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Dahl K, Bremer K, Wilberg T. The significance of connectedness: avoidant personality disorder patients' subjective experiences of change after attending a specialized treatment program. Front Psychol 2024; 15:1412665. [PMID: 39040961 PMCID: PMC11260824 DOI: 10.3389/fpsyg.2024.1412665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
Objectives This study aimed to inquire into the subjective experiences and meaning-making of change of people diagnosed with avoidant personality disorder (AvPD) after attending a treatment program developed for AvPD. Methods Eighteen AvPD patients were interviewed 1 year after completing their treatment using a semi-structured interview guide. The interviews were analyzed through reflexive thematic analysis. Results Three main themes were found to capture the various subjective experiences of change. The first main theme "being more alive" included the subthemes "talking and listening together" and "opening up and grounding into myself." The second main theme was "still longing for more," and the third main theme "I cannot even manage therapy" included the subthemes "as if we were together" and "capitulation." Conclusion Although these findings may not be specific to AvPD, they shed light on the importance of attending to the dynamic interplay of intersubjectivity, social motivations, and agency in a therapeutic context. Discovering a sense of agency within an interpersonal context in which the patient feels connected may lead to them opening up for development in accordance with their social motivational intentions.
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Affiliation(s)
- Kristine Dahl
- Group Therapy Team, Aust-Agder County Outpatient Psychiatric Unit, Sorlandet Hospital, Kristiansand, Norway
| | - Kjetil Bremer
- Norwegian National Advisory Unit on Personality Psychiatry (NAPP), Oslo University Hospital, Oslo, Norway
| | - Theresa Wilberg
- Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Madarasmi S, Gutierrez-Ramirez P, Barsoum N, Banerjee S, Ramirez Gomez L, Melero-Dominguez M, Gitlin LN, Pederson A, Liu RT, Jain FA. Family dementia caregivers with suicidal ideation improve with mentalizing imagery therapy: Results from a pilot study. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2024; 16:100721. [PMID: 38737194 PMCID: PMC11086673 DOI: 10.1016/j.jadr.2024.100721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Family caregivers of persons living with dementia often experience increased depression and suicidal ideation (SI). However, the feasibility and impact of therapies on caregiver SI has remained largely unexplored. Mentalizing imagery therapy (MIT) helps reduce psychological symptoms through mindfulness and guided imagery. This pilot study examined the feasibility of participation by caregivers with SI in a randomized controlled trial (RCT) of MIT versus a psychosocial support group (SG), and the respective impact of group on SI, depression, and secondary outcomes. Methods A secondary analysis of data from an RCT of 4-week MIT or SG for caregivers (n = 46) was performed, identifying SI (n = 23) and non-SI (n = 23) cohorts. Group attendance and home practice were compared between cohorts. In the SI cohort (total n = 23, MIT n = 11, SG n = 12), group differences in SI, depression, and secondary outcomes were evaluated post-group and at 4-month follow-up. Results Attendance in both groups and home practice in MIT were similar between SI and non-SI cohorts. In the SI cohort, MIT evinced greater improvements relative to SG in SI (p=.02) and depression (p=.02) post-group, and other secondary outcomes at follow-up. Limitations Limitations include small sample size and single-item assessments of SI from validated depression rating scales. Conclusions Participation in an RCT was feasible for caregivers with SI. MIT resulted in important benefits for SI and depression, while SG showed no acute SI benefit. The role of MIT in improving SI should be confirmed with adequately powered trials, as effective therapies to address caregiver SI are critical.
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Affiliation(s)
- Saira Madarasmi
- Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
| | - Paulina Gutierrez-Ramirez
- Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
| | - Nader Barsoum
- Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
| | - Sreya Banerjee
- Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Liliana Ramirez Gomez
- Harvard Medical School, Boston, MA, United States
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Maria Melero-Dominguez
- Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
| | - Laura N. Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, United States
| | - Aderonke Pederson
- Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Richard T. Liu
- Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Felipe A. Jain
- Department of Psychiatry, Depression Clinical and Research Program, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Harvard-Massachusetts Institute of Technology (MIT) Division of Health Sciences and Technology, Boston, MA, United States
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Pourová M, Řiháček T, Chvála L, Vybíral Z, Boehnke JR. Negative effects during multicomponent group-based treatment: A multisite study. Psychother Res 2022; 33:282-297. [PMID: 35776667 DOI: 10.1080/10503307.2022.2095237] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Objective Negative effects (NEs) in group treatments remain an under-researched area. This study aimed to explore the prevalence of various types of NEs in a multicomponent group-based treatment and to determine their predictors. Method: A total of 330 patients participating in a multicomponent group-based treatment were recruited across seven clinical sites. At the end of treatment, the Negative Effects Questionnaire (NEQ) was used to measure NEs. Item-level descriptive analysis was conducted to explore the prevalence of various types of NEs, and structural equation modeling was used to determine predictors of these NEs. Results: The most frequently reported type of NEs was the worsening of symptoms, and the single most frequently reported item was the resurfacing of unpleasant memories. Predictors of NEs included the overall distress level, alexithymia, attachment avoidance, low working alliance, problem actuation, and worse outcomes; psychological mindedness was a protective factor. Conclusion: Patients who experience higher levels of distress at the beginning of treatment, who perceive the group working alliance as problematic, and who experience high in-session emotional arousal related to their problem seem to be especially prone to reporting NEs. Furthermore, the findings do not support the assumption that NEs are a prerequisite for therapeutic change.Trial registration: ISRCTN.org identifier: ISRCTN13532466.
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Affiliation(s)
- Martina Pourová
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Luboš Chvála
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Zbyněk Vybíral
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Jan R Boehnke
- School of Health Sciences, University of Dundee, Dundee, Scotland
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