496 | Healio.com/Psychiatry PSYCHIATRIC ANNALS 43:11 | NOVEMBER 2013 C M E T he health care burden of chronic disability, with mental illness and somatic symptom disorders leading the way, is crippling to global economies. 1 In the recent JAMA report by the U.S. Burden of Disease Collabo- rators, the top diseases with the largest number of years lived with disability in 2010 were low back pain, major depres- sive disorder, other musculoskeletal dis- orders, neck pain, and anxiety disorders. Migraine, drug use, alcohol use and dys- thymia were also in the top 20. The au- thors noted that half of the health system cost is due to disability and morbidity. 1 Based on extensive research dur- ing the past 20 years, psychotherapy is now acknowledged to be an effective and cost-effective treatment for a broad range of conditions. 2 Given evidence that psychotherapy is beneficial, the relative cost of treatment has become an important consideration in clinical decision making. 3 With this in mind, the shorter and less expensive a psycho- therapy model can be while retaining ef- fectiveness, the greater the effect it can have on widespread health system costs. Based on long wait lists and wait times for long-term psychotherapy in public clinics, Habib Davanloo, MD, of McGill University developed his method of intensive short-term dynamic psycho- therapy (ISTDP) between the 1970s and 2000s. 4 Thus, two major reasons for this development were to improve service access and to reduce service cost per patient in publically funded Canadian medicine. ISTDP is a brief treatment designed to achieve broad-based gains across symptoms and personality difficulties. At its core, the objective of ISTDP is to help patients overcome emotional blocks that lead to occupational disabil- ity, somatic symptoms, depression, anx- iety, and self-defeating behaviors. The method includes a specialized series of interventions designed to overcome high levels of resistance, low levels of emo- tional tolerance (depression, somatiza- tion, conversion), and dissociation (frag- ile character structure). ISTDP has been The Cost-Effectiveness of Intensive Short-Term Dynamic Psychotherapy 1. Expose the reader to various sources of health care costs and diagnoses responsible for these. 2. Review the evidence for multiple categories of cost reduction for intensive short-term dynamic psychotherapy (ISTDP). 3. Review the return-to-work rates for patients receiving ISTDP treatment. Allan Abbass, MD, FRCPC, is Professor and Director of Education, as well as Di- rector, Centre for Emotions and Health, Dalhousie University Department of Psychiatry. Jeffrey W. Katzman, MD, is Professor and Vice Chair, Education and Academic Affairs, University of New Mex- ico Department of Psychiatry. Address correspondence to: Allan Ab- bass MD, FRCPC, Room 8203, 5909 Veter- ans Memorial Lane, Halifax NS, Canada B3H 2E2; email: allan.abbass@dal.ca. Disclosure: Drs. Abbass and Katzman have no relevant financial relationships to disclose. doi: 10.3928/00485713-20131105-04 EDUCATIONAL OBJECTIVES C M E Allan Abbass, MD, FRCPC; and Jeffrey W. Katzman, MD © Shutterstock Psychiatric Annals - Proof Copy