Differential effects of brief psychodynamic therapy on depression in chronic pain: Insights from a randomized multicenter study

Background and aims Chronic pain conditions such as fibromyalgia (FM), chronic migraine (CM), and their comorbid form (FibroMig) are frequently associated with psychological distress. Although brief psychological interventions are increasingly used in clinical practice, direct comparisons between psychodynamic and expressive approaches are limited. This study examined the short-term efficacy of brief psychodynamic therapy (BPT) compared with expressive writing technique (EWT) and treatment as usual (TAU), focusing on depressive symptoms. Method Women aged 18–65 years with FM, CM, or FibroMig were randomized to BPT, EWT, or TAU. Assessments were conducted at baseline (T0) and post-treatment (T1). Outcomes included pain intensity (VAS), central sensitization (CSI), quality of life (SF-12), anxiety (GAD-7), mental pain (MPQ), and depression (PHQ-9). Three-way repeated-measures ANOVAs tested the effects of time, diagnosis, and treatment. Results The final sample included 101 participants (20 BPT, 40 EWT, 41 TAU). At baseline, diagnostic differences were observed in central sensitization and physical quality of life, but not in anxiety or depression. No treatment-related changes emerged for pain, central sensitization, anxiety, mental pain, or physical functioning. A significant treatment effect was found for depressive symptoms, with a time × treatment interaction indicating greater PHQ-9 reduction in BPT compared with EWT and TAU. Mental quality of life improved across all groups. Discussion Findings indicate a selective and consistent effect of BPT on depression across chronic pain diagnoses. Conclusion BPT appears to be a feasible and effective brief intervention for depressive symptoms in FM, CM, and FibroMig. References 1. Fitzcharles, M. A., Cohen, S. P., Clauw, D. J., Littlejohn, G., Usui, C., & Häuser, W. (2021). Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet (London, England), 397(10289), 2098–2110. https://doi.org/10.1016/S0140-6736(21)00392-5. 2. Fonagy, P., Lemma, A., Target, M., O'Keeffe, S., Constantinou, M. P., Ventura Wurman, T., Luyten, P., Allison, E., Roth, A., Cape, J., & Pilling, S. (2020). Dynamic interpersonal therapy for moderate to severe depression: a pilot randomized controlled and feasibility trial. Psychological medicine, 50(6), 1010–1019. https://doi.org/10.1017/S0033291719000928. 3. Romeo, A., Di Tella, M., Perutelli, V., Galli, F., Geminiani, G. C., & Castelli, L. (2025). A randomised pilot study comparing brief psychodynamic therapy with cognitive-behavioural therapy in the treatment of patients with fibromyalgia. Journal of psychiatric research, 190, 145–153. https://doi.org/10.1016/j.jpsychires.2025.07.037.