1
|
Keefe JR, Kimmel D, Weitz E. A Meta-Analysis of Interpersonal and Psychodynamic Psychotherapies for Posttraumatic Stress Disorder. Am J Psychother 2024:appipsychotherapy20230043. [PMID: 39104248 DOI: 10.1176/appi.psychotherapy.20230043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
OBJECTIVE Established trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder (PTSD) have remission rates of approximately 30%-40%. Alternatively, interpersonal psychotherapy (IPT) and psychodynamic psychotherapy (PDT) focus on disrupted attachment, mentalization, and social connection in PTSD and may help some patients. The authors conducted a meta-analysis on these interpersonal and affect-oriented approaches to treating PTSD. METHODS Building on a prior meta-analysis, the authors searched for randomized controlled trials (RCTs) comparing IPT or PDT with other established PTSD treatments or control conditions for adults diagnosed as having PTSD. Random-effects meta-analyses were conducted to assess outcome effect sizes and dropout rates. RCTs were rated via the Randomized Controlled Trial Psychotherapy Quality Rating Scale. RESULTS Ten RCTs (eight of IPT) comparing IPT or PDT with control (k=7) or active treatment (k=4) conditions were identified, nine of which were of adequate quality. IPT (k=5) and PDT (k=2), when analyzed together, were superior to control conditions overall (g=-1.14, p=0.011 [as was IPT alone: g=-0.88, p=0.034]) and to waitlist (g=-1.49) and treatment-as-usual (g=-0.70) groups. Effect sizes, however, may have been inflated by outliers or publication bias. IPT (k=3) and PDT (k=1), when analyzed together, were equally efficacious compared with other active PTSD treatments (primarily exposure-based psychotherapies), as was IPT alone, and had lower dropout rates (relative risk=0.63, p=0.049 for IPT and PDT analyzed together; relative risk=0.61, p=0.098 for IPT alone). CONCLUSIONS Affect-focused therapies hold promise in the treatment of PTSD. IPT has demonstrated efficacy in multiple trials, whereas the evidence base for PDT is sparse.
Collapse
Affiliation(s)
- John R Keefe
- Department of Psychology, Long Island University Brooklyn, and Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Psychiatry, University of Maryland-Sheppard Pratt Psychiatry Residency Program, Baltimore (Kimmel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Weitz)
| | - Duncan Kimmel
- Department of Psychology, Long Island University Brooklyn, and Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Psychiatry, University of Maryland-Sheppard Pratt Psychiatry Residency Program, Baltimore (Kimmel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Weitz)
| | - Erica Weitz
- Department of Psychology, Long Island University Brooklyn, and Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Psychiatry, University of Maryland-Sheppard Pratt Psychiatry Residency Program, Baltimore (Kimmel); Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Weitz)
| |
Collapse
|
2
|
Free G, Swildens W, Knapen S, Beekman A, van Meijel B. Mentalizing capacities of mental health nurses: A systematic PRISMA review. J Psychiatr Ment Health Nurs 2024; 31:87-110. [PMID: 37551628 DOI: 10.1111/jpm.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/08/2023] [Accepted: 07/12/2023] [Indexed: 08/09/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Mentalizing is the capacity to understand both one's own and other people's behaviour in terms of mental states, such as, for example, desires, feelings and beliefs. The mentalizing capacities of healthcare professionals help to establish effective therapeutic relationships and, in turn, lead to better patient outcomes. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The personal factors positively associated with the mentalizing capacities of healthcare professionals are being female, greater work experience and having a more secure attachment style. Psychosocial factors are having personal experience with psychotherapy, burnout, and in the case of female students, being able to identify with the female psychotherapist role model during training. There is limited evidence that training programmes can improve mentalizing capacities. Although the mentalization field is gaining importance and research is expanding, the implications for mental health nursing have not been previously reviewed. Mental health nurses are underrepresented in research on the mentalizing capacities of healthcare professionals. This is significant given that mental health nurses work closest to patients and thus are more often confronted with patients' behaviour compared to other health care professionals, and constitute a large part of the workforce in mental healthcare for patients with mental illness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Given the importance of mentalizing capacity of both the patient and the nurse for a constructive working relationship, it is important that mental health nurses are trained in the basic principles of mentalization. Mental health nurses should be able to recognize situations where patients' lack of ability to mentalize creates difficulties in the interaction. They should also be able to recognize their own difficulties with mentalizing and be sensitive to the communicative implications this may have. ABSTRACT INTRODUCTION: Mentalizing capacities of clinicians help to build effective therapeutic relationships and lead to better patient outcomes. Few studies have focused on factors associated with clinicians' mentalizing capacities and the intervention strategies to improve them. AIM Present a systematic review of empirical studies on factors associated with healthcare professionals' mentalizing capacities and the effectiveness of intervention programmes designed to improve these capacities. METHOD Following PRISMA-guidelines, a systematic literature search was conducted in PubMed, PsycINFO, Cochrane Library and CINAHL. RESULTS Out of a systematic search with 1537 hits, 22 studies were included. Personal factors positively associated with mentalizing capacities of healthcare professionals are being female, greater work experience and having a more secure attachment style. Psychosocial factors are having personal experience with psychotherapy, burnout, and in the case of female students, being able to identify with the female psychotherapist role model during training. Evidence that training programmes improve mentalizing capacities is limited. DISCUSSION Mental health nurses are underrepresented in research on mentalizing capacities of healthcare professionals and training programs to improve these capacities are practically absent. IMPLICATIONS FOR PRACTICE For mental health nurses, training in basic mentalizing theory and skills will improve their capacities in building effective working relationships with patients.
Collapse
Affiliation(s)
- Gieke Free
- Altrecht Institution for Mental Health Care, Utrecht, The Netherlands
- Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Wilma Swildens
- Altrecht Institution for Mental Health Care, Utrecht, The Netherlands
- Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Saskia Knapen
- Altrecht Institution for Mental Health Care, Utrecht, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Aartjan Beekman
- Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam University Medical Centre, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, Parnassia Academy, The Hague, The Netherlands
| |
Collapse
|
3
|
Langenbach BP, Koelkebeck K, Knoch D. Mentalising and depression: a mini-review on behavior, neural substrates, and treatment options. Front Psychiatry 2023; 14:1116306. [PMID: 37398589 PMCID: PMC10308027 DOI: 10.3389/fpsyt.2023.1116306] [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: 12/05/2022] [Accepted: 05/24/2023] [Indexed: 07/04/2023] Open
Abstract
Major depression is one of the most common mental disorders, affecting millions of people around the globe. In recent years, researchers increasingly investigated social cognition in depression and discovered pronounced alterations. A special focus has been put on mentalising or Theory of Mind, the ability to recognize and understand another person's thoughts and feelings. While there is behavioral evidence for deficits in this ability in patients with depression as well as specialized therapeutic interventions, the neuroscientific substrates are only beginning to be understood. In this mini-review, we take a social neuroscience perspective to analyse the importance of altered mentalising in depression and whether it can help to understand the origins and perpetuation of the disorder. We will put a special focus on treatment options and corresponding neural changes to identify relevant paths for future (neuroscientific) research.
Collapse
Affiliation(s)
- Benedikt P. Langenbach
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Katja Koelkebeck
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
| | - Daria Knoch
- Department of Social Neuroscience and Social Psychology, Institute of Psychology, University of Bern, Bern, Switzerland
| |
Collapse
|
4
|
Gori A, Topino E. Exploring and Deepening the Facets of Mentalizing: The Integration of Network and Factorial Analysis Approaches to Verify the Psychometric Properties of the Multidimensional Mentalizing Questionnaire (MMQ). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4744. [PMID: 36981653 PMCID: PMC10049311 DOI: 10.3390/ijerph20064744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Mentalization is a complex and multifaceted trans-theoretical and trans-diagnostic construct that has found increasing application in the clinical context. This research aimed at deepening the psychometric properties of the Multidimensional Mentalizing Questionnaire (MMQ), a 33-item theoretically based self-report questionnaire allowing for a comprehensive assessment of mentalizing, by integrating factor analysis and network analysis approaches. A sample of 1640 participants (Mage = 33 years; SD = 13.28) was involved in the research. The six-factor structure was confirmed for the MMQ, and both the total and the subdimensions demonstrated good reliability. The network analysis has further enriched these results, showing the central role of the items attributable to Emotional Dysregulation or Reflexivity in influencing the network as well as the contribution of aspects related to Relational Discomfort in managing the flow of communication flow. Such findings may have useful clinical implications and emphasize the usefulness of the MMQ in both research and clinical practice.
Collapse
Affiliation(s)
- Alessio Gori
- Department of Health Sciences, University of Florence, Via di San Salvi 12, Pad. 26, 50135 Florence, Italy
- Integrated Psychodynamic Psychotherapy Institute (IPPI), Via Ricasoli 32, 50122 Florence, Italy
| | - Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Via della Traspontina 21, 00193 Rome, Italy
| |
Collapse
|
5
|
Ballespí S, Nonweiler J, Sharp C, Vives J, Barrantes‐Vidal N. Self- but not other-mentalizing moderates the association between BPD symptoms and somatic complaints in community-dwelling adolescents. Psychol Psychother 2022; 95:905-920. [PMID: 35746823 PMCID: PMC9795931 DOI: 10.1111/papt.12409] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/14/2022] [Accepted: 05/25/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the potential moderator role of poor mentalization in the association between borderline personality disorder (BPD) traits and somatization, specifically focusing on the polarities of self- and other-mentalizing. DESIGN This is a cross-sectional, general population study evaluating adolescents (n = 162, 61.3% female; ages 12-18, M = 14.63, SD = 1.02). The relationship between BPD traits and somatization was evaluated with self-mentalization (attention to emotions and clarity of emotions) and other-mentalizing as moderator variables. METHODS One hundred sixty-two adolescents without serious mental health disorders were evaluated using self-report measures for borderline personality disorder traits (screening questionnaire for the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), somatic symptoms using the Somatic Symptoms Questionnaire (SSQ), self-mentalizing using the Trait Meta-Mood Scale-24 (TMMS) and other-mentalizing using the Adolescent Mentalizing Interview (AMI)). Linear regressions were conducted to test the moderation effects of self- and other-mentalizing in the relationship between BPD symptoms and somatic complaints, controlling for age and sex. Moderation analysis was conducted using PROCESS version 3.5. RESULTS The association between BPD symptoms and somatic complaints was moderated by a self-mentalizing dimension (emotional clarity) (b = -0.019, 95% CI = -0.0379 to -0.0002, p = .0476), but not other-mentalizing (b = 0.027, 95% CI = 0.000 to 0.053, p = .051). The effect of BPD symptoms on somatization disappears when emotional clarity is high, regardless the level of attention to emotions. CONCLUSIONS Self-mentalizing appears to be an adaptive skill as it attenuates the relationship between BPD traits and somatization. Specifically, emotional clarity rather than simple attention to emotions is the aspect of self-mentalizing attenuating this association. These results support that self-mentalization is an important function in the management of body-associated emotions even in non-clinical levels of BPD traits. Findings suggest that strengthening self-mentalizing skills across development might contribute to resilience and salutogenesis.
Collapse
Affiliation(s)
- Sergi Ballespí
- Department of Clinical and Health PsychologyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Jacqueline Nonweiler
- Department of Clinical and Health PsychologyUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Carla Sharp
- Department of PsychologyUniversity of HoustonHoustonTexasUSA
| | - Jaume Vives
- Department of Psychobiology and Methodology of Health SciencesUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Neus Barrantes‐Vidal
- Department of Clinical and Health PsychologyUniversitat Autònoma de BarcelonaBarcelonaSpain,Department of Mental HealthFundació Sanitària Sant Pere ClaverBarcelonaSpain,Centre for Biomedical Research Network on Mental Health (CIBERSAM)Instituto de Salud Carlos IIIMadridSpain
| |
Collapse
|
6
|
Ekeblad A, Holmqvist R, Andersson G, Falkenström F. Change in reflective functioning in interpersonal psychotherapy and cognitive behavioral therapy for major depressive disorder. Psychother Res 2022; 33:342-349. [PMID: 35952325 DOI: 10.1080/10503307.2022.2109443] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
BACKGROUND Patients with Major Depressive Disorder (MDD) have been found to have restricted capacity for mentalization, and it is possible that this constitutes a vulnerability factor for developing depression. Due to its focus on linking depressive symptomatology to emotions and interpersonal relations, it was hypothesized that Interpersonal Psychotherapy (IPT) would improve mentalization more than Cognitive Behavioral Therapy (CBT). METHODS In a randomized controlled trial of 90 patients undergoing IPT and CBT for MDD, Reflective Functioning (RF) was rated from Adult Attachment and from Depression-Specific Reflective Functioning (DSRF) Interviews before and after therapy. Treatment outcome was assessed using the Beck Depression Inventory-II. RESULTS The interaction between time and treatment approach was statistically significant, with RF improving significantly more in IPT than in CBT. Change in RF was not correlated with change in depression. The difference in DSRF ratings before and after therapy was not statistically significant for any of the treatments. CONCLUSIONS IPT may improve mentalization more than CBT. However, although RF increased significantly in IPT, the mean level was still low after therapy. A limitation of the study is the large amount of post-treatment missing data. More research is needed to understand the potential role of mentalization in symptom reduction.
Collapse
Affiliation(s)
- Annika Ekeblad
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.,Psychiatric Clinic, Västernorrland County Council, Sundsvall, Sweden
| | - Rolf Holmqvist
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Fredrik Falkenström
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| |
Collapse
|
7
|
Wagner-Skacel J, Riedl D, Kampling H, Lampe A. Mentalization and dissociation after adverse childhood experiences. Sci Rep 2022; 12:6809. [PMID: 35474233 PMCID: PMC9043194 DOI: 10.1038/s41598-022-10787-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 04/12/2022] [Indexed: 11/09/2022] Open
Abstract
.Impairment of mentalization may impact coping strategies, regulation of affect and stress. The influence of impaired mentalization on dissociation in patients with adverse childhood experiences (ACEs) could be important for treatment strategies. The aim of this study is to assess the relationship between ACEs, mentalizing and dissociation in adult individuals. Sixty-seven patients with ACEs completed the Mentalization Questionnaire (MZQ), the Essener Trauma Inventory (ETI) and the Brief Symptom Inventory-18 (BSI-18). The SPSS PROCESS macro tool was applied to test if mentalization mediated the relationship of ACEs and dissociation. ACEs were significantly associated with higher dissociation (β = 0.42, p < 0.001) and lower mentalization (β = - 0.49, p < 0.001). When mentalization was added to the model as a predictor, the association of ACEs with dissociation was no longer significant (β = 0.11, p = 0.31) and a statistically significant indirect effect was found (β = 0.32, 95% CI 0.16-0.47). The overall explained variance of dissociation notably improved after inclusion of mentalization (17.5% to 49.1%). Thus, the results indicated that the association of ACEs on dissociation was fully mediated by mentalization. Our results suggest that ACEs are associated with lower mentalization and higher dissociation. Lower mentalization was also associated with worse depression, anxiety, somatization and PTSD symptoms. These findings underline the increasing importance of early treatment of individuals affected by ACEs with a focus to foster the development of mentalization.
Collapse
Affiliation(s)
- J Wagner-Skacel
- Department of Medical Psychology and Psychotherapy, Medical University Graz, Graz, Austria
| | - D Riedl
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University Innsbruck, Innsbruck, Austria.
| | - H Kampling
- Department of Psychosomatic and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - A Lampe
- VAMED Rehabilitation Center, Schruns, Austria.,Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| |
Collapse
|
8
|
Law R, Ravitz P, Pain C, Fonagy P. Interpersonal Psychotherapy and Mentalizing-Synergies in Clinical Practice. Am J Psychother 2022; 75:44-50. [PMID: 35232220 DOI: 10.1176/appi.psychotherapy.20210024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Interpersonal psychotherapy (IPT) is an evidence-supported, relationally focused treatment for people living with depression and other psychiatric disorders in the context of stressful life events. Mentalizing, also relationally focused, promotes the ability to perceive, understand, and interpret human behavior in terms of intentional mental states of others or oneself, in order to support social leaning. IPT and mentalization-based treatments (MBT) both seek to improve interpersonal effectiveness, albeit with different emphases in the therapeutic process, with IPT promoting interpersonal problem solving and MBT promoting understanding of the obstacles to this outcome. In this article, the authors propose that the central intentions of IPT and mentalizing are essentially linked and complementary; understanding others and oneself in relationships facilitates interpersonal problem resolution and symptomatic recovery and enhances resilience. The clinical synergies of IPT and mentalizing are elaborated and illustrated through a case example of treatment for a socially isolated woman with depression and interpersonal sensitivities.
Collapse
Affiliation(s)
- Roslyn Law
- Anna Freud Centre London (Law, Fonagy); Faculty of Medicine, Department of Psychiatry, Sinai Health System and University of Toronto, Toronto (Ravitz, Pain); Division of Psychology and Language Sciences University College London, London (Fonagy)
| | - Paula Ravitz
- Anna Freud Centre London (Law, Fonagy); Faculty of Medicine, Department of Psychiatry, Sinai Health System and University of Toronto, Toronto (Ravitz, Pain); Division of Psychology and Language Sciences University College London, London (Fonagy)
| | - Clare Pain
- Anna Freud Centre London (Law, Fonagy); Faculty of Medicine, Department of Psychiatry, Sinai Health System and University of Toronto, Toronto (Ravitz, Pain); Division of Psychology and Language Sciences University College London, London (Fonagy)
| | - Peter Fonagy
- Anna Freud Centre London (Law, Fonagy); Faculty of Medicine, Department of Psychiatry, Sinai Health System and University of Toronto, Toronto (Ravitz, Pain); Division of Psychology and Language Sciences University College London, London (Fonagy)
| |
Collapse
|
9
|
Hudson AR, De Coster L, Spoormans H, Verbeke S, Van der Jeught K, Brass M, Mueller SC. Childhood Abuse and Adult Sociocognitive Skills: Distinguishing Between Self and Other Following Early Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP13254-NP13274. [PMID: 32065009 DOI: 10.1177/0886260520906190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Experience of childhood abuse (CA) impairs complex social functioning in children; however, much less is known about its effects on basic sociocognitive processes and even fewer studies have investigated these in adult survivors. Using two behavioral tasks, this study investigated spontaneous theory of mind (ToM) and imitative behavior in 41 women with CA and 26 unaffected comparison (UC) women. In the spontaneous ToM task, UCs showed a larger ToM index than CAs, indicating more facilitation by knowledge of another's false belief. In the imitation-inhibition task, CAs experienced less interference than UCs when observing another's incongruent movements. After controlling for depression, differences in ToM became marginally significant, yet remained highly significant for inhibiting imitative behavior. The findings suggest CA survivors have altered perspective-taking and are less influenced by others' perspectives, potentially due to changes in self-other distinction. Clinical implications regarding therapeutic practice with survivors of CA are discussed.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Sven C Mueller
- Ghent University, Belgium
- University of Deusto, Bilbao, Spain
| |
Collapse
|
10
|
Milrod B, Keefe JR, Choo TH, Arnon S, Such S, Lowell A, Neria Y, Markowitz JC. Separation anxiety in PTSD: A pilot study of mechanisms in patients undergoing IPT. Depress Anxiety 2020; 37:386-395. [PMID: 32097526 PMCID: PMC7207264 DOI: 10.1002/da.23003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Separation anxiety disorder (SAD) comprises one aspect of attachment dysregulation or insecurity. Although SAD aggravates posttraumatic stress disorder (PTSD) risk, no clinical research has tracked how many patients with PTSD have SAD, its clinical associations, or its response to PTSD treatment. Our open trial of interpersonal psychotherapy (IPT) for veterans with PTSD assessed these SAD domains. METHODS Twenty-nine veterans diagnosed with chronic PTSD on the Clinician-Administered PTSD Scale were assessed for SAD using the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), and for Symptom-Specific Reflective Function (SSRF), another dysregulated-attachment marker capturing patients' emotional understanding of their symptoms. Patients received 14 IPT sessions for PTSD with assessments at baseline, Week 4 (SCI-SAS and SSRF), and termination for SAD, PTSD, and depression. RESULTS At baseline, 69% of patients met SAD criteria. Separation anxiety did not correlate with baseline PTSD severity, depressive severity, or age when traumatized; patients with and without SAD had comparable PTSD and depression severity. Patients with baseline comorbid SAD who completed IPT (N = 17) reported significantly improved adult separation anxiety (p = .009). Adult SAD improvements predicted depressive improvement (p = .049). Patients with SAD showed a stronger relationship between early SSRF gains and subsequent adult SAD improvement (p = .021) compared with patients without SAD. DISCUSSION This first exploration of dysregulated/insecure attachment features among patients with PTSD found high SAD comorbidity and adult SAD improvement among patients with SAD following IPT. Highly impaired attachment patients normalized attachment posttreatment: 14-session IPT improved attachment dysregulation. This small study requires replication but begins to broaden clinical understanding of separation anxiety, attachment dysregulation, and PTSD.
Collapse
Affiliation(s)
- Barbara Milrod
- Department of Psychiatry, Weill Medical College of Cornell University, New York City, New York
| | - John R Keefe
- Department of Psychiatry, Weill Medical College of Cornell University, New York City, New York
| | - Tse-Hwei Choo
- Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, New York City, New York
| | - Shay Arnon
- Anxiety Disorders Clinic, New York State Psychiatric Institute, New York City, New York
| | - Sara Such
- Anxiety Disorders Clinic, New York State Psychiatric Institute, New York City, New York
| | - Ari Lowell
- Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, New York City, New York
- Anxiety Disorders Clinic, New York State Psychiatric Institute, New York City, New York
| | - Yuval Neria
- Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, New York City, New York
- Anxiety Disorders Clinic, New York State Psychiatric Institute, New York City, New York
| | - John C Markowitz
- Department of Psychiatry, Vagelos College of Physicians and Surgeons of Columbia University, New York City, New York
- Anxiety Disorders Clinic, New York State Psychiatric Institute, New York City, New York
| |
Collapse
|
11
|
Colonnello V, Agostini A. Disease course, stress, attachment, and mentalization in patients with inflammatory bowel disease. Med Hypotheses 2020; 140:109665. [PMID: 32155541 DOI: 10.1016/j.mehy.2020.109665] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 12/15/2022]
Abstract
Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, are chronic intestinal disorders that requires lifelong treatments. IBD are associated with perceived stress, poor quality of life, and psychopathological disorders. Previous studies have documented that psychological distress and depression are risk factors for IBD. On the other hand, IBD itself might be a source of psychological stress. IBD negatively affect individuals' daily social interactions and close interpersonal relationships. Despite IBD's detrimental effects on quality of life, patients' adherence to medicaments remains low, increasing the risk of relapses and the subsequent worsening of the clinical condition. Drawing on attachment and mentalization theories, we aim to contribute to understanding of the mechanisms involved in the poor quality of social relationships and the tendency for medication non-adherence in patients with IBD. We hypothesize a bidirectional link between IBD and attachment style and related mentalization abilities, where an individual's attachment style refers to a complex and characteristic pattern of relating to self and others and mentalization refers to the process of inferring one's own and others' mental and physical states. This hypothesized link between IBD and insecure attachment style, mediated by reduced mentalizing abilities, may be a risk factor for developing both IBD-related psychological disorders and reduced medication adherence, which could then lead to worsening disease management and prognoses for the disease course. The medication nonadherence is here considered as both an outcome and a risk factor of this vicious circle. We share the view that preventing the worsening of the IBD condition and promoting patients' medication adherence would be possible by considering the circular relationship between IBD, attachment, and mentalization and by promoting reflective functioning in patients with IBD, from the onset of the disease.
Collapse
Affiliation(s)
- Valentina Colonnello
- Department of Experimental, Diagnostic, and Specialty Medicine DIMES St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Alessandro Agostini
- Department of Experimental, Diagnostic, and Specialty Medicine DIMES St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
| |
Collapse
|
12
|
Markowitz JC, Lowell A, Milrod BL, Lopez-Yianilos A, Neria Y. Symptom-Specific Reflective Function as a Potential Mechanism of Interpersonal Psychotherapy Outcome: A Case Report. Am J Psychother 2020; 73:35-40. [PMID: 31902227 DOI: 10.1176/appi.psychotherapy.20190026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- John C Markowitz
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York (Markowitz, Lowell, Neria); New York State Psychiatric Institute, New York (Markowitz, Lowell, Lopez-Yianilos, Neria); Department of Psychiatry, Weill Medical College, Cornell University, New York (Milrod)
| | - Ari Lowell
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York (Markowitz, Lowell, Neria); New York State Psychiatric Institute, New York (Markowitz, Lowell, Lopez-Yianilos, Neria); Department of Psychiatry, Weill Medical College, Cornell University, New York (Milrod)
| | - Barbara L Milrod
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York (Markowitz, Lowell, Neria); New York State Psychiatric Institute, New York (Markowitz, Lowell, Lopez-Yianilos, Neria); Department of Psychiatry, Weill Medical College, Cornell University, New York (Milrod)
| | - Andrea Lopez-Yianilos
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York (Markowitz, Lowell, Neria); New York State Psychiatric Institute, New York (Markowitz, Lowell, Lopez-Yianilos, Neria); Department of Psychiatry, Weill Medical College, Cornell University, New York (Milrod)
| | - Yuval Neria
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York (Markowitz, Lowell, Neria); New York State Psychiatric Institute, New York (Markowitz, Lowell, Lopez-Yianilos, Neria); Department of Psychiatry, Weill Medical College, Cornell University, New York (Milrod)
| |
Collapse
|