Psychology is a science concerning the study of mental and behavioural processes and human relations in order to improve quality of life. Psychotherapy is a branch of medicine performed by specially-trained physicians and psychologists.
Psychotherapists offer patients treatment to overcome various forms of psychological suffering, from mild to more serious conditions.
One of the Hospital’s mental health professionals implements ISTDP – Intensive Short-Term Dynamic Psychotherapy.
ORIGINS: ISTDP (H. Davanloo) is a form of psychotherapy based on the psychoanalytical model that uses numerous methods to speed up the therapeutic process to achieve the greatest possible psychotherapeutic effectiveness.
The following authors have contributed to this discipline:
– Sifneos – STAPP
DEVELOPMENT: ISTDP has evolved over the years to encompass a number of working methods:
– D. Fosha – AEDP
– L. McCullough – START
– F. Osimo – PBDE – PDEI
which, despite certain differences between them, all have the fundamental characteristics of ISTDP at their core:
INTENSIVE: use of pressure phase on emotive experience and continuous confrontation of resistance to change, especially by focusing on transference phenomenon.
EXPERIENTIAL: constant and continuous focus on the direct experience of emotions and associated feelings.
BREAKTHROUGH: an awakening in the conscious mind of previously repressed unconscious emotions and impulses.
TYPE OF PATIENTS WHO COULD BENEFIT FROM ISTDP:
– Spectrum of psychoneurotic patients: from low to highly-resistant patients, self-harm, avoidance.
– Spectrum of fragile patients: depression, somatisation, anxiety attacks (panic disorder, GAD), personality disorders (DSM IV-R).
These patients represent about 52% of the psychiatric population and 86% of referrals to psychiatric studies.
– Psychotic disorders (acute-phase psychosis, schizophrenia)
– Manic and hypomanic episodes
– Substance abuse
– Excessive sedation
– Acute severe somatisation
– Serious sociopathic tendencies
SCIENTIFIC RESEARCH ON ITS EFFICACY AND THE COST-BENEFIT RATIO:
ISTDP is an evidenced-based psychotherapeutic approach and the first efficacy studies were published by Davanloo in the 1970s (1).
Recent studies have focused on the neurobiological modifications (2) to short-term dynamic psychotherapy and on the cost-benefit ratio for the National Health System (3).
(1) Davanloo, H. “Short-Term Dynamic Psychotherapy”. Jason Aronson (1980).
(2) Karlsson, H. et al. ”Correspondence”. Psychological Medicine, Cambridge University Press (2009).
(2) Salminen J.K. et al. “Short-Term Psychodynamic Psychotherapy and fluoxetine in Major Depressive Disorder: a randomized comparative study”. Psychotherapy and psychosomatics (2008).
(3) Abbass A. “The cost-effectiveness of short-term dynamic psychotherapy” Future Drugs (2003).
Short-term dynamic psychotherapy increases serotonin receptors:
A 2009 study published by Cambridge University Press showed how short-term dynamic psychotherapy increases serotonin 5-HT1A receptors.
PET scans in patients before and after psychotherapy have shown a significant increase in serotonin receptor density.
Despite the good clinical outcomes obtained with fluoxetine, no change in serotonin receptor density has been found in patients treated with this drug.
– Total remission of symptoms in 57% of patients after 16 weeks;
– Stable remission in 71% of patients after 4 months of follow-up;
– Total remission of symptoms in 63% of patients after 16 weeks;
– Stable remission in 68% of patients after 4 months of follow-up;
CORRESPONDENCE WITH PET SCAN
– Significant increase in serotonin 5-HT1A receptor density in various regions of the brain;
– Significant increase in post-treatment 5-HT1A density versus a control group;
– No increase in serotonin 5-HT1A receptor density in the brain;
– No difference in serotonin 5-HT1A receptor density versus the control group;
This is the first direct evidence of the involvement of a specific neurotransmitter in psychopathology and its implications for psychotherapy;
A change in serotonin 5-HT1A receptor density is not associated with symptomatic change;
The high percentage of relapses in patients with major depressive disorder who undergo pharmacological treatment only could be linked to serotonin levels;
A Canadian study (Abbass, 2003) found that:
– use of the health service more than doubles in the event of an anxiety disorder
– depression is responsible for a significant financial burden due to increased disability
– patients treated with ISTDP require fewer medical visits, a shorter hospital stay and fewer medical prescriptions six months after the conclusion of treatment
ADVANTAGES OF IMPLEMENTING ISTDP:
A. Abbass identified a cost difference of 4,000 Canadian dollars (2003) per patient-year thanks to reduced disability, hospital care and drug costs.
This difference was achieved taking into account the cost of psychotherapy provided by a trained psychiatrist.
RESULTS (2003 data):
– 71% of patients on pharmacological treatment completely discontinued their therapy and 15% reduced their use of drugs over the course of the therapy
– Hospital-related costs fell by 85%
– Drug costs fell by 33%
– The financial burden on the Canadian health system due to disability fell by 5,413 Canadian dollars per patient
– 18 out of 22 patients studied were able to resume work
– After three years, the patient group treated with ISTDP showed a cost reduction in excess of three times the cost of treatment.
Dr. Maria Antonietta Pocaterra
Dr. Francesca Bergami