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Aafjes-van Doorn K, Kealy D, Ehrenthal JC, Ogrodniczuk JS, Joyce AS, Weber R. The Relationship Between Patients' Personality Traits, the Alliance, and Change in Interpersonal Distress in Intensive Group Treatment for Personality Dysfunction. J Pers Disord 2022; 36:731-748. [PMID: 36454157 DOI: 10.1521/pedi.2022.36.6.731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
This study examined patients' personality traits as operationalized by the five-factor model in relation to early alliance and reduction of interpersonal distress through an intensive group treatment program for personality dysfunction. A sample of 79 consecutively admitted psychiatric outpatients with personality dysfunction who attended an 18-week intensive group treatment program completed the NEO Five-Factor Inventory at pretreatment, the Inventory of Interpersonal Problems at pre- and posttreatment, and the Edmonton Therapeutic Alliance Scale, a measure of the therapeutic alliance with the program therapist, at Session 5. Results indicated that patients who were relatively extraverted tended to rate the alliance with their program therapist higher and subsequently reported more improvement of interpersonal distress. The presence of a personality disorder did not moderate this mediation. Patients' extraversion likely promotes a bonding with the therapist and facilitates the interpersonal group work necessary for improvement. Assessing patients' level of extraversion before starting intensive group treatment might indicate which intervention strategies could be useful with that patient within the program frame.
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Affiliation(s)
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | | | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Anthony S Joyce
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Rainer Weber
- Clinic for Psychosomatics and Psychotherapy, University of Cologne, Germany
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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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Bryde Christensen A, Wahrén S, Reinholt N, Poulsen S, Hvenegaard M, Simonsen E, Arnfred S. "Despite the Differences, We Were All the Same". Group Cohesion in Diagnosis-Specific and Transdiagnostic CBT Groups for Anxiety and Depression: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5324. [PMID: 34067758 PMCID: PMC8157163 DOI: 10.3390/ijerph18105324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
Group cohesion refers to a sense of belonging, mutual support and identification with other group members. Group cohesion has been associated with better outcomes, lower drop-out rates, more interpersonal support and better participation in psychotherapy. Nevertheless, the role of group cohesion in CBT has not yet received much attention. The rationale for delivering CBT in groups is that patients can model themselves through each other due to their similarities in symptoms. However, there has recently been a shift towards transdiagnostic CBT protocols, in which patients with varied diagnoses participate in the same groups. This shift challenges the rationale of delivering CBT in groups, and it is therefore highly important to understand if and how group cohesion develops in mixed diagnoses CBT groups. The current study used a qualitative comparative framework to investigate the patients' experiences of group cohesion in diagnosis-specific versus transdiagnostic CBT groups. Twenty-three patients were interviewed with semi-structured interviews upon completion of the treatment. Participants had a primary diagnosis of MDD, panic disorder, agoraphobia or social anxiety disorder. A comparative thematic analysis was carried out. Three themes were found: the move from differences to similarities, the role of group cohesion in group CBT and factors helpful and hindering to group cohesion. Group cohesion developed across groups and was considered highly important in both diagnosis-specific and transdiagnostic CBT groups.
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Affiliation(s)
- Anne Bryde Christensen
- Research Unit for Psychotherapy & Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark; (N.R.); (S.A.)
| | - Signe Wahrén
- Department of Psychology, University of Copenhagen, 1353 København K, Denmark; (S.W.); (S.P.)
| | - Nina Reinholt
- Research Unit for Psychotherapy & Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark; (N.R.); (S.A.)
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, 1353 København K, Denmark; (S.W.); (S.P.)
| | - Morten Hvenegaard
- Mental Health Services, Capital Region of Denmark, 2200 København N, Denmark;
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, 4200 Slagelse, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2200 København N, Denmark
| | - Sidse Arnfred
- Research Unit for Psychotherapy & Psychopathology, Psychiatry West, Region Zealand, 4200 Slagelse, Denmark; (N.R.); (S.A.)
- Department of Clinical Medicine, University of Copenhagen, 2200 København N, Denmark
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Wechselseitige Effekte von Gruppenkohäsion und Symptomen. PSYCHOTHERAPEUT 2020. [DOI: 10.1007/s00278-020-00436-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ZusammenfassungKohäsion ist ein bedeutsamer Teil gruppentherapeutischer Beziehungen und stellt einen potenziell kurativen Faktor dar, der nachfolgende Symptomverbesserungen erklären kann. Trotz der häufig belegten Korrelation zwischen erlebter Kohäsion und der Symptomschwere fehlen longitudinale Studien, in denen sowohl die zeitliche Abfolge von Kohäsion und Symptomveränderungen angemessen berücksichtigt und zusätzlich zwischen dem mittleren Level der Kohäsion einzelner Gruppenteilnehmer („between-person effect“) und der individuellen Veränderung („within-person effect“) differenziert wird. Diese Studie untersucht das Kohäsionserleben zur Patientengruppe auf einer Psychotherapiestation mit integrierter Tagesklinik. Vierzig depressive Patienten wurden im Rahmen einer randomisierten kontrollierten Studie zum Vergleich tagesklinischer und stationärer Psychotherapie rekrutiert. Alle Patienten gaben wöchentlich Auskunft über die Therapiebeziehungen (einschließlich Kohäsion) und die aktuelle Symptombelastung; für die Auswertung der Multilevel Daten wurde ein autoregressives cross-lagged Modell verwendet. Die Ergebnisse deuten auf eine wechselseitige Beeinflussung hin. Ein individueller Anstieg der Kohäsion war ein signifikanter Prädiktor für verbesserte Symptome, auch wenn für die vorherige Symptombelastung kontrolliert wurde. Umgekehrt war auch eine Symptomverbesserung prädiktiv für ein höheres Kohäsionserleben im Verlauf. Damit zeigt die Studie die Bedeutung der Beziehungsqualität zur Gruppe der Mitpatienten und weist auf eine wechselseitige Beeinflussung von Kohäsion und Symptomen hin. Allerdings müssen die Ergebnisse aufgrund der kleinen Stichprobe mit Vorsicht interpretiert werden.
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Kealy D, Aafjes‐van Doorn K, Ehrenthal JC, Weber R, Ogrodniczuk JS, Joyce AS. Improving social functioning and life satisfaction among patients with personality dysfunction: Connectedness and engagement in integrative group treatment. Clin Psychol Psychother 2020; 27:288-299. [DOI: 10.1002/cpp.2427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
- David Kealy
- Department of PsychiatryUniversity of British Columbia Vancouver Canada
| | | | | | - Rainer Weber
- Clinic for Psychosomatics and PsychotherapyUniversity of Cologne Cologne Germany
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Schore AN. Forging Connections in Group Psychotherapy Through Right Brain-to-Right Brain Emotional Communications. Part 1: Theoretical Models of Right Brain Therapeutic Action. Part 2: Clinical Case Analyses of Group Right Brain Regressive Enactments. Int J Group Psychother 2020; 70:29-88. [PMID: 38449193 DOI: 10.1080/00207284.2019.1682460] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Part 1: Theoretical Models of Right Brain Therapeutic Action. The first part of this article on the central role of the right brain in group psychotherapy offers evidence-based theoretical models of therapeutic action cocreated by the group members and the group leader. It describes how recent advances in interpersonal neurobiology and neuropsychoanalysis allow for a deeper understanding of the underlying nonverbal right brain change mechanisms beneath the words in individual psychotherapy. It then expands this model to the group context, specifically focusing on the theoretical constructs of cohesion, attachment, transference-countertransference dynamics, and implicit affect regulation, all of which are right brain functions. Part 1 concludes with a discussion of the fundamental role of these right brain mechanisms in synchronized group regressions and reenactments of attachment trauma that allow for new beginnings in emotional and relational development. Part 2: Clinical Case Analyses of Group Right Brain Regressive Enactments. The second part of this article offers case examples and commentary on working with early dysregulated attachment histories and the affect blunting defense of dissociation. Clinical vignettes demonstrate how the group reenacts attachment dynamics in transient regressions into an earlier stage of preverbal development, outside of the domain of language. Such emotionally shared regressions of attachment trauma, rupture, and repair allow the group members and leader to companion each other into and out of enactments. In this manner, regulated reenactments of preverbal emotional experiences potentially allow the cohesive group to expand adaptive right brain capacities to regulate and communicate a broader range of affectively charged subjective self states, thereby cocreating new ways of being with others.
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Brunner F, Dinger U, Komo-Lang M, Friederich HC, Schauenburg H, Herzog W, Nikendei C. Psychosomatic-psychotherapeutic treatment in an evening clinic: a qualitative examination of patients' expectations and experiences. Int J Ment Health Syst 2019; 13:69. [PMID: 31719843 PMCID: PMC6836647 DOI: 10.1186/s13033-019-0326-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 10/30/2019] [Indexed: 12/04/2022] Open
Abstract
Background Over a course of 10 weeks the psychosomatic–psychotherapeutic evening clinic at the University of Heidelberg offers an intensive and multimodal 3-h treatment program on three evenings a week. The clinic aims at accommodating patients who on the one hand do not fit the criteria of partial or full-time inpatient therapy, but on the other hand requires a more intensified therapy dose than the usual German outpatient settings can cater for. In the presented monocentric, qualitative study, we wanted to examine this treatment concept with regard to the patients’ specific concerns, expectations, and individual experiences. By contrasting differences in intensity of outpatient and inpatient treatment, we aimed to identify those characteristics of the evening clinic setting that were perceived as especially helpful. Method Each of the 25 patients was interviewed twice, using semi-structured interviews. The interviews took place before (T0) and after (T1) the 10-week treatment interval. A qualitative content analysis of the transcribed interviews was performed using the software “MaxQDA”. Results We identified a total of 1609 separate codes and grouped them into 33 topics and 5 overarching categories. Here, we found some aspects independent of the therapeutic setting, and others concerning the patients’ specific expectations and experiences resulting from the particularities of the evening clinic as an outpatient setting including certain inpatient characteristics. This included the possibility of patients continuing to work and being able to fulfil social obligations, i.e. childcare or caring for relatives, while at the same time undergoing intensive psychotherapeutic treatment. Conclusions Our results show that the evening clinic concept is particularly suitable for patients with mental and psychosomatic disorders who require intensified multimodal therapy while continuing to meet their obligations in their private and working lives. However, in comparison to other therapeutic methods, this concept generated greater stress and time challenges. Patients should therefore have a reasonably good standard of functioning in everyday life and sufficient coping resources. This is especially important for patients who continue working in their jobs while undergoing treatment. So far, there is a lack of quantitative data which would be needed to evaluate the effectiveness of this novel setting.
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Affiliation(s)
- F Brunner
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 4, 69115 Heidelberg, Germany
| | - U Dinger
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 4, 69115 Heidelberg, Germany
| | - M Komo-Lang
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 4, 69115 Heidelberg, Germany
| | - H C Friederich
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 4, 69115 Heidelberg, Germany
| | - H Schauenburg
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 4, 69115 Heidelberg, Germany
| | - W Herzog
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 4, 69115 Heidelberg, Germany
| | - C Nikendei
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 4, 69115 Heidelberg, Germany
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Group psychotherapy with young adults: Exploring change using the Core Conflictual Relationship Theme method. ARTS IN PSYCHOTHERAPY 2019. [DOI: 10.1016/j.aip.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
One of the most potent protective factors against psychiatric symptoms after military trauma is perceived social support. Although group psychotherapy has been linked with increasing social support, no research has evaluated which therapeutic mechanisms are associated with this increase beyond symptom reduction. We investigated which interpersonal therapeutic factors were related to changes in social support, beyond posttraumatic stress disorder (PTSD) symptom reduction. Participants were 117 veterans in a multimodal outpatient group psychotherapy treatment designed to reduce PTSD symptoms and interpersonal difficulties. Generally, therapeutic factors were related to improvements in social support from baseline to posttreatment beyond the effects of PTSD symptom reduction. Specifically, social learning was associated with changes in appraisal support, secure emotional expression was associated with changes in tangible support, and neither was associated with changes in belonging support. Depending on the goals of treatment, understanding these variations are important so clinicians and researchers can appropriately design and target their interventions to facilitate desired changes.
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Nikendei C, Haitz M, Huber J, Ehrenthal JC, Herzog W, Schauenburg H, Dinger U. Day clinic and inpatient psychotherapy of depression (DIP-D): qualitative results from a randomized controlled study. Int J Ment Health Syst 2016; 10:41. [PMID: 27222663 PMCID: PMC4877763 DOI: 10.1186/s13033-016-0074-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 05/10/2016] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Depressive disorders are among the most common psychiatric disorders. For severely depressed patients, day clinic and inpatient settings represent important treatment options. However, little is known about patients' perceptions of the different levels of care. This study aimed to obtain an in-depth analysis of depressive patients' experiences of day clinic and inpatient treatment in a combined clinical setting. METHODS Following a randomized controlled trial comparing day clinic and inpatient psychotherapy for depression (Dinger et al. in Psychother Psychosom 83:194-195, 2014), a sample of depressive patients (n = 35) was invited to participate in a semi-structured interview during an early follow up 4 weeks after discharge. A qualitative analysis of interview transcripts was performed following the principles of constructivist thematic analysis. RESULTS Following analysis, 1355 single codes were identified from which five main categories and 26 themes were derived for both groups. In regard to patient group integration and skill transfer to everyday life, distinct differences could be observed between the day clinic and inpatient group. CONCLUSION While adjustment to therapeutic setting and patient group integration seem to be facilitated by inpatient treatment, the day clinical setting appears to promote treatment integration into patients' everyday contexts, aiding treatment-related skill transfer to everyday life as well as alleviating discharge from clinic treatment. Further studies on depressive subject groups in day clinic and inpatient treatment should investigate aspects of group cohesion and treatment integration in relation to therapeutic outcome.
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Affiliation(s)
- Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 2, 69115 Heidelberg, Germany
| | - Mirjam Haitz
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 2, 69115 Heidelberg, Germany
| | - Julia Huber
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 2, 69115 Heidelberg, Germany
| | - Johannes C Ehrenthal
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 2, 69115 Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 2, 69115 Heidelberg, Germany
| | - Henning Schauenburg
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 2, 69115 Heidelberg, Germany
| | - Ulrike Dinger
- Department of General Internal Medicine and Psychosomatics, Centre for Psychosocial Medicine, University Hospital Heidelberg, Thibautstrasse 2, 69115 Heidelberg, Germany
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Sotskova A, Woodin E, Cyr KS. Understanding the Role of Group Cohesion and Group Alliance in a Secular Peer Support Group for Recovery from Substance Misuse. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/1556035x.2015.1132400] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Inpatient and Day-Clinic Experience Scale (IDES) - a Psychometric Evaluation. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2016; 61:327-41. [PMID: 26646912 DOI: 10.13109/zptm.2015.61.4.327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The Inpatient and Day-Clinic Experience Scale (IDES) was developed to assess common factors in a multimodal psychotherapy setting from the patients' perspective. The questionnaire measures different aspects of therapeutic relationships, a positive self-view and a critical attitude towards therapy. METHODS Three samples (total N = 821) were used to evaluate the psychometric properties and factor structure of the questionnaire. RESULTS Confirmatory analyses show a good model fit and support the proposed structure with 25 items and seven scales. In addition, reliability indices were stable throughout multiple assessments over time. Concerning validity, early IDES process measures were moderately associated with symptomatic improvement. CONCLUSIONS The IDES is a psychometrically reliable questionnaire for the evaluation of process factors in inpatient and day-clinic psychotherapy settings.
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Moffett LA, Kharrazi N, Vaught A. Using Clinicians' Ideal Social Climate Ratings in Group Therapy Training: Staff Development, Supervision, and Teaching. Int J Group Psychother 2016; 66:34-55. [PMID: 38449118 DOI: 10.1080/00207284.2015.1089686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A group's norms are reflected in the group's social climate, and social climate dimensions have been associated with treatment outcomes in group therapy. However, novice group therapists are often not clear about which norms to develop in a given group. We describe a procedure in which clinicians specify their ideal social climate for a therapy group or a treatment setting on the Group Environment Scale (Moos, 2002) or the Community-Oriented Program Environment Scale (Moos, 1988) and compare their ideals with various reference groups and with one another. Discrepancies in ideal social climate ratings between co-therapists or among clinical staff can be explored in order to enhance coordinated interventions. This procedure has been used with experienced clinicians, trainees, and graduate students in group therapy courses.
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Reuter L, Munder T, Altmann U, Hartmann A, Strauss B, Scheidt CE. Pretreatment and process predictors of nonresponse at different stages of inpatient psychotherapy. Psychother Res 2015; 26:410-24. [PMID: 25959603 DOI: 10.1080/10503307.2015.1030471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Up to 50% of psychotherapeutic treatments end without significant improvements. While there is first evidence about predictors of nonresponse in outpatient psychotherapy, there are currently no studies investigating predictors of nonresponse in inpatient settings. Based upon a previous systematic literature review, we analyzed the predictive value of initial patient characteristics on nonresponse in symptom distress. METHODS Treatment episodes from 546 patients, treated for at least 4 weeks, were assessed under naturalistic conditions. Nonresponse status (i.e., lack of a reliable improvement in symptom distress) was investigated at four different time points: at week 4, at discharge, and at a two follow-ups (3 and 12 months after discharge). Hierarchical binary logistic regression models were used to predict nonresponse. Sociodemographic data, clinical variables, and the previous response status were entered subsequently in the model. RESULTS A moderate or functional level of initial symptom distress, a comorbid personality disorder, and previous nonresponse were the most consistent predictors of nonresponse. CONCLUSIONS The results point to the importance of early outcome assessment and suggest the implementation of more symptom-specific treatments.
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Affiliation(s)
- Laurence Reuter
- a Universitätsklinikum Freiburg, Zentrum für psychische Erkrankungen, Klinik für psychosomatische Medizin und Psychotherapie , Freiburg im Breisgau , Germany.,b Institut für Psychosoziale Medizin und Psychotherapie , Friedrich-Schiller Universität , Jena , Germany
| | - Thomas Munder
- c Psychologische Hochschule Berlin , Berlin , Germany
| | - Uwe Altmann
- b Institut für Psychosoziale Medizin und Psychotherapie , Friedrich-Schiller Universität , Jena , Germany
| | - Armin Hartmann
- a Universitätsklinikum Freiburg, Zentrum für psychische Erkrankungen, Klinik für psychosomatische Medizin und Psychotherapie , Freiburg im Breisgau , Germany
| | - Bernhard Strauss
- b Institut für Psychosoziale Medizin und Psychotherapie , Friedrich-Schiller Universität , Jena , Germany
| | - Carl Eduard Scheidt
- a Universitätsklinikum Freiburg, Zentrum für psychische Erkrankungen, Klinik für psychosomatische Medizin und Psychotherapie , Freiburg im Breisgau , Germany
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Current Issues on Group Psychotherapy Research: An Overview. Psychother Res 2015. [DOI: 10.1007/978-3-7091-1382-0_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Probst T, Lambert MJ, Loew TH, Dahlbender RW, Tritt K. Extreme deviations from expected recovery curves and their associations with therapeutic alliance, social support, motivation, and life events in psychosomatic in-patient therapy. Psychother Res 2014; 25:714-23. [PMID: 25410009 DOI: 10.1080/10503307.2014.981682] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES Within the clinical support tools (CST) of the OQ-Analyst, the "Assessment for Signal Cases" (ASC) evaluates the therapeutic alliance, social support, motivation, and life events. We investigated whether the ASC covers domains of importance in treatment weeks with extreme deviations from expected recovery curves (ERCs). METHODS Psychosomatic in-patients were monitored weekly with the ASC and the "Outcome Questionnaire" (OQ-45). The ERCs of the OQ-45 empirical algorithm were used to define treatment weeks with extreme positive deviations (EPD), extreme negative deviations (END), or without extreme deviations (NO). Associations between the ASC scales and EPD as well as END were analyzed by multilevel models. RESULTS While each ASC scale was positively associated with EPD, only the social support and life events scales were negatively related to END. CONCLUSIONS CSTs prioritizing social support and life events might be more effective in preventing treatment failure.
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Affiliation(s)
- Thomas Probst
- a Deparment of Psychology , University of Regensburg , Regensburg , Germany
| | - Michael J Lambert
- b Department of Psychology , Brigham Young University , Provo , UT , USA
| | - Thomas H Loew
- c Department of Psychosomatics , University Clinic of Regensburg, Regensburg , Germany
| | - Reiner W Dahlbender
- d Clinic for Psychosomatic Medicine and Psychotherapy , University Clinic of Ulm , Ulm , Germany
| | - Karin Tritt
- c Department of Psychosomatics , University Clinic of Regensburg, Regensburg , Germany
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Parker TJ, Page AC, Hooke GR. The influence of individual, group, and relative self-esteem on outcome for patients undergoing group cognitive-behavioural therapy treatment. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2013; 52:450-63. [PMID: 24117916 DOI: 10.1111/bjc.12029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 07/07/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Despite a strong association between individual self-esteem and treatment outcome in group cognitive-behavioural therapy (GCBT), no study has investigated how patient outcomes might be influenced by an individual's self-esteem relative to other group members. DESIGN The study comprised a retrospective examination of patients' data and used a multiple regression analysis to identify predictors of treatment outcome. Patients' pre-treatment self-esteem scores were assessed on a continuum and assigned to be low, medium, or high. Therapy groups were assigned to be either low, balanced or high self-esteem groups based on averaged self-esteem scores of participants. METHODS In this study, 3,878 patients who had completed a 10-day intensive cognitive behavioural group therapy programme at a private psychiatric facility were included in the study. The Rosenberg Self-Esteem measure was chosen to assess self-esteem. The three subscales of the Depression Anxiety Stress Scales were used as the outcome measures. RESULTS Patient outcomes were influenced by pre-treatment self-esteem scores, such that higher initial self-esteem was associated with better treatment outcomes. Low group self-esteem was predictive of significantly better outcomes for depression, relative to higher self-esteem groups. Additionally, the combined influence of high individual self-esteem and low group self-esteem was associated with significantly enhanced depression improvement. CONCLUSIONS High self-esteem patients perform better on outcome measures following completion of GCBT. Low self-esteem groups show greater improvement in depression symptoms. Similar results for depression are achieved when patients with high self-esteem complete treatment in low self-esteem groups.
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Affiliation(s)
- Thomas J Parker
- School of Psychology, The University of Western Australia, Crawley, Australia
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Lerner MD, McLeod BD, Mikami AY. Preliminary Evaluation of an Observational Measure of Group Cohesion for Group Psychotherapy. J Clin Psychol 2012; 69:191-208. [DOI: 10.1002/jclp.21933] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tschacher W, Zorn P, Ramseyer F. Change mechanisms of schema-centered group psychotherapy with personality disorder patients. PLoS One 2012; 7:e39687. [PMID: 22745811 PMCID: PMC3382158 DOI: 10.1371/journal.pone.0039687] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 05/29/2012] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND This study addressed the temporal properties of personality disorders and their treatment by schema-centered group psychotherapy. It investigated the change mechanisms of psychotherapy using a novel method by which psychotherapy can be modeled explicitly in the temporal domain. METHODOLOGY AND FINDINGS 69 patients were assigned to a specific schema-centered behavioral group psychotherapy, 26 to social skills training as a control condition. The largest diagnostic subgroups were narcissistic and borderline personality disorder. Both treatments offered 30 group sessions of 100 min duration each, at a frequency of two sessions per week. Therapy process was described by components resulting from principal component analysis of patients' session-reports that were obtained after each session. These patient-assessed components were Clarification, Bond, Rejection, and Emotional Activation. The statistical approach focused on time-lagged associations of components using time-series panel analysis. This method provided a detailed quantitative representation of therapy process. It was found that Clarification played a core role in schema-centered psychotherapy, reducing rejection and regulating the emotion of patients. This was also a change mechanism linked to therapy outcome. CONCLUSIONS/SIGNIFICANCE The introduced process-oriented methodology allowed to highlight the mechanisms by which psychotherapeutic treatment became effective. Additionally, process models depicted the actual patterns that differentiated specific diagnostic subgroups. Time-series analysis explores Granger causality, a non-experimental approximation of causality based on temporal sequences. This methodology, resting upon naturalistic data, can explicate mechanisms of action in psychotherapy research and illustrate the temporal patterns underlying personality disorders.
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Affiliation(s)
- Wolfgang Tschacher
- Department of Psychotherapy, University Hospital of Psychiatry, Bern, Switzerland.
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Leising D, Zimmermann J. An Integrative Conceptual Framework for Assessing Personality and Personality Pathology. REVIEW OF GENERAL PSYCHOLOGY 2011. [DOI: 10.1037/a0025070] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
As a contribution to the ongoing debate over the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, we present a framework for jointly conceptualizing personality and personality pathology. The key element is an explicit distinction between personality description (which is the realm of basic personality psychology) and personality evaluation (which is the realm of clinical personality psychology). Previous diagnostic systems did not acknowledge this crucial distinction. We created a sample diagnostic system, to illustrate how a practical application of our conceptual framework may look like. The system comprises two ingredients: First, a list of personality dispositions that may become problematic. These are described at a “basic level” of abstraction (i.e., the level at which patients and clinicians intuitively communicate about personality problems). Second, a list of negative consequences that are used to evaluate the extent to which a patient's personality pattern is “problematic.” A sample of therapists used the system for describing actual patients and found it to be better than the International Classification of Diseases (ICD)-10 and DSM–IV. Based on our conceptual deliberations, we analyze the DSM-5 proposal for personality and personality disorders. The proposal contains three different sets of “higher-order concepts” (personality traits, personality types, and levels of personality functioning). Only the first of these is sufficiently supported by empirical evidence, including analyses of our own set of personality dispositions.
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Affiliation(s)
- Daniel Leising
- Department of Psychology, University of Halle-Wittenberg, Germany
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