Clinical- and cost-effectiveness of intensive short-term dynamic psychotherapy for chronic pain in a tertiary psychotherapy service

Abstract

Objective:

The objective of this study is to assess the clinical- and cost-effectiveness of intensive short-term dynamic psychotherapy (ISTDP) for patients with chronic pain.

Method:

A sample of 228 pain patients was drawn from a larger naturalistic study of ISTDP. They received an average of 6.1 sessions delivered by 31 therapists. Psychiatric symptoms and interpersonal problems were assessed at three time points. Healthcare data from baseline year and three years following treatment came from independent governmental databases.

Results:

Multilevel models indicated significant reductions in symptoms and interpersonal problems during treatment, including a moderate to large pre-post effect size (d = 0.76) for somatization. Further, the sample had successive reductions in yearly healthcare costs, reaching the normal population mean two years post-treatment.

Conclusion:

Within the limitations of the uncontrolled design, our study suggests that ISTDP may be both clinically effective and cost-effective for patients with chronic pain.

Keywords

chronic pain cost-effectiveness naturalistic short-term dynamic psychotherapy

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References

Gerrits

van Marwijk

van Oppen

, et al. Longitudinal association between pain, and depression and anxiety over four years. J Psychosom Res 2015; 78: 64–70.

Gaskin

Richard

The economic costs of pain in the United States. Journal of Pain 2012; 13: 715–724.

Lane

Anderson

Smith

Biased competition favoring physical over emotional pain: a possible explanation for the link between early adversity and chronic pain. Psychosom Med 2018; 80: 880–890.

McWilliams

LA.

Adult attachment insecurity is positively associated with medically unexplained chronic pain. Eur J Pain 2017; 21: 1378–1383.

Lumley

Cohen

Borszcz

, et al. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol 2011; 67: 942–968.

Pfeifer

A-C

Penedo

JMG

Ehrenthal

, et al. Impact of attachment behavior on the treatment process of chronic pain patients. J Pain Res 2018; 11: 2653–2662.

Davanloo

Intensive short-term dynamic psychotherapy. In: Sadock

Sadock

Kaplan

HI.

(eds) Kaplan and Sadock’s comprehensive textbook of psychiatry. Philadelphia, PA: Lippincot Williams & Wilkins, 2005, pp.2628–2652.

Abbass

Reaching through resistance: advanced psychotherapy techniques. Kansas City, MO: Seven Leaves Press, 2015.

Abbass

Somatization: diagnosing it sooner through emotion-focused interviewing. Journal of Family Practice 2005; 54: 231–9, 243.

10.

Town

Driessen

Emerging evidence for intensive short-term dynamic psychotherapy with personality disorders and somatic disorders. Psychiatric Annals 2013; 43: 502–507.

11.

Chavooshi

Mohammadkhani

Dolatshahee

A randomized double-blind controlled trial comparing Davanloo’s intensive short-term dynamic psychotherapy as internet-delivered versus treatment as usual for medically unexplained pain: a six-month pilot study. Psychosomatics 2016; 57: 292–300.

12.

Chavooshi

Mohammadkhani

Dolatshahee

Efficacy of intensive short-term dynamic psychotherapy for medically unexplained pain: a pilot three-armed randomized controlled trial comparison with mindfulness-based stress reduction. Psychother Psychosom 2016; 85: 123–125.

13.

Chavooshi

Saberi

Tavallaie

, et al. Psychotherapy for medically unexplained pain: a randomized clinical trial comparing intensive short-term dynamic psychotherapy and cognitive behavior therapy. Psychosomatics 2017; 58: 1–13.

14.

Abbass

Kisely

Rasic

, et al. Long-term healthcare cost reduction with Intensive Short-term Dynamic Psychotherapy in a tertiary psychiatric service. J Psychiatr Res 2015; 64: 114–120.

15.

Derogatis

LR.

BSI brief symptom inventory. Administration, scoring, and procedures manual (4th ed). Minneapolis, MN: National Computer Systems, 1993.

16.

Horowitz

Rosenberg

Baer

, et al. Inventory of interpersonal problems: psychometric properties and clinical applications. J Consult Clin Psychol 1988; 56: 885–92.

17.

Singer

Willett

JB.

Applied longitudinal data analysis: modeling change and event occurrence. New York, NY: Oxford University Press, 2003.

18.

Enders

CK.

Analyzing longitudinal data with missing values. Rehabil Psychol 2011; 56: 267–88.

19.

Nova Scotia Department of Health. Annual statistical report 2007/2008. http://www.gov.ns.ca/health/reports/pubs/DOH_Annual_Statistical_Report_2007_08.pdf.

20.

Canadian Institute for Health Information. National health expenditure trends, 1975 to 2012. Table A.3.1.3 part 1. https://secure.cihi.ca/free_products/NHEXTrendsReport2012EN.pdf.

21.

Schwartz

Slater

Birchler

GR.

Interpersonal stress and pain behaviors in patients with chronic pain. J Consult Clin Psychol 1994; 62: 861–864.

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