Psychodynamic therapy for adolescents suffering from co-morbid disorders of conduct and emotions in an in-patient setting: a randomized controlled trial
Abstract
Background: Co-morbid disorders of conduct and emotions can be regarded as childhood antecedents of further negative developments (e.g. manifestation of personality disorders in adulthood). We evaluated a manualized psychodynamic therapy (PDT) for adolescents with these co-morbid disorders. Method: In a randomized controlled trial (RCT), 66 adolescents diagnosed with mixed disorders of conduct and emotions (F92 in ICD-10) were randomly assigned to a manualized in-patient PDT group or a waiting list/treatment-as-usual (WL/TAU) control condition. Diagnoses according to DSM-IV were also documented. Patients were compared using rates of remission as the primary outcome. The Global Severity Index (GSI) and the Strengths and Difficulties Questionnaire (SDQ) were used as secondary measures. Assessments were performed at baseline, post-treatment and at the 6-month follow-up. Results: The sample consisted of severely impaired adolescents with high rates of further co-morbid disorders and academic failure. Patients in the treatment group had a significantly higher rate of remission [odds ratio (OR) 26.41, 95% confidence interval (CI) 6.42–108.55, p < 0.001]. Compared with the control group, the PDT group resulted in significantly better outcomes on the SDQ (p = 0.04) but not the GSI (p = 0.18), with small between-group effect sizes (SDQ: d = 0.38, GSI: d = 0.18). However, the scores of patients treated with PDT were post-treatment no longer significantly different from normative data on the GSI and within the normal range on the SDQ. The effects in the treatment group were stable at follow-up. Furthermore, most patients were reintegrated into educational processes. Conclusion: PDT led to remarkable improvement and furthered necessary preconditions for long-term stabilization. In future, PDT should be compared to other strong active treatments.
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Dropout rates varied widely, ranging from 15 to 75%.
“Dropout rates varied widely, ranging from 15 to 75%.”
The evidence base for these adaptations is rather scarce; a recent review identified only ten randomized clinical trials.
“The evidence base for these adaptations is rather scarce. A recent review identified only ten randomized clinical trials [22–31].”
The majority of these trials did not show the superiority of the specialized treatments compared with treatment as usual.
“The results indicate that the majority of these trials did not show the superiority of the specialized treatments compared with treatment as usual.”
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- Authors
- Salzer, S., Cropp, C., Jaeger, U., Masuhr, O., & Streeck-Fischer, A.
- Affiliations
- University of Göttingen (DE)
- Asklepios Fachklinikum Tiefenbrunn (DE)
- International Psychoanalytic University Berlin (DE)
- Corresponding author
- Salzer, S.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-11-12
- Volume
- 44
- Issue
- 10
- Pages
- 2213-2222
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2031045863
- Cited by
- 36
- References
- 50
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 6 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 7 · 2019: 2 · 2018: 1 · 2017: 2 · 2015: 1 · 2014: 2 · 2012: 1
- FWCI
- 1.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- GRO (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- psychodynamic psychotherapy, adolescents, conduct disorder, emotional disorders, comorbidities, inpatient care, remission, Strengths and Difficulties Questionnaire, Global Severity Index, school failure
- MeSH terms
- Adolescent, Adult, Affective Symptoms, Female, Humans, Male, Comorbidity, Treatment Outcome, Conduct Disorder, Young Adult, Psychotherapy, Psychodynamic
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