Intensive Short-Term Dynamic Psychotherapy (ISTDP)

Scientific Rating:
2
Supported by Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Intensive Short-Term Dynamic Psychotherapy (ISTDP) has been rated by the CEBC in the area of: Depression Treatment (Adult).

Target Population: Adults with a broad range of disorders including personality disorders

Brief Description

The basic ISTDP understanding of many psychological disorders is based on attachment and the emotional effects of broken attachments. Interruptions and trauma to human attachments may cause a cascade of complex emotions which may become blocked and avoided. When later life events stir up these feelings, anxiety and emotional defenses may be activated. These reactions may be totally unconscious to the person having them, and the result is ruined relationships, physical symptoms, and a range of psychiatric symptoms. A proportion of all patients with anxiety, depression, substance use, and interpersonal problems have this emotional blockage problem. ISTDP focuses on emotional awareness and the ability to feel these emotions in order to heal.

Program Goals:

The overall goal of Intensive Short-Term Dynamic Psychotherapy (ISTDP) is:

  • Resolution of attachment trauma-related symptoms that manifest as anxiety, depression, conduct problemss, and somatic symptoms

Essential Components

The essential components for Intensive Short-Term Dynamic Psychotherapy (ISTDP) include:

  • The treatment approach ISTDP as designed by Davanloo has these steps:
    • To acquaint the patient with the unconscious processes that the patient uses to deal with difficult situations
    • To help them to overcome the emotional blocking processes. This often means a focus on the feelings the patient has in the office during the moments of the interview and pointing out the ways the patient blocks off both the emotions and the connection with the therapist in treatment.
  • When these feelings are experienced there is an abrupt drop in tension, anxiety and other physical symptoms and defenses. Thus, the patient and therapist can then see the driving emotional forces that were being defended. Thereafter, a healing process may occur in which the old avoided feelings are experienced and worked through. Often one of these breakthroughs is enough to bring about major symptom improvement, while in most cases a series of these events are required to bring about major behavioral changes. If the patient has very low tolerance of anxiety, a treatment process in group or individual therapy may be required first to build this up before the emotions can be experienced.
  • At the end of a successful therapy, there is an absence of somatic anxiety and major defenses, so health and relationships are free to develop and persist as they were meant to before the original trauma.
  • This treatment and variants of it have been extensively researched and shown effective with some patients with depression, anxiety, somatization, substance abuse, eating disorders and personality problems.

Adult Services

Intensive Short-Term Dynamic Psychotherapy (ISTDP) directly provides services to adults (regardless of whether they are parents or caregivers) and addresses the following:

  • Broad range of disorders including personality disorders

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Hospital
  • Outpatient Clinic

Homework

This program does not include a homework component.

Languages

Intensive Short-Term Dynamic Psychotherapy (ISTDP) does not have materials available in a language other than English.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Camera
  • DVD player
  • Television
  • Room

Minimum Provider Qualifications

Moderate training including videotape supervision is required.

Education and Training Resources

There is not a manual that describes how to implement this program; but there is training available for this program.

Training Contact:
Training is obtained:

Periodic immersion courses

Number of days/hours:

5 days per year

Additional Resources:

There currently are additional qualified resources for training:

Southern California Institute for ISTDP - www.istdp.com

Implementation Information

Since Intensive Short-Term Dynamic Psychotherapy (ISTDP) is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

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Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Intensive Short-Term Dynamic Psychotherapy (ISTDP).

Formal Support for Implementation

There is no formal support available for implementation of Intensive Short-Term Dynamic Psychotherapy (ISTDP).

Fidelity Measures

There are no fidelity measures for Intensive Short-Term Dynamic Psychotherapy (ISTDP).

Implementation Guides or Manuals

There are no implementation guides or manuals for Intensive Short-Term Dynamic Psychotherapy (ISTDP).

Research on How to Implement the Program

Research has not been conducted on how to implement Intensive Short-Term Dynamic Psychotherapy (ISTDP).

Relevant Published, Peer-Reviewed Research

This program is rated a "2 - Supported by Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The program must have at least one rigorous randomized controlled trial with a sustained effect of at least 6 months. The article(s) below that reports outcomes from an RCT showing a sustained effect of at least 6 months has an asterisk (*) at the beginning of its entry. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Abbass, A. (2002). Intensive short-term dynamic psychotherapy in a private psychiatric office. American Journal of Psychotherapy, 56(2), 225-232.

Type of Study: One-group pretest-posttest design
Number of Participants: 89 patients

Population:

  • Age — Mean age=39.6 years (SD=9.8)
  • Race/Ethnicity — Not Specified
  • Gender — 52% female and 48% male
  • Status — Participants were consecutively referred patients who accepted a treatment trial of Intensive Short-Term Dynamic Psychotherapy (ISTDP) from 1995-1997.

Location/Institution: Vancouver, British Columbia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The goal of the study was to examine whether ISTDP provided by a trained therapist is effective in achieving normalization on standardized self-report measures and whether ISTDP is cost effective when provided by a psychiatrist in a private clinical setting. Self-report measures included the Brief Symptom Inventory (BSI), the Inventory of Interpersonal Problems (IIP), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) [both Beck inventories were later removed]. Results indicated that post-therapy levels were significantly lower than mean pre-therapy levels on each measure. Mean scores on each measure decreased from pathological levels at pre-therapy to within normal ranges at post-therapy. Data gathered from prescription administration, disability insurance costs, and hospital and physician service costs, suggest an overall cost reduction to the system of approximately $402,523 over the 12-month period after these 89 patients finished therapy. The lack of a control group was a significant limitation.

Length of postintervention follow-up: 1 year.

Cooper, P. J., Murray, L., Wilson, A., & Romaniuk, H. (2003). Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression. British Journal of Psychiatry, 182, 412-419.

Type of Study: Randomized controlled trial
Number of Participants: 193

Population:

  • Age — Mean age=28 years
  • Race/Ethnicity — Not specified
  • Gender — 100% Female
  • Status — Participants were women who were recruited through hospital birth records.

Location/Institution: Cambridge, England

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Women identified through hospital birth records were screened for depression by mail using the Edinburgh Postnatal Depression Scale (EPDS). They were randomly assigned to receive routine primary care, Cognitive-behavioral therapy (CBT), psychodynamic therapy (ISTDP), or non-directive counseling. They were assessed immediately after treatment, and at 9 months, 18 months, and 5 years post partum, using the EPDS and by structured interview according to the DSM-III-R . Results showed that all intervention conditions showed a reduction in depressive symptoms, but that only the ISTDP condition was significantly better than the control condition immediately after treatment. No intervention effects were apparent by the 9-month evaluation.

Length of postintervention follow-up: 9, 18, and 60 months.

Murray, L., Cooper, P. J., Wilson, A., & Romaniuk, H. (2003). Controlled trial of the short- and long-term effect of psychological treatment of post-partum depression. British Journal of Psychiatry, 182, 420-427.

Type of Study: Randomized controlled trial
Number of Participants: 193

Population:

  • Age — Mean age=28 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were women who were recruited through hospital birth records.

Location/Institution: Cambridge, England

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This study uses the same sample as Cooper, et al. (2003). Women identified through hospital birth records were screened for depression by mail using the Edinburgh Postnatal Depression Scale (EPDS). They were randomly assigned to receive routine primary care, Cognitive-behavioral therapy (CBT), psychodynamic therapy (PT), or non-directive counseling. Using a checklist developed for this study, researchers assessed experiences of managing infant behaviors and problems in the mother-infant relationship. Video-taped mother-infant interactions in the home were also coded for sensitivity. At 18 months post-partum, participants were assessed for infant attachment using the Ainsworth Strange Situation and were interviewed using the Behavioral Screening Questionnaire (BSQ) to assess infant problems such as sleep and feeding issues, separation anxiety, and tantrums. Results showed significant beneficial effects on maternal reports of difficulties for all treatments at 4.5 months and counseling was related to positive maternal reports at 18 months. No other significant treatment effects were found.

Length of postintervention follow-up: 9, 18, and 60 months.

*Maina, G., Forner, F., & Bogetto, F. (2005). Randomized controlled trial comparing brief dynamic and supportive therapy with waiting list condition in minor depressive disorders. Psychotherapy and Psychosomatics, 74, 43-50.

Type of Study: Randomized controlled trial
Number of Participants: 30

Population:

  • Age — Waitlist: Mean age=30.2 years, BDT/ISTDP: Mean age=40.7 years, and BSP: Mean age=39.5 years
  • Race/Ethnicity — Not Specified
  • Gender — Not Specified
  • Status — Participants were recruited from the outpatient waiting list at a university-based treatment center.

Location/Institution: Turin, Italy

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were randomly assigned to receive Brief Dynamic Therapy (BDT, former name for Intensive Short-Term Dynamic Psychotherapy [ISTDP]), Brief Supportive Therapy (BST), or to a waitlist control condition (WL). They were assessed at baseline using the Hamilton Depression Rating Scale (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A) and the Clinical Global Impression Scales for Severity and Improvement (CGI-S and CGI-I). Participants in both treatment conditions showed improvement in comparison to the control condition, however, overall response rates were low (50% in the BDT group and 40% in the BST group). However, the BDT group continued to improve over the follow-up period in all areas.

Length of postintervention follow-up: 6 months.

Abbass, A. A. (2006). Intensive short-term dynamic psychotherapy of treatment-resistant depression: A pilot study. Depression and Anxiety, 23, 449-452.

Type of Study: Pretest-Posttest
Number of Participants: 10

Population:

  • Age — Mean age=49.7 years
  • Race/Ethnicity — Caucasian
  • Gender — Not Specified
  • Status — Participants were outpatients who were referred to the study by their psychiatrists.

Location/Institution: Canada

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were required to have a diagnosis of treatment-resistant depression (TRD), which was defined as inadequate response to two different appropriately prescribed antidepressants. Patients were assessed using the Brief Symptom Inventory—Depression subscale (BSI-D), the Inventory of Interpersonal Problems (IIP), the Hamilton Rating Scale for Depression (HAM-D-17), and the Clinical Global Index (CGI). Nine out of 10 patients showed improved HAM-D-17 scores and other depression measures showed a return to the normal range, which was maintained at follow-up. This study is limited by the small sample size and lack of a comparison group.

Length of postintervention follow-up: Approximately 6 months.

References

Davanloo, H. (2000). Intensive Short-Term Dynamic Psychotherapy: Selected Papers of Habib Davanloo, MD. New York: Wiley.

Driessen, E., Cuijpers, P., de Maat, S. C. M., Abbass, A. A., de Jonghe, F., & Dekker, J. J. M. (2010). The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis. Clinical Psychology Review, 30(1), 25-36.

Contact Information

Name: Danielle Haber, MD
Agency/Affiliation: University of California - San Diego
Website: www.istdp.com
Email:
Phone: (858) 401-9922
Fax: (858) 792-8333

Date Research Evidence Last Reviewed by CEBC: June 2016

Date Program Content Last Reviewed by Program Staff: March 2016

Date Program Originally Loaded onto CEBC: March 2010