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Vierl L, Von Bremen C, Hagmayer Y, Benecke C, Sell C. How are psychodynamic conflicts associated with personality functioning? A network analysis. Front Psychol 2023; 14:1152150. [PMID: 37151325 PMCID: PMC10155610 DOI: 10.3389/fpsyg.2023.1152150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Personality functioning and psychodynamic conflicts are central constructs in psychoanalytic theories of psychopathology as well as in many psychodynamic treatment models. Although there has been a longstanding conceptual discussion on how they relate to each other, empirical evidence on this question is still scarce. In this study, we explore the associations between psychodynamic conflicts and levels of structural integration (which can be used synonymously with personality functioning) by means of a partial correlation network analysis in a sample of N = 220 outpatients interviewed and rated according to Operationalized Psychodynamic Diagnosis (OPD-2). We examined network centrality, bridge centrality, clustering, and network stability. The network analysis resulted in separate clusters for levels of structural integration and conflicts, supporting the assumption of distinct psychodynamic constructs. The greatest association between the two clusters was found between the individuation vs. dependency conflict (C1) and the structural capacity to attach to internal objects. In general, C1 showed significantly greater connections with structural dimensions compared to the other five OPD conflicts included. C1 was also more central in the network compared to most other conflicts, whereas the structural dimensions did not differ in centrality. All structural dimensions were found to be strongly interconnected. C1 showed exclusively negative edges to the other conflicts, suggesting that a profound C1 decreases the probability of other psychodynamic conflicts. We discuss clinical as well as conceptual implications of our findings for psychodynamic diagnosis and treatment.
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Affiliation(s)
- Larissa Vierl
- Department of Psychology, University of Kassel, Kassel, Germany
- Akademie für Psychoanalyse und Psychotherapie München e.V., Munich, Germany
- *Correspondence: Larissa Vierl,
| | - Charlotte Von Bremen
- Georg-Elias-Mueller Institute of Psychology, University of Göettingen, Göttingen, Germany
| | - York Hagmayer
- Georg-Elias-Mueller Institute of Psychology, University of Göettingen, Göttingen, Germany
| | - Cord Benecke
- Department of Psychology, University of Kassel, Kassel, Germany
| | - Christian Sell
- International Psychoanalytic University Berlin, Berlin, Germany
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Valt C, Huber D, Stürmer B. Treatment-related changes towards normalization of the abnormal external signal processing in panic disorder. PLoS One 2020; 15:e0227673. [PMID: 31986163 PMCID: PMC6984717 DOI: 10.1371/journal.pone.0227673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 12/25/2019] [Indexed: 11/29/2022] Open
Abstract
Despite the scientific consensus on the efficacy of psychotherapy for the treatment of psychological disorders, the evidence of treatment-related changes towards normalization of abnormal brain functions in patients is mixed. In the present experiment, we investigated whether treatment can affect early information processing, by testing abnormal event-related potentials (ERPs) evoked by internal and external signals in panic disorder. Sixteen patients with panic disorder and comorbid personality disorder and sixteen control participants performed a response-choice task and a passive viewing task in two testing sessions, separated by around 14 months. During this period, patients received psychological treatment. In agreement with previous studies of performance monitoring, the abnormal amplitude of the Ne/ERN–an index of error processing based on internal signals—did not change between the first and second testing session. However, treatment-related changes were evident for the abnormal vertex positive potential (VPP) evoked by external signals in the response-choice task and the passive viewing task. In patients, the VPP was smaller in the second session compared to the first session, whereas no significant changes occurred in controls. This result supplies evidence of treatment-related changes towards normalization in the early information processing of external visual stimuli in panic disorder.
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Affiliation(s)
- Christian Valt
- International Psychoanalytic University Berlin, Berlin, Germany
- * E-mail:
| | - Dorothea Huber
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Birgit Stürmer
- International Psychoanalytic University Berlin, Berlin, Germany
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Woll CFJ, Schönbrodt FD. A Series of Meta-Analytic Tests of the Efficacy of Long-Term Psychoanalytic Psychotherapy. EUROPEAN PSYCHOLOGIST 2020. [DOI: 10.1027/1016-9040/a000385] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Abstract. Recent meta-analyses come to conflicting conclusions about the efficacy of long-term psychoanalytic psychotherapy (LTPP). Our first goal was to reproduce the most recent meta-analysis by Leichsenring, Abbass, Luyten, Hilsenroth, and Rabung (2013) who found evidence for the efficacy of LTPP in the treatment of complex mental disorders. Our replicated effect sizes were in general slightly smaller. Second, we conducted an updated meta-analysis of randomized controlled trials comparing LTPP (lasting for at least 1 year and 40 sessions) to other forms of psychotherapy in the treatment of complex mental disorders. We focused on a transparent research process according to open science standards and applied a series of elaborated meta-analytic procedures to test and control for publication bias. Our updated meta-analysis comprising 191 effect sizes from 14 eligible studies revealed small, statistically significant effect sizes at post-treatment for the outcome domains psychiatric symptoms, target problems, social functioning, and overall effectiveness (Hedges’ g ranging between 0.24 and 0.35). The effect size for the domain personality functioning (0.24) was not significant ( p = .08). No signs for publication bias could be detected. In light of a heterogeneous study set and some methodological shortcomings in the primary studies, these results should be interpreted cautiously. In conclusion, LTPP might be superior to other forms of psychotherapy in the treatment of complex mental disorders. Notably, our effect sizes represent the additional gain of LTPP versus other forms of primarily long-term psychotherapy. In this case, large differences in effect sizes are not to be expected.
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Affiliation(s)
- Christian Franz Josef Woll
- Department of Psychology, Clinical Psychology of Children and Adolescents and Psychology of Interventions, Ludwig-Maximilians-Universität Munich, Germany
| | - Felix D. Schönbrodt
- Department of Psychology, Psychological Methods and Assessment, Ludwig-Maximilians-Universität Munich, Germany
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Šago D, Babić G, Bajić Ž, Filipčić I. Panic Disorder as Unthinkable Emotions: Alexithymia in Panic Disorder, a Croatian Cross-Sectional Study. Front Psychiatry 2020; 11:466. [PMID: 32581863 PMCID: PMC7282461 DOI: 10.3389/fpsyt.2020.00466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/06/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Previous research on alexithymia has led to controversy over its prevalence in panic disorder. The aim of this study was to assess the difference in the prevalence of alexithymia in panic disorder and other anxiety disorders. DESIGN AND METHODS We performed a cross-sectional study on a sample of 71 patients diagnosed with panic disorder and 113 patients diagnosed with other anxiety disorders; both groups were 18-50 years old. Primary outcome was the 20-item Toronto Alexithymia Scale (TAS) score. Secondary outcome was the prevalence of alexithymia defined as a TAS score ≥61. RESULTS Patients diagnosed with panic disorder had a 25% higher score on the TAS subscale of difficulty identifying feelings than patients diagnosed with other anxiety disorders. The prevalence of alexithymia was 27% in patients with panic disorder and 13% in patients with other anxiety disorders. Patients diagnosed with panic disorder had significantly higher odds for alexithymia. CONCLUSIONS The results of our study support the hypothesis of higher prevalence of alexithymia in individuals with panic disorder than in individuals with other anxiety disorders. In addition, difficulty identifying feelings as a salient feature of alexithymia is higher in panic disorder than in other anxiety disorders.
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Affiliation(s)
- Daniela Šago
- Day Hospital for Psychotic Disorder, Psychiatric Hospital Sveti Ivan, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Goran Babić
- Independent Researcher, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Žarko Bajić
- Day Hospital for Psychotic Disorder, Psychiatric Hospital Sveti Ivan, Zagreb, Croatia
| | - Igor Filipčić
- Day Hospital for Psychotic Disorder, Psychiatric Hospital Sveti Ivan, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia.,Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Valt C, Huber D, Erhardt I, Stürmer B. Internal and external signal processing in patients with panic disorder: An event-related potential (ERP) study. PLoS One 2018; 13:e0208257. [PMID: 30496321 PMCID: PMC6264869 DOI: 10.1371/journal.pone.0208257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/14/2018] [Indexed: 12/16/2022] Open
Abstract
Self-absorption describes a pathological tendency towards the internal mental world (internalization) that often conflicts with the accurate monitoring of the external world. In performance monitoring, an augmented electrophysiological response evoked by internal signals in patients with anxiety or depressive disorder seems to reflect this tendency. Specifically, the error-related negativity (Ne/ERN), an index of error processing based on internal signals, is larger in patients compared to controls. In the present experiment, we investigated whether the preferential processing of internal signals in patients is linked to diminished and inflexible external signal processing. To this end, the electrophysiological response evoked by external signals was analysed in patients with panic disorder and healthy controls. Participants performed a choice-response task, where informative or uninformative feedback followed each response, and a passive viewing task. As a replication of previous studies, patients presented an augmented Ne/ERN, indexing enhanced processing of internal signals related to errors. Furthermore, the vertex positive potential (VPP) evoked by visual stimuli was larger in patients than in controls, suggesting enhanced attention to external signals. Moreover, patients and controls showed similar sensitivity to the feedback information content, indicating a normal flexibility in the allocation of monitoring resources to external signals depending on how informative these signals are for performance monitoring. These results suggest that the tendency towards internal signals in patients with panic disorder does not hinder the flexible processing of external signals. On the contrary, external signals seem to attract enhanced processing in patients compared to controls.
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Affiliation(s)
- Christian Valt
- International Psychoanalytic University Berlin, Berlin, Germany
- * E-mail:
| | - Dorothea Huber
- International Psychoanalytic University Berlin, Berlin, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum München, Munich, Germany
| | - Ingrid Erhardt
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum München, Munich, Germany
| | - Birgit Stürmer
- International Psychoanalytic University Berlin, Berlin, Germany
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Doering S, Blüml V, Parth K, Feichtinger K, Gruber M, Aigner M, Rössler-Schülein H, Freidl M, Wininger A. Personality functioning in anxiety disorders. BMC Psychiatry 2018; 18:294. [PMID: 30223818 PMCID: PMC6142416 DOI: 10.1186/s12888-018-1870-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/30/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The Alternative DSM-5 Model for Personality Disorders as well as the upcoming IDC-11 have established a new focus on diagnosing personality disorders (PD): personality functioning. An impairment of self and interpersonal functioning in these models represents a general diagnostic criterion for a personality disorder. Little is known so far about the impairment of personality functioning in patients with other mental disorders than PD. This study aims to assess personality functioning in patients with anxiety disorders. METHODS Ninety-seven patients with the diagnosis of generalized anxiety disorder, panic disorder, or phobia, and 16 healthy control persons were diagnosed using the Structured Clinical Interview for DSM-IV (SCID-I and -II) and were assessed by means of the Structured Interview for Personality Organization (STIPO) to determine the level of personality functioning. RESULTS While all three patient groups showed significant impairment in personality functioning compared to the control group, no significant differences were observed between the different patient groups. In all three groups of anxiety disorders patients with comorbid PD showed significantly worse personality functioning than patients without. Patients without comorbid PD also yielded a significant impairment in their personality functioning when compared to the control group. CONCLUSIONS Anxiety disorders are associated with a significant impairment in personality functioning, which is significantly increased by comorbid PD. There are no differences in terms of personality functioning between patients with different anxiety disorders.
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Affiliation(s)
- Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria
| | - Victor Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria
| | - Karoline Parth
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria
- Department of Psychology, Webster Vienna Private University, Wien, Austria
| | - Karin Feichtinger
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria
| | - Maria Gruber
- Department of Social Psychiatry, Medical University of Vienna, Wien, Austria
| | - Martin Aigner
- Department of Psychiatry, University Hospital Tulln, Tulln, Austria
| | | | - Marion Freidl
- Department of Social Psychiatry, Medical University of Vienna, Wien, Austria
| | - Antonia Wininger
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria
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[Editorial]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2016; 62:205-6. [PMID: 27594598 DOI: 10.13109/zptm.2016.62.3.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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