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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.
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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
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Caiada M, Felix S, Guionnet S, Valery KM, Bonilla-Guerrero J, Destaillats JM, Prouteau A. Promoting Intimate Relationships in Mental Illness: A Systematic Review of Interventions. Community Ment Health J 2024; 60:536-551. [PMID: 38015269 DOI: 10.1007/s10597-023-01204-z] [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: 06/01/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
Although persons with Serious Mental Illness (SMI) express a need for intimate relations with others, they still suffer from a severe lack of social participation in this domain. However, these unmet needs have received little attention until recently. This study reviews interventions that aim to facilitate the development and the maintenance of intimate relationships (IR) of persons with schizophrenia, bipolar disorder and major depression. A systematic review following PRISMA guidelines was conducted. Studies published in Scopus, PubMed, EBSCO (Psych INFO, Psych ARTICLES, Psychology and Behavioral Sciences Collection) from January 1, 2000, to December, 2021, were screened. The search using terms referring to "schizophrenia", "bipolar disorder", "major depression", "IR" and "interventions" revealed 11 studies. Among them, 10 reported interventions for persons with depression, including 9 for couple therapy. Most interventions targeted satisfaction with couple relationships as the main therapeutic objective. Heterogeneity in study design precludes any firm conclusions about their efficacy. Interestingly, only one intervention focused on single persons interested in developing IR. The results highlight the lack of interventions: (i) aimed at promoting IR, (ii) designed for single persons, and (iii) targeting persons with psychotic disorders. This result may reflect the persisting stigmatization of persons with psychotic disorders, and the taboo associated with the IR and sexuality of persons with mental illness. Further studies are needed to develop inclusive interventions promoting the development of IR in persons with mental illness.
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Affiliation(s)
- Meryl Caiada
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France.
| | - Simon Felix
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
| | - Sarah Guionnet
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
| | - Kevin-Marc Valery
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
| | | | | | - Antoinette Prouteau
- Laboratory of Psychology, LabPsy, UR 4139, University of Bordeaux, 33000, Bordeaux, France
- Department of Adult Psychiatry, Jonzac Hospital, Jonzac, France
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Salinger JM, Whisman MA, Randall AK, Hilpert P. Associations Between Marital Discord and Depressive Symptoms: A Cross-Cultural Analysis. FAMILY PROCESS 2021; 60:493-506. [PMID: 32599646 DOI: 10.1111/famp.12563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
The objectives of this study were to investigate actor and partner effects of the association between marital discord and depressive symptoms in a sample of 4,779 couples from 11 European countries that were divided into three groups (i.e., Northern, Central, Southern Europe), and evaluate the potential gender and cross-cultural invariance of this association. Actor-partner interdependence models were used to analyze the cross-sectional associations between self-reported perceived marital conflict and depressive symptoms. Marital conflict was significantly and positively associated with self-reported depressive symptoms for husbands and wives (actor effects), as well as with partner-reported depressive symptoms (partner effects). Pooling across cultural groups, no significant difference in the magnitude of actor or partner effects based on gender was found. The magnitude of the actor effects varied across cultural groupings only for women: a significantly weaker association existed for women residing in Northern Europe relative to women in Central or Southern Europe. These results suggest that marital discord is a reliable correlate of depressive symptoms for European couples and that the magnitude of the positive association varies by culture for women. Should these results be replicated longitudinally, couple-based interventions may be indicated to reduce marital discord and prevent and treat depression in Europe.
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Affiliation(s)
- Julia M Salinger
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Mark A Whisman
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Ashley K Randall
- Counseling and Counseling Psychology, Arizona State University, Tempe, AZ, USA
| | - Peter Hilpert
- School of Psychology, University of Surrey, Guildford, UK
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Barbato A, D'Avanzo B. The Findings of a Cochrane Meta-Analysis of Couple Therapy in Adult Depression: Implications for Research and Clinical Practice. FAMILY PROCESS 2020; 59:361-375. [PMID: 32294797 DOI: 10.1111/famp.12540] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The association between depressive symptoms and distressed intimate relationships supported the assumption that couple therapy, by focusing on the interpersonal context of depression, might be more effective as a treatment for depression than individual psychotherapy or drug therapy. This issue was addressed by a Cochrane meta-analysis assessing the evidence from clinical trials of couple therapy for depression in comparison with individual psychotherapy, drug therapy, and no/minimal intervention, including fourteen studies with 651 participants. No study was found free of bias and the quality of the evidence was low, with major problems of small sample sizes, missing outcome data, selective reporting, lack of information on random sequence generation and allocation concealment, recruitment of people not representative of clinical practice, and allegiance bias. The meta-analysis showed that both couple therapy and individual psychotherapy improved depressive symptoms at end of treatment and after 6 months or longer, with moderate effect sizes, without any difference between the two treatments. Couple therapy was more effective in reducing couple distress. This effect was larger in studies with distressed couples only and should be considered as relevant in its own right. Couple therapy is a viable option for the treatment of a depressed partner, especially in discordant couples. Future research should address several issues left open to provide a sound empirical foundation for clinical practice.
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Affiliation(s)
- Angelo Barbato
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri Sede di Milano, Milano, Italy
| | - Barbara D'Avanzo
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Spengler ES, DeVore EN, Spengler PM, Lee NA. What Does "Couple" Mean in Couple Therapy Outcome Research? A Systematic Review of the Implicit and Explicit, Inclusion and Exclusion of Gender and Sexual Minority Individuals and Identities. JOURNAL OF MARITAL AND FAMILY THERAPY 2020; 46:240-255. [PMID: 31837168 DOI: 10.1111/jmft.12415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study systematically reviewed extant couple therapy outcome studies (k = 111) through December 2018 to evaluate for implicit or explicit, inclusion or exclusion of gender and/or sexual minority individuals and identities. We evaluated sampling, participant demographic reporting, and language used in each manuscript for any reference or consideration given to participants' sexual and/or gender identity. Results indicate that couples have been historically presumed to be heterosexual and cisgender male or female without reported assessment. More recent inclusion and consideration of sexual minority individuals is limited and absent for nonmonosexual and gender minority individuals. These findings are contextualized in supplementary analyses of other sociocultural characteristics (e.g., race, age, length together). Suggestions are provided for affirmative consideration of the plurality of individuals' sexual and gender identities. Implications are discussed for research, training and practice of couple therapy with sexual and/or gender minority couples.
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6
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Responsibilisation of caregivers in depression: the limitations of policy-based evidence. SOCIAL THEORY & HEALTH 2020. [DOI: 10.1057/s41285-020-00136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Evaluation of a Brief, Skill-Building, Supportive, and Educational Intervention for Couples After Brain Injury. J Head Trauma Rehabil 2019; 35:175-186. [PMID: 31479075 DOI: 10.1097/htr.0000000000000519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the effectiveness of an intervention (Therapeutic Couples Intervention, TCI) designed to improve relationship quality for couples after acquired brain injury. SETTING Outpatient brain injury rehabilitation center. PARTICIPANTS Persons with brain injury (n = 75) and their intimate partners (n = 75). DESIGN Two-arm parallel, randomized, controlled trial with wait-listed control. METHODS Composed of 5 to 6 2-hour sessions, the TCI is a manualized, treatment program designed to enhance relationship quality by addressing issues and concerns most often identified by persons with brain injury and their partners. MAIN MEASURE Revised Dyadic Adjustment Scale completed by the persons with brain injury and their partners. RESULTS Persons with brain injury and their partners in the treatment group showed an improvement in relationship quality, both compared with their own baseline values and the control group. CONCLUSIONS Investigation provided evidence that a curriculum-based education, skill-building, and supportive intervention can benefit couples for up to 3 months after treatment. Additional research is needed to ascertain the long-term benefits of intervention and the efficacy of alternative delivery methods (eg, Internet, telephone, and group).
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Abstract
BACKGROUND Couple therapy for depression has the twofold aim of modifying negative interaction patterns and increasing mutually supportive aspects of intimate relationships, changing the interpersonal context of depression. Couple therapy is included in several guidelines among the suggested treatments for depression. OBJECTIVES 1. The main objective was to examine the effects of couple therapy compared to individual psychotherapy for depression.2. Secondary objectives were to examine the effects of couple therapy compared to drug therapy and no/minimal treatment for depression. SEARCH METHODS The Cochrane Common Mental Disorders Group Controlled Trials Register (CCMDCTR), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid) and PsycINFO (Ovid) were searched to 19 February 2018. Relevant journals and reference lists were checked. SELECTION CRITERIA Randomised and quasi-randomised controlled trials examining the effects of couple therapy versus individual psychotherapy, drug therapy, or no treatment/minimal treatment for depression were included in the review. DATA COLLECTION AND ANALYSIS We considered as primary outcomes the depressive symptom level, the depression persistence, and the dropouts; the relationship distress level was a secondary outcome. We extracted data using a standardised spreadsheet. Where data were not included in published papers, we tried to obtain the data from the authors. We synthesised data using Review Manager software version 5.3. We pooled dichotomous data using the relative risk (RR), and continuous data calculating the standardised mean difference (SMD), together with 95% confidence intervals (CIs). We employed the random-effects model for all comparisons and also calculated a formal test for heterogeneity, the natural approximate Chi2 test. MAIN RESULTS We included fourteen studies from Europe, North America, and Israel, with 651 participants. Eighty per cent of participants were Caucasian. Therefore, the findings cannot be considered as applicable to non-Western countries or to other ethnic groups in Western countries. On average, participants had moderate depression, preventing the extension of results to severely depressed patients. Almost all participants were aged between 36 and 47 years.There was no evidence of difference in effect at the end of treatment between couple therapy and individual psychotherapy, either for the continuous outcome of depressive symptoms, based on nine studies with 304 participants (SMD -0.17, 95% CI -0.44 to 0.10, low-quality evidence), or the proportion of participants remaining depressed, based on six studies with 237 participants (RR 0.94, 95% CI 0.72 to 1.22, low-quality evidence). Findings from studies with 6-month or longer follow-up confirmed the lack of difference between the two conditions.No trial gave information on harmful effects. However, we considered rates of treatment discontinuation for any reason as a proxy indicator of adverse outcomes. There was no evidence of difference for dropout rates between couple therapy and individual psychotherapy, based on eight studies with 316 participants (RR 0.85, 95% CI 0.51 to 1.41, low-quality evidence).Few data were available for the comparison with drug therapy. Data from a small study with 12 participants showed no difference for the continuous outcome of depressive symptoms at end of treatment (SMD -0.51, 95% CI -1.69 to 0.66, very low-quality evidence) and at 6-month follow-up (SMD -1.07, 95% CI -2.45 to 0.31, very low-quality evidence). Data on dropouts from two studies with 95 participants showed a clear advantage for couple therapy (RR 0.31, 95% CI 0.15 to 0.61, very low-quality evidence). However, this finding was heavily influenced by a single study, probably affected by a selection bias favouring couple therapy.The comparison between couple therapy plus drug therapy and drug therapy alone showed no difference in depressive symptom level, based on two studies with 34 participants (SMD -1.04, 95% CI -3.97 to 1.89, very low-quality evidence) and on dropouts, based on two studies with 45 participants (RR 1.03, 95% CI 0.07 to 15.52, very low-quality evidence).The comparison with no/minimal treatment showed a large significant effect favouring couple therapy both for depressive symptom level, based on three studies with 90 participants: (SMD -0.95, 95% CI -1.59 to -0.32, very low-quality evidence) and persistence of depression, based on two studies with 65 participants (RR 0.48, 95% CI 0.32 to 0.70, very low-quality evidence). No data were available for dropouts for this comparison.Concerning relationship distress, the comparison with individual psychotherapy showed that couple therapy appeared more effective in reducing distress level at the end of treatment, based on six studies with 187 participants (SMD -0.50, CI -0.97 to -0.02, very low-quality evidence) and the persistence of distress, based on two studies with 81 participants (RR 0.71, 95% CI 0.51 to 0.98, very low-quality evidence). The quality of evidence was heavily affected by substantial heterogeneity (I2 = 59%). In the analysis restricted to studies including only distressed couples, no heterogeneity was found and the effect in distress level at the end of treatment was larger (SMD -1.10, 95% CI -1.59 to -0.61). Very few data on this outcome were available for other comparisons.We assessed the certainty of the evidence using the GRADE system. The results were weakened by the low quality of evidence related to the effects on depressive symptoms, in comparison with individual psychotherapy, and by very low quality evidence for all other comparisons and for the effects on relationship distress. Most studies were affected by problems such as the small number of cases, performance bias, assessment bias due to the non-blinding outcome assessment, incomplete outcome reporting and the allegiance bias of investigators. Heterogeneity was, in particular, a problem for data about relationship distress. AUTHORS' CONCLUSIONS Although there is suggestion that couple therapy is as effective as individual psychotherapy in improving depressive symptoms and more effective in improving relations in distressed couples, the low or very low quality of the evidence seriously limits the possibility of drawing firm conclusions. Very few data were available for comparisons with no/minimal treatment and drug therapy. Future trials of high quality should test in large samples with a long follow-up of the effects of couple therapy in comparison to other interventions in discordant couples with a depressed partner, considering the role of relationship quality as a potential effect mediator in the improvement of depression.
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Affiliation(s)
- Angelo Barbato
- IRCCS‐Istituto di Ricerche Farmacologiche Mario NegriUnit for quality of care and rights promotion in mental health, Department of NeuroscienceVia La Masa 19MilanoItaly20156
| | - Barbara D'Avanzo
- IRCCS‐Istituto di Ricerche Farmacologiche Mario NegriUnit for quality of care and rights promotion in mental health, Department of NeuroscienceVia La Masa 19MilanoItaly20156
| | - Alberto Parabiaghi
- IRCCS‐Istituto di Ricerche Farmacologiche Mario NegriUnit for quality of care and rights promotion in mental health, Department of NeuroscienceVia La Masa 19MilanoItaly20156
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Abstract
The family and therapyThe term family therapy can be misleading. ‘Family’ is open to many interpretations, if not attacks, because it is frequently read as implying a two-parent, heterosexual couple with two children, with the woman primarily the ‘homemaker’ and the man the ‘breadwinner’, with occasional backup from the grandparents. Such a picture would seem to marginalise or exclude other family forms, such as childless couples, single parents with children, gay or lesbian couples and unattached elderly persons. However, the reality is that family therapists treat many different forms of committed relationships and friendships. As to the term therapy, it tends to imply the presence of illness or dysfunction, located in the family rather than one of its individual members, and may thus be quite unacceptable to families who often believe that it is the patient and not them whom requires help. Being at the receiving end of family therapy can have strong connotations of blame. Practitioners therefore increasingly use the term systemic therapy, which is also more informative because some of the work often involves the wider system. The systemic approach is essentially a contextual approach – seeing and treating people in context.
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10
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The importance of adult couple relationships in primary care. Prim Health Care Res Dev 2017; 18:405-410. [PMID: 28825531 DOI: 10.1017/s1463423617000548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Artigas L, Mateu C, Vilaregut A, Feixas G, Escudero V. Couple Therapy for Depression: Exploring How the Dyadic Adjustment Determines the Therapeutic Alliance in Two Contrasting Cases. CONTEMPORARY FAMILY THERAPY 2017. [DOI: 10.1007/s10591-017-9420-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Frisch J, Aguilar-Raab C, Eckstein M, Ditzen B. Einfluss von Paarinteraktion auf die Gesundheit. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-016-0153-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Carr A, Finnegan L, Griffin E, Cotter P, Hyland A. A Randomized Controlled Trial of the Say Yes to Life (SYTL) Positive Psychology Group Psychotherapy Program for Depression: An Interim Report. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9343-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Carrera M, Cabero A, González S, Rodríguez N, García C, Hernández L, Manjón J. Solution-focused group therapy for common mental health problems: Outcome assessment in routine clinical practice. Psychol Psychother 2016; 89:294-307. [PMID: 26549019 DOI: 10.1111/papt.12085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/19/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study aimed to assess the effectiveness of solution-focused group therapy (SFGT) for psychological distress and mild to moderate depression in a routine clinical practice setting. DESIGN AND METHODS A naturalistic pre/post-study involving 132 mental health service users was carried out. Clients received seven structured sessions of SFGT, and pre-therapy self-report scores (Spanish brief version of Beck Depression Inventory and Hospital Anxiety and Depression Scale) were compared with post-therapy scores. Additional data on effectiveness of intervention (discharges, clients returning for help and dropout rate) were analysed at 6, 12, and 24 months after initiating intervention and compared with a control sample (132 mental health service users, frequency-matched by local health board, clinical diagnosis, and gender to the group intervention) receiving usual care (UC: Psychotropic medication and/or individual psychotherapy). RESULTS Mean post-SFGT levels were significantly lower than mean pre-SFGT levels on each self-report measure in the SFGT sample. In addition, SFGT showed a significantly higher percentage of discharges and fewer clients returning for help than with UC. CONCLUSIONS SFGT included in routine clinical practice may enhance the effectiveness of treatment in clients who suffer from depression and/or psychological distress. PRACTITIONER POINTS Therapists could use SFGT as a brief and effective tool to deal with the most prevalent mental health problems at mental healthcare centres (MHCs) in Spain, without changing day-to-day clinical routines. SFGT might be effectively incorporated in routine clinical practice for helping people with psychological distress and depressive episodes of mild and moderate severity. This study should encourage systemic therapists and strategically oriented clinicians to continue delivering and offering outcome measures of solution-focused therapy.
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Affiliation(s)
- María Carrera
- Health Service of the Principality of Asturias, Spain
| | - Andrés Cabero
- Health Service of the Principality of Asturias, Spain
| | | | | | - Carlos García
- Health Service of the Principality of Asturias, Spain
| | | | - Javier Manjón
- Health Service of the Principality of Asturias, Spain
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Montesano A, Izu S. Analysis of the therapeutic process in a case of couple therapy for depression: how to deal with a problematic within-system alliance /Análisis del proceso terapéutico en un caso de terapia de pareja para la depresión: cómo lidiar con una alianza intra-sistema problemática. STUDIES IN PSYCHOLOGY 2016. [DOI: 10.1080/02109395.2016.1189210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Sherman MD, Fischer EP, Owen RR, Lu L, Han X. Multi-family Group Treatment for Veterans with Mood Disorders: A Pilot Study. COUPLE & FAMILY PSYCHOLOGY 2015; 4:136-149. [PMID: 26336613 PMCID: PMC4553244 DOI: 10.1037/cfp0000040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Mood disorders affect large numbers of individuals and their families; the ripple effects on relationship functioning can be great. Researchers have advocated for a relational perspective to mood disorder treatment, and several promising treatments have been developed. However, few rigorous evaluations have been conducted within the Veterans Affairs (VA) system. Multifamily group therapy, an evidence-based practice for people living with schizophrenia, has recently been adapted for other psychological disorders with promising results. This report describes the first published evaluation of this treatment modality in the VA system for veterans living with mood disorders. 101 male veterans (74 with major depression and 27 with bipolar disorder) and their family members participated in REACH (Reaching out to Educate and Assist Caring, Healthy Families), a 9-month, manualized, multi-family group treatment, intervention adapted from McFarlane's original multi-family group model. Participants completed self-report questionnaires at four time points across the course of the treatment, and service utilization data for veterans were obtained from VA databases. Both veterans and family members showed improvements in their knowledge about mood disorders, understanding of positive strategies for dealing with situations commonly confronted in mood disorders, and family coping strategies. Veterans also evidenced improvement in family communication and problem-solving behaviors, empowerment, perceived social support, psychiatric symptoms, and overall quality of life. The REACH intervention holds promise as a feasible, acceptable, and effective treatment for veterans living with mood disorders and their families. Further study is warranted.
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Affiliation(s)
- Michelle D. Sherman
- University of Minnesota, Address: 290 McNeal Hall, 1985 Buford Avenue, St. Paul, MN 55108
| | - Ellen P. Fischer
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Richard R. Owen
- Center for Mental Healthcare & Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Liya Lu
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Xiaotong Han
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Gangamma R, Bartle-Haring S, Holowacz E, Hartwell EE, Glebova T. Relational Ethics, Depressive Symptoms, and Relationship Satisfaction in Couples in Therapy. JOURNAL OF MARITAL AND FAMILY THERAPY 2015; 41:354-366. [PMID: 24798508 DOI: 10.1111/jmft.12070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The purpose of this study was to examine depressive symptoms and relationship satisfaction as problems related to relational ethics in one's family of origin and current partner relationships in a sample of 68 other-sex couples seeking therapy at a large university clinic. We used the Actor Partner Interdependence Model to analyze dyadic data collected prior to beginning therapy. Specifically, we found significant actor effects between relational ethics in one's family of origin and depressive symptoms, as well as between depressive symptoms and low relationship satisfaction for both male and female partners. We also found significant partner effects for relational ethics in current partner relationship, depressive symptoms, and low relationship satisfaction. Clinical application of contextual therapy theory is discussed.
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Affiliation(s)
- Rashmi Gangamma
- Department of Marriage & Family Therapy, Syracuse University
| | | | - Eugene Holowacz
- Department of Human Development & Family Science, The Ohio State University
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Darwiche J, de Roten Y. Couple and family treatments: study quality and level of evidence. FAMILY PROCESS 2015; 54:138-59. [PMID: 25308547 DOI: 10.1111/famp.12106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This paper examines the application of the guidelines for evidence-based treatments in family therapy developed by Sexton and collaborators to a set of treatment models. These guidelines classify the models using criteria that take into account the distinctive features of couple and family treatments. A two-step approach was taken: (1) The quality of each of the studies supporting the treatment models was assessed according to a list of ad hoc core criteria; (2) the level of evidence of each treatment model was determined using the guidelines. To reflect the stages of empirical validation present in the literature, nine models were selected: three models each with high, moderate, and low levels of empirical validation, determined by the number of randomized clinical trials (RCTs). The quality ratings highlighted the strengths and limitations of each of the studies that provided evidence backing the treatment models. The classification by level of evidence indicated that four of the models were level III, "evidence-based" treatments; one was a level II, "evidence-informed treatment with promising preliminary evidence-based results"; and four were level I, "evidence-informed" treatments. Using the guidelines helped identify treatments that are solid in terms of not only the number of RCTs but also the quality of the evidence supporting the efficacy of a given treatment. From a research perspective, this analysis highlighted areas to be addressed before some models can move up to a higher level of evidence. From a clinical perspective, the guidelines can help identify the models whose studies have produced clinically relevant results.
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Affiliation(s)
- Joëlle Darwiche
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
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Pinquart M, Oslejsek B, Teubert D. Efficacy of systemic therapy on adults with mental disorders: A meta-analysis. Psychother Res 2014; 26:241-57. [PMID: 25032487 DOI: 10.1080/10503307.2014.935830] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of systemic therapy on psychiatric disorders in adulthood. METHODS This meta-analysis integrates results of 37 randomized controlled trials (RCT) of therapy with an explicit systemic focus on adults with psychiatric disorders. Studies were identified through systematic searches in electronic databases and cross-referencing. RESULTS On average, systemic therapy had stronger short-term (g = .51) and long-term (g = .55) efficacies than control groups without alternative treatment and stronger short-term effects than alternative active treatments (g = .25). In addition, efficacy of systemic therapy was similar to those of other bona fide psychotherapies. Individuals receiving systemic therapy plus medication showed stronger improvements at posttest (g = .71) and follow-up (g = .87) than those receiving only medication. Illness-specific analyses showed positive short-term efficacy of systemic therapy on eating disorders, mood disorders, obsessive-compulsive disorders, schizophrenia, and somatoform disorders. At follow-up, efficacy of systemic therapy was only found on eating disorders, mood disorders, and schizophrenia. In addition, systemic therapy had lower dropout rates than alternative treatments. For certain comparisons, effect sizes were moderated by participant age, study quality, and year of publication. CONCLUSIONS We conclude that the present meta-analysis found some evidence for the efficacy of systemic therapy on five disorders, but the number of available RCT is still limited. More research is needed on systemic therapy of other disorders, such as anxiety disorders and substance use disorders.
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Affiliation(s)
- Martin Pinquart
- a Department of Psychology , Philipps University , Marburg , Germany
| | - Barbara Oslejsek
- a Department of Psychology , Philipps University , Marburg , Germany
| | - Daniela Teubert
- a Department of Psychology , Philipps University , Marburg , Germany
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Deshpande SS, Kalmegh B, Patil PN, Ghate MR, Sarmukaddam S, Paralikar VP. Stresses and Disability in Depression across Gender. DEPRESSION RESEARCH AND TREATMENT 2014; 2014:735307. [PMID: 24579042 PMCID: PMC3918847 DOI: 10.1155/2014/735307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/12/2013] [Accepted: 10/27/2013] [Indexed: 11/17/2022]
Abstract
Depression, though generally episodic, results in lasting disability, distress, and burden. Rising prevalence of depression and suicide in the context of epidemiological transition demands more attention to social dimensions like gender related stresses, dysfunction, and their role in outcome of depression. Cross-sectional and follow-up assessment of men and women with depression at a psychiatric tertiary centre was undertaken to compare their illness characteristics including suicidal ideation, stresses, and functioning on GAF, SOFAS, and GARF scales (N = 107). We reassessed the patients on HDRS-17 after 6 weeks of treatment. Paired t-test and chi-square test of significance were used to compare the two groups, both before and after treatment. Interpersonal and marital stresses were reported more commonly by women (P < 0.001) and financial stresses by men (P < 0.001) though relational functioning was equally impaired in both. Women had suffered stresses for significantly longer duration (P = 0.0038). Men had more impairment in social and occupational functioning compared to females (P = 0.0062). History of suicide attempts was significantly associated with more severe depression and lower levels of functioning in case of females with untreated depression. Significant cross-gender differences in stresses, their duration, and types of dysfunction mandate focusing on these aspects over and above the criterion-based diagnosis.
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Affiliation(s)
- Sharmishtha S. Deshpande
- Department of Psychiatry, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra 411041, India
| | - Bhalchandra Kalmegh
- Department of Psychiatry, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra 411041, India
| | - Poonam N. Patil
- Department of Psychiatry, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra 411041, India
| | - Madhav R. Ghate
- Department of Psychiatry, Smt. Kashibai Navale Medical College and General Hospital, Narhe, Pune, Maharashtra 411041, India
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Crane DR, Christenson JD, Dobbs SM, Schaalje GB, Moore AM, Pedal FFC, Ballard J, Marshall ES. Costs of treating depression with individual versus family therapy. JOURNAL OF MARITAL AND FAMILY THERAPY 2013; 39:457-469. [PMID: 25800422 DOI: 10.1111/j.1752-0606.2012.00326.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Depression is one of the most common concerns that bring clients to treatment. Although marriage and family therapy has been shown to be an effective treatment, little research exists regarding the cost-effectiveness of related services. In this study, we examined claims data for 164,667 individuals diagnosed with depression to determine (a) differences in the cost of treating depression according to type of therapy and license type, (b) differences in recidivism rates by age, gender, type of therapy, and type of mental health professional, and (c) differences in cost-effectiveness by therapy modality and type of professional. The results showed that services provided by marriage and family therapists resulted in the lowest recidivism rate, and family therapy services were the least expensive.
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The Development of Systemic Family Therapy for Changing Times in the United Kingdom. CONTEMPORARY FAMILY THERAPY 2013. [DOI: 10.1007/s10591-013-9252-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Schofield MJ, Mumford N, Jurkovic D, Jurkovic I, Bickerdike A. Short and long-term effectiveness of couple counselling: a study protocol. BMC Public Health 2012; 12:735. [PMID: 22943742 PMCID: PMC3490822 DOI: 10.1186/1471-2458-12-735] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 08/24/2012] [Indexed: 12/02/2022] Open
Abstract
Background Healthy couple relationships are fundamental to a healthy society, whereas relationship breakdown and discord are linked to a wide range of negative health and wellbeing outcomes. Two types of relationship services (couple counselling and relationship education) have demonstrated efficacy in many controlled studies but evidence of the effectiveness of community-based relationship services has lagged behind. This study protocol describes an effectiveness evaluation of the two types of community-based relationship services. The aims of the Evaluation of Couple Counselling study are to: map the profiles of clients seeking agency-based couple counselling and relationship enhancement programs in terms of socio-demographic, relationship, health, and health service use indicators; to determine 3 and 12-month outcomes for relationship satisfaction, commitment, and depression; and determine relative contributions of client and therapy factors to outcomes. Methods/Design A quasi-experimental pre-post-post evaluation design is used to assess outcomes for couples presenting for the two types of community-based relationship services. The longitudinal design involves a pre-treatment survey and two follow-up surveys at 3- and 12-months post-intervention. The study is set in eight Relationships Australia Victoria centres, across metropolitan, outer suburbs, and regional/rural sites. Relationships Australia, a non-government organisation, is the largest provider of couple counselling and relationship services in Australia. The key outcomes are couple satisfaction, relationship commitment, and depression measured by the CESD-10. Multi-level modelling will be used to account for the dyadic nature of couple data. Discussion The study protocol describes the first large scale investigation of the effectiveness of two types of relationship services to be conducted in Australia. Its significance lies in providing more detailed profiles of couples who seek relationship services, in evaluating both 3 and 12-month relationship and health outcomes, and in determining factors that best predict improvements. It builds on prior research by using a naturalistic sample, an effectiveness research design, a more robust measure of relationship satisfaction, robust health indicators, a 12-month follow-up period, and a more rigorous statistical procedure suitable for dyadic data. Findings will provide a more precise description of those seeking relationship services and factors associated with improved relationship and health outcomes.
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Affiliation(s)
- Margot J Schofield
- School of Public Health, La Trobe University, Melbourne, VIC 3086, Australia.
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Balfour A, Lanman M. An evaluation of time-limited psychodynamic psychotherapy for couples: a pilot study. Psychol Psychother 2012; 85:292-309. [PMID: 22903920 DOI: 10.1111/j.2044-8341.2011.02030.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Psychodynamic Couple Psychotherapy has developed as a modality in only a few organizations in the public and voluntary sectors in this country. Varieties of couple therapy have evolved due to economic or other constraints, some more open-ended, others involving differing time limits or behavioural techniques. In this study, a time limit of 40 sessions was imposed on the Psychodynamic therapy to improve comparability with other therapeutic approaches. We examined work with 18 couples, employing various measures which, while not in the context of a full controlled trial, produced some interesting and indicative results. We aimed to investigate (1) the effects of time-limited psychodynamic couple psychotherapy, and (2) whether the measures used produce interesting results after 40 weeks. DESIGN Within a normal clinical setting, measurements of individual and couple functioning would be taken at fixed points in the course of 40-week couple therapies, and analysed for evidence of significant change. Due to funding and clinical limitations within the setting, a baseline period before therapy started was used instead of a control group. METHOD Couples were invited to opt in to the study when applying to the agency for therapy. They were provided with 40 weekly sessions of couple therapy. Videotapes of sessions at beginning, middle, and end of the therapies were rated by independent observer, using the Personal Relatedness Profile (PRP) (Hobson, Patrick, & Valentine, 1998) adapted for couples (Lanman, Grier, & Evans, 2003), alongside two individual self-report measures, Clinical Outcomes in Routine Evaluation (CORE) (Evans et al., 2000), and the Golombok Rust Inventory of Marital Satisfaction (GRIMS) (Rust, Bennun, Crow, & Golumbok, 1990). RESULTS The couples showed improvement as rated both by therapists and observers (rating the videotaped sessions) on the PRP after 40 sessions. On the CORE measure, participants showed improvement at both 20 and 40 sessions. On the GRIMS measure of marital satisfaction, results were non-significant. CONCLUSIONS The results provide indicative evidence for the effectiveness of 40-session couple psychotherapy and provide some convergent validation for the utility of the PRP (as adapted for couples) as a measure of change.
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Abstract
Given the limitations of evidence for treatment options that are consistently effective for TRD and the possibility that TRD is in fact a form of depression that has a low probability of resolving, how can clinicians help patients with TRD? Perhaps the most important conceptual shift that needs to take place before treatment can be helpful is to accept TRD as a chronic illness, an illness similar to many others, one that can be effectively managed but that is not, at our present level of knowledge, likely to be cured. An undue focus on remission or even a 50% diminution of symptoms sets unrealistic goals for both patients and therapists and may lead to overtreatment and demoralization. The focus should be less on eliminating depressive symptoms and more on making sense of and learning to function better in spite of them. It is important to acknowledge the difficult nature of the depressive illness, to remove blame from the patient and clinician for not achieving remission, to set realistic expectations, and to help promote better psychosocial functioning even in the face of persisting symptoms. The critical element when implementing such an approach is a judicious balance between maintaining hope for improvement without setting unrealistic expectations. It is important to reemphasize that following a disease management model with acceptance of the reality of a chronic illness is not nihilistic and does not mean the abandonment of hope for improvement. The first step in treating a patient with TRD is to perform a comprehensive assessment of the patient’s past and current treatment history to ensure that evidence-based treatment trials have in fact been undertaken, and if not, such treatment trials should be implemented. If the patient continues to have significant residual symptoms, it is important to determine the impact is of these symptoms on the patient’s quality of life and ability to function. It is also important to evaluate the factors that may be contributing to the persistence of depressive symptoms such as comorbid personality disorders, somatic disorders, substance abuse, and work and interpersonal conflicts. The treatment of patients with TRD needs to move beyond attempts to modify symptoms without taking into consideration and attempting to modify the patient’s personality, coping skills, and social system. Further somatic treatment trials can be undertaken, if desired by the patient and therapist, as a small (5%–15%) percentage of patients may respond and further treatment trials, and this may engender hope. The risk with this approach is that patients and therapists may not work at disease management skills if they believe there may be a resolution of the depression if they could just find the right medication or intervention. Therapists may also feel pressured by patients, families, insurance companies, as well as their own sense of helplessness to escalate treatment in a more and more aggressive manner in an attempt to achieve an elusive remission. A disease management program can provide the therapist and patient with sufficient structure, skills, and goals to encourage ongoing treatment without resorting to unproven measures that may create more side effects and problems. It is particularly important to include the patient’s significant others in the reformulation of the patient’s problem and thereby learn how to manage the illness more effectively. Significant others and family members can be invaluable in providing support for dealing with the difficult process of acquiring a new skill set. Indeed, they spend significantly more time with the patient than does any therapist. Family members are likely to provide this kind of support only if they have been part of the assessment and treatment process. Patients with a wide range of chronic medical illnesses can and do learn to function effectively and to achieve a satisfying quality of life in spite of their illness. There is no reason to think that patients with TRD should not be able to achieve a similar level of illness management, functioning, and quality of life.
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Affiliation(s)
- Gabor I Keitner
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02912, USA.
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Abstract
Anorexia nervosa is a serious mental illness that affects women and men of all ages. Despite the gravity of its chronic morbidity, risk of premature death, and societal burden, the evidence base for its treatment-especially in adults-is weak. Guided by the finding that family-based interventions confer benefit in the treatment of anorexia nervosa in adolescents, we developed a cognitive-behavioral couple-based intervention for adults with anorexia nervosa who are in committed relationships that engages both the patient and her/his partner in the treatment process. This article describes the theoretical rationale behind the development of Uniting Couples in the treatment of Anorexia nervosa (UCAN), practical considerations in delivering the intervention, and includes reflections from the developers on the challenges of working with couples in which one member suffers from anorexia nervosa. Finally, we discuss future applications of a couple-based approach to the treatment of adults with eating disorders.
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28
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Abstract
Depression is a heterogeneous disorder with lifetime prevalence of "major depressive disorder" estimated to be 16.2%. Although the disorder is common and impairs functioning, it often goes untreated, with less than adequate response even when treated. We review research indicating the likely value of utilizing currently available, well-validated, couple- and family-based treatments with depressed individuals, and we provide empirically based treatment decision rules to guide effective application of marital and family interventions for depression in clinical practice. We suggest that traditional forms of couple-based intervention may be most appropriate for discordant, depressed couples, whereas nondiscordant, or mildly distressed, depressed couples may respond well to forms of intervention that have become available more recently and which focus on strengthening the dyad as a source of support. We also discuss parent training as an intervention for depression and describe briefly the directions for future research to enhance couple-based treatment for depression.
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Affiliation(s)
- Steven R H Beach
- Owens Institute for Behavioral Research, University of Georgia, Athens, Georgia 30602-7419, USA.
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Mannion E, Marin R, Chapman P, Real L, Berman E, Solomon P, Dinich D, Molinaro M, Cantwell K. Overcoming Systemic Barriers to Family Inclusion in Community Psychiatry: The Pennsylvania Experience. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2012. [DOI: 10.1080/15487768.2012.655643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
As has been true in every other realm of psychotherapy, couple therapy research generally has had very little impact on the day-to-day practice of couple therapists. To a significant degree, this unfortunate disconnection may be attributable to an overemphasis by researchers in the field on treatment packages and therapeutic methods/techniques. Insufficient attention has been paid to other important sources of influence on treatment outcomes, especially the couple therapist herself/himself. It is argued that effective couple therapy requires a good "fit" between the person of the therapist and her primary theoretical orientation, and that couple therapists may be more influenced by research that addresses process aspects of the therapeutic approaches to which they have their primary theoretical allegiances.
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Affiliation(s)
- Alan S Gurman
- The Family Institute at Northwestern University, Evanston, IL, USA.
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Trivedi RB, Nieuwsma JA, Williams JW. Examination of the utility of psychotherapy for patients with treatment resistant depression: a systematic review. J Gen Intern Med 2011; 26:643-50. [PMID: 21184287 PMCID: PMC3101965 DOI: 10.1007/s11606-010-1608-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 08/05/2010] [Accepted: 12/03/2010] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine the utility of psychotherapy in managing treatment resistant depression. DATA SOURCES PubMed, PsycInfo, Embase, Cochrane Registry of Controlled Clinical Trials, article bibliographies. REVIEW METHODS Eligible articles had to be in English and include English-speaking adult outpatients from general medical or mental health clinics. Studies had to be randomized clinical trials (RCT) involving at least one of the following psychotherapy modalities: cognitive therapy, interpersonal therapy, or behavior therapy. Patients were considered treatment resistant if they reported partial or no remission following treatment with an adequate antidepressant dose for ≥ 6 weeks. Exclusion criteria included receiving psychotherapy at the time of recruitment, and/or comorbid psychiatric conditions unlikely to be treated outside of specialized mental health care (e.g., severe substance abuse). Due to heterogeneity in study designs, a summary estimate of effect was not calculated. Studies were critically analyzed and a qualitative synthesis was conducted. RESULTS Of 941 original titles, 13 articles evaluating 7 unique treatment comparisons were included. Psychotherapy was examined as an augmentation to antidepressants in five studies and as substitution treatment in two studies. A total of 592 patients were evaluated (Mean age ~40 y; Females = 50-85%; Caucasians ≥ 75%). The STAR*D trial used an equipoise stratified randomization design; the remaining studies were RCTs. Compared to active management, two good quality trials showed similar benefit from augmenting antidepressants with psychotherapy; one fair quality and one poor quality trial showed benefit from psychotherapy augmentation; and one good and one poor trial found similar benefit from substituting psychotherapy for antidepressants. One fair quality trial showed lithium augmentation to be more beneficial than psychotherapy. CONCLUSIONS Review demonstrates the utility of psychotherapy in managing treatment resistant depression. However, evidence is sparse and results are mixed. Given that quality trials are lacking, rigorous clinical trials are recommended to guide practice. In the interim, primary care providers should consider psychotherapy when treating patients with treatment resistant depression.
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Affiliation(s)
- Ranak B Trivedi
- VA Puget Sound Health Care System, University of Washington School of Public Health, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA.
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Shimazu K, Shimodera S, Mino Y, Nishida A, Kamimura N, Sawada K, Fujita H, Furukawa TA, Inoue S. Family psychoeducation for major depression: randomised controlled trial. Br J Psychiatry 2011; 198:385-90. [PMID: 21343330 DOI: 10.1192/bjp.bp.110.078626] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The value of family psychoeducation for schizophrenia has been well established, and indications for its use have recently expanded to include bipolar affective disorder. However, no study to date has adequately examined its use in depression. AIMS To examine family psychoeducation in the maintenance treatment of depression and to investigate the influence of the family's expressed emotion (EE) on its effectiveness. METHOD Of 103 patients diagnosed with major depression and their primary family members, 57 pairs provided written informed consent. The pairs were randomly allocated to the intervention (n = 25) or control (n = 32). One family in the intervention group and two in the control group withdrew their consent after randomisation. The intervention group underwent four psychoeducation sessions consisting of didactic lectures about depression and group problem-solving focusing on how to cope in high-EE situations. Patients did not attend these sessions. Patients in both the intervention and control groups received treatment as usual. The families' EE levels were evaluated through Five-Minute Speech Samples. The primary outcome was relapse. RESULTS Time to relapse was statistically significantly longer in the psychoeducation group than in the control group (Kaplan-Meier survival analysis, P = 0.002). The relapse rates up to the 9-month follow-up were 8% and 50% respectively (risk ratio 0.17, 95% CI 0.04-0.66; number needed to treat 2.4, 95% CI 1.6-4.9). In Cox proportional hazard analysis, baseline EE did not moderate the effectiveness of the intervention. CONCLUSIONS Family psychoeducation is effective in the prevention of relapse in adult patients with major depression.
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Affiliation(s)
- Kae Shimazu
- Department of Neuropsychiatry, Kochi Medical School, Koch, Japan
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Searle L, Lyon L, Young L, Wiseman M, Foster-Davis B. THE YOUNG PEOPLE'S CONSULTATION SERVICE: AN EVALUATION OF A CONSULTATION MODEL OF VERY BRIEF PSYCHOTHERAPY. BRITISH JOURNAL OF PSYCHOTHERAPY 2011. [DOI: 10.1111/j.1752-0118.2010.01222.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bulik CM, Baucom D, Kirby J, Pisetsky E. Uniting Couples (in the treatment of) Anorexia Nervosa (UCAN). Int J Eat Disord 2011; 44:19-28. [PMID: 20063308 PMCID: PMC2889168 DOI: 10.1002/eat.20790] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe the development of a novel couple-based cognitive-behavioral intervention for adult anorexia nervosa (AN) called Uniting Couples (in the treatment of) Anorexia Nervosa (UCAN). METHOD We review the state of the science for the treatment of adult AN, the nature of relationships in AN, our model of couple functioning in AN, and the development of the UCAN intervention. RESULTS We present the UCAN treatment for patients with AN and their partners and discuss important considerations in the delivery of the intervention. DISCUSSION With further evaluation, we expect that UCAN will emerge to be an effective, acceptable, disseminable, and developmentally tailored intervention that will serve to improve both core AN pathology as well as couple functioning.
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Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, University of North Carolina, 101 Manning Drive, Chapel Hill, North Carolina.
| | - Donald Baucom
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Jennifer Kirby
- Department of Psychology, University of North Carolina at Chapel Hill
| | - Emily Pisetsky
- Department of Psychology, University of North Carolina at Chapel Hill
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von Sydow K, Beher S, Schweitzer J, Retzlaff R. The efficacy of systemic therapy with adult patients: a meta-content analysis of 38 randomized controlled trials. FAMILY PROCESS 2010; 49:457-85. [PMID: 21083549 DOI: 10.1111/j.1545-5300.2010.01334.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Systemic therapy is a widely used psychotherapy approach. Yet there exist few systematic reviews on its efficacy. A meta-content analysis was performed to analyze the efficacy of systemic therapy for the treatment of mental disorders in adulthood. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems oriented therapy in various settings (family, couple, individual, group, multifamily group therapy) with adult index patients suffering from mental disorders were identified by database searches and cross-references in other reviews. Inclusion criteria were: index patient diagnosed with a DSM or ICD listed mental disorder, trial published in any language up to the end of 2008. The RCTs were content analyzed according to their research methodology, interventions applied, and results. Thirty-eight trials published in English, German, Spanish, and Chinese were identified, 34 of them showing systemic therapy to be efficacious for the treatment of mood disorders, eating disorders, substance use disorders, mental and social factors related to medical conditions and physical disorders, and schizophrenia. Systemic therapy may also be efficacious for anxiety disorders. Results were stable across follow-up periods of up to 5 years. There is a sound evidence-base for the efficacy of systemic therapy for adult index patients with mental disorders in at least five diagnostic groups.
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Ward CD, Smith A, James H, Novelle L, Bruder M. Using systemic approaches, methods and techniques in rehabilitation medicine. Clin Rehabil 2010; 25:3-13. [DOI: 10.1177/0269215510382497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This series of articles for rehabilitation in practice aims to cover a knowledge element of the rehabilitation medicine curriculum. Nevertheless they are intended to be of interest to a multidisciplinary audience. The competency addressed in this article is ‘The trainee demonstrates a knowledge of benefits and limitations of counselling approaches, specifically in this article systemic family therapy.’
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Affiliation(s)
- Christopher D Ward
- Department of Rehabilitation Medicine, Royal Derby Hospital, Derby
- Occupational Therapy Department, Derbyshire Children’s Hospital, Royal Derby Hospital, Derby, UK
| | - Alison Smith
- Department of Rehabilitation Medicine, Royal Derby Hospital, Derby
- Occupational Therapy Department, Derbyshire Children’s Hospital, Royal Derby Hospital, Derby, UK
| | - Helen James
- Huntington’s Disease Association, Neurosupport Centre, Liverpool
- Occupational Therapy Department, Derbyshire Children’s Hospital, Royal Derby Hospital, Derby, UK
| | - Lesley Novelle
- Clinical Skills Suite, University of Derby
- Occupational Therapy Department, Derbyshire Children’s Hospital, Royal Derby Hospital, Derby, UK
| | - Mel Bruder
- Occupational Therapy Department, Derbyshire Children’s Hospital, Royal Derby Hospital, Derby, UK
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Flynn B. Using systemic reflective practice to treat couples and families with alcohol problems. J Psychiatr Ment Health Nurs 2010; 17:583-93. [PMID: 20712681 DOI: 10.1111/j.1365-2850.2010.01574.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the UK, an adult with a drinking problem is generally treated from an individual perspective with minimal involvement of carers and relatives. In response to this gap in service provision, a systemic reflecting intervention was introduced to assist couples and families experiencing alcohol-related difficulties. The article documents the background and development of this initiative. Findings from evaluation and clinical outcome studies are reviewed and demonstrate how the use of the approach proved to be effective in facilitating positive change both in drinking and family behaviour. In conclusion, the paper explores the implications of how systemic reflective practice with family groups may be extended and be usefully used in wider addiction, diverse mental and general health-care settings.
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Affiliation(s)
- B Flynn
- Mt Zeehan Unit, St Martins Hospital, Canterbury, UK.
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Denton WH, Carmody TJ, Rush AJ, Thase ME, Trivedi MH, Arnow BA, Klein DN, Keller MB. Dyadic discord at baseline is associated with lack of remission in the acute treatment of chronic depression. Psychol Med 2010; 40:415-24. [PMID: 19607755 PMCID: PMC3687348 DOI: 10.1017/s0033291709990535] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Dyadic discord, while common in depression, has not been specifically evaluated as an outcome predictor in chronic major depressive disorder. This study investigated pretreatment dyadic discord as a predictor of non-remission and its relationship to depressive symptom change during acute treatment for chronic depression. METHOD Out-patients with chronic depression were randomized to 12 weeks of treatment with nefazodone, the Cognitive Behavioral Analysis System of Psychotherapy or their combination. Measures included the Marital Adjustment Scale (MAS) and the Inventory of Depressive Symptomatology - Self Report (IDS-SR30). Of 681 original patients, 316 were partnered and 171 of these completed a baseline and exit MAS, and at least one post-baseline IDS-SR30. MAS scores were analysed as continuous and categorical variables ('dyadic discord' v. 'no dyadic discord' defined as an MAS score >2.36. Remission was defined as an IDS-SR30 of 14 at exit (equivalent to a 17-item Hamilton Rating Scale for Depression of 7). RESULTS Patients with dyadic discord at baseline had lower remission rates (34.1%) than those without dyadic discord (61.2%) (all three treatment groups) (chi2=12.6, df=1, p=0.0004). MAS scores improved significantly with each of the treatments, although the change was reduced by controlling for improvement in depression. Depression remission at exit was associated with less dyadic discord at exit than non-remission for all three groups [for total sample, 1.8 v. 2.4, t(169)=7.3, p<0.0001]. CONCLUSIONS Dyadic discord in chronically depressed patients is predictive of a lower likelihood of remission of depression. Couple therapy for those with dyadic discord may increase remission rates.
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Affiliation(s)
- W H Denton
- Department of Psychiatry, The University of Texas Southwestern Medical Center at Dallas, TX 75390-9121, USA.
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39
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Tilden T, Gude T, Hoffart A. The course of dyadic adjustment and depressive symptoms during and after couples therapy: a prospective follow-up study of inpatient treatment. JOURNAL OF MARITAL AND FAMILY THERAPY 2010; 36:43-58. [PMID: 20074123 DOI: 10.1111/j.1752-0606.2009.00187.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A clinical sample of adult patients suffering from relational distress and concurrent psychiatric symptoms was followed from admission, through residential couple therapy, to 1-year follow-up. At follow-up, 9.8% were separated. The remaining couples showed significant improvement in dyadic adjustment at posttreatment. However, at 1-year follow-up, a subgroup of 25% of the positive treatment responders had deteriorated to below their admission levels of dyadic adjustment. Contrary to expectation, the deteriorated group had showed significantly less distress both in depressive symptoms and in one early maladaptive schema domain-Impaired Autonomy-at admission, when compared with the rest of the sample, which suggests the need for further research and possible replication in this area.
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Affiliation(s)
- Terje Tilden
- Department of Behavioral Sciences in Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway, and Research Institute, Modum Bad, 3370 Vikersund, Norway.
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40
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Blanchard A, Hodgson J, Gunn W, Jesse E, White M. Understanding social support and the couple's relationship among women with depressive symptoms in pregnancy. Issues Ment Health Nurs 2009; 30:764-76. [PMID: 19916811 DOI: 10.3109/01612840903225594] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This qualitative study explored the experiences of seven couples where the female partner experienced depressive symptoms during pregnancy. Female and male partners were interviewed together and data was collected and analyzed according to Colaizzi's ( 1978 ) phenomenological research design. The interviews yielded the following themes: (a) Challenges and stressors associated with depressive symptoms during pregnancy, (b) Pregnancy's effect on mood states, (c) Relationship dynamics that influence moods, (d) Pregnancy and the influence of mood on relationship dynamics, and (e) Reliance on external sources of support. The findings extend current research and provide insight into possibilities of how to enhance assessment and intervention for women who are depressed during pregnancy by including a relational component. Findings, clinical implications, and future research are discussed.
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Affiliation(s)
- Amy Blanchard
- Antioch University New England, Keene, New Hampshire, USA. amy
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41
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Östman M. Severe depression and relationships: the effect of mental illness on sexuality. SEXUAL AND RELATIONSHIP THERAPY 2008. [DOI: 10.1080/14681990802419266] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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42
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Nandrino JL. Les modèles étiologiques de la récurrence dépressive. PSYCHOLOGIE FRANCAISE 2008. [DOI: 10.1016/j.psfr.2008.02.004] [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: 10/22/2022]
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43
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Barbato A, D'Avanzo B. Efficacy of couple therapy as a treatment for depression: a meta-analysis. Psychiatr Q 2008; 79:121-32. [PMID: 18259866 DOI: 10.1007/s11126-008-9068-0] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Accepted: 01/21/2008] [Indexed: 10/22/2022]
Abstract
Data from clinical trials of couple therapy for depression have never been subjected to systematic analyses. We performed a meta-analysis of eight controlled trials involving 567 subjects. No difference was found on depressive symptoms between couple therapy and individual psychotherapy. Relationship distress was significantly reduced in the couple therapy group. Too few data are available for comparisons with drug therapy and no treatment. The findings are weakened by small sample sizes, assessments at the end of treatment or short follow-up, unclear sample representativeness, heterogeneity among studies. The mediating role of improvement in quality of couple relationships is not supported by data. However, it has not been adequately tested. Evidence on efficacy of couple therapy as a treatment for depression is inconclusive. The evidence for improvement in couple relationships may favor the choice of couple therapy when relational distress is a major problem.
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Affiliation(s)
- Angelo Barbato
- Epidemiology and Social Psychiatry Unit, Mario Negri Institute for Pharmacological Research, Via La Masa 19, Milan, Italy.
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44
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Depressive Störungen. PSYCHIATRIE UND PSYCHOTHERAPIE 2008. [PMCID: PMC7122695 DOI: 10.1007/978-3-540-33129-2_55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Das Spektrum depressiver Erkrankungen macht den Hauptteil affektiver Störungen aus und gehört mit einer Inzidenz von ca. 8–20% zu den häufigsten psychischen Erkrankungen. Depressionen werden nach wie vor zu selten einer adäquaten Therapie (Antidepressiva, störungsspezifische Psychotherapie wie z. B. kognitive Verhaltenstherapie) zugeführt.
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45
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Yoon KL, Zinbarg RE. Generalized anxiety disorder and entry into marriage or a marriage-like relationship. J Anxiety Disord 2007; 21:955-65. [PMID: 17270393 DOI: 10.1016/j.janxdis.2006.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Revised: 08/14/2006] [Accepted: 10/18/2006] [Indexed: 11/28/2022]
Abstract
Previous studies have suggested that individuals with generalized anxiety disorder report significantly higher levels of marital distress and are at a greater risk for divorce than those without generalized anxiety disorder. Studies also showed that relationship difficulties among those with generalized anxiety disorder predict poor treatment response and long-term outcome. In this study, the relation between a lifetime diagnosis of generalized anxiety disorder and marital history was examined with the data from the National Comorbidity Survey (NCS). Respondents were grouped into those who have no mental disorder, those who have only generalized anxiety disorder, and those who have generalized anxiety disorder and a lifetime history of at least one of the 16 DSM-III-R diagnoses assessed in the NCS. Generalized anxiety disorder was significantly associated with the likelihood of entry into a marriage-like relationship. The results support the continued investigation into the association between couple functioning and the onset, course, and treatment of generalized anxiety disorder, and suggest that couples intervention could be an untapped resource for generalized anxiety disorder treatment.
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46
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Bowen C. Family therapy and neuro-rehabilitation: Forging a link. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2007. [DOI: 10.12968/ijtr.2007.14.8.24353] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ceri Bowen
- Institute of Neuropalliative Rehabilitation The Royal Hospital for Neuro-disability West Hill Putney London SW14 8LY
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47
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von Sydow K, Beher S, Retzlaff R, Schweitzer-Rothers J. Systemische Therapie bei Störungen des Erwachsenenalters. PSYCHOTHERAPEUT 2007. [DOI: 10.1007/s00278-005-0453-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wolf NJ, Hopko DR. Psychosocial and pharmacological interventions for depressed adults in primary care: a critical review. Clin Psychol Rev 2007; 28:131-161. [PMID: 17555857 DOI: 10.1016/j.cpr.2007.04.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2006] [Revised: 02/09/2007] [Accepted: 04/20/2007] [Indexed: 11/25/2022]
Abstract
Primary care settings are the principal context for treating clinical depression, with researchers beginning to explore the efficacy of psychosocial and pharmacological treatments for depression within this infrastructure. Feasibility and process variables also are being assessed, including issues of cost-effectiveness, viability of collaborative care models, predictors of treatment outcome, and effectiveness of treatment providers without specialized mental health training. The Agency for Health Care Policy and Research and American Psychiatric Association initially released guidelines for the treatment of depression in primary care [American Psychiatric Association, 1993. Practice Guidelines for major depressive disorder in adults. American Journal of Psychiatry, 150, 1-26., American Psychiatric Association, 2000. Practice Guideline for the treatment of patients with major depressive disorder (revision). American Journal of Psychiatry, 157, 1-45], however, a vast literature has accumulated over the past several years, calling for a systematic re-evaluation of the status of depression treatment in primary care. The present study provides a contemporary review of outcome data for psychosocial and pharmacological interventions in primary care and extends beyond AHCPR guidelines insofar as focusing on feasibility and process variables, including the training and proficiency of primary care treatment providers, cost-effectiveness of primary care interventions, and predictors of treatment response and relapse. Based on current guidelines, problem-solving therapy (PST-PC), interpersonal psychotherapy, and pharmacotherapy would be considered efficacious interventions for major depression, with cognitive-behavioral and cognitive therapy considered possibly efficacious. Psychotherapy and pharmacotherapy generally are of comparable efficacy, and both modalities are superior to usual care in treating depression. Methodological limitations and directions for future research are discussed.
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Affiliation(s)
- Nicole J Wolf
- The University of Tennessee - Knoxville, United States
| | - Derek R Hopko
- The University of Tennessee - Knoxville, United States.
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Smith J. FROM BASE EVIDENCE THROUGH TO EVIDENCE BASE: A CONSIDERATION OF THE NICE GUIDELINES. PSYCHOANALYTIC PSYCHOTHERAPY 2007. [DOI: 10.1080/02668730601181101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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50
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Vetere A. Bio/psycho/social models and multidisciplinary team working--can systemic thinking help? Clin Child Psychol Psychiatry 2007; 12:5-12. [PMID: 17375806 DOI: 10.1177/1359104507071050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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