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Heinonen E, Knekt P, Lindfors O. What Works for Whom: Patients' Psychological Resources and Vulnerabilities as Common and Specific Predictors of Working Alliance in Different Psychotherapies. Front Psychiatry 2022; 13:848408. [PMID: 35865305 PMCID: PMC9294449 DOI: 10.3389/fpsyt.2022.848408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background Across different types of psychotherapy, one of the most robust predictors of better therapeutic outcomes is a good working alliance between patient and therapist. Yet there is little comparative research on whether particular patients more likely achieve a better alliance in certain treatments which represent particular therapeutic approaches or durations. Methods 326 patients suffering from depressive and/or anxiety disorder were randomized into two short-term (solution-focused or psychodynamic) and one long-term (psychodynamic) therapy models. Treatments lasted ~7 and 36 months, respectively. Before randomization, patients were assessed with the interview-based Suitability for Psychotherapy Scale and filled Childhood Family Atmosphere and Life Orientation Test questionnaires. Patients filled Working Alliance Inventory after 3rd therapy session and at end of treatment; the long-term therapy patients, additionally, at 7 months' time point. Linear regression models were used. Results Greater psychological resources (e.g., capacity for self-reflection, affect regulation, flexible interaction) had little effect on alliance during the course of the short-term therapies. However, they did predict better working alliances at end of long-term as opposed to short-term therapy. Childhood adversities impacted alliances already at 7 months. Conclusions Although patients with certain qualities achieve better alliances in long-term as opposed to short-term therapies, apparently the theoretical orientation of therapy makes little difference. For patients with childhood adversities, differences between long-term (psychodynamic) treatment vs. various brief therapy models may be particularly salient.
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Affiliation(s)
- Erkki Heinonen
- Department of Psychology, University of Oslo, Oslo, Norway
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Paul Knekt
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Olavi Lindfors
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Alanne C, Heinonen E, Knekt P, Rissanen J, Virtala E, Lindfors O. Predicting improvement of work ability in modalities of short- and long-term psychotherapy: The differential impact of reflective ability and other aspects of patient suitability. J Clin Psychol 2021; 77:1905-1920. [PMID: 33638220 DOI: 10.1002/jclp.23128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 01/27/2021] [Accepted: 02/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We investigated how patients' psychological capacities to engage in psychotherapy predict changes in work ability in short- and long-term psychotherapy. METHODS A cohort study of 326 patients, aged 20-46 years and suffering from mood and anxiety disorders, treated by short-term solution-focused, short-term psychodynamic, or long-term psychodynamic psychotherapy, followed-up for 5 years. The Suitability for Psychotherapy Scale, assessed at baseline, was the predictor. Outcomes were assessed at baseline and at six follow-up occasions using the Work Ability Index as the primary indicator. RESULTS Patients with good pretreatment psychological suitability for psychotherapy, good reflective ability in particular, improved more than patients with poor suitability in short-term psychodynamic psychotherapy. Comparisons between therapy groups showed poorer suitability to predict more improvement in solution-focused and in long-term psychodynamic psychotherapy than in short-term psychodynamic psychotherapy. CONCLUSION Patients' psychological suitability for psychotherapy has a different impact on work ability in different therapy modalities and durations.
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Affiliation(s)
- Carita Alanne
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Heinonen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Knekt
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Julius Rissanen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Esa Virtala
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Olavi Lindfors
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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3
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The Effect of Hopelessness and Perceived Group Compatibility on Treatment Outcome for Patients With Personality Dysfunction. J Nerv Ment Dis 2020; 208:677-682. [PMID: 32324676 DOI: 10.1097/nmd.0000000000001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Improvement in life satisfaction is hard to achieve for any patient with personality psychopathology, and possibly even moreso for those who feel hopeless at the start of treatment. The present research investigated the potential influence of hopelessness in the treatment of patients with personality dysfunction, using data from patients who completed an intensive group therapy program designed to reduce symptom distress and support optimal psychosocial functioning (N = 80). In the present study, we sought to examine whether hopelessness would moderate (i.e., strengthen or weaken) relations between compatibility ratings and life satisfaction outcome. Hopelessness had a significant moderating effect on the relationship between compatibility and outcome, suggesting that, for patients who entered treatment feeling more hopeless, higher appraisals of fit within the group facilitated better gains in life satisfaction. If replicated, the findings underlie the importance of focusing on increasing hope and perceived group affiliation in the treatment of personality dysfunction.
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Olawa BD, Idemudia ES. Association between schizotypal personality trait and dispositional optimism among prisoners: Findings from some selected male prisoners in a Nigerian prison. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2020.1781426] [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: 10/23/2022]
Affiliation(s)
- Babatola Dominic Olawa
- Lifestyle Diseases Mafikeng, Faculty of Health Sciences, North-West University, Mafikeng, South Africa
| | - Erhabor Sunday Idemudia
- Lifestyle Diseases Mafikeng, Faculty of Health Sciences, North-West University, Mafikeng, South Africa
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Tsungmey T, Kim JP, Dunn LB, Ryan K, Lane-McKinley K, Roberts LW. Negative association of perceived risk and willingness to participate in innovative psychiatric research protocols. J Psychiatr Res 2020; 122:9-16. [PMID: 31891880 PMCID: PMC7243412 DOI: 10.1016/j.jpsychires.2019.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/10/2019] [Accepted: 12/16/2019] [Indexed: 02/06/2023]
Abstract
Psychiatric researchers grapple with concerns that individuals with mental illness may be less likely to appreciate risks of research participation, particularly compared to people not suffering from mental illness. Therefore, empirical studies that directly compare the perspectives of such individuals are needed. In addition, it is important to evaluate perspectives regarding varied types of research protocols, particularly as innovative psychiatric research protocols emerge. In this pilot study, respondents with a mood disorder (n = 25) as well as respondents without a mood disorder (n = 55) were recruited using Amazon's Mechanical Turk (MTurk) platform. These respondents were surveyed regarding four psychiatric research projects (i.e., experimental medication [pill form]; non-invasive magnetic brain stimulation; experimental medication [intravenous infusion]; and implantation of a device in the brain). Regardless of health status, respondents rated the four research protocols as somewhat to highly risky. The brain-device implant protocol was seen as the most risky, while the magnetic brain stimulation project was viewed as "somewhat risky". Respondents, on average and regardless of health status, rated their willingness at or below "somewhat willing." Respondents were least willing to participate in the brain-device implant protocol, whereas they were "somewhat willing" to participate in the magnetic brain stimulation protocol. Trust in medical research was negatively associated with perceived risk of research protocols. Perceived risk was negatively associated with willingness to participate, even when adjusting for potential confounders, suggesting that attunement to risk crosses diagnostic, gender, and ethnic categories, and is more salient to research decision-making than trust in medical research and dispositional optimism. The findings of this study may offer reassurance about the underlying decision-making processes of individuals considering participation in innovative neuroscience studies.
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Affiliation(s)
- Tenzin Tsungmey
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Jane Paik Kim
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717.
| | - Laura B Dunn
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Katie Ryan
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Kyle Lane-McKinley
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
| | - Laura Weiss Roberts
- Department of Psychiatry and Behavioral Sciences, Stanford University, School of Medicine, 401 Quarry Road, Stanford, CA, USA, 94305-5717
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Rozek DC, Keane C, Sippel LM, Stein JY, Rollo-Carlson C, Bryan CJ. Short-term effects of crisis response planning on optimism in a U.S. Army sample. Early Interv Psychiatry 2019; 13:682-685. [PMID: 29943518 DOI: 10.1111/eip.12699] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/18/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
AIM This study examined the short-term effects of a brief crisis intervention on optimism of acutely suicidal soldiers. METHODS U.S. Soldiers (N = 97) presenting for an emergency mental health appointment in a military emergency department or behavioural health clinic were randomly assigned to treatment as usual standard crisis response plan, or enhanced crisis response plan (E-CRP). This study is used a subsample of the original clinical trial (n = 64) for those who completed self-report measures of optimism (Life Orientation Test-Revised) prior to receiving any intervention and a secondary self-report assessment one-month following the intervention. RESULTS Results indicate that individuals with low baseline optimism who received the E-CRP had significant increases in optimism 1 month post-intervention. CONCLUSION This provides evidence that discussing a patient's reasons for living during a CRP increases optimism in those high-risk patients with the lowest baseline optimism.
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Affiliation(s)
- David C Rozek
- National Center for Veterans Studies, University of Utah, Salt Lake City, Utah.,Department of Psychiatry, University of Utah, Salt Lake City, Utah
| | - Carol Keane
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Lauren M Sippel
- National Center for PTSD Executive Division, White River Junction, Vermont.,Geisel School of Medicine at Dartmouth, Department of Psychiatry, Hanover, New Hampshire
| | - Jacob Y Stein
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel.,I-Core Research Center for Mass Trauma, Tel-Aviv University, Tel Aviv, Israel
| | - Cynthia Rollo-Carlson
- University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Craig J Bryan
- National Center for Veterans Studies, University of Utah, Salt Lake City, Utah.,Department of Psychiatry, University of Utah, Salt Lake City, Utah
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Heinonen E, Knekt P, Härkänen T, Virtala E, Lindfors O. Childhood adversities as predictors of improvement in psychiatric symptoms and global functioning in solution-focused and short- and long-term psychodynamic psychotherapy during a 5-year follow-up. J Affect Disord 2018; 235:525-534. [PMID: 29689505 DOI: 10.1016/j.jad.2018.04.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/15/2018] [Accepted: 04/04/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Childhood adversities are frequent among adults who seek treatment for depression or anxiety. These disorders are commonly treated by psychotherapy. Yet it is not known if specific types or durations of psychotherapy are particularly suited for patients who have suffered various early adversities. METHODS 221 depressed and anxious adult outpatients from community, student, occupational, and private healthcare services filled the Childhood Family Atmosphere Questionnaire. They were randomly assigned to short- (solution-focused or psychodynamic) or long-term (psychodynamic) psychotherapy. Outcome was assessed via patient questionnaires and clinician interviews of psychiatric symptoms and global functioning during a 5-year follow-up. Linear regression analyses were conducted. RESULTS Less separations from caregivers expectedly predicted better outcomes in all therapies; unexpectedly, so did greater abuse. Family unhappiness and parental problems predicted faster or greater improvement when patients were assigned to a short- or long-term psychodynamic therapy model. LIMITATIONS As patients with psychotic, substance abuse, and severe personality disorders were screened out, findings might not generalize to these patient groups. CONCLUSIONS Patients with certain childhood adversities appear to respond with faster or greater improvement when the psychotherapy model is explicitly focused on working through the potential connections between past and current problems. If confirmed by in-depth studies, the findings may help match psychotherapeutic models with given patient complaints, as well as fine-tune different psychosocial interventions to individual needs for optimizing treatment outcomes.
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Affiliation(s)
| | - Paul Knekt
- National Institute for Health and Welfare, Finland
| | | | - Esa Virtala
- National Institute for Health and Welfare, Finland
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Heinonen E, Knekt P, Härkänen T, Virtala E, Lindfors O. Associations of early childhood adversities with mental disorders, psychological functioning, and suitability for psychotherapy in adulthood. Psychiatry Res 2018; 264:366-373. [PMID: 29677619 DOI: 10.1016/j.psychres.2018.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 04/01/2018] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
Abstract
Childhood adversities frequently precede adulthood depression and anxiety. Yet, how they impact needed treatment duration, type or focus in these common disorders, is unclear. For developing more individualized and precise interventions, we investigated whether specific early adversities associate with patients' distinct psychiatric problems, psychological vulnerabilities, and suitability for psychotherapy. A total of 221 depressed and anxious adult outpatients (excluding psychotic, severe personality, bipolar, and substance abuse disorders) referred from community, student, occupational, and private healthcare services filled the Childhood Family Atmosphere Questionnaire (CFAQ). They also filled self-reports on interpersonal behavior and problems, perceived competence, dispositional optimism, sense of coherence, defenses, and psychiatric history. Clinicians assessed the patients' symptomatology, personality, object relations, cognitive performance, and psychotherapy suitability. Regression analyses were conducted. Childhood adversities predicted both worse current psychological functioning (e.g., interpersonal problems), and better clinician-rated capacities for benefiting from psychotherapy (e.g. self-reflection, capacity for interaction). Parental problems had the most numerous negative associations to psychological functioning. Best capacities for psychotherapy were predicted by recollected family unhappiness. Associations with psychiatric criteria were, however, largely non-significant. In conclusion, for psychosocial treatment planning, patients' early adversities may indicate both vulnerability and resources. As childhood adversities are frequent among treatment-seekers, further studies examining how early adversities predict psychotherapy outcome are needed.
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Affiliation(s)
| | - Paul Knekt
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
| | - Esa Virtala
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
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Gramling R, Stanek S, Han PK, Duberstein P, Quill TE, Temel JS, Alexander SC, Anderson WG, Ladwig S, Norton SA. Distress Due to Prognostic Uncertainty in Palliative Care: Frequency, Distribution, and Outcomes among Hospitalized Patients with Advanced Cancer. J Palliat Med 2018; 21:315-321. [DOI: 10.1089/jpm.2017.0285] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Robert Gramling
- Division of Palliative Medicine, Department of Family Medicine, University of Vermont Medical Center, Burlington, Vermont
| | - Susan Stanek
- School of Nursing, University of Rochester, Rochester, New York
| | - Paul K.J. Han
- Maine Medical Center Research Institute, Scarborough, Maine
| | - Paul Duberstein
- Department of Psychiatry, University of Rochester, Rochester, New York
| | - Tim E. Quill
- School of Nursing, University of Rochester, Rochester, New York
| | - Jennifer S. Temel
- Department of Medicine, Harvard University, Cambridge, Massachusetts
| | - Stewart C. Alexander
- Department of Consumer Science, Department of Medicine, Purdue University, West Lafayette, Indiana
| | | | - Susan Ladwig
- Division of Palliative Care, University of Rochester, Rochester, New York
| | - Sally A. Norton
- School of Nursing, University of Rochester, Rochester, New York
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Knekt P, Lindfors O, Keinänen M, Heinonen E, Virtala E, Härkänen T. The prediction of the level of personality organization on reduction of psychiatric symptoms and improvement of work ability in short- versus long-term psychotherapies during a 5-year follow-up. Psychol Psychother 2017; 90:353-376. [PMID: 28035751 DOI: 10.1111/papt.12115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 09/08/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES How level of personality organization (LPO) predicts psychiatric symptoms and work ability in short- versus long-term psychotherapies is poorly known. We investigated the importance of the LPO on the benefits of short-term versus long-term psychotherapies. DESIGN A cohort study based on 326 outpatients with mood or anxiety disorder was allocated to long-term (LPP) and short-term (SPP) psychodynamic psychotherapy, and solution-focused therapy (SFT). METHODS The LPO was assessed by interview at baseline and categorized into neuroses and higher level borderline. Outcome was assessed at baseline and 4-9 times during a 5-year follow-up, using self-report and interview-based measures of symptoms and work ability. RESULTS For patients receiving SPP, improvement in work ability, symptom reduction, and the remission rate were more considerable in patients with neuroses than in higher level borderline patients, whereas LPP or SFT showed no notable differences in effectiveness in the two LPO groups. In patients with neuroses, improvement was more considerable in the short-term therapy groups during the first year of follow-up, and in higher level borderline patients LPP was more effective after 3 years of follow-up. The remission rate, defined as both symptom reduction and lack of auxiliary treatment, was higher in LPP than in SPP for both the LPO groups considered. CONCLUSIONS In neuroses, short-term psychotherapy was associated with a more rapid reduction of symptoms and increase in work ability, whereas LPP was more effective for longer follow-ups in both LPO groups. Further large-scale studies are needed. PRACTITIONER POINTS Level of personality organization is relevant for selection between short- and long-term psychotherapies. Short-term therapy gives faster benefits for neurotic patients but not for patients with higher level borderline personality organization. Sustained remission from symptoms is more probable after long-term than short-term therapy.
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Affiliation(s)
- Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland.,Biomedicum Helsinki, Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Erkki Heinonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Esa Virtala
- National Institute for Health and Welfare, Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, Helsinki, Finland
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