1
|
Vossler A, Pinquart M, Forbat L, Stratton P. Efficacy of systemic therapy on adults with depressive disorders: A meta-analysis. Psychother Res 2024:1-17. [PMID: 38776449 DOI: 10.1080/10503307.2024.2352741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE This meta-analysis evaluates the efficacy of systemic therapy approaches on adult clients with depressive disorders. METHODS The illness-specific systematic review updates a previous meta-analysis on the efficacy of systemic therapy on psychiatric disorders in adulthood. It integrates the results of 30 randomized controlled trials (RCTs) comparing systemic psychotherapy for depression with an untreated control group or alternative treatments. Studies were identified through systematic searches in relevant electronic databases and cross-referencing. A random-effects model calculated weighted mean effect sizes for each type of comparison (alternative treatments, control group with no alternative treatment/waiting list) on two outcomes (depressive symptoms change, drop-out rates). RESULTS On average, systemic interventions show larger improvements in depressive symptoms compared to no-treatment controls at post-test (g = 1.09) and follow-up (g = 1.23). Changes do not significantly differ when comparing systemic interventions with alternative treatments (post-test g = 0.25; follow-up g = 0.09). Results also vary, in part, by participant age, publication year, and active control condition. CONCLUSION This meta-analysis indicates the potential benefits of systemic interventions for adult patients with depression. Future randomized clinical trials in this area should enhance study quality and include relational and other relevant outcome measures.
Collapse
Affiliation(s)
- Andreas Vossler
- School of Psychology and Counselling, Faculty of Arts and Social Science, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK
| | - Martin Pinquart
- Department of Psychology, Philipps University Marburg, Marburg, Germany
| | - Liz Forbat
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Peter Stratton
- Leeds Institute of Health Sciences (LIHS), University of Leeds, Leeds, UK
| |
Collapse
|
2
|
Rief W, Wilhelm M, Bleichhardt G, Strauss B, Frostholm L, von Blanckenburg P. Competence-Based Trainings for Psychological Treatments - A Transtheoretical Perspective. CLINICAL PSYCHOLOGY IN EUROPE 2024; 6:e13277. [PMID: 39118657 PMCID: PMC11303930 DOI: 10.32872/cpe.13277] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/19/2023] [Indexed: 08/10/2024] Open
Abstract
Background Although in most countries psychotherapy trainings focus on one treatment orientation, such an approach is associated with systematic shortcomings. The priorities from teaching one theoretical framework should be moved to a more rigorous orientation in science and evidence-based practice, and to the needs of patients, even if strategies of different theoretical approaches need to be combined. Method We discuss whether competence-based trainings in psychological treatments offer a better framework to facilitate the progress of psychological treatments to a professional academic discipline with transtheoretical exchange, and we provide an example of a transtheoretical education in the basic competences of psychological treatments. A transtheoretical education program requires an umbrella model for case formulation and a transtheoretical definition of intervention goals. Results We provide an adaptation of the traditional model distinguishing vulnerability/resilience, exacerbation, and maintenance of clinical problems for case conceptualization. Dynamic network models offer a further perspective for developing modern, transtheoretical case formulations. Treatment methods should be better classified according to their transtheoretical goals, which offers opportunities to better compare or combine them. We report a case example of how to transform a general competence-based approach in the training of psychological treatments in the academic education system, which found exceptional acceptance from participating students. Conclusion Thus, a rigorous competence-based approach to training early clinicians in applying psychological treatments helps to bridge the artificial divide between psychotherapeutic traditions. It also supports the evolution of psychological treatments into an academically robust and highly professional, integrative discipline.
Collapse
Affiliation(s)
- Winfried Rief
- Division of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Marcel Wilhelm
- Division of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Gaby Bleichhardt
- Division of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Bernhard Strauss
- Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, University Hospital Jena, University of Jena, Jena, Germany
| | | | - Pia von Blanckenburg
- Division of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| |
Collapse
|
3
|
Ma CF, Chien WT, Chan SKW, Wong CL. Behavioural family interventions versus structural family interventions for people with schizophrenia. Hippokratia 2022. [DOI: 10.1002/14651858.cd014970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Chak Fai Ma
- School of Nursing; The Hong Kong Polytechnic University; Hung Hom Hong Kong
- Department of Psychiatry; The University of Hong Kong; Pokfulam Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry; The University of Hong Kong; Pokfulam Hong Kong
| | - Cho Lee Wong
- The Nethersole School of Nursing; The Chinese University of Hong Kong; Shatin Hong Kong
| |
Collapse
|
4
|
Psychological interventions for treating functional motor symptoms: Scoping review of the literature. Clin Psychol Rev 2022; 94:102146. [DOI: 10.1016/j.cpr.2022.102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 01/31/2022] [Accepted: 03/16/2022] [Indexed: 11/21/2022]
|
5
|
Wittenborn AK, Holtrop K. Introduction to the special issue on the efficacy and effectiveness of couple and family interventions: Evidence base update 2010-2019. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:5-22. [PMID: 34904252 DOI: 10.1111/jmft.12576] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 05/14/2023]
Abstract
This is the fourth Journal of Marital and Family Therapy (JMFT) special issue on the efficacy and effectiveness of couple and family therapy. Articles in this issue review studies published from 2010 to 2019 on couple and family interventions for prevalent mental and behavioral disorders and health conditions. The final article on mental health disparities tracks progress in the field and emphasizes the need for additional attention. In the current article, we provide a description of our methodological approach for the special issue and an overview of the state of the evidence for couple and family interventions across the conditions reviewed. We also offer recommendations to inspire researchers to further expand the empirical support for couple and family interventions to address pressing public health needs.
Collapse
Affiliation(s)
- Andrea K Wittenborn
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
- Division of Psychiatry and Behavioral Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Kendal Holtrop
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| |
Collapse
|
6
|
Psychosoziales Versorgungskonzept für Familien mit psychischen Kern- oder Begleitproblemen. PSYCHOTHERAPEUT 2021. [DOI: 10.1007/s00278-021-00559-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
7
|
|
8
|
Fávero M, Moreira D, Abreu B, Del Campo A, Moreira DS, Sousa-Gomes V. Psychological intervention with adult victims of sexual abuse: A comprehensive review. Clin Psychol Psychother 2021; 29:62-80. [PMID: 33844370 DOI: 10.1002/cpp.2598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/09/2022]
Abstract
Child sexual abuse (CSA) is a phenomenon that is ubiquitous to all cultures and social classes. It has short- and long-term consequences, with specific treatment models that have been developed and adapted from psychological intervention models. A wide variety of studies have sought to evaluate the results of treatments with adult CSA survivors. This study presents an overview of research on the treatment of adult victims of CSA, by reviewing the existing literature on the types of treatment and the most studied psychotherapeutic avenues, and reports the findings related to the efficacy of these treatments. It is possible to conclude that psychological intervention exhibits benefits in the reduction of symptoms resulting from the experience of CSA and demonstrates the need to conduct further research on the effectiveness of intervention.
Collapse
Affiliation(s)
- Marisalva Fávero
- Social and Behavioral Sciences Department, University Institute of Maia, Maia, Portugal.,Unit I&D of the Justice and Governance Research Center of the Law School, University of Minho (JusGov/UM), Braga, Portugal
| | - Diana Moreira
- Social and Behavioral Sciences Department, University Institute of Maia, Maia, Portugal.,Institute of Psychology and Neuropsychology of Porto - IPNP Health, Porto, Portugal.,Laboratory of Neuropsychophysiology, Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Beatriz Abreu
- Social and Behavioral Sciences Department, University Institute of Maia, Maia, Portugal
| | - Amaia Del Campo
- Department of Evolutionary and Educational Psychology, University of Salamanca, Salamanca, Spain
| | - Diana Sá Moreira
- Social and Behavioral Sciences Department, University Institute of Maia, Maia, Portugal.,Institute of Psychology and Neuropsychology of Porto - IPNP Health, Porto, Portugal
| | - Valéria Sousa-Gomes
- Social and Behavioral Sciences Department, University Institute of Maia, Maia, Portugal.,Unit I&D of the Justice and Governance Research Center of the Law School, University of Minho (JusGov/UM), Braga, Portugal.,Institute of Psychology and Neuropsychology of Porto - IPNP Health, Porto, Portugal
| |
Collapse
|
9
|
Laskowski A, Lincoln TM. Network meta-analysis on the comparative efficacy of family interventions for psychotic disorders: a protocol. BMJ Open 2021; 11:e039777. [PMID: 33472774 PMCID: PMC7818829 DOI: 10.1136/bmjopen-2020-039777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 11/30/2020] [Accepted: 12/16/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Family interventions are effective and are strongly recommended for psychotic disorders. However, there is a variety of intervention types, and their differential efficacy is widely unclear. The aim of the planned network meta-analysis (NMA) is to compare the efficacy of family interventions that differ in content (eg, psychoeducation, mutual support, skills training) and format (eg, number of sessions, inclusion of patients, form of delivery). METHODS AND ANALYSIS We will include randomised controlled trials comparing psychosocial interventions directed at the adult relatives, friends or non-professional carers of people with a diagnosis of a psychotic disorder (schizophrenia spectrum) to any kind of control condition. The main outcomes will be global clinical state for the patients and coping with psychosis as well as attitudes towards psychosis for the relatives. Additional outcomes will be severity of symptoms, functioning, burden and compliance/drop-out. We conducted a comprehensive search of Cochrane Central Register of Controlled Trials, MEDLINE(R), PsycINFO, Cumulative Index to Nursing & Allied Health Literature (8 August 2019) and reference lists of review articles. Full-text assessment of eligibility, data extraction and risk-of-bias assessment will be done by two independent reviewers. An NMA will be conducted for any of the planned outcomes and intervention characteristics for which sufficient and appropriate data are available. The analyses will make use of a random effects model within a frequentist framework. Estimates for all pairwise treatment effects will be obtained using standardised mean differences for continuous outcomes and risk ratios for dichotomous outcomes. Interventions will be ranked according to their relative efficacy. We will address the assumption of transitivity, heterogeneity and inconsistency using theoretical and statistical approaches. The possibility of publication bias and the strength of evidence will also be examined. ETHICS AND DISSEMINATION There are no ethical concerns. Results will be published in peer-reviewed journals and presented at practitioners' conferences. PROSPERO REGISTRATION NUMBER CRD42020148728.
Collapse
Affiliation(s)
- Alina Laskowski
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Science, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement Science, Universität Hamburg, Hamburg, Germany
| |
Collapse
|
10
|
Willis KL, Miller RB, Anderson SR, Bradford AB, Johnson LN, Yorgason JB. Therapist effects on dropout in couple therapy. JOURNAL OF MARITAL AND FAMILY THERAPY 2021; 47:104-119. [PMID: 33507576 DOI: 10.1111/jmft.12473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 06/12/2023]
Abstract
Marriage and family therapy scholars have argued that therapists play a crucial role in successful couple therapy, yet little research has empirically documented that the therapist in couple therapy has a significant impact on outcomes. Known as the study of therapist effects, this study sought to assess the amount of variance attributed to the therapist in couple therapy outcomes. Using dropout as the outcome variable, this study analyzed data from 1,192 couples treated by 90 masters and doctoral student therapists at a university-based training clinic. Results from multilevel analysis indicated that therapists in the sample accounted for 9.4% of the variance in couple dropout while controlling for initial couple impairment. Therapist gender and therapist experience did not significantly predict variability in therapist effects. These findings give promise to future research on therapist effects in couple therapy and encourage exploration into which therapist characteristics and behaviors contribute to successful clinical outcome.
Collapse
|
11
|
Hunger C, Hilzinger R, Klewinghaus L, Deusser L, Sander A, Mander J, Bents H, Ditzen B, Schweitzer J. Comparing Cognitive Behavioral Therapy and Systemic Therapy for Social Anxiety Disorder: Randomized Controlled Pilot Trial (SOPHO-CBT/ST). FAMILY PROCESS 2020; 59:1389-1406. [PMID: 31657011 DOI: 10.1111/famp.12492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This randomized controlled trial (RCT) aimed to pilot the newly developed manualized and monitored systemic therapy (ST) for social anxiety disorder (SAD), as compared to manualized and monitored cognitive behavioral therapy (CBT). We conducted a prospective multicenter, assessor-blind pilot RCT on 38 outpatients (ICD F40.1; Structured Clinical Interview for DSM (SCID); Liebowitz Social Anxiety Scale, LSAS-SR >30). The primary outcome was level of social anxiety (LSAS-SR) at the end of treatment. A total of 252 persons were screened, and 38 patients were randomized and started therapy (CBT: 20 patients; ST: 18 patients; age: M = 36 years, SD = 14). Within-group, simple-effect intent-to-treat analyses (ITT) showed significant reduction in LSAS-SR (CBT:d = 1.04; ST:d = 1.67), while ITT mixed-design ANOVA demonstrated the advantage of ST (d = 0.81). Per-protocol analyses supported these results. Remission based on reliable change indices also demonstrated significant difference (LSAS-SR: 15% in CBT; 39% in ST;h: 0.550), supported by blind diagnosticians' ratings of those who completed therapy (SCID; 45% in CBT, 78% in ST,p = .083). No adverse events were reported. CBT and ST both reduced social anxiety, supporting patient improvement with the newly developed ST for SAD; this has yet to be verified in a subsequent confirmatory RCT.
Collapse
Affiliation(s)
- Christina Hunger
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Rebecca Hilzinger
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Laura Klewinghaus
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Laura Deusser
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Anja Sander
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Johannes Mander
- Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Hinrich Bents
- Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jochen Schweitzer
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
12
|
Abstract
AbstractTransdiagnostic treatments span a heterogeneous group of interventions that target a wider range of disorders and can be applied to treat several disorders simultaneously. Several meta-analyses have highlighted the evidence base of these novel therapies. However, these meta-analyses adopt different definitions of transdiagnostic treatments, and the growing field of transdiagnostic therapies has become increasingly difficult to grasp. The current narrative review proposes a distinction of “one size fits all” unified and “my size fits me” individualized approaches within transdiagnostic therapies. Unified treatments are applied as “broadband” interventions to a range of disorders without tailoring to the individual, while individualized treatments are tailored to the specific problem presentation of the individual, e.g., by selecting modules within modular treatments. The underlying theoretical foundation and relevant empirical evidence for these different transdiagnostic approaches are examined. Advantages and limitations of the transdiagnostic treatments as well as future developments are discussed.
Collapse
|
13
|
Wu Q, McWey LM, Ledermann T. Clients' Attributions of the Presenting Problem and the Therapeutic Alliance in Couple Therapy: Systemic Versus Intrapersonal Perspectives. JOURNAL OF MARITAL AND FAMILY THERAPY 2020; 46:661-673. [PMID: 32342555 DOI: 10.1111/jmft.12432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The therapeutic alliance is central to couples' therapy success. The current study examined associations between couples' initial agreement and causal attributions of the presenting problem and changes in the therapeutic alliance. To test study hypotheses, 85 couples were recruited from a university training clinic focused on couple and family therapy. Couples completed an intake questionnaire concerning their attribution of the presenting problem, either as systemic or individual, and therapeutic alliance was assessed at the end of sessions 2-8. A dyadic multilevel model revealed that a disagreement in the couple's attributions of the problem (with one viewing it as systemic, the other as individual) was associated with a larger initial discrepancy in the couple's therapeutic alliance, as well as a decline in the discrepancy over time. Findings were discussed in the context of systemic family theory, with implications for improving assessment, treatment, and psychoeducation aimed toward couples in distress.
Collapse
|
14
|
Lee BK, Gilbert R, Knighton R. Couple Therapy in Substance Use and Gambling Disorders: Promoting Health System Change. CONTEMPORARY FAMILY THERAPY 2020. [DOI: 10.1007/s10591-020-09536-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
15
|
Woodhead E, Cronkite R, Finlay A, Wong J, Haverfield M, Timko C. The role of depression course on life functioning and coping outcomes from baseline through 23-year follow-up. J Ment Health 2020; 31:348-356. [PMID: 32667276 DOI: 10.1080/09638237.2020.1793127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although studies have examined how depressed patients' baseline characteristics predict depression course, still needed are studies of how depression course is associated with modifiable long-term outcomes. AIMS This study examined six outcomes of three groups representing distinct depression courses (low baseline severity, rapid decline; moderate baseline severity, rapid decline; and high baseline severity, slow decline): medical functioning, coping patterns, family functioning, social functioning, employment, and work functioning. METHOD Adults with depression at baseline (N = 382; 56% women) were followed for 23 years on self-reported outcomes (79% response rate). Data from the baseline assessment and follow-ups (1, 4, 10, and 23 years) were used in a longitudinal analysis to examine associations between depression course and outcomes. RESULTS All depression course groups declined on medical and social functioning and employment over follow-up. The high- and moderate-severity depression course groups reported poorer coping patterns than the low-severity group. The high-severity depression course group reported poorer family functioning than the moderate-severity group, and had the poorest work functioning outcome, followed by the moderate-severity and then the low-severity groups. CONCLUSIONS Patients with a high- or moderate-severity depression course may benefit from treatment that manages coping patterns and improves family and work functioning.
Collapse
Affiliation(s)
- Erin Woodhead
- Psychology Department, San José State University, San Jose, CA, USA
| | - Ruth Cronkite
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Health Policy/Center on Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA.,Department of Sociology, Stanford University, Stanford, CA, USA
| | - Andrea Finlay
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Veterans Affairs, National Center on Homelessness Among Veterans, Menlo Park, CA, USA
| | - Jessie Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Health Policy/Center on Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Marie Haverfield
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Center for Health Policy/Center on Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | - Christine Timko
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| |
Collapse
|
16
|
Hasan A, Falkai P, Lehmann I, Gaebel W. Schizophrenia. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:412-419. [PMID: 32865492 PMCID: PMC7477695 DOI: 10.3238/arztebl.2020.0412] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/03/2019] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The lifetime prevalence of schizophrenia is 1%. Schizophrenia is among the most severe mental illnesses and gives rise to the highest treatment costs per patient of any disease. It is characterized by frequent relapses, marked impairment of quality of life, and reduced social and work participation. METHODS The group entrusted with the creation of the German clinical practice guideline was chosen to be representative and pluralistic in its composition. It carried out a systematic review of the relevant literature up to March 2018 and identified a total of 13 389 publications, five source guidelines, three other relevant German clinical practice guidelines, and four reference guidelines. RESULTS As the available antipsychotic drugs do not differ to any great extent in efficacy, it is recommended that acute antipsychotic drug therapy should be sideeffect- driven, with a number needed to treat (NNT) of 5 to 8. The choice of treatment should take motor, metabolic, sexual, cardiac, and hematopoietic considerations into account. Ongoing antipsychotic treatment is recommended to prevent relapses (NNT: 3) and should be re-evaluated on a regular basis in every case. It is also recommended, with recommendation grades ranging from strong to intermediate, that disorder- and manifestation-driven forms of psychotherapy and psychosocial therapy, such as cognitive behavioral therapy for positive or negative manifestations (effect sizes ranging from d = 0.372 to d = 0.437) or psycho-education to prevent relapses (NNT: 9), should be used in combination with antipsychotic drug treatment. Further aspects include rehabilitation, the management of special treatment situations, care coordination, and quality management. A large body of evidence is available to provide a basis for guideline recommendations, particularly in the areas of pharmacotherapy and cognitive behavioral therapy. CONCLUSION The evidence-based diagnosis and treatment of persons with schizophrenia should be carried out in a multiprofessional process, with close involvement of the affected persons and the people closest to them.
Collapse
Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University of Augsburg, District Hospital Augsburg, Augsburg
- Department of Psychiatry and Psychotherapy, LMU Medical Center, Munich
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU Medical Center, Munich
| | | | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, LVR Hospital Düsseldorf, Faculty of Medicine, University of Düsseldorf
| |
Collapse
|
17
|
Southall DJL, Combes HA. Clinical psychologists’ views about talking to people with psychosis about sexuality and intimacy: a Q-methodological study. SEXUAL AND RELATIONSHIP THERAPY 2020. [DOI: 10.1080/14681994.2020.1749255] [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]
Affiliation(s)
- Daniel J. L. Southall
- Clinical Psychology, Science Centre, Stoke-on-Trent, Staffordshire University, Hull, UK
- Humber NHS Foundation Trust, Hull, UK
| | - Helen A. Combes
- Clinical Psychology, Science Centre, Stoke-on-Trent, Staffordshire University, Hull, UK
| |
Collapse
|
18
|
Focusing on Patients' Existing Resources and Strengths in Cognitive-Behavioral Therapy and Psychodynamic Therapy: A Systematic Review and Meta-Analysis. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 65:144-161. [PMID: 31154930 DOI: 10.13109/zptm.2019.65.2.144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: Integrating a stronger focus on patients' existing strengths in traditional psychotherapy approaches is suggested by recent developments in psychological science, positive psychology, and psychotherapy research. However, the empirical status of treatments focusing on patients' existing strengths is unclear. The aim of this study was to conduct a systematic review (PROSPERO registration CRD42017054362) of studies on adaptations of traditional treatment approaches (e. g., cognitive-behavior therapy or psychodynamic therapy) explicitly focused on using patients' existing resources and strengths (hereafter, resource-focused treatments; RFT). Methods: Extensive systematic literature search yielded k = 11 treatment comparisons from 10 studies contrasting RFTs with either an alternative psychotherapeutic approach or wait list. Effect sizes controlling for pre-treatment differences (gPPWC) and standard Hedges's g effect sizes (gPOWC) were aggregated with random-effects methods Results: Across 8 direct comparisons, RFTs were superior to other psychotherapeutic approaches, as indicated by small to moderate (gPPWC = -0.349, 95 % CI -0.576, -0.122, p = .003, I2 = 46.50 %) and small effect sizes (gPOWC = -0.190, 95 % CI -0.355, -0.025, p = .024, I2 = 0.00 %) in favor of RFTs. Sensitivity analyses corroborated results. Many included studies were characterized by limited sample size, risk of bias or researcher allegiance. Conclusions: This meta-analysis showed preliminary evidence for the benefits of RFTs and suggests an intensification of further research efforts. The evidence was most convincing for hypnotherapeutic-systemic interventions as an add-on for cognitive-behavioral therapy.
Collapse
|
19
|
Traber-Walker N, Gerstenberg M, Metzler S, Joris MR, Karr M, Studer N, Zulauf Logoz M, Roth A, Rössler W, Walitza S, Franscini M. Evaluation of the Combined Treatment Approach "Robin" (Standardized Manual and Smartphone App) for Adolescents at Clinical High Risk for Psychosis. Front Psychiatry 2019; 10:384. [PMID: 31244692 PMCID: PMC6562244 DOI: 10.3389/fpsyt.2019.00384] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/15/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: The prevention of schizophrenia and other psychotic disorders has led researchers to focus on early identification of individuals at clinical high risk (CHR) for psychosis and to treat the at-risk symptoms in the pre-psychotic period. Although at-risk symptoms such as attenuated hallucinations or delusions are common in adolescents and associated with a marked reduction in global functioning, the evidence base of effective interventions for adolescents at CHR state and even first-episode psychosis is limited. Thus, the present protocol describes a study design that combines therapy modules for CHR adolescents with a smartphone application supporting the young individuals between the therapy sessions. The treatment approach "Robin" is based on existing therapy strategies for adolescents with first episode of psychosis and the available recommendations for adults with at-risk symptoms. Methods: The evaluation aims firstly to compare the efficacy of Robin in 30 CHR adolescents aged 14-18 to an active control group (treatment as usual) from a previous study. Primary outcome measures will be at-risk symptomatology, comorbid diagnosis, functioning, self-efficacy, and quality of life. For the prospective intervention condition (16 weekly individual sessions + a minimum 4 family sessions), help-seeking adolescents with CHR for psychosis, aged 14-18, will be recruited over 3 years. At-risk and comorbid symptoms, functioning, self-efficacy, and quality of life are monitored at six time points (baseline, during the treatment period; immediately after intervention; and 6, 12, and 24 months later) and compared with the respective measures of the active control group. Discussion: To the best of our knowledge, this is the first controlled trial to test the efficacy of a specific early psychosis treatment in combination with a smartphone application for adolescents at CHR for developing psychosis. The results of the study are expected to add information that may substantially decrease the burden of CHR adolescents and increase their resilience. It may offer age-adapted and targeted strategies to guide clinicians in the treatment of these vulnerable individuals. Furthermore, research in the field of early intervention will be enriched by our findings. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03829527.
Collapse
Affiliation(s)
- Nina Traber-Walker
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Miriam Gerstenberg
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Sibylle Metzler
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Maria Raquel Joris
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Markus Karr
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Nadja Studer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Marina Zulauf Logoz
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Alexander Roth
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zürich University Hospital of Psychiatry, Zurich, Switzerland
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
- Laboratory of Neuroscience, LIM27, Institute of Psychiatry, University of Sao Paulo, São Paulo, Brazil
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Maurizia Franscini
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry, University of Zurich, Zurich, Switzerland
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich, Zurich, Switzerland
| |
Collapse
|
20
|
An Overview of the Evidence for Psychological Interventions for Psychosis: Results From Meta-Analyses. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i1.31407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There are numerous psychological approaches to psychosis that differ in focus, specificity and formats. These include psychodynamic, humanistic, cognitive-behavioural and
third-wave-approaches, psychoeducation, various types of training-based approaches and family interventions.
We briefly describe the main aims and focus of each of these approaches, followed by a review of their evidence-base in regard to improvement in symptoms, relapse and
functioning. We conducted a systematic search for meta-analyses dating to 2017 for each of the approaches reviewed. Where numerous meta-analyses for an approach were available,
we selected the most recent, comprehensive and methodologically sound ones.
We found convincing short- and long-term evidence for cognitive behavioural approaches if the main aim is to reduce symptom distress. Evidence is also strong for psychoeducative
family interventions that include skills training if the main aim is to reduce relapse and rehospitalisation. Acceptance and commitment therapy, mindfulness-based approaches,
meta-cognitive and social skills training, as well as systemic family interventions, were also found to be efficacious, depending on the outcome of interest, but meta-analyses
for these approaches were based on a comparatively lower number of outcome studies and a narrower selection of outcome measures. We found no convincing evidence for
psychodynamic approaches, humanistic approaches or patient-directed psychoeducation (without including the family).
An array of evidence-based psychological therapies is available for psychotic disorders from which clinicians and patients can choose, guided by the strength of the evidence and
depending on the outcome area focused on. Increased effort is needed in terms of dissemination and implementation of these therapies into clinical practice.
Meta-analyses show convincing evidence for CBT if the main target is psychotic symptoms.
Meta-analyses show convincing evidence for family interventions if the main target is relapse.
Effects are promising for ACT, mindfulness-based and systemic approaches, but more research is needed.
The array of effective approaches allows clinicians and patients to select the most appropriate one.
Meta-analyses show convincing evidence for CBT if the main target is psychotic symptoms.
Meta-analyses show convincing evidence for family interventions if the main target is relapse.
Effects are promising for ACT, mindfulness-based and systemic approaches, but more research is needed.
The array of effective approaches allows clinicians and patients to select the most appropriate one.
Collapse
|
21
|
Anderson SR, Tambling R, Yorgason JB, Rackham E. The mediating role of the therapeutic alliance in understanding early discontinuance. Psychother Res 2018; 29:882-893. [DOI: 10.1080/10503307.2018.1506949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
| | - Rachel Tambling
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
| | | | - Erin Rackham
- School of Family Life, Brigham Young University, Provo, UT, USA
| |
Collapse
|
22
|
Frantz I, Pedersen A, Lincoln TM. Psychotherapeutische Behandlungsansätze bei Psychosen. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0293-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
23
|
Aguilar-Raab C, Grevenstein D, Gotthardt L, Jarczok MN, Hunger C, Ditzen B, Schweitzer J. Changing Me, Changing Us: Relationship Quality and Collective Efficacy as Major Outcomes in Systemic Couple Therapy. FAMILY PROCESS 2018; 57:342-358. [PMID: 28657111 DOI: 10.1111/famp.12302] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We examine the sensitivity to change in the Evaluation of Social Systems (EVOS) scale, which assesses relationship quality and collective efficacy. In Study 1 we conducted a waitlist-control, short-term couple therapy RCT study (N = 43 couples) with five systemic therapy sessions treating communication and partnership problems; our intent was to provide high external validity. Construct validity of EVOS was assessed by comparison with additionally applied scales (Family Scales; Outcome Questionnaire, OQ-45.2). In Study 2, N = 332 individuals completed an experiment with high internal validity in order to verify sensitivity to change in three different social contexts. Results from Study 1 revealed a significant increase in relationship quality in the treatment group directly after treatment, as compared to the control group. Sensitivity to change was slightly better for EVOS than for other measures. While this positive change could not be fully sustained between posttreatment and a 4-week follow-up, EVOS score did not fall below baseline and pretreatment levels, supporting moderate-to-large sensitivity to change. Study 2 supported high sensitivity to change in EVOS for couple relations, family relations, and work-team relationships. Therefore, EVOS can be used as an outcome measure to monitor the process of systemic interventions focusing on relationship quality and collective efficacy. Due to its sensitivity to change, EVOS can provide evidence for treatment success with regard to relationship aspects.
Collapse
Affiliation(s)
- Corina Aguilar-Raab
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Linda Gotthardt
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Marc N Jarczok
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Christina Hunger
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jochen Schweitzer
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
24
|
Bighelli I, Salanti G, Reitmeir C, Wallis S, Barbui C, Furukawa TA, Leucht S. Psychological interventions for positive symptoms in schizophrenia: protocol for a network meta-analysis of randomised controlled trials. BMJ Open 2018. [PMID: 29540411 PMCID: PMC5857696 DOI: 10.1136/bmjopen-2017-019280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION There is rising awareness that we need multidisciplinary approaches integrating psychological treatments for schizophrenia, but a comprehensive evidence based on their relative efficacy is lacking. We will conduct a network meta-analysis (NMA), integrating direct and indirect comparisons from randomised controlled trials (RCTs) to rank psychological treatments for schizophrenia according to their efficacy, acceptability and tolerability. METHODS AND ANALYSIS We will include all RCTs comparing a psychological treatment aimed at positive symptoms of schizophrenia with another psychological intervention or with a no treatment condition (waiting-list and treatment as usual). We will include studies on adult patients with schizophrenia, excluding specific subpopulations (eg, first-episode patients or patients with psychiatric comorbidities). Primary outcome will be the change in positive symptoms on a published rating scale. Secondary outcomes will be acceptability (dropout), change in overall and negative symptoms of schizophrenia, response, relapse, adherence, depression, quality of life, functioning and adverse events. Published and unpublished studies will be sought through database searches, trial registries and websites. Study selection and data extraction will be conducted by at least two independent reviewers. We will conduct random-effects NMA to synthesise all evidences for each outcome and obtain a comprehensive ranking of all treatments. NMA will be conducted in Stata and R within a frequentist framework. The risk of bias in studies will be evaluated using the Cochrane Risk of Bias tool and the credibility of the evidence will be evaluated using an adaptation of the Grading of Recommendations Assessment, Development and Evaluation framework to NMA, recommended by the Cochrane guidance. Subgroup and sensitivity analyses will be conducted to assess the robustness of the findings. ETHICS AND DISSEMINATION No ethical issues are foreseen. Results from this study will be published in peer-reviewed journals and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42017067795.
Collapse
Affiliation(s)
- Irene Bighelli
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technischen Universitat Munchen, Munchen, Germany
| | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Cornelia Reitmeir
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technischen Universitat Munchen, Munchen, Germany
| | - Sofia Wallis
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technischen Universitat Munchen, Munchen, Germany
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technischen Universitat Munchen, Munchen, Germany
| |
Collapse
|
25
|
Abstract
Psychotherapy meta-analyses sometimes generate heterogeneous results, partially due to key methodological characteristics which vary between studies (e.g., psychotherapy conditions are contrasted with structurally different control conditions). Examining these potential moderator variables can help explain heterogeneous results within and between psychotherapy meta-analyses. The present manuscript provides an overview of moderators that are highly relevant to test the generalizability of effects across psychotherapy trials. These moderators mainly fall into one of the following groups: (a) structural equivalence of interventions, (b) preferences/allegiances, (c) therapist effects, and (d) sample representativeness. Individual moderators include: Bona fide psychotherapy, proximity to psychological interventions, psychotherapy orientation, pre-training of therapists, supervision, caseload of therapists, dosage, homework, patient preferences, researcher and therapist allegiance, therapist effects in nested designs, aspects of sample representativeness, multiple outcomes, and time of assessment. Our analysis of 15 psychotherapy meta-analyses published in 2016 suggests that the structural equivalence of psychotherapeutic conditions, patient and therapist preferences/allegiances, therapist effects and nested data structures as well as sample representativeness were often neglected and little-discussed as potential moderators. The manuscript describes further conceptual and methodological challenges when conducting moderator analyses such as the categorization of psychological treatments and the importance of interrater coding. We encourage meta-analysts to consider moderators which have previously shown utility in explaining heterogeneous results in the psychotherapy literature. Clinical or methodological significance of this article: Relevant moderator variables help explain heterogeneous results in psychotherapy meta-analyses. Though these variables are often overlooked, they should be regularly incorporated in meta-analyses.
Collapse
Affiliation(s)
- Glen I Spielmans
- a Department of Psychology , Metropolitan State University , Saint Paul , MN , USA.,b Department of Counseling Psychology , University of Wisconsin , Madison , WI , USA
| | | |
Collapse
|
26
|
Leichsenring F, Abbass A, Hilsenroth MJ, Luyten P, Munder T, Rabung S, Steinert C. "Gold Standards," Plurality and Monocultures: The Need for Diversity in Psychotherapy. Front Psychiatry 2018; 9:159. [PMID: 29740361 PMCID: PMC5928423 DOI: 10.3389/fpsyt.2018.00159] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/09/2018] [Indexed: 12/26/2022] Open
Abstract
For psychotherapy of mental disorders, presently several approaches are available, such as interpersonal, humanistic, systemic, psychodynamic or cognitive behavior therapy (CBT). Pointing to the available evidence, proponents of CBT claim that CBT is the gold standard. Some authors even argue for an integrated CBT-based form of psychotherapy as the only form of psychotherapy. CBT undoubtedly has its strengths and CBT researchers have to be credited for developing and testing treatments for many mental disorders. A critical review, however, shows that the available evidence for the theoretical foundations of CBT, assumed mechanisms of change, quality of studies, and efficacy is not as robust as some researchers claim. Most important, there is no consistent evidence that CBT is more efficacious than other evidence-based approaches. These findings do not justify regarding CBT as the gold standard psychotherapy. They even provide less justification for the idea that the future of psychotherapy lies in one integrated CBT-based form of psychotherapy as the only type of psychotherapy. For the different psychotherapeutic approaches a growing body of evidence is available. These approaches have their strengths because of differences in their respective focus on interpersonal relationships, affects, cognitions, systemic perspectives, experiential, or unconscious processes. Different approaches may be suitable to different patients and therapists. As generally assumed, progress in research results from openness to new ideas and learning from diverse perspectives. Thus, different forms of evidence-based psychotherapy are required. Plurality is the future of psychotherapy, not a uniform "one fits all" approach.
Collapse
Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Allan Abbass
- Department of Psychiatry, Centre for Emotions and Health, Dalhousie University, Halifax, NS, Canada
| | - Mark J Hilsenroth
- The Derner Institute of Advanced Psychological Studies, Adelphi University, Hy Weinberg Center, Garden City, NY, United States
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | | | - Sven Rabung
- Department of Psychology, Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany.,Department of Psychology, Medical School Berlin, Berlin, Germany
| |
Collapse
|
27
|
|
28
|
Merikangas KR, Calkins ME, Burstein M, He JP, Chiavacci R, Lateef T, Ruparel K, Gur RC, Lehner T, Hakonarson H, Gur RE. Comorbidity of physical and mental disorders in the neurodevelopmental genomics cohort study. Pediatrics 2015; 135:e927-38. [PMID: 25755242 PMCID: PMC4379458 DOI: 10.1542/peds.2014-1444] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2015] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To examine patterns of associations between a broad range of mental and physical conditions by using a large, systematically obtained pediatric registry. METHODS The sample included 9014 youth ages 8 to 21 years (4349 males and 4665 females; 3585 aged <13 years, 3678 aged 13 to 18 years, and 1751 aged 19 to 21 years) from the Philadelphia Neurodevelopmental Cohort identified through pediatric clinics at the Children's Hospital of Philadelphia health care network by the Center for Applied Genomics. Measures were as follows: physical condition based on electronic medical records and interview data on 42 physical conditions of 14 organ systems/specialties and mental disorders based on an abbreviated version of the structured Kiddie-Schedule for Affective Disorders and Schizophrenia psychiatric diagnostic interview. RESULTS There was a direct association between the severity of the physical condition and most classes of mental disorders, as well as with functional impairment. Models adjusted for sociodemographic correlates, other physical and mental disorders, and false discovery and revealed broad patterns of associations between neurodevelopmental disorders with behavior disorders (odds ratio [OR]: 1.5; 95% confidence interval [CI]: 1.3-1.8; P < .004) and attention-deficit/hyperactivity disorder (OR: 3.1; 95% CI: 2.7-3.6; P < .0001), and neurologic/central nervous system conditions (OR: 1.3; 95% CI: 1.1-1.9; P < .05) with mood disorders and attention-deficit/hyperactivity disorder (OR: 1.3; 95% CI: 1.1-1.5; P < .001), and autoimmune/inflammatory conditions with mood disorders (OR: 1.4; 95% CI: 1.1-1.8, P < .05). CONCLUSIONS Findings show the strong overlap between physical and mental conditions and their impact on severity and functional impairment in youth. Specific patterns of comorbidity have important implications for etiology. Prospective tracking of cross-disorder morbidity will be important to establish more effective mechanisms for prevention and intervention.
Collapse
Affiliation(s)
| | | | - Marcy Burstein
- Genetic Epidemiology Research Branch, Division of Intramural Research Program, and
| | - Jian-Ping He
- Genetic Epidemiology Research Branch, Division of Intramural Research Program, and
| | - Rosetta Chiavacci
- The Center for Applied Genomics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Tarannum Lateef
- Genetic Epidemiology Research Branch, Division of Intramural Research Program, and,Department of Neurology, Children’s National Medical Center, Washington, District of Columbia
| | - Kosha Ruparel
- Neuropsychiatry Section and Brain Behavior Laboratory and
| | - Ruben C. Gur
- Neuropsychiatry Section and Brain Behavior Laboratory and
| | - Thomas Lehner
- Translational Genomics Branch, National Institute of Mental Health, Bethesda, Maryland
| | - Hakon Hakonarson
- Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;,The Center for Applied Genomics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Raquel E. Gur
- Neuropsychiatry Section and Brain Behavior Laboratory and
| |
Collapse
|