***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This pilot study examined the effectiveness of Intensive Short-term Dynamic Psychotherapy ( ISTDP ) in treatment-resistant depression ( TRD ) . Ten patients with TRD were provided a course of ISTDP .  Clinician and patient symptom and interpersonal measures were completed every 4 weeks , at termination , and in follow-up . Medication , disability , and hospital costs were compared before and after treatment . After an average of 13.6 sessions of therapy , all mean measures reached the normal range , with effect sizes ranging from 0.87 to 3.3 . Gains were maintained in follow-up assessment s. Treatment costs were offset by cost reductions elsewhere in the system . This open study suggests that ISTDP may be effective with this challenging patient group . A r and omized , controlled trial and qualitative research are warranted to evaluate this treatment further and to examine its possible therapeutic elements I. H. Gotlib and C.L. Hammen 's ( 1992 ) psychopathology model of depression was used as a conceptual framework for study ing the process of change in an effective course of cognitive therapy ( CT ) for depression . Archived CT transcripts from 30 depressed out patients in the Cognitive-Pharmaco-therapy Treatment project ( S. D. Hollon et al. , 1992 ) were studied . An observational coding system was used to assess whether therapists focused on the cognitive , interpersonal , and developmental vulnerabilities of depression and whether these interventions were associated with symptom reduction . Therapists maintained a primarily cognitive focus , but it was interventions that addressed the interpersonal and developmental domains that were associated with improvement . A developmental focus also predicted a longer time of recovery and better global functioning over the 24-month followup period . These findings are consistent with recent theoretical developments in cognitive therapy and with the psychopathology research on depression Although much depression may be dysfunctional , the capacity to experience normal depressive symptoms in response to certain adverse situations appears to have been shaped by natural selection . If this is true , then different kinds of situations may evoke different patterns of depressive symptoms that are well suited to solving the adaptive challenges specific to each situation . The authors called this the situation-symptom congruence hypothesis . They tested this hypothesis by asking 445 participants to identify depressive symptoms that followed a recent adverse situation . Guilt , rumination , fatigue , and pessimism were prominent following failed efforts ; crying , sadness , and desire for social support were prominent following social losses . These significant differences were replicated in an experiment in which 113 students were r and omly assigned to visualize a major failure or the death of a loved one Perfectionism has previously been identified as having a significant negative impact on therapeutic outcome at termination in the  brief ( 16-week ) treatment of depression ( S. J. Blatt , D. M. Quinlan , P. A. Pilkonis , & T. Shea , 1995 ) as measured by the 5 primary outcome measures used in the National Institute of Mental Health Treatment of Depression Collaborative Research Program ( TDCRP ) . The present analyses of other data from the TDCRP indicated that this impact of perfectionism on therapeutic outcome was also found in ratings by therapists , independent clinical evaluators , and the patients and that this effect persisted 18 months after termination . In addition , analyses of comprehensive , independent assessment s made during the treatment process indicated that perfectionism began to impede therapeutic gain in approximately 2/3 of the sample , in the latter half of treatment , between the 9th and 12th sessions . Implication s of these findings are discussed , including the possibility that more perfectionistic patients may be negatively impacted by anticipation of an arbitrary , externally imposed termination date This article provides a critical review of the assumptions and findings of studies used to establish  psychotherapies  as empirically supported . The attempt to identify empirically supported therapies ( ESTs ) imposes particular assumptions on the use of r and omized controlled trial ( RCT ) methodology that appear to be valid for some disorders and treatments ( notably exposure-based treatments of specific anxiety symptoms ) but substantially violated for others . Meta-analytic studies support a more nuanced view of treatment efficacy than implied by a dichotomous judgment of supported versus unsupported . The authors recommend changes in reporting practice s to maximize the clinical utility of RCTs , describe alternative method ologies that may be useful when the assumptions underlying EST methodology are violated , and suggest a shift from validating treatment packages to testing intervention strategies and theories of change that clinicians can integrate into empirically informed therapies OBJECTIVE The authors examined the association of treatment preferences with treatment initiation , adherence , and clinical outcome among nonsenior adult and senior primary care patients with depression . METHODS Sixty primary care participants meeting DSM-IV criteria for major depression were r and omly assigned to receive treatment congruent or incongruent with their primary stated preference . Participants received either 20 weeks of escitalopram , with monitoring by a care manager , or 12 weekly sessions of interpersonal psychotherapy followed by two monthly booster sessions .  Adherence to treatment and depression severity were reassessed at weeks 4 , 8 , 12 , and 24 . RESULTS Participants expressed stronger preferences for psychotherapy  than for  antidepressant medication . Preference strength was a more sensitive measure of outcome than was congruence versus incongruence of preference with the assigned treatment . Across age groups , preference strength was significantly associated with treatment initiation and 12-week adherence rate but not with depression severity or remission . CONCLUSIONS A continuous measure of preference strength may be a more useful measure in clinical practice than preferences per se . Future research should focus on whether and how greater facilitation of the treatment decision-making process between patient and clinician influences clinical outcome BACKGROUND Psychotherapy 's equivalence paradox is that treatments have equivalently positive outcomes despite non-equivalent theories and techniques . We compared the outcomes of contrasting approaches practised in routine care . METHOD Patients ( n = 1309 ) who received cognitive-behavioural therapy ( CBT ) , person-centred therapy ( PCT ) and psychodynamic therapy ( PDT ) at one of 58 National Health Service ( NHS ) primary and secondary care sites in the UK during a 3-year period completed the Clinical Outcomes in Routine Evaluation- Outcome Measure ( CORE-OM ) at the beginning and end of their treatment . Therapists indicated which treatment approaches were used on an End of Therapy form . We compared outcomes of six groups : three treated with CBT , PCT or PDT only , and three treated with one of these plus one additional approach ( e.g. integrative , supportive , art ) , design ated CBT+1 , PCT+1 or PDT+1 respectively . RESULTS All six groups averaged marked improvement ( pre-post effect size = 1.36 ) . Treatment approach and degree of purity ( ' only ' vs. ' + 1 ' ) each accounted for statistically significant but comparatively tiny proportions of the variance in CORE-OM scores ( respectively 1 % and 0.5 % as much as pre-post change ) . Distributions of change scores were largely overlapping . CONCLUSIONS Results for these three treatment approaches as practised routinely across a range of NHS setting s were generally consistent with previous findings that theoretically different approaches tend to have equivalent outcomes . Caution is warranted because of limited treatment specification , non-r and om assignment , lack of a control group , missing data and other issues BACKGROUND Insufficient evidence exists about the effect of different therapies on work ability for patients with psychiatric disorders . The present study compares improvements in work ability in two short-term therapies and one long-term therapy . METHODS In the Helsinki Psychotherapy Study , 326 out patients with depressive or anxiety disorder were r and omly assigned to long-term and short-term psychodynamic psychotherapy , and solution-focused therapy . The patients were followed for 3 years from the start of treatment . Primary outcome measures were the Work Ability Index ( WAI ) , the Work-subscale ( SAS-Work ) of the Social Adjustment Scale ( SAS-SR ) , Perceived Psychological Functioning Scale , the prevalence of patients employed or study ing , and the number of sick-leave days . RESULTS Work ability was statistically significantly improved according to WAI ( 15 % ) , SAS-Work ( 17 % ) , and Perceived Psychological Functioning Scale ( 21 % ) during the 3-year follow-up . No differences in the work ability scores were found between two short-term therapies . The short-term therapies showed 4 - 11 % more improved work ability scores than long-term therapy at the 7 month follow-up point . During the second year of follow-up , no significant differences were found between therapies . After 3 years of follow-up , long-term therapy was more effective than the short-term therapies with 5 - 12 % more improved scores . No differences in the prevalence of individuals employed or study ing or in the number of sick-leave days were found between therapies during follow-up . CONCLUSIONS Short-term therapies give benefits more quickly than long-term therapy on work ability but in the long run long-term therapy is more effective than short-term therapies . More research is needed to confirm these findings Major depressive disorder is associated with considerable morbidity , disability , and risk for suicide . Treatments for depression most commonly include antidepressants , psychotherapy , or the combination . Little is known about predictors of treatment response for depression . In this study , 681 patients with chronic forms of major depression were treated with an antidepressant ( nefazodone ) , Cognitive Behavioral Analysis System of Psychotherapy ( CBASP ) , or the combination . Overall , the effects of the antidepressant alone and psychotherapy alone were equal and significantly less effective than combination treatment . Among those with a history of early childhood trauma ( loss of parents at an early age , physical or sexual abuse , or neglect ) , psychotherapy alone was superior to antidepressant monotherapy . Moreover , the combination of  psychotherapy and pharmacotherapy was only marginally superior to  psychotherapy  alone among the childhood abuse cohort . Our results suggest that psychotherapy may be an essential element in the treatment of patients with chronic forms of major depression and a history of childhood trauma OBJECTIVE To assess the cost and clinical effectiveness of psychiatrist-provided Intensive Short-term Dynamic Psychotherapy ( ISTDP ) of patients referred to a private office . METHODS ISTDP was provided to 89 patients referred to a private psychiatric office in Vancouver , Canada . Pretherapy self-report scores , ( BDI , BAI , BSI , IIP [ see full names in text ] ) medication costs , disability costs and healthcare costs were compared with posttherapy values and normative values . RESULTS Patients ' mean self-report scores went from the abnormal to normal range after an average of 14.9 hours of therapy . Returns to work , reduced healthcare utilization , and medication stopping accounted for a cost reduction of over Cdn$400,000 at one year after therapy . CONCLUSIONS ISTDP appears to be an effective and cost-effective form of intervention when provided by a psychiatrist in a private office . R and omized controlled studies are warranted to further examine the cost benefits and efficacy of ISTDP The view is widely held that experimental methods ( r and omised controlled trials ) are the " gold st and ard " for evaluation and that observational methods ( cohort and case control studies ) have little or no value . This ignores the limitations of r and omised trials , which may prove unnecessary , inappropriate , impossible , or inadequate . Many of the problems of conducting r and omised trials could often , in theory , be overcome , but the practical implication s for research ers and funding bodies mean that this is often not possible . The false conflict between those who advocate r and omised trials in all situations and those who believe observational data provide sufficient evidence needs to be replaced with mutual recognition of the complementary roles of the two approaches . Research ers should be united in their quest for scientific rigour in evaluation , regardless of the method used OBJECTIVE There have been few naturalistic follow-up studies of dysthymic disorder . This study describes the 5-year course and outcome of dysthymic disorder . METHOD The authors conducted a prospect i ve , longitudinal follow-up study of 86 out patients with early-onset dysthymic disorder and 39 out patients with episodic major depressive disorder . Follow-ups , conducted 30 and 60 months after entry into the study , rated patients on the Longitudinal Interval Follow-Up Evaluation and the Modified  Hamilton Rating Scale for Depression . RESULTS The estimated 5-year recovery rate from dysthymic disorder was 52.9 % . Among patients who recovered , the estimated risk of relapse was 45.2 % during a mean of 23 months of observation . Patients with dysthymic disorder spent approximately 70 % of the follow-up period meeting the full criteria for a mood disorder . During the course of the follow-up the patients with dysthymic disorder exhibited significantly greater levels of symptoms and lower functioning and were significantly more likely to attempt suicide and to be hospitalized than were patients with episodic major depressive disorder . Finally , among patients with dysthymic disorder who had never experienced a major depressive episode before entry into the study , the estimated risk of having a first lifetime major depressive episode was 76.9 % . CONCLUSIONS Dysthymic disorder is a chronic condition with a protracted course and a high risk of relapse . In addition , almost all patients with dysthymic disorder eventually develop superimposed major depressive episodes . Although patients with dysthymic disorder tend to show mild to moderate symptoms , from a longitudinal perspective , the condition is severe The r and omized controlled trial ( RCT ) is not a gold st and ard : it is a good experimental design in some circumstances , but that 's all . Potential shortcomings in the design and implementation of RCTs are often mentioned in passing , yet most research ers consider that RCTs are always superior to all other types of evidence . This paper examines the limitations of RCTs and shows that 
    Output:
    
It un question ingly accepts that the " br and " of psychotherapy has construct validity , and ignores psychotherapy process research indicating significant commonalities , and overlap , between treatment modalities and evidence that individual practitioner effects are larger than the differences between treatment modalities .
NICE 's systematic review actually found no evidence of superiority between CBT , IPT , psychodynamic psychotherapy , or counselling .