title: Personality disorder moderates outcome in short- and long-term group analytic psychotherapy: A randomized clinical trial.
abstract: OBJECTIVE
  In a randomized clinical trial, short- and long-term psychodynamic group psychotherapy (STG and LTG, respectively) schedules were equally effective for the 'typical' patient during a 3-year study period. Although several studies have reported good effects for patients with personality disorders (PD) in diverse forms of psychotherapy, the significance of treatment duration is unclear. Therefore, we tested the hypothesis that PD patients would improve more during and after LTG than STG.
  
  
  METHODS
  A randomized, longitudinal, prospective study contrasting the outcomes during and after short- and long-term dynamic group psychotherapies.
  
  
  METHODS
  One hundred and sixty-seven outpatients with mood disorders, anxiety disorders, or PD were randomized to STG or LTG (respectively, 20 or 80 weekly sessions of 90 min each). Outcome measures are as follows: symptoms (SCL-90-R), interpersonal problems (IIP-C), and psychosocial functioning (GAF split version: GAF-Symptom and GAF-Function). PD pathology (number of PD criteria items) was selected a priori as a putative moderator of treatment effects. Change during the 3-year study period was assessed using linear mixed models. The study was registered at ClinicalTrials.gov as NCT 00021417.
  
  
  RESULTS
  Our hypothesis was supported, as patients with PD improved significantly more regarding all outcome variables in LTG than STG. For patients without PD, the rate of change was similar across 3 years; however, the rate of change in symptoms and interpersonal problems was higher in STG during the first 6 months.
  
  
  CONCLUSIONS
  The effectiveness of LTG is higher for patients with co-morbid PD. Patients without PD do not appear to experience additional gain from LTG.
  
  
  CONCLUSIONS
  Clinical implications: LTG demonstrates better effectiveness than STG for patients with personality disorder co-morbidity (PD). Patients without PD do not appear to experience additional gain from attending LTG. Correct initial allocation to treatment duration may prevent disruptive breaks in relationships and lead to both human and economic cost savings. Limitations: Trials on mixed diagnostic samples may limit the ability to fully assess change for specific diagnostic groups. Therapists were unable to select patients and compose their own groups. Although this condition might increase the generalizability of the results, it may also have restricted the therapists and the clinical situation inadvertently.
authors.affiliation: Institute of Clinical Medicine, Clinic of Mental Health and Addiction, University of Oslo, Norway; Department of Research and Development, Clinic of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
authors.forename: Steinar
authors.initials: S
authors.lastname: Lorentzen
authors.forename: Torleif
authors.initials: T
authors.lastname: Ruud
authors.forename: Anette
authors.initials: A
authors.lastname: Fjeldstad
authors.forename: Per A
authors.initials: PA
authors.lastname: Høglend
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010045:Outpatients; D010551:Personality; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011446:Prospective Studies; D011613:Psychotherapy / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods; D011615:Psychotherapy, Group / Q000379:methods* / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome
keywords: Group analytic psychotherapy; RCT; group; personality disorder; short-term and long-term