Addiction and ISTDP Therapy

The painful events of our lives and the suffering we undergo in response is such that it fully occupies us each, “no matter whether the suffering is great or little” (Frankl, 1984). For people swayed by addictive or compulsive behaviours, that suffering is being responded to in a way that feels like the best possible option available.
 
One conceptualization of addiction centres around the idea that such behaviour is not so much directly caused by traumatic event(s), but rather stems from the subsequent “frozen residue of energy that has not been resolved and discharged” which “remains trapped in the nervous system” (Levine, 1997) – in other words, that addictive behaviour is an attempt to avoid or soothe this frozen residue of energy, or to put it even more simply, an attempt to avoid or soothe the feelings that resulted from a traumatic event.

I believe ISTDP (Intensive Short Term Dynamic Psychotherapy - Davanloo, 1990, 2000) is an extremely valuable intervention in the case of addictive behaviour. It addresses the role of the unconscious in the aforementioned ‘trapping’ and seeks to remove the obstacles to the processing of emotions which are locked in the body – the external and internal behaviours that constitute the “false front, the wall, the dam” which the individual is perhaps unconsciously maintaining, afraid that if they do not, “then everything will be swept away in the violence of their feelings” (Rogers, 1961). This wall might have developed as a protective measure against feelings once learned to be intolerable or unacceptable, but which perhaps then becomes the cage in which an individual finds themselves trapped (Kernberg, 1980).

ISTDP aims to explore the unconscious system which fuels compulsivity; it is tailored to an individual’s capacity to tolerate and process the complex emotional states that once overwhelmed them (Johansson et al., 2014) and includes a “Graded Format” that helps to create increased capacity to tolerate, and thus a reduction in, anxiety (Town et al., 2017).
 
This unique modality directly addresses the issue of intolerable emotion that is, for me, at the core of addictive behaviour. It’s also notable that cost effectiveness - a result of lower treatment times - is indicated with ISTDP (Abbass, 2006; Abbass & Katzman, 2013; Town et al., 2013; Abbass et al., 2015; Solbakken & Abbass, 2016; Abbass et al., 2019), another very good reason why this intervention seems appropriate for people with addictive behaviours - a demographic for whom many barriers to therapy exist.

Abbass, A. (2006). Intensive short-term dynamic psychotherapy of treatment-resistant depression: A pilot study. Depression and Anxiety. Vol. 23, pp. 449-452. doi: 10.1002/da.20203 
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Abbass, A. & Katzman, J. (2013). The cost-effectiveness of intensive short-term dynamic psychotherapy. Psychiatric Annals. Vol. 43, pp. 496–501. https://doi.org/10.3928/00485713-20131105-04. 
 
Abbass, A., Kisely, S., Rasic, D., Town, J.M. & Johansson, R. (2015). Long-term healthcare cost reduction with Intensive Short-term Dynamic Psychotherapy in a tertiary psychiatric service. Journal of Psychiatric Research. Vol. 64, pp. 114–120. https://doi.org/10.1016/j.jpsychires.2015.03.001. 
 
Abbass, A., Town, J., Johansson, R., Lahti, M., Kisely, S. (2019). Sustained reduction in health care service usage after adjunctive treatment of Intensive Short-Term Dynamic Psychotherapy in patients with Bipolar Disorder. Psychodynamic Psychiatry. Vol. 47, pp. 99–112. https://doi.org/10.1521/pdps.2019.47.1.99. 
 
Davanloo, H. (1990). Unlocking the Unconscious: Selected Papers of Habib Davanloo, MD. John Wiley & Sons: Chichester, England. 
 
Davanloo, H. (2000). Intensive Short-Term Dynamic Psychotherapy: Selected Papers of Habib Davanloo, MD. John Wiley & Sons: Chichester, England. 
 
Frankl, V. E. (1984). Man's Search for Meaning: An Introduction to Logotherapy. Simon & Schuster: New York, NY. 
 
Johansson, R., Town, J. M., & Abbass, A. (2014). Davanloo’s Intensive Short-Term Dynamic Psychotherapy in a tertiary psychotherapy service: overall effectiveness and association between unlocking the unconscious and outcome. PeerJ 2, e548. https://doi.org/10.7717/peerj.548. 
 
Kernberg, O. (1980). Internal World and External Reality. Aronson: New York, NY. 
 
Levine, P. A. (1997). Waking the Tiger: Healing Trauma: the Innate Capacity to Transform Overwhelming Experiences. North Atlantic Books: California, CA. 
 
Rogers, C.R. (1961). On Becoming a Person. Houghton Mifflin.
 
Solbakken, O.A. & Abbass, A. (2016). Symptom- and personality disorder changes in intensive short-term dynamic residential treatment for treatment-resistant anxiety and depressive disorders. Acta Neuropsychiatrica. Vol. 28, pp. 57–271. https://doi.org/10.1017/neu.2016.5. 
 
Town, J. M., Abbass, A., & Bernier, D. (2013). Effectiveness and cost effectiveness of Davanloo’s intensive short-term dynamic psychotherapy: Does unlocking the unconscious make a difference? American Journal of Psychotherapy. Vol. 67, pp. 89–108. 
 
Town, J. M., Falkenström, F., Salvadori, A., Bradley, S., & Hardy, G. (2017). Is affect experiencing therapeutic in major depressive disorder? Examining associations between affect experiencing and changes to the alliance and outcome in intensive short-term dynamic psychotherapy. Psychotherapy. Vol. 54 (2), pp. 148–158. doi: 10.1037/pst0000108