Intensive short-term dynamic psychotherapy (ISTDP) and other brief or short-term dynamic therapy models have a growing research base for the treatment of medically-unexplained physical problems. Here are 4 specific conditions for which there is an empirical evidence base:
Pelvic pain/ urethral syndrome—Pelvic or urinary pain in the absence of a physical injury or abnormality can have roots in unconscious emotional processes, especially from anxiety shunted into the smooth muscles of the urogenital system (see Abbass, 2015). Baldoni, et al. (1995) at the University of Bologna, Italy utilized ISTDP (e.g., Davanloo, 1990) in a randomized-controlled trial to address medically-unexplained urethral syndrome and pelvic pain. They found no significant improvement in the control group, who were treated with traditional urological therapies, and found that 70% of the people in the group that received ISTDP remained symptom free at 6 months and 4 years follow-up.
Irritable Bowel Syndrome (IBS)—Both Guthrie (1993) and Creed (2003) completed randomized, controlled trials of short-term psychodynamic therapies (STPP) for irritable bowel syndrome, both of which demonstrated efficacy of STPP for IBS. People with IBS have also been included in ISTDP studies of naturalistic case series data that suggested that ISTDP can be useful in the treatment of IBS (e.g., Abbass, 2002).
Psychogenic movement disorders—Psychogenic movement disorders (PMD) include tremors, rigidity, twitches, tics, and muscle weakness that are linked with underlying emotional factors, including anxiety, conversion, and somatization. Hinson, et al. (2006) used ISTDP (e.g., Davanloo, 2000) in a clinical trial for psychogenic movement disorders and found that ISTDP, with appropriate use of medications, can be a suitable treatment for PMD.
Headache—Barnat (1981) utilized a brief treatment course of brief dynamic therapy in an uncontrolled case series that yielded 75.6% symptom improvement in a group of people with treatment-refractory headache. People with migraine have also been included in ISTDP studies of naturalistic case series data that suggested that ISTDP can be useful in the treatment of migraine (e.g., Abbass, 2002).
Reflections on the current research base
This research base of short-term dynamic therapies for physical symptoms is exciting, but has many limitations and leaves unanswered questions. Savvy consumers of research will look at the above data with a realistically skeptical stance—the evidence base for these specific disorders is not ideally robust. The evidence base discussed here is not totally exhaustive, and more studies are coming out regularly, but we definitely require more studies of ISTDP and other STPPs that are specific to these medical diagnoses.
There is, however, a growing body of evidence that ISTDP is an effective (e.g., Abbass, et al., 2009), cost-effective (Abbass & Katzman, 2013) treatment for a variety of medically-unexplained physical symptoms (MUS)—physical problems that are associated with underlying emotional factors.
While the MUS literature contains heterogenous samples with a wide variety of medical diagnoses, the studies indicate that ISTDP may be effective in reducing symptoms and repeated medical service use in the treatment of MUS generally.
In addition to the empirical data on the 4 conditions above and on MUS in general, my clinical experience working with people with IBS, migraines, pseudoneurological symptoms (e.g., tingling and numbness, blurry vision), muscle weakness, phantom itches, chronic fatigue, and chronic pain conditions has convinced me that ISTDP can be useful in the treatment of medically-unexplained physical symptoms. If you are struggling with medical symptoms that have not responded to treatments, and if medical tests have proven inconclusive, I invite you to examine the evidence for yourself and decide whether a trial therapy of ISTDP is the right choice for you. Feel free to reach out to us if you have any questions.
Abbass, A. (2002) Office based research in ISTDP: Data from the first 6 years of practice. Ad Hoc Bulletin of Short-term Dynamic Psychotherapy, 6, 5-14.
Abbass, A. (2015). Reaching through resistance: Advanced psychotherapy techniques. Kansas City, MO: Seven Leaves Press
Abbass, A.,Campbell, S.,Magee, K. ,& Tarzwell, R. (2009) Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study.Canadian Journal of Emergency Medicine, 11,529-34
Abbass, A., & Katzman, J.W. (2013). The cost-effectiveness of intensive short-term dynamic psychotherapy. Psychiatric Annals, 43, 496-501
Baldoni, F., Baldaro, C., & Trombin, C. (1995). Psychotherapeutic perspectives in urethral syndrome. Stress Medicine, 11, 75-84
Barnat, M.R. (1981). Short-term psychotherapy and refractory headache. Headache, 21, 257-260
Creed, F., Fernandes, L., Guthrie, E., Palmer, S. Ratecliffed, J., & Read, N. (2003). The cost-effectiveness of psychotherapy and paroxetine for severe irritable bowel syndrome. Gastroenterology, 124, 303-317
Davanloo, H. (1990). Unlocking the unconscious: Selected papers of Habib Davanloo, M.D. Hoboken, NJ: Wiley
Davanloo, H. (2000). Intensive short-term dynamic psychotherapy: Selected papers of Habib Davanloo, M.D. Hoboken, NJ: Wiley
Guthrie, E., Creed, F., Dawson, D., & Tomenson, B. (1993). A randomized controlled trial of psychotherapy in patients with refractory Irritable Bowel Syndrome. British Journal of Psychiatry, 163, 315-321.
Hinson, V.K., Weinstein, S., Bernand, B., Lourgans, S.E., & Goetz, C.G. (2006). Single-blind clinical trial of psychotherapy of psychogenic movement disorders. Parkinsonism Related Disorders, 12, 177-180