Dismissed for decades, psychodynamic therapy shows gains in schizophrenia that grow over three years
STUDY: Montag C et al, Lancet Psychiatry 2026
STUDY TYPE: Randomized controlled trial
FUNDING: Berlin Institute of Health and other German academic and nonprofit foundations
Background
Psychodynamic psychotherapy for schizophrenia has fallen out of use after early trials found no benefit for psychotic symptoms. This trial tested a modified version for overall functioning.
The Study
- 130 Berlin outpatients aged 18-64 with schizophrenia or schizoaffective disorder, randomized to weekly psychodynamic therapy (30-plus sessions) plus usual care, or usual care alone.
- Assessed at baseline, 24-month post-treatment, and 36-month follow-up; 129 analyzed by intention to treat.
- Primary outcome: psychosocial functioning (Mini-ICF-APP), plus positive and negative symptoms.
Results
Psychosocial functioning improved more with therapy at post-treatment (effect size 0.70) and continued improving by 36 months (effect size 0.93). Negative symptoms improved similarly (0.83 and 1.07).
Therapy improved general psychopathology at post-treatment but not follow-up; positive symptoms and depression didn’t differ between groups.
Side Effects
No differences between groups.
Limitations
High drop out rate at 36 months; lack of blinding; usual care wasn’t matched for contact time.
Practice Implications
- This is the first adequately powered randomized trial of manualized psychodynamic therapy in schizophrenia. Although it did not treat psychotic symptoms directly, it brought other gains that grew over three years.
- Consider it as an add-on for stable outpatients with negative symptoms.
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
