A psychodynamic therapy for schizophrenia shows functional gains at three years

Design

Prospective, single-centre, assessor-blinded, parallel-group randomised controlled trial

Population

130 outpatients with schizophrenia or schizoaffective disorder

Primary outcome

Psychosocial functioning (Mini-ICF-APP) at 24 and 36 months

Effect

Adjusted difference −3.45 (−5.51 to −1.40) at 24 months; −4.07 (−6.19 to −1.94) at 36 months

Psychodynamic psychotherapy has long been used in schizophrenia-spectrum disorders but has had little trial support. This single-centre randomised trial assigned 130 outpatients with schizophrenia or schizoaffective disorder to a manualised modified psychodynamic psychotherapy of at least 30 sessions plus usual care, or usual care alone, with masked outcome assessors.

Psychosocial functioning favoured the intervention, with adjusted between-group differences on the Mini-ICF-APP of −3.45 at 24 months and −4.07 at 36 months (lower scores mean better functioning). Adverse events were similar between groups.

The result widens the evidence-based options for the interpersonal difficulties that standard care leaves unaddressed. Two caveats temper it: a single site limits generalisability, and only the assessors were blinded — participants and therapists were not — which can inflate an effect in a subjective outcome. It positions psychodynamic therapy as one option alongside established psychosocial treatments, not above them.

• Adjusted Mini-ICF-APP difference favoured therapy at 24 months (−3.45, 95% CI −5.51 to −1.40) and 36 months (−4.07, −6.19 to −1.94).
• The intervention was a manualised psychodynamic therapy of at least 30 sessions added to usual care.
• Adverse events were similar between arms.
• Consider structured psychotherapy for persistent interpersonal and functional difficulties, as one option among evidence-based psychosocial treatments.

Why it matters

It gives empirical backing to a widely used but poorly evidenced therapy for the functional problems standard care neglects.

Don't overread it

Single-centre, with only assessors blinded — an open-label design can exaggerate benefit on a subjective functioning scale.

The statistics, in plain English

On the Mini-ICF-APP a lower score is better, so the negative between-group differences favour the therapy; the intervals staying below zero make the benefit unlikely to be chance, though a 3–4 point shift is a modest functional change.

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