The Relevance of Internal Working Models of Self and Others for Equine-Assisted Psychodynamic Psychotherapy

Attachment characteristics play a key role in mental health and in understanding mental disorders. The aim of this study was to gain insight into the role the attachment characteristics can play in treatment effects in adult patients with intrapsychic and interpersonal problems who underwent Equine-assisted Short-term Psychodynamic Psychotherapy (ESTPP). In the first part of the study, we compared the effects of ESTPP to treatment-as-usual from a previous dataset regarding psychological dysfunction. For this, an explorative experimental non-randomized pre-treatment and 1-year post-treatment design was used. A mixed model revealed a significant decline in psychological dysfunction for both conditions, with no significant difference between the two. In the second part of the study, we examined the course of ESTPP effects over the period of 1 year when controlled for attachment styles and, subsequently, for internal working models of self and others. To this end, measurements were taken at baseline, 2 months waiting time, one-week intensive module, 6 months, and one year after the start of the treatment. Mixed models accounted for repeated measures showed significant improvements in psychological dysfunction, remoralization, and depression for ESTPP patients over time. The study implies that models of self and others may be used to predict the course of effects, which is relevant in determining what works for whom. In particularly, duration and intensity of therapy and a focus on the Model of Self seem relevant for shaping a more personalized treatment. ESTPP seems beneficial for patients with low pre-treatment attachment security.

Reproducibility in the Social Sciences

Concern over social scientists' inability to reproduce empirical research has spawned a vast and rapidly growing literature. The size and growth of this literature make it difficult for newly interested academics to come up to speed. Here, we provide a formal text modeling approach to characterize the entirety of the field, which allows us to summarize the breadth of this literature and identify core themes. We construct and analyze text networks built from 1,947 articles to reveal differences across social science disciplines within the body of reproducibility publications and to discuss the diversity of subtopics addressed in the literature. This field-wide view suggests that reproducibility is a heterogeneous problem with multiple sources for errors and strategies for solutions, a finding that is somewhat at odds with calls for largely passive remedies reliant on open science. We propose an alternative rigor and reproducibility model that takes an active approach to rigor prior to publication, which may overcome some of the shortfalls of the postpublication model.

Predictors of prolonged grief in an internet-based grief therapy for people bereaved by suicide

Internet-based cognitive-behavioural grief therapy (ICBGT) has proven to be effective for people bereaved by suicide, however the extent to which patients can benefit from therapy seems to differ. This study investigates predictors of initial grief as well as change in grief severity following treatment in an ICBGT for people bereaved by suicide. Data was gathered from a randomized control trial including 57 people participating in a 5-week intervention. Change in grief symptoms was calculated using absolute change scores of grief. In order to examine best overall combination of independent variables, best subset regressions were conducted. Higher levels of pre-test grief were associated with worse sleep quality (β = 0.32, p = .002), lower self-esteem (β = -0.37, p = .002), lower support seeking (β = -0.38, p = .006), and a higher need for social support (β = 0.28, p = .028). A greater reduction in grief severity was associated with higher self-efficacy (β = -0.49, p = .001), higher attachment anxiety (β = -0.31, p = .017) and higher pre-test grief symptoms (β = -0.39, p = .006). Attention should be paid to the intensity of grief, the attachment style and a positive self-image, as these variables seem to influence the extent, to which patients' symptoms of PGD subside following ICBGT. To specifically target factors of patients that require improvement, further studies are needed.

[Psychometric evaluation of the Experiences in Close Relationships Revised German 12-item version (ECR-RD 12) in a sample of psychotherapeutic inpatients]

Psychometric evaluation of the Experiences in Close Relationships Revised German 12-item version (ECR-RD 12) in a sample of psychotherapeutic inpatients Objectives: The ECR-R assesses the self-description of adult attachment strategies in romantic relationships. The present study evaluates the psychometric properties of the German 12-item short version ECR-RD 12 in a large sample of patients in psychotherapeutic inpatient treatment. Method: Inpatients in psychotherapeutic treatment (N = 2231) were assessed using the ECR-RD 12 and other clinical questionnaires. Its psychometric properties and factor structure of were evaluated. Results: The psychometric properties of the short form measure were in line with the German full length version (ECR-RD). In contrast to theoretical assumptions, factor analysis suggested a three factor solution in the present sample. Discussion: The ECR-RD 12 can be recommended as a screening measure for assessing attachment styles in inpatient psychotherapeutic settings. Further studies are required to investigate the factor structure of the measure in clinical samples.

Differential effects of adult attachment in cognitive-behavioural and psychodynamic therapy in social anxiety disorder: A comparison between a self-rating and an observer rating

Different measures of attachment are usually weakly correlated. In a subsample of an RCT comparing short-term cognitive-behavioural therapy (CBT) and psychodynamic therapy (PDT), we examined the association between attachment and outcome using two attachment measures. The sample comprises 148 patients with social anxiety disorder who were treated in the SOPHO-NET trial. Pretreatment attachment was assessed using the Adult Attachment Prototype Rating (AAPR) and the Bielefeld Questionnaire of Client Expectations (BQCE). Regression models were used to predict the therapeutic alliance (HAQ) at session 8, the Liebowitz Social Anxiety Scale (LSAS) at the end of therapy and a 6-month follow-up. Attachment groups (secure, avoidant, and ambivalent) classified with the AAPR and the BQCE were not significantly correlated (Cohen's κ = 0.08). Only the BQCE was associated with the HAQ indicating avoidantly attached patients showing lower HAQ scores than securely attached (Cohen's d = 0.722). Regarding the AAPR, we found an interaction effect of treatment and attachment related to the post-treatment LSAS scores. Post hoc tests revealed that securely attached patients in CBT had lower scores than securely attached in PDT (d = 0.922) and, on a trend level, avoidantly attached in CBT (d = 0.782). We conclude that attachment-outcome associations are affected by the applied measure. The identified differential effects suggest that psychotherapists should adapt the interventions on the attachment of their patients.

Patient Extratherapeutic Interpersonal Problems and Response to Psychotherapy for Depression

OBJECTIVES

This paper aimed to synthesize empirical findings of patient extratherapeutic interpersonal variables associated with individual psychotherapy treatment outcomes in adult outpatients with depression.

METHODS

A systematic search strategy was used to identify relevant studies. Thematic analysis was used to identify recurring themes in the findings.

RESULTS

Forty studies met search criteria. Three themes of patient extratherapeutic interpersonal variables were identified: capacity to engage with others, capacity to navigate relationships, and capacity to achieve intimacy, progressing from basic to advanced levels of interpersonal interaction. Interpersonal variables such as interpersonal distress and style, attachment orientation, and quality of object relations were particularly useful in predicting treatment outcomes, whereas access to social support and marital status provided mixed results, likely because they do not account for relationship quality.

CONCLUSIONS

Recognizing variables associated with treatment response can help clinicians identify patients at risk for nonresponse and guide efforts for adapting existing therapies and developing new ones.

The role of attachment style in interpersonal psychotherapy for depressed adolescents

OBJECTIVE(S)

This study examined changes in depressed adolescents' reports of attachment anxiety and avoidance with interpersonal psychotherapy (IPT-A), and the relationship between attachment style and change in depression with IPT-A.

METHOD

Forty adolescents (aged 12-17) participated in a 16-week randomized clinical trial of 4 adaptive treatment strategies for adolescent depression that began with IPT-A and augmented treatment for insufficient responders (n = 22) by adding additional IPT-A sessions (n = 11) or the antidepressant medication, fluoxetine (n = 11). Adolescents were 77.5% female and 22.5% male (mean age = 14.8, SD = 1.8). Ten percent of adolescents were Latino. Racial composition was 7.5% Asian, 7.5% American Indian/Alaska Native, 80.0% white, and 5.0% biracial. Measures of attachment style (Experience in Close Relationships Scale-Revised [ECR-R]) and depression (Children's Depression Rating Scale-Revised [CDRS-R]) were administered at baseline and Weeks 8 and 16.

RESULTS

Attachment Anxiety and Avoidance (ECR-R) decreased significantly from baseline to Week 16. Baseline Avoidance positively predicted greater reductions in depression (CDRS-R), controlling for fluoxetine. Reductions in Anxiety and Avoidance were also significantly associated with reductions in CDRS-R, controlling for fluoxetine.

CONCLUSIONS

Adolescents' reports of attachment anxiety and avoidance are amenable to intervention with IPT-A. IPT-A may be particularly beneficial for adolescents who report a high level of avoidant attachment. Clinical or methodological significance of this article Our findings suggest that attachment anxiety and avoidance are constructs that are amenable to intervention during adolescence, and therefore viable targets of treatment. IPT-A was found to be an effective intervention for addressing problems in attachment style, and decreases in attachment anxiety and avoidance were associated with reductions in depression. This provides support for selecting IPT-A as a treatment option for adolescents who are depressed and describe difficulty with attachment security. IPT-A appears to be particularly effective for adolescents with an avoidant attachment style, who experience discomfort with and have a tendency to avoid intimacy.

Attachment assessment in clinical practice: Factor structure of the attachment questionnaire

OBJECTIVE

Attachment theory is of great relevance to psychotherapy process and outcome. The labor-intensive and time-consuming nature of attachment codification impedes its widespread use in clinical practice. The Attachment Questionnaire (AQ), a clinician-rated instrument, was developed to address these limitations. However, the status of validation of the AQ remains preliminary. The objective of this study is to further validate the AQ by evaluating its factor structure and convergent validity.

METHODS

To this end, 389 psychotherapists completed the AQ and assessed patients' personality disorders and level of functioning.

RESULTS

Factor analyses revealed that a five-factor solution provided a better fit than the original four-factor solution. The additional factor, inhibited exploration, captured difficulties in open, nondefensive, exploration of memories and their effects. Correlations between AQ factors and criterion variables support the convergent validity of the AQ.

CONCLUSIONS

These results are discussed in light of patients' characteristics and recent advances in attachment research.

Effect of Cognitive Behavioral Therapy Versus Interpersonal Psychotherapy in Patients with Major Depressive Disorder: A Meta-analysis of Randomized Controlled Trials

BACKGROUND

Practice guidelines have recommended cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) as the treatment of choice for major depression disorder (MDD). However, whether one therapy is better than the other remains inconclusive. The aim of this study was to compare the treatment efficacy of the two treatment approaches for MDD.

METHODS

Using the terms "cognitive behavior therapy or cognitive therapy or CBT or CT or cognitive behavioral therapy" and "interpersonal psychotherapy or IPT," we systematically searched PubMed, Psyclnfo and Chinese National Knowledge Infrastructure databases up to February 2017. The language was restricted to be English and Chinese. Therapeutic outcomes, characteristics, and research quality were then extracted and analyzed independently. In accessing the included studies, we followed the criteria suggested by the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

Data for 946 patients from 10 randomized controlled trials were included in the study. Methodological quality was not optimal in most trials. Meta-analysis showed a mean difference (MD) of -1.31, 95% confidence interval (CI) (-2.49, -0.12) (P < 0.05) in favor of CBT according to the Beck Depression Inventory (BDI), and however, we did not found any statistically significant difference between CBT and IPT on the Hamilton Rating Scale for depression (HRSD) (MD -0.90, 95% CI [-2.18, 0.38]). Subgroup analyses for the studies in which patients were treated only by psychotherapy (MD -1.26, 95% CI [-2.78, 0.35]) and for those which offered more sessions of therapies (MD -0.82, 95% CI [-2.23, 0.59]) showed there was no significant difference between CBT and IPT according to BDI.

CONCLUSIONS

Differences in treatment efficacy seem to vary according to different outcome measures. CBT shows an advantage over IPT for MDD according to BDI, and there is no significant difference between the two according to HRSD. These results should be interpreted with caution.

Relationships among alexithymia, therapeutic alliance, and psychotherapy outcome in major depressive disorder

Previous studies have found that alexithymia predicts process and outcome of psychodynamic psychotherapy across a range of psychiatric disorders. There is preliminary evidence that alexithymia may exert its effects on outcome through the therapist. Other studies have found that alexithymia does not influence outcome of cognitive-behavioral therapy (CBT). The aim of the current study was to investigate the capacity of alexithymia to predict therapist- and patient-rated therapeutic alliance and response to CBT and interpersonal psychotherapy (IPT) for major depressive disorder. A total of 75 adults with major depressive disorder were randomized to receive weekly sessions of manualized individual CBT or IPT for a period of 16 weeks. Pre-treatment alexithymia exhibited a positive direct effect on depression change, and a negative indirect effect on depression change via patient-rated alliance at week 13. There was no mediating role of therapist-rated alliance. Although these findings are preliminary, they suggest that pre-treatment alexithymia has meaningful links to psychotherapy process and outcome, and that nuanced analyses incorporating intervening variables are necessary to elucidate the nature of these links.