Discontinuities and cognitive changes in an exposure-based cognitive therapy for depression

Change in emotional processing during a dialectical behavior therapy-based skills group for major depressive disorder

Across studies, paying attention to and analyzing one's emotions has been found to be both positively and negatively correlated with depression symptoms. One way of reconciling these seemingly contradictory findings is the possibility that attending to emotions in a skillful manner may help to reduce depression whereas attending to emotions with limited skill may be counterproductive. Dialectical behavior therapy (DBT) is a clinical intervention designed to foster adaptive awareness, expression, regulation, tolerance, and acceptance of emotions. Results of the present report come from a pilot study of a 16-week DBT-based skills training group for treatment-resistant major depressive disorder (MDD) as an adjunctive treatment to pharmacotherapy. Patients were randomized to treatment or a waitlist control group. A significant interaction revealed that increases in emotional processing were associated with decreases in depression symptoms in the DBT-based skills group; however, increases in emotional processing in the waitlist condition were associated with increases in depression. Results offer preliminary support for the idea that participating in DBT-based skills training may help individuals with treatment-resistant MDD to develop skills that facilitate processing emotions in a way that helps to reduce rather than exacerbate depression symptoms.

Common genetic, clinical, demographic and psychosocial predictors of response to pharmacotherapy in mood and anxiety disorders

The aim of this study is to summarize available knowledge about common genetic, clinical, demographic and psychosocial predictors of response to pharmacotherapy in mood and anxiety disorders. A literature search was carried out by using MEDLINE and references of selected articles. The search included articles published up to March 2008. The main genetic finding concerns the serotonin transporter gene promoter polymorphisms, the long variant of which seems to be related to a positive response to therapy in mood disorders and could also have a role in the treatment of anxiety disorders. Among other predictors, the main factors common to both classes of disorder are comorbid axis II disorders and early onset of illness, which are related to a worse response to therapy and concomitant good physical conditions, absence of earlier treatments, early administration and response to therapies, and higher self- directedness, which is related to a better outcome. Many common predictors have been identified and these seem to be related to features covering the totality of patients that go beyond specific characteristics of single disorders. Possible limitations and suggestions for future research based on a more integrated vision of human complexity are discussed.

Zur Funktion der nonverbalen Stimmungsmodulation des Therapeuten für den Therapieprozess und Sitzungserfolg

Zusammenfassung. Theoretischer Hintergrund: Nonverbale Modulationsprozesse in der Therapeuten-Patienten-Interaktion werden in den letzten Jahren zunehmend emotionsspezifisch konzeptualisiert. Fragestellung: Modulieren die Therapeuten die Stimmung der Patienten emotionsspezifisch und welche Bedeutung hat die nonverbale Modulation auf das Sitzungsergebnis. Methode: Mittels des für die vorliegende Studie entwickelten Emotion-Rating-Inventars II (EMORATE-II) werden 84 verhaltenstherapeutische Sitzungen zu Therapiebeginn auf die nonverbale und konzeptuelle ( Gross, 2007 ) Emotionsmodulation des Therapeuten untersucht. Dieses Video-Rating Verfahren bildet mit relativ geringem Aufwand wesentliche in der Literatur beschriebene stimmungsmodulierende Strategien im Therapieprozess ab. Ergebnisse: Die Therapeuten modulieren die Emotionen ihrer Patienten sowohl nonverbal als auch konzeptuell. Den größten Zusammenhang ergibt sich in der zusammengefassten Skala „nonverbale Modulation” des Therapeuten, welche sich durch die Gegenmodulation angespannter Stimmung und der Verstärkung begeisterter Stimmung auszeichnet. Schlussfolgerungen: Nonverbale Modulationsprozesse der Therapeuten sind bedeutsame Prädiktoren für den Sitzungserfolg. Die Emotionsmodulation der Therapeuten erfolgt emotionsspezifisch.

Written emotional disclosure: a controlled study of the benefits of expressive writing homework in outpatient psychotherapy

The current study investigated the extent to which outpatient psychotherapy clients benefited from Pennebaker's expressive writing protocol (Pennebaker & Beall, 1986) adapted for use as a homework intervention. Participants were randomly assigned to written emotional disclosure or writing control conditions. Pre- and postintervention outcome measures were collected for three consecutive therapy sessions. Clients in the written emotional disclosure group showed significantly greater reductions in anxiety and depressive symptoms as well as greater overall progress in psychotherapy in comparison to the writing control group. Results suggest that emotional disclosure writing homework, in conjunction with outpatient psychotherapy, facilitates therapeutic process and outcome.

Cognitive Behavioural Therapy for Mood Disorders

This paper provides a selected review of recent studies highlighting key aspects of mood disorders research. Cognitive models and clinical trials of cognitive therapy of depression are evolving and adapting to increase applicability to the spectrum of depressive symptoms and syndromes experienced by clients, as well exploring beyond acute phase treatment to relapse prevention. In contrast, cognitive models of bipolar disorders and the effectiveness of the therapy are unclear and there are more questions than answers for researchers in this area.