title: Self-reported immature defense style as a predictor of outcome in short-term and long-term psychotherapy.
abstract: OBJECTIVE
  Identification of pretreatment patient characteristics predictive of psychotherapy outcome could help to guide treatment choices. This study evaluates patients' initial level of immature defense style as a predictor of the outcome of short-term versus long-term psychotherapy.
  
  
  METHODS
  In the Helsinki Psychotherapy Study, 326 adult outpatients with mood or anxiety disorder were randomized to individual short-term (psychodynamic or solution-focused) or long-term (psychodynamic) psychotherapy. Their defense style was assessed at baseline using the 88-item Defense Style Questionnaire and classified as low or high around the median value of the respective score. Both specific (Beck Depression Inventory [BDI], Hamilton Depression Rating Scale [HDRS], Symptom Check List Anxiety Scale [SCL-90-Anx], Hamilton Anxiety Rating Scale [HARS]) and global (Symptom Check List Global Severity Index [SCL-90-GSI], Global Assessment of Functioning Scale [GAF]) psychiatric symptoms were measured at baseline and 3-7 times during a 3-year follow-up.
  
  
  RESULTS
  Patients with high use of immature defense style experienced greater symptom reduction in long-term than in short-term psychotherapy by the end of the 3-year follow-up (50% vs. 34%). Patients with low use of immature defense style experienced faster symptom reduction in short-term than in long-term psychotherapy during the first year of follow-up (34% vs. 19%).
  
  
  CONCLUSIONS
  Knowledge of patients' initial level of immature defense style may potentially be utilized in tailoring treatments. Further research on defense styles as outcome predictors in psychotherapies of different types is needed.
authors.affiliation: Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare (THL) Helsinki, Finland.
authors.forename: Maarit A
authors.initials: MA
authors.lastname: Laaksonen
authors.affiliation: Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare (THL) Helsinki, Finland.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sirkiä
authors.affiliation: Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare (THL) Helsinki, Finland ; Biomedicum Helsinki Helsinki, Finland ; Social Insurance Institution Helsinki, Finland.
authors.forename: Paul
authors.initials: P
authors.lastname: Knekt
authors.affiliation: Department of Health, Functional Capacity and Welfare, National Institute for Health and Welfare (THL) Helsinki, Finland.
authors.forename: Olavi
authors.initials: O
authors.lastname: Lindfors
mesh_terms: D000328:Adult; D000339:Affect; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D003674:Defense Mechanisms; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000523:psychology / Q000628:therapy*; D010551:Personality; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D057566:Self Report; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anxiety; depression; outcome; psychotherapy