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Euler S, Babl A, Dommann E, Stalujanis E, Labrish C, Kramer U, McMain S. Maladaptive defense mechanisms moderate treatment outcome in 6 months versus 12 months dialectical-behavior therapy for borderline personality disorder. Psychother Res 2024:1-17. [PMID: 38648578 DOI: 10.1080/10503307.2024.2334053] [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: 08/14/2023] [Accepted: 03/18/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE We investigated whether defense mechanisms in patients with borderline personality disorder (BPD) predict treatment response of dialectical behavior therapy (DBT) and whether they moderate outcome in different treatment lengths. METHOD We analyzed a subsample of 60 outpatients with BPD, randomized into either 6 (n = 30) or 12 (n = 30) months of DBT. The average level of defensive adaptiveness, assessed with observer-rated overall defensive functioning (ODF) and "immature" (i.e., maladaptive) defenses were used as predictors and moderators of self-reported frequency of self-harm. We conducted a Generalized Linear Mixed Model (GLMM). RESULTS A lower ODF at treatment onset predicted smaller reductions in self-harm, irrespective of treatment length (IRR = 0.92, 95% CI = [0.86, 0.99], p = .020). Lower order "immature" ("major image distorting") defenses showed significantly smaller (IRR = 1.13, 95% CI = [1.06, 1.21], p < .001) and higher order "immature" ("minor image distorting") defenses showed significantly larger (IRR = .91, 95% CI = [.85, .97], p = .006) reductions in self harm in the 6-month but not in the 12-month treatment. CONCLUSION Even though the results have to be regarded as preliminary due to the small sample size, findings might indicate that patients with BPD and lower average defensive adaptiveness may benefit from individualized treatment plans including specific interventions targeting defense function.
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Affiliation(s)
- Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital of Zürich, Zürich, Switzerland
| | - Anna Babl
- Department of Clinical Psychology, Leiden University, Leiden, Netherlands
| | - Eliane Dommann
- Clinical Psychology and Psychotherapy Department, University of Bern, Bern, Switzerland
| | - Esther Stalujanis
- Department of Consultation Psychiatry and Psychosomatics, University Hospital of Zürich, Zürich, Switzerland
| | - Cathy Labrish
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - Ueli Kramer
- Department of Psychiatry, Institute of Psychotherapy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Shelley McMain
- Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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2
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Carlucci S, Chyurlia L, Presniak M, Mcquaid N, Wiebe S, Hill R, Wiley JC, Garceau C, Baldwin D, Slowikowski C, Ivanova I, Grenon R, Balfour L, Tasca GA. Change in Defensive Functioning Following Group Psychodynamic-Interpersonal Psychotherapy in Women With Binge-Eating Disorder. Int J Group Psychother 2022; 72:143-172. [PMID: 38446586 DOI: 10.1080/00207284.2022.2061980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We examined change in defensive functioning following group psychodynamic-interpersonal psychotherapy (GPIP) for binge-eating disorder (BED) compared to a waitlist control. We hypothesized that defensive functioning will improve to a greater extent at posttreatment for those in GPIP compared with those in a waitlist control condition. Participants were women with BED assigned to GPIP (n = 131) or a waitlist control (n = 44) condition in a quasi-experimental design. Those who received GPIP had significantly greater improvements in defensive functioning from pretreatment to six months posttreatment compared to the control group. GPIP may be effective for improving defensive functioning in individuals with BED. A randomized controlled trial is needed to confirm that GPIP is efficacious for addressing defensive functioning among women with BED.
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3
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Lenzo V, Sardella A, Barberis N, Isgrò C, Torrisi R, Giunta S, Petralia MC, Verrastro V, Quattropani MC. The Interplay of Attachment Styles and Defense Mechanisms on Eating Disorders Risk: Cross-Sectional Observation in the Community Population. CLINICAL NEUROPSYCHIATRY 2022; 18:296-303. [PMID: 35126531 PMCID: PMC8808290 DOI: 10.36131/cnfioritieditore20210603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Eating Disorders (Eds) are considered a broad group of pathological conditions characterized by dysregulated eating-related behaviors and habits. Attachment styles and defense mechanisms appear to be linked to the development of EDs-related unhealthy behaviors; however, these factors have been seldom investigated jointly. This study aimed at exploring the shared association between attachment styles, defense mechanisms, and EDs-related behaviors; additionally, we aimed at investigating whether defense mechanisms might be potential mediators of the association between attachment and Eds behaviors. METHOD A community-based sample was recruited (88% females, mean age= 22.33 ± 4.81 years) and underwent a comprehensive evaluation protocol assessing attachment styles, defense mechanisms, and risk of eating disorders. RESULTS Several shared associations between attachment styles, defense mechanisms, and eating disorders scores were found. Additionally, a maladaptive defense style appeared to be a significant mediator of the association between attachment styles and EDs-related symptoms. CONCLUSIONS The integrated evaluation of attachment and defense mechanisms could generate a more comprehensive framework of the psychological antecedents related to Eating Disorders, and it could be a beneficial factor involved in therapies.
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Affiliation(s)
- Vittorio Lenzo
- Department of Social and Educational Sciences of the Mediterranean Area, University for Foreigners "Dante Alighieri" of Reggio Calabria, Reggio Calabria, Italy
| | - Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Nadia Barberis
- Department of Surgical and Medical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Carmen Isgrò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Roberta Torrisi
- Department of Surgical and Medical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | | | | | - Valeria Verrastro
- Department of Surgical and Medical Sciences, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Maria C Quattropani
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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4
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Margherita G, Gargiulo A, Gaudioso R, Esposito G. Treating eating disorders in groups: A pilot study on the role of a structured intervention on perfectionism on group climate. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Giorgia Margherita
- Department of Humanistic Studies University of Naples Federico II Naples Italy
| | - Anna Gargiulo
- Department of Humanistic Studies University of Naples Federico II Naples Italy
| | | | - Giovanna Esposito
- Department of Humanistic Studies University of Naples Federico II Naples Italy
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5
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Aouad P, Hay P, Foroughi N, Cosh SM, Mannan H. Associations Between Defence-Style, Eating Disorder Symptoms, and Quality of Life in Community Sample of Women: A Longitudinal Exploratory Study. Front Psychol 2021; 12:671652. [PMID: 34276493 PMCID: PMC8281956 DOI: 10.3389/fpsyg.2021.671652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/31/2021] [Indexed: 12/27/2022] Open
Abstract
Background and Aim: Eating Disorders (EDs) impact an estimated 15% of the global population and are linked to maladaptive defence-styles (coping strategies) and poorer mental health outcomes. Defence-styles have been grouped into immature, neurotic, and mature behaviours. Studies have yet to examine all three defence-styles in ED symptomatic individuals over an extended period of time. The current study aimed to investigate using converse analysis the relationships between defence-style and ED outcomes over a 5-years period. Methods: Participants (n = 216, mean age 33 years) were recruited through the Women's Eating and Health Literacy study, with the current study examining a 5-years period of two waves (year-4 and year-9). The current study tested associations over time between eating pathology (EDE-Q), psychological distress (K10), mental and physical health related quality of life (M/PHRQoL, SF-12), and defence-style (DSQ-40). Results: Mature, immature and neurotic defence-styles did not significantly change over 5 years. Over the same period, only PHRQoL significantly predicted mature defence-styles having positive effect. Both MHRQoL and PHRQoL significantly predicted immature defence-styles having positive and negative effects, respectively. Psychological distress, PHRQoL and weight concern significantly predicted neurotic defence-styles having positive effects except for psychological distress. PHRQoL, MHRQoL, restraint and eating concern significantly predicted overall eating pathology having positive effects except for PHRQoL and MHRQoL. Conversely, among the defence-style variables, over 5 years, both immature and neurotic defence-styles significantly predicted psychological distress having positive effects, immature and mature defence-styles significantly predicted MHRQoL having negative and positive effects, respectively, while only immature defence-styles significantly predicted overall eating pathology having positive effect. Conclusions: The results of the current study suggest that immaturity and neuroticism but not maturity were the defence-style variables predicting psychological distress over a 5-years period while conversely psychological distress predicted only neurotic defence styles. The findings of the current study may suggest that without intervention, mature, immature and neurotic defence-styles may largely remain immutable to significant shifts over time. Limitations in the current study included limited demographic representation. The current study is anticipated to generate considerations into treatments that could strengthen defence-styles in individuals with increased eating pathology.
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Affiliation(s)
- Phillip Aouad
- InsideOut Institute, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
- School of Psychology, University of New England, Armidale, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Nasim Foroughi
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Suzanne M. Cosh
- School of Psychology, University of New England, Armidale, NSW, Australia
| | - Haider Mannan
- Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
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6
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Chyurlia L, Tasca GA, Bissada H. An Integrative Approach to Clinical Decision-Making for Treating Patients With Binge-Eating Disorder. Front Psychol 2019; 10:2573. [PMID: 31824375 PMCID: PMC6881374 DOI: 10.3389/fpsyg.2019.02573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/30/2019] [Indexed: 11/25/2022] Open
Abstract
Transtheoretical integrative decision-making models help clinicians to use patient factors that are known to predict outcomes in order to inform individualized treatment. Patient factors with a strong evidence base include: functional impairment, social support and interpersonal functioning, complexity and comorbidity, coping style, level of resistance, and level of subjective distress. Among those with binge-eating disorder (BED), patient factors have not been extensively characterized relative to norms or other clinical samples. We used an integrative decision-making model of these six patient factor domains related to patient outcomes to characterize a sample of 424 adults seeking treatment for BED. Data were from medical charts, a demographics questionnaire, and validated psychometric scales. We then compared these data to published data from normative and other eating disorder (ED) samples. Results showed that the average patient with BED: (1) was significantly more functionally impaired compared to non-clinical norms but somewhat less impaired than other patients with ED, (2) demonstrated clinically significant problems in social support and interpersonal functioning, (3) presented with complex comorbid pathology and high levels of chronicity, (4) used a more internalizing coping style compared to the norm and other ED samples, (5) had low levels of resistance to interventions, and (6) experienced a moderately high level of subjective distress indicating good motivation for treatment. Corresponding recommendations to these findings are that the average patient with BED should be provided higher intensity treatment that is longer in duration, interpersonally focused, directive in nature, and emphasizing self-reflection and insight. Despite the nomothetic nature of the findings, clinicians are encouraged to assess these patient domains when developing an ideographic case conceptualization and to tailor precision treatment to the individual patient with BED.
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Affiliation(s)
- Livia Chyurlia
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Giorgio A Tasca
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Hany Bissada
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
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7
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Babl A, Berger T, Grosse Holtforth M, Taubner S, Caspar F, Gómez Penedo JM. Disentangling within- and between-patient effects of defensive functioning on psychotherapy outcome using mixed models. Psychother Res 2019; 30:1088-1100. [PMID: 31722650 DOI: 10.1080/10503307.2019.1690714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Abstract There is a great need to identify predictors of treatment response, and the analysis of defense mechanisms is a promising approach. Defensive functioning may influence psychotherapy outcome in two ways: First, when it is generally higher or lower for some patients relative to others and second, as it shifts in individual patients over time. The present study examined both within- and between patient effects of defenses using hierarchical linear modeling. Forty-seven patients diagnosed with depression, anxiety, or adjustment disorders received 25 ± 3 sessions of integrative cognitive-behavioral therapy in a university outpatient clinic. The Defense Mechanism Rating Scale (DMRS) was used to assess defenses in the 1st, 8th, 16th, and 24th session and relate them to symptom severity of depression and anxiety. A higher number of adaptive defense mechanisms was associated with less severe depressive symptoms during treatment while a higher number of immature defenses was related to more severe depressive and anxiety symptoms. An increase in adaptive and a decrease in immature defenses over the course of treatment predicted symptom reduction of depression whereas a decrease in neurotic and immature defenses was associated with reductions in anxiety symptoms. Our results empirically support defensive functioning as a mechanism of change in psychotherapy.
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Affiliation(s)
- Anna Babl
- Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Svenja Taubner
- Institute for Psychosocial Prevention, University of Heidelberg, Heidelberg, Germany
| | - Franz Caspar
- Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
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8
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Babl A, Grosse Holtforth M, Perry JC, Schneider N, Dommann E, Heer S, Stähli A, Aeschbacher N, Eggel M, Eggenberg J, Sonntag M, Berger T, Caspar F. Comparison and change of defense mechanisms over the course of psychotherapy in patients with depression or anxiety disorder: Evidence from a randomized controlled trial. J Affect Disord 2019; 252:212-220. [PMID: 30986736 DOI: 10.1016/j.jad.2019.04.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/26/2019] [Accepted: 04/07/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Defense mechanisms play an important role in the development and maintenance of both health and psychopathology. Research is still in the early stages of investigating the specific relationships among diagnostic groups and defense mechanisms along with their response to different treatment types. METHODS For the present study a total of 47 outpatients diagnosed with depression or anxiety disorders were randomized to receive 25±3 sessions of cognitive-behavioral therapy with integrated elements of either emotion-focused therapy (CBT + EFT) or treatment components based on self-regulation theory (CBT + SR). An observer-rated method, the Defense Mechanism Rating Scale (DMRS) was used to code transcripts of the 1st, 8th, 16th and 24th session to assess change in defensive functioning. RESULTS Over the course of therapy, overall defensive functioning (ODF) as well as adaptive defenses increased significantly, whereas maladaptive and neurotic defenses did not change. At the beginning of treatment, the proportion of adaptive defenses and ODF was significantly higher in patients diagnosed with anxiety disorders than in patients with depressive disorders. However, depressed patients exhibited greater improvement in their defensive functioning over the course of therapy. CONCLUSIONS Results support the view of defense mechanisms as a useful transdiagnostic and transtheoretical concept and supports the notion that change of defense mechanisms may be a relevant mechanism of change in psychotherapy.
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Affiliation(s)
- Anna Babl
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland.
| | - Martin Grosse Holtforth
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland; University Hospital Insel, Bern, Switzerland
| | | | - Noemi Schneider
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Eliane Dommann
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Sara Heer
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Annabarbara Stähli
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Nadine Aeschbacher
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Michaela Eggel
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Jelena Eggenberg
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Meret Sonntag
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Franz Caspar
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
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9
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Euler S, Stalujanis E, Allenbach G, Kolly S, de Roten Y, Despland JN, Kramer U. Dialectical behavior therapy skills training affects defense mechanisms in borderline personality disorder: An integrative approach of mechanisms in psychotherapy. Psychother Res 2018; 29:1074-1085. [DOI: 10.1080/10503307.2018.1497214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Sebastian Euler
- Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
| | - Esther Stalujanis
- Psychiatric University Hospital (UPK), University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Psychiatry, University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University, Berlin, Germany
| | - Gilles Allenbach
- Psychiatric University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Stéphane Kolly
- Psychiatric University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Yves de Roten
- Psychiatric University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Jean-Nicolas Despland
- Psychiatric University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Ueli Kramer
- Psychiatric University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Windsor, Windsor, Canada
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10
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Maxwell H, Tasca GA, Grenon R, Faye M, Ritchie K, Bissada H, Balfour L. The role of coherence of mind and reflective functioning in understanding binge-eating disorder and co-morbid overweight. Attach Hum Dev 2017; 19:407-424. [PMID: 28420317 DOI: 10.1080/14616734.2017.1318934] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Coherence of mind and reflective functioning may impact negative affect and interpersonal functioning over and above the effects of symptoms of depression and interpersonal problems that contribute to symptoms of binge-eating disorder (BED) and overweight/obesity. Matched samples of overweight women with BED and overweight and normal weight women without BED completed the Adult Attachment Interview, a measure of depressive symptoms, and a measure of interpersonal problems. Greater symptoms of depression distinguished women with BED from the matched comparison samples. Greater interpersonal problems differentiated women with BED from overweight women without BED. Coherence of Mind scores did not differentiate the samples. However, lower Reflective Functioning scores did distinguish both women with BED and overweight women without BED from normal weight women. Lower reflective functioning may lead to binge eating independent of depressive symptoms and interpersonal problems.
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Affiliation(s)
- Hilary Maxwell
- a School of Psychology , University of Ottawa , Ottawa , Canada
| | - Giorgio A Tasca
- a School of Psychology , University of Ottawa , Ottawa , Canada.,b Department of Psychology , The Ottawa Hospital , Ottawa , Canada
| | - Renee Grenon
- a School of Psychology , University of Ottawa , Ottawa , Canada
| | - Megan Faye
- c Department of Psychology , Loyola University Maryland , Baltimore , United States of America
| | - Kerri Ritchie
- a School of Psychology , University of Ottawa , Ottawa , Canada.,b Department of Psychology , The Ottawa Hospital , Ottawa , Canada
| | - Hany Bissada
- a School of Psychology , University of Ottawa , Ottawa , Canada.,b Department of Psychology , The Ottawa Hospital , Ottawa , Canada
| | - Louise Balfour
- a School of Psychology , University of Ottawa , Ottawa , Canada.,b Department of Psychology , The Ottawa Hospital , Ottawa , Canada
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11
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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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12
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Tasca GA, Maxwell H, Faye M, Balfour L. Feeling Worse Before Feeling Better: A Case of Increased Disorganized Mental States Following Group Psychotherapy. Int J Group Psychother 2017; 67:240-258. [PMID: 38449236 DOI: 10.1080/00207284.2016.1260461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Is group therapy effective if it results in members revealing greater unresolved/disorganized mental states related to childhood trauma? That is, do patients have to more fully experience partially disavowed trauma before they get better? We found a small proportion of patients whose pre-treatment Adult Attachment Interview (AAI) transcripts were not coded as Unresolved/Disorganized at the start of group treatment, but were coded as such at the end. In one case report, we examined pre- and six months post-AAI transcripts and group therapy interactions to document the emergence of an unresolved/disorganized mental state. Despite the increase in disorganization, the patient showed some symptom improvement and improved reflective functioning. The 16-week psychodynamic group therapy allowed the patient to reflect on her traumatic experiences and their impact on her life. However, this also resulted in a disorganizing effect on her mental state. Longer-term therapy may be necessary to improve interpersonal functioning and affect regulation in patients who experienced early trauma.
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13
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Abbate-Daga G, Marzola E, Amianto F, Fassino S. A comprehensive review of psychodynamic treatments for eating disorders. Eat Weight Disord 2016; 21:553-580. [PMID: 26980319 DOI: 10.1007/s40519-016-0265-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 02/17/2016] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To comprehensively review the existing literature on the effectiveness of psychodynamic psychotherapies in eating disorders (EDs) and to stimulate both debate and research on this topic. METHODS Online and hand searches were conducted to identify papers published between 1980 and 2015 on psychodynamic treatments delivered to adults with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). RESULTS A total of 47 studies were finally included in this review. Fifteen studies were available for AN, 9 for BN, 12 for BED, and 11 for samples with mixed diagnoses. Several methodological flaws emerged, but overall psychodynamic interventions showed promising results at the end of treatment and follow-up, when available. CONCLUSIONS The body of literature on psychodynamic treatments is sparse and sometimes methodologically questionable; nevertheless, current data provide support to the effectiveness of these interventions, particularly for AN. However, both a defined approach (focus, themes, and techniques) and randomized controlled trials (RCTs) are warranted to clarify the effectiveness of psychodynamic psychotherapies.
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Affiliation(s)
- Giovanni Abbate-Daga
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Enrica Marzola
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Federico Amianto
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Secondo Fassino
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Via Cherasco 15, 10126, Turin, Italy
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