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Longobardo A, Dirri F, Palomba E, Berthoud L, Hutzler A, Smith C, Russell S. Critical Aspects of Material Selection in the Packaging and Transporting of Returned Extraterrestrial Samples. Astrobiology 2023; 23:786-795. [PMID: 37294542 DOI: 10.1089/ast.2022.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the framework of the EU-funded EURO-CARES project, aimed at determining the actions to develop a European facility for curation of extraterrestrial samples returned by space missions, we identified the requirements (mainly in terms of materials selection) of the transportation containment facility which should contain the Sample Return Capsule (SRC), which in turn contains the extraterrestrial material returned to Earth. Transportation box design for restricted (i.e., possibly related to biological life) and unrestricted samples is different. Packaging and transport of restricted samples must guarantee the samples' preservation from the terrestrial environment and the safety of people performing these operations and, hence, must be done according to World Health Organization (WHO) rules. In the case of unrestricted samples, the only requirement is sample preservation. We propose a triple packaging as follows: (1) primary receptacle; (2) secondary package (plastic material), optional for unrestricted samples; (3) rigid, cushioned outer layer. Only for restricted samples, an additional layer is proposed, that is, the overpack. The primary receptacle coincides with the SRC. The plastic material of the secondary package must have a low outgassing rate (i.e., <10-7 torr/s) and preferably low permeability and cost. Teflon and Neoflon would be the best choices. The outer package must be rigid and resistant to breakage, and our trade-off analysis identified stainless steel and aluminum alloys as best options. The outer should be filled with an inert atmosphere to inhibit oxidation within the sample in case of leak: argon is more inert than nitrogen, but the latter is easily available. The overpack allows the box environment control (e.g., real-time contamination monitoring); ISO containers could be used to this end. Contamination of the environment inside the box can be monitored by different instruments, which should be selected on the basis of mission requirements. There are no mass limitations for box transport by ground or ship, but these solutions imply a long journey duration. Any aircraft might be used for transporting unrestricted samples. Only cargo aircraft may be used for transporting restricted samples, unless the total sample mass is lower than 50 g (WHO guidelines).
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Affiliation(s)
| | | | - E Palomba
- INAF-IAPS, Rome, Italy
- ASI-SSDC, Rome, Italy
| | - L Berthoud
- University of Bristol, Clifton, UK
- Thales Alenia Space UK Limited, Bristol, UK
| | - A Hutzler
- Natural History Museum Vienna, Vienna, Austria
| | - C Smith
- Department of Earth Sciences, The Natural History Museum, London, UK
- School of Geographical and Earth Sciences, University of Glasgow, Glasgow, UK
| | - S Russell
- Department of Earth Sciences, The Natural History Museum, London, UK
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Debrot A, Kheyar M, Efinger L, Berthoud L, Pomini V. Supporting People having Lost a Close Person by Bereavement or Separation: Study Protocol of a Randomized Controlled Trial Comparing Two French-Language Internet Interventions (Preprint). JMIR Res Protoc 2022; 11:e39026. [PMID: 35737454 PMCID: PMC9264124 DOI: 10.2196/39026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/25/2022] Open
Abstract
Background Internet-based interventions (IBIs) are as efficient as face-to-face psychotherapy for a variety of mental health disorders, including complicated grief. Most evidence stems from guided IBIs. However, recent research indicates that the benefit of guidance is lower in more interactive IBIs. As such, providing guidance only to people requiring it (guidance on demand) appears a cost-effective solution. This is particularly important to develop given the recent rise in grief symptoms in the context of the COVID-19 pandemic. This paper presents the protocol of a randomized controlled trial comparing the efficacy and adherence rate of 2 IBIs for grief-related symptoms after the loss a close one following death or romantic separation, using a guidance on demand framework. LIVIA 2.0 was developed based on theoretical and empirical findings on grief processes and IBIs, and it will be compared to LIVIA 1 that has already demonstrated its efficacy. Objective Our main hypotheses are that LIVIA 1 (control condition) and LIVIA 2.0 (experimental condition) increase participants’ well-being and decrease their distress at posttest and at follow-up, that LIVIA 2.0 is more efficient than LIVIA 1 for all outcomes, and that LIVIA 2.0 has less dropouts than LIVIA 1. Methods Outcomes will be assessed at pretest, posttest (12 weeks later), and follow-up (24 weeks later). We will recruit 234 participants through a variety of means, including social media and contacts with the press. Primary outcomes are grief symptoms, depressive symptoms, and eudemonic well-being. Secondary outcomes are anxiety symptoms, grief coping strategies, aspects related to self-identity reorganization, and program satisfaction. LIVIA 2.0 participants will additionally undergo a weekly mood and grief symptom monitoring, allowing us to explore the short-term efficacy of the sessions. Results The creation and development of the content of LIVIA 2.0 was completed during the first phase of the project. Participant recruitment will begin in May 2022 and will last until January 2023. Conclusions This study will emphasize the relevance of the innovations included in LIVIA 2.0 regarding the efficacy and dropout rate of IBIs for grief symptoms and will allow investigations on how these changes impact the demand for guidance. In the current postpandemic times, developing and assessing IBIs targeting grief symptoms are particularly critical given the rise in grief-related symptoms. Trial Registration clinicaltrials.gov NCT05219760; https://tinyurl.com/3dzztjts International Registered Report Identifier (IRRID) PRR1-10.2196/39026
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Affiliation(s)
- Anik Debrot
- Cognitive and Affective Regulation Laboratory, Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Maya Kheyar
- Cognitive and Affective Regulation Laboratory, Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Liliane Efinger
- Cognitive and Affective Regulation Laboratory, Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Laurent Berthoud
- Cognitive and Affective Regulation Laboratory, Institute of Psychology, University of Lausanne, Lausanne, Switzerland
| | - Valentino Pomini
- Cognitive and Affective Regulation Laboratory, Institute of Psychology, University of Lausanne, Lausanne, Switzerland
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Debrot A, Berthoud L, Caspar F, Berger T, Pomini V. Tailoring Guidance in Internet-Based Interventions With Motive-Oriented Therapeutic Relationship. Front Digit Health 2022; 4:842487. [PMID: 35419558 PMCID: PMC8995493 DOI: 10.3389/fdgth.2022.842487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 03/04/2022] [Indexed: 12/18/2022] Open
Affiliation(s)
- Anik Debrot
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
- *Correspondence: Anik Debrot
| | - Laurent Berthoud
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Franz Caspar
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Valentino Pomini
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
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Ortoleva Bucher C, Abt M, Berthoud L, Cohen C. Health and coping strategies of nursing home residents and their relatives during the COVID-19 pandemic: a mixed-methods study protocol. BMJ Open 2022; 12:e059262. [PMID: 35332046 PMCID: PMC8948078 DOI: 10.1136/bmjopen-2021-059262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic hit older adults particularly hard, especially those living in nursing homes. The present study's primary aim is to quantify the states of physical and mental health of nursing home residents and their relatives following the implementation of the exceptional confinement measures. The secondary aim is to explore the lived experiences of the stressors perceived by older adults and their relatives, as well as the support strategies implemented by health professionals and their results. METHODS AND ANALYSIS We chose a mixed-methods (quantitative/qualitative) study to best deliver a profound understanding of this phenomenon.Quantitative phase: participants are asked to complete several questionnaires. The study population includes all the nursing home residents in four French-speaking cantons of Switzerland (and their relatives) who are living through the COVID-19 pandemic. Descriptive statistics will be calculated for the scores of the General Health Questionnaire-12, Impact of Event Scale-6, Perceived Stress Scale, Brief Cope, Post-traumatic Growth Inventory, World Health Organization Quality of Life-BREF (WHOQOL-BREF) and WHOQOL-OLD scales. Correlational analyses will be considered.Qualitative phase: data are collected from several sources (individual semi-structured interviews, focus groups, field notes). Interviews are planned with about 12 representatives of each group of participants (residents and relatives). Two focus groups made up of healthcare professionals will be constituted to explore the lived experiences of the stressors perceived by residents and relatives, the coping strategies those two groups implemented to deal with them. The interviews and focus groups will be subjected to a thematic contents analysis.Integrating the quantitative and qualitative data will take place jointly with data interpretation. ETHICS AND DISSEMINATION This project was approved by the Human Research Ethics Committee of the Canton of Vaud on 14 December 2020 (project ID: 2020-02397). The prior written informed consent of the study subjects is collected by a member of the research team before data collection. Study results will be disseminated via professional and peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN12345167.
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Affiliation(s)
- Claudia Ortoleva Bucher
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Maryline Abt
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Laurent Berthoud
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Christine Cohen
- La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
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Berthoud L, Turcotte M, Dzemaili S, Ducraux D, Zumstein-Shaha M, Ortoleva Bucher C. Facilitators and barriers in implementing clinical nursing assessment in mental health care for older people: A multimethod approach. Nurs Health Sci 2021; 23:208-218. [PMID: 33295023 DOI: 10.1111/nhs.12796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 11/21/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022]
Abstract
With the aging of the population and the growing prevalence of dementia, specialized and collaborative nursing care is paramount in this area. To ensure better quality care, it is necessary to use effective and context-specific processes to implement evidence-based practices and more specifically clinical nursing assessment. This study aimed to identify and describe factors that may influence the implementation of clinical nursing assessment in mental health care for older people. The Consolidated Framework for Implementation Research was employed to guide evaluation in the pre-implementation phase in the specific context of mental health care for older people. Using a multimethod approach, interviews, focus groups, and a quantitative survey were conducted with a non-probability convenience sample. A total of 39 hospital nurses (registered nurses and head nurses) were interviewed. Analysis yielded five main factors, notably three barriers and two facilitators. Barriers include a lack of general nursing culture, deficiencies in leadership, and difficulties in communication and collaboration. Facilitators comprise team cohesion and the perceived benefits of the study.
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Affiliation(s)
- Laurent Berthoud
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western, Lausanne, Switzerland
| | - Mathieu Turcotte
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western, Lausanne, Switzerland
| | - Shota Dzemaili
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western, Lausanne, Switzerland
| | - Daniel Ducraux
- Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Maya Zumstein-Shaha
- Department of Health, Bern University of Applied Sciences, Bern, Switzerland
| | - Claudia Ortoleva Bucher
- La Source School of Nursing Sciences, HES-SO University of Applied Sciences and Arts Western, Lausanne, Switzerland.,Service of Old Age Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.,Institute of Higher Education and Research in Health, Faculty of Biology and Medicine, Lausanne University Hospital, Lausanne, Switzerland
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Berthoud L, Efinger L, Kheyar M, Pomini V, Debrot A. Hope May Come From Internet in Times of COVID-19: Building an Online Programme for Grief (LIVIA). Front Psychiatry 2021; 12:626831. [PMID: 33767639 PMCID: PMC7985089 DOI: 10.3389/fpsyt.2021.626831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/16/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Laurent Berthoud
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Liliane Efinger
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Maya Kheyar
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Valentino Pomini
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Anik Debrot
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
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Maillard P, Dimaggio G, Berthoud L, de Roten Y, Despland JN, Kramer U. Metacognitive improvement and symptom change in a 3-month treatment for borderline personality disorder. Psychol Psychother 2020; 93:309-325. [PMID: 30712326 DOI: 10.1111/papt.12219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 12/21/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Recognizing and reflecting on one's own and other people's mental states represent a major difficulty for patients with borderline personality disorder (BPD). Only recently have studies begun exploring whether these capacities increase with successful therapies and if such an improvement is linked with outcome. The present study investigated whether metacognition would improve and if its improvement was related with symptom change in BPD patients. DESIGN The transcripts from the first and the penultimate session of a ten-session version of good psychiatric management were analysed with the MAS-R scale in a N = 37 BPD sample. Patients, selected from a previously published RCT (Kramer et al., 2014), were assigned either to the good psychiatric management treatment or to the same treatment with the addition of the Motive-Oriented Therapeutic Relationship (Caspar, 2007), a form of therapeutic relationship based on an individualized case formulation. Symptoms were assessed with the OQ-45. RESULTS Findings partially support the hypotheses. First, improvement in capacities to understand others' mind, to take a critical distance from one's own rigid and maladaptive beliefs, and to use behavioural and attentional strategies to face adversities is found in both treatment groups. Controlling for marital status, only the ability to differentiate between reality and representations remains significant. Second, no link between metacognitive change and symptom change during treatment is found. However, a link is observed between the increase in metacognition and symptom reduction at 6-month follow-up. CONCLUSIONS Results invite to further investigate the role of metacognition in therapy change through different modalities and in longer-term treatments. PRACTITIONER POINTS The development of metacognitive processes and their links with symptom change were examined during a short-term treatment in 37 borderline patients Improvement was found in capacities to understand others' mind, to take a critical distance from own rigid and maladaptive beliefs, and to use behavioural and attentional strategies even in a short-term treatment Controlling for marital status, only the ability to take a critical distance from representations remained significant A link was observed between increase in metacognition and symptom reduction at 6-month follow-up Understanding and tailoring interventions to specific metacognitive difficulties could be associated with symptom change during treatment for BPD patients.
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Affiliation(s)
- Pauline Maillard
- Institute of Psychotherapy-University Hospital Center, University of Lausanne, Switzerland
| | | | - Laurent Berthoud
- Institute of Psychotherapy-University Hospital Center, University of Lausanne, Switzerland
| | - Yves de Roten
- Institute of Psychotherapy-University Hospital Center, University of Lausanne, Switzerland
| | - Jean-Nicolas Despland
- Institute of Psychotherapy-University Hospital Center, University of Lausanne, Switzerland
| | - Ueli Kramer
- Institute of Psychotherapy-University Hospital Center, University of Lausanne, Switzerland.,University of Windsor, Canada
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Delmas P, Antonini M, Berthoud L, O’Reilly L, Cara C, Brousseau S, Bellier‐Teichmann T, Weidmann J, Roulet‐Schwab D, Ledoux I, Pasquier J, Boillat E, Brandalesi V, Konishi M. A comparative descriptive analysis of perceived quality of caring attitudes and behaviours between haemodialysis patients and their nurses. Nurs Open 2020; 7:563-570. [PMID: 32089853 PMCID: PMC7024631 DOI: 10.1002/nop2.421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/30/2019] [Accepted: 11/01/2019] [Indexed: 11/23/2022] Open
Abstract
Aim Despite its importance in nursing, perceived quality of the nurse-patient relationship has seldom been researched. This study sought to examine and compare the quality of caring attitudes and behaviours as perceived by haemodialysis patients and their nurses. Design This comparative descriptive study involved 140 haemodialysis patients and 101 nurses caring for them in ten haemodialysis units in the French-speaking part of Switzerland. Methods Participants completed a sociodemographic questionnaire and the Caring Nurse-Patient Interaction Scale (CNPI-70). Results Both nurses and patients reported a high frequency of caring attitudes and behaviours. Patients gave higher ratings than nurses did on all the caring dimensions, except spirituality. Implications are discussed.
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Affiliation(s)
- Philippe Delmas
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | - Matteo Antonini
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | - Laurent Berthoud
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | | | | | | | | | - Jean Weidmann
- School of Management and Engineering VaudYverdon‐les‐BainsSwitzerland
| | | | | | - Jérôme Pasquier
- Institute of Social and Preventive MedicineLausanne University HospitalLausanneSwitzerland
| | - Evelyne Boillat
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | - Vanessa Brandalesi
- La SourceSchool of NursingHES-SO University of Applied Sciences WesternSwitzerland
| | - Mario Konishi
- School of Management and Engineering VaudYverdon‐les‐BainsSwitzerland
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Abstract
The present study aims at determining the role for outcome of potential processes of change in psychotherapy for narcissistic personality disorder (NPD). They were examined on three levels: the content, the process, and the relationship. A total of 161 patients suffering with NPD were recruited in a naturalistic setting as part of the present study. They underwent a long- term clarification-oriented psychotherapy. Sessions 15, 20, and 25 were video- or audio-recorded and analyzed with an observer-rated instrument that measures the quality of the interaction processes from the patient's and therapist's perspectives. Different self-report measures were used to assess therapy outcomes. In-session improvement was observed in both patient and therapist processes across sessions. Patient improvement in the three levels of processes was systematically related with outcome. Only partial relationships were found between therapist improvement and outcome. The present study represents the first systematic insight into core changes in patients with NPD undergoing psychotherapy.
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Affiliation(s)
- Pauline Maillard
- Institute of Psychotherapy, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Laurent Berthoud
- Institute of Psychotherapy, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Stéphane Kolly
- General Psychiatry Service, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Rainer Sachse
- Institut für Psychologische Psychotherapie, University of Bochum, Germany
| | - Ueli Kramer
- Institute of Psychotherapy, Lausanne University Hospital, University of Lausanne, Switzerland.,General Psychiatry Service, Lausanne University Hospital, University of Lausanne, Switzerland.,University of Windsor, Canada
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Maillard P, Dimaggio G, de Roten Y, Berthoud L, Despland JN, Kramer U. Metacognition as a predictor of change in the treatment for borderline personality disorder: A preliminary pilot study. Journal of Psychotherapy Integration 2017. [DOI: 10.1037/int0000090] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zanello A, Berthoud L, Bacchetta JP. Emotional crisis in a naturalistic context: characterizing outpatient profiles and treatment effectiveness. BMC Psychiatry 2017; 17:130. [PMID: 28388881 PMCID: PMC5384152 DOI: 10.1186/s12888-017-1293-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 03/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Crisis happens daily yet its understanding is often limited, even in the field of psychiatry. Indeed, a challenge is to assess the potential for change of patients so as to offer appropriate therapeutic interventions and enhance treatment program efficacy. This naturalistic study aimed to identify the socio-demographical characteristics and clinical profiles at admission of patients referred to a specialized Crisis Intervention Center (CIC) and to examine the effectiveness of the intervention. METHOD The sample was composed of 352 adult outpatients recruited among the referrals to the CIC. Assessment completed at admission and at discharge examined psychiatric symptoms, defense mechanisms, recovery styles and global functioning. The crisis intervention consisted in a psychodynamically oriented multimodal approach associated with medication. RESULTS Regarding the clinical profiles at intake, patients were middle-aged (M = 38.56, SD = 10.91), with a higher proportion of women (62.22%). They were addressed to the CIC because they had attempted to commit suicide or had suicidal ideation or presented depressed mood related to interpersonal difficulties. No statistical differences were found between patients dropping out (n = 215) and those attending the crisis intervention (n = 137). Crisis intervention demonstrated a beneficial effect (p < 0.01) on almost all variables, with Effect Sizes (ES) ranging from small to large (0.12 < ES < 0.75; median = 0.49). However, the Reliable Change Index indicated that most of the issues fall into the undetermined category (range 41.46 to 96.35%; median = 66.20%). CONCLUSIONS This study establishes the profile of patients referred to the CIC and shows that more than half of the patients dropped out from the crisis intervention before completion. Our findings suggest that people presenting an emotional crisis benefit from crisis intervention. However, given methodological constraints, these results need to be considered with caution. Moreover, the clinical significance of the improvements is not confirmed. Thus, the effectiveness of crisis intervention in naturalistic context is not fully determined and should be more rigorously studied in future research.
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Affiliation(s)
- Adriano Zanello
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland. .,HUG Département de Santé Mentale et de Psychiatrie, Site Belle-Idée, Ch. du Petit-Bel-Air 2, CH-1225, Chêne-Bourg, Switzerland.
| | - Laurent Berthoud
- grid.9851.5Department of Psychiatry, University of Lausanne, Lausanne, Switzerland
| | - Jean-Pierre Bacchetta
- grid.150338.cDepartment of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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12
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Berthoud L, Pascual-Leone A, Caspar F, Tissot H, Keller S, Rohde KB, de Roten Y, Despland JN, Kramer U. Leaving Distress Behind: A Randomized Controlled Study on Change in Emotional Processing in Borderline Personality Disorder. Psychiatry 2017; 80:139-154. [PMID: 28767333 DOI: 10.1080/00332747.2016.1220230] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The marked impulsivity and instability of clients suffering from borderline personality disorder (BPD) greatly challenge therapists' understanding and responsiveness. This may hinder the development of a constructive therapeutic relationship despite it being of particular importance in their treatment. Recent studies have shown that using motive-oriented therapeutic relationship (MOTR), a possible operationalization of appropriate therapist responsiveness, can enhance treatment outcome for BPD. The overall objective of this study is to examine change in emotional processing in BPD clients following the therapist's use of MOTR. METHOD The present paper focuses on N = 50 cases, n = 25 taken from each of two conditions of a randomized controlled add-on effectiveness design. Clients were either allocated to a manual-based psychiatric-psychodynamic 10-session version of general psychiatric management (GPM), a borderline-specific treatment, or to a 10-session version of GPM augmented with MOTR. Emotional states were assessed using the Classification of Affective-Meaning States (Pascual-Leone & Greenberg, 2005) at intake, midtreatment, and in the penultimate session. RESULTS Across treatment, early expressions of distress, especially the emotion state of global distress, were shown to significantly decrease (p = .00), and adaptive emotions were found to emerge (p < .05). Between-condition differences of change were found, including a significant increase in emotional variability and stronger outcome predictors in the MOTR condition. CONCLUSIONS The findings indicate initial emotional change in BPD clients in a relatively short time frame and suggest the addition of MOTR to psychotherapeutic treatments as promising. Clinical implications are discussed.
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Kramer U, Stulz N, Berthoud L, Caspar F, Marquet P, Kolly S, De Roten Y, Despland JN. The shorter the better? A follow-up analysis of 10-session psychiatric treatment including the motive-oriented therapeutic relationship for borderline personality disorder. Psychother Res 2015; 27:362-370. [PMID: 26684670 DOI: 10.1080/10503307.2015.1110635] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE There is little research on short-term treatments for borderline personality disorder (BPD). While the core changes may occur only in long-term treatments, short-term treatments may enable the study of early generic processes of engagement in therapy and thus inform about effective treatment components. It was shown that a 10-session version of a psychiatric treatment was effective in reducing borderline symptoms at the end of this treatment [Kramer, U., Kolly, S., Berthoud, L., Keller, S., Preisig, M., Caspar, F., … Despland, J.-N. (2014). Effects of motive-oriented therapeutic relationship in a ten-session general psychiatric treatment for borderline personality disorder: A randomized controlled trial. Psychotherapy and Psychosomatics, 83, 176-186.]. Also, it was demonstrated in a randomized design that adding the motive-oriented therapeutic relationship (MOTR), following an individualized case formulation based on Plan Analysis, further increased general outcome after session 10 and had a positive effect on the early changes in self-esteem and alliance. METHOD The present study focuses on the follow-up period after this initial treatment, examining treatment density and outcomes after 6 months and service utilization after 12 months. Outcome was measured using the OQ-45. RESULTS Results on a sub-sample of N = 40 patients with available OQ-45 data at follow-up (n = 21 for MOTR-treatment, n = 19 for comparison treatment) showed maintenance of gains over the follow-up period, which did not differ between both conditions. It appeared for this sample that MOTR treatments, while using the same number of sessions, lasted more weeks (i.e., lower treatment density, defined as the number of sessions per week), when compared to the treatments without MOTR. Density marginally predicted symptom reduction at follow-up. Patients in MOTR treatments had a greater likelihood of entering structured psychotherapy after the initial sessions than patients in the comparison group. CONCLUSIONS These results are overall consistent with earlier studies on short-term treatments for BPD and underline the importance of individualizing interventions, by using case formulations that rely on idiographic methods and integrative concepts.
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Affiliation(s)
- Ueli Kramer
- a Department of Psychiatry-CHUV , Institute of Psychotherapy, University of Lausanne , Lausanne , Switzerland.,b General Psychiatry Service, Department of Psychiatry-CHUV , University of Lausanne , Lausanne , Switzerland.,c Department of Psychology , University of Windsor , Windsor , Canada
| | - Niklaus Stulz
- d Department of Clinical Psychology and Psychotherapy , University of Berne , Bern , Switzerland.,e Aargauer Psychiatrische Dienste , Windisch , Switzerland
| | - Laurent Berthoud
- a Department of Psychiatry-CHUV , Institute of Psychotherapy, University of Lausanne , Lausanne , Switzerland.,d Department of Clinical Psychology and Psychotherapy , University of Berne , Bern , Switzerland
| | - Franz Caspar
- d Department of Clinical Psychology and Psychotherapy , University of Berne , Bern , Switzerland
| | - Pierre Marquet
- b General Psychiatry Service, Department of Psychiatry-CHUV , University of Lausanne , Lausanne , Switzerland
| | - Stéphane Kolly
- b General Psychiatry Service, Department of Psychiatry-CHUV , University of Lausanne , Lausanne , Switzerland
| | - Yves De Roten
- a Department of Psychiatry-CHUV , Institute of Psychotherapy, University of Lausanne , Lausanne , Switzerland
| | - Jean-Nicolas Despland
- a Department of Psychiatry-CHUV , Institute of Psychotherapy, University of Lausanne , Lausanne , Switzerland
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Kramer U, Pascual-Leone A, Berthoud L, de Roten Y, Marquet P, Kolly S, Despland JN, Page D. Assertive Anger Mediates Effects of Dialectical Behaviour-informed Skills Training for Borderline Personality Disorder: A Randomized Controlled Trial. Clin Psychol Psychother 2015; 23:189-202. [PMID: 25864773 DOI: 10.1002/cpp.1956] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/10/2015] [Accepted: 03/14/2015] [Indexed: 12/14/2022]
Abstract
UNLABELLED Dialectical behaviour therapy (DBT)-informed skills training for borderline personality disorder (BPD) aims at the development of specific emotion regulation skills in patients, particularly with regard to the regulation of problematic anger. While the effects of dialectical behaviour skills training have been shown, their processes of change are rarely examined. Neacsiu, Rizvi and Linehan (2010) found that patient's self-reported use of emotion regulation skills was a mediator of therapeutic change in these treatments; however, they found no effect for problematic anger. From an integrative perspective on anger (Pascual-Leone & Greenberg, 2007; Pascual-Leone & Paivio, 2013), there are several forms of anger, varying in their degree of therapeutic productivity. The present add-on randomized controlled trial included n = 41 patients with BPD (n = 21 DBT-informed skills training versus n = 20 treatment as usual). The first study examined the outcome of the DBT-informed skills training encompassing basic components of training in mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation. Results showed that symptom reduction was significantly greater in the DBT-informed skills training, compared with the treatment as usual. The second study used process assessment, for which all patient completers underwent a 50-min-long psychological interview both early and late in treatment, which was rated using the Classification of Affective Meaning States. DBT-informed skills training produced increased levels of primary 'assertive' anger, as compared with the treatment as usual, whereas no effect was found for 'rejecting' secondary anger. Most importantly, we showed that changes in assertive anger mediated the reported symptom reduction, in particular in patient's social roles. We discuss these results in the context of underlying mechanisms of change in DBT skills group treatments, in particular towards developing more productive forms of anger in this patient population. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE A 20-session dialectical behaviour therapy (DBT)-informed skills training is a promising adjunct intervention for patients with borderline personality disorder, in particular for reducing problems related to social role. Increases in assertive anger mediate the effects of DBT-informed skills training, whereas rejecting anger remains unchanged over the course of treatment. Short-term objectives for intervention might involve the specific increase of assertive anger in BPD, by using DBT-informed skills training; long-term objectives for intervention might involve a specific decrease of rejecting anger in BPD.
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Affiliation(s)
- Ueli Kramer
- Institute of Psychotherapy, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
- General Psychiatry Service, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | | | - Laurent Berthoud
- Institute of Psychotherapy, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Yves de Roten
- Institute of Psychotherapy, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Pierre Marquet
- General Psychiatry Service, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Stéphane Kolly
- General Psychiatry Service, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Jean-Nicolas Despland
- Institute of Psychotherapy, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Dominique Page
- Institute of Psychotherapy, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
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Berthoud L, Kramer U, Caspar F, Pascual-Leone A. Emotional processing in a ten-session general psychiatric treatment for borderline personality disorder: a case study. Personal Ment Health 2015; 9:73-8. [PMID: 25711648 DOI: 10.1002/pmh.1287] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study examines the effects of a borderline-specific treatment, called general psychiatric management, on emotional change, outcome and therapeutic alliance of an outpatient presenting with borderline personality disorder. Based on the sequential model of emotional processing, emotional states were assessed in a 10-session setting. The case showed an increase in expressions of distress and no change in therapeutic alliance and tended towards general deterioration. Results suggest emotional processing may play a lesser role in general psychiatric management in early phase treatment than previously hypothezised.
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Affiliation(s)
- Laurent Berthoud
- University Institute of Psychotherapy, University of Lausanne, Lausanne, Switzerland; Department for Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
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Kramer U, Kolly S, Berthoud L, Keller S, Preisig M, Caspar F, Berger T, de Roten Y, Marquet P, Despland JN. Effects of motive-oriented therapeutic relationship in a ten-session general psychiatric treatment of borderline personality disorder: a randomized controlled trial. Psychother Psychosom 2014; 83:176-86. [PMID: 24752034 DOI: 10.1159/000358528] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 01/11/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Motive-oriented therapeutic relationship (MOTR) was postulated to be a particularly helpful therapeutic ingredient in the early treatment phase of patients with personality disorders, in particular with borderline personality disorder (BPD). The present randomized controlled study using an add-on design is the first study to test this assumption in a 10-session general psychiatric treatment with patients presenting with BPD on symptom reduction and therapeutic alliance. METHODS A total of 85 patients were randomized. They were either allocated to a manual-based short variant of the general psychiatric management (GPM) treatment (in 10 sessions) or to the same treatment where MOTR was deliberately added to the treatment. Treatment attrition and integrity analyses yielded satisfactory results. RESULTS The results of the intent-to-treat analyses suggested a global efficacy of MOTR, in the sense of an additional reduction of general problems, i.e. symptoms, interpersonal and social problems (F1, 73 = 7.25, p < 0.05). However, they also showed that MOTR did not yield an additional reduction of specific borderline symptoms. It was also shown that a stronger therapeutic alliance, as assessed by the therapist, developed in MOTR treatments compared to GPM (Z55 = 0.99, p < 0.04). CONCLUSIONS These results suggest that adding MOTR to psychiatric and psychotherapeutic treatments of BPD is promising. Moreover, the findings shed additional light on the perspective of shortening treatments for patients presenting with BPD.
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Affiliation(s)
- Ueli Kramer
- Institute of Psychotherapy, CHUV, University of Lausanne, Lausanne, Switzerland
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Kramer U, Berthoud L, Keller S, Caspar F. Erratum to: Motive-Oriented Psychotherapeutic Relationship Facing a Patient Presenting with Narcissistic Personality Disorder: A Case Study. J Contemp Psychother 2014. [DOI: 10.1007/s10879-013-9251-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Zanello A, Berthoud L, Ventura J, Merlo MCG. The Brief Psychiatric Rating Scale (version 4.0) factorial structure and its sensitivity in the treatment of outpatients with unipolar depression. Psychiatry Res 2013; 210:626-33. [PMID: 23890713 PMCID: PMC4059178 DOI: 10.1016/j.psychres.2013.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/24/2013] [Accepted: 07/03/2013] [Indexed: 11/28/2022]
Abstract
The 24-item Brief Psychiatric Rating Scale (BPRS, version 4.0) enables the rater to measure psychopathology severity. Still, little is known about the BPRS's reliability and validity outside of the psychosis spectrum. The aim of this study was to examine the factorial structure and sensitivity to change of the BPRS in patients with unipolar depression. Two hundred and forty outpatients with unipolar depression were administered the 24-item BPRS. Assessments were conducted at intake and at post-treatment in a Crisis Intervention Centre. An exploratory factor analysis of the 24-item BPRS produced a six-factor solution labelled "Mood disturbance", "Reality distortion", "Activation", "Apathy", "Disorganization", and "Somatization". The reduction of the total BPRS score and dimensional scores, except for "Activation", indicates that the 24-item BPRS is sensitive to change as shown in patients that appeared to have benefited from crisis treatment. The findings suggest that the 24-item BPRS could be a useful instrument to measure symptom severity and change in symptom status in outpatients presenting with unipolar depression.
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Affiliation(s)
- Adriano Zanello
- University Department of Mental Health and Psychiatry, HUG, CAPPI Pâquis Secteur 4, 67 rue de Lausanne, 1202 Geneva, Switzerland.
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Kramer U, Berthoud L, Keller S, Caspar F. Motive-Oriented Psychotherapeutic Relationship Facing a Patient Presenting with Narcissistic Personality Disorder: A Case Study. J Contemp Psychother 2013. [DOI: 10.1007/s10879-013-9249-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Kramer U, Berthoud L, Koch N, Michaud L, Guex P, Despland JN. Monitoring the effects of adult psychotherapy in routine practice in Switzerland: A feasibility trial. Counselling and Psychotherapy Research 2013. [DOI: 10.1080/14733145.2012.729849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Berthoud L, Kramer U, de Roten Y, Despland JN, Caspar F. Using Plan Analysis in Psychotherapeutic Case Formulation of Borderline Personality Disorder. Clin Psychol Psychother 2011; 20:1-9. [DOI: 10.1002/cpp.784] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 07/22/2011] [Accepted: 07/22/2011] [Indexed: 01/04/2023]
Affiliation(s)
- Laurent Berthoud
- University Institute of Psychotherapy; Department of Psychiatry; University of Lausanne; Switzerland
| | - Ueli Kramer
- University Institute of Psychotherapy; Department of Psychiatry; University of Lausanne; Switzerland
| | - Yves de Roten
- University Institute of Psychotherapy; Department of Psychiatry; University of Lausanne; Switzerland
| | - Jean-Nicolas Despland
- University Institute of Psychotherapy; Department of Psychiatry; University of Lausanne; Switzerland
| | - Franz Caspar
- Department for Clinical Psychology and Psychotherapy; University of Bern; Switzerland
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Kramer U, Rosciano A, Pavlovic M, Berthoud L, Despland JN, de Roten Y, Caspar F. Motive-oriented therapeutic relationship in brief psychodynamic intervention for patients with depression and personality disorders. J Clin Psychol 2011; 67:1017-27. [DOI: 10.1002/jclp.20806] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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