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Moniz-Lewis DIK, Witkiewitz K. Exploring heterogeneity in recovery from substance use disorder following mindfulness-based relapse prevention: A latent profile analysis. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024:209537. [PMID: 39389547 DOI: 10.1016/j.josat.2024.209537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 09/17/2024] [Accepted: 10/03/2024] [Indexed: 10/12/2024]
Abstract
INTRODUCTION Substance use disorder (SUD) recovery is heterogeneous. Yet, over the last 50 years, substance use treatment providers and researchers have often defined success as sustained abstinence from substance use. An often overlooked but equally valid pathway to recovery for persons with SUD is non-abstinent recovery. However, most of the literature on non-abstinent recovery exists for individuals with alcohol use disorder (AUD) with few studies of non-abstinent recovery for other types of SUD. Literature exploring the mechanisms that lead to non-abstinent recovery is also lacking. As such, the current study aimed to examine recovery profiles for individuals (N = 454) recruited in two randomized clinical trials comparing mindfulness-based relapse prevention with cognitive-behavioral relapse prevention and/or treatment as usual. METHODS Latent profile analysis empirically derived profiles of recovery following outpatient aftercare SUD treatment. Multinomial logistic regression examined associations between treatment assignment and recovery profile, including potential psychological mediators (e.g., mindfulness) and contextual moderators (e.g., annual household income). RESULTS Analyses supported four recovery profiles: (1) low-functioning frequent substance use; (2) low-functioning infrequent substance use; (3) high-functioning frequent substance use; (4) high-functioning infrequent substance use. There were no significant interaction effects of race or ethnicity by treatment type, or household income by treatment type, in predicting recovery profiles. Trait mindfulness, craving, and psychological flexibility failed to mediate the association between treatment assignment and recovery profile; however, there were statistically significant differences in trait mindfulness with individuals expected to be classified in the low-functioning infrequent substance use profile showing significantly lower levels of trait mindfulness compared to individuals in the two high-functioning profiles. CONCLUSIONS Findings suggest that recovery from SUD is heterogeneous, and profiles of recovery based on dimensions of substance use and functioning can be identified across a variety of SUD, including among people with co-occurring SUD. Additionally, trait mindfulness appears to be a differentiating factor across recovery profiles. Further research is needed to explore how psychological and social factors may moderate and influence both abstinent and non-abstinent forms of recovery.
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Affiliation(s)
- David I K Moniz-Lewis
- Center for Alcohol Substance Use and Addiction, University of New Mexico, USA; Department of Psychology, University of New Mexico, USA.
| | - Katie Witkiewitz
- Center for Alcohol Substance Use and Addiction, University of New Mexico, USA; Department of Psychology, University of New Mexico, USA
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2
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Tramonti F, Saviozzi V, Ferrante B, Saliani S, Galeazzi E, Vatteroni S, Genovesi I, Di Vecchio I, Možina M. Life, complexity, and psychotherapy: A systemic perspective on the elusive construct of extra-therapeutic factors. J Eval Clin Pract 2024; 30:1272-1282. [PMID: 38837307 DOI: 10.1111/jep.14039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/30/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024]
Abstract
STUDY AIMS Despite being mentioned in well-known models of psychotherapeutic change, the concept of extra-therapeutic factors seems to have left the scene across time, eaten away by the progressive refinement of the construct of common factors. Aim of the present study is to better understanding the historical evolution of the concept of extra-therapeutic factors and its importance for psychotherapy today. METHODS This is a position paper based on a literature review on extra-therapeutic factors and psychotherapy outcome and process. DISCUSSION There is growing evidence of the decisive role of clients' and therapists' characteristics, as well as of the importance of therapeutic alliances and relationships in promoting change. Within this context, the concept of extra-therapeutic factors still deserves proper attention, rather than being relegated to a residual and vanishing category. CONCLUSION A renewed interest on extra-therapeutic factors could reinvigorate the debate over the relationship between psychotherapy and life contexts and conditions. In terms of complexity and systems thinking nothing, a priori, really falls outside the realm of psychotherapy and, in turn, psychotherapy is not a practice that could be abstracted from the context in which it is practiced or from clients' and therapists' lives.
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Affiliation(s)
| | | | - Benedetta Ferrante
- Istituto di Psicoterapia Relazionale, Pisa, Italy
- Institute of Clinical Physiology of the Italian National Research Council (IFC-CNR), Pisa, Italy
| | | | | | | | | | | | - Miran Možina
- Sigmund Freud University Ljubljana, Ljubljana, Slovenia
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3
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Vossler A, Pinquart M, Forbat L, Stratton P. Efficacy of systemic therapy on adults with depressive disorders: A meta-analysis. Psychother Res 2024:1-17. [PMID: 38776449 DOI: 10.1080/10503307.2024.2352741] [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] [Received: 07/20/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE This meta-analysis evaluates the efficacy of systemic therapy approaches on adult clients with depressive disorders. METHODS The illness-specific systematic review updates a previous meta-analysis on the efficacy of systemic therapy on psychiatric disorders in adulthood. It integrates the results of 30 randomized controlled trials (RCTs) comparing systemic psychotherapy for depression with an untreated control group or alternative treatments. Studies were identified through systematic searches in relevant electronic databases and cross-referencing. A random-effects model calculated weighted mean effect sizes for each type of comparison (alternative treatments, control group with no alternative treatment/waiting list) on two outcomes (depressive symptoms change, drop-out rates). RESULTS On average, systemic interventions show larger improvements in depressive symptoms compared to no-treatment controls at post-test (g = 1.09) and follow-up (g = 1.23). Changes do not significantly differ when comparing systemic interventions with alternative treatments (post-test g = 0.25; follow-up g = 0.09). Results also vary, in part, by participant age, publication year, and active control condition. CONCLUSION This meta-analysis indicates the potential benefits of systemic interventions for adult patients with depression. Future randomized clinical trials in this area should enhance study quality and include relational and other relevant outcome measures.
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Affiliation(s)
- Andreas Vossler
- School of Psychology and Counselling, Faculty of Arts and Social Science, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - Martin Pinquart
- Department of Psychology, Philipps University Marburg, Marburg, Germany
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Peter Stratton
- Leeds Institute of Health Sciences (LIHS), University of Leeds, Leeds, UK
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4
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Tobiassen AH, Sundal T, Stänicke E, Folmo EJ. The cultural change narrative as a core component of therapeutic change. Front Psychiatry 2023; 14:1149984. [PMID: 37867772 PMCID: PMC10587421 DOI: 10.3389/fpsyt.2023.1149984] [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] [Received: 01/23/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Research indicates a similar effect of Mentalization-based treatment (MBT) and Dialectical behavior therapy (DBT) for borderline personality disorder (BPD). However, there is a paucity in studies investigating the change narrative received from and developed in these treatments. The aim of the present study is to investigate similarities and differences in the change narratives provided by MBT and DBT, and how these narratives reflect the rationale, explanations, and procedures of the provided treatment. Methods The study is a qualitative analysis of seven interviews conducted by the authors. Three of the participants had received MBT, and four of the participants had received DBT. This study presents an Interpretative Phenomenological Analysis (IPA) of the change narratives received in two specialized treatments for BPD. Results The main findings from the IPA were that the change narratives described by the participants reflected the treatment they received. The DBT participants highlighted explicit learning of tools and techniques, with predictable and safe therapists. In contrast, the MBT participants emphasized a long-lasting process of exploring to create procedural learning with therapists who followed their lead. Discussion The participants' stories of change shed light on how a change narrative was developed, and therefore how the rationale, explanations and procedures were conveyed differently by MBT and DBT.
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Affiliation(s)
| | | | - Erik Stänicke
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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5
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Sidis A, Bøe T, Karlsson B, Lidbom P, Moore A, Pickard J, Deane F. In defence of loose ends: Psychotherapy process research in the real world. NEW IDEAS IN PSYCHOLOGY 2023. [DOI: 10.1016/j.newideapsych.2023.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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6
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Fang S, Ding D. The differences between acceptance and commitment therapy (ACT) and cognitive behavioral therapy: A three-level meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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7
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Nadkarni A, Massazza A, Guda R, Fernandes LT, Garg A, Jolly M, Andersen LS, Bhatia U, Bogdanov S, Roberts B, Tol WA, Velleman R, Moore Q, Fuhr D. Common strategies in empirically supported psychological interventions for alcohol use disorders: A meta-review. Drug Alcohol Rev 2023; 42:94-104. [PMID: 36134481 PMCID: PMC10087716 DOI: 10.1111/dar.13550] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 01/10/2023]
Abstract
ISSUES Despite the large number of effective psychological interventions for alcohol use disorders (AUD), there is still a lack of clarity concerning the strategies that make these interventions effective. APPROACH The overall goal of this review was to identify, examine and synthesise the information about common strategies from evidence-based psychological interventions for AUDs by conducting a review of systematic reviews, that is, a meta-review. We isolated the relevant primary studies from eligible systematic reviews and extracted information about the interventions from these studies to understand the strategies used. Analysis was restricted to narrative summaries. KEY FINDINGS Thirteen reviews were eligible for inclusion in our meta-review. Of these, eight demonstrated the effectiveness of a range of psychological interventions-behavioural couples therapy, cognitive behaviour therapy combined with motivational interviewing, brief interventions, contingency management, psychotherapy plus brief interventions, Alcoholics Anonymous and 12-step treatment programs, family-therapy or family-involved treatment, and community reinforcement approach. The most commonly used component strategies in effective interventions for AUDs included assessment, personalised feedback, motivational interviewing, goal setting, setting and review of homework, problem solving skills and relapse prevention/management. IMPLICATIONS Evidence about commonly used strategies in evidence-based psychological interventions for AUDs offer the possibility of creating menu-driven interventions that can be tailored to respond to individual client needs and preferences in different contexts.
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Affiliation(s)
- Abhijit Nadkarni
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Addictions Research Group, Sangath, Goa, India
| | - Alessandro Massazza
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rahul Guda
- Addictions Research Group, Sangath, Goa, India
| | | | - Ankur Garg
- Addictions Research Group, Sangath, Goa, India
| | - Mehak Jolly
- Addictions Research Group, Sangath, Goa, India
| | - Lena S Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Sergiy Bogdanov
- Centre for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Wietse A Tol
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,HealthRight International, New York, New York, USA.,Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Richard Velleman
- Addictions Research Group, Sangath, Goa, India.,Department of Psychology, University of Bath, Bath, UK
| | - Quincy Moore
- Centre for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Daniela Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany.,Health Sciences, University of Bremen, Bremen, Germany
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8
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Aardema F, Bouchard S, Koszycki D, Lavoie ME, Audet JS, O'Connor K. Evaluation of Inference-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: A Multicenter Randomized Controlled Trial with Three Treatment Modalities. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:348-359. [PMID: 35584639 DOI: 10.1159/000524425] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/30/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Inference-based cognitive-behavioral therapy (I-CBT) is a specialized psychological treatment for obsessive-compulsive disorder (OCD) without deliberate and prolonged exposure and response prevention (ERP) that focuses on strengthening reality-based reasoning and correcting the dysfunctional reasoning giving rise to erroneous obsessional doubts and ideas. OBJECTIVE The present study aimed to evaluate the effectiveness of I-CBT through a comparison with appraisal-based cognitive behavioral therapy (A-CBT) and an adapted mindfulness-based stress reduction (MBSR) intervention. METHODS This was a two-site, parallel-arm randomized controlled trial (RCT) comparing I-CBT with A-CBT. The MBSR intervention acted as a non-specific active control condition. Following formal evaluation, 111 participants diagnosed with OCD were randomly assigned. The principal outcome measure was the Yale-Brown Obsessive-Compulsive Scale. RESULTS All treatments significantly reduced general OCD severity and specific symptom dimensions without a significant difference between treatments. I-CBT was associated with significant reductions in all symptom dimensions at post-test. Also, I-CBT led to significantly greater improvement in overvalued ideation, as well as significantly higher rates of remission as compared to MBSR at mid-test. CONCLUSIONS I-CBT and MBSR appear to be effective, alternative treatment options for those with OCD that yield similar outcomes as A-CBT. I-CBT may have an edge in terms of the rapidity by which patients reach remission, its generalizability across symptom dimension, its potentially higher level of acceptability, and effectiveness for overvalued ideation. Future research is needed to assess whether additional alternative treatments options can help to increase the number of people successfully treated.
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Affiliation(s)
- Frederick Aardema
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Québec, Canada.,Montreal Mental Health University Institute Research Center, Montreal, Québec, Canada
| | - Stéphane Bouchard
- Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, Québec, Canada
| | - Diana Koszycki
- Counselling Psychology Concentration, Faculty of Education and Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Marc E Lavoie
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Québec, Canada.,Montreal Mental Health University Institute Research Center, Montreal, Québec, Canada
| | - Jean-Sebastien Audet
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Québec, Canada.,Montreal Mental Health University Institute Research Center, Montreal, Québec, Canada
| | - Kieron O'Connor
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Québec, Canada.,Montreal Mental Health University Institute Research Center, Montreal, Québec, Canada
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9
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Behan D. Do clients train therapists to become eclectic and use the common factors? A qualitative study listening to experienced psychotherapists. BMC Psychol 2022; 10:183. [PMID: 35897054 PMCID: PMC9327163 DOI: 10.1186/s40359-022-00886-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychotherapists must choose from an overwhelming number of theoretical models and empirically supported treatments to guide their work. Meta-analytic studies show there is comparable efficacy among the choices, making the decision about which approach to use difficult. Research indicates there are pantheoretical elements found in all effective models, called the common factors, which can offer psychotherapists a focusing point to maximize their effectiveness regardless of their chosen approach. Most psychotherapists begin practicing from a traditional theoretical orientation, but then their approach evolves over time toward an unintentional eclecticism, derived primarily from their practice experience with clients. METHODS This exploratory qualitative study conducted in-depth interviews with six experienced clinical social workers about their evolution as psychotherapists and what they believe creates change in psychotherapy. The interviews were conducted using standardized prompts and then coded and analyzed utilizing thematic analysis based on a six-phase framework. RESULTS The analysis suggests the psychotherapists had evolved to conducting therapy via an implicit and unique approach based on an unintentional heavy use of common factors. Five prominent themes emerged as central components of change in psychotherapy: the therapeutic relationship as a primary change agent, the importance of the therapist genuineness, the need to acknowledge and act upon a poor therapist-client match, the client bearing the primary responsibility for change, and the therapists' development of unintended eclecticism in response to client interactions. CONCLUSIONS In practice, most psychotherapists start practicing from a traditional theoretical orientation only to find their approach evolves over time toward an informal eclecticism featuring common factors. This common factors-based eclecticism emerges primarily from practice experience with clients. These findings suggest an avenue for further inquiry-if psychotherapists are going to gradually evolve in an unplanned eclectic direction guided by their client interactions, are they also concurrently and inherently drawn to the common factors? If the answer proves to be yes, what are the implications for early training? Should the gradual emphasis toward common factors be supplanted with a more intentional and efficient focus on them in the training of students and early career clinicians?
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Affiliation(s)
- Douglas Behan
- School of Social Work, Rutgers, The State University of New Jersey, 390 George St. 3rd Floor, New Brunswick, NJ, 08901, USA.
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10
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Ciarrochi J, Hayes SC, Oades LG, Hofmann SG. Toward a Unified Framework for Positive Psychology Interventions: Evidence-Based Processes of Change in Coaching, Prevention, and Training. Front Psychol 2022; 12:809362. [PMID: 35222161 PMCID: PMC8866971 DOI: 10.3389/fpsyg.2021.809362] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/14/2021] [Indexed: 01/29/2023] Open
Abstract
Since 2000, research within positive psychology has exploded, as reflected in dozens of meta-analyses of different interventions and targeted processes, including strength spotting, positive affect, meaning in life, mindfulness, gratitude, hope, and passion. Frequently, researchers treat positive psychology processes of change as distinct from each other and unrelated to processes in clinical psychology. This paper presents a comprehensive framework for positive psychology processes that crosses theoretical orientation, links coherently to clinical psychology and its more dominantly "negative" processes, and supports practitioners in their efforts to personalize positive psychological interventions. We argue that a multi-dimensional and multi-level extended evolutionary approach can organize effective processes of change in psychosocial interventions, by focusing interventions on context-appropriate variation, selection, and retention of processes, arranged in terms of key biopsychosocial dimensions across psychological, biophysiological, and sociocultural levels of analysis. We review widely studied positive psychology constructs and programs and show how this evolutionary approach can readily accommodate them and provide a common language and framework for improving human and community flourishing. We conclude that Interventions should start with the person, not the protocol.
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Affiliation(s)
- Joseph Ciarrochi
- Institute of Positive Psychology and Education, Australian Catholic University, Sydney, NSW, Australia
| | - Steven C Hayes
- Department of Psychology, University of Nevada, Reno, NV, United States
| | - Lindsay G Oades
- Centre for Positive Psychology, University of Melbourne, Melbourne, VIC, Australia
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Philipps University Marburg, Marburg, Germany.,Boston University, Boston, MA, United States
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11
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Merlo G, Nicastro L, Taibi D. Psychotherapy as a Moderator of the Relationship Between Coping Strategies and Anxiety During the COVID-19 Pandemic. Front Psychol 2021; 12:764347. [PMID: 34733221 PMCID: PMC8559725 DOI: 10.3389/fpsyg.2021.764347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has led to the development of several risk factors for mental health, not only for people directly infected but also for those experiencing social isolation, loneliness, and concern for their health. The impact of these factors on individuals' health and well-being also depends on the type of coping strategies adopted. Moreover, one of the main effects of COVID-19 is the increase in the prevalence of people who manifest anxious or depressive syndromes. This study investigates the relationship between coping strategies and a multidimensional assessment of anxiety symptoms measured during the COVID-19 pandemic in people who were having psychotherapy sessions, while participating in the study had psychotherapy sessions (clinical group) and those who have never done them (non-clinical group). The results of a questionnaire administered online to Italian subjects from June to July, 2020 were analyzed through multiple linear regressions methods to evaluate the role of psychotherapy as moderator between anxiety symptoms and coping strategies. The results of this study highlight that there are substantial differences in functioning between the clinical and non-clinical groups, underlying the key role of psychotherapy as a moderator between anxiety and the coping strategies of avoidance, social support, and positive attitude.
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Affiliation(s)
- Gianluca Merlo
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, Palermo, Italy
| | - Lucia Nicastro
- Società Italiana di Psicoterapia Funzionale, Naples, Italy
| | - Davide Taibi
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, Palermo, Italy
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12
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Clark C, Holttum S. 'A life I can cope with'. An alternative model of cognitive behavioural therapy (CBT) for CFS/ME. Health Expect 2021; 25:91-102. [PMID: 34472690 PMCID: PMC8849251 DOI: 10.1111/hex.13326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/14/2021] [Accepted: 07/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives This study aimed to explore the experience of cognitive behavioural therapy (CBT) aimed at better management of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), rather than increasing activity. Design This was a qualitative study using grounded theory analysis. Methods Semi‐structured interviews were conducted with 13 adults who had engaged in CBT at a specialist CFS/ME service in which CBT is aimed at improved management of the condition. Results A model was produced in which participants felt more able to cope with CFS/ME. Reduced fatigue did not seem to be a necessary precondition to managing. This has implications for CBT for CFS/ME. Conclusions Specialist CBT for CFS/ME may result in improved coping and reduced distress, independently of changes in fatigue. Patient or Public Contribution The researcher met with a representative from the university's service user advisory group (SAGE), who had lived experience of CFS/ME. They commented on possible questions for the interview topic guide and provided advice on ways in which ethical issues specific to CFS/ME could be considered, for example, prevention of harm during interviews. Second, for quality assurance as part of respondent validation, a proposed draft of the grounded theory was discussed with participants.
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Affiliation(s)
- Catherine Clark
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Canterbury, UK
| | - Sue Holttum
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Canterbury, UK
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13
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Quinze ans après le rapport de l’Inserm. L’efficacité de la psychanalyse ré-évaluée. EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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14
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Fifteen years after the INSERM report. Psychoanalysis's efficacy reevaluated. EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Uusitalo S, Tuominen J, Arstila V. Mapping out the philosophical questions of AI and clinical practice in diagnosing and treating mental disorders. J Eval Clin Pract 2021; 27:478-484. [PMID: 32996664 DOI: 10.1111/jep.13485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
How to classify the human condition? This is one of the main problems psychiatry has struggled with since the first diagnostic systems. The furore over the recent editions of the diagnostic systems DSM-5 and ICD-11 has evidenced it to still pose a wicked problem. Recent advances in techniques and methods of artificial intelligence and computing power which allows for the analysis of large data sets have been proposed as a possible solution for this and other problems in classification, diagnosing, and treating mental disorders. However, mental disorders contain some specific inherent features, which require critical consideration and analysis. The promises of AI for mental disorders are threatened by the unmeasurable aspects of mental disorders, and for this reason the use of AI may lead to ethically and practically undesirable consequences in its effective processing. We consider such novel and unique questions AI presents for mental health disorders in detail and evaluate potential novel, AI-specific, ethical implications.
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Affiliation(s)
- Susanne Uusitalo
- Turku Institute for Advanced Studies, University of Turku, Turku, Finland.,Department of Philosophy, Contemporary History and Political Science/Philosophy, University of Turku, Turku, Finland
| | - Jarno Tuominen
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland.,Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Valtteri Arstila
- Department of Philosophy, Contemporary History and Political Science/Philosophy, University of Turku, Turku, Finland.,Department of Philosophy, History, Art and Culture Studies, University of Helsinki, Helsinki, Finland
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16
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Holttum S, Wright T, Wood C. Art therapy with people diagnosed with psychosis: therapists’ experiences of their work and the journey to their current practice. INTERNATIONAL JOURNAL OF ART THERAPY 2021. [DOI: 10.1080/17454832.2021.1893370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Sue Holttum
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Canterbury, UK
| | | | - Chris Wood
- Art Therapy Courses Northern Programme, Sheffield Health and Social Care NHS Trust, Sheffield, UK
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17
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Is the N-of-1 method applicable in bodywork research? Lessons learned using a trial as a methodological pilot. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2021; 19:203-210. [PMID: 33583758 DOI: 10.1016/j.joim.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/08/2021] [Indexed: 11/20/2022]
Abstract
N-of-1 trial designs have rarely been used in bodywork research. Using a recent trial as a methodological pilot, critical issues related to the applicability of N-of-1 trials to bodywork are discussed. These include the issues of carry-over effects, bias-controlling approaches and statistical analysis. The discussion highlights the importance of mixed methods and draws some suggestions for a future research program. N-of-1 trials could be used to provide insights about some essential elements of bodywork modalities and their effectiveness.
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Hayes SC, Hofmann SG, Ciarrochi J. A process-based approach to psychological diagnosis and treatment:The conceptual and treatment utility of an extended evolutionary meta model. Clin Psychol Rev 2020; 82:101908. [PMID: 32932093 PMCID: PMC7680437 DOI: 10.1016/j.cpr.2020.101908] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/18/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022]
Abstract
For half a century, the dominant paradigm in psychotherapy research has been to develop syndrome-specific treatment protocols for hypothesized but unproved latent disease entities, as defined by psychiatric nosological systems. While this approach provided a common language for mental health problems, it failed to achieve its ultimate goal of conceptual and treatment utility. Process-based therapy (PBT) offers an alternative approach to understanding and treating psychological problems, and promoting human prosperity. PBT targets empirically established biopsychosocial processes of change that researchers have shown are functionally important to long terms goals and outcomes. By building on concepts of known clinical utility, and organizing them into coherent theoretical models, an idiographic, functional-analytic approach to diagnosis is within our grasp. We argue that a multi-dimensional, multi-level extended evolutionary meta-model (EEMM) provides consilience and a common language for process-based diagnosis. The EEMM applies the evolutionary concepts of context-appropriate variation, selection, and retention to key biopsychosocial dimensions and levels related to human suffering, problems, and positive functioning. The EEMM is a meta-model of diagnostic and intervention approaches that can accommodate any set of evidence-based change processes, regardless of the specific therapy orientation. In a preliminary way, it offers an idiographic, functional analytic, and clinically useful alternative to contemporary psychiatric nosological systems.
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19
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Gonon F, Keller PH. [Efficacy of psychodynamic therapies: A systematic review of the recent literature]. Encephale 2020; 47:49-57. [PMID: 32928529 DOI: 10.1016/j.encep.2020.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/23/2020] [Indexed: 12/14/2022]
Abstract
AIM A French governmental institute published, in February 2004, a report assessing the efficacy of psychotherapies in the light of the biomedical literature. It concluded that cognitive psychotherapies effectively cure common mental disorders, while the efficacy of psychodynamic therapies is not proven by scientific studies. Because many French mental health professionals are practicing with reference to psychoanalysis, this conclusion stirred up heated controversy. Since February 2004, numerous studies assessing psychodynamic therapies have been published in peer-reviewed biomedical journals. Moreover, these primary studies have been meta-analyzed in dozens of review articles. Here, we systematically review these meta-analysis articles. METHODS A systematic search for meta-analyses assessing psychodynamic therapies was performed using PubMed and identified 71 articles published from January 2004 to December 2019. Among them, 25 articles were judged to be relevant because they reported meta-analyses assessing the symptoms of common mental disorders in at least three distinct cohorts of adult patients. Although the primary studies included in these 25 meta-analysis articles often overlap, the selection criteria, calculation methods and results always differ between them. Therefore, we reviewed all of them without further selection. From all the meta-analyses reported in these 25 articles, we systematically present here the most compelling ones, i.e. those calculated from the largest number of primary studies. Results were quantified in terms of effect size (i.e. standardized mean difference). Effect sizes below 0.25 were considered as without clinical significance, whereas those superior to 0.8 were regarded as robust. Because short-term psychodynamic therapies had been assessed in 20 meta-analysis articles published until 2017, we did not search for more recent primary studies. However, because the most recent meta-analysis article about long-term psychodynamic therapies was published in 2013, we also searched, using PubMed, for primary studies assessing psychodynamic therapies lasting for at least one year and published from January 2013 to December 2019. Among the 57 publications retrieved by PubMed, three were identified as randomized controlled trials not included in meta-analyses and were extensively described here. RESULTS Eight meta-analysis articles have assessed symptom improvement at treatment termination by comparing with baseline symptoms. According to all of them, psychodynamic therapies alleviate symptoms and their effect sizes are always robust. Three meta-analysis articles compared psychodynamic therapies with inactive treatments (e.g. placebo medication, waiting list) and reported clinically significant differences in favor of psychodynamic therapies. Ten meta-analysis articles compared, at treatment termination, psychodynamic therapies to active treatments, including medication and cognitive psychotherapies. Nine of them reported no difference. Only one article concluded that psychodynamic therapies are clinically inferior to cognitive psychotherapies (d=-0.28). Seven meta-analysis articles compared psychodynamic therapies to active treatment at follow-up (i.e. months or years after treatment termination). Five of them reported no significant difference, one reported a medium effect size in favor of psychodynamic therapies over various active treatments (d=0.38), while the other reported a clinically significant difference in favor of cognitive psychotherapies (d=-0.55). Because short-term treatments are often insufficient to prevent relapse, investigations about long-term treatments (i.e. more than one year) are needed, but such published studies are still scarce. Five meta-analysis articles and three primary studies published since 2013 compared long-term psychodynamic therapies to various active treatments of similar duration. According to them, psychodynamic therapies were at least as effective as other active treatments. CONCLUSION A systematic review about psychodynamic therapies, published in 2015 in Lancet Psychiatry, included 64 randomized controlled trials of which 37 were published after 2003. Therefore, most quality studies assessing psychodynamic therapies have been published since 2003 and have been reviewed in recent meta-analysis articles. All together, this recent literature leads to the conclusion that psychodynamic therapies are as effective as active treatments, including cognitive psychotherapies, to help patients suffering from common mental disorders (unipolar depression, anxiety disorders, eating disorders and personality disorders). Beside this overall conclusion, it appears that randomized controlled trials are not well suited for answering why psychotherapies work in some patients but not in others, and how they work in general. Other approaches are needed, including case studies.
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Affiliation(s)
- F Gonon
- Institut des maladies neurodégénératives, université de Bordeaux, Bordeaux, France.
| | - P-H Keller
- Département de psychologie, université de Poitiers, Poitiers, France
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Greenway KT, Garel N, Jerome L, Feduccia AA. Integrating psychotherapy and psychopharmacology: psychedelic-assisted psychotherapy and other combined treatments. Expert Rev Clin Pharmacol 2020; 13:655-670. [DOI: 10.1080/17512433.2020.1772054] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kyle T. Greenway
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Nicolas Garel
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Lisa Jerome
- Data Services, MAPS Public Benefit Corporation
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Dindo LN, Recober A, Calarge CA, Zimmerman BM, Weinrib A, Marchman JN, Turvey C. One-Day Acceptance and Commitment Therapy Compared to Support for Depressed Migraine Patients: a Randomized Clinical Trial. Neurotherapeutics 2020; 17:743-753. [PMID: 31863406 PMCID: PMC7283406 DOI: 10.1007/s13311-019-00818-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
In patients with migraine, depression is associated with poorer medical prognosis, decreased quality of life, and increased risk of suicidality and disability; yet, behavioral interventions have rarely been investigated. The current study compared the efficacy of two 1-day (5- to 6-h) interventions for co-occurring migraine and depression: (1) acceptance and commitment therapy plus migraine education (ACT-ED), and (2) support plus migraine education (S-ED). One hundred and thirty-six patients with comorbid depression and migraine were randomized to a treatment. One hundred and three (76%) completed the ACT-ED (N = 56) or S-ED (N = 47) workshop. Primary outcomes were depression diagnosis and symptoms. Secondary outcomes were anxiety symptoms, headache-related disability and general functioning, and quality of life. Assessments were completed at baseline and 3 and 6 months following the workshop. At the 6-month follow-up, on categorical outcomes, a significantly greater number of people in the ACT-ED condition no longer met criteria for a major depressive episode and exhibited a > 50% drop in symptoms on the Hamilton Rating Scale of Depression. Similarly, though, weaker results were found when examining depressive symptoms dimensionally. On secondary outcomes, people in the ACT-ED condition exhibited significantly greater improvements in anxiety, headache-related disability, and quality of social relationships, compared to S-ED, No differences between groups were observed in general functioning. A 1-day (5- to 6-h) ACT workshop can deliver substantial and lasting benefits to depressed migraineurs, over and above those provided by group support and education. This approach is an attractive alternative to weekly psychotherapy. Clinicaltrials.gov # NCT02108678.
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Affiliation(s)
- Lilian N Dindo
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Holcombe, Houston, TX, 77030, USA.
- Department of Internal Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA.
| | - Ana Recober
- University of Pennsylvania & the Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chadi A Calarge
- Department of Internal Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | | | - Aliza Weinrib
- Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - James N Marchman
- Department of Psychology, University of Iowa, Iowa City, IA, USA
| | - Carolyn Turvey
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
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22
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Whiston A, Bockting CLH, Semkovska M. Towards personalising treatment: a systematic review and meta-analysis of face-to-face efficacy moderators of cognitive-behavioral therapy and interpersonal psychotherapy for major depressive disorder. Psychol Med 2019; 49:2657-2668. [PMID: 31615583 DOI: 10.1017/s0033291719002812] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Consistent evidence suggests that face-to-face cognitive-behavioural therapy (CBT) and interpersonal psychotherapy (IPT) may be equally effective depression treatments. Current clinical research focuses on detecting the best predictors-moderators of efficacy to guide treatment personalisation. However, individual moderator studies show inconsistent findings. This systematic review and meta-analysis aimed to compare the efficacy of CBT and IPT, including combined treatment with antidepressants for depression, and evaluate the predictive power of demographic, clinical presentation and treatment characteristics moderators for both therapies. METHODS PsycArticles, PsycINFO, PubMed and Cochrane Library were systematically searched through December 2017 for studies that have assessed individuals with major depression receiving either CBT or IPT in a face-to-face format both at pre- and post-treatment. Random-effects moderator meta-analyses were conducted. RESULTS In total 168 samples from 137 studies including 11 374 participants qualified for the meta-analytic review. CBT and IPT were equally effective across all but one prespecified moderators. For psychotherapy delivered without concomitant antidepressant treatment [antidepressant medications (ADMs)], CBT was superior to IPT (g = 1.68, Qbetweenp = 0.037). Within-CBT moderator analyses showed that increased CBT efficacy was associated with lower age, high initial depression severity, individual format of administration and no adjunctive ADMs. Within-IPT analyses showed comparable efficacy across all moderators. CONCLUSIONS Clinical guidance around combined treatment (psychotherapy plus ADMs) should be reconsidered. CBT alone is superior to IPT alone and to combined treatment, while IPT alone is non-inferior to combined treatment. More research is needed to assess the moderating effect of older age and number of previous episodes on IPT efficacy.
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Affiliation(s)
- Aoife Whiston
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Claudi L H Bockting
- Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | - Maria Semkovska
- Department of Psychology, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Abstract
Psychotherapies may work through techniques that are specific to each therapy or through factors that all therapies have in common. Proponents of the common factors model often point to meta-analyses of comparative outcome studies that show all therapies have comparable effects. However, not all meta-analyses support the common factors model; the included studies often have several methodological problems; and there are alternative explanations for finding comparable outcomes. To date, research on the working mechanisms and mediators of therapies has always been correlational, and in order to establish that a mediator is indeed a causal factor in the recovery process of a patient, studies must show a temporal relationship between the mediator and an outcome, a dose–response association, evidence that no third variable causes changes in the mediator and the outcome, supportive experimental research, and have a strong theoretical framework. Currently, no common or specific factor meets these criteria and can be considered an empirically validated working mechanism. Therefore, it is still unknown whether therapies work through common or specific factors, or both.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
| | - Mirjam Reijnders
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
| | - Marcus J.H. Huibers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
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Polese D, Fornaro M, Palermo M, De Luca V, de Bartolomeis A. Treatment-Resistant to Antipsychotics: A Resistance to Everything? Psychotherapy in Treatment-Resistant Schizophrenia and Nonaffective Psychosis: A 25-Year Systematic Review and Exploratory Meta-Analysis. Front Psychiatry 2019; 10:210. [PMID: 31057434 PMCID: PMC6478792 DOI: 10.3389/fpsyt.2019.00210] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/22/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Roughly 30% of schizophrenia patients fail to respond to at least two antipsychotic trials. Psychosis has been traditionally considered to be poorly sensitive to psychotherapy. Nevertheless, there is increasing evidence that psychological interventions could be considered in treatment-resistant psychosis (TRP). Despite the relevance of the issue and the emerging neurobiological underpinnings, no systematic reviews have been published. Here, we show a systematic review of psychotherapy interventions in TRP patients of the last 25 years. Methods: The MEDLINE/PubMed, ISI WEB of Knowledge, and Scopus databases were inquired from January 1, 1993, to August 1, 2018, for reports documenting augmentation or substitution with psychotherapy for treatment-resistant schizophrenia (TRS) and TRP patients. Quantitative data fetched by Randomized Controlled Trials (RCTs) were pooled for explorative meta-analysis. Results: Forty-two articles have been found. Cognitive behavioral therapy (CBT) was the most frequently recommended psychotherapy intervention for TRS (studies, n = 32, 76.2%), showing efficacy for general psychopathology and positive symptoms as documented by most of the studies, but with uncertain efficacy on negative symptoms. Other interventions showed similar results. The usefulness of group therapy was supported by the obtained evidence. Few studies focused on negative symptoms. Promising results were also reported for resistant early psychosis. Limitations: Measurement and publication bias due to the intrinsic limitations of the appraised original studies. Conclusions: CBT, psychosocial intervention, supportive counseling, psychodynamic psychotherapy, and other psychological interventions can be recommended for clinical practice. More studies are needed, especially for non-CBT interventions and for all psychotherapies on negative symptoms.
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Affiliation(s)
- Daniela Polese
- Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples “Federico II”, Naples, Italy
- Department of Neuroscience, Psychiatric Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Michele Fornaro
- Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples “Federico II”, Naples, Italy
| | - Mario Palermo
- Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples “Federico II”, Naples, Italy
| | - Vincenzo De Luca
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andrea de Bartolomeis
- Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples “Federico II”, Naples, Italy
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25
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Sabucedo P. Acceptance and commitment therapy (ACT) and humanistic psychotherapy: an integrative approximation. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2019. [DOI: 10.1080/03069885.2019.1597016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Pablo Sabucedo
- Department of Psychology, University of Roehampton, London, UK
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26
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Schweiger JI, Kahl KG, Klein JP, Sipos V, Schweiger U. Innovation in Psychotherapy, Challenges, and Opportunities: An Opinion Paper. Front Psychol 2019; 10:495. [PMID: 30941070 PMCID: PMC6433985 DOI: 10.3389/fpsyg.2019.00495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 02/20/2019] [Indexed: 11/13/2022] Open
Abstract
Psychotherapy as a field tends toward conservativism, and the rate of innovation and development of new evidence-based effective treatments has been slow. The paper explores important barriers to innovation like the dodo bird verdict and the habit of starting the development of therapeutic methods from techniques. The paper looks at the opportunities for translating basic science in psychology into psychotherapeutic techniques. Metacognitive therapy stands out from other psychotherapies by its development from basic science. The paper describes the development of the techniques detached mindfulness and attention training, how they were derived from basic science and tested for their suitability in the therapy of patients with anxiety disorders. By this process, metacognitive therapy may be an important model for the innovation process in psychotherapy.
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Affiliation(s)
- Janina Isabel Schweiger
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Kai G. Kahl
- Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Jan Philipp Klein
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Lübeck, Germany
| | - Valerija Sipos
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Lübeck, Germany
| | - Ulrich Schweiger
- Klinik für Psychiatrie und Psychotherapie, Universität zu Lübeck, Lübeck, Germany
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27
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van Bronswijk S, Moopen N, Beijers L, Ruhe HG, Peeters F. Effectiveness of psychotherapy for treatment-resistant depression: a meta-analysis and meta-regression. Psychol Med 2019; 49:366-379. [PMID: 30139408 DOI: 10.1017/s003329171800199x] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Despite substantial advances in treatment and management strategies for major depression, less than 50% of patients respond to first-line antidepressant treatment or psychotherapy. Given the growing number of controlled studies of psychotherapy for treatment-resistant depression (TRD) and the preference for psychotherapy of depressed subjects as a treatment option, we conducted a meta-analysis and meta-regression analysis to investigate the effectiveness of psychotherapy for TRD. Seven different psychotherapies were studied in 21 trials that included a total of 25 comparisons. In three comparisons of psychotherapy v. treatment as usual (TAU) we found no evidence to conclude that there is a significant benefit of psychotherapy as compared with TAU. In 22 comparisons of add-on psychotherapy plus TAU v. TAU only, we found a moderate general effect size of 0.42 (95% CI 0.29-0.54) in favor of psychotherapy plus TAU. The meta-regression provided evidence for a positive association between baseline severity as well as group v. individual therapy format with the treatment effect. There was no evidence for publication bias. Most frequent investigated treatments were cognitive behavior therapy, interpersonal psychotherapy, mindfulness-based cognitive therapy, and cognitive behavioral analysis system of psychotherapy. Our meta-analysis provides evidence that, in addition to pharmacological and neurostimulatory treatments, the inclusion of add-on of psychotherapy to TAU in guidelines for the treatment of TRD is justified and will provide better outcomes for this difficult-to-treat population.
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Affiliation(s)
- Suzanne van Bronswijk
- Department of Psychiatry and Psychology,University Hospital Maastricht, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University,P.O. Box 5800, 6202 AZ Maastricht,The Netherlands
| | - Neha Moopen
- School of Social and Behavioral Sciences, Tilburg University,Tilburg,The Netherlands
| | - Lian Beijers
- Department of Psychiatry,University of Groningen, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE),Groningen,The Netherlands
| | - Henricus G Ruhe
- Department of Psychiatry,Warneford Hospital, University of Oxford,Oxford,UK
| | - Frenk Peeters
- Department of Psychiatry and Psychology,University Hospital Maastricht, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University,P.O. Box 5800, 6202 AZ Maastricht,The Netherlands
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Holt R, McLean L. Australian Psychotherapy for Trauma Incorporating Neuroscience: Evidence- and Ethics-Informed Practice. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Karnouk C, Böge K, Hahn E, Strasser J, Schweininger S, Bajbouj M. Psychotherapy in Jordan: An Investigation of the Host and Syrian Refugee Community's Perspectives. Front Psychiatry 2019; 10:556. [PMID: 31456702 PMCID: PMC6700211 DOI: 10.3389/fpsyt.2019.00556] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022] Open
Abstract
Little is known about patient satisfaction, bias, stigma, and the effects of psychotherapy within the Kingdom of Jordan or the Arab world in general. The purpose of this study was to explore the perceptions of both the Jordanian host and refugee community members from the psychotherapeutic services offered at various mental health care settings in Jordan. A sample of 100 patients who received psychosocial expert interventions was recruited between October and December 2017 in Amman, Jordan. Participants were either from the host or Syrian refugee community or contacted through multiple organizations working in the mental health field. The Patient Satisfaction Questionnaire, which consists of four subscales covering 1) patient satisfaction, 2) bias toward therapy, 3) effects of therapy, and 4) stigma, was administered. As a means of investigation and exploration, descriptive statistics of participant responses are displayed. Results revealed overall high rates of satisfaction with provided services and perceived benefits of psychotherapeutic interventions. However, respondents showed ambivalence regarding bias and stigma. Subsample analyses indicated no significant differences between both communities. These findings give an understanding of perceptions surrounding psychotherapy in Jordan and some insights on therapeutic processes that may be useful for clinical applications and future research.
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Affiliation(s)
- Carine Karnouk
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin, Berlin, Germany
| | - Kerem Böge
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin, Berlin, Germany
| | - Eric Hahn
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin, Berlin, Germany
| | - Judith Strasser
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin, Berlin, Germany
| | - Stephanie Schweininger
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Charité-Universitätsmedizin, Berlin, Germany
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Abstract
SUMMARYCritical psychiatry has often been confused with what is widely known as ‘anti-psychiatry’. In this article the distinction is clarified and the particular contribution critical psychiatry makes is outlined. That contribution is constructive criticism: of the relationship between medicine and mental health practice, of the way drug and psychotherapeutic treatments for mental health difficulties might be better understood. These have implications for everyday clinical practice and there is much to be gained by openly embracing the controversies critical psychiatry highlights.LEARNING OBJECTIVES•Understand the origins of critical psychiatry and recognise some of the difficulties that arise from identifying psychiatry with medicine•Appreciate the differences between disease-centred and drug-centred approaches to prescribing psychiatric medication•Become aware of implications that arise from psychotherapeutic outcomes researchDECLARATION OF INTERESTSH. M. and J. M. are co-chairs of the UK Critical Psychiatry Network.
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31
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Zimmermann R, Krause M, Weise S, Schenk N, Fürer L, Schrobildgen C, Schlüter-Müller S, Valdes N, Koenig J, Kaess M, Schmeck K. A design for process-outcome psychotherapy research in adolescents with Borderline Personality Pathology. Contemp Clin Trials Commun 2018; 12:182-191. [PMID: 30511027 PMCID: PMC6251014 DOI: 10.1016/j.conctc.2018.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/02/2018] [Accepted: 10/28/2018] [Indexed: 01/31/2023] Open
Abstract
Underage patients with Borderline Personality Pathology (BPP) are in need of specialised psychotherapeutic treatment. A handful of these treatments, including Adolescent Identity Treatment (AIT) and Dialectical Behavior Therapy for Adolescents (DBT-A), have been adapted for adolescent patients. Psychotherapy research has shown that the outcome of different psychotherapeutic approaches can be very similar despite conceptual and practical differences between the theoretical models. Therefore, to understand what really works in psychotherapy, it is necessary to investigate the psychotherapeutic process and its effects on the patient. This paper presents a study design for process-outcome research, integrating (1) a classical outcome design, comparing AIT and DBT-A in a non-inferiority trial assessing changes in psychosocial functioning at 12 months after baseline as primary outcome; and (2) a process research design, addressing multiple BPP and psychotherapy relevant factors. These factors include well-studied generic variables such as the psychotherapeutic alliance, more recent approaches such as video-based identification of significant therapeutic events, as well as more experimental approaches such as psychophysiological markers measured during the therapeutic sessions. The use of repeated measures and the methodological pluralism which includes event and micro-process analyses has been recommended for psychotherapy research aiming at a better understanding of the interplay of factors at work to narrow the gap between research and practice in this field.
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Affiliation(s)
- Ronan Zimmermann
- Child and Adolescent Psychiatric Hospital, Psychiatric Hospitals of the University of Basel, Basel, Switzerland
| | - Mariane Krause
- Psychology School, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality, MIDAP, Santiago, Chile
| | - Sindy Weise
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine University of Heidelberg, Heidelberg, Germany
| | - Nathalie Schenk
- Child and Adolescent Psychiatric Hospital, Psychiatric Hospitals of the University of Basel, Basel, Switzerland
| | - Lukas Fürer
- Child and Adolescent Psychiatric Hospital, Psychiatric Hospitals of the University of Basel, Basel, Switzerland
| | - Christian Schrobildgen
- Child and Adolescent Psychiatric Hospital, Psychiatric Hospitals of the University of Basel, Basel, Switzerland
| | - Susanne Schlüter-Müller
- Child and Adolescent Psychiatric Hospital, Psychiatric Hospitals of the University of Basel, Basel, Switzerland
| | - Nelson Valdes
- Instituto Médico Schilkrut, Santiago, Chile
- Millennium Institute for Research in Depression and Personality, MIDAP, Santiago, Chile
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine University of Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine University of Heidelberg, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Hospital, Psychiatric Hospitals of the University of Basel, Basel, Switzerland
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Short D. Conversational Hypnosis: Conceptual and Technical Differences Relative to Traditional Hypnosis. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2018; 61:125-139. [PMID: 30260303 DOI: 10.1080/00029157.2018.1441802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This article provides an overview of conversational hypnosis (CH) as distinct from traditional forms. The article includes a history of Ericksonian hypnosis followed by a conceptual model and operational definitions for CH. The analysis is built on three levels of comparison and contrast. Three concepts commonly used in the general hypnosis literature-focusing, engaging, and inciting-structure a comprehensive definition of CH. The article concludes with recommendations for future research.
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Affiliation(s)
- Dan Short
- Southwest College of Naturopathic Medicine and Health Sciences, Tempe, Arizona, USA
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Schemer L, Vlaeyen JW, Doerr JM, Skoluda N, Nater UM, Rief W, Glombiewski JA. Treatment processes during exposure and cognitive-behavioral therapy for chronic back pain: A single-case experimental design with multiple baselines. Behav Res Ther 2018; 108:58-67. [DOI: 10.1016/j.brat.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/21/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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McQuillin SD, Lyons MD, Clayton RJ, Anderson JR. Assessing the impact of school-based mentoring: Common problems and solutions associated with evaluating nonprescriptive youth development programs. APPLIED DEVELOPMENTAL SCIENCE 2018. [DOI: 10.1080/10888691.2018.1454837] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Lutton SS, Swank JM. The Importance of Intentionality in Untangling Trauma From Severe Mental Illness. ACTA ACUST UNITED AC 2018. [DOI: 10.17744/mehc.40.2.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Trauma has become entangled and largely lost in the conceptualization and treatment of severe mental illness (SMI). Practitioners conceptualize and treat SMI with medical-model ideals. While researchers support using treatment approaches developed from a medical model in treating the symptoms of SMI, these treatments can be problematic for an individual with SMI who has also experienced trauma. Thus, it is imperative that counselors consider trauma separately when working with individuals presenting with SMI. Additionally, counselors need to employ holistic measures to treat trauma. This article focuses on understanding how SMI and trauma have become entangled, what they look like when separated, and why it is important to disentangle them. The conceptualization for the disentanglement process is presented from a Jungian theoretical foundation.
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Abstract
The issue of culture in Indian psychiatry has endured increasing neglect with the burgeoning biological paradigm. This viewpoint debates and demystifies the connotation of "culture" in mainstream psychiatry. As a template to infer dominant thinking in mainstream psychiatry about culture, DLN Murty Rao Oration in 2011, "Indianizing Psychiatry - Is there a case enough?" by Avasthi (2011) (published in the Indian Journal of Psychiatry) has been used. Engaging a broad interdisciplinary view helps unravel the inherent biases in psychiatry and opens up space for analysis of the Indian psyche from a different philosophic tradition and ways of researching it. Effort here is to open up dialog with cultural psychiatry, make efforts to involve traditional and folk therapies, and use available theoretical and empirical resources within cultural psychiatry for a refined practice of psychiatry in India.
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Affiliation(s)
- Anindya Das
- Department of Psychiatry, AIIMS, Rishikesh, Uttarakhand, India
| | - Urvashi Rautela
- School Counsellor and Independent Clinical Psychologist, Rishikesh, Uttarakhand, India
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Timimi S. The diagnosis is correct, but National Institute of Health and Care Excellence guidelines are part of the problem not the solution. J Health Psychol 2018; 23:1148-1152. [PMID: 29600731 DOI: 10.1177/1359105318766139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mike Scott's study provides data demonstrating that the national Improving Access to Psychological Therapies project is not leading to improved outcomes or value for money. I present further data from both the adult and children and young people's versions of Improving Access to Psychological Therapies that lends supports to this conclusion. However, while Scott argues in favour of better compliance with National Institute of Health and Care Excellence guidelines and greater model expertise, I argue that it is this 'technical' focus that is part of the problem not the solution.
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Affiliation(s)
- Sami Timimi
- 1 Lincolnshire Partnership NHS Foundation Trust, UK.,2 Health Education England, UK.,3 University of Lincoln, UK
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A meta-analysis of adjuvant group-interventions in psychiatric care for patients with bipolar disorders. J Affect Disord 2017; 222:28-31. [PMID: 28668712 DOI: 10.1016/j.jad.2017.06.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/08/2017] [Accepted: 06/26/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Bipolar disorders are ranked amongst the top ten causes of global disability and cause high health care costs. Previous studies have showed that mood stabilizing drug therapy combined with psychological treatments lead to significantly fewer relapses and a reduction in hospitalization rates. However, there is a wide spectrum of psychosocial intervention methods for individuals and groups which have been insufficiently examined on a scientific basis. METHODS Studies published between 2003 and 2015 on different types of adjuvant psychosocial group interventions in the MESH database were reviewed and evaluated for their efficacy on patients with bipolar disorder related to the relapse ratio by a meta-analysis. RESULTS The meta-analysis included 24 intervention groups and showed that 75% of treated groups under medication and psychosocial therapy had a lower risk of a relapse than the control groups which only received medication therapy. LIMITATIONS The meta-analysis includes a number of trials with participants in different phases of disease course and study designs, the number of studies in each analyzed intervention group was not balanced and many studies focused on recovery and recurrence of episodes, precluding identification of the impact on subsyndromal symptoms CONCLUSIONS: Adjuvant psychosocial interventions seem to be indispensable for patients, their relations as well as for saving costs in the health care system. Nevertheless, an evaluation of effectiveness and impact factors of different psychosocial intervention methods needs further research.
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Improving knowledge about the effectiveness of psychotherapy. PSYCHOTHERAPY AND POLITICS INTERNATIONAL 2017. [DOI: 10.1002/ppi.1424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Middleton H. More focused attention upon relationship; another call for paradigm shift in psychiatry. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2017. [DOI: 10.1080/13642537.2017.1348374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hugh Middleton
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
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Minges MV, Solomonov N, Barber JP. What Makes Psychodynamic Psychotherapy Work? A Review of Five Perspectives. PSYCHOANALYTIC INQUIRY 2017. [DOI: 10.1080/07351690.2017.1285188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Palpacuer C, Gallet L, Drapier D, Reymann JM, Falissard B, Naudet F. Specific and non-specific effects of psychotherapeutic interventions for depression: Results from a meta-analysis of 84 studies. J Psychiatr Res 2017; 87:95-104. [PMID: 28038336 DOI: 10.1016/j.jpsychires.2016.12.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 12/20/2016] [Accepted: 12/20/2016] [Indexed: 11/17/2022]
Abstract
There is a long-standing and very active debate regarding which psychotherapeutic intervention should be used in depressive disorders. However, the effects of psychotherapies may result majorly from non-specific factors rather than from specific factors related to the type of psychotherapeutic intervention. We performed a systematic review and meta-analysis on aggregated data to understand how the effects of different psychotherapies are impacted by non-specific factors. We included randomized controlled trials that assessed the efficacy of psychotherapeutic interventions in the treatment of adult depressive disorders. The primary outcome was the change in depression score from baseline to the latest follow-up visit (i.e. response). A meta-regression was performed to predict response according to the type of intervention and non-specific factors (e.g. number of treatment sessions, length of follow-up, therapeutic allegiance of the investigator). The main analysis included 214 study arms from 84 trials. The effects of psychotherapies compared to the waiting list control condition failed to remain significant after adjusting for non-specific factors. Response increased with the number of treatment sessions (β = 0.03, 95% CI [0.01; 0.04]) and the length of follow-up (β = 0.01, 95% CI [0.00; 0.02]). Response also improved in case of presumed therapeutic allegiances among investigators (β = 0.29, 95% CI [0.07; 0.52]). Response to psychotherapies seems to be closely related to non-specific effects. The development of a well-designed trial that controls for non-specific factors might help disentangle the effects of psychotherapies.
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Affiliation(s)
- Clément Palpacuer
- INSERM Centre d'Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Rennes, France.
| | | | - Dominique Drapier
- Centre Hospitalier Guillaume Régnier, Rennes, France; EA 4712 Comportement et Noyaux Gris Centraux, Centre Hospitalier Universitaire de Rennes et Université de Rennes 1, Rennes, France
| | - Jean-Michel Reymann
- INSERM Centre d'Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Bruno Falissard
- INSERM UMR 1178, Faculté de Médecine Paris Sud, Département de Biostatistiques, Hôpital Paul Brousse, Assistance Publique Hôpitaux de Paris, Villejuif, France
| | - Florian Naudet
- INSERM Centre d'Investigation Clinique 1414, Centre Hospitalier Universitaire de Rennes, Rennes, France; EA 4712 Comportement et Noyaux Gris Centraux, Centre Hospitalier Universitaire de Rennes et Université de Rennes 1, Rennes, France
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Tran US, Gregor B. The relative efficacy of bona fide psychotherapies for post-traumatic stress disorder: a meta-analytical evaluation of randomized controlled trials. BMC Psychiatry 2016; 16:266. [PMID: 27460057 PMCID: PMC4962479 DOI: 10.1186/s12888-016-0979-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 07/15/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In the treatment of PTSD, meta-analyses suggest comparable efficacy of cognitive behavioural therapies and various trauma focused treatments, but results for other treatments are inconsistent. One meta-analysis found no differences for bona fide therapies, but was critizised for overgeneralization and a biased study sample and relied on an omnibus test of overall effect size heterogeneity that is not widely used. METHODS We present an updated meta-analysis on bona fide psychotherapies for PTSD, contrasting an improved application of the omnibus test of overall effect size heterogeneity with conventional random-effects meta-analyses of specified treatment types against all others. Twenty-two studies were eligible, reporting 24 head-to-head comparisons in randomized controlled trials of 1694 patients. RESULTS Head-to-head comparison between trauma focused and non-trauma focused treatments revealed a small relative advantage for trauma focused treatments at post-treatment (Hedges' g = 0.14) and at two follow-ups (g = 0.17, g = 0.23) regarding PTSD symptom severity. Controlling and adjusting for influential studies and publication bias, prolonged exposure and exposure therapies (g = 0.19) were slightly more efficacious than other therapies regarding PTSD symptom severity at post-treatment; prolonged exposure had also higher recovery rates (RR = 1.26). Present-centered therapies were slightly less efficacious regarding symptom severity at post-treatment (g = -0.20) and at follow-up (g = -0.17), but equally efficacious as available comparison treatments with regards to secondary outcomes. The improved omnibus test confirmed overall effect size heterogeneity. CONCLUSIONS Trauma focused treatments, prolonged exposure and exposure therapies were slightly more efficacious than other therapies in the treatment of PTSD. However, treatment differences were at most small and far below proposed thresholds of clinically meaningful differences. Previous null findings may have stemmed from not clearly differentiating primary and secondary outcomes, but also from a specific use of the omnibus test of overall effect size heterogeneity that appears to be prone to error. However, more high-quality studies using ITT analyses are still needed to draw firm conclusions. Moreover, the PTSD treatment field may need to move beyond a focus primarily on efficacy so as to address other important issues such as public health issues and the requirements of highly vulnerable populations.
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Affiliation(s)
- Ulrich S. Tran
- Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Liebiggasse 5, A-1010 Vienna, Austria
| | - Bettina Gregor
- Department of Basic Psychological Research and Research Methods, School of Psychology, University of Vienna, Liebiggasse 5, A-1010 Vienna, Austria
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Psychotherapy and Its Role in Psychiatric Practice: A Position Paper. II. Objective, Subjective, and Intersubjective Science. J Psychiatr Pract 2016; 22:321-32. [PMID: 27427844 DOI: 10.1097/pra.0000000000000161] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the first article in this 2-part series, we outlined a psychobiological model of psychiatric treatment and reviewed the evidence showing psychotherapy to be a form of biological intervention that induces lasting alterations in brain structure and function. In this second article, we focus on the adaptive model of psychopathology, the effectiveness of psychotherapeutic interventions, the synergistic effects of combined psychotherapy and psychopharmacology treatments, and attention to the patient's subjective experience and the doctor-patient alliance to complement an "objective" case formulation. The evidence strongly suggests the need for an integrated treatment approach based on the objective, subjective, and intersubjective science that forms the foundation of psychiatry as a clinical discipline, in which psychotherapy and psychopharmacology are seen as complementary treatments within a systemic approach to psychiatric care and training. What emerges is the integrated psychobiological model of care with a complex treatment matrix unique to each patient-provider pair and comprised of biological, experiential, and relational domains of treatment which form the foundation of psychiatry as a science of attachment and meaning.
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Kirk A, Broman-Fulks J, Bergquist J. National attitudes towards mental health treatment: the importance of research evidence. Cogn Behav Ther 2016; 45:458-72. [PMID: 27352993 DOI: 10.1080/16506073.2016.1201847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Most conceptualizations of evidence-based practice view it as a "three legged stool" consisting of: the use of best available research evidence, clinical expertise, and client preferences. Although empirical evidence and clinical expertise have received greater empirical attention, relatively little research has systematically explored client preferences. The present study analyzed self-reported treatment preferences for various clinical and non-clinical presentations. Adult participants (n = 1262) residing in the United States were presented with diagnostic vignettes and rated their relative preferences among 5 treatment variables, including: use of an empirically supported treatment (EST), quality of the client-therapist relationship, therapist empathy, therapist experience, and client speaking for the majority of therapy sessions. Results indicated that participants endorsed significant preference for receiving an EST over other treatment variables for all clinical disorders, with effect sizes ranging from small to large depending on the diagnosis. There was slightly greater variability in treatment preferences for non-clinical issues, though participants generally reported greater preference for receiving an EST. Follow-up questions provided further evidence for EST preferences. The implications of these results are discussed.
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Affiliation(s)
- Alex Kirk
- a Department of Psychology and Neuroscience , University of Colorado Boulder , Boulder , CO , USA
| | - Joshua Broman-Fulks
- b Department of Psychology , Appalachian State University , Boone , NC , USA
| | - John Bergquist
- b Department of Psychology , Appalachian State University , Boone , NC , USA
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[On the present situation in psychotherapy and its implications - A critical analysis of the facts]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2015; 61:122-38. [PMID: 26175169 DOI: 10.13109/zptm.2015.61.2.122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The currently dominating research paradigm in evidence-based medicine is expounded and discussed regarding the problems deduced from so-called empirically supported treatments (EST) in psychology and psychotherapy. Prevalent political and economic as well as ideological backgrounds influence the present dominance of the medical model in psychotherapy by implementing the randomized-controlled research design as the standard in the field. It has been demonstrated that randomized controlled trials (RCTs) are inadequate in psychotherapy research, not the least because of the high complexity of the psychotherapy and the relatively weak role of the treatment concept in the change process itself. All major meta-analyses show that the Dodo bird verdict is still alive, thereby demonstrating that the medical model in psychotherapy with its RCT paradigm cannot explain the equivalence paradox. The medical model is inappropriate, so that the contextual model is proposed as an alternative. Extensive process-outcome research is suggested as the only viable and reasonable way to identify highly complex interactions between the many factors regularly involved in change processes in psychotherapy.
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Fonagy P, Luyten P, Allison E. Epistemic Petrification and the Restoration of Epistemic Trust: A New Conceptualization of Borderline Personality Disorder and Its Psychosocial Treatment. J Pers Disord 2015; 29:575-609. [PMID: 26393477 DOI: 10.1521/pedi.2015.29.5.575] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A new developmental model of borderline personality disorder (BPD) and its treatment is advanced based on evolutionary considerations concerning the role of attachment, mentalizing, and epistemic trust in the development of psychopathology. We propose that vulnerability to psychopathology in general is related to impairments in epistemic trust, leading to disruptions in the process of salutogenesis, the positive effects associated with the capacity to benefit from the social environment. BPD is perhaps the disorder par excellence that illustrates this view. We argue that this conceptualization makes sense of the presence of both marked rigidity and instability in BPD, and has far-reaching implications for intervention.
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Affiliation(s)
- Peter Fonagy
- Department of Clinical, Educational and Health Psychology, University College London
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Belgium, and Research Department of Clinical, Educational and Health Psychology, University College London
| | - Elizabeth Allison
- Department of Clinical, Educational and Health Psychology, University College London
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Kramer U, Stiles WB. The responsiveness problem in psychotherapy: A review of proposed solutions. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/cpsp.12107] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bruijniks SJE, Bosmans J, Peeters FPML, Hollon SD, van Oppen P, van den Boogaard M, Dingemanse P, Cuijpers P, Arntz A, Franx G, Huibers MJH. Frequency and change mechanisms of psychotherapy among depressed patients: study protocol for a multicenter randomized trial comparing twice-weekly versus once-weekly sessions of CBT and IPT. BMC Psychiatry 2015; 15:137. [PMID: 26122891 PMCID: PMC4486419 DOI: 10.1186/s12888-015-0532-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/16/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) and interpersonal therapy (IPT) are among the most well established therapies for the treatment of depression. However, some major questions remain unanswered. First, it is unknown what session frequency results in the most optimal (cost) effectiveness in psychotherapy. Second, the debate as to what mechanisms underlie the effect of psychotherapy has not yet been resolved. Enhancing knowledge about the optimal session frequency and mechanisms of change seems crucial in order to optimize the (cost) effectiveness of psychotherapy for depression. This study aims to compare treatment outcome of twice-weekly versus once-weekly sessions of CBT and IPT. We expect twice-weekly sessions to be more effective and lead to more rapid recovery of depressive symptoms in comparison to once-weekly sessions. Both therapy-specific and non-specific process measures will be included to unravel the mechanisms of change in psychotherapy for depression. Besides the use of self-reports and behavioral observations, this study will also examine underlying biological processes by collecting blood samples. METHOD In a multicenter randomized trial, two hundred depressed patients will be recruited from Dutch specialized mental healthcare centers and randomized into one of the following groups, all receiving a maximum of 20 sessions in different frequencies: a) twice-weekly sessions at the start of CBT, b) twice-weekly sessions at the start of IPT, c) once-weekly sessions at the start of CBT, d) once-weekly sessions at the start of IPT. Primary outcome measures are depression severity, cost-effectiveness and quality of life. Process measures include therapeutic alliance, recall, therapy-specific skills, motivation and compliance. Assessments will take place during baseline, monthly during treatment and follow-up at month 9, 12 and 24. In addition, at 12 and 24 months, the frequency of depressive episodes in the previous year will be assessed. Blood samples will be taken pre- and post-treatment. The study has been ethically approved and registered. DISCUSSION Finding that twice-weekly sessions are more effective or lead to more rapid recovery of depressive symptoms could lead to treatment adaptations that have the potential to reduce the personal and societal burden of depression. In addition, insight into the mechanisms of change and physiological processes in psychotherapy will enable us to optimize treatments and may help to understand human functioning beyond the context of treatment. TRIAL REGISTRATION The study has been registered on October 21th, 2014 at the Netherlands Trial Register, part of the Dutch Cochrane Centre ( NTR4856 ).
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Affiliation(s)
- Sanne J. E. Bruijniks
- Department of Clinical Psychology, VU University Amsterdam, and EMGO Institute, Amsterdam, The Netherlands
| | - Judith Bosmans
- Department of Health Sciences, EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, Section of Health Economics and Health Technology Assessment, VU University Amsterdam, Amsterdam, The Netherlands.
| | - Frenk P. M. L. Peeters
- Department of Psychiatry and Psychology, University Hospital Maastricht; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Steven D. Hollon
- Department of Psychology, Vanderbilt University, Nashville, Tennessee USA
| | - Patricia van Oppen
- Department of Psychiatry, VU Medical Centre/GGZ ingeest, and the EMGO Institute, Amsterdam, The Netherlands.
| | | | | | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, and EMGO Institute, Amsterdam, The Netherlands.
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Gerdien Franx
- Trimbos-institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Marcus J. H. Huibers
- Department of Clinical Psychology, VU University Amsterdam, and EMGO Institute, Amsterdam, The Netherlands
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