society of Child and Adolescent Therapy. The statement is a reaction to the public claim for effective evidence of psychotherapy and takes the opportunity for a comprehensive presentation of this field. In the introduction Alf Gerlach, as chairman of the umbrella society at the time of the formulation of this statement and now executive chairman responsible for coordinating research, describes the history of the development of the statement.There were two particular moments prompting this statement. On the one hand the Scientific Advisory Board for Psychotherapy as an advisory committee based on the law of psychotherapy, has presented demands for effective evidence that are incompatible with psychoanalysis. Thus, the recognition of psychoanalysis as a treatment met...
Psychotherapy and psychosomatics, 2015
The Task Force on Promotion and Dissemination of Psychological Procedures proposed rigorous crite... more The Task Force on Promotion and Dissemination of Psychological Procedures proposed rigorous criteria to define empirically supported psychotherapies. According to these criteria, 2 randomized controlled trials (RCTs) showing efficacy are required for a treatment to be designated as 'efficacious' and 1 RCT for a designation as 'possibly efficacious'. Applying these criteria modified by Chambless and Hollon, this article presents an update on the evidence for psychodynamic therapy (PDT) in specific mental disorders. A systematic search was performed using the criteria by Chambless and Hollon for study selection, as follows: (1) RCT of PDT in adults, (2) use of reliable and valid measures for diagnosis and outcome, (3) use of treatment manuals or manual-like guidelines, (4) adult population treated for specific problems and (5) PDT superior to no treatment, placebo or alternative treatment or equivalent to an established treatment. A total of 39 RCTs were included. Foll...
Journal of affective disorders, 2014
There is evidence that psychotherapy is helpful in depressive disorders, with no significant diff... more There is evidence that psychotherapy is helpful in depressive disorders, with no significant differences between psychotherapies. For psychodynamic therapy (PDT) various models prove to be efficacious. Thus, the evidence for PDT is "scattered" between different forms of PDT, also implying problems in training of psychotherapy and in transferring research to clinical practice. A unified protocol based on empirically-supported methods of PDT in depression may contribute to solve these problems Systematic search for randomized controlled trials fulfilling the following criteria: (a) individual psychodynamic therapy (PDT) of depressive disorders, (b) treatment manuals or manual-like guidelines, (c) PDT proved to be efficacious compared to control conditions, (d) reliable measures for diagnosis and outcome, and (f) adult patients. Fourteen RCTs fulfilled the inclusion criteria. By a systematic review of the applied methods of PDT seven treatment components were identified. A hi...
Journal of affective disorders, Jan 15, 2014
Depression is the most common mental disorder. Effective psychotherapeutic treatments for depress... more Depression is the most common mental disorder. Effective psychotherapeutic treatments for depression exist; however, data on their long-term effectiveness beyond a time span of two years is still scarce. Our aim was to perform a meta-analysis, investigating (a) overall rates of relapse more than two years after psychotherapy (meta-analysis 1), and (b) if psychotherapy has more enduring effects than non-psychotherapeutic comparison conditions (e.g. pharmacotherapy, treatment as usual), again beyond a time span of two years post-therapy (meta-analysis 2). We searched electronic databases Medline, PsycINFO and the COCHRANE Library. Main selection criteria were (i) RCT of psychotherapy with follow-up interval of more than 2 years, (ii) primary diagnosis of depression, assessed by observer ratings, (iii) report of relapse at follow-up. We identified 11 studies, 6 of which included a non-psychotherapeutic comparison condition. Together they comprised long-term data of 966 patients. Mean f...
Psychodynamic psychiatry, 2013
There is growing evidence from RCTs supporting the efficacy of both short-term (STPP) and long-te... more There is growing evidence from RCTs supporting the efficacy of both short-term (STPP) and long-term psychodynamic psychotherapy (LTPP) for specific mental disorders. In a first series of meta-analyses, LTPP was shown to be superior to shorter forms of psychotherapy, especially in complex mental disorders. However, the evidence for LTPP has not gone unchallenged. After several responses have addressed the raised concerns, a recent meta-analysis by Smit and colleagues (2012) again challenges the efficacy of LTPP. From a methodological perspective, a critical analysis of the Smit et al. meta-analysis was performed. Furthermore, we conducted two new metaanalyses adding studies not included in previous meta-analyses. The purpose was to examine whether the results of the previous meta-analyses are stable. Due to differing inclusion criteria, the meta-analysis by Smit et al. actually compared LTPP to other forms of long-term psychotherapy. Thus, they essentially showed that LTPP was as eff...
Bulletin of The Menninger Clinic, 2006
Although psychotherapeutic observation and empirical data suggest a link between borderline and a... more Although psychotherapeutic observation and empirical data suggest a link between borderline and antisocial personality disorder or traits in adolescents, there is no study on the relationships of borderline personality organization (BPO) and psychopathic traits in adolescents. The aim of this study was to explore the relationship of structural criteria of (BPO) as assessed by the French version of the Borderline Personality Inventory (BPI), with psychopathic traits, as assessed by the French version of the Levenson Self-Report Psychopathy Scale (LSRP), in a nonclinical sample of 243 adolescents. Significant correlations were found between the BPI scales of identity diffusion, primitive defense mechanisms, impaired reality testing, and psychopathic traits of callousness and impulsivity, suggesting that BPO may contribute to psychopathic traits in nonforensic, nonclinical adolescents.
European Journal of Psychological Assessment, 2004
Summary: Borderline personality disorder (BPD) is a frequent disorder in in- and outpatient setti... more Summary: Borderline personality disorder (BPD) is a frequent disorder in in- and outpatient settings. However, empirical studies suggest that BPD lacks construct validity in adolescents. Problems with validity may be linked to the fact that borderline symptoms can occur in the course of normal adolescence. This study examined the factor structure of borderline symptomatology in a community-based sample of 616
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Papers by Falk Leichsenring