Title: Improving psychodynamic psychotherapy in primary care: An evaluation and feasibility study of dynamic interpersonal therapy (DIT) training and practice
Funder: Department of Health (England)

Abstract: Background Psychosocial treatments for depression are as effective as medication and are often preferred by clients. The NICE guidelines identify Short Term Psychodynamic Psychotherapy (STPP) as a potential approach for those who have declined other therapies. However, the evidence base for STPPs is small and mixed, due to lack of standardized procedures rather than inherent problems with effectiveness. Dynamic Interpersonal Therapy (DIT), which integrates evidence based psychodynamic treatment models, has been adopted by IAPT as the “prototype” for STPP but research is needed to determine (a) the feasibility and effectiveness of DIT training in the context of the IAPT programme, (b) for whom DIT is indicated and (c) the effectiveness of DIT compared to other evidence-based psychotherapies. Aims This project comprises three interlinked studies. Study A will investigate the feasibility and efficacy of using the DIT training programme and manual to establish DIT as a routine component within IAPT services. Study B will develop consensus guidelines and a clinical protocol to identify clients for whom DIT is likely to be the most effective intervention, and will gather preliminary data on the likely numbers of patients meeting these guidelines. Study C will benchmark the results likely to be achieved using this method in routine practice to quality assure the service and the training for service users and comissioners. Together these studies will create a platform to establish the effectiveness of DIT as delivered in routine service settings, through RCT comparison of DIT and CBT. Plan of Investigation Months 1-9 • Study A: Recruitment and training of 14 therapists from the 3 IAPT sites. After the 5-day training their capacity to achieve appropriate levels of adherence and competence in delivery of DIT will be measured by objective assessors. • Study B: Development of consensus guidelines and a clinical protocol through use of 3 expert panels who will revise an initial questionnaire using the modified Delphi method. Months 10-21 • Study C: Recruitment and treatment period for pilot RCT feasibility study trial of DIT Wait list comparator sub-study (Newham & Tower Hamlets): 100 participants to be randomized to DIT or enhanced wait list/holding protocol (EWLP. High intensity comparator sub-study (Camden): 40 patients to be randomized to CBT or DIT. Months 22-24 • Analysis/writing up Potential Impact If a brief training programme can suffice to turn generically trained psychodynamic practitioners into therapists with specific competence in treating mood disorder this can create savings for the NHS in retraining practitioners already in its workforce. Developing and implementing the clinical protocol for allocating clients to therapies to which they are most suited will have immediate benefits for a range of stakeholders: It will assist clinicians to work towards rational treatment decisions, aid patients in treatment choice, and help commissioners to plan adequate capacity. It is critical to benchmark the effectiveness of DIT in an IAPT service and hence to ensure that it is at least as effective as the alternative interventions offered by IAPT.


Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH