Randomized trial on the effectiveness of long- and short-term psychotherapy on psychiatric symptoms and working ability during a 5-year follow-up

Knekt P, Lindfors O, Sares-Jaske L, Virtala E, Harkanen T. Randomized trial on the effectiveness of long-and short-term psychotherapy on psychiatric symptoms and working ability during a 5-year follow-up. Nord J Psychiatry 2013;67:59-68. Background: The information on whether long-term psychotherapy is superior in comparison with short-term therapies during a long time-perspective in the treatment of mood and anxiety disorder is incomplete. Aims: The present study addresses this question in a clinical trial with an exceptionally long follow-up. Methods: In the Helsinki Psychotherapy Study, 326 outpatients with mood or anxiety disorder were randomly assigned to long-term psychodynamic psychotherapy and two types of short-term psychotherapy (short-term psychodynamic psychotherapy and solution-focused therapy) and were followed up for 5 years from the start of treatment. The outcome measures were psychiatric symptoms measured by Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), Symptom Check List, anxiety scale (SCL-90-Anx), Hamilton Anxiety Rating Scale (HARS) and Symptom Check List, Global Severity Index (SCL-90-GSI), and working ability measured by the Work Ability Index (WAI), the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR) and the Perceived Psychological Functioning Scale (PPF). Furthermore, remission variables based on changes in psychiatric symptoms and use of auxiliary treatment, were used. Results: After the 5-year follow-up, the rate of recovery from psychiatric symptoms and the work ability improvement rate remained higher in the long-term therapy group, whereas no differences in the effectiveness of the two short-term therapies of different modalities were found. Conclusions: Long-term psychotherapy is more effective than short-term therapy during a long follow-up, suggesting the need for a careful evaluation of suitability to short-term therapy. More research on the long-term effects of psychotherapy in large-scale studies is still needed, however.