Research Division

Allan Abbass, MD, Chair
Patricia Coughlin, Ph.D.
Susan Hajkowski, Ph.D.
Peter Liliengren, Ph.D.
Tony Rousmaniere, Ph.D.
Roger Sandvik Hansen, Ph.D.
Ole Andre Solbakken, Ph.D.
Joel Town, Ph.D.


Meta-analysis of research studies

Research summary:

1. What conditions can ISTDP treat?

ISTDP has very broad inclusive criteria including almost all DSM5 diagnostic categories. This includes some data for mood disorders, anxiety disorders, somatic symptom disorders, dissociative disorders, personality disorders and some preliminary data for some psychotic disorder patients, bipolar disorders and dementia. The largest amount of study is in the area of patients with personality disorders. The approach is applicable across the full range of patients with character disorders. Eighty-six percent of a large series of private psychiatric referred patients were candidates for a trial therapy of ISTDP (Abbass, 2002).

2. How effective is ISTDP?

Based on recent metanalysis (Abbass et al, 2012) ISTDP appears to be highly effective with these broad range of patient categories just described above. Meta-analysis of studies showed robust effect sizes which were sustained or even tended to increase in long term follow up. There are twenty-five published outcome studies and the majority of these were included in this metanalysis.

3. Is ISTDP cost effective?

There is a growing body of data that finds ISTDP to be very cost effective. These studies include studies of mixed samples (Abbass, 2002b, Abbass, 2003), personality disorders (Cornelissen, 2002, Abbass and others, 2008), mood disorders, (Abbass, 2006), and Somatic disorders (Abbass and others, in press). The treatment appears to be effective in reducing the need for electroconvulsive therapy on an inpatient psychiatry ward (Abbass, Bernier & Town, in press). Moreover the method is effective and cost effective in reducing emergency department visits for medically unexplained symptoms (Abbass and others, 2009, Town and others, in preparation Psychiatric Annals).

4. What appear to be the key ingredients in ISTDP?

The central curative factor of ISTDP has been found to be mobilization and experience of the complex transference feelings resulting in direct access to the unconscious. This has been determined by case based research by Dr. Davanloo over many years and replicated by others of his trainees. A rise in the complex transference feelings and unlocking the unconscious is also correlated with symptom reduction and cost reduction in a recent published outcome study (Town, Abbass & Bernier, 2012)

5. How long does the treatment usually take?

ISTDP is designed to produce as rapid change as possible with respect to the patient´s specific capacities. Research suggests that the initial 1-3-hour trial therapy can lead to significant symptom reduction for many patients (Abbass, Joffres & Ogrodniczuk, 2009).  In practice, each treatment course is tailored to the patient and a course of therapy ranges between 1-100 sessions depending on patient capacity, goals of therapy and the level of therapist skill. Meta-analytic findings suggests that ISTDP takes about 20 sessions across disorders on average (Abbass, Town & Driessen, 2012).

6. What are the contraindications for ISTDP?

Other treatment options should be considered for patients suffering from organic syndromes, brain injury, active psychosis, active alcohol and/or drug addiction, severe acting out, antisocial personality disorder, life threatening active health conditions (i.e. active inflammatory bowel disease) and conditions involving neurological deficits such as Asberger´s syndrome and autism. For some disorders ISTDP might be considered if the patient condition has stabilized  (i.e. bipolar disorder, some psychotic conditions) but these would need be attempted with great care and advanced training.

7. Is ISTDP the treatment of choice for all conditions?

No treatment is the treatment of choice for all conditions. At this point there is no research to support any claim that any kind of therapy is uniquely more effective than all other kinds of therapy for all conditions. That is why we always start with an initial consultation to determine what the patient needs and whether ISTDP is the treatment of choice for that person. We can’t make that assessment in advance based on our assumptions, but only as a result of how that person responds to treatment in the initial session.