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Kempe S, Köpp W, Wittmann L. Personality Functioning Improvement during Psychotherapy Is Associated with an Enhanced Capacity for Affect Regulation in Dreams: A Preliminary Study. Brain Sci 2024; 14:489. [PMID: 38790467 PMCID: PMC11118223 DOI: 10.3390/brainsci14050489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Clinical case illustrations of patients with an impairment of personality functioning (IPF) have repeatedly reported that progress during psychotherapy is reflected by alterations in dream content. However, quantitative studies based on samples of psychotherapy patients are scarce. As a core component of both personality functioning and contemporary psychodynamic dream theory, the construct of affect regulation is of specific significance in this context. AIMS To test if improvement in personality functioning in the course of psychotherapy is associated with an increasing ability to regulate affects in dreams. METHOD In a longitudinal design, affect regulation was compared in N = 94 unsolicited dream reports from the first vs. last third of long term psychotherapy of ten patients with initial IPF. Dream reports were transcribed from recordings of the sessions. Expert ratings of the level of personality functioning were obtained using the Scales of Psychological Capacities. The capacity for affect regulation was assessed using the Zurich Dream Process Coding System. Group differences were assessed using linear mixed models, controlling for dream length as well as the nested structure of this data set. RESULTS Patients demonstrated an increased capacity for affect regulation in dreams that was primarily evident in three core features: the complexity of dream elements (cf., e.g., parameter attributes, p = 0.024); the extent of affective involvement in the dream ego (cf., e.g., parameter subject feeling, p = 0.014); and the flexibility to regulate the dynamics of safety/involvement processes (p ≤ 0.001). This pattern was especially prominent in a subgroup (n = 7) of patients with more pronounced improvements in personality functioning. CONCLUSION These findings support the hypotheses that decreasing IPF during psychotherapy is associated with increases in the capacity for affect regulation in dreams. Thus, researchers and therapists can utilize dream reports to illuminate the important aspects of treatment progress in clinical practice.
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Affiliation(s)
- Simon Kempe
- Department of Psychology, International Psychoanalytic University, Stromstraße 1, 10555 Berlin, Germany
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Laurila M, Lindfors O, Knekt P, Heinonen E. The effect of individual short- and long-term psychotherapy on perceived social support: analysis of secondary outcomes of a randomized clinical trial. Nord J Psychiatry 2024; 78:230-237. [PMID: 38323800 DOI: 10.1080/08039488.2024.2306229] [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: 08/26/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Social support is important for maintaining and restoring psychological well-being but the effects of individual psychotherapies on perceived social support are not well known. In this analysis of secondary outcomes from a randomized clinical study, we compared the effects of long-term psychotherapy and two short-term psychotherapies on social support during a 5-year follow-up. MATERIALS AND METHODS Altogether 326 adult outpatients suffering from depressive and/or anxiety disorders were randomly assigned to long-term psychodynamic psychotherapy (LPP, n = 126), short-term psychodynamic psychotherapy (SPP, n = 101) and solution-focused therapy (SFT, n = 97). Outcome was measured by the global index and six subscores of the self-reported Brief Inventory of Social Support and Integration scale (BISSI) at baseline and at 1, 2, 3, 4 and 5 years after the beginning of the therapy. RESULTS Social support improved in all therapy groups and the improvement was relatively stable, lasting several years after the end of therapy. Little difference in improvement was observed either between therapy orientations or durations. CONCLUSIONS While no major differences were observed between treatment groups, the slight differences call for further research to verify these findings and to better understand how different therapies may improve perceived social support.
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Affiliation(s)
- Matias Laurila
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Olavi Lindfors
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Paul Knekt
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Heinonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- University of Oslo, Oslo, Norway
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Krakau L, Leuzinger-Bohleber M, Brähler E, Schmidt P, Rost F, Huber D, Klug G, Löffler-Stastka H, Rössler-Schülein H, Leichsenring F, Salzer S, Brockmann J, Jakobsen T, Ernst M, Beutel ME. Efficacy of high-intensity versus low-intensity psychoanalytically oriented long-term treatments and determinants of outcome: individual participant data Meta-analysis of Long-term Analytic treatment Studies (MeLAS). BMJ Open 2023; 13:e069332. [PMID: 37474167 PMCID: PMC10357799 DOI: 10.1136/bmjopen-2022-069332] [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] [Indexed: 07/22/2023] Open
Abstract
INTRODUCTION Long-term psychodynamic/psychoanalytic psychotherapy (LTPP) is a prevalent treatment option for complex mental disorders. Yet, little is known about the role of treatment intensity in LTPP. We present a study protocol for a systematic review and individual participant data (IPD) meta-analysis aggregating and analysing individual data from randomised and quasi-experimental trials by meta-analysis. The purpose is to (1) determine the treatment effectiveness of LTPP with low versus high intensity (up to 2 weekly sessions vs three or more), (2) compare their joint effectiveness to shorter therapies and treatments as usual, (3) identify predictors and moderators of treatment outcomes and (4) determine reciprocal relationships between different outcome domains (symptomatic and structural/personality change) over the courses of LTPP. METHODS AND ANALYSIS We include studies from (randomised controlled trial, RCT) and quasi-experimental trials, where at least one condition was LTPP of high or low frequency. Long-term treatment is defined as ≥1 year or ≥50 sessions. To be eligible studies must include a standardised outcome measure of symptoms (global or disorder specific) with at least one proof of reliability. The primary outcome is symptom reduction (global or specific), secondary outcome criteria are reliable change, remission, functional capacities, personality, personality functioning and interpersonal pathology. Relevant studies will mainly be identified by searching relevant databases: PubMed, PsycINFO (via EBSCO), Web of Science (via Elsevier), Chochrane's Central Register of Controlled Trials (via Wiley). Risk of bias will be evaluated in line with the Cochrane assessments tools for quasi-experimental trials and RCTs, respectively. ETHICS AND DISSEMINATION Aggregation of data from primary trials collected based on ethics votes. Dissemination into clinical practice via open access publications of findings. PROSPERO REGISTRATION NUMBER CRD42022304982; Pre-results.
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Affiliation(s)
- Lina Krakau
- Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University, Mainz, Germany
| | - Marianne Leuzinger-Bohleber
- Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University, Mainz, Germany
| | - Elmar Brähler
- Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University, Mainz, Germany
- Department of Psychiatry and Psychotherapy Leipzig, Leipzig University Medical Center, Leipzig, Germany
| | - Peter Schmidt
- Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University, Mainz, Germany
| | - Felicitas Rost
- Tavistock and Portman NHS Foundation Trust, London, UK
- School of Psychology and Psychotherapy, Faculty of Arts and Social Sciences, The Open University, Milton Keynes, UK
| | - Dorothea Huber
- Department of Clinical Psychology and Psychosomatics, International Psychoanalytic University, Berlin, Germany
| | | | | | | | - Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Simone Salzer
- Clinical Psychology and Psychoanalysis, International Psychoanalytic University, Berlin, Germany
| | | | | | - Mareike Ernst
- Department of Clinical Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Manfred E Beutel
- Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University, Mainz, Germany
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Werbart A, Lagerlöf S. How much time does psychoanalysis take? The duration of psychoanalytic treatments from Freud's cases to the Swedish clinical practice of today. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2022; 103:786-805. [PMID: 36200357 DOI: 10.1080/00207578.2022.2050463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The starting point for this paper is Freud's thinking about the length of psychoanalysis and the conditions for ending it. His psychoanalytic treatments were intense, but varied greatly in length. Freud's assertion that deep psychological changes take time is still topical; however, the length of time has gradually increased. Available documentation from psychoanalytic training institutes, and findings from empirical studies, indicate that the mean length of psychoanalysis ranges from between three to seven years, and varies between different countries and periods. A recent survey among Swedish psychoanalysts found a mean length of 5.7 years and a wide variation in length from 1.5 to 12 years. Discussions in a seminar group on endings and the qualitative follow-up survey showed that a unique combination of factors determined the duration of psychoanalysis in each individual case. We briefly review the potential determinants of the treatment length and the different meanings of time in open-ended psychoanalytic treatments. To conclude, we stress the need for systematic clinical and empirical studies of determinants and the underlying processes behind the different lengths of psychoanalyses.
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Affiliation(s)
- Andrzej Werbart
- Swedish Psychoanalytical Association, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Sven Lagerlöf
- Swedish Psychoanalytical Association, Stockholm, Sweden
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Stefana A, D’Imperio D, Dakanalis A, Vieta E, Fusar-Poli P, Youngstrom E. Probing the impact of psychoanalytic therapy for bipolar disorders: A scoping review. INTERNATIONAL FORUM OF PSYCHOANALYSIS 2022. [DOI: 10.1080/0803706x.2022.2097307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Jankowski PJ, Hall E, Crabtree SA, Sandage SJ, Bronstein M, Sandage D. Risk, Symptoms, and Well‐Being: Emerging Adult Latent Profiles During Treatment. JOURNAL OF COUNSELING AND DEVELOPMENT 2021. [DOI: 10.1002/jcad.12396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Peter J. Jankowski
- Albert and Jessie Danielsen Institute Boston University, and Counseling Program, Bethel University
| | - Eugene Hall
- Albert and Jessie Danielsen Institute Boston University
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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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[Looking into international journals]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 64:411-414. [PMID: 30829166 DOI: 10.13109/zptm.2018.64.4.411] [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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Jankowski PJ, Sandage SJ, Bell CA, Rupert D, Bronstein M, Stavros GS. Latent trajectories of change for clients at a psychodynamic training clinic. J Clin Psychol 2019; 75:1147-1168. [PMID: 30817007 DOI: 10.1002/jclp.22769] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 02/13/2019] [Accepted: 02/13/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Employing practice-based research methods, we addressed the need to examine the effectiveness of psychodynamic treatment as a supplement to the efficacy evidence offered by randomized clinical trials. METHOD We used person-centered analyses to generate latent subgroups of clients (N = 118; M age = 40.92; 53.4% female; 81.4% Caucasian; 80.5% heterosexual) receiving contemporary relational psychotherapy (CRP) at a psychodynamic community mental health training clinic. RESULTS Subgroups of clients reported a change in depression, social conflict, and anxiety symptomatology, and overall life satisfaction, depicted by significant quadratic growth curves. Findings also offered exploratory support for a theoretical proposition from CRP that improved relational functioning would correspond to improved affect dysregulation and overall life satisfaction. CONCLUSION Clinical and training implications highlight the need to distinguish subgroups of "responders" and "nonresponders" to inform treatment.
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Affiliation(s)
- Peter J Jankowski
- Counseling Program, Bethel University, St. Paul, Minnesota.,Albert and Jessie Danielsen Institute, Boston University, Boston, Massachusetts
| | - Steven J Sandage
- Albert and Jessie Danielsen Institute, Boston University, Boston, Massachusetts
| | - Chance A Bell
- Albert and Jessie Danielsen Institute, Boston University, Boston, Massachusetts
| | - David Rupert
- Albert and Jessie Danielsen Institute, Boston University, Boston, Massachusetts
| | - Miriam Bronstein
- Albert and Jessie Danielsen Institute, Boston University, Boston, Massachusetts
| | - George S Stavros
- Albert and Jessie Danielsen Institute, Boston University, Boston, Massachusetts
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Lindfors O, Knekt P, Lehtonen J, Virtala E, Maljanen T, Härkänen T. Effectiveness of psychoanalysis and long-term psychodynamic psychotherapy on personality and social functioning 10 years after start of treatment. Psychiatry Res 2019; 272:774-783. [PMID: 30832198 DOI: 10.1016/j.psychres.2018.12.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 11/30/2018] [Accepted: 12/16/2018] [Indexed: 11/18/2022]
Abstract
The evidence on potentially greater benefits of psychoanalysis (PA) vs. long-term psychodynamic psychotherapy (LPP) is scarce. This study compared the effectiveness of PA and LPP on personality and social functioning during a 10-year follow-up from the beginning of the treatments. The eligible patients, 41 self-selected for PA and 128 assigned to LPP, were 20-45 years of age and had anxiety or mood disorder. Outcomes were analyzed using ten standard measures of personality and social functioning, carried out 5-9 times during the follow-up. Different change patterns by time in PA and LPP emerged, suggesting less benefit of PA during the first years of follow-up and more benefit in most outcomes thereafter. Greater post-treatment improvement in PA than in LPP was seen up to 1-2 years after PA had ended in more mature defense style (DSQ), level of personality organization (LPO), more positive self-concept (SASB), more improved social adjustment (SAS-SR) and sense of coherence (SOC). However, at the 10-year follow-up the differences were non-significant. In conclusion, PA may give some additional benefits when long-term aims are linked to personality and social functioning. The relatively small differences and higher costs in comparison to LPP may restrict the feasibility of PA.
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Affiliation(s)
- Olavi Lindfors
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland; University of Helsinki, Helsinki, Finland.
| | - Paul Knekt
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland
| | - Johannes Lehtonen
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland; University of Eastern Finland, Kuopio, Finland
| | - Esa Virtala
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland
| | - Timo Maljanen
- The Social Insurance Institution, Helsinki, Finland; National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, P. O. Box 30, 00271, Helsinki, Finland
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Löffler-Stastka H, Sell C, Zimmermann J, Huber D, Klug G. Is countertransference a valid source of clinical information? Investigating emotional responses to audiotaped psychotherapy sessions. Bull Menninger Clin 2019; 83:353-375. [PMID: 31180236 DOI: 10.1521/bumc_2019_83_02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The study aimed to test whether countertransference reactions contain valid information about the patient. The authors examined whether a significant part of the variance in emotional, cognitive, and motivational responses to recorded therapy sessions is attributable to the patient. Six student raters listened to 605 audiotaped sessions of 81 patients with major depression treated by 19 therapists and indicated their reactions using a modified version of the Countertransference Questionnaire. The relative amount of variance in countertransference reactions due to differences between patients, ranging from 2% to 16%, was significant for most of the countertransference dimensions. Reactions were influenced by type of treatment and severity of depression but not by comorbid personality disorder or interpersonal problems. The relative amount of variance due to differences between raters was large, averaging at 23%. The authors conclude that-albeit having a relatively low "signal-to-noise ratio"in raters without psychotherapy training-countertransference reactions contain valid clinical information.
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Affiliation(s)
| | | | | | - Dorothea Huber
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Guenther Klug
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technische Universität München, Germany
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Yakeley J. Psychoanalysis in modern mental health practice. Lancet Psychiatry 2018; 5:443-450. [PMID: 29574047 DOI: 10.1016/s2215-0366(18)30052-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/13/2018] [Accepted: 01/18/2018] [Indexed: 01/09/2023]
Abstract
Like any discipline, psychoanalysis has evolved considerably since its inception by Freud over a century ago, and a multitude of different psychoanalytic traditions and schools of theory and practice now exist. However, some of Freud's original ideas, such as the dynamic unconscious, a developmental approach, defence mechanisms, and transference and countertransference remain essential tenets of psychoanalytic thinking to this day. This Review outlines several areas within modern mental health practice in which contemporary adaptations and applications of these psychoanalytic concepts might offer helpful insights and improvements in patient care and management, and concludes with an overview of evidence-based psychoanalytically informed treatments and the links between psychoanalysis, attachment research, and neuroscience.
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Affiliation(s)
- Jessica Yakeley
- Portman Clinic, The Tavistock and Portman NHS Foundation Trust, London, UK.
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Knekt P, Lindfors O, Keinänen M, Heinonen E, Virtala E, Härkänen T. The prediction of the level of personality organization on reduction of psychiatric symptoms and improvement of work ability in short- versus long-term psychotherapies during a 5-year follow-up. Psychol Psychother 2017; 90:353-376. [PMID: 28035751 DOI: 10.1111/papt.12115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 09/08/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES How level of personality organization (LPO) predicts psychiatric symptoms and work ability in short- versus long-term psychotherapies is poorly known. We investigated the importance of the LPO on the benefits of short-term versus long-term psychotherapies. DESIGN A cohort study based on 326 outpatients with mood or anxiety disorder was allocated to long-term (LPP) and short-term (SPP) psychodynamic psychotherapy, and solution-focused therapy (SFT). METHODS The LPO was assessed by interview at baseline and categorized into neuroses and higher level borderline. Outcome was assessed at baseline and 4-9 times during a 5-year follow-up, using self-report and interview-based measures of symptoms and work ability. RESULTS For patients receiving SPP, improvement in work ability, symptom reduction, and the remission rate were more considerable in patients with neuroses than in higher level borderline patients, whereas LPP or SFT showed no notable differences in effectiveness in the two LPO groups. In patients with neuroses, improvement was more considerable in the short-term therapy groups during the first year of follow-up, and in higher level borderline patients LPP was more effective after 3 years of follow-up. The remission rate, defined as both symptom reduction and lack of auxiliary treatment, was higher in LPP than in SPP for both the LPO groups considered. CONCLUSIONS In neuroses, short-term psychotherapy was associated with a more rapid reduction of symptoms and increase in work ability, whereas LPP was more effective for longer follow-ups in both LPO groups. Further large-scale studies are needed. PRACTITIONER POINTS Level of personality organization is relevant for selection between short- and long-term psychotherapies. Short-term therapy gives faster benefits for neurotic patients but not for patients with higher level borderline personality organization. Sustained remission from symptoms is more probable after long-term than short-term therapy.
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Affiliation(s)
- Paul Knekt
- National Institute for Health and Welfare, Helsinki, Finland.,Biomedicum Helsinki, Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Erkki Heinonen
- National Institute for Health and Welfare, Helsinki, Finland
| | - Esa Virtala
- National Institute for Health and Welfare, Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, Helsinki, Finland
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Mulay AL, Kelly E, Cain NM. Psychodynamic Treatment of the Criminal Offender: Making the Case for Longer-Term Treatment in a Longer-Term Setting. Psychodyn Psychiatry 2017; 45:143-173. [PMID: 28590205 DOI: 10.1521/pdps.2017.45.2.143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years, prisons and jails have become de facto psychiatric hospitals, responsible for the care and treatment of individuals with serious mental illness. Historically, cognitive-behaviorally informed therapeutic approaches have been the treatment of choice among mental health practitioners in correctional settings. However, inmate-clients often present with complex diagnostic issues that are arguably better served by long-term treatment options, such as psychodynamic psychotherapy. We first review the nature of psychotherapy in the correctional setting, as well as treatment barriers and challenges faced by both mental health providers and inmate-clients. We then review treatment studies that examine the efficacy of various therapeutic techniques in correctional/forensic contexts. Finally, we argue that, due to the complex nature of psychopathology, average length of time incarcerated, and treatment issues that arise in this multifaceted and challenging setting, mental health treatment providers should consider providing psychodynamic treatment modalities when working with incarcerated individuals. We also argue that more research is needed to examine the efficacy of these treatment approaches with inmate-clients.
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Ratzek M, Brandl T, Huber D. Standardisierte vergleichende Kasuistiken von psychoanalytisch begründeten Psychotherapien. FORUM DER PSYCHOANALYSE 2017. [DOI: 10.1007/s00451-017-0266-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Huber D, Klug G. Research evidence and the provision of long-term and open-ended psychotherapy and counselling in Germany. EUROPEAN JOURNAL OF PSYCHOTHERAPY & COUNSELLING 2017. [DOI: 10.1080/13642537.2017.1313880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Dorothea Huber
- Klinik für Psychosomatische Medizin und Psychotherapie, Klinikum München, München, Germany
- Clinic and Polyclinic for Psychosomatic, International Psychoanalytic University, Berlin, Germany
| | - Guenther Klug
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technische Universität München, München, Germany
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A Comparison of Psychoanalytic Therapy and Cognitive Behavioral Therapy for Anxiety (Panic/Agoraphobia) and Personality Disorders (APD Study): Presentation of the RCT Study Design. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2017; 62:252-69. [PMID: 27594602 DOI: 10.13109/zptm.2016.62.3.252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Anxiety disorders, most notably panic disorders and agoraphobia, are common mental disorders, and there is a high comorbidity with personality disorders. Randomized controlled trails addressing this highly relevant group of patients are missing. DESIGN The multicenter Anxiety and Personality Disorders (APD) study investigates 200 patients with panic disorder and/or agoraphobia with comorbid personality disorder in a randomized control-group comparison of psychoanalytic therapy (PT) and cognitive behavioral therapy (CBT), including 100 patients in each group. Each patient will be examined over a period of six years, regardless of the duration of the individual treatment. The main issues that are addressed in this study are the comparison of the efficacy of PT and CBT in this special patient population, the comparison of the sustainability of the effects of PT and CBT, the comparison of the long-term cost-benefit-ratios of PT and CBT as well as the investigation of prescriptive patient characteristics for individualized treatment recommendations (differential indication). DISCUSSION The APD study compares efficacy, sustainability, and cost-benefit-ratios of CBT and PT for anxiety plus personality disorders in a randomized controlled trail. The study design meets the requirements for an efficacy study for PT, which were recently defined. TRIAL REGISTRATION Current Controlled Trials ISRCTN12449681.
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What we know, what we do not know, and where are we heading? Efficacy and acceptability of psychological interventions for depression. Epidemiol Psychiatr Sci 2016; 25:301-8. [PMID: 26411324 PMCID: PMC7137604 DOI: 10.1017/s2045796015000815] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
In the past several decades, increasing evidence supports the efficacy of psychotherapies for depression. The vast majority of findings from meta-analyses, randomized clinical trials (RCTs) and naturalistic studies have demonstrated that well-established psychotherapies (behavioural activation, problem-solving therapy, psychodynamic therapy, cognitive-behavioural therapy, interpersonal therapy and emotion-focused therapy) are superior to no-treatment and control conditions, and are in most cases equally effective in treating depression. However, despite this abundant support for psychotherapies, studies have also consistently shown high drop-out rates, high percentages of non-respondent patients who experience treatment failures, and mixed findings regarding the enduring effects of psychotherapy. Thus, there is a need to develop more personalised treatment models tailored to patients' needs. A new integrative sequential stepwise approach to the treatment of depression is suggested.
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Klug G, Zimmermann J, Huber D. Outcome trajectories and mediation in psychotherapeutic treatments of major depression. J Am Psychoanal Assoc 2016; 64:307-43. [PMID: 27151999 DOI: 10.1177/0003065116644742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Indexed: 11/16/2022]
Abstract
Trajectories and mediators of change were investigated in a process-outcome study. Patients were allocated at random to psychoanalytic therapy (PA) or psychodynamic therapy (PD), and later to cognitive-behavioral therapy (CBT). Measurement points were at pre-treatment, during ongoing treatment, at post-treatment, and during a three-year follow-up. Outcome trajectories were assessed using the Beck Depression Inventory (BDI; Hautzinger et al. 1994), the Symptom Checklist 90 Revised Version (SCL-90-R; Franke 1995), and the Inventory of Interpersonal Problems (IIP; Horowitz, Strauss, and Kordy 2000). Therapeutic alliance and introject were tested as mediators, assessed using the Helping Alliance Questionnaire (HAQ; Bassler, Potratz, and Krauthauser 1995) and INTREX, introject surface (Tress 1993). Multilevel modeling was applied to estimate outcome trajectories and to test for mediation. Symptoms decreased in early and ongoing treatment in all treatment groups. After the end of treatment, depressive and general psychiatric symptoms continued to decrease in significantly greater degree in the PA group than in the PD and CBT cohorts. During early treatment, interpersonal problems decreased significantly more in those allocated to PD than in the PA and CBT groups. During ongoing treatment, improvement in interpersonal problems was significantly higher in the PA group than in the others and, compared to CBT, continued to increase significantly after termination. Mediational analyses revealed that neither introject affiliation nor therapeutic alliance mediated differential treatment effects.
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Lorentzen S, Fjeldstad A, Ruud T, Høglend PA. Comparing Short- and Long-Term Group Therapy: Seven-Year Follow-Up of a Randomized Clinical Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2016; 84:320-1. [PMID: 26279294 DOI: 10.1159/000381751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/17/2015] [Indexed: 11/19/2022]
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Jobst A, Brakemeier EL, Buchheim A, Caspar F, Cuijpers P, Ebmeier KP, Falkai P, Jan van der Gaag R, Gaebel W, Herpertz S, Kurimay T, Sabaß L, Schnell K, Schramm E, Torrent C, Wasserman D, Wiersma J, Padberg F. European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe. Eur Psychiatry 2016; 33:18-36. [PMID: 26854984 DOI: 10.1016/j.eurpsy.2015.12.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given. METHODS We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders. RESULTS We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences. DISCUSSION The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD. CONCLUSION Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm.
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Affiliation(s)
- A Jobst
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - E-L Brakemeier
- Department of Clinical Psychology and Psychotherapy, Berlin University of Psychology, Berlin, Germany
| | - A Buchheim
- Department of Psychology, Clinical Psychology, University of Innsbruck, Innsbruck, Austria
| | - F Caspar
- Institute of Psychology, University of Bern, Bern, Switzerland
| | - P Cuijpers
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - K P Ebmeier
- Department of Psychiatry, Division of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - P Falkai
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | | | - W Gaebel
- Department of Psychiatry und Psychotherapy, Heinrich Heine University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - S Herpertz
- Department of Psychiatry and Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - T Kurimay
- Institute of Behaviour Sciences, Semmelweis University, Budapest, Hungary
| | - L Sabaß
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany
| | - K Schnell
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - E Schramm
- Department of Psychiatry and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - C Torrent
- Clinical Institute of Neuroscience, Hospital Clinic Barcelona, CIBERSAM, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - D Wasserman
- National Centre for Suicide Research and Prevention of Mental lll-Health (NASP), Karolinska Institutet, Stockholm, Sweden
| | - J Wiersma
- Department of Psychiatry, GGZinGeest, Amsterdam, The Netherlands
| | - F Padberg
- Department of Psychiatry und Psychotherapy, Ludwig Maximilian University, Munich, Germany.
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Maljanen T, Knekt P, Lindfors O, Virtala E, Tillman P, Härkänen T. The cost-effectiveness of short-term and long-term psychotherapy in the treatment of depressive and anxiety disorders during a 5-year follow-up. J Affect Disord 2016; 190:254-263. [PMID: 26540079 DOI: 10.1016/j.jad.2015.09.065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
Both short-term and long-term psychotherapies are used extensively in treating different mental disorders, but there have been practically no attempts to compare their cost-effectiveness. The aim of this study, which is part of the Helsinki Psychotherapy Study, is to assess the cost-effectiveness of two short-term therapies compared to that of a long-term therapy. In this study 326 outpatients suffering from mood or anxiety disorder were randomized to solution-focused therapy (SFT), short-term psychodynamic psychotherapy (SPP) or to long-term psychodynamic psychotherapy (LPP). Psychiatric symptoms and working ability were assessed at baseline and then 4-9 times during a 5-year follow-up using eight widely used measures including e.g. Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), Symptom Check List, anxiety scale (SCL-90-Anx), Hamilton Anxiety Rating Scale (HARS), Symptom Check List, Global Severity Index (SCL-90-GSI), and the Work-subscale (SAS-Work) of the Social Adjustment Scale (SAS-SR). Both direct and indirect costs were measured. During the 5-year follow-up period statistically significant improvements were observed in all health indicators in all therapy groups. At first the recovery was faster in the short-term therapy groups than in the LPP group, but taking the whole follow-up period into account, the effectiveness of the LPP was somewhat greater than that of the short-term therapies. Especially the direct costs were, however, much higher in the LPP group than in the short-term therapy groups. Thus the long-term therapy can hardly be regarded as cost-effective compared to short-term therapies when patients are randomized to the therapy groups.
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Affiliation(s)
- Timo Maljanen
- Social Insurance Institution, P.O. Box 450, FI-00101 Helsinki, Finland.
| | - Paul Knekt
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland
| | - Olavi Lindfors
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Esa Virtala
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
| | - Päivi Tillman
- Social Insurance Institution, P.O. Box 450, FI-00101 Helsinki, Finland
| | - Tommi Härkänen
- National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland
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- Social Insurance Institution, P.O. Box 450, FI-00101 Helsinki, Finland; National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland; Biomedicum Helsinki, Helsinki, Finland; Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland; Rehabilitation Foundation, Helsinki, Finland
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Zimmermann J, Löffler-Stastka H, Huber D, Klug G, Alhabbo S, Bock A, Benecke C. Is It All about the Higher Dose? Why Psychoanalytic Therapy Is an Effective Treatment for Major Depression. Clin Psychol Psychother 2015; 22:469-87. [PMID: 25196642 DOI: 10.1002/cpp.1917] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 07/08/2014] [Accepted: 07/29/2014] [Indexed: 02/05/2023]
Abstract
UNLABELLED Empirical evidence for the effectiveness of long-term psychodynamic psychotherapy (LTPP) in patients with mood disorders is growing. However, it is unclear whether the effectiveness of LTPP is due to distinctive features of psychodynamic/psychoanalytic techniques or to a higher number of sessions. We tested these rival hypotheses in a quasi-experimental study comparing psychoanalytic therapy (i.e., high-dose LTPP) with psychodynamic therapy (i.e., low-dose LTPP) and cognitive-behavioural therapy (CBT) for depression. Analyses were based on a subsample of 77 subjects, with 27 receiving psychoanalytic therapy, 26 receiving psychodynamic therapy and 24 receiving CBT. Depressive symptoms, interpersonal problems and introject affiliation were assessed prior to treatment, after treatment and at the 1-, 2- and 3-year follow-ups. Psychoanalytic techniques were assessed from three audiotaped middle sessions per treatment using the Psychotherapy Process Q-Set. Subjects receiving psychoanalytic therapy reported having fewer interpersonal problems, treated themselves in a more affiliative way directly after treatment and tended to improve in depressive symptoms and interpersonal problems during follow-up as compared with patients receiving psychodynamic therapy and/or CBT. Multilevel mediation analyses suggested that post-treatment differences in interpersonal problems and introject affiliation were mediated by the higher number of sessions, and follow-up differences in depressive symptoms were mediated by the more pronounced application of psychoanalytic techniques. We also found some evidence for indirect treatment effects via psychoanalytic techniques on changes in introject affiliation during follow-up. These results provide support for the prediction that both a high dose and the application of psychoanalytic techniques facilitate therapeutic change in patients with major depression. KEY PRACTITIONER MESSAGE Psychoanalytic therapy is an effective treatment for major depression, especially in the long run. The differential effectiveness of psychoanalytic therapy cannot be fully explained by its higher dose. Distinctive features of psychoanalytic technique (e.g., focusing on patients' dreams, fantasies, sexual experiences or childhood memories) may play an important role in establishing sustained therapeutic change.
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Affiliation(s)
| | | | - Dorothea Huber
- International Psychoanalytic University Berlin, Berlin, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum München-Harlaching, Munich, Germany
| | - Günther Klug
- Department of Psychosomatic Medicine, Technical University Munich, Munich, Germany
| | - Sarah Alhabbo
- Department of Psychology, University of Kassel, Kassel, Germany
| | - Astrid Bock
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Cord Benecke
- Department of Psychology, University of Kassel, Kassel, Germany
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Abstract
This paper provides a comprehensive review of outcome studies and meta-analyses of effectiveness studies of psychodynamic therapy (PDT) for the major categories of mental disorders. Comparisons with inactive controls (waitlist, treatment as usual and placebo) generally but by no means invariably show PDT to be effective for depression, some anxiety disorders, eating disorders and somatic disorders. There is little evidence to support its implementation for post-traumatic stress disorder, obsessive-compulsive disorder, bulimia nervosa, cocaine dependence or psychosis. The strongest current evidence base supports relatively long-term psychodynamic treatment of some personality disorders, particularly borderline personality disorder. Comparisons with active treatments rarely identify PDT as superior to control interventions and studies are generally not appropriately designed to provide tests of statistical equivalence. Studies that demonstrate inferiority of PDT to alternatives exist, but are small in number and often questionable in design. Reviews of the field appear to be subject to allegiance effects. The present review recommends abandoning the inherently conservative strategy of comparing heterogeneous "families" of therapies for heterogeneous diagnostic groups. Instead, it advocates using the opportunities provided by bioscience and computational psychiatry to creatively explore and assess the value of protocol-directed combinations of specific treatment components to address the key problems of individual patients.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, and The Anna Freud Centre, London, UK
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Ratzek M, Huber D, Klug G. Development of an Adherence Scale for Differentiation between Psychodynamic Psychotherapy and Psychoanalytic Psychotherapy. J Am Psychoanal Assoc 2015; 63:NP23-7. [PMID: 26185299 DOI: 10.1177/0003065115594457] [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: 11/17/2022]
Affiliation(s)
| | - Dorothea Huber
- International Psychoanalytic University, Berlin; Department of Psychosomatic Medicine and Psychotherapy, Klinikum München
| | - Günther Klug
- Klinik und Poliklinic für Psychosomatische Medizin und Psychotherapie, Klinikum rects der Isar, Technische Universität München
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Leichsenring F, Schauenburg H. Empirically supported methods of short-term psychodynamic therapy in depression - towards an evidence-based unified protocol. J Affect Disord 2014; 169:128-43. [PMID: 25194781 DOI: 10.1016/j.jad.2014.08.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/22/2014] [Accepted: 08/04/2014] [Indexed: 12/28/2022]
Abstract
CONTEXT There is evidence that psychotherapy is helpful in depressive disorders, with no significant differences between psychotherapies. For psychodynamic therapy (PDT) various models prove to be efficacious. Thus, the evidence for PDT is "scattered" between different forms of PDT, also implying problems in training of psychotherapy and in transferring research to clinical practice. A unified protocol based on empirically-supported methods of PDT in depression may contribute to solve these problems METHODS Systematic search for randomized controlled trials fulfilling the following criteria: (a) individual psychodynamic therapy (PDT) of depressive disorders, (b) treatment manuals or manual-like guidelines, (c) PDT proved to be efficacious compared to control conditions, (d) reliable measures for diagnosis and outcome, and (f) adult patients. FINDINGS Fourteen RCTs fulfilled the inclusion criteria. By a systematic review of the applied methods of PDT seven treatment components were identified. A high consistency between components was found. The components were conceptualized in the form of seven interrelated treatment modules. CONCLUSIONS A unified psychodynamic protocol for depression may enhance the empirical status of PDT, facilitate both the training in psychotherapy and the transfer of research to clinical practice and may have an impact on the health care system.
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Affiliation(s)
- Falk Leichsenring
- Clinic of Psychosomatics and Psychotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen, Germany.
| | - Henning Schauenburg
- Clinic for General Internal Medicine and Psychosomatics, University of Heidelberg, Germany
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Steinert C, Hofmann M, Kruse J, Leichsenring F. Relapse rates after psychotherapy for depression - stable long-term effects? A meta-analysis. J Affect Disord 2014; 168:107-18. [PMID: 25043322 DOI: 10.1016/j.jad.2014.06.043] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 01/04/2023]
Abstract
BACKGROUND Depression is the most common mental disorder. Effective psychotherapeutic treatments for depression exist; however, data on their long-term effectiveness beyond a time span of two years is still scarce. Our aim was to perform a meta-analysis, investigating (a) overall rates of relapse more than two years after psychotherapy (meta-analysis 1), and (b) if psychotherapy has more enduring effects than non-psychotherapeutic comparison conditions (e.g. pharmacotherapy, treatment as usual), again beyond a time span of two years post-therapy (meta-analysis 2). METHODS We searched electronic databases Medline, PsycINFO and the COCHRANE Library. Main selection criteria were (i) RCT of psychotherapy with follow-up interval of more than 2 years, (ii) primary diagnosis of depression, assessed by observer ratings, (iii) report of relapse at follow-up. RESULTS We identified 11 studies, 6 of which included a non-psychotherapeutic comparison condition. Together they comprised long-term data of 966 patients. Mean follow-up duration was 4.4 years. The overall relapse rate at long-term follow-up was 0.39 (95% CI 0.29, 0.50). Psychotherapy resulted in significantly less relapses (53.1% vs. 71.1%, OR 0.51; 95% CI 0.32, 0.82, p=0.005) than comparison treatments. This finding corresponded to a number needed to treat (NNT) of 5.55. LIMITATIONS Results can only be preliminary as data was sparse and studies differed methodologically. Heterogeneity in the first meta-analysis was high (I(2)=82%). Results indicated publication bias. CONCLUSIONS The relapse rate more than two years after psychotherapy is relatively high, but significantly lower compared to non-psychotherapeutic treatments. Multiannual follow-ups should routinely be included in future psychotherapy RCTs.
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Affiliation(s)
- Christiane Steinert
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen, Germany.
| | - Mareike Hofmann
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen, Germany
| | - Johannes Kruse
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen, Germany; Clinic for Psychosomatic Medicine and Psychotherapy, University of Marburg, Germany
| | - Falk Leichsenring
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Giessen, Ludwigstrasse 76, 35392 Giessen, Germany
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Seybert C, Huber D, Ratzek M, Zimmermann J, Klug G. How to Capture Emotional Processing in a Process-Outcome Study of Psychoanalytic, Psychodynamic, and Cognitive-Behavioral Psychotherapies. J Am Psychoanal Assoc 2014; 62:NP4-NP8. [PMID: 24973397 DOI: 10.1177/0003065114539840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Dorothea Huber
- International Psychoanalytic University, Berlin; Department of Psychosomatic Medicine and Psychotherapy, Clinical Center, München
| | | | | | - Günther Klug
- Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, Technische Universität München
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Martin S. Journal Watch review of The efficacy of cognitive-behavioral therapy and psychodynamic therapy in the outpatient treatment of major depression: a randomized clinical trial. J Am Psychoanal Assoc 2014; 62:116-8. [PMID: 24610763 DOI: 10.1177/0003065114525237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Clapp JD, Grubaugh AL, Allen JG, Oldham JM, Fowler JC, Hardesty S, Frueh BC. Interpersonal Change Following Intensive Inpatient Treatment. Psychiatry 2014; 77:247-62. [PMID: 25162133 PMCID: PMC4267225 DOI: 10.1521/psyc.2014.77.3.247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Persons admitted for inpatient psychiatric care often present with interpersonal difficulties that disrupt adaptive social relations and complicate the provision of treatment. Whereas domains of psychosocial functioning in this population demonstrate clear growth in response to intervention, the impact of treatment on more complex patterns of interpersonal behavior has been largely overlooked within the existing literature. Interpersonal profiles characteristic of psychiatric inpatients were identified in the current study to determine rates of transition to adaptive functioning following hospitalization. METHODS Personality disturbance was assessed in 513 psychiatric inpatients using the Inventory of Interpersonal Problems. Scores were analyzed within a series of latent profile models to isolate unique interpersonal profiles at admission and at discharge. Longitudinal modeling was then employed to determine rates of transition from dysfunctional to adaptive profiles. Relationships with background characteristics, clinical presentation, and treatment response were explored. RESULTS Normative, Submissive, and Hostile/Withdrawn profiles emerged at both admission and discharge. Patients in the Normative profile demonstrated relatively moderate symptoms. Submissive and Hostile/Withdrawn profiles were related to known risk factors and elevated psychopathology. Approximately half of the patients who had been identified as Submissive or Hostile/Withdrawn transitioned to the Normative profile by discharge. Transition status evidenced modest associations with background characteristics and clinical presentation. Treatment engagement and reduction of clinical symptoms were strongly associated with adaptive transition. CONCLUSION Maladaptive interpersonal profiles characteristic of psychiatric inpatients demonstrated categorical change following inpatient hospitalization. Enhanced therapeutic engagement and overall reductions in psychiatric symptoms appear to increase potential for interpersonal change.
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Was macht stationäre Psychotherapie erfolgreich? Der Einfluss von Patienten- und Behandlungsmerkmalen auf den Therapieerfolg in der stationären Psychotherapie. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2013. [DOI: 10.13109/zptm.2013.59.3.273] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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