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Cornelius JT. Two Perspectives of Mental Distress. PSYCHOANALYTIC INQUIRY 2021. [DOI: 10.1080/07351690.2021.1983407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Chaimowitz G, Weerasekera P, Ravitz P. Psychotherapy in Psychiatry. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2021; 66:999-1004. [PMID: 34871512 PMCID: PMC8652312 DOI: 10.1177/07067437211040958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Gary Chaimowitz
- Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Priyanthy Weerasekera
- Professor Emeritus, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario
| | - Paula Ravitz
- Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
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Çitak S, Avci SH, Kahraman BB. The effectiveness of short-term psychodynamic psychotherapy in depression and anxiety disorders. PSYCHODYNAMIC PRACTICE 2021. [DOI: 10.1080/14753634.2021.1951825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Serhat Çitak
- İstanbul Medeniyet University, Department of Psychiatry, Istanbul, Turkey
| | - Selma Hilal Avci
- İstanbul Medeniyet University, Department of Psychiatry, Istanbul, Turkey
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Nolte S, Busija L, Berger T, Meyer B, Moritz S, Rose M, Schröder J, Späth-Nellissen C, Klein JP. Do sociodemographic variables moderate effects of an internet intervention for mild to moderate depressive symptoms? An exploratory analysis of a randomised controlled trial (EVIDENT) including 1013 participants. BMJ Open 2021; 11:e041389. [PMID: 33500282 PMCID: PMC7839881 DOI: 10.1136/bmjopen-2020-041389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To explore the moderating effects of sociodemographic variables on treatment benefits received from participating in an internet intervention for depression. DESIGN Randomised, assessor-blind, controlled trial. SETTING Online intervention, with participant recruitment using multiple settings, including inpatient and outpatient medical and psychological clinics, depression online forums, health insurance companies and the media (eg, newspaper, radio). PARTICIPANTS The EVIDENT trial included 1013 participants with mild to moderate depressive symptoms. INTERVENTIONS The intervention group subjects (n=509) received an online intervention (Deprexis) in addition to care as usual (CAU), while 504 participants received CAU alone. METHODS To explore subgroup differences, moderating effects were investigated using linear regression models based on intention-to-treat analyses. Moderating effects included sex, age, educational attainment, employment status, relationship status and lifetime frequency of episodes. PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint was change in self-rated depression severity measured by the Patient Health Questionnaire-9 (PHQ-9), comparing baseline versus 12-week post-test assessment. Secondary outcome measures were the Hamilton Rating Scale for Depression and the Quick Inventory of Depressive Symptoms each at 12 weeks and at 6 and 12 months, and PHQ-9 at 6 and 12 months, respectively. In this article, we focus on the primary outcome measure only. RESULTS Between-group differences were observed in post-test scores, indicating the effectiveness of Deprexis. While the effects of the intervention could be demonstrated across all subgroups, some showed larger between-group differences than others. However, after exploring the moderating effects based on linear regression models, none of the selected variables was found to be moderating treatment outcomes. CONCLUSIONS Our findings suggest that Deprexis is equally beneficial to a wide range of people; that is, participant characteristics were not associated with treatment benefits. Therefore, participant recruitment into web-based psychotherapeutic interventions should be broad, while special attention may be paid to those currently under-represented in these interventions. TRIAL REGISTRATION NUMBER NCT01636752.
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Affiliation(s)
- Sandra Nolte
- Medical Department, Division of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ljoudmila Busija
- Research Methodology Division, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Björn Meyer
- Research Department, GAIA AG, Hamburg, Germany
- Department of Psychology, City University London, London, UK
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Rose
- Medical Department, Division of Psychosomatic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johanna Schröder
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
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Rao AS, Lemma A, Fonagy P, Sosnowska M, Constantinou MP, Fijak-Koch M, Gelberg G. Development of dynamic interpersonal therapy in complex care (DITCC): a pilot study. PSYCHOANALYTIC PSYCHOTHERAPY 2019. [DOI: 10.1080/02668734.2019.1622147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Amra S Rao
- East London Foundation Trust, London, UK
| | | | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud Centre, London, UK
| | | | - Matthew P Constantinou
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Solms ML. The Neurobiological Underpinnings of Psychoanalytic Theory and Therapy. Front Behav Neurosci 2018; 12:294. [PMID: 30564106 PMCID: PMC6288296 DOI: 10.3389/fnbeh.2018.00294] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/13/2018] [Indexed: 11/13/2022] Open
Abstract
This paper sets out the neurobiological underpinnings of the core theoretical claims of psychoanalysis. These claims concern (1) innate emotional needs, (2) learning from experience, and (3) unconscious mental processing. The paper also considers the neurobiological underpinnings of the mechanisms of psychoanalytic treatment-a treatment which is based on the aforementioned claims. Lastly, it reviews the available empirical evidence concerning the therapeutic efficacy of this form of treatment.
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Frederickson JJ, Messina I, Grecucci A. Dysregulated Anxiety and Dysregulating Defenses: Toward an Emotion Regulation Informed Dynamic Psychotherapy. Front Psychol 2018; 9:2054. [PMID: 30455650 PMCID: PMC6230578 DOI: 10.3389/fpsyg.2018.02054] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 10/05/2018] [Indexed: 11/26/2022] Open
Abstract
One of the main objectives of psychotherapy is to address emotion dysregulation that causes pathological symptoms and distress in patients. Following psychodynamic theory, we propose that in humans, the combination of emotions plus conditioned anxiety due to traumatic attachment can lead to dysregulated affects. Likewise, defenses can generate and maintain dysregulated affects (altogether Dysregulated Affective States, DAS). We propose the Experiential-Dynamic Emotion Regulation methodology, a framework to understand emotion dysregulation by integrating scientific evidence coming from the fields of affective neuroscience and Experiential-Dynamic Psychotherapy aimed at resolving DAS. This method and the techniques proposed can be integrated within other approaches. Similarities and differences with the Cognitive model of emotion regulation and cognitive-behavioral approaches are discussed within the paper.
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Affiliation(s)
| | - Irene Messina
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padova, Italy
| | - Alessandro Grecucci
- Department of Psychology and Cognitive Sciences, University of Trento, Trento, Italy
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Scandurra C, Picariello S, Scafaro D, Bochicchio V, Valerio P, Amodeo AL. Group Psychodynamic Counselling as a Clinical Training Device to Enhance Metacognitive Skills and Agency in Future Clinical Psychologists. EUROPES JOURNAL OF PSYCHOLOGY 2018; 14:444-463. [PMID: 30008956 PMCID: PMC6016038 DOI: 10.5964/ejop.v14i2.1528] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/14/2018] [Indexed: 11/20/2022]
Abstract
Metacognitive skills and agency are among the main psychological abilities a clinical psychologist should have. This study aimed to assess the efficacy of group psychodynamic counselling as a clinical training device able to enhance metacognitive skills and agency in final-year undergraduates in clinical psychology within an educational context. Thirty-three final-year students of clinical psychology participated in an experiential laboratory lasting two months. Participants completed measures regarding metacognitive skills and agency at pre-, post-treatment, and 3-month follow-up assessment. The results suggested that group psychodynamic counselling made students feel more capable of recognizing emotional states, understanding causal relationships, inferring mental states of others in terms of beliefs, desires, intentions, and expectations, and thinking critically. Furthermore, the group psychodynamic counselling helped students to feel more able to derive pathways to desired goals and to motivate themselves via agency thinking to use those pathways. Thus, the study confirmed the efficacy of group psychodynamic counselling as a clinical training device able to enhance metacognitive skills and agency in future clinical psychologists.
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Affiliation(s)
- Cristiano Scandurra
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | | | - Daniela Scafaro
- SInAPSi Center, University of Naples Federico II, Naples, Italy
| | | | - Paolo Valerio
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Anna Lisa Amodeo
- Department of Humanistic Studies, University of Naples Federico II, Naples, Italy
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Kennedy KG. Advocacy for Psychodynamic Psychotherapy: Challenges and Benefits. Psychiatr Clin North Am 2018; 41:289-303. [PMID: 29739527 DOI: 10.1016/j.psc.2018.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Psychodynamic psychotherapy, also called psychodynamic therapy (PDT), is an effective mental health treatment that is currently under siege on several fronts. It is at risk of being effectively excluded from the future of American health care. Psychiatrists need to learn how to advocate for a future mental health care delivery system that assures their patients have access to PDT. This article examines the stigma against both psychiatrists and PDT, identifies some of the challenges to advocacy that psychiatrists face, and offers an approach to developing the necessary skills that psychiatrists need to advocate effectively for PDT.
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Yakeley J. Psychoanalysis in modern mental health practice. Lancet Psychiatry 2018; 5:443-450. [PMID: 29574047 DOI: 10.1016/s2215-0366(18)30052-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/13/2018] [Accepted: 01/18/2018] [Indexed: 01/09/2023]
Abstract
Like any discipline, psychoanalysis has evolved considerably since its inception by Freud over a century ago, and a multitude of different psychoanalytic traditions and schools of theory and practice now exist. However, some of Freud's original ideas, such as the dynamic unconscious, a developmental approach, defence mechanisms, and transference and countertransference remain essential tenets of psychoanalytic thinking to this day. This Review outlines several areas within modern mental health practice in which contemporary adaptations and applications of these psychoanalytic concepts might offer helpful insights and improvements in patient care and management, and concludes with an overview of evidence-based psychoanalytically informed treatments and the links between psychoanalysis, attachment research, and neuroscience.
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Affiliation(s)
- Jessica Yakeley
- Portman Clinic, The Tavistock and Portman NHS Foundation Trust, London, UK.
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Abstract
This paper summarises the core scientific claims of psychoanalysis and rebuts the prejudice that it is not 'evidence-based'. I address the following questions. (A) How does the emotional mind work, in health and disease? (B) Therefore, what does psychoanalytic treatment aim to achieve? (C) How effective is it?
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Affiliation(s)
- Mark Solms
- University of Cape Town, South Africa; email
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Solms M. Psicoanalisi e ricerca scientifica. PSICOTERAPIA E SCIENZE UMANE 2018. [DOI: 10.3280/pu2018-001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Vengono riassunte le affermazioni centrali della psicoanalisi, e date sintetiche risposte alle seguenti tre domande: (a) Come funziona la mente emotiva, nella salute e nella malattia? (b) Cosa si propone di raggiungere il trattamento psicoanalitico? (c) Quanto è efficace il trattamento psicoanalitico? Viene argomentato che, mentre possono esservi differenti opinioni su dettagli specifici, vi è un accordo su alcune affermazioni centrali della psicoanalisi, o premesse di base, che sono scientifiche in quanto verificabili e falsificabili. Queste affermazioni centrali, che sono basate sulle evidenze (evidence-based), mostrano che il trattamento psicoanalitico è altamente efficace, e per alcuni aspetti superiore alla terapia cognitivo-comportamentale e ai farmaci.
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Abstract
This article argues that the current approach to guideline development for the treatment of depression is not supported by the evidence: clearly depression is not a disease for which treatment efficacy is best determined by short-term randomised controlled trials. As a result, important findings have been marginalised. Different principles of evidence-gathering are described. When a wider range of the available evidence is critically considered the case for dynamic approaches to the treatment of depression can be seen to be stronger than is often thought. Broadly, the benefits of short-term psychodynamic therapies are equivalent in size to the effects of antidepressants and cognitive–behavioural therapy (CBT). The benefits of CBT may occur more quickly, but those of short-term psychodynamic therapies may continue to increase after treatment. There may be a ceiling on the effects of short-term treatments of whatever type. Longer-term psychodynamic treatments may improve associated social, work and personal dysfunctions as well as reductions in depressive symptoms.
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Bressi C, Fronza S, Minacapelli E, Nocito EP, Dipasquale E, Magri L, Lionetti F, Barone L. Short-Term Psychodynamic Psychotherapy with Mentalization-Based Techniques in Major Depressive Disorder patients: Relationship among alexithymia, reflective functioning, and outcome variables - A Pilot study. Psychol Psychother 2017; 90:299-313. [PMID: 27801544 DOI: 10.1111/papt.12110] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 08/16/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In depressed patients, recent advances have highlighted impairment in mentalizing: identifying and interpreting one's own or other's mental states. Short-Term Psychodynamic Psychotherapy (STPP) has proven to be effective in reducing symptoms and improving relational/functional abilities in these subjects. Therefore, the first aim of our study was to evaluate effectiveness of STPP with Mentalization-Based Techniques (STMBP) on their clinical outcomes and the second, to investigate Reflective Functioning and alexithymia concerning treatment outcomes in depressed subjects. DESIGN A baseline evaluation of reflective functioning, alexithymia and depression was conducted before an STMBP treatment. Patients were re-tested successively after 40 weeks (T1) and in a follow-up after 1 year at the end of the treatment (T2). METHODS A total of 24 patients principally diagnosed with Major Depressive Disorder (MDD) underwent a STMBP conducted by two expert therapists. Global Assessment Functioning (GAF), Toronto Alexithymia Scale-20 (TAS-20) and Hamilton Depression Rating Scale (HAM-D) data were collected at the baseline (T0) by two clinical therapists, along with RF scores rated by two trained raters. HAM-D, TAS-20 and GAF follow-ups were conducted at the end of the treatment after 40 weeks (T1) and after 1-year follow-up (T2). RESULTS Results highlighted an improvement of both HAM-D and TAS-20 scores in our sample. Moreover, a negative correlation between RF and TAS-20 was found. Both HAM-D and RF at T0 influenced depressive outcomes at the end of the treatment. CONCLUSIONS Results confirmed the effectiveness of STMBP in MDD, suggesting also an inverse association between RF and alexithymia. PRACTITIONER POINTS Our study demonstrates how STMBP could be effective in MDD even after 40 sessions, maintaining its effect in a 1-year follow-up. STMBP improves subjective capability of reflecting on the mental states of oneself and others. Our intervention allows patients to orientate thoughts from inside to outside, reducing negative beliefs also in absence of a pharmacological therapy (during the follow-up).
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Affiliation(s)
- Cinzia Bressi
- Unit of Psychiatry, Homogenous Area of Mental Health, Psychotherapy Service, Department of Pathophysiology and Transplantation (DePT), Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, State University of Milan, Italy
| | - Silvia Fronza
- Homogenous Area of Mental Health, Psychotherapy Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Minacapelli
- Homogenous Area of Mental Health, Psychotherapy Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuela Paola Nocito
- Homogenous Area of Mental Health, Psychotherapy Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Dipasquale
- Homogenous Area of Mental Health, Psychotherapy Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Lorenzo Magri
- Homogenous Area of Mental Health, Psychotherapy Service, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Lionetti
- Psychology Section, Department of Brain and Behavioral Sciences, University of Pavia, Milan, Italy
| | - Lavinia Barone
- Psychology Section, Department of Brain and Behavioral Sciences, University of Pavia, Milan, Italy
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Goodman G, Chung H, Fischel L, Athey-Lloyd L. Simulation modeling analysis of sequential relations among therapeutic alliance, symptoms, and adherence to child-centered play therapy between a child with autism spectrum disorder and two therapists. Clin Child Psychol Psychiatry 2017; 22:455-466. [PMID: 28191795 DOI: 10.1177/1359104517691082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This study examined the sequential relations among three pertinent variables in child psychotherapy: therapeutic alliance (TA) (including ruptures and repairs), autism symptoms, and adherence to child-centered play therapy (CCPT) process. A 2-year CCPT of a 6-year-old Caucasian boy diagnosed with autism spectrum disorder was conducted weekly with two doctoral-student therapists, working consecutively for 1 year each, in a university-based community mental-health clinic. Sessions were video-recorded and coded using the Child Psychotherapy Process Q-Set (CPQ), a measure of the TA, and an autism symptom measure. Sequential relations among these variables were examined using simulation modeling analysis (SMA). In Therapist 1's treatment, unexpectedly, autism symptoms decreased three sessions after a rupture occurred in the therapeutic dyad. In Therapist 2's treatment, adherence to CCPT process increased 2 weeks after a repair occurred in the therapeutic dyad. The TA decreased 1 week after autism symptoms increased. Finally, adherence to CCPT process decreased 1 week after autism symptoms increased. The authors concluded that (1) sequential relations differ by therapist even though the child remains constant, (2) therapeutic ruptures can have an unexpected effect on autism symptoms, and (3) changes in autism symptoms can precede as well as follow changes in process variables.
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Affiliation(s)
| | - Hyewon Chung
- 2 Chungnam National University, Daejeon, South Korea
| | - Leah Fischel
- 1 Long Island University, Brookville, New York, USA
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Ribeiro Â, Ribeiro JP, von Doellinger O. Depression and psychodynamic psychotherapy. ACTA ACUST UNITED AC 2017; 40:105-109. [PMID: 28614491 PMCID: PMC6899418 DOI: 10.1590/1516-4446-2016-2107] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/30/2017] [Indexed: 11/22/2022]
Abstract
Depression is a complex condition, and its classical biological/psychosocial distinction is fading. Current guidelines are increasingly advocating psychotherapy as a treatment option. Psychodynamic psychotherapy models encompass a heterogeneous group of interventions derived from early psychoanalytic conceptualizations. Growing literature is raising awareness in the scientific community about the importance of these treatment options, as well as their favorable impact on post-treatment outcomes and relapse prevention. Considering the shifting paradigm regarding treatment of depressive disorder, the authors aim to provide a brief overview of the definition and theoretical basis of psychodynamic psychotherapy, as well as evaluate current evidence for its effectiveness.
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Affiliation(s)
- Ângela Ribeiro
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - João P Ribeiro
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
| | - Orlando von Doellinger
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal
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Development and Evaluation of Cognitive Analytic Guided Self-Help (CAT-SH) for Use in IAPT Services. Behav Cogn Psychother 2017; 45:266-284. [PMID: 28325165 DOI: 10.1017/s1352465816000485] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is a lack of treatment plurality at step 2 of Improving Access to Psychological Therapies (IAPT) services. This project therefore sought to develop and pilot a cognitive analytic informed guided self-help treatment for mild-to-moderate anxiety for delivery by Psychological Wellbeing Practitioners (PWPs). METHOD Medical Research Council treatment development guidelines were used. Phase I included development of the six-session treatment manual using practice guidelines, small-scale modelling (n = 3) and indicated manual iterations. Phase II consisted of a mixed methods case series design (n = 11) to index feasibility, uptake and clinical outcomes. RESULTS Cognitive analytic guided self-help (CAT-SH) met established quality parameters for guided self-help. A high treatment completion rate was observed, with 10/11 patients who attended the first treatment session subsequently completing full treatment. Six out of ten patients completing full treatment met reliable recovery criteria at follow-up. Effect sizes and recovery rates equate with extant PWP outcome benchmarks. Practitioner feedback indicated that delivery of CAT-SH was feasible. CONCLUSION CAT-SH shows promise as a low-intensity treatment for anxiety, and so further, larger and more controlled evaluations are indicated.
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Meganck R, Desmet M, Bockting C, Inslegers R, Truijens F, De Smet M, De Geest R, Van Nieuwenhove K, Hennissen V, Hermans G, Loeys T, Norman UA, Baeken C, Vanheule S. The Ghent Psychotherapy Study (GPS) on the differential efficacy of supportive-expressive and cognitive behavioral interventions in dependent and self-critical depressive patients: study protocol for a randomized controlled trial. Trials 2017; 18:126. [PMID: 28292331 PMCID: PMC5351275 DOI: 10.1186/s13063-017-1867-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 02/27/2017] [Indexed: 12/04/2022] Open
Abstract
Background Major depressive disorder is a leading cause of disease burden worldwide, indicating the importance of effective therapies. Outcome studies have shown overall efficacy of different types of psychotherapy across groups, yet large variability within groups. Although patient characteristics are considered crucial in understanding outcome, they have received limited research attention. This trial aims at investigating the interaction between therapeutic approach (pre-structured versus explorative) and the personality style of patients (dependent versus self-critical), which is considered a core underlying dimension of depressive pathology. Methods/design This study is a pragmatic stratified (dependent and self-critical patients) parallel trial with equal randomization (allocation 1:1) conducted in Flanders, Belgium. One hundred and four patients will be recruited and randomized to either 16–20 sessions of cognitive behavioral therapy for depression (pre-structured approach) or 16–20 sessions of short-term psychodynamic psychotherapy for depression (explorative approach) conducted by trained psychotherapists in private practices. The primary outcome is the severity of depression as measured by the Hamilton Rating Scale for Depression at completion of therapy. Secondary outcome measures include self-reported depressive and other symptoms, interpersonal functioning, idiosyncratic complaints, and the presence of the diagnosis of depression. Additional measures include biological measures, narrative material (sessions, interviews), and health care costs. Discussion This trial presents the test of an often-described, yet hardly investigated interaction between important personality dimensions and therapeutic approach in the treatment of depression. Results could inform therapists on how to match psychotherapeutic treatments to specific personality characteristics of their patients. Trial registration Isrctn.com, ISRCTN17130982. Registered on 2 February 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1867-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium.
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Claudi Bockting
- Department of Clinical Psychology, Social and Behavioral Sciences, Universiteit Utrecht, Heidelberglaan 1, Utrecht, 3584 CS, Netherlands
| | - Ruth Inslegers
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Femke Truijens
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Melissa De Smet
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Rosa De Geest
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Kimberly Van Nieuwenhove
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Vicky Hennissen
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Goedele Hermans
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Tom Loeys
- Department of Data Analysis, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 1, Ghent, 9000, Belgium
| | - Ufuoma Angelica Norman
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
| | - Chris Baeken
- Department of Psychiatry and Medical Psychology, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, K12, Ghent, 9000, Belgium
| | - Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium
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Wiltink J, Ruckes C, Hoyer J, Leichsenring F, Joraschky P, Leweke F, Pöhlmann K, Beutel ME. Transfer of manualized Short Term Psychodynamic Psychotherapy (STPP) for social anxiety disorder into clinical practice: results from a cluster-randomised controlled trial. BMC Psychiatry 2017; 17:92. [PMID: 28288592 PMCID: PMC5348808 DOI: 10.1186/s12888-017-1257-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 03/08/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Despite growing evidence for manualized psychodynamic treatments, there is a lack of studies on their transfer to routine practice. This is the first study to examine the effects of an additional training in manualized Short Term Psychodynamic Psychotherapy (STPP) on the outcome in routine psychotherapy for social anxiety disorder (SAD). The study is an extension to a large RCT comparing STPP to Cognitive-Behavioral Therapy of SAD. METHODS The manualized treatment was designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners were randomized to training in manualized STPP (mSTPP) vs. treatment as usual without a specific training (tauSTPP). A total of 109 patients were enrolled (105 started treatment; 75 completed at least 20 treatment sessions). Assessments were conducted pre-treatment, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 and 12 months after termination of treatment. Remission as primary outcome was defined by the Liebowitz-Social-Anxiety-Scale (LSAS) score ≤30. Secondary outcomes were response (at least 31% reduction in LSAS), treatment duration and number of sessions, changes in social anxiety (LSAS, SPAI), depression (BDI), clinical global impression (CGI), and quality of life (EQ-5D). RESULTS Remission rates of mSTPP (9%) resp. tauSTPP (16%) and also response rates of 33% resp. 28% were comparable between the two treatment approaches as well as treatment duration and number of sessions. Most of the within-group differences (baseline to 25 sessions) indicated moderate to large improvements in both treatments; within-group differences from baseline to 12 months follow-up (LSAS, SPAI, BDI, CGI) were large ranging from d = -0.605 to d = -2.937. Benefits of mSTPP were limited to single outcomes. CONCLUSIONS Findings are discussed with regard to implementation and dissemination of empirically validated treatments in psychodynamic training and practice. SAD patients with a high comorbidity of personality disorders and a long treatment history may need longer treatments. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00000570 , registered 03. March 2011.
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Affiliation(s)
- Jörg Wiltink
- Clinic of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Christian Ruckes
- grid.410607.4Interdisciplinary Center for Clinical Trials (IZKS), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jürgen Hoyer
- 0000 0001 2111 7257grid.4488.0Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Falk Leichsenring
- 0000 0001 2165 8627grid.8664.cDepartment of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Peter Joraschky
- 0000 0001 2111 7257grid.4488.0Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Frank Leweke
- 0000 0001 2165 8627grid.8664.cDepartment of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Karin Pöhlmann
- 0000 0001 2111 7257grid.4488.0Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Manfred E. Beutel
- grid.410607.4Clinic of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Potik D. “Winter Is Coming!”—Treatment of Obsessive-Compulsive Disorder Imagery After Viewing the Television Series Game of Thrones. JOURNAL OF EMDR PRACTICE AND RESEARCH 2017. [DOI: 10.1891/1933-3196.11.3.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article presents the detailed case of a 27-year-old man who began to suffer from intrusive imagery after watching a brutal scene in the TV series Game of Thrones. The content of the intrusive imagery included images of people with enucleated eyes and was initially accompanied by anxiety about sharp objects. The patient’s mental distress was assessed by the Yale-Brown Obsessive Compulsive Scale and the Impact of Event Scale—Revised, and the patient was diagnosed with obsessive-compulsive disorder (OCD). Eye movement desensitization and reprocessing (EMDR) therapy was provided to treat related distressing memories and the intrusive imagery. As treatment progressed, more complex and layered aspects of the symptom presentation became evident, and EMDR was integrated with other treatments. These included psychodynamic psychotherapy to address his complicated relationship with his father, exposure and response prevention (ERP) therapy to reduce avoidance of sharp objects, and cognitive therapy (CT) for aggressive violent thoughts toward others. The article identifies the various clinical decision points and discusses theoretical conceptualizations and related factors. This clinical case report provides additional support for the body of knowledge on the relationship between traumatic events and imagery in OCD. Therefore, trauma-focused treatments, such as EMDR therapy, which concentrates specifically on those experiences, might be especially effective.
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Sauer-Zavala S, Gutner CA, Farchione TJ, Boettcher HT, Bullis JR, Barlow DH. Current Definitions of "Transdiagnostic" in Treatment Development: A Search for Consensus. Behav Ther 2017; 48:128-138. [PMID: 28077216 DOI: 10.1016/j.beth.2016.09.004] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 06/10/2016] [Accepted: 09/15/2016] [Indexed: 12/22/2022]
Abstract
Research in psychopathology has identified psychological processes that are relevant across a range of Diagnostic and Statistical Manual (DSM) mental disorders, and these efforts have begun to produce treatment principles and protocols that can be applied transdiagnostically. However, review of recent work suggests that there has been great variability in conceptions of the term "transdiagnostic" in the treatment development literature. We believe that there is value in arriving at a common understanding of the term "transdiagnostic." The purpose of the current paper is to outline three principal ways in which the term "transdiagnostic" is currently used, to delineate treatment approaches that fall into these three categories, and to consider potential advantages and disadvantages of each approach.
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Affiliation(s)
| | | | | | | | | | - David H Barlow
- Center for Anxiety and Related Disorders, Boston University
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Abstract
Both theoretical and empirical findings have demonstrated similarities across diagnoses, leading to a growing interest in transdiagnostic interventions. Most of the evidence supporting transdiagnostic treatment has accumulated for depression, anxiety, and eating disorders, with minimal attention given to posttraumatic stress disorder and other reactions to traumatic stressors. Although single-diagnosis protocols are effective for posttraumatic stress disorder (PTSD) and other trauma-related disorders, in principle, transdiagnostic approaches may have beneficial applications within a traumatized population. This paper defines different types of transdiagnostic treatments, reviews transdiagnostic approaches used in related disorders, and discusses their applicability to PTSD. Examples are drawn from existing transdiagnostic treatments in order to provide a framework for the application of such interventions to the field of traumatic stress. Implications for implementation and dissemination are also discussed.
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Affiliation(s)
- Cassidy A Gutner
- National Center for PTSD, Women's Health Sciences Division, Boston University School of Medicine, 150 South Huntington Avenue, (116B-3), Boston, MA, 02130, USA.
| | - Tara Galovski
- National Center for PTSD, Women's Health Sciences Division, Boston University School of Medicine, 150 South Huntington Avenue, (116B-3), Boston, MA, 02130, USA
| | - Michelle J Bovin
- National Center for PTSD, Behavioral Science Division, Boston University School of Medicine, 150 South Huntington Avenue, (116B-3), Boston, MA, 02130, USA
| | - Paula P Schnurr
- National Center for PTSD, Executive Division, VA Medical Center (116D), Geisel School of Medicine at Dartmouth, 215 North Main St, White River Junction, VT, 05009, USA
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Kenny DT, Arthey S, Abbass A. Identifying attachment ruptures underlying severe music performance anxiety in a professional musician undertaking an assessment and trial therapy of Intensive Short-Term Dynamic Psychotherapy (ISTDP). SPRINGERPLUS 2016; 5:1591. [PMID: 27652164 PMCID: PMC5026982 DOI: 10.1186/s40064-016-3268-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 09/08/2016] [Indexed: 11/11/2022]
Abstract
Introduction Kenny has proposed that severe music performance anxiety that is unresponsive to usual treatments such as cognitive-behaviour therapy may be one manifestation of unresolved attachment ruptures in early life. Intensive Short-Term Dynamic Psychotherapy specifically targets early relationship trauma. Accordingly, a trial of Intensive Short-Term Dynamic Psychotherapy with severely anxious musicians was implemented to assess whether resolution of attachment ruptures resulted in clinically significant relief from music performance anxiety. Methods Volunteer musicians participating in a nationally funded study were screened for MPA severity. Those meeting the critical cut-off score on the Kenny Music Performance Anxiety Inventory were offered a trial of Intensive Short-Term Dynamic Psychotherapy. In this paper, we present the theoretical foundations and rationale for the treatment approach, followed by sections of a verbatim transcript and process analysis of the assessment phase of treatment that comprised a 3-h trial therapy session. Case description The ‘case’ was a professional orchestral musician (male, aged 55) who had suffered severe music performance anxiety over the course of his entire career, which spanned more than 30 years at the time he presented for treatment following his failure to secure a position at audition. Discussion and evaluation The participant was able to access the pain, rage and grief associated with unresolved attachment ruptures with both parents that demonstrated the likely nexus between early attachment trauma and severe music performance anxiety. Conclusion Intensive Short-Term Dynamic Psychotherapy is a potentially cost-effective treatment for severe music performance anxiety. Further research using designs with higher levels of evidence are required before clinical recommendations can be made for the use of this therapy with this population.
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Affiliation(s)
- Dianna T Kenny
- Faculty of Arts and Social Sciences, The University of Sydney, Room 468, Building H04, Sydney, 2006 Australia
| | | | - Allan Abbass
- Centre for Emotions and Health, Dalhousie University, Halifax, NS Canada
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Nolte S, Erdur L, Fischer HF, Rose M, Palmowski B. Course of self-reported symptoms of 342 outpatients receiving medium- versus long-term psychodynamic psychotherapy. Biopsychosoc Med 2016; 10:23. [PMID: 27478497 PMCID: PMC4966565 DOI: 10.1186/s13030-016-0074-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 07/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background The course of self-reported symptoms during medium- versus long-term psychodynamic psychotherapy has rarely been documented for outpatient settings. This observational study describes routine practice of ambulatory treatment in Germany and explores self-reported symptoms of a broad patient sample undergoing one (medium-term) versus two years (long-term) of psychodynamic psychotherapy. Methods Over four and a half years, longitudinal self-report symptom data were collected from 342 outpatients as part of a standardized documentation system. Self-report data were compared between patients receiving either medium-term or long-term psychodynamic psychotherapy. Results Routine care significantly decreased disease burden as reported by patients by small to medium effect sizes (ES) for depression (ES = 0.58), anxiety (ES = 0.49), obsessive-compulsive disorder (ES = 0.54), somatoform disorder (ES = 0.32), eating disorder (ES = 0.38). The majority of patients completed treatment after one year and showed medium-size changes. For a subgroup of patients with depressive and/or obsessive-compulsive disorder symptoms for whom two years of therapy were deemed necessary, additional benefits were reported during the second year of treatment (ES = 0.61 and ES 0.47, respectively). Conclusions Our findings suggest that both medium- and long-term psychodynamic psychotherapy decrease self-reported disease burden of patients with depression, anxiety, obsessive-compulsive, somatoform and/or eating disorders. For a subgroup of patients, additional benefits were gained in the second year of treatment.
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Affiliation(s)
- S Nolte
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany ; Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Melbourne, VIC Australia
| | - L Erdur
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - H F Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany ; Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany ; Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA USA
| | - B Palmowski
- Private Practice Dr Bernhard Palmowski, Berlin, Germany
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Prout TA, Gaines E, Gerber LE, Rice T, Hoffman L. The development of an evidence-based treatment: Regulation-Focused Psychotherapy for Children with externalising behaviours (RFP-C). JOURNAL OF CHILD PSYCHOTHERAPY 2015. [DOI: 10.1080/0075417x.2015.1090695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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The enduring effects of psychodynamic treatments vis-à-vis alternative treatments: A multilevel longitudinal meta-analysis. Clin Psychol Rev 2015; 40:1-14. [DOI: 10.1016/j.cpr.2015.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 03/18/2015] [Accepted: 05/14/2015] [Indexed: 11/30/2022]
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Nader-Mohammadi Moghadam M, Atef-Vahid MK, Asgharnejad-Farid AA, Shabani A, Lavasni F. Short-term Dynamic Psychotherapy versus Sertraline in Treatment of Social Phobia. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2015; 9:e228. [PMID: 26288643 PMCID: PMC4539396 DOI: 10.17795/ijpbs228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 11/22/2014] [Accepted: 02/07/2015] [Indexed: 11/29/2022]
Abstract
Background: A few studies on short-term psychodynamic approach have been conducted on social phobia. Objectives: In this study, the effectiveness of short-term psychodynamic psychotherapy on the treatment of social phobia has been compared to the effectiveness of sertraline and waiting list. Materials and Methods: In this randomized-controlled trial study, 13 male students were treated with short-term dynamic psychotherapy (McCullough method) lasting 25 sessions, 11 students received sertraline for 12 weeks, and 14 students, as the waiting list, received no intervention for 8 weeks. Participants completed the Social Phobia Inventory (SPIN) as primary efficacy variable 4 times, and were rated with Clinical Global Impression scale (CGI) and Global Assessment of Functioning (GAF) as secondary efficacy variables. The data were analyzed with analysis of variance (ANOVA), analysis of covariance (ANCOVA), general linear model repeated measures analysis of variance and Fisher exact test. Results: ANCOVA showed significant differences between groups based on SPIN scores (F = 23.51, Sig. = 0.001) and Bonferroni test, as post hoc compression, showed means of both short-term dynamic therapy and sertraline therapy groups were significantly different from waiting list mean (STDP-WL: x̅dif = 15.76, Sig. = 0.001), (MED-WL: x̅ = 15.91, Sig. = 0.001). Mean of SPIN scores was not significantly different between short-term dynamic psychotherapy and pharmacotherapy groups. In both treatment groups, means of SPIN scores significantly decreased in posttest, but not in waiting. These results repeated with GAF and CGI scores. Conclusions: The results indicated that short-term dynamic psychotherapy sertraline are effective in decreasing social phobia symptoms and were superior to control group.
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Affiliation(s)
| | | | | | - Amir Shabani
- Tehran Institute of Psychiatry, Tehran University of Medical Sciences Tehran, IR Iran
| | - Fahimeh Lavasni
- Tehran Institute of Psychiatry, Tehran University of Medical Sciences Tehran, IR Iran
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Sandell R, Svensson M, Nilsson T, Johansson H, Viborg G, Perrin S. The POSE study - panic control treatment versus panic-focused psychodynamic psychotherapy under randomized and self-selection conditions: study protocol for a randomized controlled trial. Trials 2015; 16:130. [PMID: 25873067 PMCID: PMC4393576 DOI: 10.1186/s13063-015-0656-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 03/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Panic disorder with or without agoraphobia is a commonly occurring disorder affecting 2 to 3% of the population in Sweden. Untreated, panic disorder is a chronic condition that significantly increases the risk for psychiatric comorbidity, morbidity and mortality, employment difficulties, and healthcare utilization. Cognitive behavioral approaches are the recommended first-line treatment for panic disorder; however, many patients in routine care receive another evidence-based psychotherapy, including psychodynamic therapy. Allowing patients to choose among evidence-based approaches to panic disorder may improve outcomes and reduce overall health costs. Trials comparing the 'gold standard' treatment for panic disorder to other evidence-based psychotherapies are needed, and also trials that can separate patient preferences for treatment from randomization effects on outcome, disability and healthcare utilization in the longer term. METHODS/DESIGN A phase 2/3 doubly-randomized controlled trial carried out in routine care with 216 adults (aged 18 to 70 years) with a primary diagnosis of DSM-IV Panic Disorder (with or without Agoraphobia). Within each clinic, patients are randomized to self-selection, random assignment of treatment, or wait-list. Patients choose or are randomly assigned to either Panic Control Treatment or Panic-Focused Psychodynamic Psychotherapy. Primary outcomes are changes in panic symptom severity, occupational status, and sickness-related absences from work at post-treatment and 6, 12 and 24 months post-treatment. Secondary outcomes include changes in agoraphobic avoidance, psychiatric comorbidity, disability, and healthcare utilization. The study also employs elements of an effectiveness trial as therapist and service-related effects on outcome will be estimated. Putative change mechanisms for the two treatments are also assessed. DISCUSSION Cognitive behavioral and psychodynamic therapies are both evidence-based approaches that are routinely offered to panic disordered patients in Sweden. However, little is known about the relative effectiveness of these two approaches for panic/agoraphobia, work-related disability and healthcare utilization over the longer term. The current trial (POSE) also addresses the important but understudied issue of whether patient preference for a particular psychotherapeutic approach moderates outcome. TRIAL REGISTRATION ClinicalTrials.gov NCT01606592 (registered 19 March 2012).
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Affiliation(s)
- Rolf Sandell
- Department of Psychology, Lund University, Box 213, Lund, 221 00, Sweden.
| | - Martin Svensson
- Department of Psychology, Lund University, Box 213, Lund, 221 00, Sweden.
| | - Thomas Nilsson
- Department of Psychology, Lund University, Box 213, Lund, 221 00, Sweden.
| | - Håkan Johansson
- Department of Psychology, Lund University, Box 213, Lund, 221 00, Sweden.
| | - Gardar Viborg
- Department of Psychology, Lund University, Box 213, Lund, 221 00, Sweden.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, Lund, 221 00, Sweden. .,Institute of Psychiatry, Psychology and Neurosciences, Box PO77, King's College London, 16 DeCrespigny Park, London, SE5 8AF, UK.
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Abstract
BACKGROUND Depression is a debilitating condition affecting more than 350 million people worldwide (WHO 2012) with a limited number of evidence-based treatments. Drug treatments may be inappropriate due to side effects and cost, and not everyone can use talking therapies.There is a need for evidence-based treatments that can be applied across cultures and with people who find it difficult to verbally articulate thoughts and feelings. Dance movement therapy (DMT) is used with people from a range of cultural and intellectual backgrounds, but effectiveness remains unclear. OBJECTIVES To examine the effects of DMT for depression with or without standard care, compared to no treatment or standard care alone, psychological therapies, drug treatment, or other physical interventions. Also, to compare the effectiveness of different DMT approaches. SEARCH METHODS The Cochrane Depression, Anxiety and Neurosis Review Group's Specialised Register (CCDANCTR-Studies and CCDANCTR-References) and CINAHL were searched (to 2 Oct 2014) together with the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. The review authors also searched the Allied and Complementary Medicine Database (AMED), the Education Resources Information Center (ERIC) and Dissertation Abstracts (to August 2013), handsearched bibliographies, contacted professional associations, educational programmes and dance therapy experts worldwide. SELECTION CRITERIA Inclusion criteria were: randomised controlled trials (RCTs) studying outcomes for people of any age with depression as defined by the trialist, with at least one group being DMT. DMT was defined as: participatory dance movement with clear psychotherapeutic intent, facilitated by an individual with a level of training that could be reasonably expected within the country in which the trial was conducted. For example, in the USA this would either be a trainee, or qualified and credentialed by the American Dance Therapy Association (ADTA). In the UK, the therapist would either be in training with, or accredited by, the Association for Dance Movement Psychotherapy (ADMP, UK). Similar professional bodies exist in Europe, but in some countries (e.g. China) where the profession is in development, a lower level of qualification would mirror the situation some decades previously in the USA or UK. Hence, the review authors accepted a relevant professional qualification (e.g. nursing or psychodynamic therapies) plus a clear description of the treatment that would indicate its adherence to published guidelines including Levy 1992, ADMP UK 2015, Meekums 2002, and Karkou 2006. DATA COLLECTION AND ANALYSIS Study methodological quality was evaluated and data were extracted independently by the first two review authors using a data extraction form, the third author acting as an arbitrator. MAIN RESULTS Three studies totalling 147 participants (107 adults and 40 adolescents) met the inclusion criteria. Seventy-four participants took part in DMT treatment, while 73 comprised the control groups. Two studies included male and female adults with depression. One of these studies included outpatient participants; the other study was conducted with inpatients at an urban hospital. The third study reported findings with female adolescents in a middle-school setting. All included studies collected continuous data using two different depression measures: the clinician-completed Hamilton Depression Rating Scale (HAM-D); and the Symptom Checklist-90-R (SCL-90-R) (self-rating scale).Statistical heterogeneity was identified between the three studies. There was no reliable effect of DMT on depression (SMD -0.67 95% CI -1.40 to 0.05; very low quality evidence). A planned subgroup analysis indicated a positive effect in adults, across two studies, 107 participants, but this failed to meet clinical significance (SMD -7.33 95% CI -9.92 to -4.73).One adult study reported drop-out rates, found to be non-significant with an odds ratio of 1.82 [95% CI 0.35 to 9.45]; low quality evidence. One study measured social functioning, demonstrating a large positive effect (MD -6.80 95 % CI -11.44 to -2.16; very low quality evidence), but this result was imprecise. One study showed no effect in either direction for quality of life (0.30 95% CI -0.60 to 1.20; low quality evidence) or self esteem (1.70 95% CI -2.36 to 5.76; low quality evidence). AUTHORS' CONCLUSIONS The low-quality evidence from three small trials with 147 participants does not allow any firm conclusions to be drawn regarding the effectiveness of DMT for depression. Larger trials of high methodological quality are needed to assess DMT for depression, with economic analyses and acceptability measures and for all age groups.
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Affiliation(s)
- Bonnie Meekums
- School of Healthcare, University of Leeds, Baines Wing, Leeds, West Yorkshire, UK, LS2 9JT.
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Abbass AA, Kisely SR, Town JM, Leichsenring F, Driessen E, De Maat S, Gerber A, Dekker J, Rabung S, Rusalovska S, Crowe E. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Syst Rev 2014; 2014:CD004687. [PMID: 24984083 PMCID: PMC11129844 DOI: 10.1002/14651858.cd004687.pub4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Since the mid-1970s, short-term psychodynamic psychotherapies (STPP) for a broad range of psychological and somatic disorders have been developed and studied. Early published meta-analyses of STPP, using different methods and samples, have yielded conflicting results, although some meta-analyses have consistently supported an empirical basis for STPP. This is an update of a review that was last updated in 2006. OBJECTIVES To evaluate the efficacy of STPP for adults with common mental disorders compared with wait-list controls, treatments as usual and minimal contact controls in randomised controlled trials (RCTs). To specify the differential effects of STPP for people with different disorders (e.g. depressive disorders, anxiety disorders, somatoform disorders, mixed disorders and personality disorder) and treatment characteristics (e.g. manualised versus non-manualised therapies). SEARCH METHODS The Cochrane Depression, Anxiety and Neurosis Group's Specialised Register (CCDANCTR) was searched to February 2014, this register includes relevant randomised controlled trials from The Cochrane Library (all years), EMBASE (1974-), MEDLINE (1950-) and PsycINFO (1967-). We also conducted searches on CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, DARE and Biological Abstracts (all years to July 2012) and all relevant studies (identified to 2012) were fully incorporated in this review update. We checked references from papers retrieved. We contacted a large group of psychodynamic researchers in an attempt to find new studies. SELECTION CRITERIA We included all RCTs of adults with common mental disorders, in which a brief psychodynamic therapy lasting 40 or fewer hours in total was provided in individual format. DATA COLLECTION AND ANALYSIS Eight review authors working in pairs evaluated studies. We selected studies only if pairs of review authors agreed that the studies met inclusion criteria. We consulted a third review author if two review authors could not reach consensus. Two review authors collected data and entered it into Review Manager software. Two review authors assessed and scored risk of bias. We assessed publication bias using a funnel plot. Two review authors conducted and reviewed subgroup analyses. MAIN RESULTS We included 33 studies of STPP involving 2173 randomised participants with common mental disorders. Studies were of diverse conditions in which problems with emotional regulation were purported to play a causative role albeit through a range of symptom presentations. These studies evaluated STPP for this review's primary outcomes (general, somatic, anxiety and depressive symptom reduction), as well as interpersonal problems and social adjustment. Except for somatic measures in the short-term, all outcome categories suggested significantly greater improvement in the treatment versus the control groups in the short-term and medium-term. Effect sizes increased in long-term follow-up, but some of these effects did not reach statistical significance. A relatively small number of studies (N < 20) contributed data for the outcome categories. There was also significant heterogeneity between studies in most categories, possibly due to observed differences between manualised versus non-manualised treatments, short versus longer treatments, studies with observer-rated versus self report outcomes, and studies employing different treatment models. AUTHORS' CONCLUSIONS There has been further study of STPP and it continues to show promise, with modest to large gains for a wide variety of people. However, given the limited data, loss of significance in some measures at long-term follow-up and heterogeneity between studies, these findings should be interpreted with caution. Furthermore, variability in treatment delivery and treatment quality may limit the reliability of estimates of effect for STPP. Larger studies of higher quality and with specific diagnoses are warranted.
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Affiliation(s)
- Allan A Abbass
- Dalhousie UniversityDepartment of Psychiatry8203 ‐ 5909 Veterans Memorial LaneHalifaxNSCanadaB3H 2E2
| | - Steve R Kisely
- The University of QueenslandSchool of MedicinePrincess Alexandra HospitalIpswich RoadWoolloongabbaQueenslandAustraliaQLD 4102
| | - Joel M Town
- Dalhousie UniversityCentre for Emotions & Health5909 Veterans' Memorial LaneHalifaxCanadaB3H 2E2
| | - Falk Leichsenring
- University of GiessenKlinik für Psychosomatik und PsychotherapieLudwigstr. 76GiessenGermany35392
| | - Ellen Driessen
- VU University AmsterdamFaculty of Psychology and Education, Department of Clinical PsychologyVan der Boechorststraat 1Transitorium 2B‐57AmsterdamNetherlands1081 BT
| | - Saskia De Maat
- Dutch Psychoanalytic Institute (NPI)Olympiaplein 4AmsterdamNetherlands1076 AB
| | - Andrew Gerber
- New York State Psychiatric InstitutePsychiatry1051 Riverside Drive, Unit 74New YorkNew YorkUSA10032
| | - Jack Dekker
- Arkin Mental Health InstituteResearch DepartmentKlaprozenweg 111AmsterdamNetherlands1033 NN
| | - Sven Rabung
- Alpen‐Adria‐Universität KlagenfurtDepartment of PsychologyUniversitätsstr. 65‐67KlagenfurtAustria9020
- University Medical Center Hamburg‐EppendorfDepartment of Medical PsychologyMartinistr. 52, W26HamburgGermany20246
| | | | - Elizabeth Crowe
- University of QueenslandSchool of Population HealthHerston RoadBrisbaneQueenslandAustralia4006
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Lacewing M. Psychodynamic psychotherapy, insight, and therapeutic action. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2014. [DOI: 10.1111/cpsp.12065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leichsenring F, Rabung S. [The efficacy of psychodynamic therapy: a controversy]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2013; 59:13-32. [PMID: 23467995 DOI: 10.13109/zptm.2013.59.1.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
There is growing evidence from randomized controlled trials supporting the efficacy of psychodynamic psychotherapy (PDT) in specific mental disorders. Yet the evidence for the efficacy of psychodynamic psychotherapy has not gone unchallenged. Several responses have addressed these concerns, showing that most of the criticism was not justified. Nevertheless, the evidence for psychodynamic psychotherapy continues to be frequently ignored, criticized or presented in a distorted way. A recent controversy published in the Nervenarzt may serve as an illustrative example, which is discussed here more in detail. This example shows that some authors are not interested in a truly scientific discussion, but rather try to discredit a rival method of psychotherapy and its scientific representatives for political reasons.
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Affiliation(s)
- Falk Leichsenring
- Abteilung Psychosomatik und Psychotherapie, Universität Gießen, Ludwigstraße 76, 35392 Gießen.
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Meekums B, Karkou V, Nelson EA. Dance movement therapy for depression. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009895] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Taylor D, Carlyle JA, McPherson S, Rost F, Thomas R, Fonagy P. Tavistock Adult Depression Study (TADS): a randomised controlled trial of psychoanalytic psychotherapy for treatment-resistant/treatment-refractory forms of depression. BMC Psychiatry 2012; 12:60. [PMID: 22686185 PMCID: PMC3395560 DOI: 10.1186/1471-244x-12-60] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 06/11/2012] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Long-term forms of depression represent a significant mental health problem for which there is a lack of effective evidence-based treatment. This study aims to produce findings about the effectiveness of psychoanalytic psychotherapy in patients with treatment-resistant/treatment-refractory depression and to deepen the understanding of this complex form of depression. METHODS/DESIGN INDEX GROUP Patients with treatment resistant/treatment refractory depression. DEFINITION & INCLUSION CRITERIA Current major depressive disorder, 2 years history of depression, a minimum of two failed treatment attempts, ≥14 on the HRSD or ≥21 on the BDI-II, plus complex personality and/or psycho-social difficulties. EXCLUSION CRITERIA Moderate or severe learning disability, psychotic illness, bipolar disorder, substance dependency or receipt of test intervention in the previous two years. DESIGN Pragmatic, randomised controlled trial with qualitative and clinical components. TEST INTERVENTION 18 months of weekly psychoanalytic psychotherapy, manualised and fidelity-assessed using the Psychotherapy Process Q-Sort. CONTROL CONDITION Treatment as usual, managed by the referring practitioner. RECRUITMENT GP referrals from primary care. RCT MAIN OUTCOME HRSD (with ≤14 as remission). SECONDARY OUTCOMES depression severity (BDI-II), degree of co-morbid disorders Axis-I and Axis-II (SCID-I and SCID-II-PQ), quality of life and functioning (GAF, CORE, Q-les-Q), object relations (PROQ2a), Cost-effectiveness analysis (CSRI and GP medical records). FOLLOW-UP 2 years. Plus: a). Qualitative study of participants' and therapists' problem formulation, experience of treatment and of participation in trial. (b) Narrative data from semi-structured pre/post psychodynamic interviews to produce prototypes of responders and non-responders. (c) Clinical case-studies of sub-types of TRD and of change. DISCUSSION TRD needs complex, long-term intervention and extended research follow-up for the proper evaluation of treatment outcome. This pushes at the limits of the design of randomised therapeutic trials. We discuss some of the consequent problems and suggest how they may be mitigated. TRIAL REGISTRATION Current Controlled Trials ISRCTN40586372.
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Affiliation(s)
- David Taylor
- Adult Department, Tavistock & Portman NHS Foundation Trust, London, UK
| | - Jo-anne Carlyle
- Adult Department, Tavistock & Portman NHS Foundation Trust, London, UK
- Psychology, Psychotherapy, Consultancy and Training in the Community (PSYCTC), Hamilton House, Mabledon Place, London, UK
| | - Susan McPherson
- School of Health and Human Sciences, University of Essex, Colchester, UK
| | - Felicitas Rost
- Adult Department, Tavistock & Portman NHS Foundation Trust, London, UK
| | - Rachel Thomas
- Adult Department, Tavistock & Portman NHS Foundation Trust, London, UK
| | - Peter Fonagy
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Callahan P, Liu P, Purcell R, Parker AG, Hetrick SE. Evidence map of prevention and treatment interventions for depression in young people. DEPRESSION RESEARCH AND TREATMENT 2012; 2012:820735. [PMID: 22496974 PMCID: PMC3312218 DOI: 10.1155/2012/820735] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 12/22/2011] [Accepted: 12/30/2011] [Indexed: 11/24/2022]
Abstract
Introduction. Depression in adolescents and young people is associated with reduced social, occupational, and interpersonal functioning, increases in suicide and self-harm behaviours, and problematic substance use. Age-appropriate, evidence-based treatments are required to provide optimal care. Methods. "Evidence mapping" methodology was used to quantify the nature and distribution of the extant high-quality research into the prevention and treatment of depression in young people across psychological, medical, and other treatment domains. Results. Prevention research is dominated by cognitive-behavioral- (CBT-) based interventions. Treatment studies predominantly consist of CBT and SSRI medication trials, with few trials of other psychological interventions or complementary/alternative treatments. Quality studies on relapse prevention and treatment for persistent depression are distinctly lacking. Conclusions. This map demonstrates opportunities for future research to address the numerous evidence gaps for interventions to prevent or treat depression in young people, which are of interest to clinical researchers, policy makers, and funding bodies.
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Affiliation(s)
- Patrick Callahan
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia
- Headspace Centre of Excellence, The National Youth Mental Health Foundation, P.O. Box 473, North Melbourne, Victoria 3051, Australia
| | - Ping Liu
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia
- Headspace Centre of Excellence, The National Youth Mental Health Foundation, P.O. Box 473, North Melbourne, Victoria 3051, Australia
| | - Rosemary Purcell
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia
- Headspace Centre of Excellence, The National Youth Mental Health Foundation, P.O. Box 473, North Melbourne, Victoria 3051, Australia
| | - Alexandra G. Parker
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia
- Headspace Centre of Excellence, The National Youth Mental Health Foundation, P.O. Box 473, North Melbourne, Victoria 3051, Australia
| | - Sarah E. Hetrick
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Locked Bag 10, Parkville, Victoria 3052, Australia
- Headspace Centre of Excellence, The National Youth Mental Health Foundation, P.O. Box 473, North Melbourne, Victoria 3051, Australia
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Russ TC. Bion today. PSYCHOANALYTIC PSYCHOTHERAPY 2011. [DOI: 10.1080/02668734.2011.604928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Tendal B, Nüesch E, Higgins JPT, Jüni P, Gøtzsche PC. Multiplicity of data in trial reports and the reliability of meta-analyses: empirical study. BMJ 2011; 343:d4829. [PMID: 21878462 PMCID: PMC3171064 DOI: 10.1136/bmj.d4829] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To examine the extent of multiplicity of data in trial reports and to assess the impact of multiplicity on meta-analysis results. DESIGN Empirical study on a cohort of Cochrane systematic reviews. DATA SOURCES All Cochrane systematic reviews published from issue 3 in 2006 to issue 2 in 2007 that presented a result as a standardised mean difference (SMD). We retrieved trial reports contributing to the first SMD result in each review, and downloaded review protocols. We used these SMDs to identify a specific outcome for each meta-analysis from its protocol. Review methods Reviews were eligible if SMD results were based on two to ten randomised trials and if protocols described the outcome. We excluded reviews if they only presented results of subgroup analyses. Based on review protocols and index outcomes, two observers independently extracted the data necessary to calculate SMDs from the original trial reports for any intervention group, time point, or outcome measure compatible with the protocol. From the extracted data, we used Monte Carlo simulations to calculate all possible SMDs for every meta-analysis. RESULTS We identified 19 eligible meta-analyses (including 83 trials). Published review protocols often lacked information about which data to choose. Twenty-four (29%) trials reported data for multiple intervention groups, 30 (36%) reported data for multiple time points, and 29 (35%) reported the index outcome measured on multiple scales. In 18 meta-analyses, we found multiplicity of data in at least one trial report; the median difference between the smallest and largest SMD results within a meta-analysis was 0.40 standard deviation units (range 0.04 to 0.91). CONCLUSIONS Multiplicity of data can affect the findings of systematic reviews and meta-analyses. To reduce the risk of bias, reviews and meta-analyses should comply with prespecified protocols that clearly identify time points, intervention groups, and scales of interest.
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Affiliation(s)
- Britta Tendal
- Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark.
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Goodyer IM, Tsancheva S, Byford S, Dubicka B, Hill J, Kelvin R, Reynolds S, Roberts C, Senior R, Suckling J, Wilkinson P, Target M, Fonagy P. Improving mood with psychoanalytic and cognitive therapies (IMPACT): a pragmatic effectiveness superiority trial to investigate whether specialised psychological treatment reduces the risk for relapse in adolescents with moderate to severe unipolar depression: study protocol for a randomised controlled trial. Trials 2011; 12:175. [PMID: 21752257 PMCID: PMC3148993 DOI: 10.1186/1745-6215-12-175] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/13/2011] [Indexed: 11/25/2022] Open
Abstract
Background Up to 70% of adolescents with moderate to severe unipolar major depression respond to psychological treatment plus Fluoxetine (20-50 mg) with symptom reduction and improved social function reported by 24 weeks after beginning treatment. Around 20% of non responders appear treatment resistant and 30% of responders relapse within 2 years. The specific efficacy of different psychological therapies and the moderators and mediators that influence risk for relapse are unclear. The cost-effectiveness and safety of psychological treatments remain poorly evaluated. Methods/Design Improving Mood with Psychoanalytic and Cognitive Therapies, the IMPACT Study, will determine whether Cognitive Behavioural Therapy or Short Term Psychoanalytic Therapy is superior in reducing relapse compared with Specialist Clinical Care. The study is a multicentre pragmatic effectiveness superiority randomised clinical trial: Cognitive Behavioural Therapy consists of 20 sessions over 30 weeks, Short Term Psychoanalytic Psychotherapy 30 sessions over 30 weeks and Specialist Clinical Care 12 sessions over 20 weeks. We will recruit 540 patients with 180 randomised to each arm. Patients will be reassessed at 6, 12, 36, 52 and 86 weeks. Methodological aspects of the study are systematic recruitment, explicit inclusion criteria, reliability checks of assessments with control for rater shift, research assessors independent of treatment team and blind to randomization, analysis by intention to treat, data management using remote data entry, measures of quality assurance, advanced statistical analysis, manualised treatment protocols, checks of adherence and competence of therapists and assessment of cost-effectiveness. We will also determine whether time to recovery and/or relapse are moderated by variations in brain structure and function and selected genetic and hormone biomarkers taken at entry. Discussion The objective of this clinical trial is to determine whether there are specific effects of specialist psychotherapy that reduce relapse in unipolar major depression in adolescents and thereby costs of treatment to society. We also anticipate being able to utilise psychotherapy experience, neuroimaging, genetic and hormone measures to reveal what techniques and their protocols may work best for which patients. Trial Registration Current Controlled Trials ISRCTN83033550
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Affiliation(s)
- Ian M Goodyer
- Department of Psychiatry, University of Cambridge and the Cambridge and Peterborough Foundation Trust, Douglas House, 18b Trumpington Road Cambridge, UK.
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Wiltink J, Ruckes C, Haselbacher A, Canterino M, Leichsenring F, Joraschky P, Leweke F, Pöhlmann K, Beutel ME. Transfer of manualized Short Term Psychodynamic Psychotherapy (STPP) for social phobia into clinical practice: study protocol for a cluster-randomised controlled trial. Trials 2011; 12:142. [PMID: 21651760 PMCID: PMC3123564 DOI: 10.1186/1745-6215-12-142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 06/08/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychodynamic psychotherapy is frequently applied in the treatment of social phobia. Nevertheless, there has been a lack of studies on the transfer of manualized treatments to routine psychodynamic practice. Our study is the first one to examine the effects of additional training in a manualized Short Term Psychodynamic Psychotherapy (STPP) procedure on outcome in routine psychotherapy for social phobia. This study is an extension to a large multi-site RCT (N = 512) comparing the efficacy of STPP to Cognitive-Behavioral Therapy (CBT) of Social Phobia. METHODS/DESIGN The manualized treatment is designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners will be randomized to training in manualized STPP vs. treatment as usual without a specific training (control condition). We plan to enrol a total of 105 patients (84 completers). Assessments will be conducted before treatment starts, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 months and 12 months after termination of treatment. The primary outcome measure is the Liebowitz Social Anxiety Scale. Remission from social phobia is defined scoring with 30 or less points on this scale. DISCUSSION We will investigate how the treatment can be transferred from a controlled trial into the less structured setting of routine clinical care. This question represents Phase IV of psychotherapy research. It combines the benefits of randomized controlled and naturalistic research. The study is genuinely designed to promote faster and more widespread dissemination of effective interventions. It will answer the questions whether manualized STPP can be implemented into routine outpatient care, whether the new methods improve treatment courses and outcomes and whether treatment effects reached in routine psychotherapeutic treatments are comparable to those of the controlled, strictly manualized treatment of the main study. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00000570.
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Affiliation(s)
- Jörg Wiltink
- Clinic of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Germany.
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Byles JE, Dolja‐Gore X, Loxton DJ, Parkinson L, Stewart Williams JA. Women's uptake of Medicare Benefits Schedule mental health items for general practitioners, psychologists and other allied mental health professionals. Med J Aust 2011; 194:175-9. [DOI: 10.5694/j.1326-5377.2011.tb03765.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 11/02/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Julie E Byles
- Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, NSW
| | - Xenia Dolja‐Gore
- Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, NSW
| | - Deborah J Loxton
- Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, NSW
| | - Lynne Parkinson
- Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, NSW
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Härter M, Klesse C, Bermejo I, Schneider F, Berger M. Unipolar depression: diagnostic and therapeutic recommendations from the current S3/National Clinical Practice Guideline. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:700-8. [PMID: 21031129 DOI: 10.3238/arztebl.2010.0700] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 07/26/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Depressive disorders are among the most common illnesses and reasons for obtaining health care. Their diagnosis and treatment are still in need of improvement. In Germany, a new S3/National Clinical Practice Guideline has been developed for this purpose. METHODS The existing guidelines on unipolar depression from Germany and other countries were synoptically compared and supplemented with systematic literature searches. After 14 consensus conferences, a total of 107 evidence-based recommendations were issued. RESULTS Unipolar depression should be diagnosed in accordance with ICD-10 criteria. Screening questionnaires are useful aids to diagnostic classification. When a treatment is chosen, shared decision-making with the patient is essential. Mild depressive episodes can be treated initially by watchful waiting for 14 days. For moderate depressive episodes, pharmacotherapy and psychotherapy are equally effective treatment options. For severe depression, a combination of pharmacotherapy and psychotherapy is recommended. If 4 to 6 weeks of acute therapy are insufficiently effective, lithium augmentation is recommended, rather than combination antidepressant therapy or a switch to another antidepressant. After remission, maintenance therapy should be continued for 4 to 9 months. In recurrent depression, pharmacotherapy and/or psychotherapy, where appropriate, should be continued for at least two years. Specific recommendations are given for patients who have somatic or mental comorbidities or are acutely suicidal, and recommendations are also given for coordination of care. CONCLUSION This guideline is a comprehensive set of evidence- and consensus-based recommendations for the diagnosis and treatment of unipolar depression. An improvement in the care of patients with unipolar depression will require broad implementation of the guideline, both in the inpatient and outpatient setting.
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Affiliation(s)
- Martin Härter
- Institut und Poliklinik für Medizinische Psychologie, Universi -tätsklinikum Hamburg-Eppendorf, Hamburg, Germany.
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Abstract
Clinical decision-making about suitability for psychological therapies is hampered by limitations of psychotherapy research and our lack of understanding of therapeutic mechanisms. Watzke et al's important randomised controlled study offers apparent validation for clinical judgement in relation to suitability for psychodynamic psychotherapy but also highlights the negative effects of unselected assignment to this type of treatment. Here, I consider why systematic selection for this form of treatment may be important and suggest how the limited effectiveness of psychodynamic therapy for an unselected group of patients may be addressed by more systematic treatment delivery and the ongoing monitoring of intermediate treatment outcomes.
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Bravesmith A. CAN WE BE BRIEF? BRITISH JOURNAL OF PSYCHOTHERAPY 2010. [DOI: 10.1111/j.1752-0118.2010.01186.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Churchill R, Moore THM, Davies P, Caldwell D, Jones H, Lewis G, Hunot V. Psychodynamic therapies versus other psychological therapies for depression. Cochrane Database Syst Rev 2010:CD008706. [PMID: 25267905 PMCID: PMC4176678 DOI: 10.1002/14651858.cd008706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all psychodynamic therapy approaches compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of different psychodynamic therapy approaches (drive/structural, relational and integrative analytic models) compared with all other psychological therapy approaches for acute depression.To examine the effectiveness and acceptability of all psychodynamic therapy approaches compared with different psychological therapy approaches (behavioural, humanistic, integrative, cognitive-behavioural, 'third-wave' CBT) for acute depression.
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Affiliation(s)
- Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Churchill R, Davies P, Caldwell D, Moore THM, Jones H, Lewis G, Hunot V. Interpersonal, cognitive analytic and other integrative therapies versus treatment as usual for depression. Cochrane Database Syst Rev 2010:CD008703. [PMID: 25411560 PMCID: PMC4234086 DOI: 10.1002/14651858.cd008703] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all integrative therapies compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different integrative therapies (IPT, CAT, psychodynamic-interpersonal therapy, cognitive behavioural analysis system of psychotherapy and counselling) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all integrative therapies compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression.
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Affiliation(s)
- Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Moore THM, Hunot V, Davies P, Caldwell D, Jones H, Lewis G, Churchill R. Psychodynamic therapies versus treatment as usual for depression. Cochrane Database Syst Rev 2010:CD008707. [PMID: 25267906 PMCID: PMC4176682 DOI: 10.1002/14651858.cd008707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To examine the effectiveness and acceptability of all psychodynamic therapies compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of different psychodynamic therapy models (drive/structural, relational and integrative analytic models) compared with treatment as usual/waiting list/attention placebo control conditions for acute depression.To examine the effectiveness and acceptability of all psychodynamic therapies compared with different types of comparator (standard care, no treatment, waiting list, attention placebo) for acute depression.
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Affiliation(s)
- Theresa HM Moore
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Vivien Hunot
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Philippa Davies
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Hannah Jones
- Cochrane Schizophrenia Group, The University of Nottingham, Nottingham, UK
| | - Glyn Lewis
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Salvadori A, Jackson T. A structured account of short‐term psychodynamic psychotherapy with a man with learning disabilities. ACTA ACUST UNITED AC 2009. [DOI: 10.1108/17530180200900037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Elder A. Building on the work of Alexis Brook: Further thoughts about brief psychotherapy in primary care. PSYCHOANALYTIC PSYCHOTHERAPY 2009. [DOI: 10.1080/02668730903368034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Andrew Elder
- a Consultant in General Practice and Primary Care and President of The Balint Society
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Bhar SS, Beck AT. Treatment integrity of studies that compare short-term psychodynamic psychotherapy with cognitive-behavior therapy. ACTA ACUST UNITED AC 2009. [DOI: 10.1111/j.1468-2850.2009.01176.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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