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Effects of Intensive Short-Term Dynamic Psychotherapy
on Depressive Symptoms and Executive Functioning
in Major Depression
Bita Ajilchi, PhD,* Vahid Nejati, PhD,†Joel M. Town, DClinPsy,‡
Ryan Wilson, PhD,§ and Allan Abbass, MD, FRCPC‡
Abstract: This study examined the efficacy of intensive short-term dynamic
psychotherapy (ISTDP) on depressive symptoms and executive functioning in
patients with major depression. We examined pretest, posttest, and follow-up de-
pression scores as well as pretest–posttest executive functioning scores between
16 participants receiving ISTDP and 16 allocated towait-list control. Participants
in each group were matched according to age, sex, and educational level. Mixed-
models analyses demonstrated significant interaction effects of group and time
on depression scores when the group ISTDP was compared with the wait-list
control group; participants receiving ISTDP had significantly reduced de-
pression severity both after treatment and at follow-up. Next, a series of hier-
archical regression models demonstrated modest improvements on most tests
of executive functioning in participants receiving ISTDP. Depressed patients
receiving ISTDP show a sustained reduction in depression severity after treat-
ment and after 12-month follow-up and improvements in executive functioning
after treatment compared with a wait-list control.
Key Words: Depression, executive functions,
intensive short-term dynamic psychotherapy (ISTDP)
(JNervMentDis2016;204: 500–505)
Major depressive disorder (MDD) is one of the most commonly oc-
curring forms of mental illness having significant negative im-
pact on an individual's educational, occupational, and interpersonal
functioning (Andrade and Caraveo, 2003; Kessler et al., 2005). A com-
mon feature of MDD is cognitive impairment. As highlighted in a re-
cent meta-analytic review (Snyder, 2013), there appear to be several
theories about the nonspecific factors contributing to cognitive impair-
ments in MDD, including slowed processing speed, limited availability
of cognitive resources, and a motivation. However, there is also mount-
ing evidence that in addition to these nonspecific factors, executive
function may be particularly disrupted in individuals with MDD.
Executive function has been operationalized in many different
ways. However, broadly speaking, executive function can be described
as a collection of top-down control processes that preside over “lower
level”sensory and motor processes in order to allow individuals to
respond to environmental demands in an adaptive, flexible manner.
That is, executive function is thought to include key processes for
goal directed behaviors (e.g., Friedman et al., 2008; Miyake et al.,
2000; Nee et al., 2013).
The three-component model of executive function is an influen-
tial theoretical framework that proposes a “common”executive compo-
nent (i.e., a common resource) that is engaged, along with three distinct
executive processes: (1) updating process—can add, delete, or manipu-
late information in working memory, (2) shifting process—can switch
between tasks rules or stimulus sets, and (3) inhibiting process—can
suppress prepotent responses and suppress the effects of goal-irrelevant
distracters (Friedman et al., 2008; Miyake et al., 2000).
Reports on the effects of MDD on executive functioning have
been mixed. To address these mixed findings, Snyder (2013) conducted
a meta-analytic review to examine the effects of MDD on executive
function. Synder's review used the three-component model to opera-
tionalize executive function and focused on the most commonly re-
ported measures of each of the three aspects of executive function
found in the literature. Updating ability was most commonly measured
via the n-back task, in which individuals must determine whether a cur-
rently presented stimulus (usually letters or numbers) is a match to the
stimulus presented ntrials ago (where n is usually 1 or 2; Owen et al.,
2005). Optimal performance of the task requires individuals to con-
tinuously update the contents of working memory to make correct
matches. Problem solving and task switching were most commonly
assessed by the Wisconsin Card Sorting Task (WCST), in which the in-
dividual must sort cards based on different properties that change as the
test continues. Thus, successful completion of the task requires mental
flexibility to shift between rules. Also, inhibition was most commonly
measured by the Stroop task, in which individuals must name the color
of the ink in which color words are printed while ignoring the word
itself (e.g., the correct response when confronted with the word red
presented in green ink is green). Thus, successful completion of the
Stroop task relies on the individual's ability to inhibit the prepotent re-
sponse of reading the word to make the accurate evaluation of the ink
color. The results Snyder's meta-analysis showed moderate effects sizes
(Cohen, 1988) of MDD on all three aspects of executive function. That
is, those with MDD performed worse on all aspects of executive func-
tion than healthy controls did.
At present, it is unclear to what extent the links between MDD
and executive dysfunction are causal (i.e., whether executive dysfunc-
tion is a result of depression or depression is a result of executive dys-
function) or correlative. Regardless of causal or correlative link and
given the critical roles of executive function, it is important to further
examine whether treatment of MDD may improve executive function.
To our knowledge, only a limited amount of research currently
exists that examines the relationship between changes in executive
functioning in depressed people after short-term psychotherapy. For in-
stance, preliminary evidence suggests that depressed people undergo-
ing cognitive behavioral therapy (CBT) may show improved cognitive
functioning (e.g., Alexopoulos, 2005) and 8 weeks of a mindfulness-
based approach can improve ability to concentrate and maintain at-
tention in depressed patients (Bostanov et al., 2012). Most recently,
Groves et al. (2015) found that both CBT and metacognitive therapy
(MCT) produced positive changes in neuropsychological functioning
and that MCT provided greater improvement in executive functioning
*Department of Psychology, Faculty of Human Science, Sciences & Research
Branch, Islamic Azad Univer sity (IAU); †Department of Psychology, Faculty
of Human Science, Shahid Beheshti University, Tehran, Iran; and ‡Depart-
ment of Psychiatry, and §Centre for Emotions & Health, Dalhousie Univer-
sity, Halifax, Canada.
Send reprint requests to Bita Ajilchi, PhD, Department of Psychology, Faculty of
Human Science, Sciences & Research Branch, Islamic Azad University, Hesarak,
Tehran, I.R. Iran, 1477893855. E-mail: Ajilchi_b@yahoo.com.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
ISSN: 002 2-3018/16/20407–0500
DOI: 10.1097/NMD.0000000000000518
ORIGINAL ARTICLE
500 www.jonmd.com The Journal of Nervous and Mental Disease •Volume 204, Number 7, July 2016
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
(specifically related to attention and spatial memory). The relationship
between executive functioning and treatment for depression with short-
term psychodynamic treatment has not yet been investigated.
Davanloo's (2000, 2005) intensive short-term dynamic psycho-
therapy (ISTDP) model is commonly delivered as a weekly individual
talking therapy, averaging less than 40 sessions. During this therapy,
patients are enabled to experience and tolerate painful affects associated
to traumatic attachment experiences. Recent meta-analytic studies of
the ISTDP approach demonstrate large sustained effects when treat-
ing a broad range of common mental disorders (Abbass et al., 2012;
Town and Driessen, 2013). This is consistent with the broader efficacy
of short-term psychodynamic therapy models specifically in major de-
pression (Driessen et al., 2015).
In the present study, we sought to examinewhether a short course
of ISTDP might produce significant changes in both self-reported
symptoms of depression and executive function. Although we do not
postulate a causal link, we hypothesized that with improved mood, as-
pects of executive function, specifically inhibition, and shifting would
also improve.
METHODS
Design
Using a randomized controlled design, participants meeting
Diagnostic and Statistical Manual of Mental Disorders, 4th Edition
(DSM-IV) criteria for major depressive episode were allocated by ran-
dom to either the control group (wait-list) or experimental group
(ISTDP). A clinic secretary, who had no other involvement in the de-
sign or implementation of the research procedure, was aware of
the allocation sequence and conducted the randomization proce-
dure. Patients and therapists were aware of allocation status. The first
20 patient names drawn from a hat were allocated to receive ISTDP,
and the remaining patients, to the wait-list group. Participants' depres-
sion severity and executive functioning were assessed at two time
points, baseline (before allocation) and after the experimental/control
intervention to compare group differences. Additional depression se-
verity scores were obtained at a 12-month follow-up.
Participants
Consecutive referrals, aged 19–40 years, in 2011 who were re-
ferred to a mental health outpatient psychotherapy clinic in Tehran,
Iran, were screened for inclusion in the study. Participants were evalu-
ated by a clinical psychologist and were included if they met DSM-IV
criteria for current major depressive episode, had a depression severity
score of over 20 on the Beck Depression Inventory (BDI-II), were
not currently receiving antidepressant treatment, and provided in-
formed written consent. Participants were excluded if they had bipolar
disorder, psychosis, eating disorder, drug abuse, or severe suicidality. In
total, 40 participants were included and allocated to a group (Fig. 1).
Treatment
The ISTDP treatment process in patients with major depression
begins with an extended trial therapy to evaluate psychic capacities (un-
conscious anxiety discharge pathways and defensive patterns) and ca-
pacity to respond to treatment. The process then focuses on building
the necessary capacities to tolerate anxiety and emotional experiences
through a graded process of emotion activation and intellectual reflec-
tion. When the patient has developed capacity, complex, unprocessed
feelings about recent and past traumatic events are mobilized and fo-
cused on to help the patient experience these emotions directly. Each
such focus isfollowed by recapitulation of what was learned, to encour-
age emotional awareness and weaken the patient's avoidance of emo-
tional experiences and interpersonal closeness. Common emphases of
ISTDP in depression tend to be working through grief about losses
and the experience and processing of buriedrage and guilt about rage re-
lated to attachment trauma in childhood. The experience of guilt about
rage appears to reduce drives to avoid closeness, to reduce self-harm
and to overcome repression of feelings related to these relational trau-
matic events. This allows working through of grief related to losses
and termination in a relatively short treatment course (Abbass, 2015).
The length of treatment was not determined at the onset of
therapy. Termination was determined by the therapist and patient
based on treatment progress. The average number of sessions in this
trial was 15. The first session was the trial therapy, lasting 90 minutes,
and the remaining sessions were 60 minutes in length. Therapists
were two registered psychologists with between 2 and 4 years of su-
pervision in ISTDP at the time of the trial. Treatment sessions were
recorded and reviewed regularly with an experienced supervisor to
ensure treatment adherence.
Outcome Measures
Measure of Depression: BDI-II
This 21-item self-report survey is one of the most commonly
used measures of depressive symptoms and assesses both the type
and severity of negative cognitions associated with depression. Fata
et al. (2003) has reported the correlation coefficient between BDI-II
and the Hamilton Depression Rating Scale in Iranian subjects as 0.66.
Reliability and validity of the test in normal and clinical populations
have been found to be acceptable (Kaviani et al., 2001).
Measure of Shifting: WCST
The computer-based version of the WCST was used in this study.
As described above, successful completion of the task requires mental
flexibility to shift between rules. Individuals must sort cards based on
different properties that change as the test continues. Outcome mea-
sures from this test include total number of categories achieved (maxi-
mum of 6) and number of preservative errors (i.e., how often does
the individual persist with the old rule set before adjusting to the
new rule set).
Measure of Inhibition: Stroop Task
The computer-based version of the Stroop task was used in the
current study. As described above, successful completion of the task re-
quires the individual to inhibit prepotent responses (i.e., reading the
color word) in favor of naming the color of the ink the word in printed
in. Thus, it is considered a measure of inhibition. Outcome measures
from this test include number of false alarms (i.e., incorrect responses
in which the word was read) and total response time.
Measure of Psychomotor Speed: Stroop Task
The typical Stroop task consists of two additional conditions:
color ink naming (no words) and word reading (black ink). Both of
these conditions offer measures of psychomotor speed (i.e., ability to
say the ink colors or words out loud) in the absence of executive pro-
cesses and consist of both number of errors and total response time.
Statistical Analysis
As a pilot study, sample size calculations were not performed.
Statistical analyses were carried using SPSS for Windows 20.0, and
all tests were performed with a two-sided p= 0.05 unless otherwise in-
dicated. Analyses were conducted on the per protocol sample due to
missing data preventing the option of an intention-to-treat analysis. Ini-
tially, differences between groups on demographic and baseline mea-
surement data were examined using tand chi-square tests.
We used linear mixed-effects models for repeated-measures
data to examine within-group changes in depression symptoms at
The Journal of Nervous and Mental Disease •Volume 204, Number 7, July 2016 ISTDP and Executive Functioning
© 2016 Wolters Kluwer Health, Inc. All rights reserved. www.jonmd.com 501
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
posttreatment and follow-up. An advantage of mixed models is its
ability to take into account all available data from all randomized
participants, thus enabling an intention-to-treat analysis (Singer and
Willett, 2003).
Based on the presence of multiple interdependent measures of
executive functioning, a multivariate analysis was deemed appropriate.
To account for differences in baselines functioning on each dependent
variable, study analyses examining the effects of treatment on execu-
tive functioning were carried out using multivariate analysis of covari-
ance (MANCOVA). Baseline scores on each dependent variable were
included in analyses as a covariate. Individual analyses of covariance
(ANCOVAs) were then conducted on the dependent variables as
follow-up tests to the MANCOVA to explore group effects on individ-
ual measures of executive functioning. The Bonferroni method was
used to control for type I erroracross the multiple ANCOVAs. To exam-
ine the magnitude of the treatment effects, reflecting the proportion of
variance attributable to the dependent variable after controlling for other
predictors, partial η
2
values are presented. Convention for interpreting
an effect size estimate from partial η
2
report indicates a small effect
as greater than 0.14, medium effect as greater than 0.36, and a large ef-
fect as greater than 0.51 (Leech et al., 2005).
RESULTS
Participants
From September 2011 to October 2012, participants were re-
cruited from a mental health outpatient clinic. In total, 40 participants
were included and allocated to either the treatment or control group.
From this sample, four patients from each group dropped out of the
study; therefore, final measures were not collected from these partici-
pants. The reason for dropout in the control group was that patients
FIGURE 1. Consolidated Standards of Reporting Trials diagram of participants in the clinical trial.
Ajilchi et al. The Journal of Nervous and Mental Disease •Volume 204, Number 7, July 2016
502 www.jonmd.com © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
preferred not to wait for treatment. In the ISTDP group, two patients
were referred for alternative treatment after session 1 because of low
psychological mindedness; one patient preferred antidepressant treat-
ment; and one patient terminated because of a change in location;
it was unclear why the final patient dropped out. The final completer
sample was 32 (n= 16 ISTDP, n= 16 wait-list).
Baseline demographic and clinical characteristics of the
two conditions were compared and no statistical differences were
found (Table 1).
Depression Outcomes
A repeated-measures linear mixed-effects model, fitted with
maximum likelihood estimation, was conducted specifying treatment
group and the linear effects of time and their interactions as fixed pre-
dictors. Random intercepts were included in the model but not the
change over time varying by participant (slope) because of insufficient
power. The dependent variable was BDI-II scores collected at baseline,
posttreatment, and 1-year follow-up. To examine the efficacy between
the ISTDP group and the control group, the fixed interaction term of
group and linear time was examined.
Mixed models analyses demonstrated significant effects for time,
F(1, 18.62) = 17.60, p= 0.0001; treatment group, F(1, 33.14) = 162.10,
p< 0.001; and the interaction of time and treatment group on BDI-II,
F(1, 17.91) = 11.03, p= 0.004. This revealed that self-reported de-
pression symptoms were significantly lower after ISTDP and in
follow-up compared with the wait-list control group (Table 2).
Posttreatment Executive Functioning Outcomes:
Psychomotor Speed
All four dependent variables were included in a MANCOVA and
significant differenceswere found between the groups on the dependent
measures, Wilks's Λ=0.58,F(4, 23) = 4.10, p=0.012. The multivariate
η
2
= 0.42 demonstrates that 42% of the variance in the three measures
of executive functioning was accounted for by treatment group.
Univariate ANCOVAs on the four measures of executive
functioning were conducted using a Bonferroni adjustment (critical
α= 0.0125). The results showed that on the color naming (response
time [RT]) and word reading (RT) task, allocation to treatment group
explained a significant proportion of the outcome variance indepen-
dent of the effect of baseline functioning, F(1, 29) = 18.15,
p<0.001, and F(1, 29) =11.64, p= 0.002, respectively. The ANCOVA
on the color naming (accuracy rate [ACC]) and word reading (ACC)
task was not significant. As can be seen in Table 3, individuals in the
wait-list group were slower on both the color naming and word reading
tasks at the posttreatment measurement compared with those in the
treatment group.
Posttreatment Executive Functioning
Outcomes: Inhibition
A MANCOVA was conducted to determine the effects of treat-
ment group on the two measures of inhibition, Stroop interference
(RT) and Stroop interference (ACC). Significant differences were
found between the groups on the dependent measures, Wilks's
Λ=0.67,F(2, 27) = 6.73, p=0.004. The multivariate η
2
= 0.33 dem-
onstrates that 33% of the variance in the three measures of executive
functioning was accounted for by treatment group.
Individual ANCOVAs on the two measures of executive func-
tioning inhibition were conducted using a Bonferroni adjustment (crit-
ical α= 0.025). The results showed that on both the Stroop interference
(RT) and Stroop interference (ACC) task, allocation to treatment group
explained a significant proportion of the outcome variance independent
of the effect of baseline functioning, F(1, 29) = 7.27, p=0.012, and
F(1, 29) = 5.91, p= 0.022, respectively. Table 3 demonstrates that
whereas participants in the wait-list group showed minimal changes
in functioning over time, participants in the treatment group had signif-
icant improvements on both tests of executive functioning.
Posttreatment Executive Functioning
Outcomes: Shifting
Analyses were conducted to examine the effect of allocation to
treatment group (ISTDP or wait-list) on the three dependent variables,
number of preservative errors made, the number of categories com-
pleted, and the number of correct response made for the WCST. All
three dependent variables were included in a MANCOVA and signifi-
cant differences were found between the groups on the dependent mea-
sures, Wilks's Λ=0.49,F(3, 25) = 10.29, p< 0.001. The multivariate
η
2
= 0.55 demonstrates that 55% of the variance in the three measures
of executive functioning was accounted for by treatment group.
Univariate ANCOVA on the three measures of executive
functioning were conducted using a Bonferroni adjustment (critical
α= 0.017). There were significant differences between the groups on
scores for number of correct responses, number of categories, and pre-
servative errors, F(1, 29) = 31.43, 23.18, and 7.84 respectively. Partic-
ipants in the treatment group experienced a significant improvement on
all three of these measures of executive functioning compared with
those in the wait-list group. Mean group data can be seen in Table 3.
DISCUSSION
Consistent with previous research in short-term psychodynamic
psychotherapy of major depression, the ISTDP treatment arm produced
treatment effects greater than controls that are maintained or increase
over time (Abbass et al., 2011; Driessen et al., 2015). This preliminary
result is important given that the treatment is brief and relatively cost-
effective. Considering how common major depression is and how chal-
lenging it is for governments to fund publicly available psychotherapy
services, such brief methods need to be developed (Lazar, 2014).
The primary objective of this pilot study was to examine the
extent to which the treatment of depression using psychodynamic the-
rapy, specifically ISTDP, might alter executive functioning. Consis-
tent with our original hypotheses, our results indicate that modest
TABLE 1. Descriptive Statistics of Demographic Variables
Control Group Experimental Group
n%n%
Sex
Male 13 81.3 10 62.5
Female 3 18.8 6 37.5
Age, yrs
<20 0 0 1 6.3
20–24 12 75 6 37.5
25–29 2 12.5 6 37.5
30–34 1 6.3 2 12.5
35–39 1 6.3 1 6.3
Education
High school 2 12.5 3 18.8
Bachelor 14 87.5 10 62.5
Master 0 0 2 12.5
PhD 0 0 1 6.3
Marital status
Single 11 68.8 12 75
Married 4 25 2 12.5
Divorced 1 6.3 2 12.5
The Journal of Nervous and Mental Disease •Volume 204, Number 7, July 2016 ISTDP and Executive Functioning
© 2016 Wolters Kluwer Health, Inc. All rights reserved. www.jonmd.com 503
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
improvements were observed on most tests of executive functioning.
Relative to wait-list controls, participants in the treatment group were
found to have improved scores, when compared with baseline, on mea-
sures of psychomotor speed (color naming and word reading), ability to
inhibit prepotent responses (Stroop task), and novel problem solving and
set shifting (WCST). The largest gains (i.e.,effectsizes)werefoundon
measures of psychomotor speed (word reading) and set shifting
(WCST), both of which showed moderate effect sizes.
These results are encouraging and, consistent with previous stud-
ies using other variants of psychotherapy such as CBTand MCT (e.g.,
Bostanov et al., 2012; Groves et al., 2015), do suggest that treatment
of underlying depression may improve cognitive processes such as
attention and executive functioning. However, we must be cautious
not to overinterpret the findings from this pilot study. Although the
measures used here have a solid grounding in the neuropsychological
literature with respect to measurement of executive processes, the
relationship between these measures and real-world engagement in
activities of daily living is not so clear. Our results are an impor-
tant step in establishing links between depression, cognition, and an in-
dividual's ability to operate in the world and further support the far
reaching effectiveness of talk therapy. Future studies should endeavor
to include assessment of activities of daily living in addition to execu-
tive processing.
There is relatively sparse data on neurocognitive changes in
patients receiving psychodynamic therapy and none specif ically on
patients receiving the ISTDP model. The current findings are consistent
with the cognitive improvements seen after long-term psychodynamic
psychotherapy reported by Yazigi et al. (2011), which demonstrated
increased attention capacity and processing speed in Wechsler neuro-
logical tests (Wechsler Adult Intelligence Scale). A second study of
long-term psychodynamic psychotherapy (Bastos et al., 2013) also
found wide-ranging changes in cognitive performance including atten-
tion, working memory, mental flexibility, psychomotor skills, visual
processing speed, and executive function. Although the relative differ-
ences in treatment length between these psychodynamic therapies is
notable, both consistently found positive changes posttreatment in neuro-
cognitive functioning. Bastos et al. (2013) also found that treatment
gains were maintained 1 year after treatment. Further research is neces-
sary to examine whether long-term cognitive functional changes are
also observed in short-term variants of psychodynamic therapy.
To the best of our knowledge, this is the first evaluation study of
a short-term variant of psychodynamic therapy for major depression to
include measurement of cognitive functioning. Strengths of the study
include the use of a randomized control design, standardized evaluation
of executive functioning before and after treatment, and implementation
of a controlled trial within a naturalistic health setting such that results
should have greater generalizability to routine practice. Notable limita-
tions of this study include a small sample size and the lack of follow-up
data to report on the maintenance of the observed cognitive improve-
ments. Although there was regular independent review of recordings
TABLE 3. Outcome Scores on the BDI-II and Performance on Measures of Psychomotor Speed, Inhibition, Shifting, and Sustained Attention
Controls Experimental
MANCOVAPre Post Pre Post
Mean SD Mean SD Mean SD Mean SD F(1, 24) Effect Size
Psychomotor speed
Stroop color naming (ACC) 98.8 3.5 97.5 3.83 99.8 1 99.75 1 4.28* 0.13
Stroop color naming (RT) 1.05 1.25 1.22 0.27 1.12 0.2 0.92 1 18.15* 0.39
Stroop word reading (ACC) 100 0 97.5 3.83 99 1.8 99.75 1 3.98 0.12
Stroop word reading (RT) 0.94 0.12 1.09 0.21 1.02 0.2 0.9 0.09 11.64* 0.29
Inhibitory Control
Stroop interference (ACC) 97.3 6.2 96.25 4.49 89.8 2.8 99.5 1.37 7.28** 0.2
Stroop interference (RT) 1.31 0.3 1.3 0.26 1.15 0.4 1.05 0.24 5.91** 0.17
Shifting
Number of categories 3.5 0.5 3.25 0.68 3.6 0.9 4.31 0.6 23.18* 0.44
Preservative errors 11.6 4.5 11 3.98 10.8 4.6 7.5 2.75 7.84* 0.21
Correct response 39 5.8 37.94 6.8 39.9 8.4 48.56 6.05 31.43* 0.52
*p<0.05.
** p<0.01.
TABLE 2. Means, SDs, and Effect Sizes (Cohen's d) for Measures of Depression
Measure and
Group (BDI)
Mean (SD) Effect Size
Pretreatment Posttreatment
1-yr
Follow-up
Between Group,
Posttreatment–
Follow-up
Within Group,
Pretreatment–
Posttreatment
Within Group,
Pretreatment–1yr
Follow-up
Between
Group, 1-yr
Follow-up
ISTDP group 29.06 (8.24) 17.94 (9.29) 18.06 (9.31) −0.83 (−1.53 to −0.08) −1. 27 (−2.34 to −0.19) −1.65 (−2.66 to −0.64) −1.50 (−2.24 to −0.68)
Control group 26.69 (6.79) 25.38 (8.71) 27.94 (6.34) −0.17 (−1.15 to −0.81) −0.44 (−1.26 to 0.39)
Note: The confidence intervals (in parentheses) were calculated using the standard error and an alpha level of 0.05. A confidence interval that does not overlap 0
indicates a significance of p<0.05.
Ajilchi et al. The Journal of Nervous and Mental Disease •Volume 204, Number 7, July 2016
504 www.jonmd.com © 2016 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
to verify adherence, formal adherence measures should be utilized in
future studies.
Despite these limitations, the observed results remain consistent
with existing research that point to improved cognitive functioning after
psychodynamic psychotherapy therapy for depression. In line with
these findings, future research that includes functional brain imaging
before and after treatment alongside formal cognitive function assess-
ment is warranted (Abbass et al., 2014).
DISCLOSURE
The authors declare no conflicts of interest.
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The Journal of Nervous and Mental Disease •Volume 204, Number 7, July 2016 ISTDP and Executive Functioning
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