Intensive Short-Term Dynamic Psychotherapy (ISTDP)

1  — Well-Supported by Research Evidence
Medium

About This Program

Target Population: Adults with major depression

Program Overview

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, anxiety, depression, substance abuse, eating disorders, work dysfunction 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 is designed to focus on emotional awareness and the ability to feel these emotions in order to heal and overcome these behavioral and psychiatric symptoms.

Program Goals

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

  • Resolution of attachment trauma-related symptoms that manifest as anxiety, depression, behavioral and personality problems, and somatic symptoms

Logic Model

The program representative did not provide information about a Logic Model for Intensive Short-Term Dynamic Psychotherapy (ISTDP).

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.

Program Delivery

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 anxiety, depression, personality, and somatic disorders

Recommended Intensity:

1 hour weekly

Recommended Duration:

Average is 20 sessions

Delivery Settings

This program is typically conducted in a(n):

  • Hospital
  • Outpatient Clinic
  • Community-based Agency / Organization / Provider

Homework

This program does not include a homework component.

Resources Needed to Run Program

The typical resources for implementing the program are:

  • Camera for recording for self-study and supervision
  • Television to view recording
  • Room

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Moderate training including videotape supervision is required.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Annual immersion courses and core training programs plus video-based supervision are required.

Number of days/hours:

5 days per year

Additional Resources:

There currently are additional qualified resources for training:

Implementation Information

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 implementation guides or manuals for Intensive Short-Term Dynamic Psychotherapy (ISTDP) as listed below:

This is an adherence manual. The purpose of the adherence manual is to evaluate if the therapist is attempting to follow the basic technique of ISTDP. Please contact the training contact above.

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

Child Welfare Outcome: Child/Family Well-Being

two meta-analyses, see citation following, have been conducted on the Intensive Short-Term Dynamic Psychotherapy (ISTDP), however, these articles are not used for rating and therefore is not summarized:

  • Driessen, E., Hegelmaier, L. M., Abbass, A. A., Barber, J. P., Dekker, J. J., Van, H. L., Jansma, E. P., & Cuijpers, P. (2015). The efficacy of short-term psychodynamic psychotherapy for depression: A meta-analysis update. Clinical Psychology Review, 42, 1–15. https://doi.org/10.1016/j.cpr.2015.07.004
  • Caldiroli, A., Capuzzi, E., Riva, I., Russo, S., Clerici, M., Roustayan, C., Abbass, A., & Buoli, M. (2020). Efficacy of intensive short-term dynamic psychotherapy in mood disorders: A critical review. Journal of Affective Disorders, 273, 375–379. https://doi.org/10.1016/j.jad.2020.04.002

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(5), 412–419. https://doi.org/10.1192/bjp.182.5.412412-419

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

Population:

  • Age — Mean=28 years
  • Race/Ethnicity — Not specified
  • Gender — 100% Female
  • Status — Participants were women with postpartum depression.

Location/Institution: Cambridge, England

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to evaluate the long-term effect on maternal mood of three psychological treatments (psychodynamic therapy [PT, now called Intensive Short-Term Dynamic Psychotherapy (ISTDP)], Cognitive-Behavioral Therapy [CBT], or nondirective counseling) in relation to routine primary care. Participants were randomly assigned to one of four conditions: routine primary care, CBT, PT, or nondirective counseling. Measures utilized include the Edinburgh Postnatal Depression Scale (EPDS) and the Structured Clinical Interview for DSM-III-R. Results indicate compared with the control, all three treatments had a significant impact at 4.5 months on maternal mood. Only psychodynamic therapy produced a rate of reduction in depression significantly superior to that of the control. The benefit of treatment was no longer apparent by 9 months postpartum. Treatment did not reduce subsequent episodes of postpartum depression. Limitations include lack of a significant difference in terms of remission from depressive disorder between two of the treatment conditions and the controls requires some explanation, and the outcome of those who received nondirective counselling and CBT from a specialist was unexpectedly poor.

Length of postintervention follow-up: Approximately 4.5 and 13.5 months, and 4.6 years.

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(5), 420-427. https://doi.org/10.1192/bjp.182.5.420

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

Population:

  • Age — Mean=28 years
  • Race/Ethnicity — Not specified
  • Gender — 100% Female
  • Status — Participants were women with postpartum depression.

Location/Institution: Cambridge, England

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the sample from Cooper et al. (2003). The purpose of this study was to evaluate the effect of three psychological treatments (psychodynamic therapy [PT, now called Intensive Short-Term Dynamic Psychotherapy (ISTDP)], Cognitive-Behavioral Therapy [CBT], or nondirective counseling) on the mother-child relationship and child outcome. Participants were randomly assigned to routine primary care, nondirective counselling, CBT, or PT. Measures utilized include videotaped mother-child interaction, the Ainsworth Strange Situation, the Behavioral Screening Questionnaire (BSQ), the Mental Development Index of the Bayley Scales of Infant Development, the Rutter A2 Scale, the Pre-school Behaviour Checklist, the McCarthy Scales of Children’s Abilities, and a checklist assessing experiences of managing infant behaviors and problems in the mother-infant relationship. Results indicate 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. Limitations include it may be that the study interventions offered no significant advantage over routine health visitor practice, the current treatments were brief and delivered early on in development, and study sample was drawn from a relatively low-risk population.

Length of postintervention follow-up: Approximately 4.5 and 13.5 months, and 4.6 years.

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,(1), 43–50. https://doi.org/10.1159/000082026

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

Population:

  • Age — Mean=30.2–40.7 years
  • Race/Ethnicity — Not specified
  • Gender — 20–50% Male and 50–80% Female
  • Status — Participants were patients with primary DSM-IV dysthymic disorder, depressive disorder not otherwise specified, or adjustment disorder with depressed mood.

Location/Institution: Turin, Italy

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to determine whether Brief Dynamic Therapy (BDT; now called Intensive Short-Term Dynamic Psychotherapy [ISTDP]) is more effective than Brief Supportive Psychotherapy (BSP) and waiting list condition in the treatment of minor depressive disorders. Participants were randomly assigned to BDT, BSP, or a wait list condition. Measures utilized include 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). Results indicate patients treated with both psychotherapeutic approaches showed a significant improvement after treatment in comparison to nontreated controls, but BDT was more effective at follow-up evaluation. Limitations include small sample size and lack of assessment of waitlist control group at 6-month follow up

Length of postintervention follow-up: 6 months (treatment groups only).

Ajilchi, B., Nejati, V., Town, J. M., Wilson, R., & Abbass, A. (2016). Effects of Intensive Short-Term Dynamic Psychotherapy on depressive symptoms and executive functioning in major depression. The Journal of Nervous and Mental Disease, 204(7), 500–505. https://doi.org/10.1097/NMD.0000000000000518

Type of Study: Randomized controlled trial
Number of Participants: 32

Population:

  • Age — 19–40 years
  • Race/Ethnicity — Not specified
  • Gender — 62.5–81.3% Male and 18.8–37.5% Female
  • Status — Participants were adults meeting Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria for major depressive disorder.

Location/Institution: A mental health outpatient psychotherapy clinic in Tehran, Iran

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to examine the efficacy of Intensive Short-Term Dynamic Psychotherapy (ISTDP) on depressive symptoms and executive functioning in patients with major depression. Participants were randomized to either ISTDP or a wait-list control. Measures utilized include the Beck Depression Inventory (BDI-II), the Wisconsin Cart Sorting Test (WCST), and the Stroop task. Results indicate significant interaction effects of group and time on depression scores when the group ISTDP was compared with the wait-list control group; participants receiving ISTDP had significantly reduced depression severity both after treatment and at follow-up. Results also demonstrated modest improvements on most tests of executive functioning in participants receiving ISTDP. Depressed patients receiving ISTDP show a sustained reduction in depression severity after treatment and after 12-month follow-up and improvements in executive functioning after treatment compared with a wait-list control. Limitations include small sample size, lack of follow-up data to report on the maintenance of the observed cognitive improvements, and lack of formal adherence measures.

Length of postintervention follow-up: 12 months.

Town, J. M., Abbass, A., Stride, C., & Bernier, D. (2017). A randomised controlled trial of Intensive Short-Term Dynamic Psychotherapy for treatment resistant depression: The Halifax Depression Study. Journal of Affective Disorders, 214, 15–25. https://doi.org/10.1016/j.jad.2017.02.035

Type of Study: Randomized controlled trial
Number of Participants: 60

Population:

  • Age — Mean=38.9–44.2 years
  • Race/Ethnicity — 93.3–100% Caucasian
  • Gender — 30–43.3% Male
  • Status — Participants were patients referred to secondary care community mental health teams (CMHT) who met DSM-IV criteria for major depressive episode.

Location/Institution: Halifax Regional Municipality, Nova Scotia, Canada

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of this study was to test the efficacy of time limited Intensive Short-Term Dynamic Psychotherapy (ISTDP) for treatment resistant depression (TRD). Participants were randomly assigned to 20 sessions of ISTDP or secondary care community mental health teams (CMHT) treatment as usual (TAU). Measures utilized include the Comparative Psychotherapy Process Scale (CPPS), the Hamilton Depression Rating Scale (HAM-D), and the Patient Health Questionnaire (PHQ-9). Results indicate change over time on both depression scales was significantly greater in the ISTDP group in comparison to TAU. Statistically significant between-group treatment differences, in the moderate to large range, favoring ISTDP, were observed on both the observer-rated and self-report measures of depression. Relative to TAU, patients in the ISTDP group were significantly more likely after 6 months to achieve complete remission and partial remission. Limitations include lack of follow-up and lack of clarity if the results are generalizable to other providers, geographical locations, and cultures.

Length of postintervention follow-up: None.

Town, J. M., Abbass, A., Stride, C., Nunes, A., Bernier, D., & Berrigan, P. (2020). Efficacy and cost-effectiveness of Intensive Short-Term Dynamic Psychotherapy for treatment resistant depression: 18-Month follow-up of the Halifax depression trial. Journal of Affective Disorders, 273, 194–202. https://doi.org/10.1016/j.jad.2020.04.035

Type of Study: Randomized controlled trial
Number of Participants: 60

Population:

  • Age — 18–65 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were depressed patients referred to Community Mental Health Teams (CMHT).

Location/Institution: Halifax Regional Municipality, Nova Scotia, Canada

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the same sample as Town et al. (2017). The purpose of this study was to examine the efficacy of Intensive Short-Term Dynamic Psychotherapy (ISTDP) versus secondary care treatment as usual (TAU) provided by Community Mental Health Teams (CMHTs). Participants were randomly assigned to either ISTDP or TAU. Measures utilized include the Hamilton Depression Rating Scale (HAM-D), the Patient Health Questionnaire (PHQ-9), the Generalized Anxiety Disorder Scale (GAD-7), the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), the Inventory of Interpersonal Problems (IIP-32), the Patient Health Questionnaire (PHQ-15), the Trimbos and Institute of Medical technology Assessment Cost Questionnaire for Psychiatry (TIC-P), the 12-Item Short Form Survey (SF-12), the administrative database for physician billings, and medical chart review. Results indicate statistically significant treatment differences in depression previously found at 6 months favoring ISTDP were maintained at 18-month follow-up. Group differences in depression were in the moderate to large range on both the observer rated and self-report measures. At 18 months follow-up, the remission rate in ISTDP patients was 40.0%, and 23.4% had discontinued antidepressants. Health economic analysis suggests that ISTDP was more cost-effective than CMHT at 18 months. Probabilistic analysis suggests that there is a 64.5% probability of ISTDP being cost-effective at a willingness to pay for a quality-adjusted life years (QALY) of $25,000 compared to CMHT at 18 months. Limitations include small sample size and lack of consideration for indirect costs.

Length of postintervention follow-up: 3 months, 6 months, and 1 year.

Additional References

No reference materials are currently available for Intensive Short-Term Dynamic Psychotherapy (ISTDP).

Contact Information

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: April 2021

Date Program Content Last Reviewed by Program Staff: October 2021

Date Program Originally Loaded onto CEBC: March 2010