Patient personality and time-limited group psychotherapy for complicated grief

Interrater Reliability of the Psychological Mindedness Assessment Procedure, Extended (Dutch) Version, in a Clinical Patient Population

The Psychological Mindedness Assessment Procedure, Extended Dutch Version (PMAP-plus), was developed to assess psychological mindedness in mental health care. Psychological Mindedness represents the ability to understand self and others through mental representations of internal psychodynamic states. In patients, deficits in psychological mindedness capacity can cause problems in self- and interpersonal functioning. This brief report describes interrater reliability of four PMAP-plus scenarios for evaluating psychological mindedness capacity among patients. Patients with personality disorders (N = 194) were asked to respond to four enacted videotaped PMAP-plus scenarios presenting a person talking about a personal experience. The videotaped scenarios varied in their emotional impact. All verbatim responses were scored by two clinically experienced raters on a hierarchical scale with gradually increasing complexity of psychodynamic understanding. Clinicians achieved acceptable interrater reliability on PMAP-plus in this patient population. Two scenarios with low emotional impact evoked significantly higher interrater agreement as compared to two scenarios with high emotional impact. Our results suggest that mental health professionals can reliably distinguish levels of psychological mindedness by assessing PMAP-plus in a patient population. Scenarios differ in potency to reveal psychological mindedness capacity. The variation in emotional impact in subsequent scenarios makes it a promising instrument measuring psychodynamic capacities for psychotherapeutic treatment.

Efficacy of Intellect's self-guided anxiety and worry mobile health programme: A randomized controlled trial with an active control and a 2-week follow-up

Digital self-guided mobile health [mHealth] applications are cost-effective, accessible, and well-suited to improve mental health at scale. This randomized controlled trial [RCT] evaluated the efficacy of a recently developed mHealth programme based on cognitive-behavioral therapy [CBT] principles in improving worry and anxiety. We also examined psychological mindedness [PM] as a mediator by which app engagement is thought to improve outcomes. The Intervention group completed a 2-week "Anxiety and Worry" programme with daily CBT-informed activities, while the active waitlist-control completed a matched 2-week mHealth programme on procrastination. Participants filled out the Generalized Anxiety Disorder [GAD-7], Patient Health Questionnaire [PHQ-9], and Psychological Mindedness Scale [PMS] at baseline, post-intervention, and 2-week follow-up. App engagement was measured at post-intervention only. Contrary to prediction, the Intervention group did not perform better than the Active Control group; both groups showed significant improvements on anxiety and depressive symptoms from baseline to follow-up. From post-intervention to follow-up, only the Intervention group showed further improvements for anxiety symptoms. Higher engagement with the mHealth app predicted lower anxiety and depressive symptoms at follow-up, and this relationship was fully mediated by psychological mindedness. This study provides evidence that [a] engaging in a CBT mHealth programme can reduce anxiety and worry, and [b] Psychological mindedness is a potential pathway by which engaging with a mHealth app improves anxiety and depressive symptoms. While overall effect sizes were small, at the population level, these can make significant contributions to public mental health.

Focused group analytic psychotherapy: An integration of clinical experience and research

Objective

Group‐analytic psychotherapy is probably the most commonly used psychodynamic group therapy in Europe. This paper describes focused group analytic psychotherapy (FGAP), a new time–limited version of this therapy, based on clinical experience and research.

The therapy/suitability of patients

It is relatively structured and individually oriented, and designed for patients with a certain ability to tolerate internal and external stress, without decompensating or developing serious behavioral disturbances (they should have a limited degree of personality pathology). Patients entering FGAP should establish a circumscribed therapy focus ahead of therapy, based on some dysfunctional patterns of interpersonal problems, conflicts, and/or symptoms related to a psychodynamic hypothesis/case formulation.

Selection/preparation

The paper describes patient selection and preparation, the evolvement of the group process, and how therapist and other group members interact/intervene.

Clinical material/vignettes

Central elements in the evaluation and aspects of the therapy are described and illustrated with an extensive case description and clinical material and vignettes from the group process.

Psychological Mindedness, Personality Structure, and Outcomes in Short-Term Group Analytic Psychotherapy

The present study investigated the treatment effects of focused short-term group analytic psychotherapy and examined whether outcomes were predicted by the client's psychological mindedness and personality structure as measured by the Operationalized Psychodynamic Diagnosis (OPD). Treatment foci were formulated according to the OPD for 66 student counseling clients across nine groups. Two observers independently rated client psychological mindedness and personality structure. The pre-post Cohen's d effect sizes were large on the Global Severity Index (GSI) and the Inventory of Interpersonal Problems (IIP-64) and moderate on the Social Adjustment Scale Self Report, including all 66 clients starting treatment. Psychological mindedness significantly predicted two outcomes (GSI, IIP), and personality structure predicted one outcome (GSI). These measures could be helpful when selecting clients for short-term group analytic psychotherapy. We discuss study limitations and implications for future research and practice.

COVID-19 Suicide Survivors-A Hidden Grieving Population

Present time has been dominated by the COVID-19 pandemic. People are grieving several non-death related situations: the loss of a job, of a status, of a role, of their life. Restrictive measures and uncertainty about the future makes individuals vulnerable to feelings of hopelessness and helplessness. Mental health support has been hindered and teams are reinventing themselves to reach people in need. Nevertheless, decompensation of previous psychiatric disorders, increasing levels of depression and anxiety, economical handicaps and fear of the infection, are prompting several cases of COVID-19 related suicides worldwide. Every suicide affects between 5 and 80 individuals, which are known as suicide survivors. Suicide grief is particularly challenging, with rates of complicated grief as high as 40%. Suicide survivors are at increased risk of developing depression, anxiety disorders and of suicidal behaviors. Moreover, feelings of guilt and shame, as well as social stigma, are major obstacles for them to reach form help. This article aims to review the existing literature on COVID-19 related suicides, complicated grief in suicide survivors and highlight modifiable risk factors for both conditions, as well as propose some public health measures to reduce the impact of the pandemic context on self-inflicted harm and its consequences on families, friends and the community. Obstacles to access to mental health support need to be overcome through the use of technology. Technicians should actively approach populations more vulnerable to develop suicidal ideation. Social media have the obligation to provide accurate an non-sensationalistic information. Families and friends should maintain social proximity, despite the need for physical distancing. When a suicide death occurs, police forces and health staff should be prepared to share the news with the family using an empathic and humane approach and providing psychological support. Funerals, memorials and other services should be held as much as possible. Closer contacts should be signalized and closely followed in order to detect the need for specific interventions. Help seeking behaviors should be promoted. Additionally, people should be educated on suicide and its impacts, in order to reduce stigma.

The association of loneliness after sudden bereavement with risk of suicide attempt: a nationwide survey of bereaved adults

PURPOSE

We aimed to test the hypothesis that among people who experience sudden bereavement, loneliness is associated with post-bereavement suicide attempt and post-bereavement suicidal ideation, even when adjusting for network size.

METHODS

We analysed cross-sectional data collected in the 2010 UCL Bereavement Study, to identify 3193 respondents who had experienced sudden bereavement. We used multivariable logistic regression to test for an association between loneliness (using a newly-developed eight-item loneliness measure) and post-bereavement suicide attempt and suicidal ideation, adjusting for socio-demographic factors, pre-bereavement depression and self-harm, and network size.

RESULTS

Among bereaved adults, loneliness was significantly associated with probability of post-bereavement suicide attempt (AOR 1.19; 95% CI 1.14-1.25) and of post-bereavement suicidal ideation (AOR 1.24; 95% CI 1.20-1.28), with estimates unchanged by adding perceived stigma of the bereavement to adjusted models. There was no association between suicide bereavement and loneliness (adjusted coefficient 0.22; 95% CI - 0.12 to 0.45; p = 0.063). The association of loneliness and suicide attempt risk was similar whether participants were bereaved by suicide or not.

CONCLUSIONS

People who report feeling lonely after sudden bereavement are more likely to make a suicide attempt after their loss, even when taking into account their network size and the perceived stigma of the sudden bereavement. There is no evidence that the effects of loneliness on suicidality are specific to suicide bereavement. This work identifies loneliness as a potential target for suicide prevention interventions among bereaved people. It also fuels interest in longitudinal research investigating loneliness as a putative mediator of suicide risk.

Psychological interventions for grief in adults: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

The present meta-analysis evaluates the efficacy of psychological interventions for grief in bereaved adults and explores the possible moderating influence of various study characteristics.

METHODS

A systematic literature search was conducted by two reviewers who independently searched electronic databases, reviewed and selected eligible studies, and evaluated their methodological quality.

RESULTS

A total of 31 randomized controlled trials (RCTs) were included in the meta-analysis. Statistically significant pooled effects of psychological intervention on grief symptoms were found for both post-intervention (Hedges's g = 0.41, p > .001, K = 31) and follow-up (g = 0.45, p > .001, K = 18). While generally robust, the effect was smaller at post-intervention when adjusting for possible publication bias (g = 0.31). Compared with the remaining studies, larger post-intervention effect sizes were found for studies with (1) individually delivered interventions (Beta = 0.49, p < .001), (2) the ICG-(R)/PG-13 questionnaire as the grief instrument (Beta = 0.46, p < .001), (3) participants who were ≥6 months post-loss (Beta = 0.58, p < .001), (4) participants included based on high baseline symptom levels (Beta = 0.40, p = .002) and (5) higher study quality (Beta = 0.06, p = .013).

LIMITATIONS

The included studies were methodologically heterogeneous and their methodological quality varied considerably. Moreover, there were some indications of publication bias.

CONCLUSIONS

Given the recent introduction of Prolonged Grief Disorder in the ICD-11, the results of the present meta-analysis are timely and of clinical relevance. Based on our results, psychological intervention appears efficacious for alleviating grief symptoms in bereaved adults, with several study characteristics as possible moderators of the effect. The interpretability of the results, however, is challenged by some limitations of the available research, including possible publication bias.

Towards an evidence-based unified psychodynamic protocol for emotional disorders

BACKGROUND

In psychotherapy research unified, transdiagnostic and modular treatments have emerged. This is true for both cognitive-behavioral therapy and psychodynamic therapy. Recently, two unified psychodynamic protocols were presented, one for anxiety disorders, another for depressive disorders. Integrating the treatment principles for these two highly prevalent disorder groups into one protocol for "emotional disorders" may be useful for both clinical practice and training in psychotherapy.

METHODS

After updating the evidence for psychodynamic therapy in anxiety and depressive disorders in terms of randomized controlled trials (RCTs) by a systematic search, the treatment elements applied in those RCTs providing evidence for the efficacy of psychodynamic therapy in depressive or anxiety disorders were reviewed and compared.

RESULTS

Twenty-seven RCTs for anxiety or depressive disorders were identified. A review revealed a high overlap between the principles used for the psychodynamic treatment of anxiety and depressive disorders, reflecting the transdiagnostic nature of psychodynamic therapy. The overlap suggested to integrate the identified treatment principles into one unified psychodynamic protocol for "emotional disorders" (UPP-EMO). As a result, seven treatment principles or modules were distilled which can be flexibly applied depending on the patient´s symptoms and needs. In addition, a separate module addresses diagnostic assessment. Across modules, a focus on resources has been included.

LIMITATIONS

Despite being based on RCTs, UPP-EMO has not yet been examined in an RCT - which is planned as a next step.

CONCLUSIONS

As psychodynamic therapy is transdiagnostic in origin focusing on core underlying processes of mental disorders, acceptability of UPP-EMO among psychodynamic psychotherapists is likely to be high.

Are psychodynamic and psychoanalytic therapies effective? A review of empirical data

There is a need for empirical outcome research in psychodynamic and psychoanalytic therapy. However, both the approach of empirically supported therapies (EST) and the procedures of evidence-based medicine (EBM) have severe limitations making randomised controlled trials (RCTs) an absolute standard. After a critical discussion of this approach, the author reviews the empirical evidence for the efficacy of psychodynamic psychotherapy in specific psychiatric disorders. The review aims to identify for which psychiatric disorders RCTs of specific models of psychodynamic psychotherapy are available and for which they are lacking, thus providing a basis for planning further research. In addition, results of process research of psychodynamic psychotherapy are presented. As the methodology of RCTs is not appropriate for psychoanalytic therapy, effectiveness studies of psychoanalytic therapy are reviewed as well. Studies of psychodynamic psychotherapy published between 1960 and 2004 were identified by a computerised search using Medline, PsycINFO and Current Contents. In addition, textbooks and journal articles were used. Twenty-two RCTs were identified of which 64% had not been included in the 1998 report by Chambless and Hollon. According to the results, for the following psychiatric disorders at least one RCT providing evidence for the efficacy of psychodynamic psychotherapy was identified: depressive disorders (4 RCTs), anxiety disorders (1 RCT), post-traumatic stress disorder (1 RCT), somatoform disorder (4 RCTs), bulimia nervosa (3 RCTs), anorexia nervosa (2 RCTs), borderline personality disorder (2 RCTs), Cluster C personality disorder (1 RCT), and substance-related disorders (4 RCTs). According to results of process research, outcome in psychodynamic psychotherapy is related to the competent delivery of therapeutic techniques and to the development of a therapeutic alliance. With regard to psychoanalytic therapy, controlled quasi-experimental effectiveness studies provide evidence that psychoanalytic therapy is (1) more effective than no treatment or treatment as usual, and (2) more effective than shorter forms of psychodynamic therapy. Conclusions are drawn for future research.

Nurses' Experiences of Grief Following Patient Death: A Qualitative Approach

PURPOSE

To explore the lived experiences of nurses' feelings, emotions, grief reactions, and coping mechanisms following their patients' death.

BACKGROUND

On a daily basis, nurses are experiencing patients' death, which exposes them to grief. Nurses' grief has not been sufficiently addressed in practice settings, although it has been a well-known threat to health and work performance.

DESIGN

A qualitative design guided by a phenomenological approach was adopted.

METHOD

Data were collected from a purposive sample of 21 Jordanian nurses by conducting three focus groups and analyzed using Colaizzi's framework.

FINDINGS

Four themes were generated in which participants reported feelings of grief following their patients' death. Their grief emotions were reported as sadness, crying, anger, shock, denial, faith, fear, guilt, fear of the family's reaction, and powerlessness.

CONCLUSIONS

The study provided evidence that nurses respond emotionally to patients' death and experience grief. Nurses are burdened by recurrent patients' deaths and try to cope and overcome their grief. This study emphasizes the importance of developing strategies to help nurses positively cope with their grief from a holistic perspective. This will reflect positively on the nurses' performance.

Effectiveness of Short-Term Dynamic Group Psychotherapy in Primary Care for Patients with Depressive Symptoms

An open prospective controlled study was designed to compare the efficacy of short-term dynamic group psychotherapy with the standard treatment in patients with depressive symptoms attended in the primary care setting. A total of 115 patients with depressive symptoms were assigned to receive psychotherapy (75 min) over 9 months (37 to 39 sessions) (n = 70) or the standard care (n = 45). Outcome measures were the differences between baseline and post-treatment in the 17-item Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HAM-A) and the Short-Form Health Survey (SF-12) questionnaire in the two study groups. At the end of dynamic group psychotherapy, statistically significant improvements in the mean scores of all questionnaires were observed, whereas in control patients, significant improvements were only observed in the HDRS-17 scale and in the Mental Component Summary score of the SF-12. The mean changes after treatment were also higher in the psychotherapy group than in controls in all outcome measures, with statistically significant differences in the mean differences in favour of the psychotherapy group. In summary, implementation of short-term dynamic group psychotherapy run by experienced psychotherapists for patients with depressive symptoms attended in routine primary care centres is feasible and effective. © 2016 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.

KEY PRACTITIONER MESSAGE

Short-term dynamic group psychotherapy was delivered as a non-pharmacological intervention to improve depressive symptoms. Statistically significant differences as compared with a control group were observed in 17-item Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HAM-A) and the Short-Form Health Survey (SF-12) questionnaire. Implementation of short-term dynamic group psychotherapy run by experienced psychotherapists for patients with depressive symptoms attended in routine primary care centres is feasible and effective.

Special Section: Contemporary Challenges for Research in Group Analysis

In this paper, I underline the challenges for group-analytic research by demonstrating the immense difference in the amount of research done in group psychotherapy in general as compared to group analysis. After presenting an overview of findings from empirical, quantitative outcome studies in group psychotherapy at large, I will discuss some trends in contemporary group psychotherapy research, and finally, I will give a rough sketch of group-analytic research. I will focus on quantitative research and I will see group analysis as a clinical enterprise - a theory, model, art and craft that has been developed and can be used to treat psychiatric disorders, and toameliorate psychological problems.

Assisting the bereaved: A systematic review of the evidence for grief counselling

BACKGROUND

Supporting people after bereavement is a priority area for many health services. Investment in bereavement care must be supported by a rigorous evidence-base.

AIM

To examine the (1) relative proportion of descriptive, measurement and intervention research in grief counselling and (2) quality and effectiveness of intervention studies.

DESIGN

Systematic review of studies published in the area of grief counselling.

DATA SOURCES

MEDLINE, Embase, Cochrane Library and PsycINFO databases were searched for studies published between 2000 and 2013. Eligible papers were categorised into descriptive, measurement, review, commentaries and intervention studies. Intervention studies were assessed against the Cochrane Effective Practice and Organisation of Care methodological criteria, and papers meeting criteria were assessed for quality. The impact of interventions on grief, psychological morbidity and quality of life was examined.

RESULTS

A total of 126 data-based papers, including 47 descriptive, 3 measurement and 76 grief counselling intervention studies were included. Only 59% (n = 45) of intervention studies met Effective Practice and Organisation of Care design criteria. Overall, study quality was poor, with the majority of interventions showing a risk of bias in several key areas. The three studies that met all criteria showed mixed effectiveness.

CONCLUSION

Grief counselling interventions require a strong rationale for design, and a systematic approach to development and evaluation. Descriptive research efforts should inform this process, focusing on homogeneity in sample, identification of risk factors for complicated grief and the impact of extraneous factors on intervention effects. Interventions should include comparisons to usual care, as well as replication to confirm positive findings.

Patterns of Change in Interpersonal Problems During and After Short-term and Long-term Psychodynamic Group Therapy: A Randomized Clinical Trial

OBJECTIVE

In this study, we compared the patterns of change in interpersonal problems between short-term and long-term psychodynamic group therapy.

METHOD

A total of 167 outpatients with mixed diagnoses were randomized to 20 or 80 weekly sessions of group therapy. Interpersonal problems were assessed with the Inventory of Interpersonal Problems at six time points during the 3-year study period. Using linear mixed models, change was linearly modelled in two steps. Earlier (within the first 6 months) and later (during the last 2.5 years) changes in five subscales were estimated.

RESULTS AND CONCLUSION

Contrary to what we expected, short-term therapy induced a significantly larger early change than long-term therapy on the cold subscale and there was a trend on the socially avoidant subscale, using a Bonferroni-adjusted alpha. There was no significant difference between short-term and long-term group therapy for improving problems in the areas cold, socially avoidant, nonassertive, exploitable, and overly nurturant over the 3 years.

Use of the Social Relations Model by Group Therapists: Application and Commentary

This article presents research findings concerning the relationship of patient positive regard to the outcome of time-limited, short-term group therapy for psychiatric outpatients with complicated grief. The Social Relations Model (SOREMO) of David Kenny was used to investigate this relationship. While the patient's ratings of positive regard of others in the group, known as the Perceiver Effect, accounted for the most variation of the patients' ratings, the other patients' rating of the patient's positive regard, known as the Target Effect, was directly related to favorable change. In addition, a simpler method was used to calculate variables that were analogous to the Perceiver Effect and Target Effect variables of the SOREMO. These variables yielded similar outcome findings. Because of limitations and difficulties associated with learning and using the SOREMO, the simpler method represents a more feasible choice for group therapists who are primarily clinicians or group therapists who wish to collect a small amount of data on an ongoing basis. Even experienced group therapy researchers are likely to find the SOREMO program challenging to use.

NEO-Five Factor Personality Traits as Predictors of Response to Two Forms of Group Psychotherapy

The relationships between patient personality variables and outcome for 107 psychiatric outpatients with complicated grief who completed either interpretive or supportive short-term group therapy were investigated. The personality variables were assessed prior to treatment with the NEO-Five Factor Inventory (NEO-FFI). For patients in both forms of therapy, extraversion, conscientiousness, and openness were directly associated with favorable treatment outcome. In contrast, neuroticism was inversely related to favorable outcome for patients in both forms of therapy. Agreeableness was directly related to favorable improvement in grief symptomatology for patients in interpretive therapy, but not for those in supportive therapy. The results highlight the importance of assessing patient personality in order to predict response to short-term group therapy. Possible explanations and clinical implications of these findings are discussed.

Level of Alliance, Pattern of Alliance, and Outcome in Short–term Group Therapy

This study investigated the relationships between initial level of alliance, pattern of alliance over sessions, and outcome in a sample of 107 patients who completed short-term group therapy for complicated grief. Both patient-rated alliance and therapist-rated alliance were studied. For patient-rated alliance, both the initial level of alliance and the linear pattern of alliance were directly and significantly related to favorable outcome. For therapist-rated alliance, no significant direct relationships with outcome were found. Instead, significant interaction effects were found. For patients with relatively high initial alliance, the greater the increase in alliance over sessions, the better the outcome. For patients with relatively low initial alliance, the greater the decrease in alliance over sessions, the better the outcome. Explanations for the findings are considered as well as possible clinical implications.

The empirical status of psychodynamic psychotherapy - an update: Bambi's alive and kicking

BACKGROUND

The Task Force on Promotion and Dissemination of Psychological Procedures proposed rigorous criteria to define empirically supported psychotherapies. According to these criteria, 2 randomized controlled trials (RCTs) showing efficacy are required for a treatment to be designated as 'efficacious' and 1 RCT for a designation as 'possibly efficacious'. Applying these criteria modified by Chambless and Hollon, this article presents an update on the evidence for psychodynamic therapy (PDT) in specific mental disorders.

METHODS

A systematic search was performed using the criteria by Chambless and Hollon for study selection, as follows: (1) RCT of PDT in adults, (2) use of reliable and valid measures for diagnosis and outcome, (3) use of treatment manuals or manual-like guidelines, (4) adult population treated for specific problems and (5) PDT superior to no treatment, placebo or alternative treatment or equivalent to an established treatment.

RESULTS

A total of 39 RCTs were included. Following Chambless and Hollon, PDT can presently be designated as efficacious in major depressive disorder (MDD), social anxiety disorder, borderline and heterogeneous personality disorders, somatoform pain disorder, and anorexia nervosa. For MDD, this also applies to the combination with pharmacotherapy. PDT can be considered as possibly efficacious in dysthymia, complicated grief, panic disorder, generalized anxiety disorder, and substance abuse/dependence. Evidence is lacking for obsessive-compulsive, posttraumatic stress, bipolar and schizophrenia spectrum disorder(s).

CONCLUSIONS

Evidence has emerged that PDT is efficacious or possibly efficacious in a wide range of common mental disorders. Further research is required for those disorders for which sufficient evidence does not yet exist.

Psychodynamic therapy meets evidence-based medicine: a systematic review using updated criteria

Psychodynamic therapy (PDT) is an umbrella concept for treatments that operate on an interpretive-supportive continuum and is frequently used in clinical practice. The use of any form of psychotherapy should be supported by sufficient evidence. Efficacy research has been neglected in PDT for a long time. In this review, we describe methodological requirements for proofs of efficacy and summarise the evidence for use of PDT to treat mental health disorders. After specifying the requirements for superiority, non-inferiority, and equivalence trials, we did a systematic search using the following criteria: randomised controlled trial of PDT; use of treatment manuals or manual-like guidelines; use of reliable and valid measures for diagnosis and outcome; adults treated for specific mental problems. We identified 64 randomised controlled trials that provide evidence for the efficacy of PDT in common mental health disorders. Studies sufficiently powered to test for equivalence to established treatments did not find substantial differences in efficacy. These results were corroborated by several meta-analyses that suggest PDT is as efficacious as treatments established in efficacy. More randomised controlled trials are needed for some mental health disorders such as obsessive-compulsive disorder and post-traumatic stress disorder. Furthermore, more adequately powered equivalence trials are needed.

The role of emotional intelligence in symptom reduction after psychotherapy in a heterogeneous psychiatric sample

BACKGROUND

Emotional intelligence of the patient has been claimed to potentially be an important factor in psychotherapy. Empirical studies are largely lacking. The purpose of this study was to examine if (i) pre-intervention emotional intelligence predicts outcome of psychotherapy and (ii) change in emotional intelligence during psychotherapy is associated with change in symptoms in a patient sample with heterogeneous psychiatric symptoms.

METHODS

Participants were 166 patients with different diagnoses who were hospitalized at the Center for Psychological Recovery. Before, after hospitalization and 6months after hospitalization they were asked to complete the BarOn-EQi for emotional intelligence and the Symptom Checklist-90.

RESULTS

Level of emotional intelligence at the start of hospitalization largely did not predict psychological symptoms at post-intervention or at 6month follow-up. However, an increase in the level of emotional intelligence over the course of the intervention was associated with lower levels of psychological symptoms, both immediately post-intervention and at 6-month follow-up.

CONCLUSIONS

The results suggest that while the pre-intervention level of emotional intelligence has no substantial effect on treatment outcome, an increase in emotional intelligence may have a positive effect on symptom decrease and on the preservation of treatment results.

Common therapeutic factors in bereavement groups

Group therapy remains a popular treatment format for individuals experiencing bereavement. Although many innovative group treatments for grief are being developed, common therapeutic factors can also contribute to outcomes. The author integrates research on group therapy processes and treatment for grief, and examines evidence regarding group therapeutic factors that may influence bereavement group outcomes. Specifically, research on therapeutic factors related to sharing and support, interpersonal learning, and meaning-making is highlighted where it has relevance to bereavement groups. Potential research examining the interactions of these processes, their effects on group functioning and outcomes, and the moderators of these effects are discussed.

Coping with grief responses among African American family members of homicide victims

Research relevant to coping with grief for African American family members of homicide victims is limited. This retrospective study was conducted to determine the effects of gender, length of time since death, the traumatic impact of experiencing the homicide of a loved one, and the use of coping strategies to current grief reactions of African American family members of homicide victims (N = 44). Multiple regression analysis results suggest that gender and level of traumatic stress, related to posttraumatic stress symptomatology, predict current symptoms of grief. Women reported higher levels of current grief symptoms than men. Family members of homicide victims who reported higher levels of posttraumatic stress symptomology reported higher levels of current grief. Implications for research and recommendations for practitioners are discussed.

The Group Cohesiveness Scale (GCS) for psychiatric inpatients

PURPOSE

This study aimed to examine the psychometric properties of the seven-item Group Cohesiveness Scale (GCS).

DESIGN AND METHODS

In total, 96 inpatients completed the GCS along with the Cohesion to Therapist Scale Questionnaire and the Group Benefit Questionnaire after participating in group therapy sessions. Construct and concurrent validities and internal consistency were analyzed.

FINDINGS

It yielded a Cronbach's alpha of .87, with a one-factor solution with excellent fit indices. A significant correlation was found between the GCSc, the Cohesion to Therapist Scale, and the Group Benefit Questionnaire.

PRACTICE IMPLICATIONS

The scale shows good internal consistency, and its brevity makes it suitable for use with psychiatric inpatients.

Toward a model for assessing level of personality functioning in DSM-5, part I: a review of theory and methods

Personality disorders are associated with fundamental disturbances of self and interpersonal relations, problems that vary in severity within and across disorders. This review surveyed clinician-rated measures of personality psychopathology that focus on self-other dimensions to explore the feasibility and utility of constructing a scale of severity of impairment in personality functioning for DSM-5. Robust elements of the instruments were considered in creating a continuum of personality functioning based on aspects of identity, self-direction, empathy, and intimacy. Building on preliminary findings (Morey et al., 2011 /this issue), the proposed Levels of Personality Functioning will be subjected to extensive empirical testing in the DSM-5 field trials and elsewhere. The resulting version of this severity measure is expected to have clinical utility in identifying personality psychopathology, planning treatment, building the therapeutic alliance, and studying treatment course and outcome.

Suicide bereavement and complicated grief

Losing a loved to suicide is one is one of life's most painful experiences. The feelings of loss, sadness, and loneliness experienced after any death of a loved one are often magnified in suicide survivors by feelings of quilt, confusion, rejection, shame, anger, and the effects of stigma and trauma. Furthermore, survivors of suicide loss are at higher risk of developing major depression, post-traumatic stress disorder, and suicidal behaviors, as well as a prolonged form of grief called complicated grief. Added to the burden is the substantial stigma, which can keep survivors away from much needed support and healing resources. Thus, survivors may require unique supportive measures and targeted treatment to cope with their loss. After a brief description of the epidemiology and circumstances of suicide, we review the current state of research on suicide bereavement, complicated grief in suicide survivors, and grief treatment for survivors of suicide.

Complicated grief therapy as a new treatment approach

Complicated grief therapy (CGT) is a relatively new psychotherapy model designed to address symptoms of complicated grief. Drawn from attachment theory and with roots in both interpersonal therapy (IPT) and cognitive-behavioral therapy, CGT includes techniques similar to prolonged exposure (repeatedly telling the story of the death and in vivo exposure activities). The treatment also involves focusing on personal goals and relationships. CGT has been demonstrated to be effective in a trial in which participants with complicated grief were randomly assigned to CGT or IPT; individuals receiving CGT responded more quickly and were more likely to respond overall (51% vs 28%). This article briefly summarizes the conceptual underpinnings of CGT, discusses the empirical evidence for its efficacy, describes its techniques, and presents a case example of a client treated in a 16-session manualized CGT protocol. The article concludes with a description of future research directions for CGT.

Effectiveness of group psychotherapy for adult outpatients traumatized by abuse, neglect, and/or pregnancy loss: a multiple-site, pre-post-follow-up, naturalistic study

The New Experience for Survivors of Trauma (NEST) is a group psychotherapy intervention for clients traumatized by consequences of abuse, neglect, and pregnancy loss. This multiple site study is the first investigation of its effectiveness. Ninety outpatients from a naturalistic setting completed the Symptom Checklist and the Sense of Coherence questionnaire at baseline, end of treatment, and one-year follow-up. Effectiveness was tested with statistical significance, effect size, and clinical significance. Clients from the total sample as well as from the abortion subsample showed improvement at the end of treatment and at follow-up. Lack of a control group is balanced to some extent by the high ecological validity. The findings suggest that the NEST treatment may be beneficial for traumatized clients and call for further research.

Psychodynamic treatment of depression

Findings reviewed in this article show that PT should be included in treatment guidelines for depression. BPT in particular has been found to be superior to control conditions, equally effective as other active psychological treatments, with treatment effects that are often maintained in the long run, conferring resistance to relapse. Moreover, BPT is as effective as pharmacotherapy in the acute treatment of mild to moderate depression, and, either as monotherapy or combined with medication, BPT is associated with better long-term outcome compared with pharmacotherapy alone. PT is accepted by many depressed patients as a viable and preferred treatment. Furthermore, LTPT and PA have shown promise in treating patients with complex psychological disorders characterized by mood problems, often with comorbid personality problems. Finally, although studies suggest that effects of PT may be achieved somewhat slower compared with other forms of psychotherapy as well as medication in the acute treatment of depression, LTPT appears to be more clinically effective and perhaps more cost effective in the long run, particularly for chronically depressed patients. As noted, these conclusions need to be interpreted within the context of important limitations. Compared with other treatments, the evidence base for PT in depression remains relatively small, despite a respectable research tradition supporting psychodynamic assumptions with regard to the causation of depression. Moreover, and perhaps most importantly, although more studies now include longer follow-up assessments, our knowledge about the long-term effects of so-called evidence-based treatments of depression remains sketchy at best. In this context, the growing evidence for the efficacy and effectiveness of LTPT is promising. Overall, it is clear that the future of the treatment of depression may lie in a combined disorder- and person-centered, tailored-made approach, which takes into account, particularly in chronic depression, the broader interpersonal context and life history of the individual. It is clear that psychodynamic therapies have an important role to play in this respect.

Report on a Systematic Review of the Efficacy and Clinical Effectiveness of Group Analysis and Analytic/Dynamic Group Psychotherapy

This article reports on a systematic review to assess the efficacy and clinical effectiveness of group analysis and analytic/dynamic (A/D) group psychotherapy. Systematic literature searches were undertaken; 34 primary studies and 19 reviews met the inclusion criteria and their data was extracted. Of the primary studies, the randomized controlled trials provided evidence for the efficacy and clinical effectiveness of group therapy approaches in a range of clinical problems, but not for specific benefits of any particular theoretical approach. The controlled studies and observational studies gave support for the use of group psychotherapy in a variety of conditions.

The review of reviews confirms that group therapies in general are more effective than wait list or standard care controls. Methodological challenges encountered and recommendations for further research are presented, along with a more detailed discussion of the implications of the review for the research community.

The impact of level of personality organization on treatment response: a systematic review

This paper provides a systematic review of extant research concerning the association between level of personality organization (PO) and psychotherapy response. Psychotherapy studies that reported a quantifiable association between level of PO and treatment outcome were examined for eligibility. Based on stringent inclusion and exclusion criteria, we identified 18 studies from 13 original data sources. Participants in these studies had a variety of mental disorders, of which mood, anxiety, and personality disorders were the most common. The results of this systematic review converge to suggest that higher initial levels of PO are moderately to strongly associated with better treatment outcome. Some studies indicate that level of PO may interact with the type of intervention (i.e., interpretive versus supportive) in predicting treatment outcome, which suggests the importance of tailoring the level of interpretive work to the level of PO. Yet, at the same time, the limited number of studies available and the heterogeneity of measures used to assess PO in existing research stress the need for further research. Potential implications for clinical practice and guidelines for future research are discussed.

Effect of alexithymia on the process and outcome of psychotherapy: a programmatic review

Most psychotherapeutic approaches assume that individuals have some access to their emotions. Thus, patients who are unable to identify, differentiate, and articulate their emotions present therapists with a difficult challenge. Such patients may suffer from alexithymia. Despite much attention in the clinical literature, research on alexithymia in the treatment setting has been sparse. Thus, many of the assumptions about psychotherapeutic treatment of alexithymic patients remain untested. This article summarizes findings from a series of studies that examined the effect of alexithymia on various aspects of the psychotherapeutic enterprise. Findings indicated that alexithymia has little effect on patients' treatment preferences, yet there was some tendency for alexithymic patients to prefer group therapy. However, alexithymia was associated with poor outcome in both traditional psychodynamic psychotherapy and supportive therapy. This negative effect was found in individual and group psychotherapies. In the context of group therapy, higher levels of alexithymic features elicited negative reactions from one's therapist, which partially contributed to the poor outcome experienced by such patients. Finally, the negative reaction that therapists had toward patients with high alexithymia appeared to be in response to the lack of positive emotion expressed by these patients. Clinical implications and ideas for future research are considered.

Complicated grief and related bereavement issues for DSM-5

Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally, grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief. Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence, some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over-and under-diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over-diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This article focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief. We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders.

Psychological mindedness and symptom reduction after psychotherapy in a heterogeneous psychiatric sample

BACKGROUND

Psychological mindedness (PM) has been claimed to be beneficial for outcome of various forms of psychotherapy. The purpose of this study was to investigate the influence of PM on the therapy results of a psychiatric patient sample with heterogeneous psychological symptoms.

METHODS

Participants were 110 patients with different diagnoses who were hospitalized at the Center for Psychological Recovery (Rosmalen, Netherlands). Before and after treatment, they were asked to complete the Balanced Index of Psychological Mindedness and the Symptom Checklist-90.

RESULTS

Baseline PM was not associated with a decrease in symptom scores (F(8,73) < 1.0; P > .20; partial eta(2) < 0.10). However, PM increased over the course of the intervention (F(2,84) = 43.54; P < .001; eta(2) = 0.51) and larger increases in the insight component of PM were associated with larger decreases on 6 of 8 symptom scores (F(8,70) = 3.55; P < .005; partial eta(2) = 0.29).

CONCLUSIONS

These results suggest that although a high PM is not a prerequisite for successful cognitive behavioral therapy, an increase in insight is associated with better outcome.

Psychological mindedness in relation to personality and coping in a sample of young adult psychiatric patients

Psychological mindedness (PM) is a relevant but rarely studied construct in clinical psychology. The aim was to examine the relationships among PM, personality, and coping in young adults with psychological difficulties. Sixty-three young women and 32 young men who were admitted for intake at a Dutch mental health institute completed relevant questionnaires. PM showed positive associations with the putatively adaptive personality characteristics of extraversion, openness, agreeableness, and conscientiousness and a negative correlation with neuroticism. In addition, PM was associated with problem-focused coping independently of the effect of personality characteristics. PM seems to be related to adaptive person characteristics in young adults with psychological difficulties. Longitudinal studies are needed to examine the issue of causality.