Cost-effectiveness and Budget Impact of Specialized Psychotherapy for Borderline Personality Disorder: A Synthesis of the Evidence.

PubMed

Wetzelaer, Pim; Lokkerbo, Joran; Arntz, Arnoud; van Aselt, Thea; Smit, Filip; Evers, Silvia

2017-12-01

Specialized outpatient psychotherapy for patients with borderline personality disorder (BPD) is expected to reduce their use of other health care resources. It is currently unknown to what extent the costs of providing these interventions can be expected to be offset by a reduction in other health care costs in the Netherlands. To establish the cost-effectiveness and budget impact of specialized outpatient psychotherapy, the estimated incremental costs are synthesized with the estimated incremental effects. We have developed a method for the synthesis of all relevant evidence on clinical effectiveness as well as health care resource use. The aim of this article is to present a method for the synthesis of evidence for cost-effectiveness and budget impact analysis with a specific application to specialized outpatient psychotherapy for borderline personality disorder in the Netherlands. A systematic search of the English-language literature is performed to retrieve evidence on the clinical effectiveness and the health care resource use following 12 months of specialized outpatient psychotherapy for borderline personality disorder. The available evidence is used as an input for a model-based economic evaluation. Simulated patient-level data are used to provide overall estimates of the incremental costs and incremental effects, which serve to assess the cost-effectiveness and budget impact of specialized outpatient psychotherapy for borderline personality disorder in the Netherlands. The results indicate that specialized outpatient psychotherapy for BPD can be considered cost-effective and that its scaling up to Dutch national level would require an investment of 2.367 million (95% C.I.: 1,717,000 - 3,272,000) per 1,000 additional patients with BPD. Sensitivity analyses demonstrated the robustness of our findings in light of several uncertain components and assumptions in our calculations, but also their sensitivity to the choice of included studies based on the comparator condition and the assumption of high intervention costs. We present a method for the synthesis of evidence from different types of studies in a way that respects the uncertainty surrounding those findings. Limitations of the study pertain to the inclusion of findings from studies with suboptimal designs, the transferability of research findings, and uncertainty regarding the time horizon considered. More research is needed on the sensitivity of our findings to the choice of included studies based on the comparator condition. THE results suggest that the provision of specialized outpatient psychotherapy for BPD leads to a reduction in other health care resource use. Overall, the results are promising and encourage future studies on aspects that are currently still uncertain. The results may support policy makers in deciding whether or not to allocate health care budget for the provision of specialized outpatient psychotherapy for patients with BPD in the Netherlands. The results provide important directions for future research. This includes the need for future studies to make a comparison between specialized outpatient psychotherapy and treatment as usual and to have longer follow-up time.

Interpersonal art psychotherapy for the treatment of aggression in people with learning disabilities in secure care: a protocol for a randomised controlled feasibility study.

PubMed

Hackett, Simon S; Taylor, John L; Freeston, Mark; Jahoda, Andrew; McColl, Elaine; Pennington, Lindsay; Kaner, Eileen

2017-01-01

Art psychotherapy has greater potential for use with adults with mild to moderate learning disabilities as it places less of a burden on verbal interaction to achieve positive therapeutic, psychological, and behavioural goals. The feasibility study objectives include testing procedures, outcomes, validated tools, recruitment and attrition rates, acceptability, and treatment fidelity for manualised interpersonal art psychotherapy. Adult males and females with mild to moderate learning disabilities will be recruited from four NHS secure hospitals. Twenty patients will be recruited and randomly assigned to one of two treatment groups: fifteen 1-h individual sessions of manualised interpersonal art psychotherapy, or a treatment as usual waiting list control group. The Modified Overt Aggression Scale will be administered to both treatment arms. Four patients will be recruited to a single-case design component of the study exploring the acceptability of an attentional condition. This multi-site study will assist in future trial planning and inform feasibility including, procedures, treatment acceptability, therapist adherence, and estimation of samples size for a definitive RCT.

Reengagement in PTSD psychotherapy: A case-control study.

PubMed

Buchholz, Katherine R; Bohnert, Kipling M; Pfeiffer, Paul N; Valenstein, Marcia; Ganoczy, Dara; Anderson, RaeAnn E; Sripada, Rebecca K

2017-09-01

This study sought to identify patient characteristics and care processes related to reengagement in VA psychotherapy. Using national VA data, a retrospective cohort was constructed (N=24,492) of veterans who received a new PTSD diagnosis in FY08/FY09 and attended only one to five PTSD psychotherapy sessions. A nested case-control study was conducted comparing veterans who reengaged in psychotherapy (n=9649) in a 1:5 ratio with those who did not reengage by the end of FY12. Conditional logistic regression models were run to examine differences in sociodemographic, mental health, and service utilization factors between cases and controls. Among veterans in the study cohort, 39.4% reengaged in psychotherapy. In adjusted analyses, all measured types of health system encounters (primary care [OR=1.61], primary care mental health [OR=1.61], non-PTSD psychotherapy [OR=1.76], other non-PTSD mental health care [OR=1.43], other non-psychotherapy PTSD care [OR=3.31], emergency room [OR=1.14], and psychiatric hospitalization [OR=1.56]) were related to greater odds of reengagement in PTSD psychotherapy. Veterans' receipt of a broad range of care services may play an important role in reengagement in PCT psychotherapy, suggesting providers across care settings should be knowledgeable in how to support a Veteran's return to psychotherapy for PTSD. Published by Elsevier Inc.

Patients with Borderline Personality Disorder in Emergency Departments

PubMed Central

Shaikh, Untara; Qamar, Iqra; Jafry, Farhana; Hassan, Mudasar; Shagufta, Shanila; Odhejo, Yassar Islamail; Ahmed, Saeed

2017-01-01

Borderline personality disorder (BPD) patients, when in crisis, are frequent visitors of emergency departments (EDs). When these patients exhibit symptoms such as aggressiveness, impulsivity, intense anxiety, severe depression, self-harm, and suicidal attempts or gestures, diagnosis, and treatment of the BPD becomes challenging for ED doctors. This review will, therefore, outline advice to physicians and health-care providers who face this challenging patient population in the EDs. Crisis intervention should be the first objective of clinicians when dealing with BPD in the emergency. For the patients with agitation, symptom-specific pharmacotherapy is usually recommended, while for non-agitated patients, short but intensive psychotherapy especially dialectical behavior therapy (DBT) has a positive effect. Although various psychotherapies, either alone or integrated, are preferred modes of treatment for this group of patients, the effects of psychotherapies on BPD outcomes are small to medium. Proper risk management along with developing a positive attitude and empathy toward these patients will help them in normalizing in an emergency setting after which treatment course can be decided. PMID:28824467

Patients with Borderline Personality Disorder in Emergency Departments.

PubMed

Shaikh, Untara; Qamar, Iqra; Jafry, Farhana; Hassan, Mudasar; Shagufta, Shanila; Odhejo, Yassar Islamail; Ahmed, Saeed

2017-01-01

Borderline personality disorder (BPD) patients, when in crisis, are frequent visitors of emergency departments (EDs). When these patients exhibit symptoms such as aggressiveness, impulsivity, intense anxiety, severe depression, self-harm, and suicidal attempts or gestures, diagnosis, and treatment of the BPD becomes challenging for ED doctors. This review will, therefore, outline advice to physicians and health-care providers who face this challenging patient population in the EDs. Crisis intervention should be the first objective of clinicians when dealing with BPD in the emergency. For the patients with agitation, symptom-specific pharmacotherapy is usually recommended, while for non-agitated patients, short but intensive psychotherapy especially dialectical behavior therapy (DBT) has a positive effect. Although various psychotherapies, either alone or integrated, are preferred modes of treatment for this group of patients, the effects of psychotherapies on BPD outcomes are small to medium. Proper risk management along with developing a positive attitude and empathy toward these patients will help them in normalizing in an emergency setting after which treatment course can be decided.

Exploring Psychotherapy Clients' Independent Strategies for Change While in Therapy

ERIC Educational Resources Information Center

Mackrill, Thomas

2008-01-01

Psychotherapy research usually describes how client change is caused by therapist interventions. This article describes how clients change by continuing to use and revising the strategies for change that they bring with them when they first enter therapy. This article presents data from a qualitative diary study of psychotherapy. Three cases…

A pilot randomized controlled trial of a depression and disease management program delivered by phone.

PubMed

Aburizik, Arwa; Dindo, Lilian; Kaboli, Peter; Charlton, Mary; Dawn, Klein; Turvey, Carolyn

2013-11-01

Depression in medically ill patients occurs at twice the rate found in the general population. Though pharmacologic and psychotherapeutic interventions for depression are effective, response to treatment and access to care are barriers for this population. A multidimensional telehealth intervention was designed to focus on these barriers by delivering a phone based intervention that addressed managing one's illness and coping emotionally. Veterans with diabetes, hypertension, or chronic pain and depressive symptoms were randomized to one of three conditions: Usual Care (n=23), Illness Management Only (n=31), or Combined Psychotherapy and Illness Management (n=29). Those randomized to the Combined or Illness Management Only intervention group received 10 phone visits. Veterans in the Combined group received all aspects of the illness management program plus a manualized depression intervention. Subjects completed assessments at baseline, week 5, and 10 to test the main hypothesis that veterans in the Combined condition would have a greater decline in depressive symptoms. The Combined intervention yielded a significant decline in depressive symptoms when compared with Usual Care. However, the there was no significant difference between the Combined and Illness Management Only groups. This is a pilot study with a small sample size relative to a standard randomized controlled trial in psychotherapy. This telephone-based intervention succeeded in reducing depressive symptoms in veterans with chronic illness. It adds to the building evidence base for providing phone-delivered mental health services. © 2013 Elsevier B.V. All rights reserved.

Making the business case for enhanced depression care: the National Institute of Mental Health-harvard Work Outcomes Research and Cost-effectiveness Study.

PubMed

Wang, Philip S; Simon, Gregory E; Kessler, Ronald C

2008-04-01

Explore the business case for enhanced depression care and establish a return on investment rationale for increased organizational involvement by employer-purchasers. Literature review, focused on the National Institute of Mental Health-sponsored Work Outcomes Research and Cost-effectiveness Study. This randomized controlled trial compared telephone outreach, care management, and optional psychotherapy to usual care among depressed workers in large national corporations. By 12 months, the intervention significantly improved depression outcomes, work retention, and hours worked among the employed. Results of the Work Outcomes Research and Cost-effectiveness Study trial and other studies suggest that enhanced depression care programs represent a human capital investment opportunity for employers.

Usual Course of Treatment and Predictors of Treatment Utilization for Patients with Posttraumatic Stress Disorder

PubMed Central

Nobles, Carrie J.; Valentine, Sarah E.; Zepeda, E. David; Ahles, Emily M.; Shtasel, Derri L.; Marques, Luana

2017-01-01

Objective Posttraumatic stress disorder (PTSD) is a debilitating psychiatric illness that frequently remains undiagnosed and untreated. While extensive research has been conducted among veterans, little research has evaluated course of treatment for PTSD in a general hospital setting. Method We utilized data from the Partners Healthcare Research Patient Database Registry to evaluate mental health treatment utilization, including psychotherapy and pharmacotherapy, by patients with recently diagnosed primary PTSD following Diagnostic and Statistical Manual IV criteria between January 1, 2002 and June 30, 2011. We additionally evaluated predictors of treatment utilization 6 months post-diagnosis. Results Among 2,475 patients with recently diagnosed prim ary PTSD, approximately half (55.7%) had any therapy visit and 10% at least 12 therapy visits in the 6 months following diagnosis. Approximately half (47.0%) received a psychiatric prescription, with 29.3% receiving a selective serotonin reuptake inhibitor (SSRI), 11.8% an atypical antipsychotic and 24.4% a benzodiazepine. Latinos were 25% more likely to have an SSRI prescription, 35% more likely to have an atypical antipsychotic prescription and 28% more likely to have any psychotherapy. Men were 96% more likely to have an atypical antipsychotic prescription. Patients with Medicare were 20% less likely to have any psychotherapy, and patients with Medicaid were 35% less likely to have 12 or more therapy visits. Conclusion Many patients with a primary diagnosis of PTSD do not receive psychotherapy, and psychiatric prescriptions, including atypical antipsychotics and benzodiazepines, are common. Future research is needed to determine quality of care received and explore sub-population specific barriers limiting access to care. PMID:28570794

REDUCING SUICIDAL IDEATION AND DEPRESSION IN OLDER PRIMARY CARE PATIENTS: 24-MONTH OUTCOMES OF THE PROSPECT STUDY

PubMed Central

Alexopoulos, George S.; Reynolds, Charles F.; Bruce, Martha L.; Katz, Ira R.; Raue, Patrick J.; Mulsant, Benoit H.; Oslin, David; Have, Thomas Ten

2010-01-01

Objective The PROSPECT Study evaluated the impact of a care management intervention on suicidal ideation and depression in older primary care patients. This is the first report of outcomes over a 2-year period. Method The subjects (N=599) were older (>=60 years) patients with major or minor depression selected after screening 9,072 randomly identified patients of 20 primary care practices randomly assigned to the PROSPECT intervention or usual care. The intervention consisted of services of 15 trained care managers, who offered algorithm-based recommendations to physicians and helped patients with treatment adherence over 24 months. Results Intervention patients had a higher likelihood to receive antidepressants and or psychotherapy (84.9–89% vs. 49–59%) and a 2.2 times greater decline in suicidal ideation than usual care patients over 24 months. Treatment response occurred earlier in intervention patients and continued to increase from the 18th to the 24th month, while there was no appreciable increase in usual care patients during the same period. Among patients with major depression, a greater number achieved remission in the intervention than the usual care group at 4 (26.6 vs. 15.2%), 8 (36% vs. 22.5%), and 24 (45.4% vs. 31.5%) months. Patients with minor depression had favorable outcomes regardless of treatment assignment. Conclusions Sustained collaborative care maintains high utilization of antidepressant treatment, reduces suicidal ideation, and improves the outcomes of major depression over two years. These observations suggest that sustained collaborative care increases depression-free days. PMID:19528195

MDMA and PTSD treatment: "PTSD: From novel pathophysiology to innovative therapeutics".

PubMed

Sessa, Ben

2017-05-10

There is a range of therapies to treat Post Traumatic Stress Disorder (PTSD) but treatment resistance remains high, with many sufferers experiencing the chronic condition. Engagement in trauma-focused psychotherapy is difficult for some patients with PTSD, especially those with extreme affect dysregulation associated with recall of traumatic memories. In recent years there have been a number of neuroscientific and clinical studies examining the potential role for adjunctive drug-assisted psychotherapy using 3,4,-methylenedioxmethamphetamine (MDMA) as a treatment for PTSD. re-visiting of a novel approach to trauma-focused psychotherapy with Used just two or three times, under careful medical supervision and specialised psychotherapy support MDMA appears to facilitate the recall of traumatic memories without the user feeling overwhelmed by the negative affect that usually accompanies such memories. This therapeutic approach began in the 1980s and was subsequently shelved in the midst of public health concerns surrounding the recreational use of the drug ecstasy. When pharmaceutical grade MDMA is used in a clinical setting it does not share the same risk profiles as ecstasy. Recent phase one neurophysiological studies and phase two clinical studies are showing promise as a potential new approach to managing treatment-resistant PTSD. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

Use of Psychotherapy for Depression in Older Adults

PubMed Central

Wei, Wenhui; Sambamoorthi, Usha; Olfson, Mark; Walkup, James T.; Crystal, Stephen

2010-01-01

Objective The authors examine national patterns in psychotherapy for older adults with a diagnosis of depression and analyze correlates of psychotherapy use that is consistent with Agency for Health Care Policy and Research guidelines for duration of treatment. Method Linked Medicare claims and survey data from the 1992–1999 Medicare Current Beneficiary Survey were used. The data were merged with the Area Resource File to assess the effect of provider-supply influences on psychotherapy treatment. An episode-of-care framework approach was used to analyze psychotherapy use and treatment duration. Multiple logistic regression analysis was used to predict psychotherapy use and its consistency. Results The authors identified 2,025 episodes of depression treatment between 1992 and 1999. Overall, psychotherapy was used in 25% (N=474) of the episodes, with 68% of episodes with psychotherapy involving services received only from psychiatrists. (Percentages were weighted for the complex design of the Medicare Current Beneficiary Survey.) Use of psychotherapy was correlated with younger patient age, higher patient educational attainment, and availability of local psychotherapy providers. Among episodes in which psychotherapy was used, only a minority (33%, N=141) involved patients who remained in consistent treatment, defined as extending for at least two-thirds of the episode of depression. Availability of local providers was positively correlated with consistent psychotherapy use. In analyses with adjustment for provider-related factors, patients’ socioeconomic and demographic characteristics did not affect the odds of receiving consistent psychotherapy. Conclusions Use of psychotherapy remains uncommon among depressed older adults despite its widely acknowledged efficacy. Some of the disparities in psychotherapy utilization suggest supply-side barriers. Increasing the geographic availability of mental health care providers may be one way of increasing access to psychotherapy for depressed older adults. PMID:15800143

Effectiveness of Collaborative Care for Depression in Public-Sector Primary Care Clinics Serving Latinos.

PubMed

Lagomasino, Isabel T; Dwight-Johnson, Megan; Green, Jennifer M; Tang, Lingqi; Zhang, Lily; Duan, Naihua; Miranda, Jeanne

2017-04-01

Quality improvement interventions for depression care have been shown to be effective for improving quality of care and depression outcomes in settings with primarily insured patients. The aim of this study was to determine the impact of a collaborative care intervention for depression that was tailored for low-income Latino patients seen in public-sector clinics. A total of 400 depressed patients from three public-sector primary care clinics were enrolled in a randomized controlled trial of a tailored collaborative care intervention versus enhanced usual care. Social workers without previous mental health experience served as depression care specialists for the intervention patients (N=196). Depending on patient preference, they delivered a cognitive-behavioral therapy (CBT) intervention or facilitated antidepressant medication given by primary care providers or both. In enhanced usual care, patients (N=204) received a pamphlet about depression, a letter for their primary care provider stating that they had a positive depression screen, and a list of local mental health resources. Intent-to-treat analyses examined clinical and process-of-care outcomes at 16 weeks. Compared with patients in the enhanced usual care group, patients in the intervention group had significantly improved depression, quality of life, and satisfaction outcomes (p<.001 for all). Intervention patients also had significantly improved quality-of-care indicators, including the proportion of patients receiving either psychotherapy or antidepressant medication (77% versus 21%, p<.001). Collaborative care for depression can greatly improve care and outcomes in public-sector clinics. Social workers without prior mental health experience can effectively provide CBT and manage depression care.

Usual Course of Treatment and Predictors of Treatment Utilization for Patients With Posttraumatic Stress Disorder.

PubMed

Nobles, Carrie J; Valentine, Sarah E; Zepeda, E David; Ahles, Emily M; Shtasel, Derri L; Marques, Luana

2017-05-01

Posttraumatic stress disorder (PTSD) is a debilitating psychiatric illness that frequently remains undiagnosed and untreated. While extensive research has been conducted among veterans, little research has evaluated course of treatment for PTSD in a general hospital setting. We utilized data from the Partners HealthCare Research Patient Data Registry to evaluate mental health treatment utilization, including psychotherapy and pharmacotherapy, by patients with recently diagnosed primary PTSD following DSM-IV criteria between January 1, 2002, and June 30, 2011. We additionally evaluated predictors of treatment utilization 6 months postdiagnosis. Among 2,475 patients with recently diagnosed primary PTSD, approximately half (55.7%) had any therapy visit and 10% had at least 12 therapy visits in the 6 months following diagnosis. Approximately half (47.0%) received a psychiatric prescription, with 29.3% receiving a selective serotonin reuptake inhibitor (SSRI), 11.8% receiving an atypical antipsychotic, and 24.4% receiving a benzodiazepine. Latinos were 25% (95% CL = 1.09, 1.43) more likely to have an SSRI prescription, 35% (95% CL = 1.05, 1.75) more likely to have an atypical antipsychotic prescription, and 28% (95% CL = 1.19, 1.38) more likely to receive any psychotherapy. Women were 49% (95% CL = 0.42, 0.63) less likely to have an atypical antipsychotic prescription. Patients with Medicare were 23% (95% CL = 0.67, 0.88) less likely to have any psychotherapy, and patients with Medicaid were 35% (95% CL = 0.46, 0.92) less likely to have 12 or more therapy visits. Many patients with a primary diagnosis of PTSD do not receive psychotherapy, and psychiatric prescriptions, including atypical antipsychotics and benzodiazepines, are common. Future research is needed to determine the quality of care received and explore subpopulation-specific barriers limiting access to care. © Copyright 2017 Physicians Postgraduate Press, Inc.

Effect of Psychotherapy on Health Care Utilization in Children With Inflammatory Bowel Disease and Depression.

PubMed

Keerthy, Divya; Youk, Ada; Srinath, Arvind I; Malas, Nasuh; Bujoreanu, Simona; Bousvaros, Athos; Keljo, David; DeMaso, David R; Szigethy, Eva M

2016-12-01

Pediatric patients with inflammatory bowel disease (IBD) are at an increased risk of developing depression compared with community controls. Depression often negatively influences illness behaviors such as resource utilization. We sought to investigate the effects of treating depression on utilization of medical resources in depressed pediatric patients with IBD by comparing rates of health care utilization 1 year before and after psychotherapy. Two hundred seventeen subjects ages 9 to 17 years with IBD and depression received 3 months of psychotherapy for depression as part of a multicenter randomized controlled trial. Of these 217 subjects, 70 had utilization data available 1 year prior and 1 year after receiving 3 months of psychotherapy. Primary outcomes included frequency of hospitalizations, inpatient hospital days, outpatient gastrointestinal visits, and number of emergency room visits, radiological examinations, and endoscopies. Within subject analyses were completed comparing health care utilization 12 months before psychotherapy compared with the 12 months after the conclusion of psychotherapy. Fifty-one and 19 patients had CD and UC, respectively. A total of 55.7% of patients had major depression and 44.3% had minor depression. Overall, all study measures of health care utilization were significantly reduced after psychotherapy (P < 0.01)-including gastrointestinal-related (mean values) hospitalization frequency, inpatient days, outpatient visit, emergency room visits, radiological examinations, and endoscopies. Psychotherapy for comorbid depression in pediatric patients with IBD is associated with decreased GI-related health care utilization. The present study highlights the importance of screening for depression in a pediatric population with IBD, and that psychotherapy may be a reasonable adjunctive treatment for pediatric patients with IBD and comorbid depression.

The effectiveness of individual interpersonal psychotherapy as a treatment for major depressive disorder in adult outpatients: a systematic review.

PubMed

van Hees, Madelon L J M; Rotter, Thomas; Ellermann, Tim; Evers, Silvia M A A

2013-01-11

This systematic review describes a comparison between several standard treatments for major depressive disorder (MDD) in adult outpatients, with a focus on interpersonal psychotherapy (IPT). Systematic searches of PubMed and PsycINFO studies between January 1970 and August 2012 were performed to identify (C-)RCTs, in which MDD was a primary diagnosis in adult outpatients receiving individual IPT as a monotherapy compared to other forms of psychotherapy and/or pharmacotherapy. 1233 patients were included in eight eligible studies, out of which 854 completed treatment in outpatient facilities. IPT combined with nefazodone improved depressive symptoms significantly better than sole nefazodone, while undefined pharmacotherapy combined with clinical management improved symptoms better than sole IPT. IPT or imipramine hydrochloride with clinical management showed a better outcome than placebo with clinical management. Depressive symptoms were reduced more in CBASP (cognitive behavioral analysis system of psychotherapy) patients in comparison with IPT patients, while IPT reduced symptoms better than usual care and wait list condition. The differences between treatment effects are very small and often they are not significant. Psychotherapeutic treatments such as IPT and CBT, and/or pharmacotherapy are recommended as first-line treatments for depressed adult outpatients, without favoring one of them, although the individual preferences of patients should be taken into consideration in choosing a treatment.

Do treatment manuals undermine youth-therapist alliance in community clinical practice?

PubMed

Langer, David A; McLeod, Bryce D; Weisz, John R

2011-08-01

Some critics of treatment manuals have argued that their use may undermine the quality of the client-therapist alliance. This notion was tested in the context of youth psychotherapy delivered by therapists in community clinics. Seventy-six clinically referred youths (57% female, age 8-15 years, 34% Caucasian) were randomly assigned to receive nonmanualized usual care or manual-guided treatment to address anxiety or depressive disorders. Treatment was provided in community clinics by clinic therapists randomly assigned to treatment condition. Youth-therapist alliance was measured with the Therapy Process Observational Coding System--Alliance (TPOCS-A) scale at 4 points throughout treatment and with the youth report Therapeutic Alliance Scale for Children (TASC) at the end of treatment. Youths who received manual-guided treatment had significantly higher observer-rated alliance than usual care youths early in treatment; the 2 groups converged over time, and mean observer-rated alliance did not differ by condition. Similarly, the manual-guided and usual care groups did not differ on youth report of alliance. Our findings did not support the contention that using manuals to guide treatment harms the youth-therapist alliance. In fact, use of manuals was related to a stronger alliance in the early phase of treatment.

From Winnicott's potential space to mutual creative space: a principle for intercultural psychotherapy.

PubMed

BenEzer, Gadi

2012-04-01

This paper suggests that elaborating Winnicott's idea of "potential space" can provide a conceptual approach to psychotherapy across the cultural divide. The first part of the paper discusses the general problematic of intercultural psychotherapy. This is illustrated with an account of therapeutic work with Ethiopian Jews who have migrated to Israel. There is a significant gap between the Ethiopian cultural codes relevant to psychotherapy and those of the Israeli therapist, who is usually trained in the Western psychotherapeutic tradition. A meaningful and effective therapeutic process can take place if psychotherapist and client cocreate a "mutual creative space."

New parity, same old attitude towards psychotherapy?

PubMed

Clemens, Norman A

2010-03-01

Full parity of health insurance benefits for treatment of mental illness, including substance use disorders, is a major achievement. However, the newly-published regulations implementing the legislation strongly endorse aggressive managed care as a way of containing costs for the new equality of coverage. Reductions in "very long episodes of out-patient care," hospitalization, and provider fees, along with increased utilization, are singled out as achievements of managed care. Medical appropriateness as defined by expert medical panels is to be the basis of authorizing care, though clinicians are familiar with a history of insurance companies' application of "medical necessity" to their own advantage. The regulations do not single out psychotherapy for attention, but long-term psychotherapy geared to the needs of each patient appears to be at risk. The author recommends that the mental health professions strongly advocate for the growing evidence base for psychotherapy including long-term therapy for complex mental disorders; respect for the structure and process of psychotherapy individualized to patients' needs; awareness of the costs of aggressive managed care in terms of money, time, administrative burden, and interference with the therapy; and recognition of the extensive training and experience required to provide psychotherapy as well as the stresses and demands of the work. Parity in out-of-network benefits could lead to aggressive management of care given by non-network practitioners. Since a large percentage of psychiatrists and other mental health professionals stay out of networks, implementation of parity for out-of-network providers will have to be done in a way that respects the conditions under which they would be willing and able to provide services, especially psychotherapy, to insured patients. The shortage of psychiatrists makes this an important access issue for the insured population in need of care.

Efficacy of an adjunctive brief psychodynamic psychotherapy to usual inpatient treatment of depression: rationale and design of a randomized controlled trial

PubMed Central

2012-01-01

Background A few recent studies have found indications of the effectiveness of inpatient psychotherapy for depression, usually of an extended duration. However, there is a lack of controlled studies in this area and to date no study of adequate quality on brief psychodynamic psychotherapy for depression during short inpatient stay exists. The present article describes the protocol of a study that will examine the relative efficacy, the cost-effectiveness and the cost-utility of adding an Inpatient Brief Psychodynamic Psychotherapy to pharmacotherapy and treatment-as-usual for inpatients with unipolar depression. Methods/Design The study is a one-month randomized controlled trial with a two parallel group design and a 12-month naturalistic follow-up. A sample of 130 consecutive adult inpatients with unipolar depression and Montgomery-Asberg Depression Rating Scale score over 18 will be recruited. The study is carried out in the university hospital section for mood disorders in Lausanne, Switzerland. Patients are assessed upon admission, and at 1-, 3- and 12- month follow-ups. Inpatient therapy is a manualized brief intervention, combining the virtues of inpatient setting and of time-limited dynamic therapies (focal orientation, fixed duration, resource-oriented interventions). Treatment-as-usual represents the best level of practice for a minimal treatment condition usually proposed to inpatients. Final analyses will follow an intention–to-treat strategy. Depressive symptomatology is the primary outcome and secondary outcome includes measures of psychiatric symptomatology, psychosocial role functioning, and psychodynamic-emotional functioning. The mediating role of the therapeutic alliance is also examined. Allocation to treatment groups uses a stratified block randomization method with permuted block. To guarantee allocation concealment, randomization is done by an independent researcher. Discussion Despite the large number of studies on treatment of depression, there is a clear lack of controlled research in inpatient psychotherapy during the acute phase of a major depressive episode. Research on brief therapy is important to take into account current short lengths of stay in psychiatry. The current study has the potential to scientifically inform appropriate inpatient treatment. This study is the first to address the issue of the economic evaluation of inpatient psychotherapy. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN12612000909820) PMID:23110608

Advances in Psychotherapy for Depressed Older Adults.

PubMed

Raue, Patrick J; McGovern, Amanda R; Kiosses, Dimitris N; Sirey, Jo Anne

2017-09-01

We review recent advances in psychotherapies for depressed older adults, in particular those developed for special populations characterized by chronic medical illness, acute medical illness, cognitive impairment, and suicide risk factors. We review adaptations for psychotherapy to overcome barriers to its accessibility in non-specialty settings such as primary care, homebound or hard-to-reach older adults, and social service settings. Recent evidence supports the effectiveness of psychotherapies that target late-life depression in the context of specific comorbid conditions including COPD, heart failure, Parkinson's disease, stroke and other acute conditions, cognitive impairment, and suicide risk. Growing evidence supports the feasibility, acceptability, and effectiveness of psychotherapy modified for a variety of health care and social service settings. Research supports the benefits of selecting the type of psychotherapy based on a comprehensive assessment of the older adult's psychiatric, medical, functional, and cognitive status, and tailoring psychotherapy to the settings in which older depressed adults are most likely to present.

Adding HRV biofeedback to psychotherapy increases heart rate variability and improves the treatment of major depressive disorder.

PubMed

Caldwell, Yoko Tsui; Steffen, Patrick R

2018-01-05

Heart rate variability (HRV) is a significant marker of health outcomes with decreased HRV predicting increased disease risk. HRV is decreased in major depressive disorder (MDD) but existing treatments for depression do not return heart rate variability to normal levels even with successful treatment of depression. Heart rate variability biofeedback (HRVB) increases heart rate variability but no studies to date have examined whether combining HRVB with psychotherapy improves outcome in MDD treatment. The present study used a randomized controlled design to compare the effects of HRVB combined with psychotherapy on MDD relative to a psychotherapy treatment as usual group and to a non-depressed control group. The HRVB+psychotherapy group showed a larger increase in HRV and a larger decrease in depressive symptoms relative to the other groups over a six-week period, whereas the psychotherapy group only did not improve HRV. Results support the supplementation of psychotherapy with HRVB in the treatment of MDD. Copyright © 2018 Elsevier B.V. All rights reserved.

Psychotherapies for depression in low‐ and middle‐income countries: a meta‐analysis

PubMed Central

Cuijpers, Pim; Karyotaki, Eirini; Reijnders, Mirjam; Purgato, Marianna; Barbui, Corrado

2018-01-01

Most psychotherapies for depression have been developed in high‐income Western countries of North America, Europe and Australia. A growing number of randomized trials have examined the effects of these treatments in non‐Western countries. We conducted a meta‐analysis of these studies to examine whether these psychotherapies are effective and to compare their effects between studies from Western and non‐Western countries. We conducted systematic searches in bibliographical databases and included 253 randomized controlled trials, of which 32 were conducted in non‐Western countries. The effects of psychotherapies in non‐Western countries were large (g=1.10; 95% CI: 0.91‐1.30), with high heterogeneity (I2=90; 95% CI: 87‐92). After adjustment for publication bias, the effect size dropped to g=0.73 (95% CI: 0.51‐0.96). Subgroup analyses did not indicate that adaptation to the local situation was associated with the effect size. Comparisons with the studies in Western countries showed that the effects of the therapies were significantly larger in non‐Western countries, also after adjusting for characteristics of the participants, the treatments and the studies. These larger effect sizes in non‐Western countries may reflect true differences indicating that therapies are indeed more effective; or may be explained by the care‐as‐usual control conditions in non‐Western countries, often indicating that no care was available; or may be the result of the relative low quality of many trials in the field. This study suggests that psychotherapies that were developed in Western countries may or may not be more effective in non‐Western countries, but they are probably no less effective and can therefore also be used in these latter countries. PMID:29352530

AIDE-Acute Illness and Depression in Elderly Patients. Cognitive Behavioral Group Psychotherapy in Geriatric Patients With Comorbid Depression: A Randomized, Controlled Trial.

PubMed

Hummel, Jana; Weisbrod, Cecilia; Boesch, Leila; Himpler, Katharina; Hauer, Klaus; Hautzinger, Martin; Gaebel, Andrea; Zieschang, Tania; Fickelscherer, Andrea; Diener, Slawomira; Dutzi, Ilona; Krumm, Bertram; Oster, Peter; Kopf, Daniel

2017-04-01

Comorbid depression is highly prevalent in geriatric patients and associated with functional loss, frequent hospital re-admissions, and a higher mortality rate. Cognitive behavioral psychotherapy (CBT) has shown to be effective in older depressive patients living in the community. To date, CBT has not been applied to older patients with acute physical illness and comorbid depression. To evaluate the effectiveness of CBT in depressed geriatric patients, hospitalized for acute somatic illness. Randomized controlled trial with waiting list control group. Postdischarge intervention in a geriatric day clinic; follow-up evaluations at the patients' homes. A total of 155 randomized patients, hospitalized for acute somatic illness, aged 82 ± 6 years and suffering from depression [Hospital Anxiety and Depression Scale (HADS) scores >7]. Exclusion criteria were dementia, delirium, and terminal state of medical illness. Fifteen, weekly group sessions based on a CBT manual. Commencement of psychotherapy immediately after discharge in the intervention group and a 4-month waiting list interval with usual care in the control group. HADS depression total score after 4 months. Secondary endpoints were functional, cognitive, psychosocial and physical status, resource utilization, caregiver burden, and amount of contact with physician. The intervention group improved significantly in depression scores (HADS baseline 18.8; after 4 months 11.4), whereas the control group deteriorated (HADS baseline 18.1; after 4 months 21.6). Significant improvement in the intervention group, but not in the control group, was observed for most secondary outcome parameters such as the Barthel and Karnofsky indexes. Intervention effects were less pronounced in patients with cognitive impairment or acute fractures. CBT is feasible and highly effective in geriatric patients. The benefits extend beyond effective recovery and include improvement in physical and functional parameters. Early diagnosis, good access to psychotherapy, and early intervention could improve care for depressive older patients. www.germanctr.de German Trial Register DRKS 00004728. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

[Institutional psychotherapy, caring for patients and the place of care].

PubMed

Drogoul, Frank

2013-01-01

Institutional psychotherapy was developed in the specific context of the "assassination" of the Spanish revolution. There are two distinct movements or two periods. The first, based around Georges Daumézon and Henri Ey gave birth to the sector. The second, around FrançoisTosquelles and Jean Oury emphasised the asylum as the place of care. The function of institutional psychotherapy is to care not only for the patients but also the place of treatment. To fulfil this function, it has a tool box: transfer, the fight against the overvaluation of hierarchy as well as the function of the therapeutic club.

Differences in clinical characteristics between patients assessed for NHS specialist psychotherapy and primary care counselling.

PubMed

Chiesa, Marco; Fonagy, Peter; Bateman, Anthony W

2007-12-01

Although several studies have described patient populations in primary care counselling settings and NHS (National Health Service) specialist psychotherapy settings, there is a paucity of studies specifically comparing differences in clinical characteristics between the two groups of patients. The aim of this study is to ascertain if specialist psychotherapy referrals represent a more challenging client group than primary care counselling patients. We compare the socio-demographic features and severity of presentation in the symptomatic, interpersonal problems and global adjustment dimensions of a sample of patients (N=384) assessed by a primary care counselling service located in North London and a sample of patients (N=853) assessed in eight NHS psychotherapy centres located within urban settings in England. Both the groups completed the Brief Symptom Inventory, the Inventory of Interpersonal Problems and Clinical Outcomes in Routine Evaluation Outcome Measure. Patients referred for specialist psychotherapy services were more dysfunctional than those referred for primary care counselling. The linear function constructed to discriminate the groups showed that a combination of more psychotic symptoms, social inhibitions and higher risk of self-harm effectively identified those referred to psychotherapy services, while patients exhibiting greater levels of somatic and anxiety symptoms and non-assertiveness were more likely to be seen in primary care settings. However, similarities between the two samples were also marked, as shown by the overlap in the distribution of clinical outcomes in routine evaluation clinical scores in the two samples. The findings are discussed in terms of their implications for policy and service delivery of these two types of psychological therapy services.

A Prospective Study of Racial and Ethnic Variation in VA Psychotherapy Services for PTSD.

PubMed

Spoont, Michele R; Sayer, Nina A; Kehle-Forbes, Shannon M; Meis, Laura A; Nelson, David B

2017-03-01

To determine whether there are racial or ethnic disparities in receipt of U.S. Department of Veterans Affairs (VA) psychotherapy services for veterans with posttraumatic stress disorder (PTSD), the authors examined the odds of receipt of any psychotherapy and of individual psychotherapy among self-identified racial and ethnic groups for six months after individuals were diagnosed as having PTSD. Data were from a national prospective cohort study of 6,884 veterans with PTSD. Patients with no mental health care in the prior year were surveyed immediately following receipt of a PTSD diagnosis. VA databases were used to determine mental health service use. Analyses controlled for treatment need, access to services, and treatment beliefs. Among veterans with PTSD initially seen in VA mental health treatment settings, Latino veterans were less likely than white veterans to receive any psychotherapy, after the analyses controlled for treatment need, access, and beliefs. Among those initially seen in mental health settings who received some psychotherapy services, Latinos, African Americans, and Asian/Pacific Islanders were less likely than white veterans to receive any individual therapy. These racial-ethnic differences in psychotherapy receipt were due to factors occurring between VA health care networks as well as factors occurring within networks. Drivers of disparities differed across racial and ethnic groups. Inequity in psychotherapy services for some veterans from racial and ethnic minority groups with PTSD were due to factors operating both within and between health care networks.

Medical psychotherapy of schizophrenia--a dynamic/supportive approach.

PubMed

Corradi, Richard B

2004-01-01

Split psychiatric treatment-a psychiatrist prescribing medication while a nonphysician provides or coordinates psychosocial treatments-is common practice, especially in the managed care setting. This influence, along with a focus on the biology of mental illness, has shifted the emphasis in psychiatric education and practice away from psychotherapy. In particular, "psychotherapy" of schizophrenia has gotten short shrift. Since our drugs for schizophrenia do not cure, but only ameliorate, it would be unfortunate if psychiatrists were to become marginalized in a largely prescriptive role. This paper discusses medical psychotherapy of schizophrenia-an integrated treatment in which the psychiatrist provides the comprehensive care that such a chronic biopsychosocial illness requires.

The Family Value of Information, Community Support, and Experience Study: Rationale, Design, and Methods of a "Family-Centered" Research Study.

PubMed

Reeves, Gloria M; Wehring, Heidi J; Connors, Kathleen M; Bussell, Kristin; Schiffman, Jason; Medoff, Deborah R; Tsuji, Thomas; Walker, Jane; Brown, Alicia; Strobeck, Danielle; Clough, Tammy; Rush, Caitlin B; Riddle, Mark A; Love, Raymond C; Zachik, Albert; Hoagwood, Kimberly; Olin, S Serene; Stephan, Sharon; Okuzawa, Nana; Edwards, Sarah; Baquet, Claudia; dosReis, Susan

2015-12-01

The Patient Protection and Affordable Care Act focuses on improving consumer engagement and patient-centered care. This article describes the design and rationale of a study targeting family engagement in pediatric mental health services. The study is a 90-day randomized trial of a telephone-delivered Family Navigator services versus usual care for parents of Medicaid-insured youth younger than 13 years with serious mental illness. Youth are identified through a pediatric antipsychotic medication preauthorization program. Family Navigators offer peer support to empower and engage parents in their child's recovery. Outcomes include parent report of empowerment, social support, satisfaction with child mental health services, and child functioning as well as claims-based measures of psychotherapy service utilization and antipsychotic medication dosage. The focus on "family-centered" care in this study is strongly supported by the active role of consumers in study design and implementation.

[Doctor shopping: the difficult-to-manage patient].

PubMed

de Zwaan, Martina; Müller, Astrid

2006-08-01

Medically unexplained symptoms and bodily dysfunctions are the single most prevalent class of symptoms in primary care. Differences in opinion as to the cause of the illness between the patients and the health care professionals make somatoform disorders a challenge for the patient-doctor relationship, and frequently produce negative feelings in health care professionals. The patients are usually reluctant to consider psychosocial aspects of their illness to be a factor. Early recognition of patients with somatization tendencies would be beneficial so that more effective treatment could begin sooner and unnecessary treatment be avoided. In order not to reinforce the patient's symptomatology, physicians should schedule appointments in a time contingent rather than a symptom contingent manner. Repetition of different tests should be avoided despite patients' demands in order not to further exacerbate the disorder. In many patients, psychotherapy should be recommended, although motivational work should already be initiated at the primary care stage.

Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial.

PubMed

Zipfel, Stephan; Wild, Beate; Groß, Gaby; Friederich, Hans-Christoph; Teufel, Martin; Schellberg, Dieter; Giel, Katrin E; de Zwaan, Martina; Dinkel, Andreas; Herpertz, Stephan; Burgmer, Markus; Löwe, Bernd; Tagay, Sefik; von Wietersheim, Jörn; Zeeck, Almut; Schade-Brittinger, Carmen; Schauenburg, Henning; Herzog, Wolfgang

2014-01-11

Psychotherapy is the treatment of choice for patients with anorexia nervosa, although evidence of efficacy is weak. The Anorexia Nervosa Treatment of OutPatients (ANTOP) study aimed to assess the efficacy and safety of two manual-based outpatient treatments for anorexia nervosa--focal psychodynamic therapy and enhanced cognitive behaviour therapy--versus optimised treatment as usual. The ANTOP study is a multicentre, randomised controlled efficacy trial in adults with anorexia nervosa. We recruited patients from ten university hospitals in Germany. Participants were randomly allocated to 10 months of treatment with either focal psychodynamic therapy, enhanced cognitive behaviour therapy, or optimised treatment as usual (including outpatient psychotherapy and structured care from a family doctor). The primary outcome was weight gain, measured as increased body-mass index (BMI) at the end of treatment. A key secondary outcome was rate of recovery (based on a combination of weight gain and eating disorder-specific psychopathology). Analysis was by intention to treat. This trial is registered at http://isrctn.org, number ISRCTN72809357. Of 727 adults screened for inclusion, 242 underwent randomisation: 80 to focal psychodynamic therapy, 80 to enhanced cognitive behaviour therapy, and 82 to optimised treatment as usual. At the end of treatment, 54 patients (22%) were lost to follow-up, and at 12-month follow-up a total of 73 (30%) had dropped out. At the end of treatment, BMI had increased in all study groups (focal psychodynamic therapy 0·73 kg/m(2), enhanced cognitive behaviour therapy 0·93 kg/m(2), optimised treatment as usual 0·69 kg/m(2)); no differences were noted between groups (mean difference between focal psychodynamic therapy and enhanced cognitive behaviour therapy -0·45, 95% CI -0·96 to 0·07; focal psychodynamic therapy vs optimised treatment as usual -0·14, -0·68 to 0·39; enhanced cognitive behaviour therapy vs optimised treatment as usual -0·30, -0·22 to 0·83). At 12-month follow-up, the mean gain in BMI had risen further (1·64 kg/m(2), 1·30 kg/m(2), and 1·22 kg/m(2), respectively), but no differences between groups were recorded (0·10, -0·56 to 0·76; 0·25, -0·45 to 0·95; 0·15, -0·54 to 0·83, respectively). No serious adverse events attributable to weight loss or trial participation were recorded. Optimised treatment as usual, combining psychotherapy and structured care from a family doctor, should be regarded as solid baseline treatment for adult outpatients with anorexia nervosa. Focal psychodynamic therapy proved advantageous in terms of recovery at 12-month follow-up, and enhanced cognitive behaviour therapy was more effective with respect to speed of weight gain and improvements in eating disorder psychopathology. Long-term outcome data will be helpful to further adapt and improve these novel manual-based treatment approaches. German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF), German Eating Disorders Diagnostic and Treatment Network (EDNET). Copyright © 2014 Elsevier Ltd. All rights reserved.

Are studies of psychotherapies for depression more or less generalizable than studies of antidepressants?

PubMed

Lorenzo-Luaces, Lorenzo; Zimmerman, Mark; Cuijpers, Pim

2018-07-01

The generalizability of findings from studies exploring the efficacy of psychotherapy and antidepressants has been called into question in part because studies exclude many patients. Despite this, the frequency with which psychotherapy and antidepressant studies use specific inclusion and exclusion criteria has never been compared. We explored the exclusion criteria used in psychotherapy and pharmacotherapy studies from 1995 to 2014. Systematic literature searches were conducted in PubMed, Medline, PsycINFO, and Embase of published randomized controlled trials (RCTs) of the treatment of major depressive disorder (MDD) in adults with either antidepressants (vs. placebos) or psychotherapy (vs. placebos, treatments as usual, or other controls). Most psychotherapy (81%) and antidepressant (100%) trials excluded patients with milder symptoms as well as patients with elevated suicidal risk (56-75%), psychotic symptoms (84-88%), or substance misuse (75-81%). Psychotherapy studies were less likely to exclude patients on the basis of brief episode duration (0% vs. 48%) and co-morbid Axis I disorders (6% vs. 27%). However, psychotherapy studies excluded patients with more severe symptoms more frequently (38%) than antidepressant studies (8%). Overall, psychotherapy studies appear somewhat more inclusive than antidepressant studies. On average, antidepressant studies appear to target patients with more chronic and severe, as well as more purely depressive presentations. Copyright © 2018 Elsevier B.V. All rights reserved.

Stigma, help-seeking attitudes, and use of psychotherapy in veterans with diagnoses of posttraumatic stress disorder.

PubMed

Rosen, Craig S; Greenbaum, Mark A; Fitt, Julie E; Laffaye, Charlene; Norris, Virginia A; Kimerling, Rachel

2011-11-01

Survey and medical record data from 482 Veterans Affairs (VA) patients who recently received diagnoses of posttraumatic stress disorder (PTSD) were examined to determine need and predisposing factors associated with utilization of psychotherapy and counseling. More than half (58%) of participants initiated VA psychotherapy for PTSD within a year of diagnosis. Of those, one third completed eight or more sessions. Roughly two thirds of participants initiated counseling at a Vet Center. Initiating PTSD psychotherapy was associated with greater impairment but not with stigma, concerns about fitting in, or satisfaction with care. The use of Vet Center counseling was associated with desire for help, concerns about fitting in, and satisfaction with care. Unexpectedly, veterans with greater stigma concerns completed more psychotherapy visits and Vet Center counseling. Negative attitudes about mental health treatment did not seem to be substantial barriers to engaging in psychotherapy among these VA patients. Future research should consider enabling treatment system factors in addition to predisposing patient characteristics.

[The Application of Body-Mind-Spirit Integrated Psychotherapy in Nursing Practice].

PubMed

Hsiao, Fei-Hsiu

2017-06-01

Body-mind-spirit integrated psychotherapy reflects the core value of nursing by emphasizing the inseparable concept of body, mind, and spirit and caring for the holistic needs of the patient. Body-mind-spirit integrated psychotherapy was developed based on Western psychotherapy (positive psychology and forgiveness therapy), traditional Chinese medicine, and the Eastern philosophies of Buddhism, Taoism, and Confucianism. The present paper describes the holistic concepts that underpin this therapeutic approach. Physical health is sustained through proper nutrition, physical relaxation, and harmonized breathing; psychological well-being helps maintain inner peace and harmony in interpersonal relationships; and spiritual well-being helps develop an optimistic and meaningful life. We report on several cases in which body-mind-spirit integrated psychotherapy was applied to the care of clients with depressive disorders and of breast cancer survivors and their partners as well as the related efficacy of this intervention in these cases. Finally, we discuss the potential for culturally-enriched psychotherapy to help clients transform illness suffering into life-growth experiences.

Primary Care-Mental Health Integration in the VA Health System: Associations Between Provider Staffing and Quality of Depression Care.

PubMed

Levine, Debra S; McCarthy, John F; Cornwell, Brittany; Brockmann, Laurie; Pfeiffer, Paul N

2017-05-01

The study examined whether staffing of Primary Care-Mental Health Integration (PCMHI) services in the Department of Veterans Affairs (VA) health system is related to quality of depression care. Site surveys and administrative data from 349 VA facilities for fiscal year 2013 were used to calculate PCMHI staffing (full-time equivalents) per 10,000 primary care patients and discipline-specific staffing proportions for PCMHI psychologists, social workers, nurses, and psychiatric medication prescribers. Multivariable regression analyses were conducted at the facility level and assessed associations between PCMHI staffing ratios and the following indicators of depression treatment in the three months following a new episode of depression: any antidepressant receipt, adequacy of antidepressant receipt, any psychotherapy receipt, and psychotherapy engagement (three or more visits). Higher facility PCMHI staffing ratios were associated with a greater percentage of patients who received any psychotherapy treatment (B=1.16, p<.01) and who engaged in psychotherapy (B=.39, p<.01). When analyses controlled for total PCMHI staffing, the proportion of social workers as part of PCMHI was positively correlated with the percentage of patients with adequate antidepressant treatment continuation (B=3.16, p=.03). The proportion of nurses in PCMHI was negatively associated with the percentage of patients with engagement in psychotherapy (B=-2.83, p=.02). PCMHI programs with greater overall staffing ratios demonstrated better performance on indicators of psychotherapy for depression but not on indicators of antidepressant treatment. Further investigation is needed to determine whether differences in discipline-specific staffing play a causal role in driving associated differences in receipt of treatment.

[Psychanalitic psychotherapy: practice and indications in the aged].

PubMed

Claudel, Bertrand

2004-09-01

Use of psychoanalytic psychotherapy for the elderly remains an issue. Even though regular psychoanalysis cure is contraindicated for elderly patients in most cases, yet, face-to-face psychotherapies can prove useful. The methods used for psychoanalytic psychotherapy for elderly patients are different from those applicable to middle age patients. These methods take into account the mourning process experienced by the elderly patient in three spheres: loss of object, loss of function and loss of oneself. Indications concerning psychoanalytic psychotherapy for the elderly have to be carefully assessed and will be detailed throughout the paper.

Cost-effectiveness of quality improvement programs for patients with subthreshold depression or depressive disorder.

PubMed

Wells, Kenneth B; Schoenbaum, Michael; Duan, Naihua; Miranda, Jeanne; Tang, Lingqi; Sherbourne, Cathy

2007-10-01

This study explored the cost-effectiveness of quality-improvement interventions for depression in primary care, relative to usual care, among patients with subthreshold depression or depressive disorder. A total of 746 primary care patients in managed care organizations with 12-month depressive disorder and 502 with current depressive symptoms but no disorder (subthreshold depression) participated in a group-level randomized controlled trial initiated between June 1996 and March 1997. Matched clinics were randomly assigned to enhanced usual care or one of two quality improvement interventions that provided education to manage depression over time and resources to facilitate access to medication management or psychotherapy for six to 12 months. The cost-effectiveness ratio for the pooled intervention groups versus usual care was $2,028 for patients with subthreshold depression (95% confidence interval [CI]=-$17,225 to $21,282) and $53,716 for those with depressive disorder (CI=$14,194 to $93,238), by using a measure of quality-adjusted life years (QALY) based on the 12-Item Short Form Health Survey. Similar results were obtained when alternative QALY measures were used. Although precision was limited, even the upper limit of the 95% CIs suggests that such interventions are as cost-effective for patients with subthreshold depression as are many widely used medical therapies. Despite lack of evidence for efficacy of treatments for subthreshold depression, disease management programs that support clinical care decisions over time for patients with subthreshold depression or depressive disorder can yield cost-effectiveness ratios comparable to those of widely adopted medical therapies. Achieving greater certainty about average cost-effectiveness would require a much larger study.

[Access to government-funded psychotherapy: Comparing the point of view of psychologists and psychotherapists].

PubMed

Bradley, Stacy; Doucet, Rachelle; Kohler, Erich; Drapeau, Martin

Objectives Within the Quebec context, as well as the larger Canadian and International context, increasing access to mental health care treatment has become a major health care priority (see Peachey, Hicks, & Adams, 2013). Initiatives to increase access through government-funded psychotherapy have been successfully implemented in Australia and the United Kingdom. The current study sought to document how licensed psychologists and psychotherapists in Quebec differ in their attitudes about the components of these government-funded psychotherapy programs and increasing access to psychotherapy treatment.Methods The target population for the study included both psychologists and psychotherapists whom were licensed to practice psychotherapy with the Ordre of Psychologists of Quebec. Participants (N = 1 275) were recruited by email to participate in an online questionnaire focusing on components such as the services that should be offered in a new government-funded psychotherapy model (eg., individual therapy, family therapy; including employment and debt counselling), the choice and autonomy clinicians have in their treatment interventions, the role of the referring General Practitioner (GP), the fees per psychotherapy hour, the hiring structure (e.g., in the public sector versus reimbursing private psychotherapy services), among others.Results The results indicated that psychotherapists were more in favour of including family and couple therapy, and employment/vocational counselling than psychologists. Psychologists were more in favour of using evidence-based practices as well as tracking treatment outcomes using validated measures, and publishing treatment satisfaction ratings to the public. Psychotherapists were more in favour of being paid on a session-to-session basis as opposed to be being hired on a salaried basis to offer government-funded psychotherapy.Conclusions Given that psychologists and psychotherapists differ in their training background and have historically played different roles in the health care system, it is important to understand how they differ in their perspectives on accessibility to psychotherapy. The implications for implementing government-funded psychotherapy initiatives in Quebec given the different professional perspectives of the two groups are discussed.

Group Psychotherapy in Italy.

PubMed

Giannone, Francesca; Giordano, Cecilia; Di Blasi, Maria

2015-10-01

This article describes the history and the prevailing orientations of group psychotherapy in Italy (psychoanalytically oriented, psychodrama, CBT groups) and particularly group analysis. Provided free of charge by the Italian health system, group psychotherapy is growing, but its expansion is patchy. The main pathways of Italian training in the different group psychotherapy orientations are also presented. Clinical-theoretical elaboration on self development, psychopathology related to group experiences, and the methodological attention paid to objectives and methods in different clinical groups are issues related to group therapy in Italy. Difficulties in the relationship between research and clinical practice are discussed, as well as the empirical research network that tries to bridge the gap between research and clinical work in group psychotherapy. The economic crisis in Italy has led to massive cuts in health care and to an increasing demand for some forms of psychological treatment. For these reasons, and because of its positive cost-benefit ratio, group psychotherapy is now considered an important tool in the national health care system to expand the clinical response to different forms of psychological distress.

A Randomized Trial of Telephone Psychotherapy and Pharmacotherapy for Depression: Continuation and Durability of Effects

ERIC Educational Resources Information Center

Ludman, Evette J.; Simon, Gregory E.; Tutty, Steve; Von Korff, Michael

2007-01-01

Randomized trial evidence and expert guidelines are mixed regarding the value of combined pharmacotherapy and psychotherapy as initial treatment for depression. This study describes long-term results of a randomized trial (N = 393) evaluating telephone-based cognitive-behavioral therapy (CBT) plus care management for primary care patients…

[Psychosomatic and psychotherapeutic outpatient care in Germany - Capacity profile based on data from the National Association of Statutory Health Insurance Physicians].

PubMed

Kruse, Johannes; Larisch, Astrid; Hofmann, Mareike; Herzog, Wolfgang

2013-01-01

At the centre of the study lay a representation of outpatient psychosomatic and psychotherapeutic care with a focus on different groups of medical and psychological therapists. The routine data of the National Association of Statutory Health Insurance Physicians (KBV) from the year 2008 were analyzed based on a systematic literature review (Medline, ISI, to November 2010). Neurologists and psychiatrists see the most patients (n = 3,172 vs n = 1,347 cases per practice), but they rarely provide services according to the directives for psychotherapy (4,4 %). However, specialists for psychosomatic medicine and psychotherapy (65 %), physicians providing only psychotherapy (66 %) and psychological psychotherapists (73 %) provide care mainly according to the directives for psychotherapy and therefore see fewer patients (170-190 cases per practice).Medical psychotherapists work more often on a psychodynamic basis, while psychological psychotherapists perform more often behavioral therapy. The treatment of patients with mental and psychosomatic disorders is based on three columns of care, which differ in their supply profile and each make a specific contribution to the treatment.

Supportive-Expressive Dynamic Psychotherapy in the Community Mental Health System: A Pilot Effectiveness Trial for the Treatment of Depression

PubMed Central

Connolly Gibbons, Mary Beth; Thompson, Sarah M.; Scott, Kelli; Schauble, Lindsay A.; Mooney, Tessa; Thompson, Donald; Green, Patricia; MacArthur, Mary Jo; Crits-Christoph, Paul

2013-01-01

The goal of the current article is to present the results of a randomized pilot investigation of a brief dynamic psychotherapy compared with treatment-as-usual (TAU) in the treatment of moderate-to-severe depression in the community mental health system. Forty patients seeking services for moderate-to-severe depression in the community mental health system were randomized to 12 weeks of psychotherapy, with either a community therapist trained in brief dynamic psychotherapy or a TAU therapist. Results indicated that blind judges could discriminate the dynamic sessions from the TAU sessions on adherence to dynamic interventions. The results indicate moderate-to-large effect sizes in favor of the dynamic psychotherapy over the TAU therapy in the treatment of depression. The Behavior and Symptom Identification Scale-24 showed that 50% of patients treated with dynamic therapy moved into a normative range compared with only 29% of patients treated with TAU. PMID:22962971

[Utilization of self-help groups and psychotherapy after psychosomatic-psychotherapeutic in-patient treatment].

PubMed

Höflich, Anke; Matzat, Jürgen; Meyer, Friedhelm; Knickenberg, Rudolf J; Bleichner, Franz; Merkle, Wolfgang; Reimer, Christian; Franke, Wolfram; Beutel, Manfred E

2007-05-01

Until now little is known about the role of participation in self-help groups alone or combined with psychotherapy in post-in-patient care. In the present study 2933 patients were questioned about their experience of self-help groups and psychotherapy after discharge from a clinic for psychosomatic medicine and psychotherapy. Nearly 8 % of them utilized self-help groups (mostly combined with out-patient psychotherapy), and altogether 68 % out-patient psychotherapy following in-patient treatment. Patients without out-patient treatment were psychologically less burdened and had better resources than participants of self-help groups or psychotherapy. Self-help group members differed from patients in out-patient psychotherapy by expressing a more positive opinion of groupwork and higher openness to new experiences. Additionly, they had discussed the topic of self-help groups more frequently with their therapists. This may be a starting-point for promoting more self-help activities of patients in the future.

Supportive Psychotherapy with the Dual Diagnosis Patient

PubMed Central

2008-01-01

Psychiatrists and other mental health professionals can offer much in the care of patients with intellectual disabilities, including state-of-the-art medication regimens, psychotherapy, and other behavior therapies. Individuals with intellectual disabilities experience the full range of mental illnesses, but are often thought to be incapable of participating in or responding to psychotherapy. The following composite cases illustrate some of the psychotherapy techniques employed in a community psychiatry setting that serves patients with intellectual disabilities and co-occurring mental illness. PMID:19727299

[Evidence basis of psychotherapy for schizophrenia patients in Germany].

PubMed

Puschner, B; Vauth, R; Jacobi, F; Becker, T

2006-11-01

Little is known about the degree of implementation of evidence-based psychotherapy in routine care of people with schizophrenia in Germany. First, results of studies on the efficacy of psychotherapy in the treatment of schizophrenia are summarised. Second, the degree of implementation of psychotherapeutic practices in the routine care of schizophrenics is assessed through a systematic literature search and analyses of several data sets. There is substantial evidence for the efficacy of cognitive-behavioural interventions in the treatment of schizophrenia. The paucity of data on the degree of implementation suggests a wide gap between evidence and practice. Barriers to implementation are outlined and discussed. There is a need for more studies on epidemiological and long-term effectiveness of health care.

Moving Out of the Office: Removing Barriers to Access to Psychiatrists.

PubMed

Paris, Joel; Goldbloom, David; Kurdyak, Paul

2015-09-01

Our paper offers a perspective on barriers to access to psychiatric care. Research shows that access depends not simply on the total number of trained specialists but also on their kind of practice. In some large cities, some practitioners follow a small number of patients in long-term psychotherapy, a practice supported by government insurance, which places no limits on the number of sessions or treatment duration. The problem is that long-term psychotherapy, despite a rich tradition in psychiatry, is not an evidence-based treatment. This review recommends a model in which psychiatrists spend more time in consultation with primary care professionals, in acute care for patients with severe mental illness, and in briefer, more cost-effective forms of psychotherapy.

Treatment of obsessive compulsive disorder in a nationwide survey of office-based physician practice

PubMed Central

Patel, Sapana R; Humensky, Jennifer L; Olfson, Mark; Simpson, Helen Blair; Myers, Robert; Dixon, Lisa B.

2014-01-01

Objective To examine the treatment of obsessive compulsive disorder (OCD) in office-based physician practices. Methods Data from the 2003–2010 National Ambulatory Medical Care Survey, a nationally representative survey of visits to office-based physicians in the United States, were used to examine treatment of adult outpatient visits with a diagnosis of OCD. Results Most visits with a diagnosis of OCD (N=316) had been seen previously by the same physician (96%), usually a psychiatrist (86%), ≥6 times (56%) within the previous year. Most visits included psychotropic medications (84%), most commonly a serotonin reuptake inhibitor (69%) and less commonly included any psychotherapy (39%). Conclusions OCD is predominantly treated by psychiatrists using SRI medications, despite the prevalence of OCD and SRI prescribing practices in primary care. Given the potential shift in OCD treatment practice patterns after health care reform, future research on the treatment of OCD in primary care are warranted. PMID:24585056

Efficacy of a cognitive and behavioural psychotherapy applied by primary care psychologists in patients with mixed anxiety-depressive disorder: a research protocol.

PubMed

Jauregui, Amale; Ponte, Joaquín; Salgueiro, Monika; Unanue, Saloa; Donaire, Carmen; Gómez, Maria Cruz; Burgos-Alonso, Natalia; Grandes, Gonzalo

2015-03-20

In contrast with the recommendations of clinical practice guidelines, the most common treatment for anxiety and depressive disorders in primary care is pharmacological. The aim of this study is to assess the efficacy of a cognitive-behavioural psychological intervention, delivered by primary care psychologists in patients with mixed anxiety-depressive disorder compared to usual care. This is an open-label, multicentre, randomized, and controlled study with two parallel groups. A random sample of 246 patients will be recruited with mild-to-moderate mixed anxiety-depressive disorder, from the target population on the lists of 41 primary care doctors. Patients will be randomly assigned to the intervention group, who will receive standardised cognitive-behavioural therapy delivered by psychologists together with usual care, or to a control group, who will receive usual care alone. The cognitive-behavioural therapy intervention is composed of eight individual 60-minute face-to face sessions conducted in eight consecutive weeks. A follow-up session will be conducted over the telephone, for reinforcement or referral as appropriate, 6 months after the intervention, as required. The primary outcome variable will be the change in scores on the Short Form-36 General Health Survey. We will also measure the change in the frequency and intensity of anxiety symptoms (State-Trait Anxiety Inventory) and depression (Beck Depression Inventory) at baseline, and 3, 6 and 12 months later. Additionally, we will collect information on the use of drugs and health care services. The aim of this study is to assess the efficacy of a primary care-based cognitive-behavioural psychological intervention in patients with mixed anxiety-depressive disorder. The international scientific evidence has demonstrated the need for psychologists in primary care. However, given the differences between health policies and health services, it is important to test the effect of these psychological interventions in our geographical setting. NCT01907035 (July 22, 2013).

Family Therapy

MedlinePlus

Family therapy Overview Family therapy is a type of psychological counseling (psychotherapy) that can help family members improve communication and resolve conflicts. Family therapy is usually provided by a psychologist, ...

Psychotherapies for adult depression: recent developments.

PubMed

Cuijpers, Pim

2015-01-01

Much has been learned from the 400 randomized trials on psychotherapies for adult depression that have been conducted, but much is also still unknown. In this study some recent attempts to further reduce the disease burden of depression through psychotherapies are reviewed. In the past, many new psychotherapies have promised to be more effective than existing treatments, usually without success. We describe recent research on two new therapies, acceptance and commitment therapy and cognitive bias modification, and conclude that both have also not shown to be more effective than existing therapies. A growing number of studies have also focused on therapies that may be successful in further reducing the disease burden, such as treatments for chronic depression and relapse prevention. Other studies are aimed at scaling up psychological services, such as the training of lay health counselors in low-income and middle-income countries, telephone-based, and internet-based therapies. Psychotherapies are essential tools in the treatment of adult depression. Randomized trials have shown that these treatments are effective, and by focusing on key issues, such as chronic depression, relapse, and scaling them up, psychotherapies contribute more and more to the reduction of the disease burden of depression.

Obstacles to early career psychiatrists practicing psychotherapy.

PubMed

Clemens, Norman A; Plakun, Eric M; Lazar, Susan G; Mellman, Lisa

2014-09-01

Though psychiatric residents are expected to be competent psychotherapists on graduation, further growth in skill and versatility requires continued experience in their ongoing career. Maturity as a psychotherapist is essential because a psychiatrist is the only mental health provider who, as a physician, can assume full responsibility for biopsychosocial patient care and roles as supervisor, consultant, and team leader. Graduating residents face an environment in which surveys show a steady and alarming decline in practice of psychotherapy by psychiatrists, along with a decline in job satisfaction. High educational debts, practice structures, intrusive management, and reimbursement policies that devalue psychotherapy discourage early career psychiatrists from a practice style that enables providing it. For the early-career psychiatrist there is thus the serious risk of being unable to develop a critical mass of experience or a secure identity as a psychiatric psychotherapist. Implementation of parity laws and the Affordable Care Act (ACA) will affect the situation in unpredictable ways that call for vigilance and active response. Additional service and administrative demands may result from the ACA, creating ethical dilemmas about meeting urgent patient needs versus biopsychosocial standards of care. The authors recommend 1) vigorous advocacy for better payment levels for psychotherapy and freedom from disruptive management; 2) aggressive action against violations of the parity act, 3) active preparation of psychiatric residents for dealing with career choices and the environment for providing psychotherapy in their practice, and 4) post-graduate training in psychotherapy through supervision/consultation, continuing education courses, computer instruction, and distance learning.

Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial.

PubMed

Priebe, Stefan; Savill, Mark; Wykes, Til; Bentall, Richard; Lauber, Christoph; Reininghaus, Ulrich; McCrone, Paul; Mosweu, Iris; Bremner, Stephen; Eldridge, Sandra; Röhricht, Frank

2016-02-01

The negative symptoms of schizophrenia significantly impact on quality of life and social functioning, and current treatment options are limited. In this study the clinical effectiveness and cost-effectiveness of group body psychotherapy as a treatment for negative symptoms were compared with an active control. A parallel-arm, multisite randomised controlled trial. Randomisation was conducted independently of the research team, using a 1 : 1 computer-generated sequence. Assessors and statisticians were blinded to treatment allocation. Analysis was conducted following the intention-to-treat principle. In the cost-effectiveness analysis, a health and social care perspective was adopted. age 18-65 years; diagnosis of schizophrenia with symptoms present at > 6 months; score of ≥ 18 on Positive and Negative Syndrome Scale (PANSS) negative symptoms subscale; no change in medication type in past 6 weeks; willingness to participate; ability to give informed consent; and community outpatient. inability to participate in the groups and insufficient command of English. Participants were recruited from NHS mental health community services in five different Trusts. All groups took place in local community spaces. Control intervention: a 10-week, 90-minute, 20-session group beginners' Pilates class, run by a qualified Pilates instructor. Treatment intervention: a 10-week, 90-minute, 20-session manualised group body psychotherapy group, run by a qualified dance movement psychotherapist. The primary outcome was the PANSS negative symptoms subscale score at end of treatment. Secondary outcomes included measures of psychopathology, functional, social, service use and treatment satisfaction outcomes, both at treatment end and at 6-month follow-up. A total of 275 participants were randomised (140 body psychotherapy group, 135 Pilates group). At the end of treatment, 264 participants were assessed (137 body psychotherapy group, 127 Pilates group). The adjusted difference in means of the PANSS negative subscale at the end of treatment was 0.03 [95% confidence interval (CI) -1.11 to 1.17], showing no advantage of the intervention. In the secondary outcomes, the mean difference in the Clinical Assessment Interview for negative symptoms expression subscale at the end of treatment was 0.62 (95% CI -1.23 to 0.00), and in extrapyramidal movement disorder symptoms -0.65 (95% CI -1.13 to -0.16) at the end of treatment and -0.58 (95% CI -1.07 to -0.09) at 6 months' follow-up, showing a small significant advantage of body psychotherapy. No serious adverse events related to the interventions were reported. The total costs of the intervention were comparable with the control, with no clear evidence of cost-effectiveness for either condition. Owing to the absence of a treatment-as-usual arm, it is difficult to determine whether or not both arms are an improvement over routine care. In comparison with an active control, group body psychotherapy does not have a clinically relevant beneficial effect in the treatment of patients with negative symptoms of schizophrenia. These findings conflict with the review that led to the current National Institute for Health and Care Excellence guidelines suggesting that arts therapies may be an effective treatment for negative symptoms. Determining whether or not this lack of effectiveness extends to all types of art therapies would be informative. Current Controlled Trials ISRCTN842165587. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 11. See the NIHR Journals Library website for further project information.

Individual versus family psychotherapy in managed care: comparing the costs of treatment by the mental health professions.

PubMed

Russell Crane, D; Payne, Scott H

2011-07-01

In an effort to understand how psychotherapy is practiced in the "real world," outpatient claims data were examined to determine the cost of individual and family therapy provided by marital and family therapists, master's nurses, master's social workers, medical doctors, psychologists, or professional counselors. Claims for 490,000 unique persons over 4 years were obtained from CIGNA. Family therapy proved to be substantially more cost-effective than individual or "mixed" psychotherapy. Physicians provided care in the fewest sessions, marital and family therapists had the highest success (86.6%) and lowest recidivism rates (13.4%), and professional counselors were the least costly. Outcomes were overwhelmingly successful, with 85% of patients requiring only one episode of care. © 2011 American Association for Marriage and Family Therapy.

Incubation as a form of psychotherapy in the care of patients in ancient and modern Greece.

PubMed

Papageorgiou, M G

1975-01-01

Incubation or temple sleep in sanctuaries of Aesculapius, Amphiaraos, Trophonios, etc., for the care of patients was practised even in the older times of ancient Greece and may be viewed as a form of psychotherapy and especially as 'dream-psychotherapy'. In Greek antiquity, as it is known, dreams were considered as a way of communication between gods and men. Survival of the custom of incubation exists even in our times in modern Greece, but are disappearing slowly. An attempt is made to find an explanation, if any, of those miraculous cures in accordance with the scientific thought of today.

Fundamental dilemmas in contemporary psychotherapy: a transtheoretical concept.

PubMed

Scaturo, Douglas J

2002-01-01

The transtheoretical nature of fundamental dilemmas in contemporary psychotherapy is explored. The basic distinction between technical and ethical dilemmas in clinical practice is discussed, as well as the ramifications for the psychotherapist. Clinical dilemmas identified by survey research studies and interviews with master psychotherapists are reviewed. In addition to dilemmas relevant to circumscribed areas of psychotherapy, such as brief therapy, managed mental health care, sexual questions, feminist therapy, dilemmas fundamental to the psychotherapeutic process as a whole are examined. Finally, clinical examples are provided that include such issues as hospitalization of the suicidal patient, dealing with known contraindications, treating the intractable patient, and self-care of the psychotherapist.

Do You Really Expect Me to Get MST Care in a VA Where Everyone is Male? Innovative Delivery of Evidence-Based Psychotherapy to Women with Military Sexual Trauma

DTIC Science & Technology

2015-08-01

Based Psychotherapy to Women with Military Sexual Trauma PRINCIPAL INVESTIGATOR: Ronald Acierno, PhD CONTRACTING ORGANIZATION: Medical University of...a VA Where Everyone is Male? Innovative Delivery of Evidence-Based Psychotherapy to Women with Military Sexual Trauma 5a. CONTRACT NUMBER 5b...Based Psychotherapy to Women with Military Sexual Trauma W81XWH-14-1-0264 / PT130434 PI: Ronald Acierno, PhD Org: Medical University of South

Post-traumatic growth in adult survivors of brain injury: a qualitative study of participants completing a pilot trial of brief positive psychotherapy.

PubMed

Karagiorgou, Olga; Evans, Jonathan J; Cullen, Breda

2018-03-01

Post-traumatic growth (PTG) can occur following acquired brain injury (ABI). It has been proposed that people experiencing psychological distress following ABI may benefit from a positive psychotherapy intervention (PPT) aimed at increasing well-being; PPT may also influence PTG. We aimed to investigate PTG experiences in participants of a positive psychotherapy pilot trial. ABI survivors who had received PPT or treatment as usual (TAU) were interviewed individually after the end of the trial. Thematic analysis was conducted, to code transcripts for known themes from PTG literature as well as newly emerging themes. Four participants (age = 46-62; n = 3 male; months since injury = 11-20) from the PPT group and three (age = 58-74; n = 2 male; months since injury = 9-22) from the TAU group were interviewed. Six themes were shared across both groups: personal strength, appreciation of life, relating to others, optimism/positive attitude, feeling fortunate compared to others, and positive emotional/behavioral changes. Two themes were expressed by PPT participants only: lifestyle improvements and new possibilities. One TAU participant reported spiritual change. A greater understanding of the development of PTG following ABI may help rehabilitation clinicians to promote better adjustment by focusing on clients' potential for positive change and enhancing their capacity for growth. Implications for Rehabilitation Post-traumatic growth is "positive psychological change experienced as the result of the struggle with highly challenging life circumstances." This is the first qualitative investigation of post-traumatic growth in participants in a positive psychotherapy trial following acquired brain injury. Several post-traumatic growth themes were shared by participants from the positive psychotherapy and treatment as usual study arms, with additional themes evident only in positive psychotherapy participants. A greater understanding of post-traumatic growth among rehabilitation professionals may help to promote adjustment following brain injury.

PTSD Care Among Veterans With and Without Co-Occurring Substance Use Disorders.

PubMed

Mansfield, Alyssa J; Greenbaum, Mark A; Schaper, Kim M; Banducci, Anne N; Rosen, Craig S

2017-06-01

This study examined whether a co-occurring substance use disorder contributed to disparities in receipt of Veterans Health Administration (VHA) posttraumatic stress disorder (PTSD) specialty care or psychotherapy. Logistic regression, controlling for sociodemographic characteristics, was used to examine predictors of PTSD care among 424,211 veterans with confirmed PTSD (two or more PTSD diagnosis encounters) who accessed care in a VHA facility between fiscal years 2009 and 2010. Overall, 16% of veterans had PTSD and a co-occurring substance use disorder diagnosis. In adjusted analyses, veterans with a co-occurring substance use disorder were more likely than veterans with PTSD alone to receive any outpatient PTSD specialty care and complete eight or more sessions of outpatient psychotherapy within 14 weeks, but they were less likely to be treated in inpatient PTSD specialty units. Co-occurring substance use disorders did not appear to hinder receipt of outpatient specialty PTSD treatment or of sufficient psychotherapy among VHA-enrolled veterans.

Using modular psychotherapy in school mental health: Provider perspectives on intervention-setting fit

PubMed Central

Lyon, Aaron R.; Ludwig, Kristy; Romano, Evalynn; Koltracht, Jane; Stoep, Ann Vander; McCauley, Elizabeth

2013-01-01

Objective The “fit” or appropriateness of well-researched interventions within usual care contexts is among the most commonly-cited, but infrequently researched, factors in the successful implementation of new practices. The current study was initiated to address two exploratory research questions: (1) How do clinicians describe their current school mental health service delivery context? and (2) How do clinicians describe the fit between modular psychotherapy and multiple levels of the school mental health service delivery context? Method Following a year-long training and consultation program in an evidence-based, modular approach to psychotherapy, semi-structured qualitative interviews were conducted with seventeen school-based mental health providers to evaluate their perspectives on the appropriateness of implementing the approach within a system of school-based health centers. Interviews were transcribed and coded for themes using conventional and directed content analysis. Results Findings identified key elements of the school mental health context including characteristics of the clinicians, their practices, the school context, and the service recipients. Specific evaluation of intervention-setting appropriateness elicited many comments about both practical and value-based (e.g., cultural considerations) aspects at the clinician and client levels, but fewer comments at the school or organizational levels. Conclusions Results suggest that a modular approach may fit well with the school mental health service context, especially along practical aspects of appropriateness. Future research focused on the development of methods for routinely assessing appropriateness at different stages of the implementation process is recommended. PMID:24134063

Readiness to change and therapy outcomes of an innovative psychotherapy program for surgical patients: results from a randomized controlled trial.

PubMed

Krampe, Henning; Salz, Anna-Lena; Kerper, Léonie F; Krannich, Alexander; Schnell, Tatjana; Wernecke, Klaus-Dieter; Spies, Claudia D

2017-12-29

Readiness to change is a pivotal construct for psychotherapy research and a major target of motivational interventions. Our primary objective was to examine whether pre-treatment readiness to change moderated therapy effects of Bridging Intervention in Anesthesiology (BRIA), an innovative psychotherapy approach for surgical patients. This stepped care program aims at motivating and supporting surgical patients with mental disorders to engage in psychosocial mental health care. The major steps of BRIA are two motivational interventions with different intensity. The first step of the program consists of preoperative computer-assisted psychosocial self-assessment including screening for psychological distress and automatically composed computerized brief written advice (BWA). In the second step, patients participate in postoperative psychotherapy sessions combining motivational interviewing with cognitive behavioural therapy (BRIA psychotherapy sessions). We performed regression-based moderator analyses on data from a recent randomized controlled trial published by our research group. The sample comprised 220 surgical patients with diverse comorbid mental disorders according to ICD-10. The most frequent disorders were mood, anxiety, substance use and adjustment disorders. The patients had a mean age of 43.31 years, and 60.90% were women. In a regression model adjusted for pre-treatment psychological distress, we investigated whether readiness to change moderated outcome differences between (1) the BRIA psychotherapy sessions and (2) no psychotherapy / BWA only. Multiple regression analyses showed that readiness to change moderated treatment effects regarding the primary outcomes "Participation in psychosocial mental health care options at month 6" (p = 0.03) and "Having approached psychosocial mental health care options at month 6" (p = 0.048) but not regarding the secondary outcome "Change of general psychological distress between baseline assessment and month 6" (p = 0.329). Probing the moderation effect with the Johnson-Neyman technique revealed that BRIA psychotherapy sessions were superior to BWA in patients with low to moderate readiness, but not in those with high readiness. Readiness to change may act as moderator of the efficacy of psychosocial therapy. Combinations of motivational interviewing and cognitive behavioural therapy may be effective particularly in patients with a variety of mental disorders and low readiness to change. clinicaltrials.gov Identifier: NCT01357694.

Comparing Effectiveness of Treatments for Borderline Personality Disorder in Communal Mental Health Care: The Oulu BPD Study.

PubMed

Leppänen, V; Hakko, H; Sintonen, H; Lindeman, S

2016-02-01

The implementation of effective psychotherapies in community mental health care is challenging. This study aimed to create a well-structured and easily applicable treatment model for patients with severe borderline personality disorder (BPD). We integrated a schema therapy based psycho-educational group into an available individual therapy. Two groups were formed: (1) community treatment by experts (CTBE) patients (n = 24) receiving new treatment and (2) treatment as usual (TAU) patients (n = 47). Changes in symptoms were measured by Borderline Personality Disorder Severity Index-IV interview and quality of life by the 15D health-related quality of life questionnaire. After 1 year the CTBE patients showed a significant reduction in a wider range of BPD symptoms and better quality of life than TAU patients. The results of this study are encouraging. A well-structured treatment model was successfully implemented into community mental health care with improved patient adherence to treatment and superior treatment outcomes compared to TAU patients.

Psychotherapy: Playing the Three Monkeys in Mental Health Service Provision?

PubMed Central

DEREBOY, Çiğdem; ŞENEL, Hakan; ŞAFAK ÖZTÜRK, Cennet; ŞAKİROĞLU, Mehmet; ESKİN, Mehmet

2017-01-01

Introduction The purpose of the present study was to investigate the effect of sociodemographic variables on the knowledge of, demand for, and reception of psychotherapy as a treatment modality among psychiatric outpatients. Methods Participants of the study were 240 psychiatric outpatients (170 females and 70 males). Data for mental health services were collected from a subgroup of 103 “experienced” patients (42.9%) having had received psychiatric help previously. All participants were administered a questionnaire containing questions about various forms of psychiatric services. Results Of all participants, 40.83% reported having heard of psychotherapy a few of times before, mostly (44.58%) from the media and only 3.33% from a mental health professional. Most participants with previous applications to psychiatric outpatient clinic had first received mental health service from a psychiatrist (93.2%) and at a state hospital (72.8%), and a small minority (17.4%) had subsequently received care from a psychologist. None had demanded to, but 5 patients (4.86%) had been recommended to receive psychotherapy by mental health professionals. Of these experienced patients, 20 (19.41%) have an idea that the interviews they had previously at the outpatient clinics were sort of psychotherapeutic interviews; yet, only 7 (6.79%) retained the same idea after reading the definition of appropriate psychotherapy written on the questionnaire. All of these patients declared that they have received both their medication and psychotherapy at the same time. Thus, only 2.91% of 240 participants received psychotherapy that corresponds to the given definition. Conclusions Findings from this study suggest that mental health care is mostly performed by psychiatrists alone, with a limited contribution by psychologists. Consequently, the choice of treatment is solely pharmacotherapy for most patients, while psychotherapy as a treatment modality is neither offered nor demanded in routine practice. PMID:29321701

[Effects of a Positive Psychotherapy Program on Positive Affect, Interpersonal Relations, Resilience, and Mental Health Recovery in Community-Dwelling People with Schizophrenia].

PubMed

Kim, Jinhee; Na, Hyunjoo

2017-10-01

Recently, the interest in positive psychotherapy is growing, which can help to encourage positive relationships and develop strengths of people. This study was conducted to investigate the effects of a positive psychotherapy program on positive affect, interpersonal relations, resilience, and mental health recovery in community-dwelling people with schizophrenia. The research was conducted using a randomized control group pretest-posttest design. A total of 57 adults with schizophrenia participated in this study. The study participants in experimental group received a positive psychotherapy program (n=28) and the participants in control group received only the usual treatment in community centers (n=29). The positive psychotherapy program was provided for 5 weeks (of 10 sessions, held twice/week, for 60 minutes). The study outcomes included positive affect, interpersonal relations, resilience, and mental health recovery. The collected data were analyzed using repeated measures ANOVA for examining study hypothesis. Results showed that interpersonal relations (F=11.83, p=.001) and resilience (F=9.62, p=.003) significantly increased in the experimental group compared to the control group. Although experimental group showed a slight increase in positive affect, it was not significant. The study findings confirm that the positive psychotherapy program is effective for improving interpersonal relations and resilience of community-dwelling people with schizophrenia. Based on the findings, we believe that the positive psychotherapy program would be acceptable and helpful to improve recovery of mental health in schizophrenia. © 2017 Korean Society of Nursing Science

New developments in psychosocial interventions for adults with unipolar depression.

PubMed

Lau, Mark A

2008-01-01

Depression treatment guidelines typically recommend cognitive behavioral therapy and/or interpersonal therapy for the acute treatment of mild-moderate depression. However, several new developments support an expanded role for psychotherapy in depression treatment. This article summarizes recent psychotherapy efficacy studies across the depression treatment continuum and the effectiveness of psychosocial interventions in community settings. New psychotherapies in the acute treatment of mild-moderate depression include emotion-focused therapy, self-system therapy, cognitive control training and positive psychotherapy. Furthermore, emerging evidence supports the use of psychotherapy for moderate-severe and treatment-resistant depression and for recurrent depression with a seasonal pattern. An important area of growth is the development and evaluation of continuation/maintenance treatments based on cognitive behavioral therapy and interpersonal therapy to reduce depressive relapse risk in recurrent and chronic depression. Finally, there is evidence supporting the effectiveness of stepped care, chronic disease management and collaborative care models in community settings. Emerging evidence supports an expanded role for the use of psychosocial interventions as acute and continuation/maintenance treatments for unipolar depression. Although further research is required to replicate these findings, a remaining challenge is to increase the availability of these treatments to the mental health consumer.

Design of the Coordinated Anxiety Learning and Management (CALM) Study: Innovations in Collaborative Care for Anxiety Disorders

PubMed Central

Sullivan, Greer; Craske, Michelle G; Sherbourne, Cathy; Edlund, Mark J; Rose, Raphael D; Golinelli, Daniela; Chavira, Denise A; Bystritsky, Alexander; Stein, Murray B; Roy-Byrne, Peter P

2007-01-01

Background: Despite a marked increase in persons seeking help for anxiety disorders, the care provided may not be evidence-based, especially when delivered by non-specialists. Since anxiety disorders are most often treated in primary care, quality improvement interventions are needed there. Research Design: A randomized controlled trial of a collaborative care effectiveness intervention for anxiety disorders. Subjects: Approximately 1040 adult primary care patients with one of four anxiety disorders (generalized anxiety disorder, panic disorder, posttraumatic stress disorder, or social anxiety disorder), recruited from four national sites. Intervention: Anxiety clinical specialists deliver education and behavioral activation to intervention patients and monitor their symptoms. Intervention patients choose cognitive behavioral therapy, anti-anxiety medications, or both, in a “stepped care” treatment that varies according to clinical need. Control patients receive usual care from their primary care clinician. CALM's innovations include the flexibility to treat any one of four anxiety disorders, co-occurring depression, and/or alcohol abuse; its use of on-site clinicians to conduct initial assessments, and its computer-assisted psychotherapy delivery. Evaluation: Anxiety symptoms, functioning, satisfaction with care, and health care utilization are assessed at 6-month intervals. Conclusion: CALM was designed for clinical effectiveness and easy dissemination in a variety of primary care settings. PMID:17888803

History of Division 29, 1993-2013: another 20 years of psychotherapy.

PubMed

Williams, Elizabeth Nutt; Barnett, Jeffrey E; Canter, Mathilda B

2013-03-01

The history of Division 29 (Psychotherapy) of the American Psychological Association (APA) from 1993 to 2013 is reviewed. The 20 years of history can be traced via the Division's primary publications (the journal Psychotherapy and its newsletter Psychotherapy Bulletin) as well as the history of those who have served leadership roles in the Division and have won Divisional awards. Several recurring themes emerge related to the Division's articulations of its own identity, the Division's advocacy efforts vis-à-vis the profession and the APA, and the work of the Division on behalf of major social issues (such as disaster relief and the nation's health care).

Competency in integrative psychotherapy: perspectives on training and supervision.

PubMed

Boswell, James F; Nelson, Dana L; Nordberg, Samuel S; McAleavey, Andrew A; Castonguay, Louis G

2010-03-01

Increasingly, many psychotherapists identify with an integrative approach to psychotherapy. In recent years, more attention has been directed toward the operationalization and evaluation of competence in professional psychology and health care service delivery. Aspects of integrative psychotherapy competency may differ from competency in other psychotherapy orientations, although convergence is more often the case. Despite the potential differences, there exist very few formal training programs or guidelines to systematically guide clinicians in developing a competent integrative practice. This paper attempts to distill the essential elements of competent integrative psychotherapy practice and focuses on how these might be developed in training and supervision. We address most of these complex issues from a specific integrative perspective: principle-based assimilative integration. PsycINFO Database Record (c) 2010 APA, all rights reserved

Cost-utility analysis of meaning-centered group psychotherapy for cancer survivors.

PubMed

van der Spek, Nadia; Jansen, Femke; Holtmaat, Karen; Vos, Joël; Breitbart, William; van Uden-Kraan, Cornelia F; Tollenaar, Rob A E M; Cuijpers, Pim; Coupé, Veerle M H; Verdonck-de Leeuw, Irma M

2018-04-06

Meaning-centered group psychotherapy for cancer survivors (MCGP-CS) improves meaning, psychological well-being, and mental adjustment to cancer and reduces psychological distress. This randomized controlled trial was conducted to investigate the cost-utility of MCGP-CS compared with supportive group psychotherapy (SGP) and care-as-usual (CAU). In total, 170 patients were randomized to MCGP-CS, SGP, or CAU. Intervention costs, direct medical and nonmedical costs, productivity losses, and health-related quality of life were measured until 6 months follow-up, using the TIC-P, PRODISQ, data from the hospital information system, and the EQ-5D. The cost-utility was calculated by comparing mean cumulative costs and quality-adjusted life years (QALYs). Mean total costs ranged from €4492 (MCGP-CS) to €5304 (CAU). Mean QALYs ranged .507 (CAU) to .540 (MCGP-CS). MCGP-CS had a probability of 74% to be both less costly and more effective than CAU, and 49% compared with SGP. Sensitivity analyses showed these findings are robust. If society is willing to pay €0 for one gained QALY, MCGP-CS has a 78% probability of being cost-effective compared with CAU. This increases to 85% and 92% at willingness-to-pay thresholds of €10 000 and €30 000, which are commonly accepted thresholds. MCGP-CS is highly likely a cost-effective intervention, meaning that there is a positive balance between the costs and gains of MCGP-CS, in comparison with SGP and CAU. Copyright © 2018 John Wiley & Sons, Ltd.

Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial

PubMed Central

Wang, Philip S.; Simon, Gregory E.; Avorn, Jerry; Azocar, Francisca; Ludman, Evette J.; McCulloch, Joyce; Petukhova, Maria Z.; Kessler, Ronald C.

2010-01-01

Context Although guideline-concordant depression treatment is clearly effective, treatment often falls short of evidence-based recommendations. Organized depression care programs significantly improve treatment quality, but employer-purchasers have been slow to demand these programs based on lack of evidence for cost-effectiveness from their perspective. Objective To evaluate the effects of a depression outreach-treatment program on workplace outcomes of concern to employers. Design Randomized controlled trial with allocation concealment and blinded assessment of depression severity and work performance at 6 and 12 months. Setting and Participants Two-stage screening of employees covered by a managed behavioral health plan identified 604 with clinically significant depression (excluding those with lifetime bipolar disorder, substance disorder, recent mental health specialty care, or suicidality). Intervention A telephonic outreach and care management program encouraged workers to enter outpatient treatment (psychotherapy and/or antidepressant medication), monitored treatment quality-continuity, and attempted to improve treatment by giving recommendations to providers. Participants reluctant to enter treatment were offered a structured telephone cognitive-behavioral psychotherapy. Main Outcome Measures Depression severity (Quick Inventory of Depressive Symptomatology, QIDS-SR) and work performance (WHO Health and Productivity Questionnaire, HPQ, a validated self-report instrument assessing job retention, time missed from work, work performance, and critical workplace incidents). Results Combining data across 6-month and 12-month assessments, the intervention group had significantly lower QIDS-SR scores (1.4 relative-odds of recovery), significantly higher job retention (1.7 relative-odds), and significantly more hours worked among the employed (equivalent to an annualized effect of approximately 2.5 weeks of work) than usual care subjects. Conclusions A systematic program to identify depression and promote effective treatment significantly improves not only clinical outcomes but also workplace outcomes. The financial value of the latter to employers in terms of recovered hiring-training and salary costs suggests that many employers would experience a positive return on investment from outreach and enhanced treatment of depressed workers. PMID:17895456

Maternal care and paternal protection influence response to psychotherapy treatment for adult depression.

PubMed

Johnstone, Jeanette M; Carter, Janet D; Luty, Suzanne E; Mulder, Roger T; Frampton, Christopher M; Joyce, Peter R

2013-07-01

Adverse childhood experiences of neglect, overprotection and abuse, well-recognized risk factors for the development of adult psychopathology, were examined as predictors of response to psychotherapy treatment for adults with depression. Outpatients in a randomized clinical trial of interpersonal psychotherapy (IPT) or cognitive-behavioral therapy (CBT) completed the parental bonding instrument (PBI) at baseline to establish levels of care and protection. Childhood abuse was asked about using clinical interviews. The PBI variables were examined in tertiles while the abuse variables were categorized as "none," "some," and "severe." Associations between these childhood adversities and treatment response were examined in those who completed the trial. Of 177 outpatients with depression who were randomized, 159 completed an adequate trial of therapy. Within these 159 patients, 57% were categorized as responders to treatment. The mean percentage improvement on the MADRS was 57.7% (±31.4). Across both treatments, patients reporting intermediate levels of maternal care had the best response to treatment. Also across both treatments, the interaction effects of maternal care and paternal protection by treatment were statistically significant. Examining the two therapies independently, maternal care and paternal protection were associated with a differential response to IPT but not CBT. Reports of abuse, whether physical, emotional or sexual, did not impact treatment response. This study examined patients who completed treatment, which may have attenuated the findings. Two categories of childhood adversity were measured although a range of other adverse childhood experiences exist. The results were from exploratory analyses and require replication. Maternal care, demonstrating a robust main effect across treatments, appears to be the childhood variable most strongly associated with response to psychotherapy in this sample. In addition, maternal care and paternal protection were associated with a differential response to treatment. These results suggest that the quality of on-going intra-familial relationships has a greater impact on treatment response than experiences of abuse. The findings may aid clinicians in selecting which psychotherapy to use, depending on a patient's childhood history. Copyright © 2013 Elsevier B.V. All rights reserved.

Adolescents in Residential and Inpatient Treatment: A Review of the Outcome Literature

ERIC Educational Resources Information Center

Bettmann, Joanna E.; Jasperson, Rachael A.

2009-01-01

Operationalizing treatment efficacy has become essential in the field of psychotherapy. Managed health care now requires psychotherapy to produce measurable outcomes and define success concretely. This requirement has resulted in research attempting to identify empirically supported and evidence-based treatments. This article presents a review of…

A Short-Term Dynamic Psychotherapy Approach for College Students

ERIC Educational Resources Information Center

Carlson, Thomas M.

2004-01-01

This article explores the need for university counseling centers (UCCs) to implement brief therapies and describes one such treatment, intensive short-term dynamic psychotherapy (ISTDP), as a particularly viable therapeutic approach in this setting. Because ISTDP is not appropriate for all students seeking therapy, a careful assessment of the…

Psychotherapy in Mexico: practice, training, and regulation.

PubMed

Sanchez-Sosa, Juan Jose

2007-08-01

Psychotherapy conducted by psychologists in Mexico has a long history and shows promising developments but offers a relatively limited choice for health care recipients, especially in public facilities. Psychotherapy by psychologists occurs mainly in private practice, although it is spreading to public institutions such as hospitals and outpatient clinics. Most clinical psychologists in Mexico are trained in some type of psychodynamic approach, although the use of cognitive-behavioral treatments is spreading quickly. The probability that a patient will actually be seen by a psychologist depends mainly on such characteristics of the patient as socioeconomic status, place of residence, and insurance coverage, if any. These and other attributes of psychotherapy in Mexico are illustrated by the probable treatment of Mrs. A. Psychotherapy in Mexico continues to evolve toward both multidisciplinary work and evidence-based practices. (c) 2007 Wiley Periodicals, Inc.

Internet-mediated psychotherapy: Are we ready for the ethical challenges?

PubMed

Satalkar, Priya; Shrivastava, Shivanshu; Desousa, Avinash

2015-01-01

Advances in information and communication technology have facilitated the development of online psychotherapy. This form of psychotherapy would provide the developing world with better access to professional mental healthcare services. At the same time, it is prudent to carefully consider the various ethical, legal and regulatory issues involved in online psychotherapy. This paper highlights the major ethical issues involved in the use of online psychotherapy, whether conducted via e-mail, chat rooms or interactive video, and identifies practical solutions for the ethical dilemmas that exist. Many authors and organisations have expressed their opinions on the subject, but no consensus has evolved. The advice offered to psychologists is mostly skewed and the scarcity of literature available to those considering expanding their practice to include online psychotherapy is certainly a source of vexation. While reviewing the existing literature, this paper seeks to describe and discuss the major ethical issues in this area, particularly in India, but many of these issues will be equally applicable to any developing world settings.

Behavioral interventions for office-based care: depressive disorders.

PubMed

James, Ernest; Larzelere, Michele McCarthy

2014-03-01

Depressive disorders commonly are diagnosed and managed in primary care settings, and many patients prefer a nonpharmacologic approach. Traditionally, symptom reduction through pharmacotherapy has been the primary focus of management, but there is a growing acknowledgment of the need to develop modalities that prevent subsequent relapse and recurrences. Psychotherapy, including cognitive behavioral and interpersonal therapies, can have enduring effects that reduce subsequent risk in ways that drugs cannot. Although most family physicians do not provide formal psychosocial interventions for depression, brief interventions and behavioral intervention technologies, such as those that deliver care via the Internet or mobile device, are key means of increasing access to psychotherapy. For children and adolescents with mild, uncomplicated depression, physician-provided social support, encouragement, and reinforcement of adaptive behavior patterns can be as effective as cognitive behavioral therapy. In addition, a primary care physician's involvement in parent education and safety planning for suicide prevention holds promise for risk reduction. Evidence also supports the use of problem-solving therapy and components of cognitive behavioral therapy and interpersonal psychotherapy provided by primary care physicians for patients with depression. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Managing depression in primary care.

PubMed

Ng, Chung Wai Mark; How, Choon How; Ng, Yin Ping

2017-08-01

Major depression is common in the primary care setting. In the final article of this series, we illustrate the approach to the management of depression in primary care. Psychotherapy has been shown to be as effective as antidepressants for mild to moderate major depression. The common myth that antidepressants are addictive should be addressed. Antidepressants should be started at a subtherapeutic dose to assess tolerability, then gradually increased until a minimally effective dose is achieved. Apart from pharmacotherapy and psychotherapy, management of depression should include managing stressors, engaging social and community support, dealing with stigma and discrimination, and managing concomitant comorbidities. A strong therapeutic relationship and empathic listening are important between the primary care physician and patient. Copyright: © Singapore Medical Association.

Managing depression in primary care

PubMed Central

Ng, Chung Wai Mark; How, Choon How; Ng, Yin Ping

2017-01-01

Major depression is common in the primary care setting. In the final article of this series, we illustrate the approach to the management of depression in primary care. Psychotherapy has been shown to be as effective as antidepressants for mild to moderate major depression. The common myth that antidepressants are addictive should be addressed. Antidepressants should be started at a subtherapeutic dose to assess tolerability, then gradually increased until a minimally effective dose is achieved. Apart from pharmacotherapy and psychotherapy, management of depression should include managing stressors, engaging social and community support, dealing with stigma and discrimination, and managing concomitant comorbidities. A strong therapeutic relationship and empathic listening are important between the primary care physician and patient. PMID:28848991

Comparative efficacy and acceptability of psychotherapies for depression in children and adolescents: A systematic review and network meta-analysis

PubMed Central

Zhou, Xinyu; Hetrick, Sarah E; Cuijpers, Pim; Qin, Bin; Barth, Jürgen; Whittington, Craig J; Cohen, David; Del Giovane, Cinzia; Liu, Yiyun; Michael, Kurt D; Zhang, Yuqing; Weisz, John R; Xie, Peng

2015-01-01

Previous meta-analyses of psychotherapies for child and adolescent depression were limited because of the small number of trials with direct comparisons between two treatments. A network meta-analysis, a novel approach that integrates direct and indirect evidence from randomized controlled studies, was undertaken to investigate the comparative efficacy and acceptability of psychotherapies for depression in children and adolescents. Systematic searches resulted in 52 studies (total N=3805) of nine psychotherapies and four control conditions. We assessed the efficacy at post-treatment and at follow-up, as well as the acceptability (all-cause discontinuation) of psychotherapies and control conditions. At post-treatment, only interpersonal therapy (IPT) and cognitive-behavioral therapy (CBT) were significantly more effective than most control conditions (standardized mean differences, SMDs ranged from −0.47 to −0.96). Also, IPT and CBT were more beneficial than play therapy. Only psychodynamic therapy and play therapy were not significantly superior to waitlist. At follow-up, IPT and CBT were significantly more effective than most control conditions (SMDs ranged from −0.26 to −1.05), although only IPT retained this superiority at both short-term and long-term follow-up. In addition, IPT and CBT were more beneficial than problem-solving therapy. Waitlist was significantly inferior to other control conditions. With regard to acceptability, IPT and problem-solving therapy had significantly fewer all-cause discontinuations than cognitive therapy and CBT (ORs ranged from 0.06 to 0.33). These data suggest that IPT and CBT should be considered as the best available psychotherapies for depression in children and adolescents. However, several alternative psychotherapies are understudied in this age group. Waitlist may inflate the effect of psychotherapies, so that psychological placebo or treatment-as-usual may be preferable as a control condition in psychotherapy trials. PMID:26043339

Generalizability of Clinical Trial Results for Adolescent Major Depressive Disorder.

PubMed

Blanco, Carlos; Hoertel, Nicolas; Franco, Silvia; Olfson, Mark; He, Jian-Ping; López, Saioa; González-Pinto, Ana; Limosin, Frédéric; Merikangas, Kathleen R

2017-12-01

Although there have been a number of clinical trials evaluating treatments for adolescents with major depressive disorder (MDD), the generalizability of those trials to samples of depressed adolescents who present for routine clinical care is unknown. Examining the generalizability of clinical trials of pharmacological and psychotherapy interventions for adolescent depression can help administrators and frontline practitioners determine the relevance of these studies for their patients and may also guide eligibility criteria for future clinical trials in this clinical population. Data on nationally representative adolescents were derived from the National Comorbidity Survey: Adolescent Supplement. To assess the generalizability of adolescent clinical trials for MDD, we applied a standard set of eligibility criteria representative of clinical trials to all adolescents in the National Comorbidity Survey: Adolescent Supplement with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of MDD ( N = 592). From the overall MDD sample, 61.9% would have been excluded from a typical pharmacological trial, whereas 42.2% would have been excluded from a psychotherapy trial. Among those who sought treatment ( n = 412), the corresponding exclusion rates were 72.7% for a pharmacological trial and 52.2% for a psychotherapy trial. The criterion leading to the largest number of exclusions was "significant risk of suicide" in both pharmacological and psychotherapy trials. Pharmacological and, to a lesser extent, psychotherapy clinical trials likely exclude most adolescents with MDD. Careful consideration should be given to balancing eligibility criteria and internal validity with applicability in routine clinical care while ensuring patient safety. Copyright © 2017 by the American Academy of Pediatrics.

Effectiveness of psychological treatments for depressive disorders in primary care: systematic review and meta-analysis.

PubMed

Linde, Klaus; Sigterman, Kirsten; Kriston, Levente; Rücker, Gerta; Jamil, Susanne; Meissner, Karin; Schneider, Antonius

2015-01-01

We performed a systematic review of the currently available evidence on whether psychological treatments are effective for treating depressed primary care patients in comparison with usual care or placebo, taking the type of therapy and its delivery mode into account. Randomized controlled trials comparing a psychological treatment with a usual care or a placebo control in adult, depressed, primary care patients were identified by searches in MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and PsycINFO up to December 2013. At least 2 reviewers extracted information from included studies and assessed the risk of bias. Random effects meta-analyses were performed using posttreatment depression scores as outcome. A total of 30 studies with 5,159 patients met the inclusion criteria. Compared with control, the effect (standardized mean difference) at completion of treatment was -0.30 (95% CI, -0.48 to -0.13) for face-to-face cognitive behavioral therapy (CBT), -0.14 (-0.40 to 0.12) for face-to-face problem-solving therapy, -0.24 (-0.47 to -0.02) for face-to-face interpersonal psychotherapy, -0.28 (-0.44 to -0.12) for other face-to-face psychological interventions, -0.43 (-0.62 to -0.24) for remote therapist-led CBT, -0.56 (-1.57 to 0.45) for remote therapist-led problem-solving therapy, -0.40 (-0.69 to -0.11) for guided self-help CBT, and -0.27 (-0.44 to -0.10) for no or minimal contact CBT. There is evidence that psychological treatments are effective in depressed primary care patients. For CBT approaches, substantial evidence suggests that interventions that are less resource intensive might have effects similar to more intense treatments. © 2015 Annals of Family Medicine, Inc.

Development and implementation of a psychotherapy tracking database in primary care.

PubMed

Craner, Julia R; Sawchuk, Craig N; Mack, John D; LeRoy, Michelle A

2017-06-01

Although there is a rapid increase in the integration of behavioral health services in primary care, few studies have evaluated the effectiveness of these services in real-world clinical settings, in part due to the difficulty of translating traditional mental health research designs to this setting. Accordingly, innovative approaches are needed to fit the unique challenges of conducting research in primary care. The development and implementation of one such approach is described in this article. A continuously populating database for psychotherapy services was implemented across 5 primary care clinics in a large health system to assess several levels of patient care, including service utilization, symptomatic outcomes, and session-by-session use of psychotherapy principles by providers. Each phase of implementation revealed challenges, including clinician time, dissemination to clinics with different resources, and fidelity of data collection strategy across providers, as well as benefits, including the generation of useful data to inform clinical care, program development, and empirical research. The feasible and sustainable implementation of data collection for routine clinical practice in primary care has the potential to fuel the evidence base around integrated care. The current project describes the development of an innovative approach that, with further empirical study and refinement, could enable health care professionals and systems to understand their population and clinical process in a way that addresses essential gaps in the integrated care literature. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Practical Ways Psychotherapy Can Support Physical Healthcare Experiences for Male Survivors of Childhood Sexual Abuse

ERIC Educational Resources Information Center

Hovey, Angela; Stalker, Carol A.; Schachter, Candice L.; Teram, Eli; Lasiuk, Gerri

2011-01-01

Many survivors of child sexual abuse who engage in psychotherapy also experience physical health problems. This article summarizes the findings of a multiphased qualitative study about survivors' experiences in healthcare settings. The study informed the development of the "Handbook on Sensitive Practice for Health Care Practitioners: Lessons…

Design and methods for a pilot randomized clinical trial involving exercise and behavioral activation to treat comorbid type 2 diabetes and major depressive disorder

PubMed Central

Schneider, Kristin L.; Pagoto, Sherry L.; Handschin, Barbara; Panza, Emily; Bakke, Susan; Liu, Qin; Blendea, Mihaela; Ockene, Ira S.; Ma, Yunsheng

2011-01-01

Background The comorbidity of type 2 diabetes mellitus (T2DM) and depression is associated with poor glycemic control. Exercise has been shown to improve mood and glycemic control, but individuals with comorbid T2DM and depression are disproportionately sedentary compared to the general population and report more difficulty with exercise. Behavioral activation, an evidence-based depression psychotherapy, was designed to help people with depression make gradual behavior changes, and may be helpful to build exercise adherence in sedentary populations. This pilot randomized clinical trial will test the feasibility of a group exercise program enhanced with behavioral activation strategies among women with comorbid T2DM and depression. Methods/Design Sedentary women with inadequately controlled T2DM and depression (N=60) will be randomly assigned to one of two conditions: exercise or usual care. Participants randomized to the exercise condition will attend 38 behavioral activation-enhanced group exercise classes over 24 weeks in addition to usual care. Participants randomized to the usual care condition will receive depression treatment referrals and print information on diabetes management via diet and physical activity. Assessments will occur at baseline and 3-, 6-, and 9-months following randomization. The goals of this pilot study are to demonstrate feasibility and intervention acceptability, estimate the resources and costs required to deliver the intervention and to estimate the standard deviation of continuous outcomes (e.g., depressive symptoms and glycosylated hemoglobin) in preparation for a fully-powered randomized clinical trial. Discussion A novel intervention that combines exercise and behavioral activation strategies could potentially improve glycemic control and mood in women with comorbid type 2 diabetes and depression. Trial registration NCT01024790 PMID:21765864

Culturally-Competent Treatments for Asian Americans: The Relevance of Mindfulness and Acceptance-Based Psychotherapies

PubMed Central

Nagayama Hall, Gordon C.; Hong, Janie J.; Zane, Nolan W. S.; Meyer, Oanh L.

2011-01-01

The development of effective treatments for Asian Americans is important because treatment disparities continue to exist for this population. Because of their theoretical grounding in East Asian philosophies, mindfulness and acceptance-based psychotherapies appear to constitute promising ways to provide culturally responsive mental health care to Asian Americans. However, in practice these approaches often reflect conceptions of mental health that are more consistent with Western world views. We review points of intersection and divergence between Western-based mindfulness and acceptance psychotherapies and Asian American cultural values. We then propose a culturally syntonic approach that accentuates certain components of mindfulness and acceptance psychotherapies and adapts other components of these approaches to be more consistent with Asian American cultural values. PMID:22065893

Psychotherapy in psychiatry: the current situation and future directions in Germany.

PubMed

Schnell, Knut; Herpertz, Sabine C

2011-11-01

The aim of this article is to review how psychotherapy is dispensed to patients in psychiatric treatment and to render the future perspectives of psychotherapy in psychiatric outpatient and inpatient care in Germany. We demonstrate that--according to the currently available data about healthcare providers, allocation of financial resources and curricular regulations--the presently used definition of the term "psychotherapy" is ambiguous. One major problem for the application of psychotherapy in psychiatry is obviously constituted by the dominance of the major guideline therapies ("Richtlinienverfahren") within psychiatric services. Here, guideline therapies do not meet the needs of a significant proportion of acutely, severely and/or chronically ill psychiatric patients and restrain the application of scientifically approved, disorder-oriented and context compliant interventions in psychiatric practice. As a future perspective, we suggest that the training of psychiatrists should impart profound interpersonal skills and provide the competence to offer psychotherapy within a multimodal, modular, and flexible treatment plan on the background of the self-conception of psychiatry as a medical discipline. Moreover, future concepts of psychiatric psychotherapy should promote an evidence-based selection and application of scientifically approved, disorder-oriented, and integrative treatment methods, which are available in growing number.

Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial.

PubMed

Wiles, Nicola; Thomas, Laura; Abel, Anna; Barnes, Maria; Carroll, Fran; Ridgway, Nicola; Sherlock, Sofie; Turner, Nicholas; Button, Katherine; Odondi, Lang'o; Metcalfe, Chris; Owen-Smith, Amanda; Campbell, John; Garland, Anne; Hollinghurst, Sandra; Jerrom, Bill; Kessler, David; Kuyken, Willem; Morrison, Jill; Turner, Katrina; Williams, Chris; Peters, Tim; Lewis, Glyn

2014-05-01

Only one-third of patients with depression respond fully to treatment with antidepressant medication. However, there is little robust evidence to guide the management of those whose symptoms are 'treatment resistant'. The CoBalT trial examined the clinical effectiveness and cost-effectiveness of cognitive behavioural therapy (CBT) as an adjunct to usual care (including pharmacotherapy) for primary care patients with treatment-resistant depression (TRD) compared with usual care alone. Pragmatic, multicentre individually randomised controlled trial with follow-up at 3, 6, 9 and 12 months. A subset took part in a qualitative study investigating views and experiences of CBT, reasons for completing/not completing therapy, and usual care for TRD. General practices in Bristol, Exeter and Glasgow, and surrounding areas. Patients aged 18-75 years who had TRD [on antidepressants for ≥ 6 weeks, had adhered to medication, Beck Depression Inventory, 2nd version (BDI-II) score of ≥ 14 and fulfilled the International Classification of Diseases and Related Health Problems, Tenth edition criteria for depression]. Individuals were excluded who (1) had bipolar disorder/psychosis or major alcohol/substance abuse problems; (2) were unable to complete the questionnaires; or (3) were pregnant, as were those currently receiving CBT/other psychotherapy/secondary care for depression, or who had received CBT in the past 3 years. Participants were randomised, using a computer-generated code, to usual care or CBT (12-18 sessions) in addition to usual care. The primary outcome was 'response', defined as ≥ 50% reduction in depressive symptoms (BDI-II score) at 6 months compared with baseline. Secondary outcomes included BDI-II score as a continuous variable, remission of symptoms (BDI-II score of < 10), quality of life, anxiety and antidepressant use at 6 and 12 months. Data on health and social care use, personal costs, and time off work were collected at 6 and 12 months. Costs from these three perspectives were reported using a cost-consequence analysis. A cost-utility analysis compared health and social care costs with quality adjusted life-years. A total of 469 patients were randomised (intervention: n = 234; usual care: n = 235), with 422 participants (90%) and 396 (84%) followed up at 6 and 12 months. Ninety-five participants (46.1%) in the intervention group met criteria for 'response' at 6 months compared with 46 (21.6%) in the usual-care group {odds ratio [OR] 3.26 [95% confidence interval (CI) 2.10 to 5.06], p < 0.001}. In repeated measures analyses using data from 6 and 12 months, the OR for 'response' was 2.89 (95% CI 2.03 to 4.10, p < 0.001) and for a secondary 'remission' outcome (BDI-II score of < 10) 2.74 (95% CI 1.82 to 4.13, p < 0.001). The mean cost of CBT per participant was £ 910, the incremental health and social care cost £ 850, the incremental QALY gain 0.057 and incremental cost-effectiveness ratio £ 14,911. Forty participants were interviewed. Patients described CBT as challenging but helping them to manage their depression; listed social, emotional and practical reasons for not completing treatment; and described usual care as mainly taking medication. Among patients who have not responded to antidepressants, augmenting usual care with CBT is effective in reducing depressive symptoms, and these effects, including outcomes reflecting remission, are maintained over 12 months. The intervention was cost-effective based on the National Institute for Health and Care Excellence threshold. Patients may experience CBT as difficult but effective. Further research should evaluate long-term effectiveness, as this would have major implications for the recommended treatment of depression. Current Controlled Trials ISRCTN38231611.

Comparing three forms of early intervention for youth with borderline personality disorder (the MOBY study): study protocol for a randomised controlled trial.

PubMed

Chanen, Andrew; Jackson, Henry; Cotton, Sue M; Gleeson, John; Davey, Christopher G; Betts, Jennifer; Reid, Sophie; Thompson, Katherine; McCutcheon, Louise

2015-10-21

Borderline personality disorder is a severe mental disorder that usually has its onset in youth, but its diagnosis and treatment are often delayed. Psychosocial 'early intervention' is effective in improving symptoms and behaviours, but no trial has studied adaptive functioning as a primary outcome, even though this remains the major persistent impairment in this patient group. Also, the degree of complexity of treatment and requirements for implementation in mainstream health services are unclear. The primary aim of this trial is to evaluate the effectiveness of three forms of early intervention for borderline personality disorder in terms of adaptive functioning. Each treatment is defined by combining either a specialised or a general service delivery model with either an individual psychotherapy or a control psychotherapy condition. The study is a parallel-group, single-blind, randomised controlled trial, which has randomised permuted blocking, stratified by depression score, sex and age. The treatments are: (1) the specialised Helping Young People Early service model plus up to 16 sessions of individual cognitive analytic therapy; (2) the Helping Young People Early service plus up to 16 sessions of a control psychotherapy condition known as 'befriending'; (3) a general youth mental health care model plus up to 16 sessions of befriending. Participants will comprise 135 help-seeking youth aged 15-25 years with borderline personality disorder. After baseline assessment, staff blind to the study design and treatment group allocation will conduct assessments at 3, 6, 12 and 18 months. At the 12-month primary endpoint, the primary outcome is adaptive functioning (measures of social adjustment and interpersonal problems); secondary outcomes include measures of client satisfaction, borderline personality disorder features, depression and substance use. The results of this trial will help to clarify the comparative effectiveness of a specialised early intervention service model over and above general youth mental health care, along with the contribution of individual cognitive analytic therapy over and above specialised general clinical care in early intervention for borderline personality disorder. Consequently, the findings will also inform the level of training and competency required for effective delivery of early intervention services. Registered with the Australian New Zealand Clinical Trial Registry ACTRN12610000100099 on 1 February 2010.

Feasibility of Providing Culturally Relevant, Brief Interpersonal Psychotherapy for Antenatal Depression in an Obstetrics Clinic: A Pilot Study

ERIC Educational Resources Information Center

Grote, Nancy K.; Bledsoe, Sarah E.; Swartz, Holly A.; Frank, Ellen

2004-01-01

Objective: To minimize barriers to care, ameliorate antenatal depression, and prevent postpartum depression, we conducted a pilot study to assess the feasibility of providing brief interpersonal psychotherapy (IPT-B) to depressed, pregnant patients on low incomes in an obstetrics and gynecological (OB/GYN) clinic. Method: Twelve pregnant,…

Depression Care in the United States

PubMed Central

González, Hector M.; Vega, William A.; Williams, David R.; Tarraf, Wassim; West, Brady T.; Neighbors, Harold W.

2010-01-01

Objective: To determine the prevalence and adequacy of depression care among different ethnic and racial groups in the United States. Design: Collaborative Psychiatric Epidemiology Surveys (CPES) data were analyzed to calculate nationally representative estimates of depression care. Setting: The 48 coterminous United States. Participants: Household residents 18 years and older (N=15 762) participated in the study. Main Outcome Measures: Past-year depression pharmacotherapy and psychotherapy using American Psychiatric Association guideline-concordant therapies. Depression severity was assessed with the Quick Inventory of Depressive Symptomatology Self-Report. Primary predictors were major ethnic/racial groups (Mexican American, Puerto Rican, Caribbean black, African American, and non-Latino white) and World Mental Health Composite International Diagnostic Interview criteria for 12-month major depressive episode. Results: Mexican American and African American individuals meeting 12-month major depression criteria consistently and significantly had lower odds for any depression therapy and guideline-concordant therapies despite depression severity ratings not significantly differing between ethnic/racial groups. All groups reported higher use of any past-year psychotherapy and guideline-concordant psychotherapy compared with pharmacotherapy; however, Caribbean black and African American individuals reported the highest proportions of this use. Conclusions: Few Americans with recent major depression have used depression therapies and guideline-concordant therapies; however, the lowest rates of use were found among Mexican American and African American individuals. Ethnic/racial differences were found despite comparable depression care need. More Americans with recent major depression used psychotherapy over pharmacotherapy, and these differences were most pronounced among Mexican American and African American individuals. This report underscores the importance of disaggregating ethnic/racial groups and depression therapies in understanding and directing efforts to improve depression care in the United States. PMID:20048221

Effects of Screening for Psychological Distress on Patient Outcomes in Cancer: a Systematic Review

PubMed Central

Meijer, Anna; Roseman, Michelle; Delisle, Vanessa C.; Milette, Katherine; Levis, Brooke; Syamchandra, Achyuth; Stefanek, Michael E.; Stewart, Donna E.; de Jonge, Peter; Coyne, James C.; Thombs, Brett D.

2013-01-01

Objective Several practice guidelines recommend routine screening for psychological distress in cancer care. The objective was to evaluate the effect of screening cancer patients for psychological distress by assessing the (1) effectiveness of interventions to reduce distress among patients identified as distressed; and (2) effects of screening for distress on distress outcomes. Methods CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO, and SCOPUS databases were searched through April 6, 2011 with manual searches of 45 relevant journals, reference list review, citation tracking of included articles, and trial registry reviews through June 30, 2012. Articles in any language on cancer patients were included if they (1) compared treatment for patients with psychological distress to placebo or usual care in a randomized controlled trial (RCT); or (2) assessed the effect of screening on psychological distress in a RCT. Results There were 14 eligible RCTs for treatment of distress, and 1 RCT on the effects of screening on patient distress. Pharmacological, psychotherapy and collaborative care interventions generally reduced distress with small to moderate effects. One study investigated effects of screening for distress on psychological outcomes, and it found no improvement. Conclusion Treatment studies reported modest improvement in distress symptoms, but only a single eligible study was found on the effects of screening cancer patients for distress, and distress did not improve in screened patients versus those receiving usual care. Because of the lack of evidence of beneficial effects of screening cancer patients for distress, it is premature to recommend or mandate implementation of routine screening. PMID:23751231

PSYCHOTHERAPY VERSUS PHARMACOTHERAPY FOR POSTTRAUMATIC STRESS DISORDER: SYSTEMIC REVIEW AND META-ANALYSES TO DETERMINE FIRST-LINE TREATMENTS.

PubMed

Lee, Daniel J; Schnitzlein, Carla W; Wolf, Jonathan P; Vythilingam, Meena; Rasmusson, Ann M; Hoge, Charles W

2016-09-01

Current clinical practice guidelines (CPGs) for posttraumatic stress disorder (PTSD) offer contradictory recommendations regarding use of medications or psychotherapy as first-line treatment. Direct head-to-head comparisons are lacking. Systemic review of Medline, EMBASE, PILOTS, Cochrane Central Register of Controlled Trials, PsycINFO, and Global Health Library was conducted without language restrictions. Randomized clinical trials ≥8 weeks in duration using structured clinical interview-based outcome measures, active-control conditions (e.g. supportive psychotherapy), and intent-to-treat analysis were selected for analyses. Independent review, data abstraction, and bias assessment were performed using standardized processes. Study outcomes were grouped around conventional follow-up time periods (3, 6, and 9 months). Combined effect sizes were computed using meta-analyses for medication versus control, medication pre-/posttreatment, psychotherapy versus control, and psychotherapy pre-/posttreatment. Effect sizes for trauma-focused psychotherapies (TFPs) versus active control conditions were greater than medications versus placebo and other psychotherapies versus active controls. TFPs resulted in greater sustained benefit over time than medications. Sertraline, venlafaxine, and nefazodone outperformed other medications, although potential for methodological biases were high. Improvement following paroxetine and fluoxetine treatment was small. Venlafaxine and stress inoculation training (SIT) demonstrated large initial effects that decreased over time. Bupropion, citalopram, divalproex, mirtazapine, tiagabine, and topiramate failed to differentiate from placebo. Aripiprazole, divalproex, guanfacine, and olanzapine failed to differentiate from placebo when combined with an antidepressant. Study findings support use of TFPs over nontrauma-focused psychotherapy or medication as first-line interventions. Second-line interventions include SIT, and potentially sertraline or venlafaxine, rather than entire classes of medication, such as SSRIs. Future revisions of CPGs should prioritize studies that utilize active controls over waitlist or treatment-as-usual conditions. Direct head-to-head trials of TFPs versus sertraline or venlafaxine are needed. © 2016 Wiley Periodicals, Inc.

Assessment of therapists' and patients' personality: relationship to therapeutic technique and outcome in brief dynamic psychotherapy.

PubMed

Hersoug, Anne Grete

2004-12-01

My first focus of this study was to explore therapists' personal characteristics as predictors of the proportion of interpretation in brief dynamic psychotherapy (N=39; maximum 40 sessions). In this study, I used data from the Norwegian Multicenter Study on Process and Outcome of Psychotherapy (1995). The main finding was that therapists who had experienced good parental care gave less interpretation (28% variance was accounted for). Therapists who had more negative introjects used a higher proportion of interpretation (16% variance was accounted for). Patients' pretreatment characteristics were not predictive of therapists' use of interpretation. The second focus was to investigate the impact of therapists' personality and the proportion of interpretation on the development of patients' maladaptive defensive functioning over the course of therapy. Better parental care and less negative introjects in therapists were associated with a positive influence and accounted for 5% variance in the reduction of patients' maladaptive defense.

The Overall Diagnosis: Psychodynamic Psychiatry, Six-Minute Psychotherapy, and Patient-Centered Care.

PubMed

Weinberg, Elizabeth; Mintz, David

2018-06-01

Optimal patient care in psychiatry necessitates attention to the treatment relationship and to the patient's experience as an individual. The growth of patient-centered medicine has led to an increased appreciation of the importance of the biopsychosocial formulation, the personhood of both the patient and the physician, the autonomy and authority of the patient, and the therapeutic alliance. Patient-centered medicine, developed by the seminal psychoanalytic theorist Michael Balint, has its roots in psychodynamic concepts. A psychodynamic approach to psychopharmacology improves psychiatric prescribing, and guides the psychiatrist in providing brief, limited psychotherapy, similar to that which the Balints recommended in primary care practice. Copyright © 2018 Elsevier Inc. All rights reserved.

Feasibility and Effectiveness of Memory Specificity Training in Depressed Outpatients: A Pilot Study.

PubMed

Eigenhuis, Eline; Seldenrijk, Adrie; van Schaik, Anneke; Raes, Filip; van Oppen, Patricia

2017-01-01

Research has shown that depressed patients suffer from reduced autobiographical memory specificity (rAMS). This cognitive phenomenon is associated with the maintenance and recurrence of depressive symptoms. This pilot study aims to investigate the feasibility and effectiveness of a relatively new group-based intervention (Memory Specificity Training; MeST) that aims to reduce rAMS in an outpatient setting. Twenty-six depressed outpatients received MeST during the waiting period prior to psychotherapy. The Client Satisfaction Questionnaire (CSQ-8) was used to measure client satisfaction after the training. The Autobiographical Memory Test (AMT) was used to measure memory specificity before and after the training. Depressive symptoms were measured using the Beck Depression Inventory (BDI-II) and the Montgomery Asberg Depression Rating Scale (MADRS), before and after the training, and at a 3-month follow-up. Participants as well as trainers were positive about the use of MeST. Participants also showed an increase in memory specificity and a decrease in depressive symptoms. This study suggests that MeST is feasible in an outpatient setting, that it increases autobiographical memory specificity and that it may decrease depressive symptoms. A randomized controlled trial is recommended to examine MeST and its effects on autobiographical memory specificity, depressive symptoms and depressive relapse more extensively. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message: Research suggests that modification of rAMS can advance recovery and reduce the chance of developing a depression relapse. However, most existing psychotherapies for depression do not include these specific interventions. This is the first study to show that MeST in an outpatient setting is feasible and can lead to an increase in autobiographical memory specificity and that it may decrease depressive symptoms. A larger scale randomized controlled trial is required to examine whether the addition of MeST to care as usual decreases depressive symptoms more effectively than care as usual without MeST, and to examine whether subgroups of patients benefit specifically from this intervention (e.g. patients with more severely decreased memory specificity). Copyright © 2015 John Wiley & Sons, Ltd.

Mother-Infant Group Psychotherapy as an Intensive Treatment in Early Interaction among Mothers with Substance Abuse Problems

ERIC Educational Resources Information Center

Belt, Ritva; Punamaki, Raija-Leena

2007-01-01

In this article we present a novel method of outpatient care: brief, dynamic mother-infant group psychotherapy with mothers who have substance use problems. In this therapy, substance abuse treatment is part of mental health and parenting interventions. The focus is on preventing disturbance in the mother-infant relationship in this high-risk…

Benefits and challenges in practice-oriented psychotherapy research in Germany: the TK and the QS-PSY-BAY projects of quality assurance in outpatient psychotherapy.

PubMed

Strauss, Bernhard Michael; Lutz, Wolfgang; Steffanowski, Andres; Wittmann, Werner W; Boehnke, Jan R; Rubel, Julian; Scheidt, Carl E; Caspar, Franz; Vogel, Heiner; Altmann, Uwe; Steyer, Rolf; Zimmermann, Anna; Bruckmayer, Ellen; von Heymann, Friedrich; Kramer, Dietmar; Kirchmann, Helmut

2015-01-01

Two patient-focused long-term research projects performed in the German outpatient psychotherapy system are focused on in this article. The TK (Techniker Krankenkasse) project is the first study to evaluate a quality assurance and feedback system with regard to its practical feasibility in German routine care. The other study ("Quality Assurance in Outpatient Psychotherapy in Bavaria"; QS-PSY-BAY) was designed to test a new approach for quality assurance in outpatient psychotherapy using electronic documentation of patient characteristics and outcome parameters. In addition this project provides the opportunity to analyze data on health-related costs for the patients undergoing outpatient psychotherapy. Both projects and their results indicating high effect sizes are briefly described. From the perspectives of the research teams, advisory boards and other stakeholders, the experiences with these projects are discussed focusing on obstacles, challenges, difficulties, and benefits in developing and implementing the studies. The triangle collaboration of therapists, researchers, and health insurance companies/health service institutions turned out to be fruitful in both studies. Despite some controversies between the partners the experiences indicate the importance of practiced-research collaborations to provide relevant information about the delivery of outpatient psychotherapy in the health system.

Transdiagnostic Motivational Enhancement Therapy to Reduce Treatment Attrition: Use in Emerging Adults

PubMed Central

Mistler, Lisa A.; Sheidow, Ashli J.; Davis, Maryann

2017-01-01

Improving outcomes of youth with mental health (MH) needs as they transition into adulthood is of critical public health significance. Effective psychotherapy MH treatment is available, but can be effective only if the emerging adult (EA) attends long enough to benefit. Unfortunately, completion of psychotherapy among EAs is lower than for more mature adults (Edlund et al., 2002; Olfson, Marcus, Druss, & Pincus, 2002). To target the high attrition of EAs in MH treatment, investigators adapted a developmentally appropriate brief intervention aimed at reducing treatment attrition (TA) in psychotherapy and conducted a feasibility study of implementation. The intervention employs motivational interviewing strategies aimed at engaging and retaining EAs in outpatient MH treatment. Motivational enhancement therapy for treatment attrition, or MET-TA, takes only a few sessions at the outset of treatment as an adjunct to usual treatment. Importantly, it can be used for TA with psychotherapy for any MH condition; in other words, it is transdiagnostic. This article presents the first description of MET-TA, along with a case example that demonstrates important characteristics of the approach, and then briefly describes implementation feasibility based on a small pilot randomized controlled trial. PMID:28979088

The effects of simultaneous exercise and psychotherapy on depressive symptoms in inpatient, psychiatric older adults.

PubMed

Jacquart, Son D; Marshak, Helen H; Dos Santos, Hildemar; Luu, Sen M; Berk, Lee S; McMahon, Paul T; Riggs, Matt

2014-01-01

Depression is the leading cause of early death, affecting 15% of Americans older than 65 y and costing $43 billion each year. The current mental health service system for seniors, particularly for the population hospitalized in acute inpatient psychiatric units, is fragmented because of poor funding and a shift to a transitory health care paradigm, leading to inadequate treatment modalities, questionable quality of care, and lack of research demonstrating the superiority of a particular treatment. These issues are likely to lead to a public health crisis in the coming years. To investigate the effectiveness of combining exercise and psychotherapy in improving acute depressive symptoms among older adults who were receiving treatment in an inpatient psychiatric unit. Based on rolling admissions, inpatients were randomly assigned to 1 of 3 treatment groups. The study was blinded and controlled. This study took place in inpatient psychiatric units at the Loma Linda University's Behavioral Medicine Center (LLUBMC) in Redlands, California. Participants were 78 inpatients, aged 50-89 y. Participants in the simultaneous exercise and psychotherapy (STEP) group (n = 26) took part in exercise and received psychotherapy for 30 min per session, whereas those in the TALK group (n = 26) received individual psychotherapy for 30 min per session. Participants in the control group (n = 26) served as a comparison group, receiving standard therapy. The effects of the interventions were determined by assessing differences from baseline to postintervention in the symptomatology of all 3 groups. The research team also administered the Behavioral and Symptom Identification Scale (BASIS-32) and the Geriatric Depression Scale (GDS) pre- and postintervention. At posttest, the STEP group (M = 4.24, SE = 0.62) had a better response than the TALK group (M = 11.34, SE = 0.62, P < .001), which in turn showed greater improvement than the control group (M = 14.84, SE = 0.62, P < .001). Overall, these results indicate that patients' posttreatment depression scores were significantly lower in those receiving the STEP treatment compared with those receiving individual psychotherapy only or standard care. A short-term exercise program consisting of 30 min of walking in conjunction with individual psychotherapy was an effective intervention for depression among older adults in inpatient psychiatric units.

Generalizability of Pharmacologic and Psychotherapy Clinical Trial Results for Posttraumatic Stress Disorder to Community Samples.

PubMed

Franco, Silvia; Hoertel, Nicolas; McMahon, Kibby; Wang, Shuai; Rodríguez-Fernández, Jorge Mario; Peyre, Hugo; Limosin, Frédéric; Blanco, Carlos

2016-08-01

The present study sought to quantify the generalizability of pharmacologic and psychotherapy clinical trial results in individuals with a DSM-IV diagnosis of posttraumatic stress disorder (PTSD) to a large representative community sample. Data were derived from the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a large nationally representative sample of the adult US population. We applied a standard set of exclusion criteria representative of pharmacologic and psychotherapy clinical trials to all adults with a DSM-IV diagnosis of PTSD in the previous 12 months (n = 1,715) and then to a subsample of participants seeking treatment (n = 366). Our aim was to assess how many participants with PTSD would fulfill typical eligibility criteria. We found that more than 6 of 10 respondents from the overall PTSD sample and more than 7 of 10 respondents seeking treatment for PTSD would have been excluded by 1 exclusion criterion or more in a typical pharmacologic trial. In contrast, about 2 of 10 participants in the full sample and about 3 of 10 participants seeking treatment for PTSD would have been excluded in a typical psychotherapy efficacy trial. We found that psychotherapy trial results may be applied to most patients with PTSD in routine clinical practice. The designers of pharmacologic clinical trials should carefully consider the trade-offs between the application of each exclusion criterion and its impact on representativeness. Specification a priori of the goals of the study, better justification for each exclusion criterion, and estimation of the proportion of individuals ineligible for the trial would assist study design. Developing integrated forms of pharmacotherapy and psychotherapy that simultaneously target commonly overlapping psychiatric disorders may yield more informative results for mental health care providers and research funding agencies. © Copyright 2016 Physicians Postgraduate Press, Inc.

Models of Counselling Centres.

ERIC Educational Resources Information Center

Calgary Univ. (Alberta).

University counseling centers usually follow one of a variety of themes or "models," although not in pure form. Perhaps the oldest is the vocational counseling model, which concentrates on helping students find suitable careers. In the psychotherapy model, most student concerns are seen for their personal content. Another model, student affairs…

Countertransference. Its continued importance in psychiatric education

PubMed Central

Rao, Nyapati R.; Meinzer, Arthur E.; Berman, Sheldon S.

1997-01-01

Psychotherapy is likely to play a minor or nonexistent role in the future general psychiatrist's training and practice. However, the component skills of recognition and management of the countertransference will remain important. Because psychotherapy training and supervision have been the venues for countertransference learning, the field is in danger of losing its teaching laboratory and hence losing these skills. The authors examine the concept of countertransference and discuss its importance in four increasingly significant areas: managed care, psychopharmacological treatment, emergency intervention, and the management of professional boundaries regarding sexual misconduct. Methods are discussed for enhancing residents' countertransference skills through supervision, training groups, and the resident's personal psychotherapy. PMID:9058556

Sustained reduction in health care costs after adjunctive treatment of graded intensive short-term dynamic psychotherapy in patients with psychotic disorders.

PubMed

Abbass, Allan; Bernier, Denise; Kisely, Steve; Town, Joel; Johansson, Robert

2015-08-30

The aim of this pilot study was to evaluate the changes in symptom severity and long-term health care cost after intensive short-term dynamic psychotherapy (ISTDP) individually tailored and administered to patients with psychotic disorders undergoing standard psychiatric care. Eleven therapists with different levels of expertise delivered an average of 13 one-hour sessions of graded ISTDP to 38 patients with psychotic disorders. Costs for health care services were compiled for a one-year period prior to the start of ISTDP (baseline) along with four one-year periods after termination. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination of ISTDP. Results revealed that health care cost reductions were significant for the one-year post-treatment period relative to baseline year, for both physician costs and hospital costs, and the reductions were sustained for the follow-up period of four post-treatment years. Furthermore, at treatment termination self-reported symptoms and interpersonal problems were significantly reduced. These preliminary findings suggest that this brief adjunctive psychotherapy may be beneficial and reduce costs in selected patients with psychotic disorders, and that gains are sustained in long-term follow-up. Future research directions are discussed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting

PubMed Central

Cooper, Angela; Abbass, Allan; Town, Joel

2017-01-01

Medically unexplained symptoms (MUS) are known to be costly, complex to manage and inadequately addressed in primary care settings. In many cases, there are unresolved psychological and emotional processes underlying these symptoms, leaving traditional medical approaches insufficient. This paper details the implementation of an evidence-based, emotion-focused psychotherapy service for MUS across two family medicine clinics. The theory and evidence-base for using Intensive Short-Term Dynamic Psychotherapy (ISTDP) with MUS is presented along with the key service components of assessment, treatment, education and research. Preliminary outcome indicators showed diverse benefits. Patients reported significantly decreased somatic symptoms in the Patient Health Questionnaire-15 (d = 0.4). A statistically significant (23%) decrease in family physicians’ visits was found in the 6 months after attending the MUS service compared to the 6 months prior. Both patients and primary care clinicians reported a high degree of satisfaction with the service. Whilst further research is needed, these findings suggest that a direct psychology service maintained within the family practice clinic may assist patient and clinician function while reducing healthcare utilization. Challenges and further service developments are discussed, including the potential benefits of re-branding the service to become a ‘Primary Care Psychological Consultation and Treatment Service’. PMID:29186054

Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting.

PubMed

Cooper, Angela; Abbass, Allan; Town, Joel

2017-11-29

Medically unexplained symptoms (MUS) are known to be costly, complex to manage and inadequately addressed in primary care settings. In many cases, there are unresolved psychological and emotional processes underlying these symptoms, leaving traditional medical approaches insufficient. This paper details the implementation of an evidence-based, emotion-focused psychotherapy service for MUS across two family medicine clinics. The theory and evidence-base for using Intensive Short-Term Dynamic Psychotherapy (ISTDP) with MUS is presented along with the key service components of assessment, treatment, education and research. Preliminary outcome indicators showed diverse benefits. Patients reported significantly decreased somatic symptoms in the Patient Health Questionnaire-15 ( d = 0.4). A statistically significant (23%) decrease in family physicians' visits was found in the 6 months after attending the MUS service compared to the 6 months prior. Both patients and primary care clinicians reported a high degree of satisfaction with the service. Whilst further research is needed, these findings suggest that a direct psychology service maintained within the family practice clinic may assist patient and clinician function while reducing healthcare utilization. Challenges and further service developments are discussed, including the potential benefits of re-branding the service to become a 'Primary Care Psychological Consultation and Treatment Service'.

Recommendations for mental health professionals in the NICU

PubMed Central

Hynan, M T; Steinberg, Z; Baker, L; Cicco, R; Geller, P A; Lassen, S; Milford, C; Mounts, K O; Patterson, C; Saxton, S; Segre, L; Stuebe, A

2015-01-01

This article describes recommended activities of social workers, psychologists and psychiatric staff within the neonatal intensive care unit (NICU). NICU mental health professionals (NMHPs) should interact with all NICU parents in providing emotional support, screening, education, psychotherapy and teleservices for families. NMHPs should also offer educational and emotional support for the NICU health-care staff. NMHPs should function at all levels of layered care delivered to NICU parents. Methods of screening for emotional distress are described, as well as evidence for the benefits of peer-to-peer support and psychotherapy delivered in the NICU. In the ideal NICU, care for the emotional and educational needs of NICU parents are outcomes equal in importance to the health and development of their babies. Whenever possible, NMHPs should be involved with parents from the antepartum period through after discharge. PMID:26597800

Psychotherapy with Southeast Asian refugees: implications for treatment of Western patients.

PubMed

Gerber, L

1994-01-01

Working with Southeast Asian refugees in psychotherapy can teach Western psychotherapists how our culture-impacted notions of health, psychopathology, and psychotherapy influence the way we hear, understand, and respond to our patients. Western conceptions of individual boundaries, family ties, the relationship of mind and body, and ways of knowing are among the issues that arise for the Western psychotherapist who works with Southeast Asian refugees. While we in the West have seen rapid technological advances, we also have suffered dislocations, change, and the loss of traditional bases of meaning. Yet despite the differences, there are also elements within Western culture that resonate with what are usually considered "Asian" ways. These include the self-in-relation concepts described by feminist writers and the attitude of therapist as learner described by some contemporary psychoanalysts as well as by a contemporary Western philosopher. Refugees and Western patients alike want their unique faces "seen" and hope to birth new and expanded meanings in their psychotherapeutic dialogues.

Incorporation of massage into psychotherapy: an integrative and conjoint approach.

PubMed

Posadzki, Paul; Parekh-Bhurke, Sheetal

2011-02-01

This article presents the potential integration of psychotherapy and massage when considering the essence of their beneficial effects. The essence of this model of practice is multifaceted, combining principles from anatomy, physiology and neuroscience with psychotherapy to benefit patient care. It has been advocated that possessing multidisciplinary knowledge from these areas of science enhances psychotherapists' holistic care of their depressive patients. A narrative review of the literatures and a qualitative, conceptual synthesis has been performed to create a new theoretical-pragmatic construct. This article introduces the concept of massage practice as a part of psychotherapy practice and presents the potential integration of psychotherapeutic knowledge with clinical decision-making and the management of depressive symptoms. The authors emphasize the usefulness of multi- and interdisciplinary knowledge in the psychotherapeutic process and explain how this knowledge might be extrapolated and incorporated into theoretical and practical settings to benefit depressive patients. The justification for this concept is also presented. The principles set out in this article may be a useful source of information for psychotherapists concerned about their patients' holistic well-being in addition to the psychopathology for which they have sought treatment. Researchers and psychotherapists can obtain valuable and additional knowledge through cross-fertilization of ideas across the arguments presented here.

[Socio- and psychotherapy in patients with Alzheimer disease].

PubMed

Hirsch, R D

2001-04-01

Symptoms presented by patients with Alzheimer-type dementia do not only reflect organic disturbances only but require a holistic and person-oriented view. Affective and behavioral disturbances are not necessarily secondary to cognitive impairment. Guidelines are presented for a multidimensional treatment involving the significant other. Socio- and psychotherapy are essential for this treatment. Their approaches have greatly increased in number and diversity in the past few years. Sociotherapy is based on milieu therapy and includes different training- and group activities. Several psychosocial treatment modalities are available, including validation, dementia care mapping, reminiscence therapy, cognitive training and psychoeducational group work. Psychotherapeutic approaches include relaxation techniques, and psychodynamic oriented- and behavioral modalities. The indication for a specific modality is based on an assessment of the disturbances present and available resources. Of special importance are also services to family carers, including counseling, psychotherapy, as well as support and modification of the care-setting. Even though there are only limited empirical data available on the effects of socio- and psychotherapy for patients with Alzheimer-type dementia, the available evidence is indicative of a positive influence on symptoms of this illness. Diversity of symptoms and individualized, variable course of the illness may point to the importance of psychological and social factors in this illness, by far larger than presently recognized.

Cultural standards, power and subversion in cross-cultural psychotherapy.

PubMed

Rechtman, Richard

2006-06-01

In a creolizing world, psychotherapy is challenged by the growing influence of cultural standards, systems of meaning and idioms of distress supported by new groups who play a major role in public health policies. While these elements were originally introduced in psychotherapy with ethnic minorities both to improve the patient-doctor relationship and to bring relevant material from patients' cultural background, they also became a way to empower nonwestern patients in western health care systems. When in the 1980s it became possible to readdress the issue of power in psychiatric practice, something had already changed in the social regulation that psychiatry should endorse. In this article, the author focuses on the new legitimated social and cultural values that underpin the therapeutic process. While obviously these new values should be taken into account, the aim for psychotherapy remains to find a path for a 'subversive' practice that could be something more than just following social guidelines.

Psychodynamic psychotherapy: a core conceptual model and its application.

PubMed

Corradi, Richard B

2006-01-01

Contemporary American psychiatry, influenced by the "biologic revolution" with its emphasis on a brain-disease model of mental illness, and operating in a managed care delivery system, is in danger of relinquishing its listening and talking functions--psychotherapy--in favor of prescribing drugs. However, despite remarkable advances in the neurosciences, there is still no pharmaceutical magic bullet. The author argues for the continued relevancy of psychotherapy and outlines a practical psychodynamic approach that utilizes fundamental analytic concepts. These concepts--transference, the dual theory of drives, the repetition compulsion, and mechanisms of defense--are described and their clinical application is illustrated. This core conceptual model has significant heuristic value in treating patients and in teaching psychotherapy to psychiatric residents. With its emphasis on the power of the doctor-patient relationship, it teaches residents an effective body of knowledge that helps them define their professional identity-as psychiatrists whose most effective therapeutic tool is themselves, not the drugs they dispense.

Population-based outreach versus care as usual to prevent suicide attempt: study protocol for a randomized controlled trial.

PubMed

Simon, Gregory E; Beck, Arne; Rossom, Rebecca; Richards, Julie; Kirlin, Beth; King, Deborah; Shulman, Lisa; Ludman, Evette J; Penfold, Robert; Shortreed, Susan M; Whiteside, Ursula

2016-09-15

Suicide remains the 10th-ranked most frequent cause of death in the United States, accounting for over 40,000 deaths per year. Nonfatal suicide attempts lead to over 200,000 hospitalizations and 600,000 emergency department visits annually. Recent evidence indicates that responses to the commonly used Patient Health Questionnaire (PHQ9) can identify outpatients who are at risk of suicide attempt and suicide death and that specific psychotherapy or Care Management programs can prevent suicide attempts in high-risk patients. Motivated by these developments, the NIMH-funded Mental Health Research Network has undertaken a multisite trial of two outreach programs to prevent suicide attempts among outpatients identified by routinely administered PHQ9 questionnaires. Outpatients who are at risk of suicide attempt are automatically identified using data from electronic health records (EHRs). Following a modified Zelen design, all those identified are assigned to continued usual care (i.e., no contact) or to be offered one of two population-based outreach programs. A Care Management intervention includes systematic outreach to assess suicide risk, EHR-based tools to implement risk-based care pathways, and care management to facilitate recommended follow-up. A Skills Training intervention includes interactive online training in Dialectical Behavior Therapy skills, supported by reminder and reinforcement messages from a skills coach. Each intervention supplements, rather than replaces, usual care; participants may receive any other services normally available. Interventions are delivered primarily by secure messaging through EHR patient portals. Suicide attempts and deaths following randomization are identified using state vital statistics data and health system EHR and insurance claim data. Primary evaluation will compare risk of suicide attempt or death over 18 months according to the initial assignment, regardless of intervention participation. Recruitment is underway in three health systems (Group Health Cooperative, HealthPartners, and Kaiser Permanente Colorado). Over 2500 participants have been randomized as of 1 March 2016, with enrollment averaging approximately 100 per week. Assessing the effectiveness of population-based suicide prevention requires adherence to the principles of pragmatic trials: population-based enrollment, accepting variable treatment participation, assessing outcomes using health record data, and analyses based on intent-to-treat. ClinicalTrials.gov registration # NCT02326883 , registered on 23 December 2014.

Depression, women, and the workplace.

PubMed

Wollersheim, J P

1993-01-01

Depression is a highly prevalent disorder that causes much personal distress and difficulties in functioning at home and in the workplace. In the workplace, as elsewhere, depression can manifest as a variation in normal mood, as a symptom, as a disorder, or as a disease. Occupational health professionals are more concerned with clinical depression, a term used to signify any type of depression that causes significant personal distress and/or problems in functioning. Clinical depression is manifest in the workplace and adversely affects the employee's work satisfaction and performance. For most types of depression, women are at a higher risk than men. A number of events and variables related to women and depression were reviewed. Although the effects of some of these events, such as menopause, can be manifest in the workplace, they are not associated with an increased incidence of clinical depression. Other events, such as victimization (e.g., childhood sexual abuse or battering by an intimate partner), are associated with higher risks of depression in women. Women derive substantial satisfaction from interpersonal relationships but also are at greater risk for depression when strains and conflicts in these relationships occur. In the workplace women who have no difficulty in arranging for child care and whose spouses share in the care of children show lower rates of depression. When marriages are unhappy, women are three times as likely as men to be depressed. These findings speak to the importance of relationships to women. In the workplace, when women are depressed, problems with relationships are likely to be involved. Clinically depressed women are not difficult to identify in work settings. Dejected mood and loss of interest in usual activities are noticeable, along with numerous other symptoms that accompany depression. The effective treatment of depression depends on careful diagnosis and assessment. Both drug therapy and the more structured psychotherapies, such as cognitive-behavioral and interpersonal therapy, have demonstrated effectiveness in treating depression. For mild depression, pharmacotherapy is likely to be the treatment of choice. In cases in which the depressive symptomatology is moderate to severe, a combination of drug therapy and psychotherapy is likely to be the most effective treatment and to provide the best prophylaxis. Drug therapy seems particularly effective in promoting rapid reduction of vegetative and physical symptoms. Psychotherapy enhances coping skills at home and at work and also focuses on problem-solving, relationship difficulties, and dealing with stressors. In the area of prevention, occupational health practitioners currently can have the greatest impact in secondary prevention.(ABSTRACT TRUNCATED AT 400 WORDS)

Psychoanalysis and analytic psychotherapy in the NHS--a problem for medical ethics.

PubMed Central

Wilkinson, G

1986-01-01

I question the place of psychoanalysis and psychoanalytically oriented psychotherapy in the National Health Service (NHS), with reference to published material; and, particularly, in relation to primary care, health economics and medical ethics. I argue that there are pressing clinical, research, economic, and ethical reasons in support of the contention that an urgent review of the extent and impact of psychoanalytic practices in the health service is called for. PMID:3735363

Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis.

PubMed

Cristea, Ioana A; Gentili, Claudio; Cotet, Carmen D; Palomba, Daniela; Barbui, Corrado; Cuijpers, Pim

2017-04-01

Borderline personality disorder (BPD) is a debilitating condition, but several psychotherapies are considered effective. To conduct an updated systematic review and meta-analysis of randomized clinical trials to assess the efficacy of psychotherapies for BPD populations. Search terms were combined for borderline personality and randomized trials in PubMed, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials (from database inception to November 2015), as well as the reference lists of earlier meta-analyses. Included were randomized clinical trials of adults with diagnosed BPD randomized to psychotherapy exclusively or to a control intervention. Study selection differentiated stand-alone designs (in which an independent psychotherapy was compared with control interventions) from add-on designs (in which an experimental intervention added to usual treatment was compared with usual treatment alone). Data extraction coded characteristics of trials, participants, and interventions and assessed risk of bias using 4 domains of the Cochrane Collaboration Risk of Bias tool (independent extraction by 2 assessors). Outcomes were pooled using a random-effects model. Subgroup and meta-regression analyses were conducted. Standardized mean differences (Hedges g) were calculated using all outcomes reported in the trials for borderline symptoms, self-harm, suicide, health service use, and general psychopathology at posttest and follow-up. Differential treatment retention at posttest was analyzed, reporting odds ratios. Thirty-three trials (2256 participants) were included. For borderline-relevant outcomes combined (symptoms, self-harm, and suicide) at posttest, the investigated psychotherapies were moderately more effective than control interventions in stand-alone designs (g = 0.32; 95% CI, 0.14-0.51) and add-on designs (g = 0.40; 95% CI, 0.15-0.65). Results were similar for other outcomes, including stand-alone designs: self-harm (g = 0.32; 95% CI, 0.09-0.54), suicide (g = 0.44; 95% CI, 0.15-0.74), health service use (g = 0.40; 95% CI, 0.22-0.58), and general psychopathology (g = 0.32; 95% CI, 0.09-0.55), with no differences between design types. There were no significant differences in the odds ratios for treatment retention (1.32; 95% CI, 0.87-2.00 for stand-alone designs and 1.01; 95% CI, 0.55-1.87 for add-on designs). Thirteen trials reported borderline-relevant outcomes at follow-up (g = 0.45; 95% CI, 0.15-0.75). Dialectical behavior therapy (g = 0.34; 95% CI, 0.15-0.53) and psychodynamic approaches (g = 0.41; 95% CI, 0.12-0.69) were the only types of psychotherapies more effective than control interventions. Risk of bias was a significant moderator in subgroup and meta-regression analyses (slope β = -0.16; 95% CI, -0.29 to -0.03; P = .02). Publication bias was persistent, particularly for follow-up. Psychotherapies, most notably dialectical behavior therapy and psychodynamic approaches, are effective for borderline symptoms and related problems. Nonetheless, effects are small, inflated by risk of bias and publication bias, and particularly unstable at follow-up.

Sex therapy and mastectomy.

PubMed

Witkin, M H

1975-01-01

Because the emotional trauma associated with a mastectomy exceeds the physical trauma, the recovery of the woman is greatly affected by the response of her husband or lover. Sex therapy, therefore, involves the couple. The approach described here is aimed at assisting the couple to confront and intergrate the mastectomy experience. The use of a prosthesis is discouraged during intercourse because it delays such confrontation; certain sex therapy exercises (body imagery and sensate focus) are usually recommended because they facilitate confrontation and acceptance. These, modified for the circumstances, are described. It is suggested that intercourse be attempted as early as possible, and that if physical weakness or psychological trepidation intervenes, the physical desire and caring of the husband be expressed nonetheless. The "professional" attitudes that psychotherapy is always indicated for mastectomy patients and that the proper role of the husband is matter-of-fact denial are rejected; emphasis is placed on the beneficial consequences of sharing of all emotions.

THE CALIFORNIA YOUTH AUTHORITY PSYCHIATRIC TREATMENT PROGRAM—Its Historical Significance and Philosophy

PubMed Central

Gerstle, Mark Lewis

1960-01-01

Three psychiatric treatment units for dealing with emotionally disturbed teen-age delinquents who become wards of the California Youth Authority are operating on a pilot basis in three of the Authority's corrective schools. It is recognized that treatment is far more than psychotherapy; the solicitude, encouragement, understanding and sympathy that a disturbed teen-ager receives from the people who make up his custodial surroundings are a part of it. An aim of the treatment units is to relieve these young people of disruptive, destructive emotions. A most important aspect is the integration of treatment with custody, which requires—and is getting—the cooperation of the administrative staffs. Although the cost of the program is relatively high, it can result in a considerable net saving to taxpayers. Helping to make an orderly, productive citizen of a disturbed youth can usually prevent years of costly custodial care. PMID:13827626

Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design.

PubMed

Cully, Jeffrey A; Armento, Maria E A; Mott, Juliette; Nadorff, Michael R; Naik, Aanand D; Stanley, Melinda A; Sorocco, Kristen H; Kunik, Mark E; Petersen, Nancy J; Kauth, Michael R

2012-07-11

Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1) to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases) primary care patients and (2) to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200) or usual care (n = 120). Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points) and qualitative methods (e.g., focus interviews and surveys from patients and providers). Patient-effectiveness outcomes include measures of depression, anxiety, and physical health functioning using blinded independent evaluators. Implementation outcomes include patient engagement and adherence and clinician brief cognitive behavioral therapy adoption and fidelity. Hybrid designs are needed to advance clinical effectiveness and implementation knowledge to improve healthcare practices. The current article describes the rationale and challenges associated with the use of a hybrid design for the study of brief cognitive behavioral therapy in primary care. Although trade-offs exist between scientific control and external validity, hybrid designs are part of an emerging approach that has the potential to rapidly advance both science and practice. NCT01149772 at http://www.clinicaltrials.gov/ct2/show/NCT01149772.

Metacognitive Reflection and Insight Therapy for Early Psychosis: A preliminary study of a novel integrative psychotherapy.

PubMed

Vohs, Jenifer L; Leonhardt, Bethany L; James, Alison V; Francis, Michael M; Breier, Alan; Mehdiyoun, Nikki; Visco, Andrew C; Lysaker, Paul H

2018-05-01

Poor insight impedes treatment in early phase psychosis (EPP). This manuscript outlines preliminary findings of an investigation of the novel metacognitively oriented integrative psychotherapy, Metacognitive Reflection and Insight Therapy, for individuals with early phase psychosis (MERIT-EP). Twenty adults with EPP and poor insight were randomized to either six months of MERIT-EP or treatment as usual (TAU). Therapists were trained and therapy was successfully delivered under routine, outpatient conditions. Insight, assessed before and after treatment, revealed significant improvement for the MERIT-EP, but not TAU, group. These results suggest MERIT-EP is feasible to deliver, accepted by patients, and leads to clinically significant improvements in insight. Copyright © 2017 Elsevier B.V. All rights reserved.

A Randomized Double-Blind Controlled Trial Comparing Davanloo Intensive Short-Term Dynamic Psychotherapy as Internet-Delivered Vs Treatment as Usual for Medically Unexplained Pain: A 6-Month Pilot Study.

PubMed

Chavooshi, Behzad; Mohammadkhani, Parvaneh; Dolatshahi, Behrouz

2016-01-01

Research has shown that Intensive Short-Term Dynamic Psychotherapy (ISTDP) can effectively decrease pain intensity and improve quality of life in patients with medically unexplained pain. Understanding that not all patients with medically unexplained pain have access to in-person ISTDP, this study aims to investigate the efficacy of an Internet-delivered ISTDP for individuals with medically unexplained pain using Skype in comparison with treatment as usual. In this randomized controlled trial, 100 patients were randomly allocated into Internet-delivered ISTDP (n = 50) and treatment-as- usual (n = 50) groups. Treatment intervention consisted of 16 weekly, hour-long therapy sessions. The primary outcome was perceived pain assessed using the Numeric Pain Rating Scale. The secondary outcome included Depression Anxiety Stress Scale-21, Emotion Regulation Questionnaire, Mindful Attention Awareness Scale, and Quality-of-Life Inventory. Blind assessments were conducted at the baseline, posttreatment, and at a 6-month follow-up. In the intention-to-treat analysis, pain symptoms in the intervention group were significantly reduced (p < 0.001), whereas a reduction was not observed in the treatment as usual group (p = 0.651). Moreover, there were significant decreases in depression, anxiety, and stress, as well as a greater increase in emotion regulation functioning, mindfulness, and quality of life observed in the intervention group 6 months after the treatment compared with the treatment as usual condition. The results of this pilot trial demonstrate that 16 weeks of ISTDP delivered by Skype can significantly improve pain intensity and clinical symptoms of medically unexplained pain. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Enhancing the Reach of Cognitive-Behavioral Therapy Targeting Posttraumatic Stress in Acute Care Medical Settings.

PubMed

Darnell, Doyanne; O'Connor, Stephen; Wagner, Amy; Russo, Joan; Wang, Jin; Ingraham, Leah; Sandgren, Kirsten; Zatzick, Douglas

2017-03-01

Injured patients presenting to acute care medical settings have high rates of posttraumatic stress disorder (PTSD) and comorbidities, such as depression and substance use disorders. Integrating behavioral interventions that target symptoms of PTSD and comorbidities into the acute care setting can overcome common barriers to obtaining mental health care. This study examined the feasibility and acceptability of embedding elements of cognitive-behavioral therapy (CBT) in the delivery of routine postinjury care management. The investigation also explored the potential effectiveness of completion of CBT element homework that targeted PTSD symptom reduction. This study was a secondary analysis of data from a U.S. clinical trial of the effectiveness of a stepped collaborative care intervention versus usual care for injured inpatients. The investigation examined patients' willingness at baseline (prerandomization) to engage in CBT and pre- and postrandomization mental health service utilization among 115 patients enrolled in the clinical trial. Among intervention patients (N=56), the investigation examined acceptability of the intervention and used multiple linear regression to examine the association between homework completion as reported by the care manager and six-month PTSD symptom reduction as assessed by the PTSD Checklist-Civilian DSM-IV Version. Patients in the intervention condition reported obtaining significantly more psychotherapy or counseling than patients in the control group during the six-month follow-up, as well as a high degree of intervention acceptability. Completion of CBT element homework assignments was associated with improvement in PTSD symptoms. Integrating behavioral interventions into routine acute care service delivery may improve the reach of evidence-based mental health care targeting PTSD.

Panic-Focused Psychodynamic Psychotherapy in a Woman with Panic Disorder and Generalized Anxiety Disorder

PubMed Central

Sandberg, Larry; Busch, Fredric; Schneier, Franklin; Gerber, Andrew; Caligor, Eve; Milrod, Barbara

2016-01-01

Panic-focused psychodynamic psychotherapy (PFPP) is a 24-session, twice-weekly (12 weeks), manualized psychoanalytic psychotherapy with demonstrated preliminary efficacy for panic disorder (PD).1,2 Given the substantial morbidity and the health care utilization of the PD population,3,4 coupled with the sizable proportion of such patients who do not respond (or respond inadequately) to alternate treatments (cognitive-behavioral therapy [CBT] and drug therapy),5–7 PFPP may offer clinicians an additional tool for their therapeutic armamentarium. It may also facilitate a rapprochement between academic psychiatry and psychodynamic perspectives, and a reassessment of the role of psychodynamic therapy as part of the educational experience of residents in training—an experience that has diminished over two decades. PMID:23030215

[Concept of budget-based remuneration system for the fields of psychiatry and psychotherapy, psychosomatic medicine and psychotherapy, child and adolescent psychiatry and psychotherapy].

PubMed

2015-11-01

A new remuneration system is currently being developed for the hospital care of people with mental disorders. Last year, because of sharp criticism the option phase of the planned Flat-rate Charges in Psychiatry and Psychosomatics (Pauschalierende Entgelte Psychiatrie und Psychosomatik, PEPP) was extended by 2 years. During this time the Federal Ministry of Health wants to look for alternatives and possible starting points for the further development of care. Now, 16 scientific professional associations and organisations have presented a joint concept for a sustainable solution: the budget-based remuneration system. The system is suitable for ensuring that people with mental disorders are treated according to their particular needs and for promoting the appropriate further development of regional care in all treatment settings. It corresponds with the objectives as formulated in Section 17d of the Hospital Finance Act (Krankenhausfinanzierungsgesetz, KHG) and translates the PEPP system, which is currently being developed and focusses on average prices, into a performance-oriented, transparent budgetary system. The fundamental principle is the separation of the individual hospitals' budgeting on the basis of evidence-based, feature- and performance-related modules and billing in the form of advance payments from the agreed budget.

Interactive effects of stress and individual differences on alcohol use and posttraumatic stress disorder among personnel deployed to Guantanamo Bay.

PubMed

De La Rosa, Gabriel M; Delaney, Eileen M; Webb-Murphy, Jennifer A; Johnston, Scott L

2015-11-01

This study examines the role of factors such as perceived stress, neuroticism, beliefs in psychotherapy stigma, resilience, and demographics in understanding posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) among deployed military personnel. Results show that personnel who screened positive for PTSD were more likely to screen positive for AUD (versus those who did not screen positive for PTSD). Perceived stress, neuroticism, and psychotherapy stigma all have direct multivariate relationships with PTSD symptoms. Moderated regression analyses show that the positive relationship between perceived stress and PTSD symptoms is significantly stronger among those scoring high on neuroticism and psychotherapy stigma. The positive relationship between perceived stress and AUD symptoms is only significant among those scoring high on psychotherapy stigma. Given the moderating role of psychotherapy stigma in the relationship between perceived stress and PTSD symptoms and the relationship between perceived stress and AUD symptoms efforts to reduce the stigma associated with mental health care in the military should be expanded. Also, the current research adds to the literature highlighting the role of neuroticism as a key variable in understanding PTSD. Copyright © 2015. Published by Elsevier Ltd.

MAP as a model for practice-based learning and improvement in child psychiatry training.

PubMed

Kataoka, Sheryl H; Podell, Jennifer L; Zima, Bonnie T; Best, Karin; Sidhu, Shawn; Jura, Martha Bates

2014-01-01

Not only is there a growing literature demonstrating the positive outcomes that result from implementing evidence based treatments (EBTs) but also studies that suggest a lack of delivery of these EBTs in "usual care" practices. One way to address this deficit is to improve the quality of psychotherapy teaching for clinicians-in-training. The Accreditation Council for Graduate Medical Education (ACGME) requires all training programs to assess residents in a number of competencies including Practice-Based Learning and Improvements (PBLI). This article describes the piloting of Managing and Adapting Practice (MAP) for child psychiatry fellows, to teach them both EBT and PBLI skills. Eight child psychiatry trainees received 5 full days of MAP training and are delivering MAP in a year-long outpatient teaching clinic. In this setting, MAP is applied to the complex, multiply diagnosed psychiatric patients that present to this clinic. This article describes how MAP tools and resources assist in teaching trainees each of the eight required competency components of PBLI, including identifying deficits in expertise, setting learning goals, performing learning activities, conducting quality improvement methods in practice, incorporating formative feedback, using scientific studies to inform practice, using technology for learning, and participating in patient education. A case example illustrates the use of MAP in teaching PBLI. MAP provides a unique way to teach important quality improvement and practice-based learning skills to trainees while training them in important psychotherapy competence.

Behavioural activation by mental health nurses for late-life depression in primary care: a randomized controlled trial.

PubMed

Janssen, Noortje; Huibers, Marcus J H; Lucassen, Peter; Voshaar, Richard Oude; van Marwijk, Harm; Bosmans, Judith; Pijnappels, Mirjam; Spijker, Jan; Hendriks, Gert-Jan

2017-06-26

Depressive symptoms are common in older adults. The effectiveness of pharmacological treatments and the availability of psychological treatments in primary care are limited. A behavioural approach to depression treatment might be beneficial to many older adults but such care is still largely unavailable. Behavioural Activation (BA) protocols are less complicated and more easy to train than other psychological therapies, making them very suitable for delivery by less specialised therapists. The recent introduction of the mental health nurse in primary care centres in the Netherlands has created major opportunities for improving the accessibility of psychological treatments for late-life depression in primary care. BA may thus address the needs of older patients while improving treatment outcome and lowering costs.The primary objective of this study is to compare the effectiveness and cost-effectiveness of BA in comparison with treatment as usual (TAU) for late-life depression in Dutch primary care. A secondary goal is to explore several potential mechanisms of change, as well as predictors and moderators of treatment outcome of BA for late-life depression. Cluster-randomised controlled multicentre trial with two parallel groups: a) behavioural activation, and b) treatment as usual, conducted in primary care centres with a follow-up of 52 weeks. The main inclusion criterion is a PHQ-9 score > 9. Patients are excluded from the trial in case of severe mental illness that requires specialized treatment, high suicide risk, drug and/or alcohol abuse, prior psychotherapy, change in dosage or type of prescribed antidepressants in the previous 12 weeks, or moderate to severe cognitive impairment. The intervention consists of 8 weekly 30-min BA sessions delivered by a trained mental health nurse. We expect BA to be an effective and cost-effective treatment for late-life depression compared to TAU. BA delivered by mental health nurses could increase the availability and accessibility of non-pharmacological treatments for late-life depression in primary care. This study is retrospectively registered in the Dutch Clinical Trial Register NTR6013 on August 25th 2016.

Technology-Enhanced Stepped Collaborative Care Targeting Posttraumatic Stress Disorder and Comorbidity After Injury: A Randomized Controlled Trial.

PubMed

Zatzick, Douglas; O'Connor, Stephen S; Russo, Joan; Wang, Jin; Bush, Nigel; Love, Jeff; Peterson, Roselyn; Ingraham, Leah; Darnell, Doyanne; Whiteside, Lauren; Van Eaton, Erik

2015-10-01

Posttraumatic stress disorder (PTSD) and its comorbidities are endemic among injured trauma survivors. Previous collaborative care trials targeting PTSD after injury have been effective, but they have required intensive clinical resources. The present pragmatic clinical trial randomized acutely injured trauma survivors who screened positive on an automated electronic medical record PTSD assessment to collaborative care intervention (n = 60) and usual care control (n = 61) conditions. The stepped measurement-based intervention included care management, psychopharmacology, and psychotherapy elements. Embedded within the intervention were a series of information technology (IT) components. PTSD symptoms were assessed with the PTSD Checklist at baseline prerandomization and again, 1-, 3-, and 6-months postinjury. IT utilization was also assessed. The technology-assisted intervention required a median of 2.25 hours (interquartile range = 1.57 hours) per patient. The intervention was associated with modest symptom reductions, but beyond the margin of statistical significance in the unadjusted model: F(2, 204) = 2.95, p = .055. The covariate adjusted regression was significant: F(2, 204) = 3.06, p = .049. The PTSD intervention effect was greatest at the 3-month (Cohen's effect size d = 0.35, F(1, 204) = 4.11, p = .044) and 6-month (d = 0.38, F(1, 204) = 4.10, p = .044) time points. IT-enhanced collaborative care was associated with modest PTSD symptom reductions and reduced delivery times; the intervention model could potentially facilitate efficient PTSD treatment after injury. Copyright © 2015 Wiley Periodicals, Inc., A Wiley Company.

The Effects of Quality Improvement for Depression in Primary Care at Nine Years: Results from a Randomized, Controlled Group-Level Trial

PubMed Central

Wells, Kenneth B; Tang, Lingqi; Miranda, Jeanne; Benjamin, Bernadette; Duan, Naihua; Sherbourne, Cathy D

2008-01-01

Objective To examine 9-year outcomes of implementation of short-term quality improvement (QI) programs for depression in primary care. Data Sources Depressed primary care patients from six U.S. health care organizations. Study Design Group-level, randomized controlled trial. Data Collection Patients were randomly assigned to short-term QI programs supporting education and resources for medication management (QI-Meds) or access to evidence-based psychotherapy (QI-Therapy); and usual care (UC). Of 1,088 eligible patients, 805 (74 percent) completed 9-year follow-up; results were extrapolated to 1,269 initially enrolled and living. Outcomes were psychological well-being (Mental Health Inventory, five-item version [MHI5]), unmet need, services use, and intermediate outcomes. Principal Findings At 9 years, there were no overall intervention status effects on MHI5 or unmet need (largest F (2,41)=2.34, p=.11), but relative to UC, QI-Meds worsened MHI5, reduced effectiveness of coping and among whites lowered tangible social support (smallest t(42)=2.02, p=.05). The interventions reduced outpatient visits and increased perceived barriers to care among whites, but reduced attitudinal barriers due to racial discrimination and other factors among minorities (smallest F (2,41)=3.89, p=.03). Conclusions Main intervention effects were over but the results suggest some unintended negative consequences at 9 years particularly for the medication-resource intervention and shifts to greater perceived barriers among whites yet reduced attitudinal barriers among minorities. PMID:18522664

Long-term effects of transference interpretation in dynamic psychotherapy of personality disorders.

PubMed

Høglend, P; Dahl, H-S; Hersoug, A G; Lorentzen, S; Perry, J C

2011-10-01

Only a few treatment studies of personality disorders (PD) patients are on longer-term psychotherapy, general outcome measures are used, and follow-up periods are usually short. More studies of long-term therapies, using outcome measures of core psychopathology, are needed. This study is a dismantling randomized controlled clinical trial, specifically designed to study long-term effects of transference interpretation. Forty-six patients with mainly cluster C personality disorders were randomly assigned to 1 year of dynamic psychotherapy with or without transference interpretations. The outcome measures were remission from PD, improvement in interpersonal functioning, and use of mental health resources in the 3-year period after treatment termination. After therapy with transference interpretation PD-patients improved significantly more in core psychopathology and interpersonal functioning, the drop-out rate was reduced to zero, and use of health services was reduced to 50%, compared to therapy without this ingredient. Three years after treatment termination, 73% no longer met diagnostic criteria for any PD in the transference group, compared to 44% in the comparison group. PD-patients with co-morbid disorders improved in both treatment arms in this study. However, transference interpretation improved outcome substantially more. Long-term psychotherapy that includes transference interpretation is an effective treatment for cluster C personality disorders and milder cluster B personality disorders. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Reasons and Determinants for Perceiving Unmet Needs for Mental Health in Primary Care in Quebec

PubMed Central

Dezetter, Anne; Duhoux, Arnaud; Menear, Matthew; Roberge, Pasquale; Chartrand, Elise; Fournier, Louise

2015-01-01

Objective: To evaluate the mental health care needs perceived as unmet by adults in Quebec who had experienced depressive and (or) anxious symptomatology (DAS) in the previous 2 years and who used primary care services, and to identify the reasons associated with different types of unmet needs for care (UNCs) and the determinants of reporting UNCs. Method: Longitudinal data from the Dialogue Project were used. The sample consisted of 1288 adults who presented a common mental disorder and who consulted a general practitioner. The Hospital Anxiety and Depression Scale was used to measure DAS, and the Perceived Need for Care Questionnaire facilitated the assessment of the different types of UNCs and their motives. Results: About 40% of the participants perceived UNCs. Psychotherapy, help to improve ability to work, as well as general information on mental health and services were the most mentioned UNCs. The main reasons associated with reporting UNCs for psychotherapy and psychosocial interventions are “couldn’t afford to pay” and “didn’t know how or where to get help,” respectively. The factors associated with mentioning UNCs (compared with met needs) are to present a high DAS or a DAS that increased during the past 12 months, to perceive oneself as poor or to not have private health insurance. Conclusions: To reduce the UNCs and, further, to reduce DAS, it is necessary to improve the availability and affordability of psychotherapy and psychosocial intervention services, and to inform users on the types of services available and how to access them. PMID:26175326

Correlates of VA mental health treatment utilization among OEF/OIF/OND veterans: Resilience, stigma, social support, personality, and beliefs about treatment.

PubMed

DeViva, Jason C; Sheerin, Christina M; Southwick, Steven M; Roy, Alicia M; Pietrzak, Robert H; Harpaz-Rotem, Ilan

2016-05-01

Veterans of Operations Iraqi Freedom/Enduring Freedom/New Dawn (OEF/OIF/OND) tend not to engage in mental health care. Identifying modifiable factors related to mental health service utilization could facilitate development of interventions to increase utilization. The current study examined the relationship between mental health care utilization and measures of PTSD symptoms, resilience, stigma, beliefs about mental health care, perceived barriers to mental health care, posttraumatic growth and meaning, social support, and personality factors in a sample of 100 OEF/OIF/OND veterans with PTSD symptoms referred to VA mental health care. Participants who received psychotherapy and pharmacotherapy (PP) scored higher on measures of PTSD symptoms, stigma, and adaptive beliefs about mental health treatment, and lower on measures of resilience, postdeployment social support, emotional stability, and conscientiousness, than participants who received no treatment (NT). Participants who received psychotherapy only (PT) scored higher on a measure of PTSD symptoms than NT participants. PT participants scored higher on an emotional stability measure and lower on measures of PTSD symptoms and stigma than PP participants. Multinomial logistic regression including all variables significantly related to treatment utilization indicated that PTSD symptoms and adaptive beliefs about psychotherapy and pharmacotherapy were higher in the PT and PP groups than in the NT group, and concerns about discrimination were higher in the PP group than the NT group. Interventions targeting beliefs about mental health care could increase mental health treatment utilization among OEF/OIF/OND veterans. Concerns about stigma may affect the utilization process differently at different decision points. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Tailoring the Psychotherapy to the Borderline Patient

PubMed Central

HORWITZ, LEONARD; GABBARD, GLEN O.; ALLEN, JON G.; COLSON, DONALD B.; FRIESWYK, SIEBOLT; NEWSOM, GAVIN E.; COYNE, LOLAFAYE

1996-01-01

Views still differ as to the optimal psychodynamic treatment of borderline patients. Recommendations range from psychoanalysis and exploratory psychotherapy to an explicitly supportive treatment aimed at strengthening adaptive defenses. The authors contend that no single approach is appropriate for all patients in this wide-ranging diagnostic category, which spans a continuum from close-to-neurotic to close-to-psychotic levels of functioning. Careful differentiations based on developmental considerations, ego structures, and relationship patterns provide the basis for the optimal treatment approach. PMID:22700301

Psychotherapy for Military-Related PTSD: A Review of Randomized Clinical Trials.

PubMed

Steenkamp, Maria M; Litz, Brett T; Hoge, Charles W; Marmar, Charles R

2015-08-04

Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder common among military personnel and veterans. First-line psychotherapies most often recommended for PTSD consist mainly of "trauma-focused" psychotherapies that involve focusing on details of the trauma or associated cognitive and emotional effects. To examine the effectiveness of psychotherapies for PTSD in military and veteran populations. PubMed, PsycINFO, and PILOTS were searched for randomized clinical trials (RCTs) of individual and group psychotherapies for PTSD in military personnel and veterans, published from January 1980 to March 1, 2015. We also searched reference lists of articles, selected reviews, and meta-analyses. Of 891 publications initially identified, 36 were included. Two trauma-focused therapies, cognitive processing therapy (CPT) and prolonged exposure, have been the most frequently studied psychotherapies for military-related PTSD. Five RCTs of CPT (that included 481 patients) and 4 RCTs of prolonged exposure (that included 402 patients) met inclusion criteria. Focusing on intent-to-treat outcomes, within-group posttreatment effect sizes for CPT and prolonged exposure were large (Cohen d range, 0.78-1.10). CPT and prolonged exposure also outperformed waitlist and treatment-as-usual control conditions. Forty-nine percent to 70% of participants receiving CPT and prolonged exposure attained clinically meaningful symptom improvement (defined as a 10- to 12-point decrease in interviewer-assessed or self-reported symptoms). However, mean posttreatment scores for CPT and prolonged exposure remained at or above clinical criteria for PTSD, and approximately two-thirds of patients receiving CPT or prolonged exposure retained their PTSD diagnosis after treatment (range, 60%-72%). CPT and prolonged exposure were marginally superior compared with non-trauma-focused psychotherapy comparison conditions. In military and veteran populations, trials of the first-line trauma-focused interventions CPT and prolonged exposure have shown clinically meaningful improvements for many patients with PTSD. However, nonresponse rates have been high, many patients continue to have symptoms, and trauma-focused interventions show marginally superior results compared with active control conditions. There is a need for improvement in existing PTSD treatments and for development and testing of novel evidence-based treatments, both trauma-focused and non-trauma-focused.

Ethical reflection and psychotherapy.

PubMed

Vyskocilová, Jana; Prasko, Jan

2013-01-01

Theories of ethics and ethical reflection may be applied to both theory and practice in psychotherapy. There is a natural affinity between ethics and psychotherapy. Psychotherapy practice is concerned with human problems, dilemmas and emotions related to both one's own and other people's values. Ethics is also concerned with dilemmas in human thinking and with how these dilemmas reflect other individuals' values. Philosophical reflection itself is not a sufficient basis for the ethics of psychotherapy but it may aid in exploring attitudes related to psychotherapy, psychiatry and health care. PubMed, Web of Science and Scopus databases were searched for articles containing the keywords "psychotherapy", "ethics", "therapeutic relationship" and "supervision". The search was conducted by repeating the terms in various combinations without language or time restrictions. Also included were data from monographs cited in reviews. The resulting text is a review with conclusions concerning ethical aspects of psychotherapy. The ability to behave altruistically, sense for justice and reciprocity and mutual help are likely to be genetically determined as dispositions to be later developed by upbringing or to be formed or deformed by upbringing. Early experiences lead to formation of ethical attitudes which are internalized and then applied to both one's own and other people's behavior. Altruistic behavior has a strong impact on an individual's health and its acceptance may positively influence the pathophysiological mechanisms underlying numerous diseases. Ethical theory and reflection, however, may be applied to both theory and practice of psychotherapy in a conscious, targeted and thoughtful manner. In everyday practice, psychotherapists and organizations must necessarily deal with conscious conflicts between therapeutic possibilities, clients' wishes, their own as well as clients' ideas and the real world. Understanding one's own motives in therapy is one of the aims of a psychotherapist's personal therapy and a frequent goal of supervision interventions. It is a psychotherapist's ethical obligation to do no harm, maintain clear therapeutic borders, not abuse patients, undertake supervision and learn good self-reflection. Knowledge of ethical questions and related issues as well as continuous ethical self-reflection are essential components of high-quality psychotherapeutic management. This requires both good psychotherapy training and systematic supervision.

Outpatient Psychotherapy Improves Symptoms and Reduces Health Care Costs in Regularly and Prematurely Terminated Therapies

PubMed Central

Altmann, Uwe; Thielemann, Désirée; Zimmermann, Anna; Steffanowski, Andrés; Bruckmeier, Ellen; Pfaffinger, Irmgard; Fembacher, Andrea; Strauß, Bernhard

2018-01-01

Background: In view of a shortage of health care costs, monetary aspects of psychotherapy become increasingly relevant. The present study examined the pre-post reduction of impairment and direct health care costs depending on therapy termination (regularly terminated, dropout with an unproblematic reason, and dropout with a quality-relevant reason) and the association of symptom and cost reduction. Methods: In a naturalistic longitudinal study, we examined a disorder heterogeneous sample of N = 584 outpatients who were either treated with cognitive-behavioral, psychodynamic, or psychoanalytic therapy. Depression, anxiety, stress, and somatization were assessed with the Patient Health Questionnaire (PHQ). Annual amounts of inpatient costs, outpatient costs, medication costs, days of hospitalization, work disability days, utilization of psychotherapy, and utilization of pharmacotherapy 1 year before therapy and 1 year after therapy were provided by health care insurances. Symptom and cost reduction were analyzed using t-tests. Associations between symptom and cost reduction were examined using partial correlations and hierarchical linear models. Results: Patients who terminated therapy regularly showed the largest symptom reduction (d = 0.981–1.22). Patients who dropped out due to an unproblematic reason and patients who terminated early due to a quality-relevant reason showed significant but small effects of symptom reductions (e.g., depression: d = 0.429 vs. d = 0.366). For patients with a regular end and those dropping out due to a quality-relevant reason, we observed a significant reduction of work disability (diff in % of pre-test value = 56.3 vs. 42.9%) and hospitalization days (52.8 vs. 35.0%). Annual inpatient costs decreased in the group with a regular therapy end (31.5%). Furthermore, reduction of symptoms on the one side and reduction of work disability days and psychotherapy utilization on the other side were significant correlated (r = 0.091–0.135). Conclusion: Health care costs and symptoms were reduced in each of the three groups. The average symptom and cost reduction of patients with a quality-relevant dropout suggested that not each dropout might be seen as therapy failure. PMID:29867697

Inner resources for survival: integrating interpersonal psychotherapy with spiritual visualization with homeless youth.

PubMed

Mastropieri, Biagio; Schussel, Lorne; Forbes, David; Miller, Lisa

2015-06-01

Homeless youth have particular need to develop inner resources to confront the stress, abusive environment of street life, and the paucity of external resources. Research suggests that treatment supporting spiritual awareness and growth may create a foundation for coping, relationships, and negotiating styles to mitigate distress. The current pilot study tests the feasibility, acceptability, and helpfulness of an interpersonal spiritual group psychotherapy, interpersonal psychotherapy (IPT) integrated with spiritual visualization (SV), offered through a homeless shelter, toward improving interpersonal coping and ameliorating symptoms of depression, distress, and anxiety in homeless youth. An exploratory pilot of integrative group psychotherapy (IPT + SV) for homeless young adults was conducted in a New York City on the residential floor of a shelter-based transitional living program. Thirteen young adult men (mean age 20.3 years, SD = 1.06) participated in a weekly evening psychotherapy group (55 % African-American, 18 % biracial, 18 % Hispanic, 9 % Caucasian). Measures of psychological functioning were assessed at pre-intervention and post-intervention using the General Health Questionnaire (GHQ-12), Patient Health Questionnaire (PHQ-9, GAD-7), and the Inventory of Interpersonal Problems (IIP-32). A semi-structured exit interview and a treatment satisfaction questionnaire were also employed to assess acceptability following treatment. Among homeless young adults to participate in the group treatment, significant decreases in symptoms of general distress and depression were found between baseline and termination of treatment, and at the level of a trend, improvement in overall interpersonal functioning and levels of general anxiety. High utilization and treatment satisfaction showed the intervention to be both feasible and acceptable. Offered as an adjunct to the services-as-usual model at homeless shelters serving young adults, interpersonal psychotherapy with spiritual visualization (IPT + SV) in group appears to be a feasible and potentially useful treatment option for promoting improved mental health.

Predictors of Initiation and Engagement of Cognitive Processing Therapy Among Veterans With PTSD Enrolled in Collaborative Care.

PubMed

Grubbs, Kathleen M; Fortney, John C; Pyne, Jeffrey M; Hudson, Teresa; Moore, William Mark; Custer, Paul; Schneider, Ronald; Schnurr, Paula P

2015-12-01

Collaborative care (CC) increases access to evidence-based pharmacotherapy and psychotherapy. The study aim was to identify the characteristics of rural veterans receiving a telemedicine-based CC intervention for posttraumatic stress disorder (PTSD) who initiated and engaged in cognitive processing therapy (CPT) delivered via interactive video. Veterans diagnosed with PTSD were recruited from 11 community-based outpatient clinics (N = 133). Chart abstraction identified all mental health encounters received during the 12-month study. General linear mixed models were used to identify characteristics that predicted CPT initiation and engagement (attendance at 8 or more sessions). For initiation, higher PTSD severity according to the Clinician Administered PTSD Scale (d = -0.39, p = .038) and opt-out recruitment (vs. self-referral; d = -0.49, p = .010) were negative predictors. For engagement, major depression (d = -1.32, p = .006) was a negative predictor whereas a pending claim for military service connected disability (d = 2.02, p = .008) was a positive predictor. In general, veterans enrolled in CC initiated and engaged in CPT at higher rates than usual care. Those with more severe symptoms and comorbidity, however, were at risk of not starting or completing CPT. © 2015 International Society for Traumatic Stress Studies.

Adapted Behavior Therapy for Persistently Depressed Primary Care Patients: An Open Trial

ERIC Educational Resources Information Center

Uebelacker, Lisa A.; Weisberg, Risa B.; Haggarty, Ryan; Miller, Ivan W.

2009-01-01

Major depressive disorder is commonly treated in primary care settings. Psychotherapy occurring in primary care should take advantage of the unique aspects of the setting and must adapt to the problems and limitations of the setting. In this open trial, the authors used a treatment development model to adapt behavior therapy for primary care…

Identifying attachment ruptures underlying severe music performance anxiety in a professional musician undertaking an assessment and trial therapy of Intensive Short-Term Dynamic Psychotherapy (ISTDP).

PubMed

Kenny, Dianna T; Arthey, Stephen; Abbass, Allan

2016-01-01

Kenny has proposed that severe music performance anxiety that is unresponsive to usual treatments such as cognitive-behaviour therapy may be one manifestation of unresolved attachment ruptures in early life. Intensive Short-Term Dynamic Psychotherapy specifically targets early relationship trauma. Accordingly, a trial of Intensive Short-Term Dynamic Psychotherapy with severely anxious musicians was implemented to assess whether resolution of attachment ruptures resulted in clinically significant relief from music performance anxiety. Volunteer musicians participating in a nationally funded study were screened for MPA severity. Those meeting the critical cut-off score on the Kenny Music Performance Anxiety Inventory were offered a trial of Intensive Short-Term Dynamic Psychotherapy. In this paper, we present the theoretical foundations and rationale for the treatment approach, followed by sections of a verbatim transcript and process analysis of the assessment phase of treatment that comprised a 3-h trial therapy session. The 'case' was a professional orchestral musician (male, aged 55) who had suffered severe music performance anxiety over the course of his entire career, which spanned more than 30 years at the time he presented for treatment following his failure to secure a position at audition. The participant was able to access the pain, rage and grief associated with unresolved attachment ruptures with both parents that demonstrated the likely nexus between early attachment trauma and severe music performance anxiety. Intensive Short-Term Dynamic Psychotherapy is a potentially cost-effective treatment for severe music performance anxiety. Further research using designs with higher levels of evidence are required before clinical recommendations can be made for the use of this therapy with this population.

The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa - a randomized controlled trial

PubMed Central

Wild, Beate; Friederich, Hans-Christoph; Gross, Gaby; Teufel, Martin; Herzog, Wolfgang; Giel, Katrin E; de Zwaan, Martina; Schauenburg, Henning; Schade-Brittinger, Carmen; Schäfer, Helmut; Zipfel, Stephan

2009-01-01

Background Anorexia nervosa is a serious eating disorder leading to high morbidity and mortality as a result of both malnutrition and suicide. The seriousness of the disorder requires extensive knowledge of effective treatment options. However, evidence for treatment efficacy in this area is remarkably weak. A recent Cochrane review states that there is an urgent need for large, well-designed treatment studies for patients with anorexia nervosa. The aim of this particular multi-centre study is to evaluate the efficacy of two standardized outpatient treatments for patients with anorexia nervosa: focal psychodynamic (FPT) and cognitive behavioural therapy (CBT). Each therapeutic approach is compared to a "treatment-as-usual" control group. Methods/Design 237 patients meeting eligibility criteria are randomly and evenly assigned to the three groups – two intervention groups (CBT and FPT) and one control group. The treatment period for each intervention group is 10 months, consisting of 40 sessions respectively. Body weight, eating disorder related symptoms, and variables of therapeutic alliance are measured during the course of treatment. Psychotherapy sessions are audiotaped for adherence monitoring. The treatment in the control group, both the dosage and type of therapy, is not regulated in the study protocol, but rather reflects the current practice of established outpatient care. The primary outcome measure is the body mass index (BMI) at the end of the treatment (10 months after randomization). Discussion The study design surmounts the disadvantages of previous studies in that it provides a randomized controlled design, a large sample size, adequate inclusion criteria, an adequate treatment protocol, and a clear separation of the treatment conditions in order to avoid contamination. Nevertheless, the study has to deal with difficulties specific to the psychopathology of anorexia nervosa. The treatment protocol allows for dealing with the typically occurring medical complications without dropping patients from the protocol. However, because patients are difficult to recruit and often ambivalent about treatment, a drop-out rate of 30% is assumed for sample size calculation. Due to the ethical problem of denying active treatment to patients with anorexia nervosa, the control group is defined as "treatment-as-usual". Trial registration Current Controlled Trials ISRCTN72809357 PMID:19389245

[Recommendations for psychotherapy in psychiatric inpatient treatment : Results of the PAKT Study Part I].

PubMed

Uhlmann, C; Flammer, E; Pfiffner, C; Grempler, J; Längle, G; Eschweiler, G-W; Spießl, H; Steinert, T

2017-03-01

In the S3 treatment guidelines psychotherapy is recommended in all psychological disorders. Therefore, outpatient or inpatient psychotherapy should be recommended by therapists in most cases. On the other hand, it is well known that waiting periods for psychotherapeutic treatment are considerable, which raises the question how the recommendation for psychotherapy is presented in psychiatric hospitals in Germany. The article deals with the question of how frequent the recommendation of psychotherapeutic treatment is made after psychiatric inpatient stay or day care, and if there are differences between hospitals and patient groups. In four psychiatric hospitals in southern Germany the frequency of recommendation for psychotherapy in psychiatric patients was registered and compared to the number of all patients treated in the equivalent time. For this purpose, we analyzed data of the basic documentation in the four participating hospitals. Overall, 9.6 % of the patients received a recommendation of psychotherapeutic treatment. In the psychiatric university hospital a subsequent psychotherapeutic treatment was recommended somewhat more often. Differences between hospitals were present but marginal. Over all participating hospitals, psychotherapy was recommended markedly less frequently in patients with an F2 diagnosis in comparison with patients with F3 or F4 diagnoses. Psychotherapeutic treatment after psychiatric inpatient stay is recommended cautiously. Probably therapists anticipate the fact that the growing demand for psychotherapeutic treatment in general reduces the chances for persons after psychiatric inpatient treatment.

Morris B. Parloff (1918-2011).

PubMed

Elkin, Irene; Wolfe, Barry E

2012-04-01

Morris B. Parloff was considered an elder statesman in the field of psychotherapy research, and his wisdom and stewardship were of enormous benefit to several generations of psychotherapy researchers. Parloff received his bachelor's degree from Western Reserve University (1940), a degree in psychiatric social work from the University of Chicago (1942), and a doctorate in psychology from Western Reserve University (1953). Parloff spent most of his career (from 1953 until his retirement in 1983) as a researcher and administrator at the National Institute of Mental Health (NIMH). He was also on the senior faculty of the Washington School of Psychiatry, taught or consulted at a number of universities, and maintained a private practice of psychotherapy. In the NIMH intramural program, Parloff was chief of the Section on Personality in the Laboratory of Psychology. There he conducted a major longitudinal study on the personality characteristics of adolescent and adult scientists. In the NIMH extramural program, he served as chief of the Psychotherapy and Behavioral Intervention Section in the Clinical Research Branch (1972-1980), after which he became chief of the new Psychosocial Treatments Research Branch. Throughout his career, from his pioneering teaching and research on group psychotherapy through his 30 years at NIMH, Parloff provided researchers and practitioners with a broad understanding of the field of psychotherapy research, the complexity of its subject matter, and its relationship to the "real world." Often ahead of others in the field, Parloff dealt with many topics that retain their importance today, including the need to carefully define criteria for improvement in psychotherapy, the transmission of values in psychotherapy, the concepts of the placebo and of common factors in psychotherapy research, and the role of the patient-therapist relationship (in both individual and group therapy) and its impact on the outcome of therapy. Starting with a 1979 article in the American Psychologist ("Can Psychotherapy Research Guide the Policymaker? Vol. 34, pp. 296-306), Parloff wrote extensively about the relationship among practitioners, psychotherapy researchers, and policymakers. To promote the systematic use of clinical trials and address methodological issues in the field, Parloff obtained support to fund the first NIMH multisite collaborative outcome study in the field of psychotherapy. He and the first author (I. E.) then designed and launched the NIMH Treatment of Depression Collaborative Research Program. This study would serve as a model for future collaborative research by independent investigators. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Adequacy of depression treatment among college students in the United States.

PubMed

Eisenberg, Daniel; Chung, Henry

2012-01-01

There is no published evidence on the adequacy of depression care among college students and how this varies by subpopulations and provider types. We estimated the prevalence of minimally adequate treatment among students with significant past-year depressive symptoms. Data were collected via a confidential online survey of a random sample of 8488 students from 15 colleges and universities in the 2009 Healthy Minds Study. Depressive symptoms were assessed by the Patient Health Questionnaire-2, adapted to a past-year time frame. Students with probable depression were coded as having received minimally adequate depression care based on the criteria from Wang and colleagues (2005). Minimally adequate treatment was received by only 22% of depressed students. The likelihood of minimally adequate treatment was similarly low for both psychiatric medication and psychotherapy. Minimally adequate care was lower for students prescribed medication by a primary care provider as compared to a psychiatrist (P<.01). Racial/ethnic minority students were less likely to receive depression care (P<.01). Adequacy of depression care is a significant problem in the college population. Solutions will likely require greater availability of psychiatry care, better coordination between specialty and primary care using collaborative care models, and increased efforts to retain students in psychotherapy. Copyright © 2012 Elsevier Inc. All rights reserved.

Deconstructing Risk Management in Psychotherapy Supervision.

PubMed

Kroll, Jerome; Radden, Jennifer

2017-12-01

In the ongoing controversy over how much regulation and standardization to impose on clinical practice and research, it is not surprising that the activity of psychotherapy supervision should be swept up in the drive for uniformity. The managers amongst us want to regulate and institutionalize all aspects of practice. In opposition, many clinicians resist the relentless march toward the safety of uniformity travel alongside managerial imposition of regulations. Psychotherapy supervision's method of a close apprenticeship relationship between supervisor and trainee and its focus on the process and ethics of professional interaction stand at the humanistic core of what is otherwise becoming an increasingly mechanistic model of providing care to persons with mental illness. Our commentary picks up on these themes as it reviews the work by Mehrtens et al about strengthening awareness of liability in psychiatry residency training programs. We argue that the practice of psychiatry is overburdened by documentation requirements. In imposing further record-keeping on psychotherapy supervision, we lose much more than we gain. We recommend that the supervisory process focus on the characterological virtues essential to functioning as an ethical therapist. We also argue that self-protective rules place restraints on possibilities for imaginative insights and innovations in psychotherapy. © 2017 American Academy of Psychiatry and the Law.

[Initial training in psychotherapy for psychiatrists in France, a national qualitative study].

PubMed

Van Effenterre, Aude; Azoulay, Marion; Briffault, Xavier; Dezetter, Anne; Champion, Françoise

Objectives To explore the level of satisfaction among residents regarding their training in psychotherapies, the interest they have in these therapies, and their wishes in the area of training.Methods A survey including both a quantitative and qualitative methodology was undertaken among 869 residents out of 1,334 enrolled in the psychiatric residency program. In the 2009-2010 academic year. The survey included five themes of study: theoretical academic training, psychoanalysis, training in institutes outside the university, supervision, wishes in the area of training. This article presents results from the qualitative sociological survey using a semi-guided interview with 27 residents. Their conceptions and practice in the field of psychotherapy, and its place in psychiatric practice were questioned in-depth.Results The vast majority of residents were interested in psychotherapy, but simultaneously dissatisfied with the training they had received. Almost half opted for various sorts of extra-curricular training, costly in time and money. The psychotherapeutic orientations among these residents were varied, and a plurality of methods and theoretical approaches was advocated both for reasons of having a wider viewpoint and good practice in psychiatry, and because the residents considered this plurality to be an essential component in their training. They saw psychotherapy as a medical practice, and considered that it is the responsibility of the psychiatric discipline to provide training in psychotherapies.Conclusion The absence of any real training in psychotherapies for residents in psychiatry is damaging for care quality in psychiatry. The recent creation of a protected title of psychotherapist for psychiatrists without the need of additional training suggests an urgent need to develop a training course. A proposal by the authors should be discussed in light of reflections and proposals already underway in other countries.

The cost-effectiveness of psychotherapy for the major psychiatric diagnoses.

PubMed

Lazar, Susan G

2014-09-01

Psychotherapy is an effective and often highly cost-effective medical intervention for many serious psychiatric conditions. Psychotherapy can also lead to savings in other medical and societal costs. It is at times the firstline and most important treatment and at other times augments the efficacy of psychotropic medication. Many patients are in need of more prolonged and intensive psychotherapy, including those with personality disorders and those with chronic complex psychiatric conditions often with severe anxiety and depression. Many patients with serious and complex psychiatric illness have experienced severe early life trauma in an atmosphere in which family members or caretakers themselves have serious psychiatric disorders. Children and adolescents with learning disabilities and those with severe psychiatric disorders can also require more than brief treatment. Other diagnostic groups for whom psychotherapy is effective and cost-effective include patients with schizophrenia, anxiety disorders (including posttraumatic stress disorder), depression, and substance abuse. In addition, psychotherapy for the medically ill with concomitant psychiatric illness often lowers medical costs, improves recovery from medical illness, and at times even prolongs life compared to similar patients not given psychotherapy. While "cost-effective" treatments can yield savings in healthcare costs, disability claims, and other societal costs, "cost-effective" by no means translates to "cheap" but instead describes treatments that are clinically effective and provided at a cost that is considered reasonable given the benefit they provide, even if the treatments increase direct expenses. In the current insurance climate in which Mental Health Parity is the law, insurers nonetheless often use their own non-research and non-clinically based medical necessity guidelines to subvert it and limit access to appropriate psychotherapeutic treatments. Many patients, especially those who need extended and intensive psychotherapy, are at risk of receiving substandard care due to inadequate insurance reimbursement. These patients remain vulnerable to residual illness and the concomitant sequelae in lost productivity, dysfunctional interpersonal and family relationships, comorbidity including increased medical and surgical services, and increased mortality.

Nursing and Psychological Treatments

ERIC Educational Resources Information Center

Kwekkeboom, Kristine L.; Ameringer, Suzanne; Harrison, Tondi; Phillips, Christopher M.; Serlin, Ronald C.; Ward, Sandra E.

2005-01-01

This brief article presents a comment on "Psychological Treatments" by D. H. Barlow. In his article, Barlow pointed to the need "to solidify the identification of psychology as a health care profession" by changing the terminology of practice in the health care context from psychotherapy to psychological treatments and suggested that the only…

Integrative Therapies in Anxiety Treatment with Special Emphasis on the Gut Microbiome.

PubMed

Schnorr, Stephanie L; Bachner, Harriet A

2016-09-01

Over the past decade, research has shown that diet and gut health affects symptoms expressed in stress related disorders, depression, and anxiety through changes in the gut microbiota. Psycho-behavioral function and somatic health interaction have often been ignored in health care with resulting deficits in treatment quality and outcomes. While mental health care requires the professional training in counseling, psychotherapy and psychiatry, complimentary therapeutic strategies, such as attention to a nutritional and diverse diet and supplementation of probiotic foods, may be integrated alongside psychotherapy treatment models. Development of these alternative strategies is predicated on experimental evidence and diligent research on the biology of stress, fear, anxiety-related behaviors, and the gut-brain connection. This article provides a brief overview on biological markers of anxiety and the expanding nutritional literature relating to brain health and mental disorders. A case study demonstrates an example of a biopsychosocial approach integrating cognitive psychotherapy, dietary changes, and mindfulness activities, in treating symptoms of anxiety. This case study shows a possible treatment protocol to explore the efficacy of targeting the gut-brain-axis that may be used as an impetus for future controlled studies.

[Psychotherapy with mild cognitive impairment and dementia].

PubMed

Linnemann, A; Fellgiebel, A

2017-11-01

Despite evidence for psychotherapy (PT) in elderly patients, it is not standard care in patients with mild cognitive impairment and dementia. Although neuropsychiatric symptoms are frequent in these patients, there is a lack of studies investigating the importance and efficiency of PT. Can patients with mild cognitive impairment and dementia benefit from PT? If so, which modifications of therapeutic strategies are necessary for treating elderly patients with mild cognitive impairments? Evaluation of empirical evidence on the efficiency of PT for patients with mild cognitive impairment and dementia. Presentation of interventions and modifications of therapeutic strategies. Empirical evidence points towards beneficial effects of PT on depressive symptoms and quality of life. The treatment of anxiety disorders has so far been broadly neglected. Modifications of therapeutic strategies include simplification of content, repetitions, implementation of external memory aids and inclusion of caregivers into therapeutic process. Psychotherapy can be effective in patients with mild cognitive impairment and early stages of dementia. When practicing PT, an adaptation of therapeutic strategies is necessary. Nevertheless, there is a need for further studies investigating the benefits and implementation of PT into standard care, especially as pharmacological interventions are very limited in their efficiency and tolerability in this patient population.

Psychodynamic psychotherapy, religious beliefs, and self-disclosure.

PubMed

Tillman, J G

1998-01-01

The intersection of psychodynamic psychotherapy and religious beliefs may present technical challenges for the psychotherapists; particularly if patients request to know more about the therapist's religious beliefs. Contrary to a recent technical recommendation for therapists to self-disclose personal religious beliefs when asked to do so, I suggest that such a request is complex and requires a thoughtful grounding in psychotherapeutic theory. Disclosing personal beliefs to patients runs the risk of being off-task as well as holding oneself out as an exemplar for the patient. Rather than adopt a formulaic response to requests for information, to deepen the understanding of the patient and the work of therapy, the therapist needs a complex understanding based on a careful diagnostic assessment of the patient, as well as an assessment of the current status of the psychotherapeutic venture. The workings of patients' particular transferences are often evident in requests for personal information and require careful evaluation and consideration. Likewise, countertransference elements may influence the type of response offered by the therapist. Using ethical principles as a guide is different from using them as a rule. The nexus of religious belief, psychosocial context, psychotherapy, and self-disclosure provides a potentially rich source of understanding when explored in the psychotherapeutic situation.

Psychological treatments delivered by community health workers in low-resource government health systems: effectiveness of group interpersonal psychotherapy for caregivers of children affected by nodding syndrome in Uganda.

PubMed

Mutamba, Byamah B; Kane, Jeremy C; de Jong, Joop T V M; Okello, James; Musisi, Seggane; Kohrt, Brandon A

2018-02-15

Despite increasing evidence for the benefits of psychological treatments (PTs) in low- and middle-income countries, few national health systems have adopted PTs as standard care. We aimed to evaluate the effectiveness of a group interpersonal psychotherapy (IPT-G) intervention, when delivered by lay community health workers (LCHWs) in a low-resource government health system in Uganda. The intended outcome was reduction of depression among caregivers of children with nodding syndrome, a neuropsychiatric condition with high morbidity, mortality and social stigma. A non-randomized trial design was used. Caregivers in six villages (n = 69) received treatment as usual (TAU), according to government guidelines. Caregivers in seven villages (n = 73) received TAU as well as 12 sessions of IPT-G delivered by LCHWs. Primary outcomes were caregiver and child depression assessed at 1 and 6 months post-intervention. Caregivers who received IPT-G had a significantly greater reduction in the risk of depression from baseline to 1 month [risk ratio (RR) 0.25, 95% confidence interval (CI) 0.10-0.62] and 6 months (RR 0.33, 95% CI 0.11-0.95) post-intervention compared with caregivers who received TAU. Children of caregivers who received IPT-G had significantly greater reduction in depression scores than children of TAU caregivers at 1 month (Cohen's d = 0.57, p = 0.01) and 6 months (Cohen's d = 0.54, p = 0.03). Significant effects were also observed for psychological distress, stigma and social support among caregivers. IPT-G delivered within a low-resource health system is an effective PT for common mental health problems in caregivers of children with a severe neuropsychiatric condition and has psychological benefits for the children as well. This supports national health policy initiatives to integrate PTs into primary health care services in Uganda.

Social Psychotherapy in Brazil.

PubMed

Fleury, Heloisa J; Marra, Marlene M; Knobel, Anna M

2015-10-01

This paper describes the practice of sociodrama, a method created by J. L. Moreno in the 1930s, and the Brazilian contemporary socio-psychodrama. In 1970, after the Fifth International Congress of Psychodrama was held in Brazil, group psychotherapy began to flourish both in private practice and hospital clinical settings. Twenty years later, the Brazilian health care system added group work as a reimbursable mental health procedure to improve social health policies. In this context, socio-psychodrama became a key resource for social health promotion within groups. Some specific conceptual contributions by Brazilians on sociodrama are also noteworthy.

Theoretical and treatment issues of personality disorders in individualistic and collectivistic societies.

PubMed

Kim, H A

1998-12-01

The author will attempt to equate so-called personality disorders with what used to be called psychoneurosis. Some suggestions for theoretical and technical modifications to apply psychoanalysis and psychotherapy on selective cases within the current managed care environment have been offered. In order to develop a comprehensive and effective psychotherapy system, a collaboration of psychotherapists both in collectivistic and individualistic societies is highly desirable. Furthermore, the differences of personality disorder and neurosis in both social structure are either minimal or insignificant from a psychotherapeutic point of view.

Assessing the marks of change: how psychotherapy alters the brain structure in women with borderline personality disorder.

PubMed

Mancke, Falk; Schmitt, Ruth; Winter, Dorina; Niedtfeld, Inga; Herpertz, Sabine C; Schmahl, Christian

2017-12-13

There is increasing evidence that psychotherapy can alter the function of the brain of patients with borderline personality disorder (BPD). However, it is not known whether psychotherapy can also modify the brain structure of patients with BPD. We used structural MRI data of female patients with BPD before and after participation in 12 weeks of residential dialectical behavioural therapy (DBT) and compared them to data from female patients with BPD who received treatment as usual (TAU). We applied voxel-based morphometry to study voxel-wise changes in grey matter volume over time. We included 31 patients in the DBT group and 17 in the TAU group. Patients receiving DBT showed an increase of grey matter volume in the anterior cingulate cortex, inferior frontal gyrus and superior temporal gyrus together with an alteration of grey matter volume in the angular gyrus and supramarginal gyrus compared with patients receiving TAU. Furthermore, therapy response correlated with increase of grey matter volume in the angular gyrus. Only women were investigated, and groups differed in size, medication (controlled for) and intensity of the treatment condition. We found that DBT increased grey matter volume of brain regions that are critically implicated in emotion regulation and higher-order functions, such as mentalizing. The role of the angular gyrus for treatment response may reside in its cross-modal integrative function. These findings enhance our understanding of psychotherapy mechanisms of change and may foster the development of neurobiologically informed therapeutic interventions.

European COMPARative Effectiveness research on blended Depression treatment versus treatment-as-usual (E-COMPARED): study protocol for a randomized controlled, non-inferiority trial in eight European countries.

PubMed

Kleiboer, Annet; Smit, Jan; Bosmans, Judith; Ruwaard, Jeroen; Andersson, Gerhard; Topooco, Naira; Berger, Thomas; Krieger, Tobias; Botella, Cristina; Baños, Rosa; Chevreul, Karine; Araya, Ricardo; Cerga-Pashoja, Arlinda; Cieślak, Roman; Rogala, Anna; Vis, Christiaan; Draisma, Stasja; van Schaik, Anneke; Kemmeren, Lise; Ebert, David; Berking, Matthias; Funk, Burkhardt; Cuijpers, Pim; Riper, Heleen

2016-08-03

Effective, accessible, and affordable depression treatment is of high importance considering the large personal and economic burden of depression. Internet-based treatment is considered a promising clinical and cost-effective alternative to current routine depression treatment strategies such as face-to-face psychotherapy. However, it is not clear whether research findings translate to routine clinical practice such as primary or specialized mental health care. The E-COMPARED project aims to gain knowledge on the clinical and cost-effectiveness of blended depression treatment compared to treatment-as-usual in routine care. E-COMPARED will employ a pragmatic, multinational, randomized controlled, non-inferiority trial in eight European countries. Adults diagnosed with major depressive disorder (MDD) will be recruited in primary care (Germany, Poland, Spain, Sweden, and the United Kingdom) or specialized mental health care (France, The Netherlands, and Switzerland). Regular care for depression is compared to "blended" service delivery combining mobile and Internet technologies with face-to-face treatment in one treatment protocol. Participants will be followed up at 3, 6, and 12 months after baseline to determine clinical improvements in symptoms of depression (primary outcome: Patient Health Questionnaire-9), remission of depression, and cost-effectiveness. Main analyses will be conducted on the pooled data from the eight countries (n = 1200 in total, 150 participants in each country). The E-COMPARED project will provide mental health care stakeholders with evidence-based information and recommendations on the clinical and cost-effectiveness of blended depression treatment. France: ClinicalTrials.gov NCT02542891 . Registered on 4 September 2015; Germany: German Clinical Trials Register DRKS00006866 . Registered on 2 December 2014; The Netherlands: Netherlands Trials Register NTR4962 . Registered on 5 January 2015; Poland: ClinicalTrials.Gov NCT02389660 . Registered on 18 February 2015; Spain: ClinicalTrials.gov NCT02361684 . Registered on 8 January 2015; Sweden: ClinicalTrials.gov NCT02449447 . Registered on 30 March 2015; Switzerland: ClinicalTrials.gov NCT02410616 . Registered on 2 April 2015; United Kingdom: ISRCTN registry, ISRCTN12388725 . Registered on 20 March 2015.

Review of Psychoanalytic Psychotherapy: A Practitioner's Guide.

PubMed

Papouchis, Nicholas

2006-01-01

Reviews the book, Psychoanalytic Psychotherapy: A Practitioner's Guide by Nancy McWilliams (see record 2004-16060-000). Nancy McWilliams' book on analytic therapy is her latest contribution to the training needs of young clinicians. The book is organized into chapters that address fundamental issues clinical trainees typically face as they work with patients. To establish the context for describing psychoanalytic work, the first chapter defines what she means by psychoanalytic therapy. The three chapters that follow address what McWilliams means by a psychoanalytic sensibility: how the therapist may be prepared for doing therapy and how the client may be prepared for the experience of psychoanalytic psychotherapy. The next three chapters address the maintenance of boundaries and basic therapy processes. Two case examples follow in chapters eight and nine, and each example is a richly evocative description of the complexity of psychoanalytic psychotherapy. The last three chapters of the book deal with the ancillary lessons of psychoanalytic therapy, the occupational hazards and gratifications of the work, and a final chapter on self-care. This is an excellent book, but it should be read together with other texts on psychoanalytic psychotherapy that describe the treatment process systematically in more technical terms. This is a book written for clinicians in training or for experienced clinicians to use in working with clinical trainees. In this sense, Nancy McWilliams has more than achieved her goal of writing a book that will introduce clinical trainees to the psychoanalytic sensibility of doing psychoanalytic psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

[Psychoanalysis and psychoanalytic oriented psychotherapy: differences and similarities].

PubMed

Rössler-Schülein, Hemma; Löffler-Stastka, Henriette

2013-01-01

Psychoanalysis as well as Psychoanalytic Psychotherapy derived from Psychoanalysis are efficient methods offered by the Austrian health care system in the treatment for anxiety, depression, personality disorders, neurotic and somatoform disorders. In both methods similar basic treatment techniques are applied. Therefore differentiation between both treatment options often is made pragmatically by the frequency of sessions or the use of the couch and seems to be vague in the light of empirical studies. This overview focuses a potential differentiation-the objective and subjective dimensions of the indication process. Concerning the latter it is to investigate, if reflective functioning and ego-integration can be enhanced in the patient during the interaction process between patient and psychoanalyst. Empirical data underline the necessity to investigate to which extent externalizing defence processes are used and to integrate such factors into the decision and indication process. Differing treatment aims display another possibility to differentiate psychoanalysis and psychoanalytic psychotherapy. Psychoanalytic psychotherapy aims for example more at circumscribed problem-foci, the capability for self-reflexion is one of the most prominent treatment effects in psychoanalysis that results in on-going symptom reduction and resilience. The most prominent differentiation lies in the utilization of technical neutrality. Within Psychoanalytic Psychotherapy neutrality has sometimes to be suspended in order to stop severe acting out. Empirical evidence is given concerning the differentiation between psychoanalysis and psychoanalytic psychotherapy, that treatment efficacy is not correlated with the duration of the treatment, but with the frequency of sessions. Results give support to the assumption that the dosage of specific and appropriate psychoanalytic techniques facilitates sustained therapeutic change.

Adapting interpersonal psychotherapy for older adults at risk for suicide.

PubMed

Heisel, Marnin J; Talbot, Nancy L; King, Deborah A; Tu, Xin M; Duberstein, Paul R

2015-01-01

To pilot a psychological intervention adapted for older adults at risk for suicide. A focused, uncontrolled, pre-to-post-treatment psychotherapy trial. All eligible participants were offered the study intervention. Outpatient mental health care provided in the psychiatry department of an academic medical center in a mid-sized Canadian city. Seventeen English-speaking adults 60 years or older, at risk for suicide by virtue of current suicide ideation, death ideation, and/or recent self-injury. A 16-session course of Interpersonal Psychotherapy (IPT) adapted for older adults at risk for suicide who were receiving medication and/or other standard psychiatric treatment for underlying mood disorders. Participants completed a demographics form, screens for cognitive impairment and alcohol misuse, a semi-structured diagnostic interview, and measures of primary (suicide ideation and death ideation) and secondary study outcomes (depressive symptom severity, social adjustment and support, psychological well-being), and psychotherapy process measures. Participants experienced significant reductions in suicide ideation, death ideation, and depressive symptom severity, and significant improvement in perceived meaning in life, social adjustment, perceived social support, and other psychological well-being variables. Study participants experienced enhanced psychological well-being and reduced symptoms of depression and suicide ideation over the course of IPT adapted for older adults at risk for suicide. Larger, controlled trials are needed to further evaluate the impact of this novel intervention and to test methods for translating and integrating focused interventions into standard clinical care with at-risk older adults. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Serious Games for Psychotherapy: A Systematic Review.

PubMed

Eichenberg, Christiane; Schott, Markus

2017-06-01

In the evolving digital age, media applications are increasingly playing a greater role in the field of psychotherapy. While the Internet is already in the phase of being established when it comes to the care of mental disorders, experimentation is going on with other modern media such as serious games. A serious game is a game in which education and behavior change is the goal, alongside with entertainment. The objective of the present article was to provide a first empirical overview of serious games applied to psychotherapy and psychosomatic rehabilitation. Therefore, a systematic literature search, including the terms "serious game" or "computer game" and "psychotherapy" or "rehabilitation" or "intervention" or "mental disorders" in the databases Medline and PsycINFO, was performed. Subsequently, an Internet search was conducted to identify studies not published in journals. Publications not providing empirical data about effectiveness were excluded. On the basis of this systematic literature review, the results of N = 15 studies met inclusion criteria. They utilized primarily cognitive behavioral techniques and can be useful for treating a range of mental disorders. Serious games are effective both as a stand-alone intervention or part of psychotherapy and appeal to patients independent of age and sex. Included serious games proved to be an effective therapeutic component. Nonetheless, findings are not conclusive and more research is needed to further investigate the effectiveness of serious games for psychotherapeutic purposes.

[The future of psychosomatic medicine in West Germany--an illusion?].

PubMed

Meyer, A E

1990-01-01

Due to historical developments the structure and function of German Psychosomatics is unique in the world. Hence, to predict its future is difficult. There is the intimate conjunction of psycho-somatics with psychotherapy and the mandatory teaching of this combination to medical students, so that every medical school has to have a corresponding department and that most of these are psychoanalytically orientated. Medical care insurances finance psycho-therapy to a degree unknown in any other country. Then, in excess of the 700 beds for psychosomatics/psychotherapy in university and communal hospitals, the FRG provides another 4000 beds which are legally, financially and geographically separated from the former. Epidemiological data show that in spite of the above average out-patient financing many patients in need are not treated psychotherapeutically until their working capacity is reduced by which they become subject to another (and separate) legal system: The law of rehabilitation the measures of which are financed by the federal or state pension funds. At this late stage only in-patient psychosomatic treatment has some chance of rehabilitation. Hence, in cooperation with private entrepreneurs or non-profit organizations the above-mentioned over 4000 additional beds were provided. Two examples show that the effects of psychotherapy with somatic illness (myocardial infarction and metastatic cancer) are remarkable but discrete and their full impact can only been seen after several years. These features probably explain the habitual underestimation of psychotherapy in medicine.

The role of the psychiatrist : defining methods, theories, and practice in the time of managed care.

PubMed

Verhulst, J

1996-12-01

This essay proposes that the division between biological and psychotherapy-oriented psychiatry originates in the discipline's reliance on two fundamentally different methods of inquiry, that is, the medical-biological and the empathic-narrative. These terms are defined and distinguished from psychotherapy and psychodynamic psychiatry, as well as from general humanistic qualities in medicine. The division within the field may be fueled by a lack of clarity with respect to these concepts. The author argues that the essence of psychiatry is defined by a balanced combination of both methods. Psychiatry does not consist only of basic methods, but also of rules and guidelines for clinical practice, and of knowledge and theories used in the application of the methods. The role expectations for psychiatry in the managed care environment are examined and their effects upon methods, theory, and practice are analyzed. Some suggestions for dealing with the challenges of health care reform are offered.

Clinician Documentation on Receipt of Trauma-Focused Evidence-Based Psychotherapies in a VA PTSD Clinic.

PubMed

Lu, Mary W; Plagge, Jane M; Marsiglio, Mary C; Dobscha, Steven K

2016-01-01

The U.S. Department of Veterans Affairs (VA) is implementing two trauma-focused, evidence-based psychotherapies (TF-EBPs) for posttraumatic stress disorder (PTSD): cognitive processing therapy and prolonged exposure therapy (PE). Veterans with PTSD often do not receive these treatments, and little is known about the reasons veterans may not receive TF-EBPs. The aim of this qualitative study was to summarize clinician-reported reasons in medical records for nonreceipt of TF-EBPs. All veterans (N = 63) identified through PTSD screening who were newly engaged in mental health care and received individual evaluations in a PTSD specialty clinic in fiscal year 2008 were included in the sample. Content analysis of electronic medical records revealed multiple potential reasons for nonreceipt of TF-EBPs including referral to other PTSD treatments, other clinical priorities, poor engagement in care, practical barriers, negative beliefs, and receipt of care in other settings. Eight veterans (13%) initiated TF-EBPs. Further interventions to promote engagement in PTSD treatment are warranted.

Differences in Treatment Attitudes Between Depressed African-American and Caucasian Veterans in Primary Care

PubMed Central

Kasckow, John; Ingram, Erin; Brown, Charlotte; Tew, James D.; Conner, Kyaien O.; Morse, Jennifer Q.; Haas, Gretchen L.; Reynolds, Charles F.; Oslin, David W.

2011-01-01

Objectives Depressive disorders are common, and it is important to understand the factors that contribute to racial disparities in depression treatment. This primary care study of veterans with subsyndromal depression examined two hypotheses: that African Americans would be less likely than Caucasians to believe that medication is beneficial in depression treatment and would be more likely to believe that counseling or psychotherapy is beneficial. Methods Primary care patients with subsyndromal depression were referred to the Philadelphia Department of Veterans Affairs Behavioral Health Laboratory and asked about past experiences and attitudes toward depression treatment. Results Among 111 African-American and 95 Caucasian participants, logistic regression analyses determined that African Americans were less likely to view medication as beneficial (odds ratio=.44). No racial differences were found in participants’ attitude toward counseling or psychotherapy. Conclusions The findings support the premise that clinicians treating patients with subsyndromal depressive syndromes should take into account racial differences in attitudes toward treatment. PMID:21459996

Forensic nursing interventions with patients with personality disorder: a holistic approach.

PubMed

Byrt, Richard

2013-01-01

Research findings suggest that nursing assessment and care and psychotherapy of forensic patients with personality disorder should be based on a holistic approach that addresses a wide range of their needs. Such an approach should be in collaboration with patients, informal carers, and other professionals and informed by appropriate education, training, clinical supervision, and support. Holistic care includes areas (such as physical health, cultural, spiritual, and psychosexual needs) that are addressed to a limited extent in the literature on patients with personality disorder. Despite limitations in research evidence, findings suggest that some patients with personality disorder benefit from psychotherapies, sometimes facilitated by nurse-therapists, and therapeutic community principles. These interventions should take account of patients' cultural and spiritual needs and perspectives. Helping patients to manage anger has potentially positive consequences for their physical health, personal and work relationships, and other areas. Research is needed to consider how to deliver holistic care with limited resources and in organizations, such as prisons, with conflicting goals.

Self-defense against verbal assault: shame, anger, and the social bond.

PubMed

Scheff, T J

1995-09-01

With many years of experience and refinement, the arts of self-defense against physical assault are highly developed. Without an effective theory and and a useful practice, there is little in the way of self-defense against verbal assault. For THEORY, I draw upon ideas from aikido, family systems theory, and the sociology of emotions. Since unacknowledged shame seems to generate rage and damage social bonds, I emphasize the management of shame, anger, and bonds. To illustrate the meaning of these principles, I offer several episodes as examples, using the METHOD of discourse analysis. I apply this theory and method to the PRACTICE of psychotherapy by describing some rudimentary principles of defense of self against verbal aggression, especially the subtle aggression of innuendo. Psychotherapy is often an arena of verbal aggression by both therapist and client, even though it is usually unintentional and outside of awareness.

Randomised controlled trial of the clinical and cost effectiveness of a specialist team for managing refractory unipolar depressive disorder.

PubMed

Morriss, Richard; Marttunnen, Sarah; Garland, Anne; Nixon, Neil; McDonald, Ruth; Sweeney, Tim; Flambert, Heather; Fox, Richard; Kaylor-Hughes, Catherine; James, Marilyn; Yang, Min

2010-11-29

Around 40 per cent of patients with unipolar depressive disorder who are treated in secondary care mental health services do not respond to first or second line treatments for depression. Such patients have 20 times the suicide rate of the general population and treatment response becomes harder to achieve and sustain the longer they remain depressed. Despite this there are no randomised controlled trials of community based service delivery interventions delivering both algorithm based pharmacotherapy and psychotherapy for patients with chronic depressive disorder in secondary care mental health services who remain moderately or severely depressed after six months treatment. Without such trials evidence based guidelines on services for such patients cannot be derived. Single blind individually randomised controlled trial of a specialist depression disorder team (psychiatrist and psychotherapist jointly assessing and providing algorithm based drug and psychological treatment) versus usual secondary care treatment. We will recruit 174 patients with unipolar depressive disorder in secondary mental health services with a Hamilton Depression Rating Scale (HDRS) score ≥ 16 and global assessment of function (GAF) ≤ 60 after ≥ 6 months treatment. The primary outcome measures will be the HDRS and GAF supplemented by economic analysis including the EQ5 D and analysis of barriers to care, implementation and the process of care. Audits to benchmark both treatment arms against national standards of care will aid the interpretation of the results of the study. This trial will be the first to assess the effectiveness and implementation of a community based specialist depression disorder team. The study has been specially designed as part of the CLAHRC Nottinghamshire, Derbyshire and Lincolnshire joint collaboration between university, health and social care organisations to provide information of direct relevance to decisions on commissioning, service provision and implementation.

Psychotherapy for Depression in Older Veterans Via Telemedicine: Effect on Quality of Life, Satisfaction, Treatment Credibility, and Service Delivery Perception.

PubMed

Egede, Leonard E; Acierno, Ron; Knapp, Rebecca G; Walker, Rebekah J; Payne, Elizabeth H; Frueh, B Christopher

2016-12-01

To analyze the impact of telepsychology and same-room care on functioning, satisfaction, and perception of care based on a noninferiority trial of psychotherapy delivered via telemedicine or same-room care to elderly patients with depression. 241 elderly patients with depression (meeting DSM-IV diagnostic criteria) were randomly assigned to either telemedicine (n = 120) or same-room treatment (n = 121) between April 1, 2007, and July 31, 2011. The primary outcomes included quality of life (36-item Short Form Survey [SF-36]), satisfaction (Charleston Psychiatric Outpatient Satisfaction Scale), treatment credibility, and service delivery perception scores obtained at 4 weeks, 8 weeks, 3 months, and 12 months. Comparisons of intervention means were carried out at each time point using independent sample t tests and SAS Procedure MIANALYZE to combine results across the multiply imputed complete data sets. If significant differences were detected for a given outcome within a domain, a Bonferroni correction was applied to determine if significance was maintained. None of the SF-36 scores showed a significant difference between the 2 treatment groups by the end of the study period, with little significance shown throughout the intermediate time points. Similarly, over all time points, there was no statistically significant difference in patient satisfaction or treatment credibility. This study found that telemedicine is a viable alternative modality for providing evidence-based psychotherapy for elderly patients with depression. Results provide evidence that quality of life and satisfaction with care are not adversely influenced by the decision to use a telehealth modality instead of in-person treatment, and, as a result, resources can be devoted to offering services in patients' homes through telemedicine. ClinicalTrials.gov identifier: NCT00324701. © Copyright 2016 Physicians Postgraduate Press, Inc.

Racial and Ethnic Differences in ADHD Treatment Quality Among Medicaid-Enrolled Youth.

PubMed

Cummings, Janet R; Ji, Xu; Allen, Lindsay; Lally, Cathy; Druss, Benjamin G

2017-06-01

We estimated racial/ethnic differences in attention-deficit/hyperactivity disorder (ADHD) care quality and treatment continuity among Medicaid-enrolled children. Using Medicaid data from 9 states (2008 to 2011), we identified 172 322 youth (age 6 to 12) initiating ADHD medication. Outcome measures included: (1) adequate follow-up care in the (a) initiation and (b) continuation and maintenance (C&M) treatment phases; (2) combined treatment with medication and psychotherapy (versus medication alone); (3) medication discontinuation; and (4) treatment disengagement (ie, discontinued medication and received no psychotherapy). Logistic regressions controlled for confounding measures. Among those initiating medication, three-fifths received adequate follow-up care in the initiation and C&M phases, and under two-fifths received combined treatment. Compared with whites, African American youth were less likely to receive adequate follow-up in either phase ( P < .05), whereas Hispanic youth were more likely to receive adequate follow-up in the C&M phase ( P < .001). African American and Hispanic youth were more likely than whites to receive combined treatment ( P < .05). Over three-fifths discontinued medication, and over four-tenths disengaged from treatment. Compared with whites, African American and Hispanic children were 22.4% and 16.7% points more likely to discontinue medication, and 13.1% and 9.4% points more likely to disengage from treatment, respectively ( P < .001). Care quality for Medicaid-enrolled youth initiating ADHD medication is poor, and racial/ethnic differences in these measures are mixed. The most important disparities occur in the higher rates of medication discontinuation among minorities, which translate into higher rates of treatment disengagement because most youth discontinuing medication receive no psychotherapy. Copyright © 2017 by the American Academy of Pediatrics.

Adapting Interpersonal Psychotherapy for Older Adults at Risk for Suicide: Preliminary Findings

PubMed Central

Heisel, Marnin J.; Duberstein, Paul R.; Talbot, Nancy L.; King, Deborah A.; Tu, Xin M.

2010-01-01

We report preliminary findings of the first ever study testing a 16-week course of Interpersonal Psychotherapy (IPT) modified for older outpatients at elevated risk for suicide. Participants were referred from inpatient and outpatient medicine and mental health services. Psychotherapy sessions took place in a therapist’s office in a teaching hospital. Twelve adults 60 years or older (M=70.5, SD=6.1) with current thoughts of suicide (suicide ideation) or a wish to die (death ideation) or with recent self-injurious behavior were recruited into weekly sessions of IPT; one was subsequently excluded due to severe cognitive impairment. Participants completed measures of suicide ideation, death ideation, and depressive symptom severity at pre-treatment, mid-treatment, post-treatment, and at 3-month follow-up periods, and measures of therapeutic process variables. Preliminary findings of this uncontrolled pre-post-treatment study support the feasibility of recruiting and retaining older adults at-risk for suicide into psychotherapy research and suggest that adapted IPT is tolerable and safe. Findings indicate a substantial reduction in participant suicide ideation, death ideation, and depressive symptoms; controlled trials are needed to further evaluate these findings. We discuss implications for clinical care with at-risk older adults. PMID:20574546

Psychotherapy for Bipolar Disorder in Adults: A Review of the Evidence

PubMed Central

Swartz, Holly A.; Swanson, Joshua

2015-01-01

Although pharmacotherapy is the mainstay of treatment for bipolar disorder, medication offers only partial relief for patients. Treatment with pharmacologic interventions alone is associated with disappointingly low rates of remission, high rates of recurrence, residual symptoms, and psychosocial impairment. Bipolar-specific therapy is increasingly recommended as an essential component of illness management. This review summarizes the available data on psychotherapy for adults with bipolar disorder. We conducted a search of the literature for outcome studies published between 1995 and 2013 and identified 35 reports of 28 randomized controlled trials testing individual or group psychosocial interventions for adults with bipolar disorder. These reports include systematic trials investigating the efficacy and effectiveness of individual psychoeducation, group psychoeducation, individual cognitive-behavioral therapy, group cognitive-behavioral therapy, family therapy, interpersonal and social rhythm therapy, and integrated care management. The evidence demonstrates that bipolar disorder-specific psychotherapies, when added to medication for the treatment of bipolar disorder, consistently show advantages over medication alone on measures of symptom burden and risk of relapse. Whether delivered in a group or individual format, those who receive bipolar disorder-specific psychotherapy fare better than those who do not. Psychotherapeutic strategies common to most bipolar disorder-specific interventions are identified. PMID:26279641

Mental Health and Resilience: Soldiers’ Perceptions about Psychotherapy, Medications, and Barriers to Care in the United States Military

DTIC Science & Technology

2014-08-01

Revisiting the behavioral model and access to medical care: Does it matter? J Health Soc Behav. 36:1-10. Andrews, P., and Meyer, R. (2003). Marlowe ... Marlowe , D. (1960). A new scale of social desirability independent of psychopathology. Journal of Consulting and Clinical Psychology, 24, 349

The Role of Therapeutic Alliance in Therapy Outcomes for Youth in Residential Care

ERIC Educational Resources Information Center

Handwerk, Michael L.; Huefner, Jonathan C.; Ringle, Jay L.; Howard, Brigid K.; Soper, Stephen H.; Almquist, Julie K.; Chmelka, M. Beth

2008-01-01

This study examined the impact of therapeutic alliance (TA) on therapy outcomes for youth with behavioral and emotional problems residing in residential care. Study participants were 71 youth in an out-of-home family-style residential treatment facility who were referred to an onsite psychotherapy clinic. A therapeutic alliance scale was completed…

Costs and benefits of improving access to psychotherapies for common mental disorders.

PubMed

Dezetter, Anne; Briffault, Xavier; Ben Lakhdar, Christian; Kovess-Masfety, Viviane

2013-12-01

Structured psychotherapies are treatments used in common mental health disorders (CMHDs) that are recommended by international good practice guidelines. Their efficacy and positive impact on health--and thereby on the reduction of related costs for health insurance schemes and society--have been widely demonstrated. However in France, despite the considerable financial burden of CMHDs, psychotherapies with a non-medical psychotherapist are not reimbursed by the health insurance schemes. To assess the cost of coverage for psychotherapies by the health insurance bodies for adults aged 18 to 75 with CMHDs--depressive or anxious disorders, severe or recurrent--and to estimate the cost-benefit ratio for these psychotherapies for the community. The data was derived from l'Enquete Indicateurs de sante mentale dans quatre regions francaises 2005, which is a cross-sectional study on 20,777 adults in the general population. Telephone interviews were backed up by the CIDI-SF. The Sheehan Disability Scale was used to assess the severity of the disorders. The proportion of patients who would agree to and then attend psychotherapies was estimated using the methodology developed in the UK in the Improving Access to Psychological Therapies programme, adapted to the French setting. The number of sessions to be covered was defined according to recommendations by the National Institute for Health and Clinical Excellence. The cost was estimated to be 41 per session, the reimbursement rate was set at 60% for the compulsory health coverage system. The annual costs engendered by CMHDs were estimated to be 4,702 for depressive disorders and 1,500 for anxiety disorders. The remission rate attributable to psychotherapies was estimated to be 30% pm10%. For average series of 10 sessions (anxiety disorders) to 18 sessions (depressive disorders) the yearly cost of psychotherapies would be 514 million Euros, of which 308 million would be covered by the compulsory coverage system, to treat 1.033 million patients, or 2.3% of the population. For patients with depressive disorders, 1 spent by the community for the psychotherapy would enable the community a saving of 1.95 (1.30-2.60), and for anxiety disorders a saving of 1.14 (0.76-1.52). This programme for provision of coverage for psychotherapies would have a positive impact for the community as a whole, in terms of quality-of-life, health and absenteeism. Funding psychotherapies proves to be a cost-efficient investment in the short and the long term, and this is backed up further by the fact that the impact of psychotherapies on somatic disorders interacting with CMHDs was not taken into account here. Decision-makers in the health insurance schemes will thus have reliable medico-economic data available to assist in decisions for a possible policy for reimbursement of psychotherapies. Financial coverage of psychotherapies would in particular enable access to treatment by people for whom the financial barrier would have prevented access to this treatment. Furthermore, reimbursing sessions with non-medical psychotherapists could also improve conditions of care-provision by mental health professionals. Finally, this model could be replicated in other countries where the health system is sufficiently comparable to that prevailing in France. An in-depth study is required to detail cost and benefit of providing insurance coverage for psychotherapies for the different protagonists involved in this funding, and its effects.

Assessing the marks of change: how psychotherapy alters the brain structure in women with borderline personality disorder

PubMed Central

Schmitt, Ruth; Winter, Dorina; Niedtfeld, Inga; Herpertz, Sabine C.; Schmahl, Christian

2018-01-01

Background There is increasing evidence that psychotherapy can alter the function of the brain of patients with borderline personality disorder (BPD). However, it is not known whether psychotherapy can also modify the brain structure of patients with BPD. Methods We used structural MRI data of female patients with BPD before and after participation in 12 weeks of residential dialectical behavioural therapy (DBT) and compared them to data from female patients with BPD who received treatment as usual (TAU). We applied voxel-based morphometry to study voxel-wise changes in grey matter volume over time. Results We included 31 patients in the DBT group and 17 in the TAU group. Patients receiving DBT showed an increase of grey matter volume in the anterior cingulate cortex, inferior frontal gyrus and superior temporal gyrus together with an alteration of grey matter volume in the angular gyrus and supramarginal gyrus compared with patients receiving TAU. Furthermore, therapy response correlated with increase of grey matter volume in the angular gyrus. Limitations Only women were investigated, and groups differed in size, medication (controlled for) and intensity of the treatment condition. Conclusion We found that DBT increased grey matter volume of brain regions that are critically implicated in emotion regulation and higher-order functions, such as mentalizing. The role of the angular gyrus for treatment response may reside in its cross-modal integrative function. These findings enhance our understanding of psychotherapy mechanisms of change and may foster the development of neurobiologically informed therapeutic interventions. PMID:29688873

Long-term healthcare cost reduction with Intensive Short-term Dynamic Psychotherapy in a tertiary psychiatric service.

PubMed

Abbass, Allan; Kisely, Steve; Rasic, Daniel; Town, Joel M; Johansson, Robert

2015-05-01

To evaluate whether a mixed population of patients treated with Intensive Short-term Dynamic Psychotherapy (ISTDP) would exhibit reduced healthcare costs in long-term follow-up. A quasi-experimental design was employed in which data on pre- and post-treatment healthcare cost were compared for all ISTDP cases treated in a tertiary care service over a nine year period. Observed cost changes were compared with those of a control group of patients referred but never treated. Physician and hospital costs were compared to treatment cost estimates and normal population cost figures. 1082 patients were included; 890 treated cases for a broad range of somatic and psychiatric disorders and 192 controls. The treatment averaged 7.3 sessions and measures of symptoms and interpersonal problems significantly improved. The average cost reduction per treated case was $12,628 over 3 follow-up years: this compared favorably with the estimated treatment cost of $708 per patient. Significant differences were seen between groups for follow-up hospital costs. ISTDP in this setting appears to facilitate reductions in healthcare costs, supporting the notion that brief dynamic psychotherapy provided in a tertiary setting can be beneficial to health care systems overall. CLINICALTRIALS. NCT01924715. Copyright © 2015 Elsevier Ltd. All rights reserved.

Looking outside the (voice)box.

PubMed

Gartrell, Nanette; Rothblum, Esther

2014-01-01

Laura S. Brown, PhD, is a clinical and forensic psychologist in independent practice in Seattle, Washington. The bulk of her scholarly work has been in the fields of feminist therapy theory, trauma treatment, lesbian and gay issues, assessment and diagnosis, ethics and standards of care in psychotherapy, and cultural competence. She has authored or edited ten professional books, including the award-winning Subversive Dialogues: Theory in Feminist Therapy, as well as more than 140 other professional publications. She has also recently published her first book for general audiences, Your turn for care: Surviving the aging and death of the adults who harmed you. Laura has been featured in five psychotherapy training videos produced by the American Psychological Association. She was President of American Psychological Association Divisions 35 (Society for the Psychology of Women), 44 (Society for the Psychological Study of Lesbian, Gay and Bisexual Issues), and 56 (Trauma Psychology). Laura was also President of the Washington State Psychological Association. She is the founder and Director of the Fremont Community Therapy Project, a low-fee psychotherapy training clinic in Seattle. In the fall of 2000, she was the on-site psychologist for the reality show Survivor: The Australian Outback. In 1987, Laura lost her voice and was diagnosed with spasmodic dysphonia. In 1988, she found her voice again.

Advancing psychotherapy and evidence-based psychological interventions.

PubMed

Emmelkamp, Paul M G; David, Daniel; Beckers, Tom; Muris, Peter; Cuijpers, Pim; Lutz, Wolfgang; Andersson, Gerhard; Araya, Ricardo; Banos Rivera, Rosa M; Barkham, Michael; Berking, Matthias; Berger, Thomas; Botella, Christina; Carlbring, Per; Colom, Francesc; Essau, Cecilia; Hermans, Dirk; Hofmann, Stefan G; Knappe, Susanne; Ollendick, Thomas H; Raes, Filip; Rief, Winfried; Riper, Heleen; Van Der Oord, Saskia; Vervliet, Bram

2014-01-01

Psychological models of mental disorders guide research into psychological and environmental factors that elicit and maintain mental disorders as well as interventions to reduce them. This paper addresses four areas. (1) Psychological models of mental disorders have become increasingly transdiagnostic, focusing on core cognitive endophenotypes of psychopathology from an integrative cognitive psychology perspective rather than offering explanations for unitary mental disorders. It is argued that psychological interventions for mental disorders will increasingly target specific cognitive dysfunctions rather than symptom-based mental disorders as a result. (2) Psychotherapy research still lacks a comprehensive conceptual framework that brings together the wide variety of findings, models and perspectives. Analysing the state-of-the-art in psychotherapy treatment research, "component analyses" aiming at an optimal identification of core ingredients and the mechanisms of change is highlighted as the core need towards improved efficacy and effectiveness of psychotherapy, and improved translation to routine care. (3) In order to provide more effective psychological interventions to children and adolescents, there is a need to develop new and/or improved psychotherapeutic interventions on the basis of developmental psychopathology research taking into account knowledge of mediators and moderators. Developmental neuroscience research might be instrumental to uncover associated aberrant brain processes in children and adolescents with mental health problems and to better examine mechanisms of their correction by means of psychotherapy and psychological interventions. (4) Psychotherapy research needs to broaden in terms of adoption of large-scale public health strategies and treatments that can be applied to more patients in a simpler and cost-effective way. Increased research on efficacy and moderators of Internet-based treatments and e-mental health tools (e.g. to support "real time" clinical decision-making to prevent treatment failure or relapse) might be one promising way forward. Copyright © 2013 John Wiley & Sons, Ltd.

Online Self-Help as an Add-On to Inpatient Psychotherapy: Efficacy of a New Blended Treatment Approach.

PubMed

Zwerenz, Rüdiger; Becker, Jan; Knickenberg, Rudolf J; Siepmann, Martin; Hagen, Karin; Beutel, Manfred E

2017-01-01

Depression is one of the most frequent and costly mental disorders. While there is increasing evidence for the efficacy of online self-help to improve depression or prevent relapse, there is little evidence in blended care settings, especially combined with inpatient face-to-face psychotherapy. Therefore, we evaluated whether an evidence-based online self-help program improves the efficacy of inpatient psychotherapy. A total of 229 depressed patients were randomly allocated either to an online self-help program (intervention group [IG]; Deprexis) or an active control group (CG; weekly online information on depression) in addition to inpatient psychodynamic psychotherapy. Both groups had access to their respective experimental intervention for 12 weeks, regardless of inpatient treatment duration. Reduction of depressive symptoms, as measured with the Beck Depression Inventory-II, was the primary outcome at the end of the intervention (T2). Depressive symptoms were statistically significantly lower in the IG compared to the active CG at T2 with a moderate between-group effect size of d = 0.44. The same applied to anxiety (d = 0.33), quality of life (d = 0.34), and self-esteem (d = 0.38) at discharge from inpatient treatment (T1). No statistically significant differences were found regarding dysfunctional attitudes (d = 0.14) and work ability (d = 0.08) at T1. This is the first evidence for blended treatment combining online self-help with inpatient psychotherapy. The study opens new and promising avenues for increasing the efficacy of inpatient psychotherapy. Future studies should determine how integration of online self-help into the therapeutic process can be developed further. © 2017 S. Karger AG, Basel.

A developmental approach to the treatment of bipolar disorder: IPSRT with an adolescent.

PubMed

Crowe, Marie; Inder, Maree; Joyce, Peter; Moor, Stephanie; Carter, Janet; Luty, Sue

2009-01-01

This case study explains how a psychotherapy previously used with adults can be used with adolescents by focusing on the specific developmental issues associated with adolescence. Bipolar disorder is a damaging disorder to experience during the developmental phase of adolescence. Interpersonal social rhythm psychotherapy has been developed as an adjunct to medication for managing bipolar disorder and shows some promising outcomes in adults. This is a single case study design drawn from a larger randomised control trial of two psychotherapies for bipolar disorder. The case study addressed the question: How can Interpersonal social rhythm therapy be applied with adolescents who have bipolar disorder? This study used a purposeful sampling process by selecting the youngest adolescent participating in the randomised control trial. All the subject's sessions of Interpersonal social rhythm therapy were taped, transcribed and analysed. The analysis involved describing the process of psychotherapy as it occurred over time, mapping the process as a trajectory across the three phases of psychotherapy experience and focusing the analysis around the impact of bipolar disorder and IPSRT on adolescent developmental issues, specifically the issue of identity development. Interpersonal social rhythm therapy allowed the therapist to address developmental issues within its framework. As a result of participation in the psychotherapy the adolescent was able to manage her mood symptoms and develop a sense of identity that was age-appropriate. Interpersonal social rhythm therapy provided the adolescent in the case study the opportunity to consider what it meant to have bipolar disorder and to integrate this meaning into her sense of self. Bipolar disorder is a chronic and recurring disorder that can have a serious impact on development and functioning. Interpersonal social rhythm therapy provides an approach to nursing care that enables adolescents to improve social functioning.

[Improving Health Care for Patients with Somatoform and Functional Disorders: A Collaborative Stepped Care Network (Sofu-Net)].

PubMed

Shedden-Mora, Meike; Lau, Katharina; Kuby, Amina; Groß, Beatrice; Gladigau, Maria; Fabisch, Alexandra; Löwe, Bernd

2015-07-01

The management of somatoform disorders in primary care is often limited due to low diagnostic accuracy, delayed referral to psychotherapy and overuse of health care. To address these difficulties, this study aimed to establish a collaborative stepped health care network (Sofu-Net). Sofu-Net was established among 41 primary care physicians, 35 psychotherapists and 8 mental health clinics. Baseline assessment in primary care showed elevated psychopathology and deficits in health care among patients with somatoform symptoms. Network partners provided positive evaluations of Sofu-Net. © Georg Thieme Verlag KG Stuttgart · New York.

Current Views and Perspectives on E-Mental Health: An Exploratory Survey Study for Understanding Public Attitudes Toward Internet-Based Psychotherapy in Germany.

PubMed

Apolinário-Hagen, Jennifer; Vehreschild, Viktor; Alkoudmani, Ramez M

2017-02-23

Despite the advanced development of evidence-based psychological treatment services, help-seeking persons with mental health problems often fail to receive appropriate professional help. Internet-delivered psychotherapy has thus been suggested as an efficient strategy to overcome barriers to access mental health care on a large scale. However, previous research indicated poor public acceptability as an issue for the dissemination of Internet-delivered therapies. Currently, little is known about the expectations and attitudes toward Internet-delivered therapies in the general population. This is especially the case for countries such as Germany where electronic mental health (e-mental health) treatment services are planned to be implemented in routine care. This pilot study aimed to determine the expectations and attitudes toward Internet-based psychotherapy in the general population in Germany. Furthermore, it aimed to explore the associations between attitudes toward Internet-based therapies and perceived stress. To assess public attitudes toward Internet-based psychotherapy, we conducted both Web-based and paper-and-pencil surveys using a self-developed 14-item questionnaire (Cronbach alpha=.89). Psychological distress was measured by employing a visual analogue scale (VAS) and the 20-item German version of the Perceived Stress Questionnaire (PSQ). In addition, we conducted explorative factor analysis (principal axis factor analysis with promax rotation). Spearman's rank correlations were used to determine the associations between attitudes toward Internet-based therapies and perceived stress. Descriptive analyses revealed that most respondents (N=1558; female: 78.95%, 1230/1558) indicated being not aware of the existence of Internet-delivered therapies (83.46%, 1141/1367). The average age was 32 years (standard deviation, SD 10.9; range 16-76). Through exploratory factor analysis, we identified 3 dimensions of public attitudes toward Internet-based therapies, which we labeled "usefulness or helpfulness," "relative advantage or comparability," and "accessibility or access to health care." Analyses revealed negative views about Internet-based therapies on most domains, such as perceived helpfulness. The study findings further indicated ambivalent attitudes: Although most respondents agreed to statements on expected improvements in health care (eg, expanded access), we observed low intentions to future use of Internet-delivered therapies in case of mental health problems. This pilot study showed deficient "e-awareness" and rather negative or ambivalent attitudes toward Internet-delivered therapies in the German-speaking general population. However, research targeting determinants of the large-scale adoption of Internet-based psychotherapy is still in its infancy. Thus, further research is required to explore the "black box" of public attitudes toward Internet-delivered therapies with representative samples, validated measures, and longitudinal survey designs. ©Jennifer Apolinário-Hagen, Viktor Vehreschild, Ramez M Alkoudmani. Originally published in JMIR Mental Health (http://mental.jmir.org), 23.02.2017.

Current Views and Perspectives on E-Mental Health: An Exploratory Survey Study for Understanding Public Attitudes Toward Internet-Based Psychotherapy in Germany

PubMed Central

Vehreschild, Viktor; Alkoudmani, Ramez M

2017-01-01

Background Despite the advanced development of evidence-based psychological treatment services, help-seeking persons with mental health problems often fail to receive appropriate professional help. Internet-delivered psychotherapy has thus been suggested as an efficient strategy to overcome barriers to access mental health care on a large scale. However, previous research indicated poor public acceptability as an issue for the dissemination of Internet-delivered therapies. Currently, little is known about the expectations and attitudes toward Internet-delivered therapies in the general population. This is especially the case for countries such as Germany where electronic mental health (e-mental health) treatment services are planned to be implemented in routine care. Objective This pilot study aimed to determine the expectations and attitudes toward Internet-based psychotherapy in the general population in Germany. Furthermore, it aimed to explore the associations between attitudes toward Internet-based therapies and perceived stress. Methods To assess public attitudes toward Internet-based psychotherapy, we conducted both Web-based and paper-and-pencil surveys using a self-developed 14-item questionnaire (Cronbach alpha=.89). Psychological distress was measured by employing a visual analogue scale (VAS) and the 20-item German version of the Perceived Stress Questionnaire (PSQ). In addition, we conducted explorative factor analysis (principal axis factor analysis with promax rotation). Spearman’s rank correlations were used to determine the associations between attitudes toward Internet-based therapies and perceived stress. Results Descriptive analyses revealed that most respondents (N=1558; female: 78.95%, 1230/1558) indicated being not aware of the existence of Internet-delivered therapies (83.46%, 1141/1367). The average age was 32 years (standard deviation, SD 10.9; range 16-76). Through exploratory factor analysis, we identified 3 dimensions of public attitudes toward Internet-based therapies, which we labeled “usefulness or helpfulness,” “relative advantage or comparability,” and “accessibility or access to health care.” Analyses revealed negative views about Internet-based therapies on most domains, such as perceived helpfulness. The study findings further indicated ambivalent attitudes: Although most respondents agreed to statements on expected improvements in health care (eg, expanded access), we observed low intentions to future use of Internet-delivered therapies in case of mental health problems. Conclusions This pilot study showed deficient “e-awareness” and rather negative or ambivalent attitudes toward Internet-delivered therapies in the German-speaking general population. However, research targeting determinants of the large-scale adoption of Internet-based psychotherapy is still in its infancy. Thus, further research is required to explore the “black box” of public attitudes toward Internet-delivered therapies with representative samples, validated measures, and longitudinal survey designs. PMID:28232298

From local to global – Contributions of Indian psychiatry to international psychiatry

PubMed Central

Murthy, R. Srinivasa

2010-01-01

Indian psychiatrists have actively engaged with world psychiatry by contributing to understanding and care of persons with mental disorders based on the religious, cultural and social aspects of Indian life. The contributions are significant in the areas of outlining the scope of mental health, classification of mental disorders, understanding the course of mental disorders, psychotherapy, traditional methods of care, role of family in mental health care and care of the mentally ill in the community settings. PMID:21836699

The creative arts therapies: making health care whole.

PubMed

Goodill, Sharon W

2010-07-01

The creative arts therapies are six fields that combine artistic expression with psychotherapy to promote healing, wellness, and personal change. Although they are well-established fields, they are garnering renewed attention with the recent focus on health care and the arts. This article describes these fields and provides information about the training and professional standards of creative arts therapists and examples of how these therapies are being used in health care settings.

Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial.

PubMed

Fortney, John C; Pyne, Jeffrey M; Kimbrell, Timothy A; Hudson, Teresa J; Robinson, Dean E; Schneider, Ronald; Moore, William M; Custer, Paul J; Grubbs, Kathleen M; Schnurr, Paula P

2015-01-01

Posttraumatic stress disorder (PTSD) is prevalent, persistent, and disabling. Although psychotherapy and pharmacotherapy have proven efficacious in randomized clinical trials, geographic barriers impede rural veterans from engaging in these evidence-based treatments. To test a telemedicine-based collaborative care model designed to improve engagement in evidence-based treatment of PTSD. The Telemedicine Outreach for PTSD (TOP) study used a pragmatic randomized effectiveness trial design with intention-to-treat analyses. Outpatients were recruited from 11 Department of Veterans Affairs (VA) community-based outpatient clinics serving predominantly rural veterans. Inclusion required meeting diagnostic criteria for current PTSD according to the Clinician-Administered PTSD Scale. Exclusion criteria included receiving PTSD treatment at a VA medical center or a current diagnosis of schizophrenia, bipolar disorder, or substance dependence. Two hundred sixty-five veterans were enrolled from November 23, 2009, through September 28, 2011, randomized to usual care (UC) or the TOP intervention, and followed up for 12 months. Off-site PTSD care teams located at VA medical centers supported on-site community-based outpatient clinic providers. Off-site PTSD care teams included telephone nurse care managers, telephone pharmacists, telepsychologists, and telepsychiatrists. Nurses conducted care management activities. Pharmacists reviewed medication histories. Psychologists delivered cognitive processing therapy via interactive video. Psychiatrists supervised the team and conducted interactive video psychiatric consultations. The primary outcome was PTSD severity as measured by the Posttraumatic Diagnostic Scale. Process-of-care outcomes included medication prescribing and regimen adherence and initiation of and adherence to cognitive processing therapy. During the 12-month follow-up period, 73 of the 133 patients randomized to TOP (54.9%) received cognitive processing therapy compared with 16 of 132 randomized to UC (12.1%) (odds ratio, 18.08 [95% CI, 7.96-41.06]; P < .001). Patients in the TOP arm had significantly larger decreases in Posttraumatic Diagnostic Scale scores (from 35.0 to 29.1) compared with those in the UC arm (from 33.5 to 32.1) at 6 months (β = -3.81; P = .002). Patients in the TOP arm also had significantly larger decreases in Posttraumatic Diagnostic Scale scores (from 35.0 to 30.1) compared with those in the UC arm (from 33.5 to 31.7) at 12 months (β = -2.49; P=.04). There were no significant group differences in the number of PTSD medications prescribed and adherence to medication regimens were not significant. Attendance at 8 or more sessions of cognitive processing therapy significantly predicted improvement in Posttraumatic Diagnostic Scale scores (β = -3.86 [95% CI, -7.19 to -0.54]; P = .02) and fully mediated the intervention effect at 12 months. Telemedicine-based collaborative care can successfully engage rural veterans in evidence-based psychotherapy to improve PTSD outcomes. clinicaltrials.gov Identifier: NCT00821678.

Therapeutic Guidance for Infants and Families: Using Multi-Family Groups as an Extension of Child-Parent Psychotherapy

ERIC Educational Resources Information Center

Frame, Laura; Ivins, Barbara; Wong, Lynette; Cantrell, Sally

2015-01-01

Treatment of very young children in foster care involves the complex dynamics of a child's trauma history, multiple relationships, and caregivers' and providers' feelings about working with the child welfare system. Through the story of a toddler removed from his parents and placed in foster care, the authors illustrate a model of combined group…

Prescribing Clinicians’ Perspectives on Evidence-Based Psychotherapy for Posttraumatic Stress Disorder

PubMed Central

Barnett, Erin R.; Bernardy, Nancy C.; Jenkyn, Aaron B.; Parker, Louise E.; Lund, Brian C.; Alexander, Bruce; Friedman, Matthew J.

2014-01-01

Evidence-based psychotherapies (EBP) for Posttraumatic Stress Disorder are not utilized to their full extent within the Department of Veterans Affairs (VA). VA provides care to many persons with PTSD and has been in the forefront of clinical practice guidelines and EBP training and dissemination. Yet VA continues to find EBP implementation difficult. Veterans with PTSD often initially present to prescribing clinicians, who then help make care decisions. It is therefore critical that these clinicians correctly screen and triage appropriate mental health care. The purpose of this study was to assess VA prescribing clinicians’ knowledge, perceptions, and referral behaviors related to EBPs for PTSD and to identify facilitators and barriers to implementing EBPs within VA. We conducted qualitative interviews with 26 VA prescribing clinicians. Limited access to EBPs was the most commonly noted barrier. The clinicians we interviewed also held specific beliefs and behaviors that may delay or deter EBPs. Strategies to improve utilization also emerged. Findings suggest the need for increased access to EBPs, training to optimize the role of prescribing clinicians in helping Veterans with PTSD make appropriate care decisions, and specific organizational changes to facilitate access and effective referral systems for EBPs. PMID:25431445

Preferences for Depression Treatment Including Internet-Based Interventions: Results From a Large Sample of Primary Care Patients

PubMed Central

Dorow, Marie; Löbner, Margrit; Pabst, Alexander; Stein, Janine; Riedel-Heller, Steffi G.

2018-01-01

Background: To date, little is known about treatment preferences for depression concerning new media. This study aims to (1) investigate treatment preferences for depression including internet-based interventions and (2) examine subgroup differences concerning age, gender and severity of depression as well as patient-related factors associated with treatment preferences. Methods: Data were derived from the baseline assessment of the @ktiv-trial. Depression treatment preferences were assessed from n = 641 primary care patients with mild to moderate depression regarding the following treatments: medication, psychotherapy, combined treatment, alternative treatment, talking to friends and family, exercise, self-help literature, and internet-based interventions. Depression severity was specified by GPs according to ICD-10 criteria. Ordinal logistic regression models were conducted to identify associated factors of treatment preferences. Results: Patients had a mean age of 43.9 years (SD = 13.8) and more than two thirds (68.6%) were female. About 43% of patients had mild depression while 57% were diagnosed with moderate depression. The majority of patients reported strong preferences for psychotherapy, talking to friends and family, and exercise. About one in five patients was very likely to consider internet-based interventions in case of depression. Younger patients expressed significantly stronger treatment preferences for psychotherapy and internet-based interventions than older patients. The most salient factors associated with treatment preferences were the patients' education and perceived self-efficacy. Conclusions: Patients with depression report individually different treatment preferences.Our results underline the importance of shared decision-making within primary care. Future studies should investigate treatment preferences for different types of internet-based interventions. PMID:29867605

Where Is the Evidence for "Evidence-Based" Therapy?

PubMed

Shedler, Jonathan

2018-06-01

The term evidence-based therapy is a de facto code word for manualized therapy, most often brief cognitive behavior therapy and its variants. It is widely asserted that "evidence-based" therapy is scientifically proven, superior to other forms of psychotherapy, and the gold standard of care. Research findings do not support such assertions. Research on evidence-based therapies demonstrates that they are weak treatments. They have not shown superiority to other forms of psychotherapy, few patients get well, and treatment benefits do not last. Questionable research practices create a distorted picture of the actual benefits of these therapies. Copyright © 2018 Jonathan Shedler. Published by Elsevier Inc. All rights reserved.

Mental health and psychosocial support in humanitarian settings: linking practice and research

PubMed Central

Tol, Wietse A; Barbui, Corrado; Galappatti, Ananda; Silove, Derrick; Betancourt, Theresa S; Souza, Renato; Golaz, Anne; van Ommeren, Mark

2014-01-01

This review links practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. We studied practice by reviewing reports of mental health and psychosocial support activities (2007–10); funding by analysis of the financial tracking service and the creditor reporting system (2007–09); and interventions by systematic review and meta-analysis. In 160 reports, the five most commonly reported activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%). Most interventions took place and were funded outside national mental health and protection systems. 32 controlled studies of interventions were identified, 13 of which were randomised controlled trials (RCTs) that met the criteria for meta-analysis. Two studies showed promising effects for strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis, because its definition varied across studies. In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed beneficial effects for several interventions (psychotherapy and psychosocial supports) compared with usual care or waiting list (standardised mean difference [SMD] −0.38, 95% CI −0.55 to −0.20). In children, meta-analysis of four RCTs failed to show an effect for symptoms of PTSD (−0.36, −0.83 to 0.10), but showed a beneficial effect of interventions (group psychotherapy, school-based support, and other psychosocial support) for internalising symptoms (six RCTs; SMD −0.24, −0.40 to −0.09). Overall, research and evidence focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little rigorous scrutiny. PMID:22008428

The relationship between attachment orientations and the course of depression in coronary artery disease patients: A secondary analysis of the SPIRR-CAD trial.

PubMed

Söllner, Wolfgang; Müller, Markus M; Albus, Christian; Behnisch, Rüdiger; Beutel, Manfred E; de Zwaan, Martina; Fritzsche, Kurt; Habermeier, Anita; Hellmich, Martin; Jordan, Jochen; Jünger, Jana; Ladwig, Karl-Heinz; Michal, Matthias; Petrowski, Katja; Ronel, Joram; Stein, Barbara; Weber, Cora; Weber, Rainer; Herrmann-Lingen, Christoph

2018-05-01

The relationship between attachment orientations and the recovery from depressive symptoms in patients diagnosed with coronary artery disease (CAD) with and without a psychotherapeutic intervention was examined in this study. In a multicenter trial of 570 depressed CAD patients (SPIRR-CAD), assigned to usual care plus either a stepwise psychotherapy intervention or one information session, 522 patients provided attachment data at baseline. Attachment was measured with the Relationship Scales Questionnaire (RSQ), yielding four attachment orientations. The primary outcome was change in Hospital Anxiety and Depression Scale depression (HADS-D) scores from baseline to follow-up at 18 months. Secondary outcomes were HADS-D scores at 1, 6, 12, and 24 months. Independent of treatment assignment, attachment was related to change in depression at 18 months (p < 0.01) with secure attachment resulting in a significant reduction (-2.72, SE = 0.27) in depression compared to dismissive-avoidant (-1.51, SE = 0.35, p = 0.040) and fearful-avoidant (-0.65, SE = 0.61, p = 0.012) attachment. Patients with anxious-preoccupied attachment showed changes similar to secure attachment (-2.01, SE = 0.47). An explorative subgroup analysis across all assessment time points revealed patients with a dismissive-avoidant attachment benefitted from psychotherapy (average mean difference = 0.93, SE = 0.47, p = 0.048). Attachment played an important role for improvement in depressive symptoms. Only dismissive-avoidant patients seemed to benefit from the intervention. The lack of improvement in fearful-avoidant patients shows a need for specific interventions for this group. www.clinicaltrials.govNCT00705965; www.isrctn.com ISRCTN76240576. Copyright © 2018 Elsevier Inc. All rights reserved.

The diagnosis and treatment of eating disorders.

PubMed

Herpertz, Stephan; Hagenah, Ulrich; Vocks, Silja; von Wietersheim, Jörn; Cuntz, Ulrich; Zeeck, Almut

2011-10-01

Eating disorders are of major significance both in clinical medicine and in society at large. Anorexia and bulimia nervosa almost exclusively afflict young persons, severely impairing their physical and mental health. The peak ages for these diseases are in late adolescence and young adulthood; patients therefore suffer setbacks both in school and/or in their occupational careers. This scientifically based S3 guideline was developed with the intention of improving the treatment of eating disorders and motivating future research in this area. The existing national and international guidelines on the three types of eating disorders were synoptically compared, the literature on the subject was systematically searched, and meta-analyses on bulimia nervosa and binge-eating disorder were carried out. 15 consensus conferences were held, as a result of which 44 evidence-based recommendations were issued. Anorexia and bulimia nervosa are diagnosed according to the ICD-10 criteria (International Classification of Diseases), binge-eating disorder according to those of the DSM (Diagnostic and Statistical Manual of Mental Disorders). Psychotherapy is the mainstay of treatment for all three disorders, and cognitive behavioral therapy is the form of psychotherapy best supported by the available evidence. The administration of selective serotonin reuptake inhibitors (SSRI) can be recommended as a flanking measure in the treatment of bulimia nervosa only. The evidence does not support any type of pharmacotherapy for anorexia nervosa or binge-eating disorder. Bulimia nervosa and binge-eating disorder can usually be treated on an outpatient basis, as long as they are no more than moderately severe; full-fledged anorexia nervosa is generally an indication for in-hospital treatment. This guideline contains evidence- and consensus-based recommendations for the diagnosis and treatment of eating disorders. If strictly implemented, it should result in improved care for the affected patients.

Staying well with bipolar disorder: A qualitative analysis of five-year follow-up interviews with young people.

PubMed

Crowe, M; Inder, M

2018-05-01

WHAT IS ALREADY KNOWN ABOUT THE TOPIC?: Bipolar disorder is a long-term condition which causes ongoing disruptions to the individual's life. Current evidence suggests that a combination of medication in combination with psychotherapy is more effective than medication alone. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: There are few published reports of the effects of interventions (pharmacological or psychotherapeutic) for treatment in bipolar disorder. While both psychotherapies provided a framework for understanding bipolar disorder each had specific strategies that participants identified as effective. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Because bipolar disorder is a long-term condition, its treatment needs to incorporate psychotherapeutic approaches that address the unique nature of its impact on each individual and provide individualized strategies for managing the disorder. Both Interpersonal and Social Rhythm Therapy and Specialist Supportive Care provide strategies that promote personal recovery. Introduction The primary outcomes from this study of psychotherapy for young people with bipolar disorder identified that most participants had continued to remain well. Given that up to 80% of people relapse within 2 years, it was important to establish how these participants described the process of staying well. Aim To examine how participants in a psychotherapy for young people with bipolar disorder study at 5-year follow-up described their experiences of the intervention and its impact on living with the disorder. Methods This qualitative study was conducted 5 years after participants had completed a psychotherapy intervention in a randomized controlled trial for young people with bipolar disorder. Thirty people were recruited into this qualitative study and interviewed regarding their experiences. The data were analysed using an inductive thematic analysis. Findings Three themes were identified from the data: self-awareness in the context of bipolar disorder; understanding my bipolar disorder; and learning to stay well with bipolar disorder. Conclusions Mental health nurses can promote the factors that participants found helpful in learning to stay well self-awareness, understanding the unique characteristics of their disorder, learning to take care of the self and stabilization of social rhythms. © 2018 John Wiley & Sons Ltd.

[Cooperation, Job Satisfaction and Burn Out - Sustainability in Outpatient Mental Health Care among Medical Specialists in Germany].

PubMed

Baumgardt, Johanna; Moock, Jörn; Rössler, Wulf; Kawohl, Wolfram

2017-04-01

Objective Cooperation, job satisfaction, and burn out risk are indicators of sustainability in mental health services. Thus they were assessed among registered medical specialists in outpatient mental health care in Germany. Method A postal survey consisting of three questionnaires about cooperation, job satisfaction, and burnout was carried out among all registered medical specialists in outpatient mental health care in Germany (n = 4,430). Results 14.1 % (n = 626) of the specialists responded to the survey. Quality and quantity of cooperation regarding mental health care services were rated diverse, job satisfaction was assessed medium to high, and burnout risk was low to medium. Higher job satisfaction correlated with good quality of cooperation, fewer years of practice, fewer patients' chronically ill, more patients who as well seek psychotherapy, and less time spent on cooperation. Low burn out risk correlated with good quality of cooperation, higher age, single practice setting and a higher amount of patients who as well seek psychotherapy. Conclusion Quality and quantity of cooperation in outpatient mental health care - especially regarding community mental health care institutions - should be fostered. Aspects to be considered to reinforce job satisfaction and minimize burn out risk are age, years of practice, quality and quantity of cooperation, practice setting, and the mixture of patients. © Georg Thieme Verlag KG Stuttgart · New York.

Ethical Issues for Direct-to-Consumer Digital Psychotherapy Apps: Addressing Accountability, Data Protection, and Consent

PubMed Central

Kreitmair, Karola

2018-01-01

This paper focuses on the ethical challenges presented by direct-to-consumer (DTC) digital psychotherapy services that do not involve oversight by a professional mental health provider. DTC digital psychotherapy services can potentially assist in improving access to mental health care for the many people who would otherwise not have the resources or ability to connect with a therapist. However, the lack of adequate regulation in this area exacerbates concerns over how safety, privacy, accountability, and other ethical obligations to protect an individual in therapy are addressed within these services. In the traditional therapeutic relationship, there are ethical obligations that serve to protect the interests of the client and provide warnings. In contrast, in a DTC therapy app, there are no clear lines of accountability or associated ethical obligations to protect the user seeking mental health services. The types of DTC services that present ethical challenges include apps that use a digital platform to connect users to minimally trained nonprofessional counselors, as well as services that provide counseling steered by artificial intelligence and conversational agents. There is a need for adequate oversight of DTC nonprofessional psychotherapy services and additional empirical research to inform policy that will provide protection to the consumer. PMID:29685865

Does prior psychotherapy experience affect the course of cognitive-behavioural group therapy for social anxiety disorder?

PubMed

Delsignore, Aba

2008-08-01

To examine whether and how different patterns of psychotherapy history (no prior therapy, successful therapy experience, and unsuccessful therapy experience) affect the outcome of future treatment among patients undergoing cognitive-behavioural group therapy for social anxiety disorder. Fifty-seven patients with varying histories of psychotherapy participating in cognitive-behavioural group treatment for social anxiety disorder were included in the study. Symptom severity (including anxiety, depression, self-efficacy, and global symptom severity) was assessed at pre- and posttreatment. A therapist-rated measure of patient therapy engagement was included as a process variable. First-time therapy patients showed more favourable pretreatment variables and achieved greater benefit from group therapy. Among patients with unsuccessful therapy experience, substantial gains were attained by those who were able to actively engage in the therapy process. Patients rating previous therapies as successful could benefit the least and tended to stagnate. Possible explanations for group differences and clinical implications are discussed. Prior psychotherapy experience affects the course of cognitive-behavioural group therapy in patients with social phobias. While patients with negative therapy experience may need extensive support in being and remaining actively engaged, those rating previous therapies as successful should be assessed very carefully and may benefit from a major focus on relational aspects.

[The way to proceed in psychotherapy--focusing on the framework of phobias and obsessive-compulsive stories].

PubMed

Nishimura, Ryoji

2012-01-01

Compulsion becomes long-term when treatment is commenced with very severe resistance. Patients showing emotional changes are rare compared to those with conversion and phobic disorders. However, most people improve when careful treatment is carried out. Although there are those in whom drug treatment is effective, drug treatment and psychotherapy are concomitantly used in most cases. In this lecture, the characteristics of compulsion were psychodynamically investigated regarding: 1. Central conflict, 2. Defense mechanisms, 3. Condition of love life (including sex life), 4. Growth history, by comparing with phobias. When the life of the inner-self protrudes, obsessive-compulsive patients try to contradict and deny this. The symptoms sometimes directly represent the mental conflict of the person, and sometimes the symptom formation process may be understood to some extent. It is said that such cases are suitable for psychotherapy. Psychodynamic psychotherapy involves regaining the continuity of emotional life divided due to defenses such as negation, reaction formation, and isolation. Meanwhile, the real nature of phobias is avoidance and escape. Therefore, the trick in proceeding with interviews is to lead the phobia patient to areas which they avoid during interviews and areas which they avoid in daily life, and to have the patient enter these fields at times by encouraging them.

Mindfulness Meditation in Clinical Practice

ERIC Educational Resources Information Center

Salmon, Paul; Sephton, Sandra; Weissbecker, Inka; Hoover, Katherine; Ulmer, Christi; Studts, Jamie L.

2004-01-01

The practice of mindfulness is increasingly being integrated into contemporary clinical psychology. Based in Buddhist philosophy and subsequently integrated into Western health care in the contexts of psychotherapy and stress management, mindfulness meditation is evolving as a systematic clinical intervention. This article describes…

Opinions of general practitioners about psychotherapy and their relationships with mental health professionals in the management of major depression: A qualitative survey

PubMed Central

Dumesnil, Hélène; Apostolidis, Thémis; Verger, Pierre

2018-01-01

Background French general practitioners (GPs) refer their patients with major depression to psychiatrists or for psychotherapy at particularly low rates. Objectives This qualitative study aims to explore general practitioners' (GP) opinions about psychotherapy, their relationships with mental health professionals, their perceptions of their role and that of psychiatrists in treating depression, and the relations between these factors and the GPs' strategies for managing depression. Methods In 2011, in-depth interviews based on a semi-structured interview guide were conducted with 32 GPs practicing in southeastern France. Verbatim transcripts were examined by analyzing their thematic content. Results We identified three profiles of physicians according to their opinions and practices about treatment strategies for depression: pro-pharmacological treatment, pro-psychotherapy and those with mixed practices. Most participants considered their relationships with psychiatrists unsatisfactory, would like more and better collaboration with them and shared the same concept of management in general practice. This concept was based both on the values and principles of practice shared by GPs and on their strong differentiation of their management practices from those of psychiatrists, Conclusion Several attitudes and values common to GPs might contribute to their low rate of referrals for psychotherapy in France: strong occupational identity, substantial variations in GPs' attitudes and practices regarding depression treatment strategies, representations sometimes unfavorable toward psychiatrists. Actions to develop a common culture and improve cooperation between GPs and psychiatrists are essential. They include systems of collaborative care and the development of interdisciplinary training common to GPs and psychiatrists practicing in the same area. PMID:29385155

A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes.

PubMed

O'Mahen, Heather; Himle, Joseph A; Fedock, Gina; Henshaw, Erin; Flynn, Heather

2013-07-01

Perinatal women with identified depression in prenatal care settings have low rates of engagement and adherence with depression-specific psychotherapy. We report the feasibility and symptom outcomes of Cognitive Behavioral Therapy (CBT) modified (mCBT) to address the needs of perinatal, low-income women with Major Depressive Disorder (MDD). Pregnant women (n = 1421) were screened for depressive symptoms in obstetrics clinics in conjunction with prenatal care visits. A total of 59 women met diagnostic criteria for MDD; 55 women were randomly assigned to mCBT or Treatment as Usual (TAU). The mCBT intervention included an initial engagement session, outreach, specific perinatal content and interpersonal components. Measures were gathered at pre-treatment, 16 week post-randomization, and 3-month follow-up. Most participants attended at least one CBT session and met study criteria for treatment adherence. Active research staff outreach promoted engagement and retention in the trial. Treatment satisfaction was rated as very good. In both observed and multiple imputation results, women who received mCBT demonstrated greater improvement in depressed mood than those in TAU at 16-week post-randomization and 3-month follow-up, Cohen's d = -0.71 (95% CI -4.93, -5.70). Modified CBT offers promise as a feasible and acceptable treatment for perinatal women with low-incomes in prenatal care settings. Targeted delivery and content modifications are needed to engage populations tailored to setting and psychosocial challenges specific to the perinatal period. © 2013 Wiley Periodicals, Inc.

Management of sexual disorders.

PubMed

Kok, L P

1993-12-01

Sexual disorders comprise (a) disorders of function in which sexual functioning is disturbed leading to problems during sexual intercourse, (b) disorders of orientation whereby a non heterosexual partner or object is sought, and (c) other disorders involving aberrant psychosexual behaviour. In managing such problems a thorough psychosexual assessment is required in order to ascertain the exact nature of the problem and what the precipitating, predisposing and prolonging factors are. In disorders of orientation and disorders involving aberrant sexual behaviours, the developmental history and early childhood relationships must be looked into carefully. Laboratory investigations are usually indicated in erectile dysfunction as up to 80% would have an organic aetiology--vascular, neurological and endocrine disorders have to be ruled out. Treatment of the various conditions involves general sexual counselling, behaviour therapy including stress management, psychotherapy, marital therapy and drug therapy as indicated. However, in erectile dysfunction, drug treatment (including intracavernosal injections), mechanical aids, or surgery may be indicated; and in transsexualism--for those who are unable to revert to accepting their natural status--a sex reassignment operation is the treatment of choice.

Strategies of Intervention with Public Offenders.

ERIC Educational Resources Information Center

Chaneles, Sol, Ed.

1981-01-01

Reviews intervention strategies with public offenders, including learning therapy, education, group assertive training, and the use of volunteers. The l0 articles deal with inmates' rights in terms of health care and psychotherapy, and evaluation of social programs, and a psychodrama program description/model. (JAC)

Oral health considerations in anorexia and bulimia nervosa. 2. Multidisciplinary management and personalized dental care.

PubMed

Bassiouny, Mohamed A; Tweddale, Elizabeth

2017-01-01

This article outlines a comprehensive, multidisciplinary strategy for treatment of patients with anorexia and bulimia nervosa. In this approach, primary medical intervention and emergency dental care are followed by the staging of treatment phases that integrate medical care, psychotherapy, nutritional counseling, and dental management, which may encompass various treatment options for repair of damaged dentition. Emphasis is placed on prevention of further tissue damage during all phases of management and following completion of the treatment course.

Diversity of effective treatments of panic attacks: what do they have in common?

PubMed

Roth, Walton T

2010-01-01

By comparing efficacious psychological therapies of different kinds, inferences about common effective treatment mechanisms can be made. We selected six therapies for review on the basis of the diversity of their theoretical rationales and evidence for superior efficacy: psychoanalytic psychotherapy, hypercapnic breathing training, hypocapnic breathing training, reprocessing with and without eye-movement desensitization, muscle relaxation, and cognitive behavior therapy. The likely common element of all these therapies is that they reduce the immediate expectancy of a panic attack, disrupting the vicious circle of fearing fear. Modifying expectation is usually regarded as a placebo mechanism in psychotherapy, but may be a specific treatment mechanism for panic. The fact that this is seldom the rationale communicated to the patient creates a moral dilemma: Is it ethical for therapists to mislead patients to help them? Pragmatic justification of a successful practice is a way out of this dilemma. Therapies should be evaluated that deal with expectations directly by promoting positive thinking or by fostering non-expectancy.

An Archetype of the Collaborative Efforts of Psychotherapy and Psychopharmacology in Successfully Treating Dissociative Identity Disorder with Comorbid Bipolar Disorder

PubMed Central

Lakshmanan, Manu N.; Meier, Stacey L. Colton; Meier, Robert S.

2010-01-01

We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient’s comorbid bipolar disorder contributed to the patient’s instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully diagnosing and treating existing comorbid conditions may be the most important aspect in treating dissociative identity disorder. We present our experience of successfully treating a patient with dissociative identity disorder and bipolar disorder using this collaborative method. PMID:20805917

An archetype of the collaborative efforts of psychotherapy and psychopharmacology in successfully treating dissociative identity disorder with comorbid bipolar disorder.

PubMed

Lakshmanan, Manu N; Meier, Stacey L Colton; Meier, Robert S; Lakshmanan, Ramaswamy

2010-07-01

We present a case where dissociative identity disorder was effectively treated with memory retrieval psychotherapy. However, the patient's comorbid bipolar disorder contributed to the patient's instability and fortified the amnesiac barriers that exist between alter personality states in dissociative identity disorder, which made memory retrieval difficult to achieve. Implications from this case indicate that a close collaboration between psychologist and psychiatrist focused on carefully diagnosing and treating existing comorbid conditions may be the most important aspect in treating dissociative identity disorder. We present our experience of successfully treating a patient with dissociative identity disorder and bipolar disorder using this collaborative method.

CULTURAL COMPETENCE AND PSYCHOTHERAPY: APPLYING ANTHROPOLOGICALLY INFORMED CONCEPTIONS OF CULTURE

PubMed Central

Lakes, Kimberley; López, Steven R.; Garro, Linda C.

2013-01-01

The authors apply two contemporary notions of culture to advance the conceptual basis of cultural competence in psychotherapy: Kleinman’s (1995) definition of culture as what is at stake in local, social worlds, and Mattingly and Lawlor’s (2001) concept of shared narratives between practitioners and patients. The authors examine these cultural constructs within a clinical case of an immigrant family caring for a young boy with an autism-spectrum disorder. Their analysis suggests that the socially based model of culture and the concept of shared narratives have the potential to broaden and enrich the definition of cultural competence beyond its current emphasis on the presumed cultural differences of specific racial and ethnic minority groups. PMID:22122131

From the laboratory to the therapy room: National dissemination and implementation of evidence-based psychotherapies in the U.S. Department of Veterans Affairs Health Care System.

PubMed

Karlin, Bradley E; Cross, Gerald

2014-01-01

Despite their established efficacy and recommendation--often as first-line treatments--in clinical practice guidelines, evidence-based psychotherapies (EBPs) have largely failed to make their way into mainstream clinical settings. Numerous attempts over the years to promote the translation of EBPs from science to practice, typically relying on one-dimensional dissemination approaches, have yielded limited success. As part of the transformation of its mental health care system, the Veterans Health Administration (VHA) of the U.S. Department of Veterans Affairs (VA) is working to disseminate and implement a number of EBPs for various mental and behavioral health conditions throughout the VA health care system. This article examines VHA's multidimensional model and specific strategies, involving policy, provider, local systems, patient, and accountability levels, for promoting the national dissemination and implementation of EBPs in VHA. In addition, the article identifies key lessons learned and next steps for further promoting EBP delivery and sustainability in the VA health care system. Beyond promoting the availability of effective treatments for veterans returning from Iraq and Afghanistan and for veterans of previous combat eras, VHA's EBP dissemination and implementation model and key lessons learned may help to inform other private and public health care systems interested in disseminating and implementing EBPs. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Effectiveness of adjunct psychotherapy for cancer treatment: a review.

PubMed

Chen, YokeYong; Ahmad, Mahadir

2018-05-16

Psychotherapies were offered to alleviate psychological and physical symptoms; however, most psychological interventions were only delivered after cancer treatment. Newly diagnosed cancer patients experienced psychological distress while waiting for treatments. This review paper focused on randomized control trial studies, aimed to investigate the effectiveness of psychological intervention among newly diagnosed cancer patients. Eight randomized control trial papers were found in recent 10 years period through electronic database. A moderate to large effect size was detected on the outcomes, ranging from 0.43 to 0.89. This indicated that psychological-based prehabilitation with standard care yielded better outcomes than standard care alone. Psychological-based prehabilitation provides evidence in its effectiveness to reduce psychological distress, functional impairment, recurrence of cancer, numbers of immune reactivity and sleeping quality; however, inconsistent with longer survival result among cancer patients. In conclusion, psychological-based prehabilitation before cancer treatment is necessary for better treatment outcome, and future research is needed to investigate more directly the outcome.

Counterbalancing patient demands with evidence: results from a pan-Canadian randomized clinical trial of brief supportive-expressive group psychotherapy for women with systemic lupus erythematosus.

PubMed

Dobkin, Patricia L; Da Costa, Deborah; Joseph, Lawrence; Fortin, Paul R; Edworthy, Steven; Barr, Susan; Ensworth, Stephanie; Esdaile, John M; Beaulieu, André; Zummer, Michel; Senécal, Jean-Luc; Goulet, Jean-Richard; Choquette, Denis; Rich, Eric; Smith, Doug; Cividino, Alfred; Gladman, Dafna; St-Pierre, Yvan; Clarke, Ann E

2002-01-01

To evaluate the effect of Brief Supportive-Expressive Group Psychotherapy as an adjunct to standard medical care in reducing psychological distress, medical symptoms, and health care costs and improving quality of life in women with systemic lupus erythematosus (SLE). A randomized clinical trial was conducted with 133 SLE female patients from 9 clinics across Canada. Clinical and psychosocial measures were taken at baseline, posttreatment, and 6 and 12 months posttreatment. Outcomes assessed were psychological distress, quality of life, disease activity, health service utilization, and diminished productivity. Intention-to-treat analyses revealed that there were no clinically important group differences on any of the outcome measures. Although both groups improved over time on several measures (e.g., decreases in psychological distress, stress, and emotion-oriented coping), these changes could not be attributed to the psychotherapeutic intervention. Thus, evidence does not support the referral of these patients to this type of intervention.

Behavioural medicine and gastrointestinal disorders: the promise of positive psychology.

PubMed

Keefer, Laurie

2018-04-12

Psychosocial risk factors linked to brain-gut dysregulation are prevalent across the spectrum of gastrointestinal disorders and are associated with poor patient outcomes. Robust and reproducible data in the areas of behavioural intervention science and the brain-gut axis have led to major advances in patient care, including the routine use of brain-gut psychotherapies to manage digestive symptoms and optimize coping. The logical next step for the emerging field of psychogastroenterology is to develop a scientific framework that enables the identification of those individual characteristics and coping styles that buffer patients against the negative psychological effects of chronic gastrointestinal disorders. A shift towards a strength-based, positive psychological science of gastrointestinal disorders could facilitate the integration of early, effective psychological care into gastroenterology practice. In this Perspective, I discuss the potential role of three human strengths with relevance to gastrointestinal health - resilience, optimism and self-regulation - and how these three constructs can be cultivated through existing or emerging brain-gut psychotherapies.

For whom does it work? moderators of outcome on the effect of a transdiagnostic internet-based maintenance treatment after inpatient psychotherapy: randomized controlled trial.

PubMed

Ebert, David Daniel; Gollwitzer, Mario; Riper, Heleen; Cuijpers, Pim; Baumeister, Harald; Berking, Matthias

2013-10-10

Recent studies provide evidence for the effectiveness of Internet-based maintenance treatments for mental disorders. However, it is still unclear which participants might or might not profit from this particular kind of treatment delivery. The study aimed to identify moderators of treatment outcome in a transdiagnostic Internet-based maintenance treatment (TIMT) offered to patients after inpatient psychotherapy for mental disorders in routine care. Using data from a randomized controlled trial (N=400) designed to test the effectiveness of TIMT, we performed secondary analyses to identify factors moderating the effects of TIMT (intervention) when compared with those of a treatment-as-usual control condition. TIMT involved an online self-management module, asynchronous patient-therapist communication, a peer support group, and online-based progress monitoring. Participants in the control condition had unstructured access to outpatient psychotherapy, standardized outpatient face-to-face continuation treatment, and psychotropic management. Self-reports of psychopathological symptoms and potential moderators were assessed at the start of inpatient treatment (T1), at discharge from inpatient treatment/start of TIMT (T2), and at 3-month (T3) and 12-month follow-up (T4). Education level, positive outcome expectations, and diagnoses significantly moderated intervention versus control differences regarding changes in outcomes between T2 and T3. Only education level moderated change differences between T2 and T4. The effectiveness of the intervention (vs control) was more pronounced among participants with a low (vs high) education level (T2-T3: B=-0.32, SE 0.16, P=.049; T2-T4: B=-0.42, SE 0.21, P=.049), participants with high (vs low) positive outcome expectations (T2-T3: B=-0.12, SE 0.05, P=.02) and participants with anxiety disorder (vs mood disorder) (T2-T3: B=-0.43, SE 0.21, P=.04). Simple slope analyses revealed that despite some subgroups benefiting less from the intervention than others, all subgroups still benefited significantly. This transdiagnostic Internet-based maintenance treatment might be suitable for a wide range of participants differing in various clinical, motivational, and demographic characteristics. The treatment is especially effective for participants with low education levels. These findings may generalize to other Internet-based maintenance treatments.

Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients With Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial

PubMed Central

Ell, Kathleen; Jin, Haomiao; Vidyanti, Irene; Chou, Chih-Ping; Lee, Pey-Jiuan; Gross-Schulman, Sandra; Sklaroff, Laura Myerchin; Belson, David; Nezu, Arthur M; Hay, Joel; Wang, Chien-Ju; Scheib, Geoffrey; Di Capua, Paul; Hawkins, Caitlin; Liu, Pai; Ramirez, Magaly; Wu, Brian W; Richman, Mark; Myers, Caitlin; Agustines, Davin; Dasher, Robert; Kopelowicz, Alex; Allevato, Joseph; Roybal, Mike; Ipp, Eli; Haider, Uzma; Graham, Sharon; Mahabadi, Vahid; Guterman, Jeffrey

2018-01-01

Background Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. Objective The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. Methods DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. Results DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5.16; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.02); decreased prevalence of major depression (odds ratio, OR: supported care vs usual care=0.45, technology-facilitated care vs usual care=0.33; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.007); and reduced functional disability as measured by Sheehan Disability Scale scores (LSE: usual care=3.21, supported care=2.61, technology-facilitated care=2.59; P value: supported care vs usual care=.04, technology-facilitated care vs usual care=.03). Technology-facilitated care was significantly associated with depression remission (technology-facilitated care vs usual care: OR=2.98, P=.04); increased satisfaction with care for emotional problems among depressed patients (LSE: usual care=3.20, technology-facilitated care=3.70; P=.05); reduced total cholesterol level (LSE: usual care=176.40, technology-facilitated care=160.46; P=.01); improved satisfaction with diabetes care (LSE: usual care=4.01, technology-facilitated care=4.20; P=.05); and increased odds of taking an glycated hemoglobin test (technology-facilitated care vs usual care: OR=3.40, P<.001). Conclusions Both the technology-facilitated care and supported care delivery models showed potential to improve 6-month depression and functional disability outcomes. The technology-facilitated care model has a greater likelihood to improve depression remission, patient satisfaction, and diabetes care quality. PMID:29685872

Tailored care for somatoform vertigo/dizziness: study protocol for a randomised controlled trial evaluating integrative group psychotherapy.

PubMed

Lahmann, Claas; Henningsen, P; Dieterich, M; Radziej, K; Schmid, G

2015-08-01

Vertigo/dizziness (VD) ranks high in lifetime prevalence and clinical relevance. Nearly half of the complex VD disorders presenting at specialised units for vertigo or otoneurological disorders are not fully explained by an identifiable medical illness, but instead are related to anxiety, depressive, or somatoform disorders. Although there is some evidence that psychotherapy may be effective for these patients, therapeutic options remain unsatisfactory. This report describes the objectives, design and methods of a randomised, controlled clinical trial, evaluating the efficacy of manualised, multimodal group psychotherapy, based on integrative psychotherapy (IPT) and tailored to subgroups of mental disorders in medically unexplained VD. This psychotherapeutic approach will be compared to self-help groups (n = 172; n = 86 per study arm). Improvements with regard to handicap due to VD at 12 months follow-up will serve as primary outcome. Additionally, measures of generic quality of life, severity of vertigo, depression, anxiety, somatisation as well as Head Impulse Test and Computerized Static Posturography will be applied. We will also analyse the cost-effectiveness of this trial. The study aims to improve treatment of this therapeutically underserved population who are often severely impaired in their working and daily lives. ClinicalTrials.gov Identifier: NCT02320851. This is an on-going study; recruitment for the study is about to start.

Ethical Issues for Direct-to-Consumer Digital Psychotherapy Apps: Addressing Accountability, Data Protection, and Consent.

PubMed

Martinez-Martin, Nicole; Kreitmair, Karola

2018-04-23

This paper focuses on the ethical challenges presented by direct-to-consumer (DTC) digital psychotherapy services that do not involve oversight by a professional mental health provider. DTC digital psychotherapy services can potentially assist in improving access to mental health care for the many people who would otherwise not have the resources or ability to connect with a therapist. However, the lack of adequate regulation in this area exacerbates concerns over how safety, privacy, accountability, and other ethical obligations to protect an individual in therapy are addressed within these services. In the traditional therapeutic relationship, there are ethical obligations that serve to protect the interests of the client and provide warnings. In contrast, in a DTC therapy app, there are no clear lines of accountability or associated ethical obligations to protect the user seeking mental health services. The types of DTC services that present ethical challenges include apps that use a digital platform to connect users to minimally trained nonprofessional counselors, as well as services that provide counseling steered by artificial intelligence and conversational agents. There is a need for adequate oversight of DTC nonprofessional psychotherapy services and additional empirical research to inform policy that will provide protection to the consumer. ©Nicole Martinez-Martin, Karola Kreitmair. Originally published in JMIR Mental Health (http://mental.jmir.org), 23.04.2018.

Protocol for the ENCODE trial: evaluating a novel online depression intervention for persons with epilepsy.

PubMed

Meyer, Björn; Weiss, Mario; Holtkamp, Martin; Arnold, Stephan; Brückner, Katja; Schröder, Johanna; Scheibe, Franziska; Nestoriuc, Yvonne

2017-02-07

Depression is common among persons with epilepsy (PwE), affecting roughly one in three individuals, and its presence is associated with personal suffering, impaired quality of life, and worse prognosis. Despite the availability of effective treatments, depression is often overlooked and treated inadequately in PwE, in part because of assumed concerns over drug interactions or proconvulsant effects of antidepressants. Internet-administered psychological interventions might complement antidepressant medication or psychotherapy, and preliminary evidence suggests that they can be effective. However, no trial has yet examined whether an Internet intervention designed to meet the needs of PwE can achieve sustained reductions in depression and related symptoms, such as anxiety, when offered as adjunct to treatment as usual. This randomized controlled trial will include 200 participants with epilepsy and a current depressive disorder, along with currently at least moderately elevated depression (Patient Health Questionnaire (PHQ-9) sum score of at least 10). Patients will be recruited via epilepsy treatment centers and other sources, including Internet forums, newspaper articles, flyers, posters, and media articles or advertisements, in German-speaking countries. Main inclusion criteria are: self-reported diagnosis of epilepsy and a depressive disorder, as assessed with a phone-administered structured diagnostic interview, none or stable antidepressant medication, no current psychotherapy, no other major psychiatric disorder, no acute suicidality. Participants will be randomly assigned to either (1) a care-as-usual/waitlist (CAU/WL) control group, in which they receive CAU and are given access to the Internet intervention after 3 months (that is, a CAU/WL control group), or (2) a treatment group that may also use CAU and in addition immediately receives six-month access to the novel, Internet-administered intervention. The primary outcome measure is the PHQ-9, collected at three months post-baseline; secondary measures include self-reported anxiety, work and social adjustment, epilepsy symptoms (including seizure frequency and severity), medication adherence, potential negative treatment effects and health-related quality of life. Measurements are collected online at pre-treatment (T0), three months (T1), six months (T2), and nine months (T3). Results of this trial are expected to extend the body of knowledge with regard to effective and efficient treatment options for PwE who experience elevated depression and anxiety. ClinicalTrials.gov: NCT02791724 . Registered 01 June 2016.

Interpersonal psychotherapy versus treatment as usual for PTSD and depression among Sichuan earthquake survivors: a randomized clinical trial

PubMed Central

2014-01-01

Background Without effective treatment, PTSD and depression can cause persistent disability in disaster-affected populations. Methods Our objective was to test the efficacy of Interpersonal Psychotherapy (IPT) delivered by trained local personnel compared with treatment as usual (TAU) for Posttraumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) among adults affected by the Sichuan 2008 earthquake. A small randomized controlled trial of IPT + TAU versus TAU alone was delivered by local mental health personnel in Shifang, China. Between July 2011 and January 2012, 49 adults ≥ 18 years with PTSD, MDD or both were enrolled and randomized to 12 weekly sessions of IPT + TAU (27) or TAU (22) alone x 12 weeks. IPT was then offered to the TAU group. Unblinded follow up assessments were conducted at three and six months. IPT was a 12 session, weekly one hour treatment delivered by local personnel who were trained and supervised in IPT. TAU was continuation of prescribed psychotropic medication (if applicable) and crisis counseling, as needed. Main Outcome(s) and Measures (s): Clinician Administered PTSD Scale (CAPS) PTSD diagnosis; Structured Clinical Interview for DSM-IV (SCID) for MDD diagnosis. Secondary measures included PTSD/depression symptoms, interpersonal conflict/anger, social support, self-efficacy and functioning. Results Using an intent-to-treat analysis, 22 IPT + TAU and 19 TAU participants were compared at three months post-baseline. A significantly greater reduction of PTSD and MDD diagnoses was found in the IPT group (51.9%, 30.1%, respectively) versus the TAU group (3.4%, 3.4%, respectively). Despite the small sample, the estimates for time-by-condition analyses of target outcomes (2.37 for PTSD (p = .018) and 1.91 for MDD (p = .056)) indicate the improvement was better in the IPT + TAU condition versus the TAU group. Treatment gains were maintained at 6 months for the IPT group. A similar treatment response was observed in the TAU group upon receipt of IPT. Conclusions This initial study shows that IPT is a promising treatment for reducing PTSD and depression, the two major mental health disorders affecting populations surviving natural disaster, using a design that builds local mental health care capacity. Trial Registration ClinicalTrials.Gov number, NCT01624935. PMID:25254070

TIGA-CUB - manualised psychoanalytic child psychotherapy versus treatment as usual for children aged 5-11 years with treatment-resistant conduct disorders and their primary carers: study protocol for a randomised controlled feasibility trial.

PubMed

Edginton, Elizabeth; Walwyn, Rebecca; Burton, Kayleigh; Cicero, Robert; Graham, Liz; Reed, Sadie; Tubeuf, Sandy; Twiddy, Maureen; Wright-Hughes, Alex; Ellis, Lynda; Evans, Dot; Hughes, Tom; Midgley, Nick; Wallis, Paul; Cottrell, David

2017-09-15

The National Institute for Health and Care Excellence (NICE) recommends evidence-based parenting programmes as a first-line intervention for conduct disorders (CD) in children aged 5-11 years. As these are not effective in 25-33% of cases, NICE has requested research into second-line interventions. Child and Adolescent Psychotherapists (CAPTs) address highly complex problems where first-line treatments have failed and there have been small-scale studies of Psychoanalytic Child Psychotherapy (PCP) for CD. A feasibility trial is needed to determine whether a confirmatory trial of manualised PCP (mPCP) versus Treatment as Usual (TaU) for CD is practicable or needs refinement. The aim of this paper is to publish the abridged protocol of this feasibility trial. TIGA-CUB (Trial on improving Inter-Generational Attachment for Children Undergoing Behaviour problems) is a two-arm, pragmatic, parallel-group, multicentre, individually randomised (1:1) controlled feasibility trial (target n = 60) with blinded outcome assessment (at 4 and 8 months), which aims to develop an optimum practicable protocol for a confirmatory, pragmatic, randomised controlled trial (RCT) (primary outcome: child's behaviour; secondary outcomes: parental reflective functioning and mental health, child and parent quality of life), comparing mPCP and TaU as second-line treatments for children aged 5-11 years with treatment-resistant CD and inter-generational attachment difficulties, and for their primary carers. Child-primary carer dyads will be recruited following a referral to, or re-referral within, National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) after an unsuccessful first-line parenting intervention. PCP will be delivered by qualified CAPTs working in routine NHS clinical practice, using a trial-specific PCP manual (a brief version of established PCP clinical practice). Outcomes are: (1) feasibility of recruitment methods, (2) uptake and follow-up rates, (3) therapeutic delivery, treatment retention and attendance, intervention adherence rates, (4) follow-up data collection, and (5) statistical, health economics, process evaluation, and qualitative outcomes. TIGA-CUB will provide important information on the feasibility and potential challenges of undertaking a confirmatory RCT to evaluate the effectiveness and cost-effectiveness of mPCP. Current Controlled Trials, ID: ISRCTN86725795 . Registered on 31 May 2016.

Missing Mechanism Information

ERIC Educational Resources Information Center

Tryon, Warren W.

2009-01-01

The first recommendation Kazdin made for advancing the psychotherapy research knowledge base, improving patient care, and reducing the gulf between research and practice was to study the mechanisms of therapeutic change. He noted, "The study of mechanisms of change has received the least attention even though understanding mechanisms may well be…

Indian family systems, collectivistic society and psychotherapy

PubMed Central

Chadda, Rakesh K.; Deb, Koushik Sinha

2013-01-01

Indian society is collectivistic and promotes social cohesion and interdependence. The traditional Indian joint family, which follows the same principles of collectivism, has proved itself to be an excellent resource for the care of the mentally ill. However, the society is changing with one of the most significant alterations being the disintegration of the joint family and the rise of nuclear and extended family system. Although even in today's changed scenario, the family forms a resource for mental health that the country cannot neglect, yet utilization of family in management of mental disorders is minimal. Family focused psychotherapeutic interventions might be the right tool for greater involvement of families in management of their mentally ill and it may pave the path for a deeper community focused treatment in mental disorders. This paper elaborates the features of Indian family systems in the light of the Asian collectivistic culture that are pertinent in psychotherapy. Authors evaluate the scope and effectiveness of family focused psychotherapy for mental disorders in India, and debate the issues and concerns faced in the practice of family therapy in India. PMID:23858272

Psychotherapy for neurologists.

PubMed

Hobday, Gabrielle S; Gabbard, Glen O

2009-07-01

Psychotherapy has traditionally been regarded as the purview of psychiatry rather than neurology. Yet, the doctor-patient relationship is fundamental to both specialties, and the principles that derive from psychotherapy theory and practice apply to that relationship regardless of the specialty. It is common knowledge that a large proportion of patients seen in the context of the practice of medicine have some kind of emotional disturbance. Moreover, patients with organic disease may also have significant emotional difficulties that complicate both the primary illness and its treatment. This experience inevitably has drawn attention to the need for the nonpsychiatric physician to have an understanding and proficiency in psychiatric diagnosis and psychotherapeutic principles. In this article, we consider basic psychotherapeutic principles that are useful in the everyday practice of neurologists and other nonpsychiatric physicians. These skills are important not only for practical reasons, but also because responsiveness to their emotional distress is essential to maintain empathy and caring as cornerstones of the art of medicine. With the use of clinical examples to illustrate these principles, we hope that readers can apply them to their own clinical experiences.

Indian family systems, collectivistic society and psychotherapy.

PubMed

Chadda, Rakesh K; Deb, Koushik Sinha

2013-01-01

Indian society is collectivistic and promotes social cohesion and interdependence. The traditional Indian joint family, which follows the same principles of collectivism, has proved itself to be an excellent resource for the care of the mentally ill. However, the society is changing with one of the most significant alterations being the disintegration of the joint family and the rise of nuclear and extended family system. Although even in today's changed scenario, the family forms a resource for mental health that the country cannot neglect, yet utilization of family in management of mental disorders is minimal. Family focused psychotherapeutic interventions might be the right tool for greater involvement of families in management of their mentally ill and it may pave the path for a deeper community focused treatment in mental disorders. This paper elaborates the features of Indian family systems in the light of the Asian collectivistic culture that are pertinent in psychotherapy. Authors evaluate the scope and effectiveness of family focused psychotherapy for mental disorders in India, and debate the issues and concerns faced in the practice of family therapy in India.

Psychoanalysis and spirituality-catastrophic change and becoming "o".

PubMed

Nachmani, Gilead

2009-01-01

This article considers the relationship between post-Kleinian psychoanalysis and spiritual experience in the healing process of a physically ill man undergoing medical care for an unknown disorder. He entered psychoanalytic psychotherapy after two years of being ill and after numerous medical interventions had failed. The psychotherapy involved certain religious experiences in the patient and the analyst that attuned them to one another. It also involved his fighting with doctors, family, and analyst. The fights were considered a transcendence of his troubling life, a mustering of courage and strength to live with illness and loss, and his use of a godlike fantasy figure, which could also be considered as a vivid good internal object. The therapeutic work was punctuated by numerous instances of catastrophic change, hope, and disappointment and by his not knowing about why his body acted as it has and why important people treated him as they had. He learned to know, in the sense that Bion used the term, to live with adversity, and return to as normal a life as is possible. The psychotherapy is a work in progress.

The Effects of Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Analysis System of Psychotherapy added to Treatment as Usual on suicidal ideation in chronic depression: Results of a randomized-clinical trial.

PubMed

Forkmann, Thomas; Brakemeier, Eva-Lotta; Teismann, Tobias; Schramm, Elisabeth; Michalak, Johannes

2016-08-01

Suicidal ideation (SI) is common in chronic depression, but only limited evidence exists for the assumption that psychological treatments for depression are effective for reducing SI. In the present study, the effects of Mindfulness-based Cognitive Therapy (MBCT; group version) plus treatment-as-usual (TAU: individual treatment by either a psychiatrist or a licensed psychotherapist, including medication when indicated) and Cognitive Behavioral Analysis System of Psychotherapy (CBASP; group version) plus TAU on SI was compared to TAU alone in a prospective, bi-center, randomized controlled trial. The sample consisted of 106 outpatients with chronic depression. Multivariate regression analyses revealed different results, depending on whether SI was assessed via self-report (Beck Depression Inventory suicide item) or via clinician rating (Hamilton Depression Rating Scale suicide item). Whereas significant reduction of SI emerged when assessed via clinician rating in the MBCT and CBASP group, but not in the TAU group while controlling for changes in depression, there was no significant effect of treatment on SI when assessed via self-report. SI was measured with only two single items. Because all effects were of small to medium size and were independent of effects from other depression symptoms, the present results warrant the application of such psychotherapeutical treatment strategies like MBCT and CBASP for SI in patients with chronic depression. Copyright © 2016 Elsevier B.V. All rights reserved.

Delivering Clinical Practice Guideline-Concordant Care for PTSD and Major Depression in Military Treatment Facilities.

PubMed

Hepner, Kimberly A; Farris, Coreen; Farmer, Carrie M; Iyiewuare, Praise O; Tanielian, Terri; Wilks, Asa; Robbins, Michael; Paddock, Susan M; Pincus, Harold Alan

2018-04-01

Providing accessible, high-quality care for psychological health (PH) conditions, such as posttraumatic stress disorder (PTSD) and major depressive disorder (MDD), is important to maintaining a healthy, mission-ready force. It is unclear whether the current system of care meets the needs of service members with PTSD or MDD, and little is known about the barriers to delivering guideline-concordant care. RAND used existing provider workforce data, a provider survey, and key informant interviews to (1) provide an overview of the PH workforce at military treatment facilities (MTFs), (2) examine the extent to which care for PTSD and MDD in military treatment facilities is consistent with Department of Veterans Affairs/Department of Defense clinical practice guidelines, and (3) identify facilitators and barriers to providing this care. This study provides a comprehensive assessment of providers' perspectives on their capacity to deliver PH care within MTFs and presents detailed results by provider type and service branch. Findings suggest that most providers report using guideline-concordant psychotherapies, but use varied by provider type. The majority of providers reported receiving at least minimal training and supervision in at least one recommended psychotherapy for PTSD and for MDD. Still, more than one-quarter of providers reported that limits on travel and lack of protected time in their schedule affected their ability to access additional professional training. Finally, most providers reported routinely screening patients for PTSD and MDD with a validated screening instrument, but fewer providers reported using a validated screening instrument to monitor treatment progress.

Thinking Outside of Outpatient: Underutilized Settings for Psychotherapy Education.

PubMed

Blumenshine, Philip; Lenet, Alison E; Havel, Lauren K; Arbuckle, Melissa R; Cabaniss, Deborah L

2017-02-01

Although psychiatry residents are expected to achieve competency in conducting psychotherapy during their training, it is unclear how psychotherapy teaching is integrated across diverse clinical settings. Between January and March 2015, 177 psychiatry residency training directors were sent a survey asking about psychotherapy training practices in their programs, as well as perceived barriers to psychotherapy teaching. Eighty-two training directors (44%) completed the survey. While 95% indicated that psychotherapy was a formal learning objective for outpatient clinic rotations, fifty percent or fewer noted psychotherapy was a learning objective in other settings. Most program directors would like to see psychotherapy training included (particularly supportive psychotherapy and cognitive behavioral therapy) on inpatient (82%) and consultation-liaison settings (57%). The most common barriers identified to teaching psychotherapy in these settings were time and perceived inadequate staff training and interest. Non-outpatient rotations appear to be an underutilized setting for psychotherapy teaching.

Advanced Psychotherapy Training: Psychotherapy Scholars' Track, and the Apprenticeship Model

ERIC Educational Resources Information Center

Feinstein, Robert E.; Yager, Joel

2013-01-01

Background/Objective: Guided by ACGME's requirements, psychiatric residency training in psychotherapy currently focuses on teaching school-specific forms of psychotherapy (i.e., cognitive-behavioral, supportive, and psychodynamic psychotherapy). On the basis of a literature review of common factors affecting psychotherapy outcomes and…

Psychotherapy

PubMed Central

Sansone, Lori A.

2009-01-01

Clinicians have a number of treatment options for dealing with the emotional ills of patients, including psychoeducation, psychotherapy, and pharmacotherapy. However, after years of experience in the clinical field, we have recognized that these treatment options may not be sufficient to adequately address the problems of some patients. We have found that adding a metaphysical/spiritual component may be helpful, particularly for those patients with histories of childhood trauma. In this edition of The Interface, we discuss four metaphysical techniques for facilitating patient healing—1) refocusing on the present, 2) reframing adversity, 3) practicing surrender, and 4) meditation. These approaches can be mutually integrated and compliment a psychological treatment in either the psychiatric or primary care setting, regardless of whether or not the patient has formal religious beliefs. PMID:20104289

The use of electronic games in therapy: a review with clinical implications.

PubMed

Horne-Moyer, H Lynn; Moyer, Brian H; Messer, Drew C; Messer, Elizabeth S

2014-12-01

Therapists and patients enjoy and benefit from interventions that use electronic games (EG) in health care and mental health settings, with a variety of diagnoses and therapeutic goals. We reviewed the use of electronic games designed specifically for a therapeutic purpose, electronic games for psychotherapy (EGP), also called serious games, and commercially produced games used as an adjunct to psychotherapy, electronic games for entertainment (EGE). Recent research on the benefits of EG in rehabilitation settings, EGP, and EGE indicates that electronic methods are often equivalent to more traditional treatments and may be more enjoyable or acceptable, at least to some consumers. Methodological concerns include the lack of randomized controlled trials (RCT) for many applications. Suggestions are offered for using EG in therapeutic practice.

Mental Health and Resilience: Soldiers’ Perceptions about Psychotherapy, Medications, and Barriers to Care in the United States Military

DTIC Science & Technology

2013-10-01

and will complete our longitudinal medical record data collection. REFERENCES Andrews, P., and Meyer, R. (2003). Marlowe -Crowne Social... Marlowe , D. (1960). A new scale of social desirability independent of psychopathology. Journal of Consulting and Clinical Psychology, 24, 349-354

Comparative Effectiveness of a Technology-Facilitated Depression Care Management Model in Safety-Net Primary Care Patients With Type 2 Diabetes: 6-Month Outcomes of a Large Clinical Trial.

PubMed

Wu, Shinyi; Ell, Kathleen; Jin, Haomiao; Vidyanti, Irene; Chou, Chih-Ping; Lee, Pey-Jiuan; Gross-Schulman, Sandra; Sklaroff, Laura Myerchin; Belson, David; Nezu, Arthur M; Hay, Joel; Wang, Chien-Ju; Scheib, Geoffrey; Di Capua, Paul; Hawkins, Caitlin; Liu, Pai; Ramirez, Magaly; Wu, Brian W; Richman, Mark; Myers, Caitlin; Agustines, Davin; Dasher, Robert; Kopelowicz, Alex; Allevato, Joseph; Roybal, Mike; Ipp, Eli; Haider, Uzma; Graham, Sharon; Mahabadi, Vahid; Guterman, Jeffrey

2018-04-23

Comorbid depression is a significant challenge for safety-net primary care systems. Team-based collaborative depression care is effective, but complex system factors in safety-net organizations impede adoption and result in persistent disparities in outcomes. Diabetes-Depression Care-management Adoption Trial (DCAT) evaluated whether depression care could be significantly improved by harnessing information and communication technologies to automate routine screening and monitoring of patient symptoms and treatment adherence and allow timely communication with providers. The aim of this study was to compare 6-month outcomes of a technology-facilitated care model with a usual care model and a supported care model that involved team-based collaborative depression care for safety-net primary care adult patients with type 2 diabetes. DCAT is a translational study in collaboration with Los Angeles County Department of Health Services, the second largest safety-net care system in the United States. A comparative effectiveness study with quasi-experimental design was conducted in three groups of adult patients with type 2 diabetes to compare three delivery models: usual care, supported care, and technology-facilitated care. Six-month outcomes included depression and diabetes care measures and patient-reported outcomes. Comparative treatment effects were estimated by linear or logistic regression models that used generalized propensity scores to adjust for sampling bias inherent in the nonrandomized design. DCAT enrolled 1406 patients (484 in usual care, 480 in supported care, and 442 in technology-facilitated care), most of whom were Hispanic or Latino and female. Compared with usual care, both the supported care and technology-facilitated care groups were associated with significant reduction in depressive symptoms measured by scores on the 9-item Patient Health Questionnaire (least squares estimate, LSE: usual care=6.35, supported care=5.05, technology-facilitated care=5.16; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.02); decreased prevalence of major depression (odds ratio, OR: supported care vs usual care=0.45, technology-facilitated care vs usual care=0.33; P value: supported care vs usual care=.02, technology-facilitated care vs usual care=.007); and reduced functional disability as measured by Sheehan Disability Scale scores (LSE: usual care=3.21, supported care=2.61, technology-facilitated care=2.59; P value: supported care vs usual care=.04, technology-facilitated care vs usual care=.03). Technology-facilitated care was significantly associated with depression remission (technology-facilitated care vs usual care: OR=2.98, P=.04); increased satisfaction with care for emotional problems among depressed patients (LSE: usual care=3.20, technology-facilitated care=3.70; P=.05); reduced total cholesterol level (LSE: usual care=176.40, technology-facilitated care=160.46; P=.01); improved satisfaction with diabetes care (LSE: usual care=4.01, technology-facilitated care=4.20; P=.05); and increased odds of taking an glycated hemoglobin test (technology-facilitated care vs usual care: OR=3.40, P<.001). Both the technology-facilitated care and supported care delivery models showed potential to improve 6-month depression and functional disability outcomes. The technology-facilitated care model has a greater likelihood to improve depression remission, patient satisfaction, and diabetes care quality. ©Shinyi Wu, Kathleen Ell, Haomiao Jin, Irene Vidyanti, Chih-Ping Chou, Pey-Jiuan Lee, Sandra Gross-Schulman, Laura Myerchin Sklaroff, David Belson, Arthur M Nezu, Joel Hay, Chien-Ju Wang, Geoffrey Scheib, Paul Di Capua, Caitlin Hawkins, Pai Liu, Magaly Ramirez, Brian W Wu, Mark Richman, Caitlin Myers, Davin Agustines, Robert Dasher, Alex Kopelowicz, Joseph Allevato, Mike Roybal, Eli Ipp, Uzma Haider, Sharon Graham, Vahid Mahabadi, Jeffrey Guterman. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 23.04.2018.

[How is burnout treated? Treatment approaches between wellness, job-related prevention of stress, psychotherapy, and social criticism].

PubMed

Hillert, A

2012-02-01

The subjective illness burnout is often described as the combination of workload-related suffering and job dissatisfaction, thus, leading to depressive symptoms. Burnout is a serious model of personal illness perception, but not useful as a diagnosis term because of its lack of specification and reliability. In this respect, burnout therapy cannot be regarded as a specific form of psychotherapy or any other form of therapy, but rather a pragmatic procedure focusing on the burnout clients' needs. When applying scientific standards, the evidence of a more or less specific anti-burnout effect of such procedures involving relaxation, wellness, alternative medical approaches, and psychotherapy are between weak and non-existent. From a conceptual point of view, strategies focusing on relaxation and symptom-reduction can be distinguished from prospective, job-related stress management efforts. In clinical psychotherapeutic settings, aspects of both are usually combined in programs claimed to be integrative or holistic. However, whether these programs really enhance the individual therapeutic outcome has yet to be proved in controlled clinical trials. The efficacy of preventive anti-stress programs and of job-related therapeutic groups, offered complementary to common therapeutic programs in psychosomatic hospitals, have been demonstrated in several studies. Therapeutic information focusing on side effects of social and work-related changes on an individual's psychosomatic wellbeing are needed. The prominent term burnout may be helpful in the public discussion but is not useful in the conceptual framework of a rational, scientific-based procedure in this field.

A pilot program in rural telepsychiatry for deaf and hard of hearing populations.

PubMed

Crowe, Teresa; Jani, Suni; Jani, Sushma; Jani, Niranjan; Jani, Raja

2016-03-01

Access to mental health care in deaf communities is limited by cultural considerations, availability of translators, and technological considerations. Telepsychiatry can mitigate the deaf community's lack of access to care by allowing for deaf individuals in remote communities access to care with facilities that cater to their needs. Community Behavioral Health, Arundel Lodge, and Gallaudet University worked in conjunction to test three hypotheses: 1.Telepsychiatry will be as effective as traditional face-to-face psychotherapy with deaf adults who have chronic mental illness.2.Patients living in remote locations will report an improvement in accessibility to mental health services.3.Patients who receive telepsychiatry will report a comparable level of satisfaction of services to those receiving traditional services. The patient sample consisted of 24 participants, 13 women, 11 men. Telepsychiatry sessions were scheduled based on each patient's individual treatment plan against a control group who saw their providers face to face. The telepsychiatry and in-person groups were slightly different at baseline. Analysis of the data revealed no significant difference in coping abilities and psychiatric symptoms between those receiving face-to-face psychotherapy and those receiving telepsychiatry. The quality and outcome of care was equal to in-person for the telepsychiatry in deaf patients. Since telepsychiatry does not compromise the quality of care, it is a good means of reaching out to members of the deaf community that cannot readily access mental health resources that meet their needs.

The treatment of fetishism in an adolescent with attention deficit hyperactivity disorder.

PubMed

Chang, Hsueh-Ling; Chow, Chia-Chi

2011-01-01

Fetishism is characterized by recurrent, intense sexual fantasy or behavior involving the use of nonliving objects, such as women's undergarments, over a period of at least six months. This disorder occurs mostly in males and usually begins in adolescence. The neurobiological etiologies of fetishism remain unclear, and studies on treatment were limited. We present a 14- year-old boy with attention deficit hyperactivity disorder with fetishistic behavior who was treated successfully with 36 mg extended-release methylphenidate daily and 4 months of cognitive-rational emotive psychotherapy.

Projective identification, self-disclosure, and the patient's view of the object: the need for flexibility.

PubMed

Waska, R T

1999-01-01

Certain patients, through projective identification and splitting mechanisms, test the boundaries of the analytic situation. These patients are usually experiencing overwhelming paranoid-schizoid anxieties and view the object as ruthless and persecutory. Using a Kleinian perspective, the author advocates greater analytic flexibility with these difficult patients who seem unable to use the standard analytic environment. The concept of self-disclosure is examined, and the author discusses certain technical situations where self-disclosure may be helpful. (The Journal of Psychotherapy Practice and Research 1999; 8:225-233)

Adapting Interpersonal Psychotherapy for Older Adults at Risk for Suicide

PubMed Central

Heisel, Marnin J.; Talbot, Nancy L.; King, Deborah A.; Tu, Xin M.; Duberstein, Paul R.

2014-01-01

Objective To pilot a psychological intervention adapted for older adults at-risk for suicide. Design A focused, uncontrolled, pre-to-post-treatment psychotherapy trial. All eligible participants were offered the study intervention. Setting Outpatient mental healthcare provided in the psychiatry department of an academic medical center in a mid-sized Canadian city. Participants Seventeen English-speaking adults 60 years or older, at- risk for suicide by virtue of current suicide ideation, death ideation, and/or recent self-injury. Intervention A 16-session course of Interpersonal Psychotherapy (IPT) adapted for older adults at-risk for suicide who were receiving medication and/or other standard psychiatric treatment for underlying mood disorders. Measurements Participants completed a demographics form, screens for cognitive impairment and alcohol misuse, a semi-structured diagnostic interview, and measures of primary (suicide ideation and death ideation), and secondary study outcomes (depressive symptom severity; social adjustment and support; psychological well-being), and psychotherapy process measures. Results Participants experienced significant reductions in suicide ideation, death ideation, and depressive symptom severity, and significant improvement in perceived meaning in life, social adjustment, perceived social support, and other psychological well-being variables. Conclusions Study participants experienced enhanced psychological well-being and reduced symptoms of depression and suicide ideation over the course of IPT adapted for older adults at-risk for suicide. Larger, controlled trials are needed to further evaluate the impact of this novel intervention and to test methods for translating and integrating focused interventions into standard clinical care with at-risk older adults. PMID:24840611

Differential predictive value of PTSD symptom clusters for mental health care among Iraq and Afghanistan veterans following PTSD diagnosis.

PubMed

Smith, Noelle B; Tsai, Jack; Pietrzak, Robert H; Cook, Joan M; Hoff, Rani; Harpaz-Rotem, Ilan

2017-10-01

Veterans from the recent conflicts in Iraq and Afghanistan are being diagnosed with posttraumatic stress disorder (PTSD) at high rates. This study examined characteristics associated with mental health service utilization, specifically psychotherapy, through the Department of Veterans Affairs (VA), in a large cohort of Iraq and Afghanistan veterans newly diagnosed with PTSD. This study utilized national VA administrative data from Iraq and Afghanistan veterans following an initial diagnosis of PTSD and completed a self-report measure of PTSD symptoms between Fiscal Years 2008-2012 (N=52,456; 91.7% male; 59.7% Caucasian; mean age 30.6, SD=8.3). Regression analyses examined the relation between PTSD symptom cluster severity and treatment-related variables. Accounting for demographic/clinical variables, PTSD symptom clusters were related to psychotherapy initiation (re-experiencing, OR=1.23; numbing, OR=1.15), combination treatment (medication and psychotherapy; re-experiencing, OR=1.13; avoidance, OR=1.07; dysphoric arousal, OR=1.06), number of psychotherapy visits (re-experiencing, IRR= 1.08; numbing, IRR=1.09), and adequate dose of therapy (e.g., 8 visits/14 weeks; re-experiencing: OR= 1.07). When considering treatment approaches for trauma-exposed veterans, it is important to map the severity of unique PTSD symptoms clusters; this may have implications on the selection of treatment that best fits the veterans' needs and preferences (e.g., exposure therapy versus cognitive processing therapy). Published by Elsevier B.V.

Evidence for the Effectiveness of Jungian Psychotherapy: A Review of Empirical Studies

PubMed Central

Roesler, Christian

2013-01-01

Since the 1990s several research projects and empirical studies (process and outcome) on Jungian Psychotherapy have been conducted mainly in Germany and Switzerland. Prospective, naturalistic outcome studies and retrospective studies using standardized instruments and health insurance data as well as several qualitative studies of aspects of the psychotherapeutic process will be summarized. The studies are diligently designed and the results are well applicable to the conditions of outpatient practice. All the studies show significant improvements not only on the level of symptoms and interpersonal problems, but also on the level of personality structure and in every day life conduct. These improvements remain stable after completion of therapy over a period of up to six years. Several studies show further improvements after the end of therapy, an effect which psychoanalysis has always claimed. Health insurance data show that, after Jungian therapy, patients reduce health care utilization to a level even below the average of the total population. Results of several studies show that Jungian treatment moves patients from a level of severe symptoms to a level where one can speak of psychological health. These significant changes are reached by Jungian therapy with an average of 90 sessions, which makes Jungian psychotherapy an effective and cost-effective method. Process studies support Jungian theories on psychodynamics and elements of change in the therapeutic process. So finally, Jungian psychotherapy has reached the point where it can be called an empirically proven, effective method. PMID:25379256

NICE recommendations for psychotherapy in depression: Of limited clinical utility.

PubMed

McQueen, D; Smith, P St John

2015-01-01

In 2009/10 NICE partially updated its guidelines on the treatment and management of depression in adults. Due to methodological shortcomings the recommendations for psychotherapy must be treated with caution. Despite recognising the heterogeneous and comorbid nature of depression, and the limitations of depression as a unitary diagnostic category, NICE treats depression as if it were a unitary entity differentiated only by severity. The guidance ignores important aetiological factors such as trauma, loss and maltreatment, personality and interpersonal difficulties. It excludes the largest naturalistic studies on clinical populations treated in the National Health Service on the grounds that they are observational studies conducted in heterogeneous groups with mixed neurotic disorders. It unquestioningly accepts that the "brand" of psychotherapy has construct validity, and ignores psychotherapy process research indicating significant commonalities, and overlap, between treatment modalities and evidence that individual practitioner effects are larger than the differences between treatment modalities. It fails to consider patient differences and preferences, which are known to influence uptake, completion and response. It takes an exclusively short-term perspective on a chronic relapsing disorder. It does not consider the evidence for longer-term treatments. It is of special concern that NICE misrepresents the findings of its own systematic review by implying that CBT and IPT are superior treatments. NICE's systematic review actually found no evidence of superiority between CBT, IPT, psychodynamic psychotherapy, or counselling. Based on the exclusion of much clinically relevant research demonstrating the effectiveness of psychodynamic psychotherapy and counselling many commentators have alleged a bias towards CBT in the guidance. With regard to service delivery NICE proposes the replacement of psychiatric assessment and individualised treatment plans, with an unproven stepped-care model. These clinical and theoretical limitations, perceived bias in the selection of studies, neglect of patient differences, preferences and values, misrepresentation of results of the systematic review, and the proposal for an unproven service delivery model together seriously undermine the validity of the guidance. The guidance, lacking validity is of questionable use, it undermines patient autonomy, professional expertise and, ultimately, patient welfare.

Psychotherapy: The Powerful Placebo.

ERIC Educational Resources Information Center

Wilkins, Wallace

1984-01-01

Discusses research designs in which psychotherapy treatments are compared to placebo conditions, and suggests that chemotherapy and psychotherapy research efforts are complementary rather than analogous. Recommends the elimination of placebo groups in psychotherapy research. Discusses the negative connotation of psychotherapy as a placebo. (JAC)

Psychotherapy with a narcissistic playboy facing the end of his life: a self-psychology and object relations perspective.

PubMed

Rothe, Eugenio M

2010-01-01

Narcissistic Personality Disorder is considered to be one of the most tenacious and stable types of personality organization. It usually presents a challenge to clinicians and is often resistant to treatment. The continuous search for the affirmation by others of the grandiose self and the devaluation of others in an attempt to stabilize their self-esteem is typically seen in individuals with narcissistic personality organization. On the other hand, corrective life events such as personal achievements, long-term nurturing relationships, and the management of loss and disillusionment can contribute to a more realistic realignment of the person's Ego Ideals and self-esteem. One such example is the case of Don Joaquin, a 69-year-old playboy who was facing death from leukemia. This article will describe the supportive and psychodynamic psychotherapy treatment approach that was utilized, and how Self-Psychology and Object Relations Theory provided a useful framework to bring help and relief to this patient, as he prepared to face the end of his life.

Integrative Medicine and Mood, Emotions and Mental Health.

PubMed

Shah, Anuj K; Becicka, Roman; Talen, Mary R; Edberg, Deborah; Namboodiri, Sreela

2017-06-01

An integrative approach to individuals with mood, emotional or mental health concerns involves a comprehensive model of care that is person-centered. Integrative medicine builds on a patient's personal meaning and goals (spiritual aspects) and includes herbal therapies, nutritional support, movement and physical manipulative therapies, mindfulness, relaxation strategies, and psychotherapies. Published by Elsevier Inc.

An Integrative Conceptual Framework for Assessing and Treating Suicidal Behavior in Adolescents.

ERIC Educational Resources Information Center

Rudd, M. David; Joiner, Thomas E., Jr.

1998-01-01

An integrative conceptual framework is provided for ongoing assessment and day-to-day treatment of suicidal adolescents. Goals are to provide a summary of therapeutic and assessment tasks consistent with existing standards of care and supported by empirical findings and to emphasize the roles, tasks, demands, and limitations of psychotherapy with…

The Impact of NATO/Multinational Military Missions on Health Care Management (l’Impact des missions OTAN/militaires internationales sur la gestion des soins de sante)

DTIC Science & Technology

2001-05-01

audio-visual aids. Rapid correction methods of the pilot’s performance capacity: * psychosomatic self-management; * rational psychotherapy; * music ... therapy ; * central nervous system (CNS) electro-tranquilization; * sauna; * hydrotherapy; * manual therapy; 10-3 * recreational therapy (active rest

Interest in spiritually integrated psychotherapy among acute psychiatric patients.

PubMed

Rosmarin, David H; Forester, Brent P; Shassian, Daniel M; Webb, Christian A; Björgvinsson, Thröstur

2015-12-01

Spiritually integrated psychotherapy (SIP) is increasingly common, though systematic assessment of interest in such treatments, and predictors of such interest, has not yet been conducted among acute psychiatric patients. We conducted a survey with 253 acute psychiatric patients (95-99% response rate) at a private psychiatric hospital in Eastern Massachusetts to assess for interest in SIP, religious affiliation, and general spiritual or religious involvement alongside clinical and demographic factors. More than half (58.2%) of patients reported "fairly" or greater interest in SIP, and 17.4% reported "very much" interest. Demographic and clinical factors were not significant predictors except that current depression predicted greater interest. Religious affiliation and general spiritual or religious involvement were associated with more interest; however, many affiliated patients reported low or no interest (42%), and conversely many unaffiliated patients reported "fairly" or greater interest (37%). Many acute psychiatric patients, particularly individuals with major depression, report interest in integrating spirituality into their mental health care. Assessment of interest in SIP should be considered in the context of clinical care. (c) 2015 APA, all rights reserved).

Psychotherapy: What's Metaphysical Got to Do With It?

PubMed

Sansone, Randy A; Sansone, Lori A

2009-12-01

Clinicians have a number of treatment options for dealing with the emotional ills of patients, including psychoeducation, psychotherapy, and pharmacotherapy. However, after years of experience in the clinical field, we have recognized that these treatment options may not be sufficient to adequately address the problems of some patients. We have found that adding a metaphysical/spiritual component may be helpful, particularly for those patients with histories of childhood trauma. In this edition of The Interface, we discuss four metaphysical techniques for facilitating patient healing-1) refocusing on the present, 2) reframing adversity, 3) practicing surrender, and 4) meditation. These approaches can be mutually integrated and compliment a psychological treatment in either the psychiatric or primary care setting, regardless of whether or not the patient has formal religious beliefs.

Engaging with a history of counselling, spirituality and faith in Scotland: a readers' theatre script

PubMed Central

Willis, Alette; Bondi, Liz; Burgess, MaryCatherine; Miller, Gavin; Fergusson, David

2014-01-01

This paper presents an abbreviated version of a verbatim script developed from oral history interviews with individuals key to the development of counselling and psychotherapy in Scotland from 1960 to 2000. Earlier versions were used in workshops with counsellors and pastoral care practitioners to share counter-narratives of counselling and to provide opportunities for conversations about historical and contemporary relationships between faith, spirituality, counselling and psychotherapy. By presenting intertwined histories in a readers' theatre script, the narrative nature of lives lived in context was respected. By bringing oral histories into virtual dialogue with each other and with contemporary practitioners, whether through workshops or through publications, the interplay between individual, institutional and societal narratives remains visible and open to change. PMID:25364094

Interventions to improve therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: systematic review

PubMed Central

Bhui, Kamaldeep S.; Aslam, Rabeea'h W.; Palinski, Andrea; McCabe, Rose; Johnson, Mark R. D.; Weich, Scott; Singh, Swaran P.; Knapp, Martin; Ardino, Vittoria; Szczepura, Ala

2015-01-01

Background Communication may be an influential determinant of inequality of access to, engagement with and benefit from psychiatric services. Aims To review the evidence on interventions designed to improve therapeutic communications between Black and minority ethnic patients and clinicians who provide care in psychiatric services. Method Systematic review and evidence synthesis (PROSPERO registration: CRD42011001661). Data sources included the published and the ‘grey’ literature. A survey of experts and a consultation with patients and carers all contributed to the evidence synthesis, interpretation and recommendations. Results Twenty-one studies were included in our analysis. The trials showed benefits mainly for depressive symptoms, experiences of care, knowledge, stigma, adherence to prescribed medication, insight and alliance. The effect sizes were smaller for better-quality trials (range of d 0.18–0.75) than for moderate- or lower-quality studies (range of d 0.18–4.3). The review found only two studies offering weak economic evidence. Conclusions Culturally adapted psychotherapies, and ethnographic and motivational assessment leading to psychotherapies were effective and favoured by patients and carers. Further trials are needed from outside of the UK and USA, as are economic evaluations and studies of routine psychiatric care practices. PMID:26243761

Treatment of post-traumatic psychiatric disorders: A continuum of immediate, post-immediate and follow-up care mediated by specific psychotherapeutic principles. Clinical experience in French-speaking countries.

PubMed

Auxéméry, Yann

2018-06-07

People who witness a horrific event are at risk of suffering from acute psychological disorders, potentially leading to chronic post-traumatic symptoms and severe medico-psycho-social complications. Traumatised individuals suffer from psychological damage that is initially indescribable: they are often unable to ask for care in the immediate aftermath of an event. Afterwards, traumatic events and their post-traumatic consequences are still often hidden or minimised by patients for reasons linked to the disorder itself (inexpressibility, shame, depressive thoughts, fear of stigmatisation, etc.). The provision of the initial stage of care has a major impact on the long-term prognosis. Although official French recommendations remain vague, and scientific studies lack power, there is a developing professional consensus on practices, and developments in neurobiology are opening up new opportunities to validate them. Drawing upon our clinical experience and clinical principles provided by our mentors, our aim is to clarify the phases of psychotherapeutic treatment, and we describe three practices: immediate care ("defusing"), post-immediate care ("French debriefing" or "post-immediate psychotherapeutic intervention") and follow-up care ("deferred debriefing" and psychotherapy). Although the international literature considers these phases as separate, here we describe a continuity of talking therapies that support long-term remission. The effectiveness of the combination of immediate, post-immediate and follow-up care has been confirmed by events surrounding the recent Paris and Nice attacks. Specific psychotherapeutic principles are unrelated to a particular school of psychotherapy (notably cognitive and behavioural therapies, analytical therapies, various forms of hypnosis, and eye-movement therapies, etc.). Instead, they refer to specific principles that are effective in the treatment of post-traumatic psychiatric disorders. By helping the individual to verbalise their experience, talking re-establishes dissociated psychological functions. A process of reconsolidation enables sensory memory to be integrated into verbal memory. Supported by psychotherapy, language can be used to discover, or construct, a new sense of meaning for the individual. A single session of post-immediate or deferred debriefing has been found to have a miraculous effect on post-traumatic symptoms, confirmed by follow-up. When disorders are chronic and complex, however, treatment can last several months or years. In each case, although certain therapeutic principles are key, other psychotherapeutic and pharmacological treatments should be adapted to the individual's clinical situation, and the symptoms they present. Copyright © 2018 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Psychotherapy: The Humanistic (and Effective) Treatment

ERIC Educational Resources Information Center

Wampold, Bruce E.

2007-01-01

Although it is well established that psychotherapy is remarkably effective, the change process in psychotherapy is not well understood. Psychotherapy is compared with medicine and cultural healing practices to argue that critical aspects of psychotherapy involve human processes that are used in religious, spiritual, and cultural healing practices.…

The implementation and adherence to evidence-based protocols for psychotherapy for depression: the perspective of therapists in Dutch specialized mental healthcare.

PubMed

Bruijniks, Sanne J E; Franx, Gerdien; Huibers, Marcus J H

2018-06-14

Although psychotherapy is an effective treatment for depression, a large number of patients still do not receive care according to the protocols that are used in clinical trials. Instead, patients often receive a modified version of the original intervention. It is not clear how and when treatment protocols are used or modified in the Dutch specialized mental health care and whether these changes lead to suboptimal adherence to treatment protocols. In the context of an ongoing multicenter trial that investigates whether twice-weekly sessions of protocolized interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) for depression lead to better treatment outcomes compared to once-weekly sessions, two focus groups using semi-structured interviews were organized. Aims were to increase insight in the adherence to and modifications of CBT and IPT protocols in the Dutch specialized mental health care for depression. Participants were fifteen therapists from seven mental health locations part of five mental health organizations. Verbatim transcripts were coded and analyzed using qualitative software. Three themes emerged: modification as the common practice, professional and patient factors influencing the adherence to protocols and organizational boundaries and flexibility. Treatment modification appeared to happen on a frequent basis, even in the context of a trial. Definitions of treatment modifications were multiple and varied from using intuition to flexible use of the same protocol. Therapist training and supervision, the years of work experience and individual characteristics of the therapist and the patient were mentioned to influence the adherence to protocols. Modifications of the therapists depended very much on the culture within the mental health locations, who differed in terms of the flexibility offered to therapists to choose and modify treatment protocols. Not all treatment modifications were in line with existing evidence or guidelines. Regular supervision, team meetings and a shared vision were identified as crucial factors to increase adherence to treatment protocols, whereas additional organizational factors, among which a change of mindset, may facilitate adequate implementation.

[Dissemination of psychotherapy modules for traumatized refugees : Experience gained from trauma work in crisis and conflict regions].

PubMed

Elbert, T; Wilker, S; Schauer, M; Neuner, F

2017-01-01

With each additional accumulative exposure to severe and traumatic stressors, the likelihood of developing mental health problems and physical diseases increases. Displaced individuals have usually experienced a number of serious threats to health due to organized violence in their home country or attacks during the flight. Frequently, domestic violence adds additional strain to the stressors experienced. The resulting impairments in psychosocial functioning reduce the resources needed for social adjustment and integration. Social exclusion then in turn often further aggravates the existing mental health complications. For the treatment of trauma spectrum disorders, different evidence-based psychotherapies are available. In high-income countries, trained and licensed psychotherapists are typically in positions to apply such interventions; however, even an advanced system with a high capacity, such as the psychotherapeutic care offered in Germany, severely struggles to manage the demands associated with the rapid addition of hundreds of thousands of displaced people. Germany's mental healthcare system at present lacks the resources, both human and technological, to effectively manage the present demands. Systematic scientific studies in resource-poor regions of war and conflict have demonstrated that the dissemination of effective treatment to local personnel, even with limited training, results in substantial improvements in the mental health challenges within the community: Organized as a cascade model, members of the refugee community learn to identify weakened fellow citizens requiring in-depth diagnostic interviews. Educated, bilingual individuals acquainted with their country's healthcare system (e. g. nurses, teachers and social workers) receive training to conduct structured interviews and evidence-based interventions under the supervision of centrally organized licensed psychotherapists. More complex cases are referred to local psychotherapists, psychiatrists or specialized treatment centers. These humanitarian efforts are based on the convention for the protection of human rights and secure the safety, freedom and dignity of these persons.

Mental health and psychosocial support in humanitarian settings: linking practice and research.

PubMed

Tol, Wietse A; Barbui, Corrado; Galappatti, Ananda; Silove, Derrick; Betancourt, Theresa S; Souza, Renato; Golaz, Anne; van Ommeren, Mark

2011-10-29

This review links practice, funding, and evidence for interventions for mental health and psychosocial wellbeing in humanitarian settings. We studied practice by reviewing reports of mental health and psychosocial support activities (2007-10); funding by analysis of the financial tracking service and the creditor reporting system (2007-09); and interventions by systematic review and meta-analysis. In 160 reports, the five most commonly reported activities were basic counselling for individuals (39%); facilitation of community support of vulnerable individuals (23%); provision of child-friendly spaces (21%); support of community-initiated social support (21%); and basic counselling for groups and families (20%). Most interventions took place and were funded outside national mental health and protection systems. 32 controlled studies of interventions were identified, 13 of which were randomised controlled trials (RCTs) that met the criteria for meta-analysis. Two studies showed promising effects for strengthening community and family supports. Psychosocial wellbeing was not included as an outcome in the meta-analysis, because its definition varied across studies. In adults with symptoms of post-traumatic stress disorder (PTSD), meta-analysis of seven RCTs showed beneficial effects for several interventions (psychotherapy and psychosocial supports) compared with usual care or waiting list (standardised mean difference [SMD] -0·38, 95% CI -0·55 to -0·20). In children, meta-analysis of four RCTs failed to show an effect for symptoms of PTSD (-0·36, -0·83 to 0·10), but showed a beneficial effect of interventions (group psychotherapy, school-based support, and other psychosocial support) for internalising symptoms (six RCTs; SMD -0·24, -0·40 to -0·09). Overall, research and evidence focuses on interventions that are infrequently implemented, whereas the most commonly used interventions have had little rigorous scrutiny. Copyright © 2011 Elsevier Ltd. All rights reserved.

Complaints of neurotic patients that are of interest for a cardiologist.

PubMed

Sobański, Jerzy A; Klasa, Katarzyna; Popiołek, Lech; Rutkowski, Krzysztof; Dembińska, Edyta; Mielimąka, Michał; Cyranka, Katarzyna; Müldner-Nieckowski, Łukasz; Smiatek-Mazgaj, Bogna; Rodziński, Paweł

2015-01-01

Patients in various areas of medicine report symptoms that are unexplained by other medical reasons than psychological/psychiatric. Some of them urgently seek treatment due to cardiovascular complaints, mostly rapid heart rate, palpitations and chest pain. Typical cardiac investigations, usually showing no organic reasons for these conditions, bring little information about stressful life events and psychological predispositions of these patients. Identification of coexistence of "cardiac" symptoms with other symptoms typical for neurotic disorders and difficult life circumstances may facilitate not only psychiatric diagnosis but also evaluation by cardiologists, primary care physicians, and other specialists. To determine the psychosocial context of psychogenic "pseudocardiac" symptoms and their coexistence with other symptoms in patients with neurotic disorders. Medical records of patients from the years 1980-2002 that included self-administered questionnaires transformed into an anonymised database were examined. An analysis of the relationship between symptoms reported in the Symptom Checklist and biographical circumstances described in the Life Inventory before admission to a psychotherapy day clinic for patients with neurotic disorders was performed using simple logistic regression with estimation of odds ratios and their 95% confidence intervals. The symptoms of tachycardia/palpitations and chest pain were very common, present in most subjects, and were significantly associated with such circumstances as suboptimal conflict solving by passive aggression or quarrels, uncertainty in the relationship, a sense of being inferior to the partner, and poor financial situation. In addition, these "pseudocardiac" symptoms were also associated with such childhood reminiscences as origin from a large low income family, feeling that the family of origin was inferior to others, and experience of parental hostility or lack of support. Physicians of all specialties who deal with patients experiencing pseudocardiac symptoms should expect their psychological background and perform a simple interview to identify the presence of adverse biographical circumstances described above. Identification and discussing these difficult experiences with the patients may help to convince them to seek psychological support or psychotherapy.

Psychotherapy Versus Pharmacotherapy of Depression: What's the Evidence?

PubMed

Leichsenring, Falk; Steinert, Christiane; Hoyer, Jürgen

Depression may be treated by psychotherapy or pharmacotherapy or their combination. There is an ongoing debate whether one of these approaches is possibly superior. A recent meta-analysis reported results in favour of pharmacotherapy. Individual studies and meta-analyses on the comparative efficacy of psychotherapy vs. pharmacotherapy were reviewed. Evidence suggests that psychotherapy and pharmacotherapy are equally efficacious in the short-term, but psychotherapy is superior in the long-term. For the recently stated hypothesis that pharmacotherapy is superior to psychotherapy in studies without a pill placebo condition, which implies equally including a positive expectancy effect for both pharmacotherapy and psychotherapy no evidence was found. Depression may be treated by psychotherapy or pharmacotherapy with equivalent results in the short-term and advantages for psychotherapy in the long-term. As the rates of response and remission are still limited in both treatments, further improvement of treatments is required.

Psychotherapy and Cognitive Behavioral Therapy Supervision in Danish Psychiatry: Training the Next Generation of Psychiatrists.

PubMed

Schmidt, Lasse M; Foli-Andersen, Nina J

2017-02-01

Psychotherapy training is mandatory for physicians to qualify as psychiatrists in Denmark. Evidence for the effectiveness of psychotherapy has increased, and psychotherapy is increasingly included in international treatment guidelines. The authors investigated how psychiatrists in training in Denmark evaluate the opportunities to practice psychotherapy in their training and the quality of the supervision they receive in psychotherapy training, particularly for cognitive behavioral therapy (CBT). The authors conducted a survey regarding psychotherapy training and CBT supervision among psychiatrists in training at Danish psychiatric specialist training courses. They investigated respondents' interest and experience in psychotherapy and respondents' views on the relevance and feasibility of performing psychotherapy and receiving supervision in their psychiatry training. Eighty-eight percent of the psychiatrists in training found psychotherapy to be a relevant part of their training; however, 77 % found it difficult to find time to practice psychotherapy and 44 % felt that practicing psychotherapy was a strain on their employer. Thirty-six percent and 53 %, respectively, had difficulties securing psychodynamic and CBT supervision. In CBT supervision, more than 60 % reported supervision that appeared to be below the expected CBT supervision standard and often so much below it might not qualify as CBT supervision. There is a need to focus on how to better integrate psychotherapy and supervision in the Danish psychiatric training program. Good CBT supervision may be lacking, and a way to ensure high-quality supervision is required.

Complementary medicine.

PubMed Central

Spiegel, D; Stroud, P; Fyfe, A

1998-01-01

The widespread use of complementary and alternative medicine techniques, often explored by patients without discussion with their primary care physician, is seen as a request from patients for care as well as cure. In this article, we discuss the reasons for the growth of and interest in complementary and alternative medicine in an era of rapidly advancing medical technology. There is, for instance, evidence of the efficacy of supportive techniques such as group psychotherapy in improving adjustment and increasing survival time of cancer patients. We describe current and developing complementary medicine programs as well as opportunities for integration of some complementary techniques into standard medical care. PMID:9584661

[Ethical foundations of institutional psychotherapy].

PubMed

Cano, N

2006-01-01

The idea behind this work is to have an ethical examination of the institutional psychotherapy movement which has long influenced French public psychiatry and which has progressively, since the 80s, been subject to growing doubts. In the first part, institutional psychotherapy is presented. It is a model for theoretical development and practice in psychiatric care. It came into being just following the end of the Second World War at the same time as modern medical ethics. Its principles come on the one hand, from recognition of asylums' pathogenic effects--which led to the crushing of the patient's being--and on the other, through recognition of the uniqueness of each person and the subjectivity of mental suffering. These elements gave rise to creativity within the world of medicine and, in the sector, generated the science of psychiatry which advocated for continuity in care (both inpatient and outpatient) and preventive work directed at the population. This movement called for the use of the institution in its dynamic aspect which promotes exchanges and allows patients to situate or resituate themselves in historic and symbolic dimensions. It privileges a high level of transversality, maximum communication, favouring speaking out loud and responsibility. It requires a permanent analysis of the institutional counter transference (emotional reactions of the caregivers involved, their interrelations and the social and material organization of the institution) which determines the therapeutic action itself. THEORICAL BASIS: In a second part, its theoretical foundations and its practice shall be investigated in light of the guiding concepts of medical ethics (justice, autonomy, beneficence, non-malfeasance). Institutional psychotherapy responds to the need for justice by considering the patient as a whole and by conceiving each patient as being like oneself despite the differences (associated with the mode of hospitalization, the social or diagnostic category). The principle of autonomy lies always at care's horizon, made concrete in practice by notions of habitability, orientation to place and time, references, by activities and by meetings. The principle of beneficence was the basis for round-the-clock intakes, the use of an established theoretical model and clinical practice centred on the patient's words. Institutional analysis attempts not to repeat the alienation felt by the patient, alienation being associated with the treatment environment, and draws from the principle of non-malfeasance. It therefore appears that the approach of institutional psychotherapy conforms with ethical requirements, given its major interest in the subject who aspires to find meaning in life. The third part discusses current orientations in care related to the explosion in neuroscience and technology, the promotion of the citizen as an individual, and legal doctrine, budgetary constraints, and new demands made on psychiatry from the social and political domains. The widespread trend towards simplification, swollen with hypotheses from neuroscientific research, is progressively reducing mental illness to target symptoms. The recovery of the notion of citizenship through technological capture and ideological strains in contemporary culture have also affected a suspension of the subject as a thinking and desiring being, and exempted caregivers from considering transferral phenomena, indicated with the appearance of new signifiers: user, stress, plague, network. The new medical-technical jargon of scales, tables, and management participates in the same process of patient objectification and care compartmentalization. In this context, under the cover of science and generally good actions, psychiatry has become biologisized, whilst being diluted from its social aspect, even as it becomes more repressive for patients. This observation leads to the conclusion, in the fourth part, that there is a need for psychiatry, which within its own discipline has a hard time finding sufficient resources, to refocus itself ethically. This enlightenment could come within a multi-disciplinary ethical space, uniting practitioners and psychiatric caregivers, psychoanalysts, philosophers, sociologists, neurobiologists etc. The research should concern the legitimacy of the principles that underlie psychiatric action in its care and preventive aspects.

A randomized controlled trial of a nursing psychotherapeutic intervention for anxiety in adult psychiatric outpatients.

PubMed

Sampaio, Francisco Miguel Correia; Araújo, Odete; Sequeira, Carlos; Lluch Canut, María Teresa; Martins, Teresa

2018-05-01

To evaluate the short-term efficacy of a psychotherapeutic intervention in nursing on Portuguese adult psychiatric outpatients with the nursing diagnosis "anxiety." Several efficacious forms of treatment for anxiety are available, including different forms of psychotherapy and pharmacotherapy. However, literature tends to favour findings from studies on the efficacy of psychotherapies and therapies provided by nurses to the detriment of those arising from studies on the efficacy of nursing psychotherapeutic interventions (interventions which are classified, for instance, on Nursing Interventions Classification). Randomized controlled trial. The study was performed, between November 2016 - April 2017, at a psychiatry outpatient ward. Participants were randomly allocated to an intervention group (N = 29) or a treatment-as-usual control group (N = 31). Patients in the intervention group received psychopharmacotherapy with interventions integrated in the Nursing Interventions Classification for the nursing diagnosis "anxiety." A treatment-as-usual control group received only psychopharmacotherapy (if applicable). Anxiety level and anxiety self-control were the primary outcomes. Patients from both groups had reduced anxiety levels, between the pre-test and the posttest assessment; however, according to analysis of means, patients in the intervention group displayed significantly better results than those of the control group. Furthermore, only patients in the intervention group presented significant improvements in anxiety self-control. This study demonstrated the short-term efficacy of this psychotherapeutic intervention model in nursing in the decrease of anxiety level and improvement of anxiety self-control in a group of psychiatric outpatients with pathological anxiety. NCT02930473. © 2017 John Wiley & Sons Ltd.

Psychotherapy Training: Residents' Perceptions and Experiences.

PubMed

Kovach, Jessica G; Dubin, William R; Combs, Christopher J

2015-10-01

This survey examined actual training hours in psychotherapy modalities as reported by residents, residents' perceptions of training needs, and residents' perceptions of the importance of different aspects of psychotherapy training. A brief, voluntary, anonymous, Internet-based survey was developed. All 14 program directors for Accreditation Council for Graduate Medical Education accredited programs in Pennsylvania, New Jersey, and Delaware provided email addresses for current categorical residents. The survey inquired about hours of time spent in various aspects of training, value assigned to aspects of training, residents' involvement in their own psychotherapy, and overall resident wellness. The survey was e-mailed to 328 residents. Of the 328 residents contacted, 133 (40.5%) responded. Median reported number of PGY 3 and 4 performed versus perceived ideal hours of supportive therapy, cognitive behavioral therapy (CBT), and psychodynamic therapy did not differ. Answers for clinical time utilizing these modalities ranged from "none or less than 1 h" per month to 20+ h per month. PGY 3 and 4 residents reported a median of "none or less than 1 h" per month performed of interpersonal, dialectical behavior therapy, couples/family/group, and child therapies but preferred more time using these therapies. Residents in all years of training preferred more hours of didactic instruction for all psychotherapies and for medication management. Residents ranked teaching modalities in the following order of importance: supervision, hours of psychotherapy performed, personal psychotherapy, readings, and didactic instruction. Residents engaged in their own psychotherapy were significantly more likely to rank the experiential aspects of psychotherapy training (personal psychotherapy, supervision, and hours performed) higher than residents not in psychotherapy. Current psychotherapy training for psychiatry residents is highly variable, but overall, residents want more psychotherapy education than they are receiving. Further research and discussion about how much psychotherapy training is feasible in an evolving field is required.

Individual Psychotherapy ("Talking Therapy"): A Survey of Attitudes among Residents & Specialists in Psychiatry, Israel 2010-2011.

PubMed

Levi Shachar, Orit; Mendlovic, Shlomo; Hertzberg, Libi; Baruch, Yehuda; Lurie, Ido

2016-01-01

Individual psychotherapy is an efficient tool and an integral part of psychiatric treatment. However, its status among psychiatrists in Israel has never been explored. To explore and map the attitudes of psychiatrists in Israel regarding psychotherapy and psychotherapy training during residency, with comparisons between residents vs. specialists, peripheral vs. central institutions and mental health vs. medical centers. We conducted a cross-sectional survey to examine the attitudes toward individual psychotherapy. The questionnaire was delivered via email and direct approach to psychiatrists in Israel. The survey was completed by 229 of 1,502 registered psychiatrists (15.3%). While 96% (n=218) had positive attitudes towards psychotherapy, 93.1% (n=215) thought psychotherapy was less available than pharmacotherapy. Psychiatrists from peripheral institutions prefer cognitive behavioral therapy, while psychiatrists from central institutions prefer dynamic psychotherapy. Psychiatrists from mental health centers use more dynamic psychotherapy compared to psychiatrists from medical centers. The number of dynamic psychotherapy treatments psychiatrists delivered during their residencies has been decreasing over time, meaning residents today deliver fewer dynamic psychotherapy treatments compared to the number of treatments specialists delivered during their residencies. Additionally, 97.4% (n=225) believed psychotherapy training should be included in the psychiatric residency and 87.3% thought that the training should be improved to a great extent. The survey demonstrates mixed but overall positive attitudes towards psychotherapy among psychiatrists in Israel. The findings should be taken into consideration by psychiatrists who design the residency program and by policy makers who are in charge of the mental health reform in Israel, or the psychotherapy usage and therapeutic potential may diminish, as has happened in other countries.

Cost-effectiveness of Electroconvulsive Therapy vs Pharmacotherapy/Psychotherapy for Treatment-Resistant Depression in the United States.

PubMed

Ross, Eric L; Zivin, Kara; Maixner, Daniel F

2018-05-09

Electroconvulsive therapy (ECT) is a highly effective treatment for depression but is infrequently used owing to stigma, uncertainty about indications, adverse effects, and perceived high cost. To assess the cost-effectiveness of ECT compared with pharmacotherapy/psychotherapy for treatment-resistant major depressive disorder in the United States. A decision analytic model integrating data on clinical efficacy, costs, and quality-of-life effects of ECT compared with pharmacotherapy/psychotherapy was used to simulate depression treatment during a 4-year horizon from a US health care sector perspective. Model input data were drawn from multiple meta-analyses, randomized trials, and observational studies of patients with depression. Where possible, data sources were restricted to US-based studies of nonpsychotic major depression. Data were analyzed between June 2017 and January 2018. Six alternative strategies for incorporating ECT into depression treatment (after failure of 0-5 lines of pharmacotherapy/psychotherapy) compared with no ECT. Remission, response, and nonresponse of depression; quality-adjusted life-years; costs in 2013 US dollars; and incremental cost-effectiveness ratios. Strategies with incremental cost-effectiveness ratios of $100 000 per quality-adjusted life-year or less were designated cost-effective. Based on the Sequenced Treatment Alternatives to Relieve Depression trial, we simulated a population with a mean (SD) age of 40.7 (13.2) years, and 62.2% women. Over 4 years, ECT was projected to reduce time with uncontrolled depression from 50% of life-years to 33% to 37% of life-years, with greater improvements when ECT is offered earlier. Mean health care costs were increased by $7300 to $12 000, with greater incremental costs when ECT was offered earlier. In the base case, third-line ECT was cost-effective, with an ICER of $54 000 per quality-adjusted life-year. Third-line ECT remained cost-effective in a range of univariate, scenario, and probabilistic sensitivity analyses. Incorporating all input data uncertainty, we estimate a 74% to 78% likelihood that at least 1 of the ECT strategies is cost-effective and a 56% to 58% likelihood that third-line ECT is the optimal strategy. For US patients with treatment-resistant depression, ECT may be an effective and cost-effective treatment option. Although many factors influence the decision to proceed with ECT, these data suggest that, from a health-economic standpoint, ECT should be considered after failure of 2 or more lines of pharmacotherapy/psychotherapy.

The Psychotherapy Process with Adolescents: A First Pilot Study and Preliminary Comparisons between Different Therapeutic Modalities Using the "Adolescent Psychotherapy Q-Set"

ERIC Educational Resources Information Center

Bychkova, Tetyana; Hillman, Saul; Midgley, Nick; Schneider, Celeste

2011-01-01

An innovative methodology is presented for describing the therapeutic processes involved in five types of adolescent treatments: psychoanalysis, psychodynamic psychotherapy, cognitive-behavioural therapy, mentalisation-based treatment and interpersonal psychotherapy. Using the "Adolescent Psychotherapy Q-Set" (APQ), 18 experienced clinicians…

Predictors of non-drug psychiatric/psychotherapeutic treatment in children and adolescents with mental or behavioural disorders.

PubMed

Abbas, Sascha; Ihle, Peter; Adler, Jürgen-Bernhard; Engel, Susanne; Günster, Christian; Holtmann, Martin; Kortevoss, Axel; Linder, Roland; Maier, Werner; Lehmkuhl, Gerd; Schubert, Ingrid

2017-04-01

Children and adolescents with mental health problems need effective and safe therapies to support their emotional and social development and to avoid functional impairment and progress of social deficits. Though psychotropic drugs seem to be the preferential treatment, psychotherapy and psychosocial interventions are essential in mental health care. For Germany, current data on the utilization of psychotherapy and psychosocial interventions in children with mental health problems is lacking. To analyse why certain children and adolescents with mental or behavioural disorders do and others do not receive non-drug treatment, we assessed predictors associated with specific non-drug psychiatric/psychotherapeutic treatment including psychosocial interventions, psychotherapy and other non-drug treatments. The study is based on data of two large German health insurance funds, AOK and TK, comprising 30 % of the German child and adolescent population. Predictors of non-drug psychiatric/psychotherapeutic treatment were analysed for 23,795 cases and two controls for every case of the same age and sex in children aged 0-17 years following a new diagnosis of mental or behavioural disorder in 2010. Predictors were divided according to Andersen's behavioural model into predisposing, need and enabling factors. The most prominent and significant predictors positively associated with non-drug psychiatric/psychotherapeutic treatment were the residential region as predisposing factor; specific, both ex- and internalizing, mental and behavioural disorders, psychiatric co-morbidity and psychotropic drug use as need factors; and low area deprivation and high accessibility to outpatient physicians and inpatient institutions with non-drug psychiatric/psychotherapeutic department as enabling factors. In conclusion, the present study suggests that the residential region as proxy for supply of therapist and socioeconomic situation is an influencing factor for the use of psychotherapy. The analysis sheds further light on predisposing, need and enabling factors as predictors of non-drug psychotherapeutic/psychiatric treatment in children and adolescents with mental or behavioural health disorders in Germany. More research is needed to further understand the factors promoting the gap between the need and utilization of mental health care.

Neuroimaging for psychotherapy research: Current trends

PubMed Central

WEINGARTEN, CAROL P.; STRAUMAN, TIMOTHY J.

2014-01-01

Objective This article reviews neuroimaging studies that inform psychotherapy research. An introduction to neuroimaging methods is provided as background for the increasingly sophisticated breadth of methods and findings appearing in psychotherapy research. Method We compiled and assessed a comprehensive list of neuroimaging studies of psychotherapy outcome, along with selected examples of other types of studies that also are relevant to psychotherapy research. We emphasized magnetic resonance imaging (MRI) since it is the dominant neuroimaging modality in psychological research. Results We summarize findings from neuroimaging studies of psychotherapy outcome, including treatment for depression, obsessive-compulsive disorder (OCD), and schizophrenia. Conclusions The increasing use of neuroimaging methods in the study of psychotherapy continues to refine our understanding of both outcome and process. We suggest possible directions for future neuroimaging studies in psychotherapy research. PMID:24527694

Facts and values in psychotherapy-A critique of the empirical reduction of psychotherapy within evidence-based practice.

PubMed

Berg, Henrik; Slaattelid, Rasmus

2017-10-01

This paper addresses an implicit presupposition in research-supported psychological treatments and evidence-based practice in psychology. It argues that the notion of research-supported psychological treatments is based on a reductive conceptualisation of psychotherapy. Research-supported psychological treatments hinge upon an empirical reduction where psychotherapy schools become conceptualized as mere collections of empirical propositions. However, this paper argues that the different psychotherapy schools have distinct ethoses that are constituted by normative claims. Consequently, the evaluation of the different psychotherapy schools and the practice of psychotherapy should include the underlying normative claims of these ethoses. © 2017 John Wiley & Sons, Ltd.

Humanism as a common factor in psychotherapy.

PubMed

Wampold, Bruce E

2012-12-01

There are many forms of psychotherapies, each distinctive in its own way. From the origins of psychotherapy, it has been suggested that psychotherapy is effective through factors that are common to all therapies. In this article, I suggest that the commonalities that are at the core of psychotherapy are related to evolved human characteristics, which include (a) making sense of the world, (b) influencing through social means, and (c) connectedness, expectation, and mastery. In this way, all psychotherapies are humanistic. (c) 2012 APA, all rights reserved.

A qualitative study of perceived needs and factors associated with the quality of care for common mental disorders in patients with chronic diseases: the perspective of primary care clinicians and patients.

PubMed

Roberge, Pasquale; Hudon, Catherine; Pavilanis, Alan; Beaulieu, Marie-Claude; Benoit, Annie; Brouillet, Hélène; Boulianne, Isabelle; De Pauw, Anna; Frigon, Serge; Gaboury, Isabelle; Gaudreault, Martine; Girard, Ariane; Giroux, Marie; Grégoire, Élyse; Langlois, Line; Lemieux, Martin; Loignon, Christine; Vanasse, Alain

2016-09-13

The prevalence of comorbid anxiety and depressive disorders is high among patients with chronic diseases in primary care, and is associated with increased morbidity and mortality rates. The detection and treatment of common mental disorders in patients with chronic diseases can be challenging in the primary care setting. This study aims to explore the perceived needs, barriers and facilitators for the delivery of mental health care for patients with coexisting common mental disorders and chronic diseases in primary care from the clinician and patient perspectives. In this qualitative descriptive study, we conducted semi-structured interviews with clinicians (family physician, nurse, psychologist, social worker; n = 18) and patients (n = 10) from three primary care clinics in Quebec, Canada. The themes explored included clinician factors (e.g., attitudes, perception of roles, collaboration, management of clinical priorities) and patient factors (e.g., needs, preferences, access to care, communication with health professionals) associated with the delivery of care. Qualitative data analysis was conducted based on an interactive cyclical process of data reduction, data display and conclusion drawing and verification. Clinician interviews highlighted a number of needs, barriers and enablers in the provision of patient services, which related to inter-professional collaboration, access to psychotherapy, polypharmacy as well as communication and coordination of services within the primary care clinic and the local network. Two specific facilitators associated with optimal mental health care were the broadening of nurses' functions in mental health care and the active integration of consulting psychiatrists. Patients corroborated the issues raised by the clinicians, particularly in the domains of whole-person care, service accessibility and care management. The results of this project will contribute to the development of quality improvement interventions to increase the uptake of organizational and clinical evidence-based practices for patients with chronic diseases and concurrent common mental disorders, in priority areas including collaborative care, access to psychotherapy and linkages with specialized mental health care.

Meaning-Led Learning for Pupils with Severe and Profound and Multiple Learning Difficulties

ERIC Educational Resources Information Center

Goss, Phil

2006-01-01

This paper proposes that learning and teaching for pupils with severe and profound and multiple learning difficulties could be enhanced by a closer focus on emotional factors and on the careful identification of what is meaningful for them. Phil Goss, senior lecturer in counselling and psychotherapy at the University of Central Lancashire draws on…

Safe Babies Court Teams™: Collaborative Journeys of Healing and Hope

ERIC Educational Resources Information Center

Hudson, Lucy; Beike, Sarah; Norris, Judy; Parker, Kimberly; Williams, Rebecca

2017-01-01

Child-Parent Psychotherapy (CPP) is an evidence-based mental health intervention for infants and toddlers as well as their adult caregivers. Families with young children in foster care benefit most when it is offered along with an array of other supportive measures (e.g., housing, medical attention). As a core component of the Safe Babies Court…

Web-PE: Internet-Delivered Prolonged Exposure Therapy for PTSD

DTIC Science & Technology

2015-10-01

order to meet the growing demand for effective and efficient treatment for posttraumatic stress disorder ( PTSD ) in a timely manner. Web-treatments...posttraumatic stress disorder ( PTSD ) in a timely manner. Effective EBTs for PTSD are available, but barriers to accessing care can deter military...Exposure, combat, psychological treatment, military, psychotherapy, trauma, posttraumatic stress , posttraumatic stress disorder 16. SECURITY

Engaging with a History of Counselling, Spirituality and Faith in Scotland: A Readers' Theatre Script

ERIC Educational Resources Information Center

Willis, Alette; Bondi, Liz; Burgess, MaryCatherine; Miller, Gavin; Fergusson, David

2014-01-01

This paper presents an abbreviated version of a verbatim script developed from oral history interviews with individuals key to the development of counselling and psychotherapy in Scotland from 1960 to 2000. Earlier versions were used in workshops with counsellors and pastoral care practitioners to share counter-narratives of counselling and to…

When Dieting Becomes Dangerous: A Guide to Understanding and Treating Anorexia and Bulimia.

ERIC Educational Resources Information Center

Michel, Deborah Marcontell; Willard, Susan G.

This book about anorexia and bulimia is written for patients and the people who care about them. It describes the symptoms and warning signs of eating disorders, explains their presumed causes and complexities, and suggests effective treatments. The book emphasizes the critical role of psychotherapy and family therapy in recovery, explains how…

Suicide Risk Assessment and Prevention: A Systematic Review Focusing on Veterans.

PubMed

Nelson, Heidi D; Denneson, Lauren M; Low, Allison R; Bauer, Brian W; O'Neil, Maya; Kansagara, Devan; Teo, Alan R

2017-10-01

Suicide rates in veteran and military populations in the United States are high. This article reviews studies of the accuracy of methods to identify individuals at increased risk of suicide and the effectiveness and adverse effects of health care interventions relevant to U.S. veteran and military populations in reducing suicide and suicide attempts. Trials, observational studies, and systematic reviews relevant to U.S. veterans and military personnel were identified in searches of MEDLINE, PsycINFO, SocINDEX, and Cochrane databases (January 1, 2008, to September 11, 2015), on Web sites, and in reference lists. Investigators extracted and confirmed data and dual-rated risk of bias for included studies. Nineteen studies evaluated accuracy of risk assessment methods, including models using retrospective electronic records data and clinician- or patient-rated instruments. Most methods demonstrated sensitivity ≥80% or area-under-the-curve values ≥.70 in single studies, including two studies based on electronic records of veterans and military personnel, but specificity varied. Suicide rates were reduced in six of eight observational studies of population-level interventions. Only two of ten trials of individual-level psychotherapy reported statistically significant differences between treatment and usual care. Risk assessment methods have been shown to be sensitive predictors of suicide and suicide attempts, but the frequency of false positives limits their clinical utility. Research to refine these methods and examine clinical applications is needed. Studies of suicide prevention interventions are inconclusive; trials of population-level interventions and promising therapies are required to support their clinical use.

Psychotherapy: a profile of current occupational therapy practice in Ontario.

PubMed

Moll, Sandra E; Tryssenaar, Joyce; Good, Colleen R; Detwiler, Lisa M

2013-12-01

Psychotherapy can be an important part of psychosocial occupational therapy practice; however, it requires specialized training to achieve and maintain competence. Regulation varies by province, and in Ontario, occupational therapists were recently authorized to perform psychotherapy. The purpose of this study was to explore the psychotherapy practice, training, and support needs of Ontario occupational therapists. An online survey was sent to occupational therapists who had clients with mental health or chronic pain issues, asking about their expertise and support needs in relation to nine psychotherapy approaches. Of the 331 therapists who responded, there were variations in the nature and frequency of psychotherapy practice. Experienced therapists in outpatient settings were more likely to practice psychotherapy, and cognitive-behaviour therapy, motivational interviewing, and mindfulness were the most common approaches. Supervision and training varied, with many therapists interested in occupational therapy-specific training. Recommendations for a framework of support include education about the nature of psychotherapy, training and supervision guidelines, and advocacy for occupational therapy and psychotherapy.

For Whom Does It Work? Moderators of Outcome on the Effect of a Transdiagnostic Internet-Based Maintenance Treatment After Inpatient Psychotherapy: Randomized Controlled Trial

PubMed Central

Gollwitzer, Mario; Riper, Heleen; Cuijpers, Pim; Baumeister, Harald; Berking, Matthias

2013-01-01

Background Recent studies provide evidence for the effectiveness of Internet-based maintenance treatments for mental disorders. However, it is still unclear which participants might or might not profit from this particular kind of treatment delivery. Objective The study aimed to identify moderators of treatment outcome in a transdiagnostic Internet-based maintenance treatment (TIMT) offered to patients after inpatient psychotherapy for mental disorders in routine care. Methods Using data from a randomized controlled trial (N=400) designed to test the effectiveness of TIMT, we performed secondary analyses to identify factors moderating the effects of TIMT (intervention) when compared with those of a treatment-as-usual control condition. TIMT involved an online self-management module, asynchronous patient–therapist communication, a peer support group, and online-based progress monitoring. Participants in the control condition had unstructured access to outpatient psychotherapy, standardized outpatient face-to-face continuation treatment, and psychotropic management. Self-reports of psychopathological symptoms and potential moderators were assessed at the start of inpatient treatment (T1), at discharge from inpatient treatment/start of TIMT (T2), and at 3-month (T3) and 12-month follow-up (T4). Results Education level, positive outcome expectations, and diagnoses significantly moderated intervention versus control differences regarding changes in outcomes between T2 and T3. Only education level moderated change differences between T2 and T4. The effectiveness of the intervention (vs control) was more pronounced among participants with a low (vs high) education level (T2-T3: B=–0.32, SE 0.16, P=.049; T2-T4: B=–0.42, SE 0.21, P=.049), participants with high (vs low) positive outcome expectations (T2-T3: B=–0.12, SE 0.05, P=.02) and participants with anxiety disorder (vs mood disorder) (T2-T3: B=–0.43, SE 0.21, P=.04). Simple slope analyses revealed that despite some subgroups benefiting less from the intervention than others, all subgroups still benefited significantly. Conclusions This transdiagnostic Internet-based maintenance treatment might be suitable for a wide range of participants differing in various clinical, motivational, and demographic characteristics. The treatment is especially effective for participants with low education levels. These findings may generalize to other Internet-based maintenance treatments. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 28632626; http://www.controlled-trials.com/isrctn/pf/28632626 (Archived by WebCite at http://www.webcitation.org/6IqZjTLrx). PMID:24113764

Psychotherapy in Contemporary Psychiatric Practice

PubMed Central

Hadjipavlou, George; Hernandez, Carlos A Sierra; Ogrodniczuk, John S

2015-01-01

Objective: American data suggest a declining trend in the provision of psychotherapy by psychiatrists. Nevertheless, the extent to which such findings generalize to psychiatric practice in other countries is unclear. We surveyed psychiatrists in British Columbia to examine whether the reported decline in psychotherapy provision extends to the landscape of Canadian psychiatric practice. Method: A survey was mailed to the entire population of fully licensed psychiatrists registered in British Columbia (n = 623). The survey consisted of 30 items. Descriptive statistics were used to characterize the sample and psychotherapy practice patterns. Associations between variables were evaluated using nonparametric tests. Results: A total of 423 psychiatrists returned the survey, yielding a response rate of 68%. Overall, 80.9% of psychiatrists (n = 342) reported practicing psychotherapy. A decline in the provision of psychotherapy was not observed; in fact, there was an increase in psychotherapy provision among psychiatrists entering practice in the last 10 years. Individual therapy was the predominant format used by psychiatrists. The most common primary theoretical orientation was psychodynamic (29.9%). Regarding actual practice, supportive psychotherapy was practiced most frequently. Professional time constraints were perceived as the most significant barrier to providing psychotherapy. The majority (85%) of clinicians did not view remuneration as a significant barrier to treating patients with psychotherapy. Conclusions: Our findings challenge the prevailing view that psychotherapy is in decline among psychiatrists. Psychiatrists in British Columbia continue to integrate psychotherapy and pharmacotherapy in clinical practice, thus preserving their unique place in the spectrum of mental health services. PMID:26175328

[Interpersonal therapy (IPT) in child psychiatry and adolescent].

PubMed

Lavigne, B; Audebert-Mérilhou, E; Buisson, G; Kochman, F; Clément, J P; Olliac, B

2016-12-01

Depression disorder may become the first cause of morbidity by 2030, according to the World Health Organization. It is actually one of the main causes of disease and handicap in children aged from 10 to 19. The major risk is suicide, whose prevalence is estimated, in France, around 6.7 for 100,000, which is probably underestimated. At present, the discussions about prescription of antidepressants in an adolescent's depression remain intense which is why psychotherapy becomes the first choice of treatment. We propose here to present one of them, Interpersonal PsychoTherapy (IPT), which remains largely unknown in France, and its adaptations in the adolescent population. IPT is a brief psychotherapy, structured in twelve to sixteen sessions, which was created by Klerman and Weissman in the seventies inspired by the biopsychosocial model of Meyer, interpersonal theory of Sullivan, and attachment theory of Bowlby. It is divided into three parts: the initial phase, the intermediate phase, and the termination phase. IPT was adapted for adolescents by Mufson in 1993, but a few modifications must be considered. Parental implication is the first. Indeed, parents, rather than the adolescent, often ask for the consultation; but it is the latter who benefits from the therapy. Parents may be met at some point in the therapy, for example between each phase and at the end. The initial phase is very close for the adolescent as for the adult; but the therapist must be careful about employing the "sick role" which can be used by the adolescent to avoid school, and as a consequence, to exacerbate the interpersonal deficit. The intermediate phase focuses on one of the four interpersonal issues: complicated bereavement, role transition, interpersonal role disputes, and interpersonal deficit. Complicated bereavement may become problematic when prolonged or when the adolescent had complicated relations with the deceased. The therapist essentially works on emotion verbalization. The role of transition is very common during adolescence: children become adults, they pass from high school to college, or their parents get divorced, etc. The patient and the therapist work on giving up the old role with its emotional expression (guilt, anger, and loss), and acquiring new skills, and identifying positive aspects of the new role. Interpersonal role disputes are common during adolescence, with parents or teachers for example. To determine a treatment plan, the therapist may first determine the stage of the role dispute, among impasse, renegotiation, or dissolution, and then work on the communication mode of the patient. At the least, the interpersonal deficit may be the most difficult area to work on because of the risk of psychiatric comorbidity. The therapist must be especially careful about anxious disorder which may complicate the psychotherapy and for which IPT is not the best therapy. The termination phase focuses on the new skills and abilities and works on the future without therapy. IPT is one of the psychotherapies recommended in the treatment of depression disorder in the international recommendations. But in France, all psychotherapies are considered equally. This may be a consensual approach, but the authors wonder if it is the best, especially to motivate research in the psychotherapy field. Finally, IPT has been developed in other indications in the past years, and many others are presently in research projects: depression during pregnancy, prevention of depression relapse, eating disorders, attention deficit and hyperactivity disorder, self-harm for example. Its validity, simplicity and efficacy should stimulate psychiatrists and residents to train themselves to IPT. Copyright © 2016 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Increasing access to care for young adults with cancer: Results of a quality-improvement project using a novel telemedicine approach to supportive group psychotherapy.

PubMed

Melton, Laura; Brewer, Benjamin; Kolva, Elissa; Joshi, Tanisha; Bunch, Michelle

2017-04-01

Young adults with cancer experience high levels of psychological distress. Group interventions for cancer patients have been effective in reducing levels of psychological distress but suffer from high levels of attrition and serve a limited geographic area. In a quality-improvement project, we converted an existing in-person support group to a telemedicine format in the hopes of improving attendance and reducing geographic disparities in access to care. Eight young adults (18-40 years) with cancer were recruited from across Colorado. Participants received a tablet equipped with Wi-Fi and downloaded an HIPAA-compliant video-conferencing application. Participants attended six weekly supportive psychotherapy sessions. Participants found the group to be beneficial: the technology worked, they enjoyed the group format, and they would recommend it to others. The novel treatment interface allowed for low attrition rates due to the flexibility of a patient's location during the intervention. It allowed for provision of services to a geographically diverse population of medically ill young adults, as participants lived an average of 148 miles from the cancer center (range = 25-406 miles). Internet-based mental health care is an area of growing interest for providers, but few studies have evaluated its efficacy in patients with cancer, and even fewer in young adults with cancer. Incorporating technological advances into clinical practice will increase access to care, reduce geographic health disparities, and provide more consistent services.

Implementing panic-focused psychodynamic psychotherapy into clinical practice.

PubMed

Beutel, Manfred E; Scheurich, Vera; Knebel, Achim; Michal, Matthias; Wiltink, Jörg; Graf-Morgenstern, Mechthild; Tschan, Regine; Milrod, Barbara; Wellek, Stefan; Subic-Wrana, Claudia

2013-06-01

To determine the effectiveness of manualized panic-focused psychodynamic psychotherapy (PFPP) in routine care in Germany. German psychoanalysts were trained according to the PFPP manual. Fifty-four consecutive outpatients with panic disorder (with or without agoraphobia) were randomly assigned in a 2:1 ratio to PFPP or cognitive-behavioural therapy (CBT) plus exposure therapy. Subjects (female 57.4%; mean age 36.2 years) had high rates of psychiatric (68.5%) and somatic (64.8%) comorbidity, and previous psychiatric treatments (57.4%). Assessments were performed pre- and posttreatment and at 6-month follow-up. The primary outcome measure was the Panic Disorder Severity Scale. Both treatments were highly effective. In patients randomized to PFPP, remission was achieved in 44.4% at termination and by 50% at follow-up (CBT 61.1% and 55.6%, respectively). No significant differences were found. Emotional awareness, a posited moderator of good outcome in psychotherapies, was significantly higher in the CBT group at baseline. It was found to be a strong moderator of treatment effectiveness in both treatments. After adjusting for initial Levels of Emotional Awareness Scale (LEAS) scores, effect sizes (ESs) for the primary outcome were Cohen d = 1.28, from pre- to posttreatment, and d = 1.03, from pretreatment to follow-up, for PFPP, and d = 1.81 and 1.28 for CBT, respectively. PFPP was implemented effectively into clinical practice by psychoanalysts in the community in a sample with severe mental illness with large ESs. Assessment of LEAS may facilitate the identification of patients suitable for short-term psychotherapy. ( German Clinical Trials Register, DRKS00000245; Universal Trial Number, U1111-1112-4245).

Existentially informed HIV-related psychotherapy.

PubMed

Farber, Eugene W

2009-09-01

This article describes an existentially informed approach to conducting psychotherapy with individuals living with the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS). Uses of existential concepts to guide a holistic conceptualization of the individual and illuminate core existential concerns and dilemmas in confronting HIV-related challenges are delineated. Applications of existential ideas regarding psychotherapy process and technique in HIV-related psychotherapy also are illustrated. It is concluded that existential psychotherapy offers a conceptual framework that is especially well suited to the work of psychotherapy with individuals living with HIV disease, although the approach has received only limited attention in the HIV-related psychotherapy literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Exploration of the reasons for dropping out of psychotherapy: A qualitative study.

PubMed

Khazaie, Habibolah; Rezaie, Leeba; Shahdipour, Niloofar; Weaver, Patrick

2016-06-01

Elucidating the reasons for dropping out of psychotherapy can lead to the development of interventions aimed at reducing patient drop out. The present study aimed to explore patients' reasons for dropping out of psychotherapy in Kermanshah, Iran. The present qualitative study was performed using conventional content analysis. The current sample included 15 participants consisting of 7 patients who dropped out of psychotherapy and 8 psychotherapists who have previously experienced patient dropout. A semi-structured interview was used for data collection. All interviews were audio recorded and subsequently transcribed. Content analysis using constant comparisons was performed for transcribed interviews. Four main categories emerged as reasons for dropping out of psychotherapy: dissatisfaction with the quality of psychotherapy, financial problems in psychotherapy, unprepared socio-cultural context of psychotherapy, and psychotherapy as a non-user friendly treatment. Additionally, specific subcategories within each main category were documented. The results revealed distinct reasons for psychotherapy drop out in the current Iranian-based sample. These identified reasons should be considered and addressed at the onset of treatment as well as in the development of formal interventions aimed at reducing dropout. Further research investigating the antecedents leading to patient drop out is recommended. Copyright © 2016 Elsevier Ltd. All rights reserved.

Is Exposure Necessary? A Randomized Clinical Trial of Interpersonal Psychotherapy for PTSD

PubMed Central

Markowitz, John C.; Petkova, Eva; Neria, Yuval; Van Meter, Page E.; Zhao, Yihong; Hembree, Elizabeth; Lovell, Karina; Biyanova, Tatyana; Marshall, Randall D.

2015-01-01

Background Exposure to trauma reminders has been considered imperative in psychotherapy for posttraumatic stress disorder (PTSD). No treatment benefits all patients, however. We tested Interpersonal Psychotherapy, which has demonstrated antidepressant efficacy and showed promise in pilot PTSD research, as a non-exposure-based, non-cognitive behavioral PTSD treatment. Methods A randomized, fourteen-week trial compared Interpersonal Psychotherapy; Prolonged Exposure, an exposure-based exemplar; and Relaxation Therapy, an active control psychotherapy. Subjects were 110 unmedicated patients having DSM-IV chronic PTSD and Clinician-Administered PTSD Scale (CAPS) score >50. Randomization stratified for comorbid major depression. We hypothesized Interpersonal Psychotherapy would be no more than minimally inferior (CAPS difference <12.5 points) to Prolonged Exposure. Results All therapies had large within-group pre/post effect sizes (d=1.32–1.88). Response rates (>30% CAPS improvement) were: Interpersonal Psychotherapy 63%, Prolonged Exposure 47%, Relaxation Therapy 38% (n.s.). Interpersonal psychotherapy and Prolonged Exposure CAPS outcome differed by 5.5 points (n.s.); the null hypothesis of more than minimal Interpersonal Psychotherapy inferiority was rejected (p=0.035). Patients with comorbid major depression dropped out from Prolonged Exposure nine times more than non-depressed Prolonged Exposure patients. Interpersonal Psychotherapy and Prolonged Exposure improved quality of life and social functioning more than Relaxation Therapy. Conclusions This first controlled study of individual Interpersonal Psychotherapy for PTSD demonstrated non-inferiority to the “gold standard” PTSD treatment. Interpersonal Psychotherapy had (non-significantly) lower attrition and higher response rates than Prolonged Exposure. Contradicting a widespread clinical belief, PTSD treatment may not require cognitive behavioral exposure to trauma reminders. Moreover, as differential therapeutics, patients with comorbid major depression may fare better in Interpersonal Psychotherapy than Prolonged Exposure. PMID:25677355

Projective Identification, Self-Disclosure, and the Patient's View of the Object: The Need for Flexibility

PubMed Central

Waska, Robert T.

1999-01-01

Certain patients, through projective identification and splitting mechanisms, test the boundaries of the analytic situation. These patients are usually experiencing overwhelming paranoid-schizoid anxieties and view the object as ruthless and persecutory. Using a Kleinian perspective, the author advocates greater analytic flexibility with these difficult patients who seem unable to use the standard analytic environment. The concept of self-disclosure is examined, and the author discusses certain technical situations where self-disclosure may be helpful.(The Journal of Psychotherapy Practice and Research 1999; 8:225–233) PMID:10413442

Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta‐analysis of population surveys

PubMed Central

Angermeyer, Matthias C.; van der Auwera, Sandra; Carta, Mauro G.; Schomerus, Georg

2017-01-01

Public attitudes towards psychiatry are crucial determinants of help‐seeking for mental illness. It has been argued that psychiatry as a discipline enjoys low esteem among the public, and a “crisis” of psychiatry has been noted. We conducted a systematic review and meta‐analysis of population studies examining public attitudes towards various aspects of psychiatric care. Our search in PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on population surveys conducted since 2000 and published no later than 2015. We found that professional help for mental disorders generally enjoys high esteem. While general practitioners are the preferred source of help for depression, mental health professionals are the most trusted helpers for schizophrenia. If respondents have to rank sources of help, they tend to favor mental health professionals, while open questions yield results more favorable to general practitioners. Psychiatrists and psychologists/psychotherapists are equally recommended for the treatment of schizophrenia, while for depression psychologists/psychotherapists are more recommended, at least in Europe and America. Psychotherapy is consistently preferred over medication. Attitudes towards seeking help from psychiatrists or psychologists/psychotherapists as well as towards medication and psychotherapy have markedly improved over the last twenty‐five years. Biological concepts of mental illness are associated with stronger approval of psychiatric help, particularly medication. Self‐stigma and negative attitudes towards persons with mental illness decrease the likelihood of personally considering psychiatric help. In conclusion, the public readily recommends psychiatric help for the treatment of mental disorders. Psychotherapy is the most popular method of psychiatric treatment. A useful strategy to further improve the public image of psychiatry could be to stress that listening and understanding are at the core of psychiatric care. PMID:28127931

Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta-analysis of population surveys.

PubMed

Angermeyer, Matthias C; van der Auwera, Sandra; Carta, Mauro G; Schomerus, Georg

2017-02-01

Public attitudes towards psychiatry are crucial determinants of help-seeking for mental illness. It has been argued that psychiatry as a discipline enjoys low esteem among the public, and a "crisis" of psychiatry has been noted. We conducted a systematic review and meta-analysis of population studies examining public attitudes towards various aspects of psychiatric care. Our search in PubMed, Web of Science, PsychINFO and bibliographies yielded 162 papers based on population surveys conducted since 2000 and published no later than 2015. We found that professional help for mental disorders generally enjoys high esteem. While general practitioners are the preferred source of help for depression, mental health professionals are the most trusted helpers for schizophrenia. If respondents have to rank sources of help, they tend to favor mental health professionals, while open questions yield results more favorable to general practitioners. Psychiatrists and psychologists/psychotherapists are equally recommended for the treatment of schizophrenia, while for depression psychologists/psychotherapists are more recommended, at least in Europe and America. Psychotherapy is consistently preferred over medication. Attitudes towards seeking help from psychiatrists or psychologists/psychotherapists as well as towards medication and psychotherapy have markedly improved over the last twenty-five years. Biological concepts of mental illness are associated with stronger approval of psychiatric help, particularly medication. Self-stigma and negative attitudes towards persons with mental illness decrease the likelihood of personally considering psychiatric help. In conclusion, the public readily recommends psychiatric help for the treatment of mental disorders. Psychotherapy is the most popular method of psychiatric treatment. A useful strategy to further improve the public image of psychiatry could be to stress that listening and understanding are at the core of psychiatric care. © 2017 World Psychiatric Association.

Psychotherapy with physically disabled patients.

PubMed

Oliveira, Rui Aragao; Milliner, Eric K; Page, Richard

2004-01-01

With the last decades, health care interventions have been more productively attuned to actualizing the potential for optimal recuperation of every patient. Unique and important contributions of psychotherapy to this effort include: 1) A formulation which synthesizes an understanding of clinical behaviors, reality-based physical limitations and risks with an appreciation of the patient's mechanisms of defense, ego strengths and weaknesses, and transference expectations which impact the treatment process; 2) The utilization of individual psychotherapy (focused on "insight") in combination with supportive individual and group experiences. For children and adolescents struggling with age-appropriate physical-developmental and social issues or learning disabilities, psychoeducational approach for disabled youngsters has proven very beneficial. 3) Occasional crises occur which involve the spouse or relatives more than the index patient. Working to provide supportive Couple or Family System intervention is sometimes as essential as caring for the disabled individual. 4) Numerous Group Therapy approaches have proven efficacious. Treatment in a group setting is attractive to those who are concerned about cost-containment. Unfortunately, groups for disabled are often "didactic" and utilize a format that provides factual information about disabilities, medical procedures, and sometimes an intellectual discussion of "emotional answers" for certain types of problems or conditions. Groups that facilitate self-disclosure and emotional interactions among the members accomplish more meaningful results. In conclusion, we wish to emphasize the importance of developing rigorous scientific research in the area of disabilities which will match the excellence of clinical work already being done in the field. Gaining an accurate and more thorough understanding of the psychological reality of a disabled person's internal world may be a key to facilitating his or her self-esteem and optimal adaptive functioning.

Extreme Attributions Predict the Course of Bipolar Depression: Results from the STEP-BD Randomized Controlled Trial of Psychosocial Treatment

PubMed Central

Stange, Jonathan P.; Sylvia, Louisa G.; da Silva Magalhães, Pedro Vieira; Miklowitz, David J.; Otto, Michael W.; Frank, Ellen; Berk, Michael; Nierenberg, Andrew A.; Deckersbach, Thilo

2013-01-01

Objective Little is known about predictors of recovery from bipolar depression or moderators of treatment response. In the present study we investigated attributional style (a cognitive pattern of explaining the causes of life events) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychotherapy for bipolar depression. Method 106 depressed outpatients with DSM-IV bipolar I or II disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were randomized to intensive psychotherapy for depression (n=62), or collaborative care (n=44), a minimal psychoeducational intervention. The primary outcome was recovery status at each study visit as measured by the Clinical Monitoring Form. Attributional style was measured at baseline using the Attributional Style Questionnaire. Data were collected between 1998 and 2005. Results All analyses were by intention to treat. Extreme attributions predicted a lower likelihood of recovery (p=.01, OR=0.93, 95% CI=.88-.98) and longer time until recovery (p<.01, OR=0.96, 95% CI=.93-.99), independent of the effects of initial depression severity. Among individuals with more pessimistic attributional styles, initial depression severity predicted a lower likelihood of recovery (p=.01, OR=0.64, 95% CI=.45-.91) and longer time until recovery (p<.001, OR=0.76, 95% CI=.66-.88). There was no difference in recovery rates between intensive psychotherapy and collaborative care (OR=0.90, 95% CI=0.40-2.01) in the full sample. Conclusions These results suggest that extreme, rigid attributions may be associated with a more severe course of depression, and that evaluating attributional style may help clinicians to identify patients who are at risk for experiencing a more severe course of depression. PMID:23561230

Challenges in demonstrating the effectiveness of multidisciplinary treatment on quality of life, participation and health care utilisation in patients with fibromyalgia: a randomised controlled trial.

PubMed

van Eijk-Hustings, Yvonne; Kroese, Mariëlle; Tan, Frans; Boonen, Annelies; Bessems-Beks, Monique; Landewé, Robert

2013-02-01

This study aimed to examine the effectiveness of a multidisciplinary intervention with aftercare (MD) compared to aerobic exercise (AE) and usual care (UC) in recently diagnosed patients with fibromyalgia (FM). In a Zelen-like design, eligible patients from the outpatient rheumatology clinics of three medical centres in the South of the Netherlands were consecutively recruited and pre-randomised to MD (n = 108), AE (n = 47) or UC (n = 48). MD consisted of a 12-week course of sociotherapy, physiotherapy, psychotherapy and creative arts therapy (three half days per week), followed by five aftercare meetings in 9 months. AE was given twice a week in a 12-week course. UC varied but incorporated at least education and lifestyle advice. Primary outcomes were health-related quality of life (HR-Qol), participation and health care utilisation. Secondary outcome was the Fibromyalgia Impact Questionnaire (FIQ). Total follow-up duration of the study was 21-24 months. As willingness to participate in AE was limited, this group has been analysed but interpretation of the data is considered arguable. Within the MD group, a statistically significantly improved HR-Qol and a statistically significant reduction in number of hours sick leave, number of contacts with general practitioners and number of contacts with medical specialists was found. Moreover, statistically significant improvements were found on the FIQ, which increased after the intervention. However, no statistically significant between-group differences were found at the endpoint of the study. MD seemed to yield positive effects, but firm conclusions with regard to effectiveness cannot be formulated due to small between-group differences and limitations of the study.

Evidence-Based Psychotherapy: Advantages and Challenges.

PubMed

Cook, Sarah C; Schwartz, Ann C; Kaslow, Nadine J

2017-07-01

Evidence-based psychotherapies have been shown to be efficacious and cost-effective for a wide range of psychiatric conditions. Psychiatric disorders are prevalent worldwide and associated with high rates of disease burden, as well as elevated rates of co-occurrence with medical disorders, which has led to an increased focus on the need for evidence-based psychotherapies. This chapter focuses on the current state of evidence-based psychotherapy. The strengths and challenges of evidence-based psychotherapy are discussed, as well as misperceptions regarding the approach that may discourage and limit its use. In addition, we review various factors associated with the optimal implementation and application of evidence-based psychotherapies. Lastly, suggestions are provided on ways to advance the evidence-based psychotherapy movement to become truly integrated into practice.

Integration in psychotherapy: Reasons and challenges.

PubMed

Fernández-Álvarez, Héctor; Consoli, Andrés J; Gómez, Beatriz

2016-11-01

Although integration has been formally influencing the field of psychotherapy since the 1930s, its impact gained significant momentum during the 1980s. Practical, theoretical, and scientific reasons help to explain the growing influence of integration in psychotherapy. The field of psychotherapy is characterized by many challenges which integration may change into meaningful opportunities. Nonetheless, many obstacles remain when seeking to advance integration. To appreciate the strength of integration in psychotherapy we describe an integrative, comprehensive approach to service delivery, research, and training. We then discuss the role of integration in the future of psychotherapy. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

[Attitudes towards psychotherapy of young second-generation Turkish immigrants living in Germany].

PubMed

Calliess, Iris Tatjana; Schmid-Ott, Gerhard; Akguel, Gülay; Jaeger, Burkard; Ziegenbein, Marc

2007-10-01

To assess the effect of cultural identification in Turkish immigrants living in Germany on attitudes towards psychotherapy. The approach to psychotherapy of 139 Turkish immigrants and 164 Germans was examined. Overall the Turkish population reported a less positive attitude towards psychotherapy in comparison to the German population. The Turkish immigrants with a less traditional cultural background reported a more positive attitude towards psychotherapy when compared to Turkish immigrants of a more Turkish identified traditional cultural background. Results suggest that culture-specific factors affect attitudes towards psychotherapy in Turkish immigrants, which indicates a need for intercultural psychotherapeutic education.

Predicting engagement in psychotherapy, pharmacotherapy, or both psychotherapy and pharmacotherapy among returning veterans seeking PTSD treatment.

PubMed

Haller, Moira; Myers, Ursula S; McKnight, Aaron; Angkaw, Abigail C; Norman, Sonya B

2016-11-01

Both pharmacotherapy and psychotherapy are effective treatments for posttraumatic stress disorder (PTSD). Better understanding factors that are associated with engaging in these different treatment options may improve treatment utilization and outcomes. This issue is especially important among veterans returning from Iraq and Afghanistan, given high rates of those seeking PTSD treatment. This study examined potential predictors of the type of treatment (psychotherapy, pharmacotherapy, or both) 232 returning veterans (92% male, mean age = 33.38) engaged in within 1 year of seeking treatment at a VA PTSD clinic. Results indicated that 32.3% of returning veterans engaged in pharmacotherapy only, 23.7% engaged in psychotherapy only, and 44.0% engaged in both. Veterans who engaged in pharmacotherapy only or in both pharmacotherapy and psychotherapy had higher pretreatment PTSD and depression symptoms than did those who engaged in psychotherapy only. History of pharmacotherapy treatment was associated with engagement in pharmacotherapy only or both pharmacotherapy and psychotherapy, as compared with psychotherapy only. Treatment engagement type was not significantly associated with differences in age, gender, race/ethnicity, service branch, alcohol use/misuse, history of psychotherapy, distance from the VA, or PTSD service connection. Implications for enhancing PTSD treatment engagement are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

[Clinical justification of medico-psychological care to the victims of technogenic accidents and catastrophes with prevalence of anxious and depressive symptoms of non-psychotic register].

PubMed

Volobuev, V V

2014-01-01

In the article the clinical justification of medico-psychological care to the victims of technogenic accidents and catastrophes with prevalence of anxious and depressive symptoms of non-psychotic register is described. The necessity of differentiated approach is analyzed in accomplishing of psychotherapy of this contingent of patients taking into account the high level of anxiety, emotional stress, decreased mood, low levels of the quality of life in the remote period of strong stressful factor's action.

Transpersonal Group Psychotherapy: Theory, Method, and Community.

ERIC Educational Resources Information Center

Clark, Carlton F. "Perk"

1998-01-01

Transpersonal group psychotherapy is a carpet of theory, technique, and experiences woven from threads of contemporary psychology, mysticism, and a perennial philosophy many centuries old. Introduces the basic concepts of transpersonal group psychotherapy, proposes a model of transpersonal group psychotherapy, discusses the training of…

The current situation of treatment systems for alcoholism in Korea.

PubMed

Kim, Jee Wook; Lee, Boung Chul; Kang, Tae-Cheon; Choi, Ihn-Geun

2013-02-01

Alcoholism is becoming one of the most serious issues in Korea. The purpose of this review article was to understand the present status of the treatment system for alcoholism in Korea compared to the United States and to suggest its developmental direction in Korea. Current modalities of alcoholism treatment in Korea including withdrawal treatment, pharmacotherapy, and psychosocial treatment are available according to Korean evidence-based treatment guidelines. Benzodiazepines and supportive care including vitamin and nutritional support are mainly used to treat alcohol withdrawal in Korea. Naltrexone and acamprosate are the drugs of first choice to treat chronic alcoholism. Psychosocial treatment methods such as individual psychotherapy, group psychotherapy, family therapy, cognitive behavior therapy, cue exposure therapy, 12-step facilitation therapy, self-help group therapy, and community-based treatment have been carried out to treat chronic alcoholism in Korea. However, current alcohol treatment system in Korea is not integrative compared to that in the United States. To establish the treatment system, it is important to set up an independent governmental administration on alcohol abuse, to secure experts on alcoholism, and to conduct outpatient alcoholism treatment programs and facilities in an open system including some form of continuing care.

The Current Situation of Treatment Systems for Alcoholism in Korea

PubMed Central

Kim, Jee Wook; Lee, Boung Chul; Kang, Tae-Cheon

2013-01-01

Alcoholism is becoming one of the most serious issues in Korea. The purpose of this review article was to understand the present status of the treatment system for alcoholism in Korea compared to the United States and to suggest its developmental direction in Korea. Current modalities of alcoholism treatment in Korea including withdrawal treatment, pharmacotherapy, and psychosocial treatment are available according to Korean evidence-based treatment guidelines. Benzodiazepines and supportive care including vitamin and nutritional support are mainly used to treat alcohol withdrawal in Korea. Naltrexone and acamprosate are the drugs of first choice to treat chronic alcoholism. Psychosocial treatment methods such as individual psychotherapy, group psychotherapy, family therapy, cognitive behavior therapy, cue exposure therapy, 12-step facilitation therapy, self-help group therapy, and community-based treatment have been carried out to treat chronic alcoholism in Korea. However, current alcohol treatment system in Korea is not integrative compared to that in the United States. To establish the treatment system, it is important to set up an independent governmental administration on alcohol abuse, to secure experts on alcoholism, and to conduct outpatient alcoholism treatment programs and facilities in an open system including some form of continuing care. PMID:23400047

Treating Patients Who Strain the Research Psychotherapy Paradigm

PubMed Central

Markowitz, John C.; Kaplowitz, Matthew; Suh, Eun-Jung; Meehan, Kevin; Neria, Yuval; Jonker, Hanske; Rafaeli, Alexandra; Lovell, Karina

2013-01-01

Background Clinical trials of psychotherapy require diagnostic homogeneity, which implies a convergence of clinical presentations. Yet research study patients present diversely, and patients who do not fit a treatment paradigm may greatly complicate delivery of the study psychotherapy. The research literature has not addressed this issue. Methods The authors use case illustrations of three psychotherapies – Prolonged Exposure, Relaxation Therapy, and Interpersonal Psychotherapy – from an ongoing psychotherapy outcome trial of posttraumatic stress disorder to describe psychotherapeutic responses to complex, “atypical” patients who strain standard treatment paradigms. Results Therapists required flexibility, and occasionally deviations from strict protocol, in treating heterodox patients. Conclusions Such heterogeneity of presentation may have implications for psychotherapy outcome in research trials. Despite lack of discussion in the literature, many trials may face such issues. PMID:22759936

Group psychotherapy for persons with traumatic brain injury: management of frustration and substance abuse.

PubMed

Delmonico, R L; Hanley-Peterson, P; Englander, J

1998-12-01

Residual emotional and behavioral difficulties in individuals who have sustained a traumatic brain injury (TBI) have been well documented in the literature. The issues are complex, interdependent, and often include substance abuse, depression, anxiety, chronic suicidal or homicidal ideation, poor impulse control, and significant degrees of frustration and anger. Often, preexisting psychological conditions and poor coping strategies are exacerbated by the trauma. Emotional and behavioral difficulties can interfere with the neurorehabilitation process at all levels. In acute rehabilitation, these issues have traditionally been addressed on an individual basis. However, in postacute settings, an interpersonal group format can be effectively implemented. The majority of individuals with TBI have minimal funding for long-term cognitive and behavioral remediation; often the only avenue available is support groups. This article will describe group psychotherapy models used with individuals with acute or postacute TBI within a comprehensive rehabilitation center. Interdisciplinary treatment of frustration and substance abuse and a continuum of care will be emphasized. Education, social support, skills development, interpersonal process, and cognitive-behavioral approaches will also be discussed. The psychotherapy groups focus on treatment of substance abuse and frustration management through education, social support, and development of interpersonal skills. Practical considerations of running such groups are presented.

Psychosocial Treatment Options for Major Depressive Disorder in Older Adults

PubMed Central

Renn, Brenna N.; Areán, Patricia A.

2017-01-01

Opinion Statement Late-life depression (LLD) is a public health concern with deleterious effects on overall health, cognition, quality of life, and mortality. Although LLD is relatively common, it is not a normal part of aging and is often under-recognized in older adults. However, psychotherapy is an effective treatment for LLD that aligns with many patients’ preferences and can improve health and functioning. This review synthesized the current literature on evidence-based psychotherapies for the treatment of depression in older adults. Findings suggest that active, skills-based psychotherapies (cognitive behavioral therapy [CBT] and problem-solving therapy [PST]) may be more effective for LLD than non-directive, supportive counseling. PST may be particularly relevant for offsetting skill deficit associated with LLD, such as in instances of cognitive impairment (especially executive dysfunction) and disability. Emerging treatments also consider contextual factors to improve treatment delivery, such as personalized care, access, and poverty. Tele-mental health represents one such exciting new way of improving access and uptake of treatment by older adults. Although these strategies hold promise, further investigation via randomized controlled trials and comparative effectiveness are necessary to advance our treatment of LLD. Priority should be given to recruiting and training the geriatric mental health workforce to deliver evidence-based psychosocial interventions for LLD. PMID:28932652

Patient-focused and feedback research in psychotherapy: Where are we and where do we want to go?

PubMed

Lutz, Wolfgang; De Jong, Kim; Rubel, Julian

2015-01-01

In the last 15 years feedback interventions have had a significant impact on the field of psychotherapy research and have demonstrated their potential to enhance treatment outcomes, especially for patients with an increased risk of treatment failure. This article serves as an introduction to the special issue on "Patient-focused and feedback research in psychotherapy: Where are we and where do we want to go?" Current investigations on feedback research are concerned with potential moderators and mediators of these effects, as well as the design and the implementation of feedback into routine care. This introduction summarizes the current state of feedback research and provides an overview of the three main research topics in this issue: (1) How to implement feedback systems into routine practice and how do therapist and patient attitudes influence its effects?, (2) How to design feedback reports and decision support tools?, and (3) What are the reasons for patients to become at risk of treatment failure and how should therapists intervene with these patients? We believe that the studies included in this special issue reflect the current state of feedback research and provide promising pathways for future endeavors that will enhance our understanding of feedback effects.

[Music therapy and depression].

PubMed

Van Assche, E; De Backer, J; Vermote, R

2015-01-01

Music therapy is a predominantly non-verbal psychotherapy based on music improvisation, embedded in a therapeutic relationship. This is the reason why music therapy is also used to treat depression. To examine the efficacy of music therapy and to report on the results of recent research into the value of music therapy as a treatment for depression. We reviewed the literature on recent research into music therapy and depression, reporting on the methods used and the results achieved, and we assessed the current position of music therapy for depression in the context of evidence-based scientific research. A wide variety of research methods was used to investigate the effects of using music therapy as a psychotherapy. Most studies focused usually on the added value that music therapy brings to the standard form of psychiatric treatment, when administered with or without psychopharmacological support. Music therapy produced particularly significant and favourable results when used to treat patients with depression. Current research into music therapy and depression points to a significant and persistent reduction in patients' symptoms and to improvements in their quality of life. However, further research is needed with regard to the best methods of illustrating the effects of music therapy.

Reducing the stigma associated with seeking psychotherapy through self-affirmation.

PubMed

Lannin, Daniel G; Guyll, Max; Vogel, David L; Madon, Stephanie

2013-10-01

Psychotherapy may be underutilized because people experience self-stigma-the internalization of public stigma associated with seeking psychotherapy. The purpose of this study was to experimentally test whether the self-stigma associated with seeking psychotherapy could be reduced by a self-affirmation intervention wherein participants reflected on an important personal characteristic. Compared with a control group, we hypothesized that a self-affirmation writing task would attenuate self-stigma, and thereby evidence indirect effects on intentions and willingness to seek psychotherapy. Participants were 84 undergraduates experiencing psychological distress. After completing pretest measures of self-stigma, intentions, and willingness to seek psychotherapy, participants were randomly assigned to either a self-affirmation or a control writing task, and subsequently completed posttest measures of self-stigma, intentions, and willingness to seek psychotherapy. Consistent with hypotheses, participants who engaged in self-affirmation reported lower self-stigma at posttest. Moreover, the self-affirmation writing task resulted in a positive indirect effect on willingness to seek psychotherapy, though results failed to support an indirect effect on intentions to seek psychotherapy. Findings suggest that self-affirmation theory may provide a useful framework for designing interventions that seek to address the underutilization of psychological services through reductions in self-stigma.

Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial.

PubMed

van der Heijden, Amber A W A; de Bruijne, Martine C; Feenstra, Talitha L; Dekker, Jacqueline M; Baan, Caroline A; Bosmans, Judith E; Bot, Sandra D M; Donker, Gé A; Nijpels, Giel

2014-06-25

The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care process and costs of managed, protocolized and usual care for type 2 diabetes patients from a societal perspective. In two distinct regions of the Netherlands, both managed and protocolized diabetes care were implemented. Managed care was characterized by centralized organization, coordination, responsibility and centralized annual assessment. Protocolized care had a partly centralized organizational structure. Usual care was characterized by a decentralized organizational structure. Using a quasi-experimental control group pretest-posttest design, the care process (guideline adherence) and costs were compared between managed (n = 253), protocolized (n = 197), and usual care (n = 333). We made a distinction between direct health care costs, direct non-health care costs and indirect costs. Multivariate regression models were used to estimate differences in costs adjusted for confounding factors. Because of the skewed distribution of the costs, bootstrapping methods (5000 replications) with a bias-corrected and accelerated approach were used to estimate 95% confidence intervals (CI) around the differences in costs. Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI: -2.597 to -334)) while indirect costs were higher (€ 758 (95% CI: -353 to 2.701), although not significant. Direct, indirect and total costs were lower in protocolized care compared to usual care (though not significantly). Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs. The same trends were seen for protocolized care, however they were not statistically significant. Current Controlled trials: ISRCTN66124817.

Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial

PubMed Central

2014-01-01

Background The increasing prevalence of diabetes is associated with increased health care use and costs. Innovations to improve the quality of care, manage the increasing demand for health care and control the growth of health care costs are needed. The aim of this study is to evaluate the care process and costs of managed, protocolized and usual care for type 2 diabetes patients from a societal perspective. Methods In two distinct regions of the Netherlands, both managed and protocolized diabetes care were implemented. Managed care was characterized by centralized organization, coordination, responsibility and centralized annual assessment. Protocolized care had a partly centralized organizational structure. Usual care was characterized by a decentralized organizational structure. Using a quasi-experimental control group pretest-posttest design, the care process (guideline adherence) and costs were compared between managed (n = 253), protocolized (n = 197), and usual care (n = 333). We made a distinction between direct health care costs, direct non-health care costs and indirect costs. Multivariate regression models were used to estimate differences in costs adjusted for confounding factors. Because of the skewed distribution of the costs, bootstrapping methods (5000 replications) with a bias-corrected and accelerated approach were used to estimate 95% confidence intervals (CI) around the differences in costs. Results Compared to usual and protocolized care, in managed care more patients were treated according to diabetes guidelines. Secondary health care use was higher in patients under usual care compared to managed and protocolized care. Compared to usual care, direct costs were significantly lower in managed care (€-1.181 (95% CI: -2.597 to -334)) while indirect costs were higher (€758 (95% CI: -353 to 2.701), although not significant. Direct, indirect and total costs were lower in protocolized care compared to usual care (though not significantly). Conclusions Compared to usual care, managed care was significantly associated with better process in terms of diabetes care, fewer secondary care consultations and lower health care costs. The same trends were seen for protocolized care, however they were not statistically significant. Trial registration Current Controlled trials: ISRCTN66124817. PMID:24966055

Individual psychotherapy for schizophrenia: trends and developments in the wake of the recovery movement.

PubMed

Hamm, Jay A; Hasson-Ohayon, Ilanit; Kukla, Marina; Lysaker, Paul H

2013-01-01

Although the role and relative prominence of psychotherapy in the treatment of schizophrenia has fluctuated over time, an analysis of the history of psychotherapy for schizophrenia, focusing on findings from the recovery movement, reveals recent trends including the emergence of the development of integrative psychotherapy approaches. The authors suggest that the recovery movement has revealed limitations in traditional approaches to psychotherapy, and has provided opportunities for integrative approaches to emerge as a mechanism for promoting recovery in persons with schizophrenia. Five approaches to integrative psychotherapy for persons with schizophrenia are presented, and a shared conceptual framework that allows these five approaches to be compatible with one another is proposed. The conceptual framework is consistent with theories of recovery and emphasizes interpersonal attachment, personal narrative, and metacognitive processes. Implications for future research on integrative psychotherapy are considered.

Mixed methods in psychotherapy research: A review of method(ology) integration in psychotherapy science.

PubMed

Bartholomew, Theodore T; Lockard, Allison J

2018-06-13

Mixed methods can foster depth and breadth in psychological research. However, its use remains in development in psychotherapy research. Our purpose was to review the use of mixed methods in psychotherapy research. Thirty-one studies were identified via the PRISMA systematic review method. Using Creswell & Plano Clark's typologies to identify design characteristics, we assessed each study for rigor and how each used mixed methods. Key features of mixed methods designs and these common patterns were identified: (a) integration of clients' perceptions via mixing; (b) understanding group psychotherapy; (c) integrating methods with cases and small samples; (d) analyzing clinical data as qualitative data; and (e) exploring cultural identities in psychotherapy through mixed methods. The review is discussed with respect to the value of integrating multiple data in single studies to enhance psychotherapy research. © 2018 Wiley Periodicals, Inc.

The Mental Health Parity and Addiction Equity Act Evaluation Study: Impact on Specialty Behavioral Health Care Utilization and Spending Among Carve-In Enrollees.

PubMed

Harwood, Jessica M; Azocar, Francisca; Thalmayer, Amber; Xu, Haiyong; Ong, Michael K; Tseng, Chi-Hong; Wells, Kenneth B; Friedman, Sarah; Ettner, Susan L

2017-02-01

The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between insurance coverage for behavioral health (BH) treatment and coverage for medical treatment. Our objective was to evaluate MHPAEA's impact on BH expenditures and utilization among "carve-in" enrollees. We received specialty BH insurance claims and eligibility data from Optum, sampling 5,987,776 adults enrolled in self-insured plans from large employers. An interrupted time series study design with segmented regression analysis estimated monthly time trends of per-member spending and use before (2008-2009), during (2010), and after (2011-2013) MHPAEA compliance (N=179,506,951 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits, medication management, individual and family psychotherapy); intermediate care utilization (structured outpatient, day treatment, residential); and inpatient utilization. MHPAEA was associated with increases in monthly per-member total spending, plan spending, assessment/diagnostic evaluation visits [respective immediate increases of: $1.05 (P=0.02); $0.88 (P=0.04); 0.00045 visits (P=0.00)], and individual psychotherapy visits [immediate increase of 0.00578 visits (P=0.00) and additional increases of 0.00017 visits/mo (P=0.03)]. MHPAEA was associated with modest increases in total and plan spending and outpatient utilization; for example, in July 2012 predicted per-enrollee plan spending was $4.92 without MHPAEA and $6.14 with MHPAEA. Efforts should focus on understanding how other barriers to BH care unaddressed by MHPAEA may affect access/utilization. Future research should evaluate effects produced by the Affordable Care Act's inclusion of BH care as an essential health benefit and expansion of MHPAEA protections to the individual and small group markets.

Effects of the mental health parity and addictions equality act on depression treatment choice in primary care facilities.

PubMed

Goldberg, Daniel M; Lin, Hsien-Chang

2017-01-01

Objective The Mental Health Parity and Addictions Equality Act (MHPAEA) of 2010 in the United States sought to expand mental health insurance benefits on par with medical benefits. As primary care facilities are often the first step in identifying mental health concerns, it is essential to examine the association of this policy with primary care physicians' choice on depression treatment. Method A retrospective cross-sectional study was conducted using data from the 2007-2012 National Ambulatory Medical Care Survey, including a weighted total of 162,699,930 depression patients. Using the Heckman two-step selection procedure, a logistic and a multinomial regression were conducted to examine the association of the MHPAEA with physicians' two-step process of deciding whether and which type of treatment was prescribed. Sociological factors were controlled. Results Treatment was significantly more likely to be provided after the MHPAEA. Psychotherapy was used for treatment for 10.0% of the sample while medication was used for 75.0% of the sample. Patient race/ethnicity, practice setting, physician specialty, and primary source of payment were associated with diverging likelihood of being prescribed depression treatment. Non-Hispanic White patients were more likely to be provided treatment than non-Hispanic Black patients. Patients were less likely to be prescribed only medication than only psychotherapy after the MHPAEA enactment. Conclusions The MHPAEA was associated with primary care providers' decision and choice on depression treatment. Educational and policy interventions aimed at improving physician's understanding of their own treatment tendencies and decreasing barriers to depression treatment may impact the disparities in underserved, minority, and older populations.

Reflections on Individual Psychotherapy with University Students: What Seems to Work

ERIC Educational Resources Information Center

Pinkerton, Rolffs; Talley, Joseph E.; Cooper, Stacie L.

2009-01-01

The authors offer reflections on what seems to work in individual psychotherapy with university students. Discussion centers around the topics of triage and disposition, referral, crisis intervention, stress management, open-ended psychotherapy, extratherapeutic factors, and the psychotherapy relationship. These observations are not intended to be…

Common Factors: Where the Soul of Counseling and Psychotherapy Resides

ERIC Educational Resources Information Center

Ottens, Allen J.; Klein, James F.

2005-01-01

The authors show how theoretical and empirical findings from the common factors and psychotherapy integration literatures possess potential for infusing soul into psychotherapy. They describe the term soul, outline how the definition translates into soul-nurturing psychotherapy, examine the common factors and integration literatures, and discuss…

Child Psychotherapy Dropout: An Empirical Research Review

ERIC Educational Resources Information Center

Deakin, Elisabeth; Gastaud, Marina; Nunes, Maria Lucia Tiellet

2012-01-01

This study aims to discuss the most recent data about child psychotherapy dropout, especially child psychoanalytical psychotherapy. The authors also try to offer some possible alternatives to prevent such a phenomenon. The definition of "child psychotherapy dropout" is extensively discussed. The goal has been to attempt to create a standardised…

[The treatment of postpartum depression with interpersonal psychotherapy and interpersonal counseling].

PubMed

Stuart, Scott; Clark, Elizabeth

2008-01-01

Perinatal depression is a prevalent disorder with a high degree of morbidity for both mother and infant. There are now empirically validated treatments for both postpartum depression and depression during pregnancy. Among these is Interpersonal Psychotherapy (IPT), which has been shown to be effective for postpartum depression across the spectrum of mild to severe depression. In fact, the limited evidence of efficacy for medication and concern about medication side effects have led some to suggest that IPT should be the first line treatment for depressed breastfeeding women. There are similar concerns about medication usage during pregnancy. Recent clinical and research experience also suggest that Interpersonal Counseling (IPC) may be effective for selected postpartum women as well. IPC, an abbreviated form of IPT, appears to be effective for mild to moderate depression, and has the potential advantage of being more amenable to delivery in primary care or OB settings.

Interpersonal differentiation within depression diagnosis: relating interpersonal subgroups to symptom load and the quality of the early therapeutic alliance.

PubMed

Grosse Holtforth, Martin; Altenstein, David; Krieger, Tobias; Flückiger, Christoph; Wright, Aidan G C; Caspar, Franz

2014-01-01

We examined interpersonal problems in psychotherapy outpatients with a principal diagnosis of a depressive disorder in routine care (n=361). These patients were compared to a normative non-clinical sample and to outpatients with other principal diagnoses (n=959). Furthermore, these patients were statistically assigned to interpersonally defined subgroups that were compared regarding symptoms and the quality of the early alliance. The sample of depressive patients reported higher levels of interpersonal problems than the normative sample and the sample of outpatients without a principal diagnosis of depression. Latent Class Analysis identified eight distinct interpersonal subgroups, which differed regarding self-reported symptom load and the quality of the early alliance. However, therapists' alliance ratings did not differentiate between the groups. This interpersonal differentiation within the group of patients with a principal diagnosis of depression may add to a personalized psychotherapy based on interpersonal profiles.

Animal-assisted therapy with chronic psychiatric inpatients: equine-assisted psychotherapy and aggressive behavior.

PubMed

Nurenberg, Jeffry R; Schleifer, Steven J; Shaffer, Thomas M; Yellin, Mary; Desai, Prital J; Amin, Ruchi; Bouchard, Axel; Montalvo, Cristina

2015-01-01

Animal-assisted therapy (AAT), most frequently used with dogs, is being used increasingly as an adjunctive alternative treatment for psychiatric patients. AAT with larger animals, such as horses, may have unique benefits. In this randomized controlled study, equine and canine forms of AAT were compared with standard treatments for hospitalized psychiatric patients to determine AAT effects on violent behavior and related measures. The study included 90 patients with recent in-hospital violent behavior or highly regressed behavior. Hospitalization at the 500-bed state psychiatric hospital was two months or longer (mean 5.4 years). Participants were randomly selected to receive ten weekly group therapy sessions of standardized equine-assisted psychotherapy (EAP), canine-assisted psychotherapy (CAP), enhanced social skills psychotherapy, or regular hospital care. Participants' mean age was 44, 37% were female, 76% had diagnoses of schizophrenia or schizoaffective disorder, and 56% had been committed involuntarily for civil or forensic reasons. Violence-related incident reports filed by staff in the three months after study intake were compared with reports two months preintake. Interventions were well tolerated. Analyses revealed an intervention group effect (F=3.00, df=3 and 86, p=.035); post hoc tests showed specific benefits of EAP (p<.05). Similar AAT effects were found for the incidence of 1:1 clinical observation (F=2.70, df=3 and 86, p=.051); post hoc tests suggested benefits of CAP (p=.058) as well as EAP (p=.082). Covariance analyses indicated that staff can predict which patients are likely to benefit from EAP (p=.01). AAT, and perhaps EAP uniquely, may be an effective therapeutic modality for long-term psychiatric patients at risk of violence.

Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project

PubMed Central

2014-01-01

Background Although psychotherapy is considered the treatment of choice for patients with personality disorders (PDs), there is no consensus about the optimal level of care for this group of patients. This study reports the results from the 6-year follow-up of the Ullevål Personality Project (UPP), a randomized clinical trial comparing outpatient individual psychotherapy with a long-term step-down treatment program that included a short-term day hospital treatment followed by combined group and individual psychotherapy. Methods The UPP included 113 patients with PDs. Outcome was evaluated after 8 months, 18 months, 3 years and 6 years and was based on a wide range of clinical measures, such as psychosocial functioning, interpersonal problems, symptom severity, and axis I and II diagnoses. Results At the 6-year follow-up, there were no statistically significant differences in outcome between the treatment groups. Effect sizes ranged from medium to large for all outcome variables in both treatment arms. However, patients in the outpatient group had a marked decline in psychosocial functioning during the period between the 3- and 6-year follow-ups; while psychosocial functioning continued to improve in the step-down group during the same period. This difference between groups was statistically significant. Conclusions The findings suggest that both hospital-based long-term step-down treatment and long-term outpatient individual psychotherapy may improve symptoms and psychosocial functioning in poorly functioning PD patients. Social and interpersonal functioning continued to improve in the step-down group during the post-treatment phase, indicating that longer-term changes were stimulated during treatment. Trial registration NCT00378248. PMID:24758722

Service utilization following participation in cognitive processing therapy or prolonged exposure therapy for post-traumatic stress disorder.

PubMed

Meyers, Laura L; Strom, Thad Q; Leskela, Jennie; Thuras, Paul; Kehle-Forbes, Shannon M; Curry, Kyle T

2013-01-01

This study evaluated the impact of a course of prolonged exposure or cognitive processing therapy on mental health and medical service utilization and health care service costs provided by the Department of Veterans Affairs (VA). Data on VA health service utilization and health care costs were obtained from national VA databases for 70 veterans who completed prolonged exposure or cognitive processing therapy at a Midwestern VA medical center. Utilization of services and cost data were examined for the year before and after treatment. Results demonstrated a significant decrease in the use of individual and group psychotherapy. Direct costs associated with mental health care decreased by 39.4%. Primary care and emergency department services remained unchanged.

The relationship of body image with symptoms of depression and anxiety in patients with anorexia nervosa during outpatient psychotherapy: Results of the ANTOP study.

PubMed

Junne, Florian; Zipfel, Stephan; Wild, Beate; Martus, Peter; Giel, Katrin; Resmark, Gaby; Friederich, Hans-Christoph; Teufel, Martin; de Zwaan, Martina; Dinkel, Andreas; Herpertz, Stephan; Burgmer, Markus; Tagay, Sefik; Rothermund, Eva; Zeeck, Almut; Ziser, Katrin; Herzog, Wolfgang; Löwe, Bernd

2016-06-01

Body image disturbance represents a central characteristic of anorexia nervosa (AN). Depression and anxiety are the most common mental comorbidities in patients with AN. This study aims to investigate the relationship of body image with symptoms of depression and anxiety during outpatient psychotherapy in AN. Analyses were conducted using the data set of the Anorexia Nervosa Treatment Outpatient Study (ANTOP) randomized controlled trial. The ANTOP study included N = 242 females with AN between 18 and 56 years of age. The trial was designed to compare enhanced cognitive behavioral therapy (CBT-E) and focal psychodynamic therapy (FPT) with optimized treatment as usual (TAU-O) for patients with AN. The analyses on body image dimensions were conducted using measures of correlations and multiple linear regression analyses to assess the relationship and longitudinal prediction of symptoms of depression and anxiety by body image dimensions. Results showed that body image perceptions were significantly associated with symptoms of depression and anxiety in patients with AN at all treatment stages. In addition, body image dimensions at early treatment stages predict depression and anxiety in follow-up measurements. The correlation of symptoms of depression and anxiety by body image perceptions increased along treatment course. The persistence of body image disturbance, while body mass index increases under treatment (persistency effect), may constitute a relevant factor contributing to the course of the most common affective comorbidities of depression and anxiety in patients with AN. Body image disturbances in patients with AN should therefore be explicitly targeted within the specialized psychotherapy of affected patients. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The Task before Psychiatry Today Redux: STSPIR*

PubMed Central

Singh, Ajai R.

2014-01-01

This paper outlines six important tasks for psychiatry today, which can be put in short as: Spread and scale up services;Talk;Science,Psychotherapy;Integrate; andResearch excellence. As an acronym, STSPIR. Spread and scale up services: Spreading mental health services to uncovered areas, and increasing facilities in covered areas:Mental disorders are leading cause of ill health but bottom of health agenda;Patients face widespread discrimination, human rights violations and lack of facilities;Need to stem the brain drain from developing countries;At any given point, 10% of the adult population report having some mental or behavioural disorder;In India, serious mental disorders affect nearly 80 million people, i.e. combined population of the northern top of India, including Punjab, Haryana, Jammu and Kashmir, Uttarakhand and Himachal Pradesh;Combating imbalance between burden of demand and supply of efficient psychiatric services in all countries, especially in developing ones like India, is the first task before psychiatry today. If ever a greater role for activism were needed, this is the field;The need is to scale up effective and cost-effective treatments and preventive interventions for mental disorders.Talk: Speaking to a wider audience about positive contributions of psychiatry: Being aware of, understanding, and countering, the massive anti-psychiatry propaganda online and elsewhere;Giving a firm answer to anti-psychiatry even while understanding its transformation into mental health consumerism and opposition to reckless medicalisation;Defining normality and abnormality;Bringing about greater precision in diagnosis and care;Motivating those helped by psychiatry to speak up;Setting up informative websites and organising programmes to reduce stigma and spread mental health awareness;Setting up regular columns in psychiatry journals around the globe, called ‘Patients Speak’, or something similar, wherein those who have been helped get a chance to voice their stories.Science: Shrugging ambivalence and disagreement and searching for commonalities in psychiatric phenomena; An idiographic orientation which stresses individuality cannot, and should not, preclude the nomothetic or norm laying thrust that is the crux of scientific progress.The major contribution of science has been to recognize such commonalities so they can be researched, categorized and used for human welfare.It is a mistake to stress individuality so much that commonalities are obliterated.While the purpose and approach of psychiatry, as of all medicine, has to be humane and caring, therapeutic advancements and aetiologic understandings are going to result only from a scientific methodology.Just caring is not enough, if you have not mastered the methods of care, which only science can supply.Psychotherapy: Psychiatrists continuing to do psychotherapy: Psychotherapy must be clearly defined, its parameters and methods firmly delineated, its proof of effectiveness convincingly demonstrated by evidence based and controlled trials;Psychotherapy research suffers from neglect by the mainstream at present, because of the ascendancy of biological psychiatry;It suffers resource constraints as major sponsors like pharma not interested;Needs funding from some sincere researcher organisations and altruistic sponsors, as also professional societies and governments;Psychotherapy research will have to provide enough irrefutable evidence that it works, with replicable studies that prove it across geographical areas;It will not do for psychiatrists to hand over psychotherapy to clinical psychologists and others.Integrate approaches: Welcoming biological breakthroughs, while supplying psychosocial insights: Experimental breakthroughs, both in aetiology and therapeutics, will come mainly from biology, but the insights and leads can hopefully come from many other fields, especially the psychosocial and philosophical;The biological and the psychological are not exclusive but complementary approaches;Both integration and reductionism are valid. Integration is necessary as an attitude, reductionism is necessary as an approach. Both the biological and the psychosocial must co-exist in the individual psychiatrist, as much as the branch itself.Research excellence: Promoting genuine research alone, and working towards an Indian Nobel Laureate in psychiatry by 2020: To stop promoting poor quality research and researchers, and to stop encouraging sycophants and ladder climbers. To pick up and hone genuine research talent from among faculty and students;Developing consistent quality environs in departments and having Heads of Units who recognize, hone and nurture talent. And who never give in to pessimism and cynicism;Stop being satisfied with the money, power and prestige that comes by wheeling-dealing, groupism and politicking;Infinite vistas of opportunity wait in the wings to unfold and offer opportunities for unravelling the mysteries of the ‘mind’ to the earnest seeker. Provided he is ready to seek the valuable. Provided he stops holding on to the artificial and the superfluous. PMID:24891797

The Task before Psychiatry Today Redux: STSPIR*.

PubMed

Singh, Ajai R

2014-01-01

This paper outlines six important tasks for psychiatry today, which can be put in short as: Spread and scale up services;Talk;Science,Psychotherapy;Integrate; andResearch excellence. As an acronym, STSPIR. Spread and scale up services: Spreading mental health services to uncovered areas, and increasing facilities in covered areas:Mental disorders are leading cause of ill health but bottom of health agenda;Patients face widespread discrimination, human rights violations and lack of facilities;Need to stem the brain drain from developing countries;At any given point, 10% of the adult population report having some mental or behavioural disorder;In India, serious mental disorders affect nearly 80 million people, i.e. combined population of the northern top of India, including Punjab, Haryana, Jammu and Kashmir, Uttarakhand and Himachal Pradesh;Combating imbalance between burden of demand and supply of efficient psychiatric services in all countries, especially in developing ones like India, is the first task before psychiatry today. If ever a greater role for activism were needed, this is the field;The need is to scale up effective and cost-effective treatments and preventive interventions for mental disorders.TALK: Speaking to a wider audience about positive contributions of psychiatry:Being aware of, understanding, and countering, the massive anti-psychiatry propaganda online and elsewhere;Giving a firm answer to anti-psychiatry even while understanding its transformation into mental health consumerism and opposition to reckless medicalisation;Defining normality and abnormality;Bringing about greater precision in diagnosis and care;Motivating those helped by psychiatry to speak up;Setting up informative websites and organising programmes to reduce stigma and spread mental health awareness;Setting up regular columns in psychiatry journals around the globe, called 'Patients Speak', or something similar, wherein those who have been helped get a chance to voice their stories.SCIENCE: Shrugging ambivalence and disagreement and searching for commonalities in psychiatric phenomena;An idiographic orientation which stresses individuality cannot, and should not, preclude the nomothetic or norm laying thrust that is the crux of scientific progress.The major contribution of science has been to recognize such commonalities so they can be researched, categorized and used for human welfare.It is a mistake to stress individuality so much that commonalities are obliterated.While the purpose and approach of psychiatry, as of all medicine, has to be humane and caring, therapeutic advancements and aetiologic understandings are going to result only from a scientific methodology.Just caring is not enough, if you have not mastered the methods of care, which only science can supply.PSYCHOTHERAPY: Psychiatrists continuing to do psychotherapy:Psychotherapy must be clearly defined, its parameters and methods firmly delineated, its proof of effectiveness convincingly demonstrated by evidence based and controlled trials;Psychotherapy research suffers from neglect by the mainstream at present, because of the ascendancy of biological psychiatry;It suffers resource constraints as major sponsors like pharma not interested;Needs funding from some sincere researcher organisations and altruistic sponsors, as also professional societies and governments;Psychotherapy research will have to provide enough irrefutable evidence that it works, with replicable studies that prove it across geographical areas;It will not do for psychiatrists to hand over psychotherapy to clinical psychologists and others.INTEGRATE APPROACHES: Welcoming biological breakthroughs, while supplying psychosocial insights:Experimental breakthroughs, both in aetiology and therapeutics, will come mainly from biology, but the insights and leads can hopefully come from many other fields, especially the psychosocial and philosophical;The biological and the psychological are not exclusive but complementary approaches;Both integration and reductionism are valid. Integration is necessary as an attitude, reductionism is necessary as an approach. Both the biological and the psychosocial must co-exist in the individual psychiatrist, as much as the branch itself.RESEARCH EXCELLENCE: Promoting genuine research alone, and working towards an Indian Nobel Laureate in psychiatry by 2020:To stop promoting poor quality research and researchers, and to stop encouraging sycophants and ladder climbers. To pick up and hone genuine research talent from among faculty and students;Developing consistent quality environs in departments and having Heads of Units who recognize, hone and nurture talent. And who never give in to pessimism and cynicism;Stop being satisfied with the money, power and prestige that comes by wheeling-dealing, groupism and politicking;Infinite vistas of opportunity wait in the wings to unfold and offer opportunities for unravelling the mysteries of the 'mind' to the earnest seeker. Provided he is ready to seek the valuable. Provided he stops holding on to the artificial and the superfluous.

Cognitive hypnotherapy: a new vision and strategy for research and practice.

PubMed

Alladin, Assen

2012-04-01

This article describes cognitive hypnotherapy (CH), a visionary model of adjunctive hypnotherapy that advances the role of clinical hypnosis to a recognized integrative model of psychotherapy. As hypnosis lacks a coherent theory of psychotherapy and behavior change, hypnotherapy has embodied a mixed bag of techniques and thus hindered from transfiguring into a mainstream school of psychotherapy. One way of promoting the therapeutic standing of hypnotherapy as an adjunctive therapy is to systematically integrate it with a well-established psychotherapy. By blending hypnotherapy with cognitive behavior therapy, CH offers a unified version of clinical practice that fits the assimilative model of integrated psychotherapy, which represents the best integrative psychotherapy approach for merging both theory and empirical findings.

Individual psychotherapy for schizophrenia: trends and developments in the wake of the recovery movement

PubMed Central

Hamm, Jay A; Hasson-Ohayon, Ilanit; Kukla, Marina; Lysaker, Paul H

2013-01-01

Although the role and relative prominence of psychotherapy in the treatment of schizophrenia has fluctuated over time, an analysis of the history of psychotherapy for schizophrenia, focusing on findings from the recovery movement, reveals recent trends including the emergence of the development of integrative psychotherapy approaches. The authors suggest that the recovery movement has revealed limitations in traditional approaches to psychotherapy, and has provided opportunities for integrative approaches to emerge as a mechanism for promoting recovery in persons with schizophrenia. Five approaches to integrative psychotherapy for persons with schizophrenia are presented, and a shared conceptual framework that allows these five approaches to be compatible with one another is proposed. The conceptual framework is consistent with theories of recovery and emphasizes interpersonal attachment, personal narrative, and metacognitive processes. Implications for future research on integrative psychotherapy are considered. PMID:23950665

A quality improvement project aimed at adapting primary care to ensure the delivery of evidence-based psychotherapy for adult anxiety.

PubMed

Williams, Mark D; Sawchuk, Craig N; Shippee, Nathan D; Somers, Kristin J; Berg, Summer L; Mitchell, Jay D; Mattson, Angela B; Katzelnick, David J

2018-01-01

Primary care patients frequently present with anxiety with prevalence ratios up to 30%. Brief cognitive-behavioural therapy (CBT) has been shown in meta-analytic studies to have a strong effect size in the treatment of anxiety. However, in surveys of anxious primary care patients, nearly 80% indicated that they had not received CBT. In 2010, a model of CBT (Coordinated Anxiety Learning and Management (CALM)) adapted to primary care for adult anxiety was published based on results of a randomised controlled trial. This project aimed to integrate an adaptation of CALM into one primary care practice, using results from the published research as a benchmark with the secondary intent to spread a successful model to other practices. A quality improvement approach was used to translate the CALM model of CBT for anxiety into one primary care clinic. Plan-Do-Study-Act steps are highlighted as important steps towards our goal of comparing our outcomes with benchmarks from original research. Patients with anxiety as measured by a score of 10 or higher on the Generalized Anxiety Disorder 7 item scale (GAD-7) were offered CBT as delivered by licensed social workers with support by a PhD psychologist. Outcomes were tracked and entered into an electronic registry, which became a critical tool upon which to adapt and improve our delivery of psychotherapy to our patient population. Challenges and adaptations to the model are discussed. Our 6-month response rates on the GAD-7 were 51%, which was comparable with that of the original research (57%). Quality improvement methods were critical in discovering which adaptations were needed before spread. Among these, embedding a process of measurement and data entry and ongoing feedback to patients and therapists using this data are critical step towards sustaining and improving the delivery of CBT in primary care.

A New Language for Child Psychotherapy: A Response to Jerald Kay

ERIC Educational Resources Information Center

Clark, James J.; Borden, William

2009-01-01

Jerald Kay's article in this issue reviews important research in the areas of adult psychotherapy and neuroscience, and their implications for child psychotherapy. We respond by exploring some of the strengths and limitations of these lines of research and their implications for child psychotherapy development and research. The paper closes with…

Culturally Adapted Psychotherapy and the Legitimacy of Myth: A Multilevel Model, Direct Comparison Meta-Analysis

ERIC Educational Resources Information Center

Benish, Steven G.

2010-01-01

Culturally adapted psychotherapy has potential to improve psychotherapy outcomes for ethnic and racial minorities and solve a decades-long conundrum that alteration of specific ingredients does not improve psychotherapy outcomes. Adaptation of the cultural explanation of illness, known as the anthropological Myth in universal healing practices…

Translating the Theoretical into Practical: A Logical Framework of Functional Analytic Psychotherapy Interactions for Research, Training, and Clinical Purposes

ERIC Educational Resources Information Center

Weeks, Cristal E.; Kanter, Jonathan W.; Bonow, Jordan T.; Landes, Sara J.; Busch, Andrew M.

2012-01-01

Functional analytic psychotherapy (FAP) provides a behavioral analysis of the psychotherapy relationship that directly applies basic research findings to outpatient psychotherapy settings. Specifically, FAP suggests that a therapist's in vivo (i.e., in-session) contingent responding to targeted client behaviors, particularly positive reinforcement…

Changes in personality functioning as a result of group psychotherapy with elements of individual psychotherapy in persons with neurotic and personality disorders - MMPI-2.

PubMed

Cyranka, Katarzyna; Rutkowski, Krzysztof; Mielimąka, Michał; Sobański, Jerzy A; Smiatek-Mazgaj, Bogna; Klasa, Katarzyna; Dembińska, Edyta; Müldner-Nieckowski, Łukasz; Rodziński, Paweł

2016-01-01

The study of group psychotherapy influence on the personality functioning of patients on treatment for neurotic disorders and selected personality disorders (F4-F6 under ICD-10). The study concerned 82 patients (61 women and 21 men) who underwent intensive short-term group psychotherapy in a day ward. A comprehensive assessment of the patients' personality functioning was carried out at the outset and the end of the psychotherapy utilising the MMPI-2 questionnaire. At the treatment outset the majority of the study patients demonstrated a considerable level of disorders in five MMPI-2 clinical scales (Depression, Hysteria, Psychopathic Deviate, Psychastenia, Schizophrenia) and moderate pathology in Hypochondria. In the Mania scale most patients obtained results comparable to the healthy population when the treatment commenced. Having undergone the psychotherapy treatment, the majority of the examined were observed to demonstrate positive changes in those areas of personality functioning which were classified as severe or moderate pathology. Short-term intensive comprehensive group psychotherapy with elements of individual psychotherapy leads to desirable changes in personality functioning.

Biofeedback for anismus in 15 sexually abused women.

PubMed

Leroi, A M; Duval, V; Roussignol, C; Berkelmans, I; Peninque, P; Denis, P

1996-01-01

This work aimed to see whether (1) biofeedback is useful and (2) whether it needs to be combined with psychotherapy in sexually abused patients with anismus. Fifteen women aged 41.2 +/- 4.1 years who had experienced sexual abuse in childhood (9 cases) or adulthood (6 cases) and complained of symptoms of irritable bowel disease were studied. Anismus was recorded during anorectal manometry in all cases. Patients were free to choose biofeedback and/or group psychotherapy and/or individual psychotherapy. When necessary, psychoactive drugs were prescribed after a psychiatric evaluation. Initially all the patients chose biofeedback and none accepted psychotherapy. Eight patients accepted psychotherapy after several weeks of biofeedback. Thirteen patients completed the study: 5 treated by biofeedback alone, 5 with biofeedback and group therapy, and 3 with biofeedback and individual psychotherapy. Eight women recovered completely from their symptoms, only two of whom had had biofeedback without psychotherapy. Biofeedback alone was not always sufficient to cure abused patients, but was chose initially by all the patients. It could initially be a middle path between somatic treatment and psychotherapy, at a time when patients are not yet ready to undertake the latter.

Influence of psychotherapy attendance on buprenorphine treatment outcome

PubMed Central

Montoya, Iván D.; Schroeder, Jennifer R.; Preston, Kenzie L.; Covi, Lino; Umbricht, Annie; Contoreggi, Carlo; Fudala, Paul J.; Johnson, Rolley E.; Gorelick, David A.

2008-01-01

We evaluated the influence of psychotherapy attendance on treatment outcome in 90 dually (cocaine and heroin) dependent outpatients who completed 70 days of a controlled clinical trial of sublingual buprenorphine (16 mg, 8 mg, or 2 mg daily, or 16 mg every other day) plus weekly individual standardized interpersonal cognitive psychotherapy. Treatment outcome was evaluated by quantitative urine benzoylecgonine (BZE) and morphine levels (log-transformed), performed three times per week. Repeated-measures linear regression was used to assess the effects of psychotherapy attendance (percent of visits kept), medication group, and study week on urine drug metabolite levels. Mean psychotherapy attendance was 71% of scheduled visits. Higher psychotherapy attendance was associated with lower urine BZE levels, and this association grew more pronounced as the study progressed (p = 0.04). The inverse relationship between psychotherapy attendance and urine morphine levels varied by medication group, being most pronounced for subjects receiving 16 mg every other day (p = 0.02). These results suggest that psychotherapy can improve the outcome of buprenorphine maintenance treatment for patients with dual (cocaine and opioid) dependence. PMID:15857725

A Systematic Review of the Combined Use of Electroconvulsive Therapy and Psychotherapy for Depression

PubMed Central

McClintock, Shawn M.; Brandon, Anna R.; Husain, Mustafa M.; Jarrett, Robin B.

2011-01-01

Objective Electroconvulsive therapy (ECT) is one of the most effective treatments for severe Major Depressive Disorder (MDD). However, after acute phase treatment and initial remission, relapse rates are significant. Strategies to prolong remission include continuation phase ECT, pharmacotherapy, psychotherapy, or their combinations. This systematic review synthesizes extant data regarding the combined use of psychotherapy with ECT for the treatment of patients with severe MDD and offers the hypothesis that augmenting ECT with depression-specific psychotherapy represents a promising strategy for future investigation. Methods The authors performed two independent searches in PsychInfo (1806 – 2009) and MEDLINE (1948 – 2009) using combinations of the following search terms: Electroconvulsive Therapy (including ECT, ECT therapy, electroshock therapy, EST, shock therapy) and Psychotherapy (including cognitive behavioral, interpersonal, group, psychodynamic, psychoanalytic, individual, eclectic, and supportive). We included in this review a total of six articles (English language) that mentioned ECT and psychotherapy in the abstract, and provided a case report, series, or clinical trial. We examined the articles for data related to ECT and psychotherapy treatment characteristics, cohort characteristics, and therapeutic outcome. Results Although research over the past seven decades documenting the combined use of ECT and psychotherapy is limited, the available evidence suggests that testing this combination has promise and may confer additional, positive functional outcomes. Conclusions Significant methodological variability in ECT and psychotherapy procedures, heterogeneous patient cohorts, and inconsistent outcome measures prevent strong conclusions; however, existing research supports the need for future investigations of combined ECT and psychotherapy in well-designed, controlled clinical studies. Depression-specific psychotherapy approaches may need special adaptations in view of the cognitive effects following ECT. PMID:21206376

[Tailored Care for Functional Vertigo/Dizziness - An Integrative Group Psychotherapy Approach].

PubMed

Radziej, Katharina; Schmid-Mühlbauer, Gabriele; Limburg, Karina; Lahmann, Claas

2017-06-01

Functional vertigo and dizziness (VD) symptoms are highly prevalent and usually accompanied by a strong impairment of quality in everyday and working life. The complaints are often associated with various psychiatric disorders, particularly phobic and other anxiety disorders, depressive or somatoform disorders. Despite this clinical relevance of VD symptoms, studies towards psychotherapeutic treatment options for patients with functional VD are still rare. Thus, the present study outlines a manual for outpatient group therapy for patients with functional VD symptoms. Our approach aims to assist patients in developing an understanding of the interaction between bodily complaints and psychosocial factors while detracting from a purely symptom based focus. The integrative-psychotherapeutic treatment program consists of 16 weekly sessions and includes a regular vestibular rehabilitation training as well as disorder-oriented modules towards anxiety and panic disorder, depression, and somatisation. We are currently conducting a randomised controlled trial in order to evaluate the short- and long-term effectiveness of the program in reducing VD and further bodily symptoms, vertigo-related social and physical handicap as well as anxiety and depressive complaints. A previously completed pilot trial has led to small to large pre-follow-up-effects on primary and secondary outcome measures. Conclusions regarding acceptance and feasibility of the therapy concept are discussed. © Georg Thieme Verlag KG Stuttgart · New York.

The psychotherapist and the sign language interpreter.

PubMed

de Bruin, Ed; Brugmans, Petra

2006-01-01

Specialized psychotherapy for deaf people in the Dutch and Western European mental health systems is still a rather young specialism. A key policy principle in Dutch mental health care for the deaf is that they should receive treatment in the language most accessible to them, which is usually Dutch Sign Language (Nederlandse Gebarentaal or NGT). Although psychotherapists for the deaf are trained to use sign language, situations will always arise in which a sign language interpreter is needed. Most psychotherapists have the opinion that working with a sign language interpreter in therapy sessions can be a valuable alternative option but also see it as a second-best solution because of its impact on the therapeutic process. This paper describes our years of collaborationship as a therapist and a sign language interpreter. If this collaborationship is optimal, it can generate a certain "therapeutic power" in the therapy sessions. Achieving this depends largely on the interplay between the therapist and the interpreter, which in our case is the result of literature research and our experiences during the last 17 years. We analyze this special collaborative relationship, which has several dimensions and recurrent themes like, the role conception of the interpreter, situational interpreting, organizing the interpretation setting, or managing therapeutic phenomena during therapy sessions.

A manual-based individual therapy to improve metacognition in schizophrenia: protocol of a multi-center RCT

PubMed Central

2014-01-01

Background Metacognitive dysfunction has been widely recognized as a feature of schizophrenia. As it is linked with deficits in several aspects of daily life functioning, improvement of metacognition may lead to improvement in functioning. Individual psychotherapy might be a useful form of treatment to improve metacognition in patients with schizophrenia; multiple case reports and a pilot study show promising results. The present study aims to measure the effectiveness of an individual, manual-based therapy (Metacognitive Reflection and Insight Therapy, MERIT) in improving metacognition in patients with schizophrenia. We also want to examine if improvement in metacognitive abilities is correlated with improvements in aspects of daily life functioning namely social functioning, experience of symptoms, quality of life, depression, work readiness, insight and experience of stigma. Methods/Design MERIT is currently evaluated in a multicenter randomized controlled trial. Thirteen therapists in six mental health institutions in the Netherlands participate in this study. Patients are randomly assigned to either MERIT or the control condition: treatment as usual (TAU). Discussion If proven effective, MERIT can be a useful addition to the care for schizophrenia patients. The design brings along some methodological difficulties, these issues are addressed in the discussion of this paper. Trial registration Current Controlled Trials: ISRCTN16659871. PMID:24490942

Effectiveness of Psychotherapy in Personality Disorders Not Otherwise Specified: A Comparison of Different Treatment Modalities.

PubMed

Horn, Eva K; Bartak, Anna; Meerman, Anke M M A; Rossum, Bert V; Ziegler, Uli M; Thunnissen, Moniek; Soons, Mirjam; Andrea, Helene; Hamers, Elisabeth F M; Emmelkamp, Paul M G; Stijnen, Theo; Busschbach, Jan J V; Verheul, Roel

2015-01-01

Although personality disorder not otherwise specified (PDNOS) is highly prevalent and associated with a high burden of disease, only a few treatment studies in this patient group exist. This study is the first to investigate the effectiveness of different modalities of psychotherapy in patients with PDNOS, i.e., short-term (up to 6 months) and long-term (more than 6 months) outpatient, day hospital, and inpatient psychotherapy. A total of 205 patients with PDNOS were assigned to one of six treatment modalities. Effectiveness was assessed over 60 months after baseline. The primary outcome measure was symptom severity, and the secondary outcome measures included psychosocial functioning and quality of life. The study design was quasi-experimental, and the multiple propensity score was used to control for initial differences between treatment groups. All treatment modalities showed positive outcomes, especially in terms of improvements of symptom severity and social role functioning. At 12-month follow-up, after adjustment for initial differences between the treatment groups, short-term outpatient psychotherapy and short-term inpatient psychotherapy showed most improvement and generally outperformed the other modalities concerning symptom severity. At 60 months after baseline, effectiveness remained but observed differences between modalities mostly diminished. Patients with PDNOS benefit from psychotherapy both at short-term and long-term follow-up. Short-term outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness. The effectiveness of different modalities of psychotherapy in patients with PDNOS (i.e., short-term vs long-term; outpatient versus day hospital versus inpatient psychotherapy) has not yet been compared. Different modalities of psychotherapy are effective for patients with PDNOS, and positive effects remain after 5 years. In patients with PDNOS short-term (less than 6 months) outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the four other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness. Copyright © 2014 John Wiley & Sons, Ltd.

Unconsummated marriages: a separate and different clinical entity.

PubMed

Gindin, Leon Roberto; Resnicoff, Diana

2002-01-01

We bring our experience in the treatment of unconsummated marriages (UM). We postulate that it is an independent clinical entity. Since 1991, 199 couples with UM have sought treatment in our center in Buenos Aires. A new approach to this problem is based on an intensive treatment session that lasts a whole day and a pledge to pay only if therapy succeeds. The outcome was a success (97%) with coitus consummation. We make a long-term follow up. The advantages are the brevity of the treatment and lack of desertions. We postulate that UM cannot be approached with an individual perspective or with the usual psychotherapy techniques.

Psychodynamic psychotherapy for complex trauma: targets, focus, applications, and outcomes

PubMed Central

Spermon, Deborah; Darlington, Yvonne; Gibney, Paul

2010-01-01

Complex trauma describes that category of severe, chronic interpersonal trauma usually originating in the formative years of a child. In the adult, this can result in global dissociative difficulties across areas of cognitive, affective, somatic, and behavioral functions. Targeting this field of traumatic pathology, this article reviews the contributions and developments within one broad approach: psychodynamic theory and practice. Brief descriptions of aspects of analytical, Jungian, relational, object relations, and attachment therapeutic approaches are given, along with understandings of pathology and the formulation of therapeutic goals. Major practices within client sessions are canvassed and the issues of researching treatment outcomes are discussed. PMID:22110335

Group Supervision in Psychotherapy. Main Findings from a Swedish Research Project on Psychotherapy Supervision in a Group Format

ERIC Educational Resources Information Center

Ogren, Marie-Louise; Sundin, Eva C.

2009-01-01

Psychotherapy supervision is considered crucial for psychotherapists in training. During the last decades, group supervision has been a frequently used format in many countries. Until recently, very few studies had evaluated the small-group format for training of beginner psychotherapists and psychotherapy supervisors. This article aims to…

How Do Trainees Choose Their First Psychotherapy Training? The Case of Training in Psychotherapy Integration

ERIC Educational Resources Information Center

Plchová, Romana; Hytych, Roman; Rihácek, Tomáš; Roubal, Jan; Vybíral, Zbynek

2016-01-01

Future trainees go through difficult decision-making processes when starting their first psychotherapy training. The choice of training in psychotherapy integration is a specific type of this process. In this study, qualitative data were obtained from the motivational letters, in-depth semi-structured interviews and e-mail questionnaires of 26…

Introduction: attachment theory and psychotherapy.

PubMed

Levy, Kenneth N

2013-11-01

In this introduction to the JCLP: In Session 69(11) issue on attachment theory and psychotherapy, the key points of attachment theory (Bowlby, , , 1981) and its relevance to psychotherapy are briefly described. The aim of this issue is to provide case illustrations of how an attachment theory perspective and principles can expand our understanding of psychotherapy practice. © 2013 Wiley Periodicals, Inc.

Managed Care

MedlinePlus

... three types of managed care plans: Health Maintenance Organizations (HMO) usually only pay for care within the ... who coordinates most of your care. Preferred Provider Organizations (PPO) usually pay more if you get care ...

A Capabilities Based Assessment of the United States Air Force Critical Care Air Transport Team

DTIC Science & Technology

2013-09-01

usually consist of a critical care physician, critical care nurse , and respiratory therapist. A Front-end Analysis has found several problems within...critically ill and wounded. This life-saving mission is executed by CCAT teams, which usually consist of a critical care physician, critical care nurse ...ill and wounded. This life-saving mission is executed by CCAT teams, which usually consist of a critical care physician, critical care nurse , and

Comprehensive and subacute care interventions improve health-related quality of life for older patients after surgery for hip fracture: a randomised controlled trial.

PubMed

Shyu, Yea-Ing L; Liang, Jersey; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Chou, Shih-Wei; Chen, Ching-Yen; Yang, Ching-Tzu

2013-08-01

Elderly patients with hip fracture have been found to benefit from subacute care interventions that usually comprise usual care with added geriatric intervention, early rehabilitation, and supported discharge. However, no studies were found on the effects of combining subacute care and health-maintenance interventions on health outcomes for elders with hip fracture. To compare the effects of an interdisciplinary comprehensive care programme with those of subacute care and usual care programmes on health-related quality of life (HRQoL) for elderly patients with hip fracture. Randomised controlled trial. A 3000-bed medical centre in northern Taiwan. Patients with hip fracture (N=299) were randomised into three groups: subacute care (n=101), comprehensive care (n=99), and usual care (n=99). Subacute care included geriatric consultation, continuous rehabilitation, and discharge planning. Comprehensive care consisted of subacute care plus health-maintenance interventions to manage depressive symptoms, manage malnutrition, and prevent falls. Usual care included only 1-2 in-hospital rehabilitation sessions, discharge planning without environmental assessment, no geriatric consultation, and no in-home rehabilitation. HRQoL was measured using the Medical Outcomes Study Short-Form 36 Taiwan version at 1, 3, 6, and 12 months after discharge. Participants in the comprehensive care group improved more in physical function, role physical, general health and mental health than those in the usual care group. The subacute care group had greater improvement in physical function, role physical, vitality, and social function than the usual care group. The intervention effects for both comprehensive and subacute care increased over time, specifically from 6 months after hip fracture onward, and reached a maximum at 12 months following discharge. Both comprehensive care and subacute care programmes may improve health outcomes of elders with hip fracture. Our results may provide a reference for health care providers in countries using similar programmes with Chinese/Taiwanese immigrant populations. Copyright © 2012 Elsevier Ltd. All rights reserved.

Tools for Practical Psychotherapy: A Transtheoretical Collection (or Interventions Which Have, At Least, Worked for Us).

PubMed

Yager, Joel; Feinstein, Robert E

2017-01-01

Regardless of their historical and theoretical roots, strategies, tactics, and techniques used in everyday psychotherapy across diverse theoretical schools contain common factors and methods from other specific psychotherapeutic modalities that contribute substantially to psychotherapy outcomes. Common factors include alliance, empathy, goal consensus/collaboration, positive regard/affirmation, and congruence/genuineness, among others. All therapies also recognize that factors specific to therapists impact treatment. Starting with these common factors, we add psychotherapeutic methods from many theoretical orientations to create a collection of clinical tools. We then provide concrete suggestions for enacting psychotherapy interventions, which constitute a transtheoretical collection. We begin with observations made by earlier scholars, our combined clinical and teaching experiences, and oral traditions and clinical pearls passed down from our own supervisors and mentors. We have compiled a list of tools for students with foundational knowledge in the basic forms of psychotherapy, which may expand their use of additional interventions for practicing effective psychotherapy. Our toolbox is organized into 4 categories: Relating; Exploring; Explaining; and Intervening. We note how these tools correspond to items previously published in a list of core psychotherapy competencies. In our view, the toolbox can be used most judiciously by students and practitioners schooled and grounded in frameworks for conducting established psychotherapies. Although they are still a work in progress, these tools can authorize and guide trainees and practitioners to enact specific approaches to psychotherapy utilizing other frameworks. We believe that psychotherapy education and training might benefit from explicitly focusing on the application of such interventions.

“Gold Standards,” Plurality and Monocultures: The Need for Diversity in Psychotherapy

PubMed Central

Leichsenring, Falk; Abbass, Allan; Hilsenroth, Mark J.; Luyten, Patrick; Munder, Thomas; Rabung, Sven; Steinert, Christiane

2018-01-01

For psychotherapy of mental disorders, presently several approaches are available, such as interpersonal, humanistic, systemic, psychodynamic or cognitive behavior therapy (CBT). Pointing to the available evidence, proponents of CBT claim that CBT is the gold standard. Some authors even argue for an integrated CBT-based form of psychotherapy as the only form of psychotherapy. CBT undoubtedly has its strengths and CBT researchers have to be credited for developing and testing treatments for many mental disorders. A critical review, however, shows that the available evidence for the theoretical foundations of CBT, assumed mechanisms of change, quality of studies, and efficacy is not as robust as some researchers claim. Most important, there is no consistent evidence that CBT is more efficacious than other evidence-based approaches. These findings do not justify regarding CBT as the gold standard psychotherapy. They even provide less justification for the idea that the future of psychotherapy lies in one integrated CBT-based form of psychotherapy as the only type of psychotherapy. For the different psychotherapeutic approaches a growing body of evidence is available. These approaches have their strengths because of differences in their respective focus on interpersonal relationships, affects, cognitions, systemic perspectives, experiential, or unconscious processes. Different approaches may be suitable to different patients and therapists. As generally assumed, progress in research results from openness to new ideas and learning from diverse perspectives. Thus, different forms of evidence-based psychotherapy are required. Plurality is the future of psychotherapy, not a uniform “one fits all” approach. PMID:29740361

[Hypochondriasis and somatisation in elderly].

PubMed

Thomas, Philippe; Hazif-Thomas, Cyril; Pareaud, Maurice

2008-11-30

Anxiety or masked depression are often associated with somatisation in elderly. Hypochondriasis is an excessive preoccupation or worry about having a serious illness. The DSM-IV defines it as a somatoform disorder. It affects about 3% of the population but has a heavy health care cost. Depression, obsessive-compulsive disorder generalized anxiety and somatization disorder are common in elderly and are the most common accompanying conditions in people with hypochondriasis. Old persons' unexplained medical symptoms in generalized anxiety and their relationship to the somatoform disorders are presented. Supportive care and psychotherapy are as necessary as antidepressant to help patients.

Social Problem Solving and Depressive Symptoms over Time: A Randomized Clinical Trial of Cognitive-Behavioral Analysis System of Psychotherapy, Brief Supportive Psychotherapy, and Pharmacotherapy

ERIC Educational Resources Information Center

Klein, Daniel N.; Leon, Andrew C.; Li, Chunshan; D'Zurilla, Thomas J.; Black, Sarah R.; Vivian, Dina; Dowling, Frank; Arnow, Bruce A.; Manber, Rachel; Markowitz, John C.; Kocsis, James H.

2011-01-01

Objective: Depression is associated with poor social problem solving, and psychotherapies that focus on problem-solving skills are efficacious in treating depression. We examined the associations between treatment, social problem solving, and depression in a randomized clinical trial testing the efficacy of psychotherapy augmentation for…

Does gratitude writing improve the mental health of psychotherapy clients? Evidence from a randomized controlled trial.

PubMed

Wong, Y Joel; Owen, Jesse; Gabana, Nicole T; Brown, Joshua W; McInnis, Sydney; Toth, Paul; Gilman, Lynn

2018-03-01

Although the past decade has witnessed growing research interest in positive psychological interventions (PPIs), their potential as adjunctive interventions for psychotherapy remains relatively unexplored. Therefore, this article expands the frontiers of PPI research by reporting the first randomized controlled trial to test a gratitude writing adjunctive intervention for psychotherapy clients. Participants were 293 adults seeking university-based psychotherapy services. Participants were randomly assigned to one of three conditions: (a) control (psychotherapy only), (b) a psychotherapy plus expressive writing, and (c) a psychotherapy plus gratitude writing. Participants in the gratitude condition wrote letters expressing gratitude to others, whereas those in the expressive writing condition wrote about their deepest thoughts and feelings about stressful experiences. About 4 weeks as well as 12 weeks after the conclusion of the writing intervention, participants in the gratitude condition reported significantly better mental health than those in the expressive and control conditions, whereas those in the expressive and control conditions did not differ significantly. Moreover, lower proportions of negative emotion words in participants' writing mediated the positive effect of condition (gratitude versus expressive writing) on mental health. These findings are discussed in light of the use of gratitude interventions as adjunctive interventions for psychotherapy clients.

A dynamic systems approach to psychotherapy: A meta-theoretical framework for explaining psychotherapy change processes.

PubMed

Gelo, Omar Carlo Gioacchino; Salvatore, Sergio

2016-07-01

Notwithstanding the many methodological advances made in the field of psychotherapy research, at present a metatheoretical, school-independent framework to explain psychotherapy change processes taking into account their dynamic and complex nature is still lacking. Over the last years, several authors have suggested that a dynamic systems (DS) approach might provide such a framework. In the present paper, we review the main characteristics of a DS approach to psychotherapy. After an overview of the general principles of the DS approach, we describe the extent to which psychotherapy can be considered as a self-organizing open complex system, whose developmental change processes are described in terms of a dialectic dynamics between stability and change over time. Empirical evidence in support of this conceptualization is provided and discussed. Finally, we propose a research design strategy for the empirical investigation of psychotherapy from a DS approach, together with a research case example. We conclude that a DS approach may provide a metatheoretical, school-independent framework allowing us to constructively rethink and enhance the way we conceptualize and empirically investigate psychotherapy. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Establishing psychiatric registrars' competence in psychotherapy: a portfolio based model.

PubMed

Naidu, T; Ramlall, S

2008-11-01

During most of the latter part of the last century, South Africa has followed international trends in the training of psychiatrists. Training programmes have become increasingly focused on the neurobiological aspects of psychiatric disorders with less attention being paid to psychotherapy. This is consistent with developments in psychiatric research. In the clinical arena this manifests as a focus on pharmacological and medically based interventions and a resulting relative inattention to non-pharmacological interventions, most especially psychotherapy. In an effort to address this imbalance there has been an international initiative, over the past two decades, to establish an acceptable level of competence in psychotherapy in the training of psychiatrists. A South African programme is needed that can take account of international trends and adapt them for the local context. In order to produce a programme for establishing competence in psychotherapy for psychiatric registrars at the Nelson R. Mandela School of Medicine, the authors examine directives for the development of psychotherapy skills from international regulatory bodies for graduate medical training and their application. Defining and setting preliminary standards for competence is emphasized. A programme based on five core psychotherapy components using a portfolio based model to facilitate learning and assessment of competence in psychotherapy, is proposed.

Efficacy of group psychotherapy for social anxiety disorder: A meta-analysis of randomized-controlled trials.

PubMed

Barkowski, Sarah; Schwartze, Dominique; Strauss, Bernhard; Burlingame, Gary M; Barth, Jürgen; Rosendahl, Jenny

2016-04-01

Group psychotherapy for social anxiety disorder (SAD) is an established treatment supported by findings from primary studies and earlier meta-analyses. However, a comprehensive summary of the recent evidence is still pending. This meta-analysis investigates the efficacy of group psychotherapy for adult patients with SAD. A literature search identified 36 randomized-controlled trials examining 2171 patients. Available studies used mainly cognitive-behavioral group therapies (CBGT); therefore, quantitative analyses were done for CBGT. Medium to large positive effects emerged for wait list-controlled trials for specific symptomatology: g=0.84, 95% CI [0.72; 0.97] and general psychopathology: g=0.62, 95% CI [0.36; 0.89]. Group psychotherapy was also superior to common factor control conditions in alleviating symptoms of SAD, but not in improving general psychopathology. No differences appeared for direct comparisons of group psychotherapy and individual psychotherapy or pharmacotherapy. Hence, group psychotherapy for SAD is an efficacious treatment, equivalent to other treatment formats. Copyright © 2016 Elsevier Ltd. All rights reserved.

Medical Students’ Attitudes and Beliefs towards Psychotherapy: A Mixed Research Methods Study

PubMed Central

Constantinou, Costas S.; Georgiou, Maria; Perdikogianni, Maria

2017-01-01

Background: Research findings suggest that attitudes towards psychotherapy predict willingness to seek therapy. However, understanding how medical students think about using and referring their patients for psychotherapy is limited. Aims: The aims of this study are to measure medical students’ attitudes towards professional help seeking, and to investigate the reasons for whether or not they would refer their patients to psychotherapy in their future role as doctors. Method: The participants were 127 medical students in their first and second year of the MBBS4 programme at the Cyprus campus of St George’s University of London, who completed a self-report measure of attitudes towards psychotherapy and a semi-structured interview. Findings: Participants showed general positive attitudes towards psychotherapy, but were reluctant to use or refer their patients, largely due to perceived stigma and accessibility. Conclusions: Medical students should be further trained in order to become more confident in using psychotherapy and referring their patients. PMID:28820440

[Meaning in life and mental health: personal meaning systems of psychotherapists and psychotherapy patients].

PubMed

Löffler, Sabine; Knappe, Rainer; Joraschky, Peter; Pöhlmann, Karin

2010-01-01

This study investigated differences in the personal meaning systems of psychotherapists and psychotherapy patients as well as correlations between meaning in life and mental health. We qualitatively assessed the content and structure of the personal meaning systems of 41 psychotherapists and 77 psychotherapy patients. In addition, the participants completed questionnaires measuring meaning in life (LRI-r-d), sense of coherence (SOC-9L), self-esteem (RSES), satisfaction with life (SWLS), self-efficacy (SWK), and depression (BDI). The personal meaning systems of psychotherapists were more complex and coherent compared to psychotherapy patients. In the group of psychotherapy patients, a more elaborate structure of the personal meaning system correlated with the subjective sense of meaning. We were able to confirm correlations between meaning in life and mental health for most of the instances. Psychotherapists had more elaborate and coherent meaning systems than psychotherapy patients. Especially for psychotherapy patients elaborate and coherent meaning systems turned out to be important for mental health.

Psychotherapy in psychiatry.

PubMed

Gabbard, Glen O

2007-02-01

The relationship between psychotherapy and psychiatry has become a beleagured one in recent years. The swing of the pendulum in the direction of biological psychiatry has led to a marginalization of psychotherapy within the discipline of psychiatry as a whole. However, psychotherapy continues to be a basic science of psychiatry with application in all clinical settings. It must be regarded as a biological treatment that works by changing the brain and is therefore just as important as pharmacotherapy in terms of overall treatment planning. The combined treatment of medication and psychotherapy has become the most common mode of psychiatric treatment planning in current practice. Both the two-treater model and the single-treater model have a set of advantages and disadvantages that are explicated. Further research is needed to identify clinical situations in which psychotherapy is essential, whether alone or in combination with medication. Moreover, as greater insights are gained into the brain mechanisms responsible for therapeutic changes, more specifically targeted psychotherapies can be developed.

[The state of outpatient psychotherapy in Germany].

PubMed

Zepf, Siegfried; Mengele, Ute; Hartmann, Sebastian

2003-01-01

This paper presents the results of a study of the state of adult outpatient psychotherapy in Germany after the PTG came into force. 1042 psychotherapists were questioned on certain issues. One result was that patients have to wait 4.6 months for psychotherapy and that every second patient asking for a diagnostic interview and possible treatment was refused. Of those who were given a diagnostic interview 35 % were not taken into treatment, although disturbances were diagnosed--such as tinnitus, pain, organic disturbances with psychic complications, suicidal tendencies, anorexia nervosa, addiction, psychosomatic illnesses, personality disorders, psychotic disorders--would normally demand psychotherapeutic treatment. Furthermore only 56 % of those patients who Löcherbach et al. considered needing and wanting psychotherapeutic treatment were actually in a G IV psychotherapy. Apart from this the possibility of getting psychotherapy as well as the kind of psychotherapy proved to be dependent on the kind of medical insurance. Different payments by the insurance companies caused longer waiting times for patients and determined the choice of psychotherapy by the psychotherapists.

Treating Depression to Remission in Older Adults: A Controlled Evaluation of Combined Escitalopram with Interpersonal Psychotherapy versus Escitalopram with Depression Care Management

PubMed Central

Reynolds, Charles F.; Dew, Mary Amanda; Martire, Lynn M.; Miller, Mark D.; Cyranowski, Jill M.; Lenze, Eric; Whyte, Ellen M.; Mulsant, Benoit H.; Pollock, Bruce G.; Karp, Jordan F.; Gildengers, Ariel; Szanto, Katalin; Dombrovski, Alexandre Y.; Andreescu, Carmen; Butters, Meryl A.; Morse, Jennifer Q.; Houck, Patricia R.; Bensasi, Salem; Mazumdar, Sati; Stack, Jacqueline A.; Frank, Ellen

2010-01-01

Objective More than half of older adults respond only partially to first-line antidepressant pharmacotherapy. Our objective was to test the hypothesis that a depression-specific psychotherapy, Interpersonal Psychotherapy—IPT, when used adjunctively with escitalopram, would lead to a higher rate of remission and faster resolution of symptoms in partial responders than escitalopram with depression care management (DCM). Method We conducted a 16-week randomized clinical trial of IPT and DCM in partial responders to escitalopram, enrolling 124 outpatients aged 60 and older. The primary outcome, remission, was defined as three consecutive weekly scores of ≤7 on the Hamilton Rating Scale for Depression (17-item). We conducted Cox regression analyses of time to remission and logistic modeling for rates of remission. We tested group differences in Hamilton depression ratings over time via mixed-effects modeling. Results Remission rates for escitalopram with IPT and with DCM were similar in intention-to-treat (IPT versus DCM: 58 [95% CI: 46, 71] versus 45% [33,58]; p = 0.14) and completer analyses (IPT versus DCM: 58% [95% CI: 44,72] versus 43% [30, 57]; p = 0.20). Rapidity of symptom improvement did not differ in the two treatments. Conclusion No added advantage of IPT over DCM was shown. Depression care management is a clinically useful strategy to achieve full remission in about 50% of partial responders. PMID:20957693

Pilot Data of a Brief Veteran Peer Intervention and Its Relationship to Mental Health Treatment Engagement.

PubMed

Goetter, Elizabeth M; Bui, Eric; Weiner, Travis P; Lakin, Laura; Furlong, Thomas; Simon, Naomi M

2017-05-11

Underutilization of mental health care is a significant problem among veterans. Offering peer support may improve mental health care engagement. This observational pilot study was conducted using an institutional review board-approved data repository to preliminarily evaluate the association and potential impact of a clinic-based veteran peer outreach strategy on treatment engagement and dropout. Veteran peer outreach coordinators (VPOCs) provided systematic contact (a) within 1 week after clinical evaluation and (b) 1 month after the patient's first treatment session to patients entering treatment at a specialty mental health clinic that provides military-informed mental health care to post-9/11 veterans and service members. Individuals were 102 consecutive Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn veteran psychotherapy referrals seen at an outpatient clinic. At 6 months, participants who received both contacts from VPOC had more psychotherapy sessions (M = 10.85, SD = 8.25) compared with those who had received no contact (M = 5.47, SD = 6.41) from VPOCs, t = 2.56, p < .05. The dropout rate was also significantly lower for those who received both peer outreach contacts (17.39%) compared with those who received only 1 VPOC contact (51.11%) or no VPOC contact (43.75%), χ2 = 7.27, p < .05. Veteran peer outreach may be associated with better engagement in mental health treatment and lower dropout. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

[Unwanted Side Effects in Children and Youth Psychotherapy - Introduction and Recommendations].

PubMed

Bieda, Angela; Pflug, Verena; Scholten, Saskia; Lippert, Michael Wilhelm; Ladwig, Inga; Nestoriuc, Yvonne; Schneider, Silvia

2018-05-30

Psychotherapy in children and adolescents is effective, but unwanted effects can occur. Until now, psychotherapy research has neglected this important topic, although children and youths are in need of special protection. Unwanted effects caused by therapy are not systematically investigated and a corresponding conceptualization is missing. The aim of this article is to investigate whether the current classifications of unwanted effects of psychotherapy in adults are applicable to children and adolescents and to identify distinctive features. Furthermore, the adaptation of the Inventory for the Assessment of Negative Effects of Psychotherapy for children and adolescents (Children-INEP) is presented. Finally, steps for the information and prevention of unwanted, and negative effects of psychotherapy in children and adolescents are pointed out. © Georg Thieme Verlag KG Stuttgart · New York.

Brief Psychotherapy in Family Practice

PubMed Central

MacDonald, Peter J.; Brown, Alan

1986-01-01

A large number of patients with psychosocial or psychiatric disorders present to family physicians, and the family physician needs a model of psychotherapy with which to cope with their problems. A model of brief psychotherapy is presented which is time limited, goal directed and easy to learn. It consists of four facets drawn from established areas of psychotherapy: characteristics of the therapist; characteristics of the patient; Eriksonian developmental stages; and the process of therapy as described by Carkhuff. These facets fit together in a way which is useful to the family physician in managing those patient problems for which brief psychotherapy is indicated. PMID:21267176

Using media to teach how not to do psychotherapy.

PubMed

Gabbard, Glen; Horowitz, Mardi

2010-01-01

This article describes how using media depictions of psychotherapy may help in teaching psychiatric residents. Using the HBO series In Treatment as a model, the authors suggest how boundary transgressions and technical errors may inform residents about optimal psychotherapeutic approaches. The psychotherapy vignettes depicted in In Treatment show how errors in judgment may grow out of therapists' good intentions. These errors can be understood and used constructively for teaching. With the growing interest in depicting psychotherapy on popular TV series, the use of these sessions avoids confidentiality problems and may be a useful adjunct for teaching psychotherapy.

Three Psychotherapies Examined: Ellis, Rogers, Perls

ERIC Educational Resources Information Center

Stoten, J.; Goos, W.

1974-01-01

This study uses Bales' Interaction Process Analysis (I. P. A.) to identify significant process elements in counselling and psychotherapy. For this purpose, the film "Three Approaches to Psychotherapy" was analysed. (Editor)

Shared Decision-Making in Youth Mental Health Care: Using the Evidence to Plan Treatments Collaboratively.

PubMed

Langer, David A; Jensen-Doss, Amanda

2016-12-02

The shared decision-making (SDM) model is one in which providers and consumers of health care come together as collaborators in determining the course of care. The model is especially relevant to youth mental health care, when planning a treatment frequently entails coordinating both youth and parent perspectives, preferences, and goals. The present article first provides the historical context of the SDM model and the rationale for increasing our field's use of SDM when planning psychosocial treatments for youth and families. Having established the potential utility of SDM, the article then discusses how to apply the SDM model to treatment planning for youth psychotherapy, proposing a set of steps consistent with the model and considerations when conducting SDM with youth and families.

Shared Decision-Making in Youth Mental Health Care: Using the Evidence to Plan Treatments Collaboratively

PubMed Central

Langer, David A.; Jensen-Doss, Amanda

2017-01-01

The shared decision-making (SDM) model is one in which providers and consumers of health care come together as collaborators in determining the course of care. The model is especially relevant to youth mental health care, when planning a treatment frequently entails coordinating both youth and parent perspectives, preferences, and goals. The present paper first provides the historical context of the SDM model and the rationale for increasing our field's use of SDM when planning psychosocial treatments for youth and families. Having established the potential utility of SDM, the paper then discusses how to apply the SDM model to treatment planning for youth psychotherapy, proposing a set of steps consistent with the model and considerations when conducting SDM with youth and families. PMID:27911081

[Care for unaccompanied minor migrant adolescents at the Youth Health Consultation: Support, psychotherapy and resilience].

PubMed

Devillé, Cédric; Lambert, Nelle

2018-04-18

The Unité Santé Jeunes of the Geneva University Hospitals offers multidisciplinary care to young people between the ages of 12 years and 25 years, including unaccompanied minor migrant adolescents. The psychiatrist and child psychiatrist of the unit participate actively. These young people are primarily teenagers, but it is clear from our experience that their care has some specificities and require an adaptation of the framework. The aim of this article is to open the reflection on socio-legal-educational support and the care to offer them to help them feeling secure and a different psychotherapeutic space. Fostering personal resources by building resilience and increasing self-esteem, the adolescent will thus be able to positive experiences encouraging him in his future project.

Fear extinction and memory reconsolidation as critical components in behavioral treatment for posttraumatic stress disorder and potential augmentation of these processes.

PubMed

Smith, Noelle B; Doran, Jennifer M; Sippel, Lauren M; Harpaz-Rotem, Ilan

2017-05-10

Posttraumatic stress disorder (PTSD) is associated with alterations in critical brain regions such as the amygdala, hippocampus, and prefrontal cortex. This brief review has two objectives: (1) to discuss research examining extinction and reconsolidation processes as mechanisms in PTSD psychotherapy, and (2) present possibilities for augmenting extinction and reconsolidation within treatment through alterations to therapeutic interventions and novel approaches. A key component of many effective PTSD therapies is exposure, which involves intentional confrontation and processing of the traumatic memory. Our review suggests that extinction and reconsolidation processes underlie effective exposure-based treatment, but the neurobiological mechanisms of these processes in behavioral treatments for PTSD remains unclear. We argue that enhancing extinction and/or disrupting reconsolidation of a feared memory may improve the efficacy of existing treatments (e.g., increased change for limited/non-responders, faster/greater changes for responders), which can be done through multiple channels. Potential avenues for augmentation of the processes of extinction and reconsolidation in PTSD psychotherapies are reviewed, including behavioral modifications, pharmacotherapy agents, and the use of devices during therapy. We further suggest that investigations towards understanding the extent to which extinction and reconsolidation processes are necessary in effective PTSD psychotherapy is an important future direction for enhancing clinical care among PTSD populations. Published by Elsevier B.V.

RANDOMIZED CONTROLLED TRIAL OF PARENT-INFANT PSYCHOTHERAPY FOR PARENTS WITH MENTAL HEALTH PROBLEMS AND YOUNG INFANTS.

PubMed

Fonagy, Peter; Sleed, Michelle; Baradon, Tessa

2016-01-01

There is a dearth of good-quality research investigating the outcomes of psychoanalytic parent-infant psychotherapy (PIP). This randomized controlled trial investigated the outcomes of PIP for parents with mental health problems who also were experiencing high levels of social adversity and their young infants (<12 months). Dyads were clinically referred and randomly allocated to PIP or a control condition of standard secondary and specialist primary care treatment (n = 38 in each group). Outcomes were assessed at baseline and at 6-month and 12-month follow-ups. The primary outcome was infant development. Secondary outcomes included parent-infant interaction, maternal psychopathology, maternal representations, maternal reflective functioning, and infant attachment. There were no differential effects over time between the groups on measures of infant development, parent-infant interaction, or maternal reflective functioning. Infant attachment classifications, measured only at the 12-month follow-up, did not differ between the groups. There were favorable outcomes over time for the PIP-treated dyads relative to the control group on several measures of maternal mental health, parenting stress, and parental representations of the baby and their relationship. The findings indicate potential benefits of parent-infant psychotherapy for improving mothers' psychological well-being and their representations of their baby and the parent-infant relationship. © 2016 Michigan Association for Infant Mental Health.

The second Symptom Management Research Trial in Oncology (SMaRT Oncology-2): a randomised trial to determine the effectiveness and cost-effectiveness of adding a complex intervention for major depressive disorder to usual care for cancer patients.

PubMed

Walker, Jane; Cassidy, Jim; Sharpe, Michael

2009-03-30

Depression Care for People with Cancer is a complex intervention delivered by specially trained cancer nurses, under the supervision of a psychiatrist. It is given as a supplement to the usual care for depression, which patients receive from their general practitioner and cancer service. In a 'proof of concept' trial (Symptom Management Research Trials in Oncology-1) Depression Care for People with Cancer improved depression more than usual care alone. The second Symptom Management Research Trial in Oncology (SMaRT Oncology-2 Trial) will test its effectiveness and cost-effectiveness in a 'real world' setting. A two arm parallel group multi-centre randomised controlled trial. TRIAL PROCEDURES: 500 patients will be recruited through established systematic Symptom Monitoring Services, which screen patients for depression. Patients will have: a diagnosis of cancer (of various types); an estimated life expectancy of twelve months or more and a diagnosis of Major Depressive Disorder. Patients will be randomised to usual care or usual care plus Depression Care for People with Cancer. Randomisation will be carried out by telephoning a secure computerised central randomisation system or by using a secure web interface. The primary outcome measure is 'treatment response' measured at 24 week outcome data collection. 'Treatment response' will be defined as a reduction of 50% or more in the patient's baseline depression score, measured using the 20-item Symptom Checklist (SCL-20D). Secondary outcomes include remission of major depressive disorder, depression severity and patients' self-rated improvement of depression. Current controlled trials ISRCTN40568538 TRIAL HYPOTHESES: (1) Depression Care for People with Cancer as a supplement to usual care will be more effective than usual care alone in achieving a 50% reduction in baseline SCL-20D score at 24 weeks. (2) Depression Care for People with Cancer as a supplement to usual care will cost more than usual care alone but will be more cost effective in achieving improvements in patients' depression and quality of life.

Integrative psychotherapy.

PubMed

Kozarić-Kovacić, Dragica

2008-09-01

The main purposes of the article are to present the history of integration in psychotherapy, the reasons of the development integrative approaches, and the approaches to integration in psychotherapy. Three approaches to integration in psychotherapy exist: theoretical integration, theoretical eclecticism, and common factors in different psychotherapeutic trends. In integrative psychotherapy, the basic epistemology, theory, and clinical practice are based on the phenomenology, field theory, holism, dialogue, and co-creation of dialogue in the therapeutic relationship. The main criticism is that integrative psychotherapy suffers from confusion and many unresolved controversies. It is difficult to theoretically and methodologically define the clinically applied model that is based on such a different epistemological and theoretical presumptions. Integrative psychotherapy is a synthesis of humanistic psychotherapy, object relations theory, and psychoanalytical self psychology. It focuses on the dynamics and potentials of human relationships, with a goal of changing the relations and understanding internal and external resistances. The process of integrative psychotherapy is primarily focused on the developmental-relational model and co-creation of psychotherapeutic relationship as a single interactive event, which is not unilateral, but rather a joint endeavor by both the therapist and the patient/client. The need for a relationship is an important human need and represents a process of attunement that occurs as a response to the need for a relationship, a unique interpersonal contact between two people. If this need is not met, it manifests with the different feelings and various defenses. To meet this need, we need to have another person with whom we can establish a sensitive, attuned relationship. Thus, the therapist becomes this person who tries to supplement what the person did not receive. Neuroscience can be a source of integration through different therapies. We may say that both neuroscience and neurobiology offer yet another bridge for integration of different schools of thought and supports the importance of the developmental relational model during the developmental phases and relational process in psychotherapy in which the quality of therapeutic relationship is the primary healing process. Furthermore, the development of integrative psychotherapy in Croatia and the organization of the Croatian program, which is identical to the program of the European Association for Integrative Psychotherapy is shortly described.

Relationship Between Continuity of Care and Diabetes Control: Evidence From the Third National Health and Nutrition Examination Survey

PubMed Central

Mainous, Arch G.; Koopman, Richelle J.; Gill, James M.; Baker, Richard; Pearson, William S.

2004-01-01

Objectives. We examined the relationship between continuity of care and diabetes control. Methods. We analyzed data on 1400 adults with diabetes who took part in the Third National Health and Nutrition Examination Survey. We examined the relationship of continuity of care with glycemic, blood pressure, and lipid control. Results. Continuity of care was associated with both acceptable and optimal levels of glycemic control. Continuity was not associated with blood pressure or lipid control. There was no difference between having a usual site but no usual provider and having a usual provider in any of the investigated outcomes. Conclusions. Continuity of care is associated with better glycemic control among people with diabetes. Our results do not support a benefit of having a usual provider above having a usual site of care. PMID:14713700

Motivational, reduction and usual care interventions for smokers who are not ready to quit: a randomized controlled trial.

PubMed

Klemperer, Elias M; Hughes, John R; Solomon, Laura J; Callas, Peter W; Fingar, James R

2017-01-01

To test whether, in comparison to usual care, brief motivational or reduction interventions increase quit attempts (QA) or abstinence among smokers who are not ready to quit. A parallel-group randomized controlled trial of brief motivational (n = 185), reduction (n = 186) or usual care (n = 189) telephone interventions delivered over the course of 4 weeks. Outcomes were assessed at 6- and 12-month follow-ups. No medication was provided. United States. A total of 560 adult smokers of ≥ 10 cigarettes per day who were not ready to quit in the next 30 days. The primary outcomes were whether participants made a QA that lasted ≥ 24 hours and whether they made a QA of any length between baseline and 6 months. Secondary outcomes included 7-day point-prevalence abstinence at 6 and 12 months. The 12-month follow-up was added after the study began. A priori-defined comparisons were between motivational versus usual care and reduction versus usual care conditions. The probability of making a QA that lasted ≥ 24 hours was not significantly different between the motivational (38%) or the reduction (31%) conditions and the usual care (34%) condition [motivational versus usual care odds ratio (OR) = 1.19, 95% confidence interval (CI) = 0.78-1.82; reduction versus usual care OR = 0.89, 95% CI = 0.57-1.36]. Bayes factors ranged from 0.13 to 0.18. Findings regarding a QA of any length were similar. At 6 months, the motivational condition had marginally more abstinence than usual care (11 versus 5%, OR = 2.17, 95% CI = 0.99-4.77), but the reduction condition was not significantly different from usual care (8 versus 5%, OR = 1.57, 95% CI = 0.69-3.59). At 12 months, the motivational condition had significantly more abstinence than usual care (10 versus 4%, OR = 2.80, 95% CI = 1.14-6.88) and the reduction condition had marginally more abstinence than usual care (9 versus 4%, OR = 2.45, 95% CI = 0.98-6.09). Among adult smokers who are not ready to quit, both logistic regression and Bayesian analysis indicate that neither motivational nor reduction-based telephone interventions increased the odds of making a quit attempt in comparison to usual care at 6 months. The motivational intervention appeared to increase abstinence at 6 months and did increase abstinence at 12 months. The reduction intervention did not increase abstinence at 6 months but appeared to increase abstinence at 12 months. © 2016 Society for the Study of Addiction.

Comprehensive care improves health outcomes among elderly Taiwanese patients with hip fracture.

PubMed

Shyu, Yea-Ing L; Liang, Jersey; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Yang, Ching-Tzu; Chou, Shih-Wei; Chen, Ching-Yen

2013-02-01

Few studies have investigated the effects of care models that combine interdisciplinary care with nutrition consultation, depression management, and fall prevention in older persons with hip fracture. The purpose of this study was to compare the effects of a comprehensive care program with those of interdisciplinary care and usual care for elderly patients with hip fracture. A randomized experimental trial was used to explore outcomes for 299 elderly patients with hip fracture receiving three treatment care models: interdisciplinary care (n = 101), comprehensive care (n = 99), and usual care (n = 99). Interdisciplinary care included geriatric consultation, continuous rehabilitation, and discharge planning with post-hospital services. Comprehensive care consisted of interdisciplinary care plus nutrition consultation, depression management, and fall prevention. Usual care included only in-hospital rehabilitation without geriatric consultation, in-home rehabilitation, and home environmental assessment. Participants in the comprehensive care group had better self-care ability (odds ratio, OR = 3.19, p < .01) and less risk of depression (OR = 0.48, p < .01) than those who received usual care. The comprehensive care group had less risk of depression (OR = 0.51, p < .05) and of malnutrition (OR = 0.48, p < .05) than the interdisciplinary care group during the first year following discharge. Older persons with hip fracture benefitted more from the comprehensive care program than from interdisciplinary care and usual care. Older persons with hip fracture benefitted more from comprehensive care including interdisciplinary care and nutrition consultation, depression management, and fall prevention than simply interdisciplinary care.

Characteristics and experience of the patient in psychotherapy and the psychotherapy's effectiveness. A structural approach.

PubMed

Szymańska, Agnieszka; Dobrenko, Kamila; Grzesiuk, Lidia

2017-08-29

The study concerns the relationship between three groups of variables presenting the patient's perspective: (1) "patient's characteristics" before psychotherapy, including "expectations of the therapy"; (2) "experience in the therapy", including the "psychotherapeutic relationship"; and (3) "assessment of the direct effectiveness of the psychotherapy". Data from the literature are the basis for predicting relationships between all of these variables. Measurement of the variables was conducted using a follow-up survey. The survey was sent to a total of 1,210 former patients of the Academic Center for Psychotherapy (AOP) in which the therapy is conducted mainly with the students and employees of the University of Warsaw. Responses were received from 276 people. 55% of the respondents were women and 45% were men, under 30 years of age. The analyses were performed using structural equations. Two models emerged from an analysis of the relationship between the three above-mentioned groups of variables. One concerns the relationship between (1) the patient's characteristics (2) the course of psychotherapy, in which -from the perspective of the patient - there is a good relationship with the psychotherapist and (3) psychotherapy is effective. The second model refers to (2) the patient's experience of poor psychotherapeutic relationship and (3) ineffective psychotherapy. Patient's expectations of the psychotherapy (especially "the expectation of support") proved to be important moderating variablesin the models-among the characteristics of the patient. The mathematical model also revealed strong correlation of variables measuring "the relationship with the psychotherapist" and "therapeutic interventions".

Treatment refusal and premature termination in psychotherapy, pharmacotherapy, and their combination: A meta-analysis of head-to-head comparisons.

PubMed

Swift, Joshua K; Greenberg, Roger P; Tompkins, Kelley A; Parkin, Susannah R

2017-03-01

The purpose of this meta-analysis was to examine rates of treatment refusal and premature termination for pharmacotherapy alone, psychotherapy alone, pharmacotherapy plus psychotherapy, and psychotherapy plus pill placebo treatments. A systematic review of the literature resulted in 186 comparative trials that included a report of treatment refusal and/or premature termination for at least 2 of the 4 treatment conditions. The data from these studies were pooled using a random-effects analysis. Odds Ratio effect sizes were then calculated to compare the rates between treatment conditions, once across all studies and then again for specific client disorder categories. An average treatment refusal rate of 8.2% was found across studies. Clients who were assigned to pharmacotherapy were 1.76 times more likely to refuse treatment compared with clients who were assigned psychotherapy. Differences in refusal rates for pharmacotherapy and psychotherapy were particularly evident for depressive disorders, panic disorder, and social anxiety disorder. On average, 21.9% of clients prematurely terminated their treatment. Across studies, clients who were assigned to pharmacotherapy were 1.20 times more likely to drop out compared with clients who were assigned to psychotherapy. Pharmacotherapy clients with anorexia/bulimia and depressive disorders dropped out at higher rates compared with psychotherapy clients with these disorders. Treatment refusal and dropout are significant problems in both psychotherapy and pharmacotherapy and providers of these treatments should seek to employ strategies to reduce their occurrence. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Psychotherapy for cancer patients.

PubMed

Chong Guan, Ng; Mohamed, Salina; Kian Tiah, Lai; Kar Mun, Teoh; Sulaiman, Ahmad Hatim; Zainal, Nor Zuraida

2016-07-01

Objective Psychotherapy is a common non-pharmacological approach to help cancer patients in their psychological distress. The benefit of psychotherapies was documented, but the types of psychotherapies proposed are varied. Given that the previous literature review was a decade ago and no quantitative analysis was done on this topic, we again critically and systematically reviewed all published trials on psychotherapy in cancer patients. Method We identified 17 clinical trials on six types of psychotherapy for cancer patients by searching PubMed and EMBASE. Result There were four trials involved adjunct psychological therapy which were included in quantitative analysis. Each trial demonstrated that psychotherapy improved the quality of life and coping in cancer patients. There was also a reduction in distress, anxiety, and depression after a psychological intervention. However, the number and quality of clinical trials for each type of psychotherapy were poor. The meta-analysis of the four trials involved adjunct psychological therapy showed no significant change in depression, with only significant short-term improvement in anxiety but not up to a year-the standardized mean differences were -0.37 (95% confidence interval (CI) = -0.57, -0.16) at 2 months, -0.21 (95% CI = -0.42, -0.01) at 4 months, and 0.03 (95 % CI = -0.19, 0.24) at 12 months. Conclusion The evidence on the efficacy of psychotherapy in cancer patients is unsatisfactory. There is a need for more rigorous and well-designed clinical trials on this topic.

A protocol for a trial of homeopathic treatment for irritable bowel syndrome

PubMed Central

2012-01-01

Background Irritable bowel syndrome is a chronic condition with no known cure. Many sufferers seek complementary and alternative medicine including homeopathic treatment. However there is much controversy as to the effectiveness of homeopathic treatment. This three-armed study seeks to explore the effectiveness of individualised homeopathic treatment plus usual care compared to both an attention control plus usual care and usual care alone, for patients with irritable bowel syndrome. Methods/design This is a three-armed pragmatic randomised controlled trial using the cohort multiple randomised trial methodology. Patients are recruited to an irritable bowel syndrome cohort from primary and secondary care using GP databases and consultants lists respectively. From this cohort patients are randomly selected to be offered, 5 sessions of homeopathic treatment plus usual care, 5 sessions of supportive listening plus usual care or usual care alone. The primary clinical outcome is the Irritable Bowel Syndrome Symptom Severity at 26 weeks. From a power calculation, it is estimated that 33 people will be needed for the homeopathic treatment arm and 132 for the usual care arm, to detect a minimal clinical difference at 80 percent power and 5 percent significance allowing for loss to follow up. An unequal group size has been used for reasons of cost. Analysis will be by intention to treat and will compare homeopathic treatment with usual care at 26 weeks as the primary analysis, and homeopathic treatment with supportive listening as an additional analysis. Discussion This trial has received NHS approval and results are expected in 2013. Trial registration Current Controlled Trials ISRCTN90651143 PMID:23131064

Family physicians' approach to psychotherapy and counseling. Perceptions and practices.

PubMed Central

Swanson, J. G.

1994-01-01

To determine how family physicians perceive the support they get for psychotherapy and counseling, we surveyed a random sample of Ontario College of Family Physicians members. Of 100 physicians who had family medicine residency training with psychotherapy experience, 43% indicated that such training was inadequate for their current needs. Because family physicians often provide psychotherapy and counseling, their training should reflect the needs found in practice. PMID:8080505

The relationship between clients' depression etiological beliefs and psychotherapy orientation preferences, expectations, and credibility beliefs.

PubMed

Tompkins, Kelley A; Swift, Joshua K; Rousmaniere, Tony G; Whipple, Jason L

2017-06-01

The purpose of this study was to examine the relationship between clients' etiological beliefs for depression and treatment preferences, credibility beliefs, and outcome expectations for five different depression treatments-behavioral activation, cognitive therapy, interpersonal psychotherapy, pharmacotherapy, and psychodynamic psychotherapy. Adult psychotherapy clients (N = 98) were asked to complete an online survey that included the Reasons for Depression Questionnaire, a brief description of each of the five treatment options, and credibility, expectancy, and preference questions for each option. On average, the participating clients rated pharmacotherapy as significantly less credible, having a lower likelihood of success, and being less preferred than the four types of psychotherapy. In general, interpersonal psychotherapy was also rated more negatively than the other types of psychotherapy. However, these findings depended somewhat on whether the participating client was personally experiencing depression. Credibility beliefs, outcome expectations, and preferences for pharmacotherapy were positively associated with biological beliefs for depression; however, the other hypothesized relationships between etiological beliefs and treatment attitudes were not supported. Although the study is limited based on the specific sample and treatment descriptions that were used, the results may still have implications for psychotherapy research, training, and practice. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Guidelines for Individual and Group Psychodynamic Psychotherapy for the Treatment of Persons Diagnosed with Psychosis and/or Schizophrenia.

PubMed

Ivezić, Slađana Štrkalj; Petrović, Branka Restek; Urlić, Ivan; Grah, Majda; Mayer, Nina; Stijačić, Dubravka; Jendričko, Tihana; Martić-Biočina, Sanja

2017-09-01

The hereby presented guidelines for the use of psychodynamic psychotherapy are based on references and research in the field of individual and group therapy and they refer to psychotherapy for patients suffering from the first psychotic episode, schizophrenia, schizoaffective psychosis, bipolar disorder and paranoid psychosis. The aim was to provide an overview of present literature and to give recommendations based on current knowledge. Clinical experience and research of the outcomes of psychodynamic psychotherapy encourage positioning of such treatments among recommendations for treating various mental disorders, as well as in the field of psychotherapy of patients with psychotic disorders (PD).

Is IPT Time-Limited Psychodynamic Psychotherapy?

PubMed Central

Markowitz, John C.; Svartberg, Martin; Swartz, Holly A.

1998-01-01

Interpersonal psychotherapy (IPT) has sometimes but not always been considered a psychodynamic psychotherapy. The authors discuss similarities and differences between IPT and short-term psychodynamic psychotherapy (STPP), comparing eight aspects: 1) time limit, 2) medical model, 3) dual goals of solving interpersonal problems and syndromal remission, 4) interpersonal focus on the patient solving current life problems, 5) specific techniques, 6) termination, 7) therapeutic stance, and 8) empirical support. The authors then apply both approaches to a case example of depression. They conclude that despite overlaps and similarities, IPT is distinct from STPP.(The Journal of Psychotherapy Practice and Research 1998; 7:185–195) PMID:9631340

Attachment and alliance in the treatment of depressed, sexually abused women.

PubMed

Smith, Phillip N; Gamble, Stephanie A; Cort, Natalie A; Ward, Erin A; He, Hua; Talbot, Nancy L

2012-02-01

Depression among women with sexual abuse histories is less treatment responsive than in general adult samples. One contributor to poorer treatment outcomes may be abused women's difficulties in forming and maintaining secure relationships, as reflected in insecure attachment styles, which could also impede the development of a positive therapeutic alliance. The current study examines how attachment orientation (i.e. anxiety and avoidance) and development of the working alliance are associated with treatment outcomes among depressed women with histories of childhood sexual abuse. Seventy women seeking treatment in a community mental health center who had Major Depressive Disorder and a childhood sexual abuse history were randomized to Interpersonal Psychotherapy or treatment as usual. Greater attachment avoidance and weaker working alliance were each related to worse depression symptom outcomes; these effects were independent of the presence of comorbid Borderline Personality Disorder and Post-Traumatic Stress Disorder. The effect of avoidant attachment on outcomes was not mediated by the working alliance. Further, working alliance had a stronger effect on depression outcomes in the Interpersonal Psychotherapy group. Understanding the influence of attachment style and the working alliance on treatment outcomes can inform efforts to improve the treatments for depressed women with a history of childhood sexual abuse. © 2012 Wiley Periodicals, Inc.

[Attitudes towards psychotherapy in South Korea and Germany : A cross-cultural comparative study].

PubMed

Schulz, W; Shin, M A; Schmid-Ott, G

2018-01-01

Due to the relatively recent introduction of psychotherapy in South Korea and against the background of collectivist and Confucian values, it has been suggested that South Koreans harbor more negative attitudes towards psychotherapy compared to Germans and that the social acceptance of psychotherapy is lower. We compared the attitudes of 99 women from South Korea with 98 German women using the questionnaire on attitudes towards psychotherapeutic treatment (FEP). For the study of the South Korean women we translated the questionnaire into the Korean language. The results of the psychometric analysis suggest that the Korean version of the FEP is of acceptable quality. South Korean women reported a significantly more negative attitude towards psychotherapy compared to German women. Furthermore, South Korean women anticipated a more skeptical social attitude towards psychotherapy compared to Germans. The presented results suggest the relevance of cultural imprinting in psychotherapy. They are discussed with respect to culture-specific self-concepts, concepts of disease and healing expectations and the increase of individualistic values in the Korean society.

Research on psychotherapy integration: building on the past, looking to the future.

PubMed

Castonguay, Louis G; Eubanks, Catherine F; Goldfried, Marvin R; Muran, J Christopher; Lutz, Wolfgang

2015-01-01

Integration has become an important and influential movement within psychotherapy practice, reflected by the fact that many treatment providers now identify as integrative. However, integration has not had as great an influence on psychotherapy research. The goal of this paper is to highlight the growing body of research on psychotherapy integration, and to identify future directions for research that may strengthen the integration movement as well as the field of psychotherapy as a whole. We first summarize the past 25 years of research on integration, with a focus on four approaches to integration: theoretical integration, technical eclectic, common factors, and assimilative integration. Next, we identify directions of research within these four areas that could strengthen and support integrative practice. We then propose ways in which the perspective of integrationists could contribute to psychotherapy research in the critical areas of harmful effects, therapist effects, practice-oriented research, and training. We end this paper by suggesting that a greater collaboration between integrationists and psychotherapy researchers will help to create a unified landscape of knowledge and action that will benefit all participants and advance the field.

[Psychotherapy research in the German-speaking community--a bibliometric analysis of three journals].

PubMed

Petermann, Franz; Schüssler, Gerhard

2010-01-01

Psychotherapy research has often been considered a neglected topic in clinical psychology, psychosomatic medicine, and psychiatry because of its massive organizational and financial demands. However, it is unclear whether this assumption actually reflects the research activities in the field. We conducted a bibliometric analysis of the annual volumes for 2008 and 2009 of three clinical journals published in German. All publications referring to facets of psychotherapy research were analysed. About 30% of the publications dealt with issues of psychotherapy research. Outcome and process studies were about equally distributed. Process research frequently focused on patient variables as outcome predictors. Outcome studies most often presented effectiveness studies with rather small sample sizes. Psychotherapy research is a well-represented and multifaceted field in the German speaking research community. However, the traditional distinction between efficacy and process research among the various schools of psychotherapy research may be hampering further developments in this branch. The government-funded research networks may turn out to be promising approaches to overcoming some of the obstacles of classic psychotherapy research.

[On the present situation in psychotherapy and its implications - A critical analysis of the facts].

PubMed

Tschuschke, Volker; Freyberger, Harald J

2015-01-01

The currently dominating research paradigm in evidence-based medicine is expounded and discussed regarding the problems deduced from so-called empirically supported treatments (EST) in psychology and psychotherapy. Prevalent political and economic as well as ideological backgrounds influence the present dominance of the medical model in psychotherapy by implementing the randomized-controlled research design as the standard in the field. It has been demonstrated that randomized controlled trials (RCTs) are inadequate in psychotherapy research, not the least because of the high complexity of the psychotherapy and the relatively weak role of the treatment concept in the change process itself. All major meta-analyses show that the Dodo bird verdict is still alive, thereby demonstrating that the medical model in psychotherapy with its RCT paradigm cannot explain the equivalence paradox. The medical model is inappropriate, so that the contextual model is proposed as an alternative. Extensive process-outcome research is suggested as the only viable and reasonable way to identify highly complex interactions between the many factors regularly involved in change processes in psychotherapy.

Costs of terminal patients who receive palliative care or usual care in different hospital wards.

PubMed

Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

2010-11-01

In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

Mental health treatment associated with community-based depression screening: considerations for planning multidisciplinary collaborative care.

PubMed

Winchester, Bruce R; Watkins, Sarah C; Brahm, Nancy C; Harrison, Donald L; Miller, Michael J

2013-06-01

Depression places a large economic burden on the US health care system. Routine screening has been recognized as a fundamental step in the effective treatment of depression, but should be undertaken only when support systems are available to ensure proper diagnosis, treatment, and follow-up. To estimate differences in prescribing new antidepressants and referral to stress management, psychotherapy, and other mental health (OMH) counseling at physician visits when documented depression screening was and was not performed. Cross-sectional physician visit data for adults from the 2005-2007 National Ambulatory Medical Care Survey were used. The final analytical sample included 55,143 visits, representing a national population estimate of 1,741,080,686 physician visits. Four dependent variables were considered: (1) order for new antidepressant(s), and referral to (2) stress management, (3) psycho therapy, or (4) OMH counseling. Bivariable and multivariable associations between depression screening and each measure of depression follow-up care were evaluated using the design-based F statistic and multivariable logistic regression models. New antidepressant prescribing increased significantly (2.12% of visits without depression screening vs 10.61% with depression screening resulted in a new prescription of an antidepressant). Referral to stress management was the behavioral treatment with the greatest absolute change (3.31% of visits without depression screening vs 33.10% of visits with depression screening resulted in a referral to stress management). After controlling for background sociodemographic characteristics, the adjusted odds ratio of a new antidepressant order remained significantly higher at visits involving depression screening (AOR 5.36; 99.9% CI 2.92-9.82), as did referrals for all behavioral health care services (ie, stress management, psychotherapy, and OMH counseling). At the national level, depression screening was associated with increased new antidepressant prescribing and referral for behavioral health care. It is critical for policy planners to recognize changes in follow-up depression care when implementing screening programs to ensure adequate capacity. Pharmacists are poised to assume a role in collaborative depression care, particularly with antidepressant medication therapy management.

Quality of care for major depression and its determinants: a multilevel analysis

PubMed Central

2012-01-01

Background Numerous studies highlight an important gap in the quality of care for depression in primary care. However, basic indicators were often used. Few of these studies examined factors associated with receiving adequate treatment, particularly with a simultaneous consideration of individual and organizational characteristics. The purpose of this study was to estimate the proportion of primary care patients with a major depressive episode (MDE) who receive adequate treatment and to examine the individual and organizational (i.e., clinic-level) characteristics associated with the receipt of at least one minimally adequate treatment for depression. Methods The sample used for this study included 915 adults consulting a general practitioner (GP), regardless of the motive of consultation, meeting DSM-IV criteria for MDE during the 12 months preceding the survey (T1), and nested within 65 primary care clinics. Data reported in this study were obtained from the “Dialogue” project. Adherence rates for 27 quality indicators selected to cover the most important components of depression treatment were estimated. Multilevel analyses were conducted. Results Adherence to guidelines was high (>75%) for one third of the quality indicators that were measured but was low (<60%) for nearly half of the measures. Just over half of the sample (52.2%) received at least one minimally adequate treatment for depression. At the individual level, determinants of receipt of minimally adequate care included age, having a family physician, a supplementary insurance coverage, a comorbid anxiety disorder and the severity of depression. At the clinic level, determinants included the availability of psychotherapy on-site, the use of treatment algorithms, and the mode of remuneration. Conclusions Our findings suggest that interventions are needed to increase the extent to which primary mental health care conforms to evidence-based recommendations. These interventions should target specific populations (i.e. the younger adults and the elderly), enhance accessibility to psychotherapy and to a regular family physician, and support primary care physicians in their clinical practice with patients suffering from depression in different ways such as developing knowledge to treat depression and adapting mode of remuneration. PMID:22985262

Teaching psychotherapy to psychiatric residents in Israel.

PubMed

Shalev, Arieh Y

2007-01-01

This work examines the rationale for, and the feasibility of teaching psychotherapy to psychiatric residents, and the "what if" of dropping it from the curriculum. Psychotherapy is one of the pillars of psychiatry. However, current economic constraints and the increasing weight of phenomenological and biological psychiatry make it more difficult to prioritize and allocate resources to its teaching. The term psychotherapy encompasses several techniques, some of which are extremely effective. It often confounds skills, attitudes, theory, body of knowledge and specific practices. Looking at each component separately, a stepped curriculum for teaching is outlined; alternatives to traditional theories are offered; and the need to allocate time and resources for teaching and learning are shown as the rate-limiting factor for the survival of psychotherapy within psychiatry. Not limited to residents, the debate about psychotherapy in psychiatry concerns the profession's core identity and its traditional person-centered nature.

The Effect of Telephone-Administered Psychotherapy on Symptoms of Depression and Attrition: A Meta-Analysis

PubMed Central

Mohr, David C.; Vella, Lea; Hart, Stacey; Heckman, Timothy; Simon, Gregory

2008-01-01

Increasingly, the telephone is being used to deliver psychotherapy for depression, in part as a means to reduce barriers to treatment. Twelve trials of telephone-administered psychotherapies, in which depressive symptoms were assessed, were included. There was a significant reduction in depressive symptoms for patients enrolled in telephone-administered psychotherapy as compared to control conditions (d = 0.26, 95% confidence interval [CI] = 0.14–0.39, p < .0001). There was also a significant reduction in depressive symptoms in analyses of pretreatment to posttreatment change (d = 0.81, 95% CI = 0.50–1.13, p < .0001). The mean attrition rate was 7.56% (95% CI = 4.23–10.90). These findings suggest that telephone-administered psychotherapy can produce significant reductions in depressive symptoms. Attrition rates were considerably lower than rates reported in face-to-face psychotherapy. PMID:21369344

Types of Psychotherapy for Pathological Gamblers

PubMed Central

2005-01-01

Several types of psychotherapy are currently used to treat pathological gamblers. These include Gambler's Anonymous, cognitive behavioral therapy, behavioral therapy, psychodynamic therapy, and family therapy. Research into which types of psychotherapy are the most effective for pathological gambling is limited but is a growing area of study. Group therapy, namely Gambler's Anonymous, provides peer support and structure. Cognitive behavior therapy aims to identify and correct cognitive distortions about gambling. Psychodynamic psychotherapy can help recovering gamblers address core conflicts and hidden psychological meanings of gambling. Family therapy is helpful by providing support and education and eliminating enabling behaviors. To date, no single type of psychotherapy has emerged as the most effective form of treatment. As in other addictive disorders, treatment retention of pathological gamblers is highly variable. Understanding the types of psychotherapy that are available for pathological gamblers, as well their underlying principles, will assist clinicians in managing this complex behavioral disorder. PMID:21152147

Annual Research Review: Building a science of personalized intervention for youth mental health.

PubMed

Ng, Mei Yi; Weisz, John R

2016-03-01

Within the past decade, health care service and research priorities have shifted from evidence-based medicine to personalized medicine. In mental health care, a similar shift to personalized intervention may boost the effectiveness and clinical utility of empirically supported therapies (ESTs). The emerging science of personalized intervention will need to encompass evidence-based methods for determining which problems to target and in which order, selecting treatments and deciding whether and how to combine them, and informing ongoing clinical decision-making through monitoring of treatment response throughout episodes of care. We review efforts to develop these methods, drawing primarily from psychotherapy research with youths. Then we propose strategies for building a science of personalized intervention in youth mental health. The growing evidence base for personalizing interventions includes research on therapies adapted for specific subgroups; treatments targeting youths' environments; modular therapies; sequential, multiple assignment, randomized trials; measurement feedback systems; meta-analyses comparing treatments for specific patient characteristics; data-mining decision trees; and individualized metrics. The science of personalized intervention presents questions that can be addressed in several ways. First, to evaluate and organize personalized interventions, we propose modifying the system used to evaluate and organize ESTs. Second, to help personalizing research keep pace with practice needs, we propose exploiting existing randomized trial data to inform personalizing approaches, prioritizing the personalizing approaches likely to have the greatest impact, conducting more idiographic research, and studying tailoring strategies in usual care. Third, to encourage clinicians' use of personalized intervention research to inform their practice, we propose expanding outlets for research summaries and case studies, developing heuristic frameworks that incorporate personalizing approaches into practice, and integrating personalizing approaches into service delivery systems. Finally, to build a richer understanding of how and why treatments work for particular individuals, we propose accelerating research to identify mediators within and across RCTs, to isolate mechanisms of change, and to inform the shift from diagnoses to psychopathological processes. This ambitious agenda for personalized intervention science, although challenging, could markedly alter the nature of mental health care and the benefit provided to youths and families. © 2015 Association for Child and Adolescent Mental Health.

[Effectiveness of psychotherapy compared to pharmacotherapy for the treatment of anxiety and depressive disorders in adults: A literature review].

PubMed

Fansi, Alvine; Jehanno, Cedric; Lapalme, Micheline; Drapeau, Martin; Bouchard, Sylvie

Introduction In Quebec, mental disorders affect one in five people in their lifetime. Anxiety and depressive disorders are the main common or moderate mental health disorders. They affect both the individuals with the disorder and the people around them and have substantial economic impact. Psychotropic drugs are the treatment option most often proposed to patients presenting with moderate mental health disorders. Psychotherapy is nevertheless a treatment that should be given consideration.Physical and financial access to psychotherapy remains limited because only one third of professionals qualified to offer it practise in the public sector, and the coverage and reimbursement policy for this service is very restricted. In order to improve such coverage, the Ministère de la Santé et des Services sociaux (MSSS) mandated the Institut national d'excellence en santé et en services sociaux (INESSS) to assess the evidence on the effectiveness of psychotherapy compared with those of pharmacotherapy for the treatment of adults with anxiety and depressive disorders.Methods An update of a review of recent and good quality literature was conducted through a review of systematic reviews dealing with psychotherapy compared to pharmacotherapy in the treatment of anxiety and depression in adults. The period covered included 2009 to 2013. The literature search strategy, modelled on that of the reference review, was applied to Medline, Cochrane Library, CINAHL, Web of Science and health technology assessment agencies. Exploration of the grey literature focused on information available on the websites of various health assessment organizations.Results The level of scientific evidence overall was judged to be of moderate to high quality. In general, the data showed no significant difference between psychotherapy and pharmacotherapy in terms of symptoms reduction in patients with moderate anxiety or depressive disorders, indicating comparable effectiveness of these two modes of treatment. However, the benefits of psychotherapy lasted longer after the end of treatment than those of medication. Psychotherapy therefore offers better protection against relapse. Furthermore, the combination of psychotherapy and pharmacotherapy is more effective than psychotherapy alone in severe or chronic cases.Conclusion Psychotherapy appears to be as effective as pharmacotherapy in the treatment of adult patients with moderate anxiety and/or depressive disorders. Moreover, the beneficial effects of psychotherapy last longer after the end of treatment with a lower likelihood of relapse.

Rehabilitation Aspects of Human Sexuality

PubMed Central

Madorsky, Julie G. Botvin; Dixon, Thomas P.

1983-01-01

The PLISSIT model is a comprehensive program that combines educational strategies with behavioral intervention to integrate human sexuality into the initial rehabilitation of spinal cord-injured persons. Sexuality is treated as a health care issue as important as bowel and bladder care, skin care, psychosocial issues, mobility, self-care and vocational concerns. Patients admitted to the Spinal Cord Injury Program are surrounded by a supportive milieu and an interdisciplinary staff who comfortably incorporate sexuality into discussions about catheter care, positioning, communication styles, assistive devices and so forth. Patients are exposed to a behavioral training program that makes available didactic lectures, group and individual sessions, bibliotherapy, films and opportunities for directed overnight sexual exploration within the hospital. We advocate that sex therapy be integrated into comprehensive rehabilitation programs along with physical therapy occupational therapy, recreation therapy and psychotherapy as an integral and effective form of functional restoration for patients with major physical disabilities. PMID:6636728

Context Matters: Team and Organizational Factors Associated with Reach of Evidence-Based Psychotherapies for PTSD in the Veterans Health Administration.

PubMed

Sayer, Nina A; Rosen, Craig S; Bernardy, Nancy C; Cook, Joan M; Orazem, Robert J; Chard, Kathleen M; Mohr, David C; Kehle-Forbes, Shannon M; Eftekhari, Afsoon; Crowley, Jill; Ruzek, Josef I; Smith, Brandy N; Schnurr, Paula P

2017-11-01

Evidence-based psychotherapies for PTSD are often underused. The objective of this mixed-method study was to identify organizational and clinic factors that promote high levels of reach of evidence-based psychotherapies for PTSD 10 years into their dissemination throughout the Veterans Health Administration. We conducted 96 individual interviews with staff from ten outpatient PTSD teams at nine sites that differed in reach of evidence-based psychotherapies for PTSD. Major themes associated with reach included clinic mission, clinic leader and staff engagement, clinic operations, staff perceptions, and the practice environment. Strategies to improve reach of evidence-based psychotherapies should attend to organizational and team-level factors.

New analyses of the National Institute of Mental Health Treatment of Depression Collaborative Research Program: do different treatments reflect different processes?

PubMed

Herbert, Gregory L; Callahan, Jennifer; Ruggero, Camilo J; Murrell, Amy R

2013-01-01

To determine whether or not different therapies have distinct patterns of change, it is useful to investigate not only the end result of psychotherapy (outcome) but also the processes by which outcomes are attained. The present study subjected data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program to survival analyses to examine whether the process of psychotherapy, as conceptualized by the phase model, differed between psychotherapy treatment approaches. Few differences in terms of progression through phases of psychotherapy were identified between cognitive behavior therapy and interpersonal therapy. Additionally, results indicate that phases of psychotherapy may not represent discrete, sequentially invariant processes.

Psychotherapy and transsexualism.

PubMed

Seikowski, K

2007-12-01

We questioned whether transsexuals always require the psychotherapy demanded by the health insurance system in Germany. For this purpose, we examined 430 transsexuals who came to our facility between 1988 and 2006. At the first consultation after the history was taken, they filled out standardised questionnaires, which are needed for proper diagnosis of psychotherapeutic treatment. These questionnaires included the Complaint Questionnaire (BFB), the Behaviour Questionnaire (VFB) and the Freiburg Personality Inventory (FPI-A). It was found that two-thirds of all transsexuals do not require deeper psychotherapy. However, there was evidence of personality deficits in a subgroup of transsexuals for whom supportive psychotherapy should be recommended. The conditions under which psychotherapy and other forms of support are successful are discussed.

[Significance of emotion-focused concepts to cognitive-behavioral therapy].

PubMed

Lammers, C-H

2006-09-01

Emotions are the central process of motivation and play a key role in adaptive behavior in humans. Although cognitive-behavioral therapy stresses the importance of changing both cognition and behavior, there is growing emphasis on direct therapeutic work on emotions and emotional processing, as problematic emotional processes are at the core of nearly all psychic disorders. This type of work is the goal of emotion-focused psychotherapy, which centers on direct change of problematic emotions, especially those which are usually suppressed resp. overregulated by the patient. This paper examines the basic phobic/emotional conflict, the problematic emotional processes arising from this conflict, and the importance to cognitive-behavioral therapy of their potentially integrative role.

A randomized clinical trial on the effectiveness of a reintegration training program versus booster sessions after short-term inpatient psychotherapy.

PubMed

Thunnissen, Moniek; Duivenvoorden, Hugo; Busschbach, Jan; Hakkaart-van Roijen, Leona; van Tilburg, Willem; Verheul, Roel; Trijsburg, Wim

2008-10-01

Although several studies show symptomatic improvements in patients with personality disorders after short-term inpatient psychotherapy, reintegration remains difficult. In this study the effectiveness of a specifically designed reintegration training program is investigated. One hundred twenty-eight patients were randomized to either a reintegration training program aimed at improving general functioning and work resumption, or booster sessions. Outcome measures used were symptom level, work status, absence from and impediments at work. The results showed that compliance in the booster session group was significantly better than in the reintegration training program. The percentage of persons with a paid job increased during the booster sessions from 64 to 87%, but not during the reintegration training (76%). There were no differences in the other outcome measures. We concluded that reintegration training was not more (cost)-effective than booster sessions. Our hypothesis is that continuity of care (same therapists and program) explains the favorable results of the booster sessions.

[Willingness of Psychotherapists in Private Practice to Treat Patients With Complex Post-Traumatic Stress and Dissociative Disorders].

PubMed

Schnell, T; von Katte, S; Gast, U

2015-09-01

Analyses of patient care with severe mental disorders. Psychotherapists in private praxis were interviewed about their willingness to treat patients with a range of diagnoses in the context of post-traumatic disorders. Therapists were found more willing to treat "less severe" disorders, independent of years in practice, school of psychotherapy, a rural or urban practice setting. Therapists criticized the quality of their training and the health insurance review process. Therapists are generally willing to treat patients with severe mental disorders, but experience limits of competency attributed to training deficits. They further experience the bureaucratic procedures of the health insurance review process as barriers to accepting these patients into treatment.These results indicate that recently developed concepts of psychotherapy for these patient groups should be more intensively integrated into the existing training curricula. Furthermore, a simplified health insurance review process ought to be considered. © Georg Thieme Verlag KG Stuttgart · New York.

Neuro-Physiological Psychotherapy (NPP): The development and application of an integrative, wrap-around service and treatment programme for maltreated children placed in adoptive and foster care placements.

PubMed

Vaughan, Jay; McCullough, Elaine; Burnell, Alan

2016-10-01

This article describes the development and application of a wrap-around, multidisciplinary, brain-based, developmental and attachment-focussed intervention for children who have experienced significant trauma in the context of their early life. It outlines the presentation of the children and families who are referred to the service and the model of treatment that they receive. In doing so, it identifies the core components underpinning Neuro-Physiological Psychotherapy (NPP) and links the application of the integrative model to research and practice in the field of neuroscience and attachment and to the use of therapeutic approaches that are beneficial to maltreated children and their adoptive parents. It highlights the need for a neuro-sequential approach that impacts all aspects of the child's life in the effort to redress the impact of developmental trauma with the aim of improving their overall functioning and their ability to develop healthy relationships into the future. © The Author(s) 2016.

Psychotherapy of the victims of massive violence: countertransference and ethical issues.

PubMed

Kinzie, J D; Boehnlein, J K

1993-01-01

Psychotherapy with severely traumatized patients is a long, draining process that often produces strong countertransference reactions. It is difficult to therapeutically and ethically handle these personal responses. We feel that at different stages in therapy different ethical principles should guide the therapy. At the early stages, fidelity and nonmaleficence should be the guiding principles. As trust and confidence develop, therapists may have more personal freedom to act; beneficence, i.e., providing specific confident care then becomes the primary ethical principle. In later stages of therapy, promoting the principles of autonomy and justice come into play. As therapy further progresses, therapists' own needs, the principle of self-interest, may be utilized in the therapeutic relationship. Throughout therapeutic contacts with traumatized patients, therapists need to monitor their own needs, and find appropriate ways outside of therapy to cope with these often intense feelings. Continuing to feel therapeutically competent and ethically grounded, yet maintaining the personal strength and balance to treat traumatized patients, pose major challenges for therapists.

Clinical management of "entitled" clients.

PubMed

Kerr, Norine

2002-12-01

As this process occurs, the painful affects become toned down for the clients. By exploring the source of clients' painful affects, wounded self-esteem, fearful projections, and dysfunctional defenses, misguided entitlement can be undermined. Much of this work will occur in a formal psychotherapy process, but nurses can create healthy object relatedness. To do so, they must see beyond the provocative and offensive behaviors to the vulnerable individual within who desperately needs compassionate and intelligent nursing care.

Cognitive Behavioral Analysis System of Psychotherapy as group psychotherapy for chronically depressed inpatients: a naturalistic multicenter feasibility trial.

PubMed

Sabaß, Lena; Padberg, Frank; Normann, Claus; Engel, Vera; Konrad, Carsten; Helmle, Kristina; Jobst, Andrea; Worlitz, Andrew; Brakemeier, Eva-Lotta

2017-09-27

The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is a relatively new approach in the treatment of chronic depression (CD). Adapted as group psychotherapy for inpatients, CBASP is attracting increasing attention. In this naturalistic multicenter trial, we investigated its feasibility after 10 sessions of CBASP group therapy over a treatment time of at least 5 to a maximum of 10 weeks. Treatment outcome was additionally assessed. Across four centers, 116 inpatients with CD (DSM-IV-TR) attended CBASP group psychotherapy. Feasibility was focused on acceptance, and evaluated for patients and therapists after five (t1) and ten sessions (t2) of group psychotherapy. Observer- and self-rating scales (Hamilton Depression Rating Scale-24 items, HDRS 24 ; Beck Depression Inventory-II, BDI-II; World Health Organization Quality of Life assessment, WHOQOL-BREF) were applied before group psychotherapy (t0) and at t2. Dropouts were low (10.3%). Patients' evaluation improved significantly from t1 to t2 with a medium effect size (d = 0.60). Most of the patients stated that the group had enriched their treatment (75.3%), that the size (74.3%) and duration (72.5%) were 'optimal' and 37.3% wished for a higher frequency. Patients gave CBASP group psychotherapy an overall grade of 2 ('good'). Therapists' evaluation was positive throughout, except for size of the group. Outcome scores of HDRS 24 , BDI-II, and WHOQOL-BREF were significantly reduced from t0 to t2 with medium to large effect sizes (d = 1.48; d = 1.11; d = 0.67). In this naturalistic open-label trial, CBASP, when applied as inpatient group psychotherapy, was well accepted by patients and therapists. The results point towards a clinically meaningful effect of inpatient treatment with CBASP group psychotherapy on depression and quality of life. Other potential factors that could have promoted symptom change were discussed. A future controlled study could investigate the safety and efficacy of CBASP group psychotherapy for inpatients.

Psychotherapeutic Intervention in the Demobilization Process: Addressing Combat-related Mental Injuries with Narrative Exposure in a First and Second Dissemination Stage.

PubMed

Köbach, Anke; Schaal, Susanne; Hecker, Tobias; Elbert, Thomas

2017-07-01

Depending on the exposure to traumatic stressors and combat, 20% to 50% of ex-combatants present with trauma-related disorders, and more than half of the members of armed groups have a proclivity to violence. Therefore, psychotherapeutic assistance should address both, trauma-related suffering and the lowered threshold for aggressive behaviour. Supporting the demobilization process of ex-combatants in the eastern DR-Congo, we implemented a version of Narrative Exposure Therapy adapted for Forensic Offender Rehabilitation (FORNET). In two successive dissemination stages (DS), local counsellors conducted FORNET. In DS1, they were trained by clinical experts, and in DS2, the by then experienced counsellors trained and supervised a second group of local counsellors (DS2). The training consisted of a 3-week workshop covering theoretical concepts and practical therapeutic skills. In DS1 and DS2, a total of 98 demobilizing combatants received an intervention; treatment-as-usual served as the control condition. Posttraumatic stress disorder, appetitive aggression, depression severity and drug dependence were assessed prior to the intervention and 6 and 12 months later; additionally, we assessed reintegration success. Six months post-intervention, FORNET significantly reduced Posttraumatic stress disorder symptoms but had less effect on the trait of appetitive aggression; moreover, beneficial effects were found for depression severity and drug dependence as well as for reintegration indices. Treatment gains were retained at 12 months. Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET and support the demobilization process in ongoing conflicts. The study suggests that it is possible to pass down psychotherapeutic techniques over generations of counsellors. © 2015 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd. Posttraumatic stress symptoms, depression and clinically relevant levels of drug dependence can effectively be reduced with a version of Narrative Exposure Therapy (NET) adapted for Forensic Offender Rehabilitation (FORNET). The intervention is effective in the context of ongoing conflict. Individuals without previous training in psychotherapy can learn to effectively apply the brief intervention FORNET. It is possible to pass down psychotherapeutic techniques like FORNET over generations of counsellors. Psychotherapeutic interventions like FORNET may facilitate the transition to peace in war-torn regions. © 2015 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.

Patterns of Symptomatic Recovery in Psychotherapy.

ERIC Educational Resources Information Center

Kopta, Stephen Mark; And Others

1994-01-01

Used psychotherapy dosage model in which effect was probability of recovery to compare treatment response rates for psychological symptoms. Administered symptom checklists to 854 psychotherapy outpatients at intake and during treatment. Chronic distress symptoms demonstrated fastest average response rate, whereas characterological symptoms…

Sertraline and/or interpersonal psychotherapy for patients with dysthymic disorder in primary care: 6-month comparison with longitudinal 2-year follow-up of effectiveness and costs.

PubMed

Browne, Gina; Steiner, Meir; Roberts, Jacqueline; Gafni, Amiram; Byrne, Carolyn; Dunn, Edward; Bell, Barbara; Mills, Michael; Chalklin, Lori; Wallik, David; Kraemer, James

2002-04-01

There is little information on the long-term effects and costs of a combination of Sertraline and interpersonal psychotherapy (IPT) for the treatment of dysthymia in primary care. In a single-blind, randomized clinical trial, 707 adults (18-74 years of age inclusive) with DSM-IV dysthymic disorder, with or without past and/or current major depression, as an acute or chronic episode, in a community-based primary care practice in Ontario, Canada, were randomized to treatment with either Sertraline alone (50-200 mg), or IPT alone (10 sessions), or Sertraline plus IPT combined. In the acute treatment phase (first 6 months) all groups received full active treatment. This was followed by an additional 18-month naturalistic follow-up phase. Subjects were assessed for effectiveness of treatment in reducing depressive symptoms using the Montgomery Asberg Depression Rating Scale (MADRS) at 6 months and twice again during the 18-month follow-up by blind independent observers. Treatment costs and subjects' use of other health and social services were also investigated. At 6 months, 586 subjects completed the MADRS questionnaire. There was a significant difference (P=0.025) in mean MADRS scores: 14.3 (Group I); 14.9 (Group II); 16.8 (Group III), using analysis of covariance. Response (40% improvement) rates were 60.2% for Sertraline alone, 46.6% for IPT alone, and 57.5% for Sertraline augmented by IPT (P=0.02). At 2 years, 525 subjects were retained for follow-up. There was no statistically significant difference between Sertraline alone and Sertraline plus IPT in symptom reduction. However, both were more effective than IPT alone in reducing depressive symptoms (P=0.03). There was a statistically significant difference between groups in costs for use of health and social services. The IPT treatment groups had the lower costs for use of health and social services. Sertraline or Sertraline plus IPT was more effective than IPT alone after 6 months. Over the long term (2 years), all three treatments provide reasonably effective treatment for reducing symptoms of dysthymia, but Sertraline or combining Sertraline with IPT is more effective than IPT alone. Of these two more effective treatments, subjects in the Sertraline plus IPT group had less health and social service costs by $480 per person over 2 years. These findings underscore the effects of combining pharmacotherapy and psychotherapy and the economic value of this more comprehensive treatment of dysthymia in primary care.

Practice Parameter for Psychodynamic Psychotherapy with Children

ERIC Educational Resources Information Center

Medicus, Jennifer

2012-01-01

This Practice Parameter describes the principles of psychodynamic psychotherapy with children and is based on clinical consensus and available research evidence. It presents guidelines for the practice of child psychodynamic psychotherapy, including indications and contraindications, the setting, verbal and interactive (play) techniques, work with…

Psychotherapy with Older Dying Persons.

ERIC Educational Resources Information Center

Dye, Carol J.

Psychotherapy with older dying patients can lead to problems of countertransference for the clinician. Working with dying patients requires flexibility to adapt basic therapeutics to the institutional setting. Goals of psychotherapy must be reconceptualized for dying clients. The problems of countertransference arise because clinicians themselves…

Attachment style and readiness for psychotherapy among psychiatric outpatients.

PubMed

Kealy, David; Tsai, Michelle; Ogrodniczuk, John S

2017-06-01

Ninety-two adults attending outpatient mental health services completed measures of attachment style and readiness to engage in psychotherapy. Correlation and linear regression analyses found anxious attachment to be positively associated with treatment-seeking distress and found avoidant attachment to be negatively associated with openness to personal disclosure in the therapy relationship. Insecure attachment may influence prospective patients' readiness for psychotherapy. Patients with an avoidant attachment style may need assistance in preparing for the relational aspects of psychotherapy. © 2016 The British Psychological Society.

Ethics and aims in psychotherapy: a contribution from Kant.

PubMed

Callender, J S

1998-08-01

Psychotherapy is an activity which takes many forms and which has many aims. The present paper argues that it can be viewed as a form of moral suasion. Kant's concepts of free will and ethics are described and these are then applied to the processes and outcome of psychotherapy. It is argued that his ideas, by linking rationality, free will and ethics into a single philosophical system, offer a valuable theoretical framework for thinking about aims and ethical issues in psychotherapy.

Humanism and multiculturalism: an evolutionary alliance.

PubMed

Comas-Diaz, Lillian

2012-12-01

Humanism and multiculturalism are partners in an evolutionary alliance. Humanistic and multicultural psychotherapies have historically influenced each other. Humanism represents the third force in psychotherapy, while multiculturalism embodies the fourth developmental stage. Multiculturalism embraces humanistic values grounded in collective and social justice contexts. Examples of multicultural humanistic constructs include contextualism, holism, and liberation. Certainly, the multicultural-humanistic connection is a necessary shift in the evolution of psychotherapy. Humanism and multiculturalism participate in the development of an inclusive and evolutionary psychotherapy. (c) 2012 APA, all rights reserved.

Ethics and aims in psychotherapy: a contribution from Kant.

PubMed Central

Callender, J S

1998-01-01

Psychotherapy is an activity which takes many forms and which has many aims. The present paper argues that it can be viewed as a form of moral suasion. Kant's concepts of free will and ethics are described and these are then applied to the processes and outcome of psychotherapy. It is argued that his ideas, by linking rationality, free will and ethics into a single philosophical system, offer a valuable theoretical framework for thinking about aims and ethical issues in psychotherapy. PMID:9752632

Pilot Trial of a Licensed Practical Nurse Intervention for Hypertension and Depression

PubMed Central

Bogner, Hillary R.; de Vries, Heather F.; Kaye, Elise M.; Morales, Knashawn H.

2014-01-01

BACKGROUND AND OBJECTIVES Depression is a risk factor for hypertension, and risk of depression is increased substantially in patients with hypertension. Our objective was to examine whether an intervention carried out by Licensed Practical Nurses (LPNs) integrating depression treatment into care for hypertension improved blood pressure control and depressive symptoms. METHODS In all, 60 patients ages 41 to 92 years with hypertension and depressive symptoms at a large primary care practice in Philadelphia were randomly assigned to an integrated care intervention carried out by LPNs (n=30) or usual care (n=30). Intervention and control groups did not differ statistically on baseline measures. Outcomes assessed at baseline and 12 weeks included standard laboratory procedures to measure blood pressure control and the Patient Health Questionnaire (PHQ-9) to assess depression. RESULTS Patients in the integrated care intervention had lower diastolic blood pressure (intervention 74.2 mmHg versus usual care 82.0 mmHg) and fewer depressive symptoms (PHQ-9 mean scores, intervention 2.4 versus usual care 7.1) compared with patients in the usual care group at 12 weeks after adjustment for baseline values. Patients in the integrated care intervention also had lower systolic blood pressure (intervention 130.0 mmHg versus usual care 140.6 mmHg) compared with patients in the usual care group at 12 weeks although the results approached but did not reach conventional levels of statistical significance. CONCLUSION Training existing primary care practice office staff will facilitate implementation in real world practices with limited resources and competing demands. PMID:23681683

Inpatient Palliative Care Consultation and 30-Day Readmissions in Oncology.

PubMed

DiMartino, Lisa D; Weiner, Bryan J; Hanson, Laura C; Weinberger, Morris; Birken, Sarah A; Reeder-Hayes, Katherine; Trogdon, Justin G

2018-01-01

Prior research indicates that hospice and palliative care delivered in outpatient settings are associated with reduced hospital readmissions for cancer patients. However, little is known about how inpatient palliative care affects readmissions in oncology. To examine associations among inpatient palliative care consultation, hospice use (discharge), and 30-day readmissions among patients with solid tumor cancers. We identified all live discharges from a large tertiary cancer hospital between 2010 and 2016. Palliative care consult data were abstracted from medical charts and linked to hospital encounter data. Propensity scores were used to match palliative care consult to usual care encounters. Modified Poisson regression models estimated adjusted relative risk (aRR) and 95% confidence intervals (CI) of 30-day readmissions and hospice discharge. We compared predicted probabilities of readmission for palliative care consultation with hospice discharge, without hospice discharge, and usual care. Of 8085 eligible encounters, 753 involved a palliative care consult. The likelihood of having a 30-day readmission did not differ between palliative care consult and usual care groups (p > 0.05). However, the palliative care consult group was more likely than usual care to have a hospice discharge (aRR = 4.09, 95% CI: 3.07-5.44). The predicted probability of 30-day readmission was lower when palliative care consultation was combined with hospice discharge compared to usual care or consultation with discharge to nonhospice postacute care (p < 0.001). The effect of inpatient palliative care on readmissions in oncology is largely driven by hospice enrollment. Strategies that combine palliative care consultation with hospice discharge may decrease hospital readmissions and improve cancer care quality.

The impact of parity on major depression treatment quality in the Federal Employees' Health Benefits Program after parity implementation.

PubMed

Busch, Alisa B; Huskamp, Haiden A; Normand, Sharon-Lise T; Young, Alexander S; Goldman, Howard; Frank, Richard G

2006-06-01

Since the 1990s, parity laws have been implemented to reduce inequities in mental health coverage compared with that for general medical conditions. It is unclear if parity under managed care is associated with improvements in mental health treatment quality. Major depressive disorder (MDD) is a prevalent but often undetected and undertreated and thus could potentially benefit from parity implementation. The objective of this study was to examine the association between parity implementation and changes in MDD treatment quality in the Federal Employees' Health Benefits (FEHB) Program. We conducted retrospective analyses of insurance claims data. Logistic regression models estimated quality changes for MDD-diagnosed enrollees from pre- to postparity. Subjects included MDD-diagnosed FEHB insured enrollees, aged 18-64, across multiple states and 6 FEHB plans before (1999-2000) and after (2001-2002) parity implementation. Measures included receipt of any antidepressant or psychotherapy within a given calendar year of diagnosis; receipt of appropriate psychotherapy frequency/intensity and duration; and pharmacotherapy duration during acute-phase treatment episodes. Postparity, several plans improved significantly in the likelihood of receiving antidepressant medication. In the acute-phase episodes, the greatest improvement was seen in the likelihood of follow up >or=4 months. Few or no other changes were observed in the acute-phase treatment intensity or duration quality measures. Parity under managed care was associated with modest improvements. The observed improvements were consistent with secular trends in MDD treatment. Whereas mental health parity is an important policy goal, these results highlight its limitations: improving the financing of care may not be sufficient to improve quality.

Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis.

PubMed

van der Feltz-Cornelis, Christina M; Nuyen, Jasper; Stoop, Corinne; Chan, Juliana; Jacobson, Alan M; Katon, Wayne; Snoek, Frank; Sartorius, Norman

2010-01-01

Comorbid depression in diabetes is highly prevalent, negatively impacting well-being and diabetes control. How depression in diabetes is best treated is unknown. This systematic review and meta-analysis aims to establish the effectiveness of existing anti-depressant therapies in diabetes. PubMed, Psycinfo, Embase and Cochrane library. Study eligibility criteria, participants, interventions: randomized controlled trials (RCTs) evaluating the outcome of treatment by psychotherapy, pharmacotherapy or collaborative care of depression in persons with Type 1 and Type 2 diabetes mellitus. risk of bias assessment; data extraction. Synthesis methods: data synthesis, random model meta analysis and publication bias analysis. Meta analysis of 14 RCTs with a total of 1724 patients show that treatment is effective in terms of reduction of depressive symptoms: -0.512; 95% CI -0.633 to -0.390. The combined effect of all interventions on clinical impact is moderate, -0.370; 95% CI -0.470 to -0.271; it is large for psychotherapeutic interventions that are often combined with diabetes self management: -0.581; 95% CI -0.770 to -0.391, n=310 and moderate for pharmacological treatment: -0.467; 95% CI -0.665 to -0.270, n=281. Delivery of collaborative care, which provided a stepped care intervention with a choice of starting with psychotherapy or pharmacotherapy, to a primary care population, yielded an effect size of -0.292; 95% CI -0.429 to -0.155, n=1133; indicating the effect size that can be attained on a population scale. Pharmacotherapy and collaborative care aimed at and succeeded in the reduction of depressive symptoms but, apart from sertraline, had no effect on glycemic control. amongst others, the number of RCTs is small. The treatment of depression in people with diabetes is a necessary step, but improvement of the general medical condition including glycemic control is likely to require simultaneous attention to both conditions. Further research is needed. Copyright 2010 Elsevier Inc. All rights reserved.

Differential characteristics of young and midlife adult users of psychotherapy, psychotropic medications, or both: information from a population representative sample in São Paulo, Brazil.

PubMed

Blay, Sergio L; Fillenbaum, Gerda G; Peluso, Erica T

2015-10-29

While the personal characteristics of users of psychotherapy and/or psychotropic medications have been examined, direct user comparison of these treatment approaches appears to be rare. Our aim is to ascertain extent of receipt of these services, and identify basic distinguishing characteristics of users. Information on demographics, lifetime and past 12 month use of mental health services, and presence of common mental disorders (CMD), was gathered in 2002 using a multi-stage sampling procedure that yielded a population-representative, community-resident sample (N = 2000, age 18-65) for São Paulo, Brazil. Analysis used descriptive statistics and logistic regression. Overall, 9.3% reported receiving psychotherapy and/or psychotropic medication, 54.3% of whom did not meet CMD criteria. Of those meeting criteria for CMD (n = 455, 22.8%), 2.9% reported only psychotherapy, 10.1% reported only psychotropic medication, and 5.7% reported both. CMD was associated with use of psychotropic medication (psychotropic medication alone, Odds Ratio (OR) 3.58, 95% CI 2.33-5.52; together with psychotherapy, OR 4.17, 95% CI 2.34-7.44). CMD was not associated with use of psychotherapy. Users' distinguishing characteristics were: psychotherapy only--not married; psychotropics only--increasing age, female, not married; using both--only CMD status. Neither education nor income was associated with use. Nearly 10% of all community residents age 18-65, but less than a fifth of the 23% with CMD, received psychotherapy and/or psychotropic medication. Non-married status increased odds of all treatment types, but CMD presence increased only odds of psychotropic and combined psychotherapy/psychotropic use, with odds of psychotropic only use increasing with age, and for women. Use was equitable with respect to education and income.

The relationship between the UPPS-P impulsive personality traits and substance use psychotherapy outcomes: A meta-analysis.

PubMed

Hershberger, Alexandra R; Um, Miji; Cyders, Melissa A

2017-09-01

Although impulsive personality traits have been well implicated in substance use disorder (SUD) risk, little work has established how specific impulsive personality traits influence and are influenced by SUD psychotherapy outcomes. The purpose of this meta-analysis was to quantitatively review existing work to examine 1) how impulsive personality traits affect SUD psychotherapy outcomes and 2) reductions in impulsive personality traits during SUD psychotherapy. Studies were identified by conducting a comprehensive review of the literature. For aim one (k=6), significant effects were found for lack of premeditation (g=0.60, SE=0.30, 95% CI 0.01-1.20; z=1.99, p=0.05) and negative urgency (g=0.55, SE=0.17, 95% CI 0.22-0.88, z=3.30, p=0.001), with trait scores related to poorer SUD psychotherapy outcomes. For aim two (k=10), decreases in sensation seeking (g=-0.10, SE=0.05, 95% CI -0.20 to 0.004; z=-1.88, p=0.02) and negative urgency (g=-0.25, SE=0.14, 95% CI -0.53 to 0.03; z=-1.75, p=0.03) during SUD psychotherapy were significant. Overall, our quantitative synthesis suggests that lack of premeditation and negative urgency are related to poorer SUD psychotherapy outcomes. Although negative urgency and sensation seeking are decreasing during SUD psychotherapy, the magnitude of the change is quite small. Overall, we suggest that the measurement and targeting of impulsive personality traits in psychotherapy has strong potential to improve clinical outcomes across SUDs and a wide range of clinical problems and disorders. Copyright © 2017 Elsevier B.V. All rights reserved.

Neurobiology of dynamic psychotherapy: an integration possible?

PubMed

Mundo, Emanuela

2006-01-01

In the last decades, Kandel's innovative experiments have demonstrated that brain structures and synaptic connections are dynamic. Synapses can be modified by a wide variety of environmental factors, including learning and memory processes. The hypothesis that dynamic psychotherapy process involves memory and learning processes has opened the possibility of a dialogue between neuroscience and psychoanalysis and related psychotherapy techniques. The primary aim of the present article is to critically review the more recent data on neurobiological effects of dynamic psychotherapy in psychiatric disorders. Relevant literature has been selected using the databases currently available online (i.e., PubMed). The literature search has been limited to the past 10 years and to genetic, molecular biology, and neuroimaging studies that have addressed the issue of changes induced by psychotherapy. Most of the genetic studies on mental disorders have demonstrated that psychiatric conditions result from a complex interaction of genetic susceptibility and environmental effects. For none of the many psychiatric conditions investigated has a purely genetic background been found. Molecular biology studies have indicated that gene expression is influenced by several environmental factors, including early experiences, traumas, learning, and memory processes. Neuroimaging studies (using fMRI and PET) have found that not only cognitive but also dynamic psychotherapy has measurable effects on the brain. In addition, psychotherapy may modify brain function and metabolism in specific brain areas. Most of these studies have considered patients with major depressive disorders and compared the effects of psychotherapy with the effect of standard pharmacotherapy. In conclusion, recent results from neuroscience studies have suggested that dynamic psychotherapy has a significant impact on brain function and metabolism in specific brain areas. The possible applications and developments of this new area of research toward the conceptualization of an integrative approach to treatment of psychiatric disorders are discussed.

[Does improvement of symptoms four weeks after the begin of psychodynamic inpatient psychotherapy correspond to long term outcome?].

PubMed

Franke, Gabriele Helga; Hoffmann, Thilo; Frommer, Jörg

2005-01-01

This study was conducted to explore differentiated aspects of outcome throughout and one year after psychodynamic inpatient psychotherapy with special regard to symptomatic distress and interpersonal behaviour. Sixty-four patients of the Department of Psychotherapeutic Medicine of the Jerichow Hospital (Saxonia-Anhaltina) were investigated with the SCL-90-R and the IIP-D four times: at the beginning of inpatient psychotherapy (t0), four weeks after (t1), at the end (t2), and one year after discharge (t3). The improvement of symptoms four weeks after the beginning of psychodynamic inpatient psychotherapy is equivalent with long term outcome. The Global Severity Index of SCL-90-R demonstrated a statistically significant change from markedly psychological distress to lack of distress after four weeks psychodynamic inpatient psychotherapy (effect-size d(GSI) = 0.82). At the end of psychotherapy, three weeks later, the effect-size was d = 1.11, and one year after discharge the effect-size decreased again to d = 0.85. Major improvements demonstrated the SCL-90-R subscales Depression, Anxiety, and Obsessive/Compulsive. Regarding interpersonal problems, the subscales Dominance, and Competitive demonstrated statistically significant changes from low Stanine-scores at t0 to higher scores one year after discharge. The subscales Socially avoidant, Nonassertive, and Exploitable demonstrated statistical significant changes from high levels at t0 to lower scores after one year. In conclusion the first four weeks of psychodynamic psychotherapy are not sufficient to demonstrate an optimum level of low psychological distress as well as an optimum change in interpersonal problems. Regarding stability of the effects of psychodynamic inpatient psychotherapy it was demonstrated that the first four weeks initiated changes which improved at the end of psychotherapy until one year after discharge.

Therapeutic hypnosis, psychotherapy, and the digital humanities: the narratives and culturomics of hypnosis, 1800-2008.

PubMed

Rossi, Ernest; Mortimer, Jane; Rossi, Kathryn

2013-04-01

Culturomics is a new scientific discipline of the digital humanities-the use of computer algorithms to search for meaning in large databases of text and media. This new digital discipline is used to explore 200 years of the history of hypnosis and psychotherapy in over five million digitized books from more than 40 university libraries around the world. It graphically compares the frequencies of English words about hypnosis, hypnotherapy, psychoanalysis, psychotherapy, and their founders from 1800 to 2008. This new perspective explore issues such as: Who were the major innovators in the history of therapeutic hypnosis, psychoanalysis, and psychotherapy? How well does this new digital approach to the humanities correspond to traditional histories of hypnosis and psychotherapy?

The Theory and Art of Child Psychotherapy: A Corrective Developmental Approach.

PubMed

Friedman, Robert

2017-10-01

The history of child psychotherapy is sketched from the psychoanalytic pioneers Anna Freud and Melanie Klein to the popular "nondirective" approach of Virginia Axline. The author's approach to child psychotherapy, based on contemporary psychoanalytic theories, allows the therapist to play any parental role that helps to repair developmental deficiencies and conflicts. These include nurturing, supporting, mirroring, role modeling, challenging, and limit setting. Following Winnicott, psychotherapy is conceived as a play space in which therapist and child are both spontaneous. The value of interpretation and insight in child therapy is discussed. There follows a more detailed discussion of three major problem areas in child psychotherapy: handling anger and hostile aggression; handling issues related to sexuality; and handling narcissistic issues of inferiority and shame.

Beyond usual care: the economic consequences of expanding treatment options in early pregnancy loss.

PubMed

Dalton, Vanessa K; Liang, Angela; Hutton, David W; Zochowski, Melissa K; Fendrick, A Mark

2015-02-01

The objective of this study was to estimate the economic consequences of expanding options for early pregnancy loss (EPL) treatment beyond expectant management and operating room surgical evacuation (usual care). We constructed a decision model using a hypothetical cohort of women undergoing EPL management within a 30 day horizon. Treatment options under the usual care arm include expectant management and surgical uterine evacuation in an operating room (OR). Treatment options under the expanded care arm included all evidence-based safe and effective treatment options for EPL: expectant management, misoprostol treatment, surgical uterine evacuation in an office setting, and surgical uterine evacuation in an OR. Probabilities of entering various treatment pathways were based on previously published observational studies. The cost per case was US $241.29 lower for women undergoing treatment in the expanded care model as compared with the usual care model (US $1033.29 per case vs US $1274.58 per case, expanded care and usual care, respectively). The model was the most sensitive to the failure rate of the expectant management arm, the cost of the OR surgical procedure, the proportion of women undergoing an OR surgical procedure under usual care, and the additional cost per patient associated with implementing and using the expanded care model. This study demonstrates that expanding women's treatment options for EPL beyond what is typically available can result in lower direct medical expenditures. Copyright © 2015 Elsevier Inc. All rights reserved.

Effect of integrated care for sick listed patients with chronic low back pain: economic evaluation alongside a randomised controlled trial.

PubMed

Lambeek, Ludeke C; Bosmans, Judith E; Van Royen, Barend J; Van Tulder, Maurits W; Van Mechelen, Willem; Anema, Johannes R

2010-11-30

To evaluate the cost effectiveness, cost utility, and cost-benefit of an integrated care programme compared with usual care for sick listed patients with chronic low back pain. Economic evaluation alongside a randomised controlled trial with 12 months' follow-up. Primary care (10 physiotherapy practices, one occupational health service, one occupational therapy practice) and secondary care (five hospitals) in the Netherlands, 2005-9. 134 adults aged 18-65 sick listed because of chronic low back pain: 66 were randomised to integrated care and 68 to usual care. Integrated care consisted of a workplace intervention based on participatory ergonomics, with involvement of a supervisor, and a graded activity programme based on cognitive behavioural principles. Usual care was provided by general practitioners and occupational physicians according to Dutch guidelines. The primary outcome was duration until sustainable return to work. The secondary outcome was quality adjusted life years (QALYs), measured using EuroQol. Total costs in the integrated care group (£13 165, SD £13 600) were significantly lower than in the usual care group (£18 475, SD £13 616). Cost effectiveness planes and acceptability curves showed that integrated care was cost effective compared with usual care for return to work and QALYs gained. The cost-benefit analyses showed that every £1 invested in integrated care would return an estimated £26. The net societal benefit of integrated care compared with usual care was £5744. Implementation of an integrated care programme for patients sick listed with chronic low back pain has a large potential to significantly reduce societal costs, increase effectiveness of care, improve quality of life, and improve function on a broad scale. Integrated care therefore has large gains for patients and society as well as for employers.

Effect of reversal of neuromuscular blockade with sugammadex versus usual care on bleeding risk in a randomized study of surgical patients.

PubMed

Rahe-Meyer, Niels; Fennema, Hein; Schulman, Sam; Klimscha, Walter; Przemeck, Michael; Blobner, Manfred; Wulf, Hinnerk; Speek, Marcel; McCrary Sisk, Christine; Williams-Herman, Debora; Woo, Tiffany; Szegedi, Armin

2014-11-01

Previous studies show a prolongation of activated partial thromboplastin time and prothrombin time in healthy volunteers after treatment with sugammadex. The authors investigated the effect of sugammadex on postsurgical bleeding and coagulation variables. This randomized, double-blind trial enrolled patients receiving thromboprophylaxis and undergoing hip or knee joint replacement or hip fracture surgery. Patients received sugammadex 4 mg/kg or usual care (neostigmine or spontaneous recovery) for reversal of rocuronium- or vecuronium-induced neuromuscular blockade. The Cochran-Mantel-Haenszel method, stratified by thromboprophylaxis and renal status, was used to estimate relative risk and 95% confidence interval (CI) of bleeding events with sugammadex versus usual care. Safety was further evaluated by prespecified endpoints and adverse event reporting. Of 1,198 patients randomized, 1,184 were treated (sugammadex n = 596, usual care n = 588). Bleeding events within 24 h (classified by an independent, blinded Adjudication Committee) were reported in 17 (2.9%) sugammadex and 24 (4.1%) usual care patients (relative risk [95% CI], 0.70 [0.38 to 1.29]). Compared with usual care, increases of 5.5% in activated partial thromboplastin time (P < 0.001) and 3.0% in prothrombin time (P < 0.001) from baseline with sugammadex occurred 10 min after administration and resolved within 60 min. There were no significant differences between sugammadex and usual care for other blood loss measures (transfusion, 24-h drain volume, drop in hemoglobin, and anemia), or risk of venous thromboembolism, and no cases of anaphylaxis. Sugammadex produced limited, transient (<1 h) increases in activated partial thromboplastin time and prothrombin time but was not associated with increased risk of bleeding versus usual care.

Research on Psychotherapy Integration: Recommendations and Conclusions from an NIMH Workshop.

ERIC Educational Resources Information Center

Wolfe, Barry E.; Goldfried, Marvin R.

1988-01-01

Describes National Institute of Mental Health (NIMH) workshop (March 1986) which invited 14 psychotherapy researchers to consider key issues associated with psychotherapy integration. Discusses recommendations developed to initiate a research program encompassing conceptual clarification, efficacy studies of systematic eclectic therapies, the role…

The Grandmaternal Transference in Parent-Infant/Child Psychotherapy

ERIC Educational Resources Information Center

Dugmore, Nicola

2013-01-01

The psychic significance of the figure of the grandmother in psychodynamic psychotherapy has received scant attention. This paper develops the concept of the "grandmaternal transference" in parent-infant psychotherapy and explores its identification, its possible functions and its therapeutic significance. The grandmaternal transference has…

Use of psychotherapy in a representative adult community sample in São Paulo, Brazil

PubMed Central

Blay, Sergio L.; Fillenbaum, Gerda G.; da Silva, Paula Freitas R.; Peluso, Erica T.

2014-01-01

Little is known about the use of psychotherapy to treat common mental disorders in a major city in a middle income country. Data come from in-home interviews with a stratified random sample of 2,000 community residents age 18–65 in the city of São Paulo, Brazil. The information obtained included sociodemographic characteristics; psychotropic drugs; mental status; and lifetime, previous 12 months, and current use of psychotherapy. Logistic regression was used to examine determinants of use of psychotherapy. Of the sample, 22.7% met General Health Questionnaire-12 criteria for common mental disorders. Lifetime, previous 12 months, and current use of psychotherapy were reported by 14.6%, 4.6%, and 2.3% of the sample respectively. Users were typically women, more educated, higher income, not married, unemployed, with common mental disorders. Further analysis found that 47% (with higher education and income) paid out-of-pocket, and 53% used psychotropic medication. Psychotherapy does not appear to be the preferred treatment for common mental disorders. PMID:25118139

Is the residential combined (psychotherapy plus medication) treatment of patients with severe personality disorder effective in terms of suicidality and impulsivity?

PubMed

Vaslamatzis, Grigorios; Theodoropoulos, Panayiotis; Vondikaki, Stamatia; Karamanolaki, Hara; MiliaTsanira, Myrto; Gourounti, Kleanthi

2014-02-01

The aim of this study was to compare the effectiveness of combined treatment-medication plus psychodynamic psychotherapy-and psychodynamic psychotherapy alone on the outcome variables of suicidality and impulsivity in a population of adult inpatients with severe personality disorder (SPD). This is a naturalistic-empirical (observational) study under the conditions of clinical practice (an intensive specialized inpatient psychotherapeutic program [SIPP]). The sample consisted of 33 inpatients with SPD who were allocated to two subgroups (groups A and B). The patients in group A received psychodynamic psychotherapy and adjunctive pharmacotherapy, whereas the patients in group B received multimodal psychodynamic psychotherapy only. A statistically significant reduction in suicidality score was observed in the patients in group A, whereas a tendency for significant reduction in impulsivity score was observed in group B after the SIPP termination. Pharmacotherapy combined with multimodal psychodynamic psychotherapy, always within the SIPP, seems more effective in the case of suicidality rather than impulsivity.

Effectiveness of group body psychotherapy for negative symptoms of schizophrenia: multicentre randomised controlled trial†

PubMed Central

Priebe, S.; Savill, M.; Wykes, T.; Bentall, R. P.; Reininghaus, U.; Lauber, C.; Bremner, S.; Eldridge, S.; Röhricht, F.

2016-01-01

Background Negative symptoms of schizophrenia have a severe impact on functional outcomes and treatment options are limited. Arts therapies are currently recommended but more evidence is required. Aims To assess body psychotherapy as a treatment for negative symptoms compared with an active control (trial registration: ISRCTN84216587). Method Schizophrenia out-patients were randomised into a 20-session body psychotherapy or Pilates group. The primary outcome was negative symptoms at end of treatment. Secondary outcomes included psychopathology, functional, social and treatment satisfaction outcomes at treatment end and 6-months later. Results In total, 275 participants were randomised. The adjusted difference in negative symptoms was 0.03 (95% CI −1.11 to 1.17), indicating no benefit from body psychotherapy. Small improvements in expressive deficits and movement disorder symptoms were detected in favour of body psychotherapy. No other outcomes were significantly different. Conclusions Body psychotherapy does not have a clinically relevant beneficial effect in the treatment of patients with negative symptoms of schizophrenia. PMID:27151073

Integrating palliative care with usual care of diabetic foot wounds.

PubMed

Dunning, Trisha

2016-01-01

Palliative care is a philosophy and a system for deciding care and can be used alone or integrated with usual chronic disease care. Palliative care encompasses end-of-life care. Palliative care aims to enhance quality of life, optimize function and manage symptoms including early in the course of chronic diseases. The purposes of this article are to outline palliative care and discuss how it can be integrated with usual care of diabetic foot wounds. Many people with diabetes who have foot wounds also have other comorbidities and diabetes complications such as cardiovascular and renal disease and depression, which affect medicine and other treatment choices, functional status, surgical risk and quality of life. Two broad of diabetic foot disease exist: those likely to heal but who could still benefit from integrated palliative care such as managing pain and those where healing is unlikely where palliation can be the primary focus. People with diabetes can die suddenly, although the life course is usually long with periods of stable and unstable disease. Many health professionals are reluctant to discuss palliative care or suggest people to document their end-of-life care preferences. If such preferences are not documented, the person might not achieve their desired death or place of death and health professionals and families can be confronted with difficult decisions. Palliative care can be integrated with usual foot care and is associated with improved function, better quality of life and greater patient and family satisfaction. Copyright © 2016 John Wiley & Sons, Ltd.

[Treatment of psychiatric disorders during pregnancy and the breast feeding : Psychotherapy and other nondrug therapies].

PubMed

Kittel-Schneider, S; Reif, A

2016-09-01

The majority of women suffering from psychiatric disorders in pregnancy and the breast feeding prefer psychotherapy and other nonpharmacological treatment over psychopharmacological treatment although the risk of malformations and postnatal complications in children exposed to psychopharmacological drugs must be regarded as acceptable in moderate to severely ill patients. Data are lacking, but several psychotherapeutic and biological treatments as well as noninvasive brain stimulation procedures have been investigated to treat depressive episodes and anxiety disorders in pregnancy and the breast feeding. In mild to moderate depressive episodes different psychotherapy treatments and counseling are significantly more effective in reducing depressive symptoms than no treatment.The same seems to be true for anxiety disorders; however, studies on this are sparse. Treatment by telephone and internet also seems to improve symptoms, which is of interest especially in the less flexible group of breast feeding women and for the development of future health care structures. Noninvasive stimulation treatment has been shown to be an effective nonpharmacological therapeutic option. Data for other recent noninvasive brain stimulation treatments and biological treatments as well as exercise therapy are sparse. In severe and delusional cases as well as treatment-resistant depressive episodes, electroconvulsive therapy should be considered in pregnant women. Because several patients prefer nonpharmacological therapy during this period, those should be applied if available and feasible. Regarding nonpharmacological treatment of obsessive-compulsive disorder, bipolar disorder and schizophrenia during pregnancy and the breast feeding, no recommendation can currently be given.

Development and validation of a 6-item working alliance questionnaire for repeated administrations during psychotherapy.

PubMed

Falkenström, Fredrik; Hatcher, Robert L; Skjulsvik, Tommy; Larsson, Mattias Holmqvist; Holmqvist, Rolf

2015-03-01

Recently, researchers have started to measure the working alliance repeatedly across sessions of psychotherapy, relating the working alliance to symptom change session by session. Responding to questionnaires after each session can become tedious, leading to careless responses and/or increasing levels of missing data. Therefore, assessment with the briefest possible instrument is desirable. Because previous research on the Working Alliance Inventory has found the separation of the Goal and Task factors problematic, the present study examined the psychometric properties of a 2-factor, 6-item working alliance measure, adapted from the Working Alliance Inventory, in 3 patient samples (ns = 1,095, 235, and 234). Results showed that a bifactor model fit the data well across the 3 samples, and the factor structure was stable across 10 sessions of primary care counseling/psychotherapy. Although the bifactor model with 1 general and 2 specific factors outperformed the 1-factor model in terms of model fit, dimensionality analyses based on the bifactor model results indicated that in practice the instrument is best treated as unidimensional. Results support the use of composite scores of all 6 items. The instrument was validated by replicating previous findings of session-by-session prediction of symptom reduction using the Autoregressive Latent Trajectory model. The 6-item working alliance scale, called the Session Alliance Inventory, is a promising alternative for researchers in search for a brief alliance measure to administer after every session. 2015 APA, all rights reserved

[Stumbling-blocks: initiating a psychosomatic pain clinic].

PubMed

Heger, S; Lieberz, K

2000-12-01

Despite psychosocial factors playing an important role in the course of chronic pain disorder, there is a noticeable imbalance between demand and availability of psychosomatic care for these patients. This led us to establish a psychosomatic pain clinic within the framework of our outpatient clinic at the Department of Psychosomatic Medicine and Psychotherapy at the Central Institute of Mental Health, Mannheim, Germany. A recent study aimed at the evaluation of sociodemographic variables, state of chronification, symptom load and psychiatric comorbidity. Additionally we wanted to determine whether existing conditions at our hospital can be considered suitable for those patients. During the clinic's first year we assessed 40 consecutive patients based on a psychosomatic interview as well as a set of psychometric questionnaires (BDI, STAI, SCL-90-R). To detect differences between pain patients and psychotherapy inpatients, we compared the two groups in terms of sociodemographic variables and symptom load. Most pain patients were in advanced states of chronification, showing extensive psychiatric comorbidity, particularly anxiety and depressive syndromes. Drug addiction was found more infrequently. Use of the before mentioned questionnaires prevented us from underestimating existing anxiety syndromes. Pain patients differed substantially from psychotherapy inpatients in terms of age, education, family status and symptom load. Our examination routine effectively demonstrated the special needs of chronic pain patients. As there is significant demand for psychosomatic intervention in those patients, earlier referral appears highly desirable. As pain patients differ also greatly from the remaining hospital population, specialized therapeutic concepts must be developed.

Enhanced interdisciplinary care improves self-care ability and decreases emergency department visits for older Taiwanese patients over 2 years after hip-fracture surgery: A randomised controlled trial.

PubMed

Shyu, Yea-Ing L; Liang, Jersey; Tseng, Ming-Yueh; Li, Hsiao-Juan; Wu, Chi-Chuan; Cheng, Huey-Shinn; Chou, Shih-Wei; Chen, Ching-Yen; Yang, Ching-Tzu

2016-04-01

Little evidence is available on the longer-term effects (beyond 12 months) of intervention models consisting of hip fracture-specific care in conjunction with management of malnutrition, depression, and falls. To compare the relative effects of an interdisciplinary care, and a comprehensive care programme with those of usual care for elderly patients with a hip fracture on self-care ability, health care use, and mortality. Randomised experimental trial. A 3000-bed medical centre in northern Taiwan. Patients with hip fracture aged 60 years or older (N=299). Patients were randomly assigned to three groups: comprehensive care (n=99), interdisciplinary care (n=101), and usual care (control) (n=99). Usual care entailed only one or two in-hospital rehabilitation sessions. Interdisciplinary care included not only hospital rehabilitation, but also geriatric consultation, discharge planning, and 4-month in-home rehabilitation. Building upon interdisciplinary care, comprehensive care extended in-home rehabilitation to 12 months and added management of malnutrition and depressive symptoms, and fall prevention. Patients' self-care ability was measured by activities of daily living and instrumental activities of daily living using the Chinese Barthel Index and Chinese version Instrumental Activities of Daily Living scale, respectively. Outcomes were assessed before discharge, and 1, 3, 6, 12, 18, 24 months following hip fracture. Hierarchical linear models were used to analyse health outcomes and health care utilisation, including emergency department visit and hospital re-admission. The comprehensive care group had better performance trajectories for both measures of activities of daily living and fewer emergency department visits than the usual care group, but no difference in hospital readmissions. The interdisciplinary care and usual care groups did not differ in trajectories of self-care ability and service utilisation. The three groups did not differ in mortality during the 2-year follow-up. Comprehensive care, with enhanced rehabilitation, management of malnutrition and depressive symptoms, and fall prevention, improved self-care ability and decreased emergency department visits for elders up to 2 years after hip-fracture surgery, above and beyond the effects of usual care and interdisciplinary care. Copyright © 2015 Elsevier Ltd. All rights reserved.

The effects of blinding on the outcomes of psychotherapy and pharmacotherapy for adult depression: A meta-analysis.

PubMed

Cuijpers, P; Karyotaki, E; Andersson, G; Li, J; Mergl, R; Hegerl, U

2015-09-01

Randomized trials with antidepressants are often run under double blind placebo-controlled conditions, whereas those with psychotherapies are mostly unblinded. This can introduce bias in favor of psychotherapy when the treatments are directly compared. In this meta-analysis, we examine this potential source of bias. We searched Pubmed, PsycInfo, Embase and the Cochrane database (1966 to January 2014) by combining terms indicative of psychological treatment and depression, and limited to randomized trials. We included 35 trials (with 3721 patients) in which psychotherapy and pharmacotherapy for adult depression were directly compared with each other. We calculated effect sizes for each study indicating the difference between psychotherapy and pharmacotherapy at post-test. Then, we examined the difference between studies with a placebo condition and those without in moderator analyses. We did not find a significant difference between the studies with and those without a placebo condition. The studies in which a placebo condition was included indicated no significant difference between psychotherapy and pharmacotherapy (g=-0.07; NNT=25). Studies in which no placebo condition was included (and patients and clinicians in both conditions were not blinded), resulted in a small, but significant difference between psychotherapy and pharmacotherapy in favor of pharmacotherapy (g=-0.13; NNT=14). Studies comparing psychotherapy and pharmacotherapy in which both groups of patients (and therapists) are not blinded (no placebo condition is included) result in a very small, but significantly higher effect for pharmacotherapy. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

[Psychotherapy: Quo vadis?

PubMed

Meinlschmidt, Gunther; Tegethoff, Marion

2017-08-01

Background: The science and practice of psychotherapy is continuously developing. The goal of this article is to describe new impulses, guiding current advancements in the field. Methods: This paper provides a selective narrative review, synthesizing and condensing relevant literature identified through various sources, including MEDLINE, EMBASE, PsycINFO, and "Web of Science", as well as citation tracking, to elaborate key developments in the field of psychotherapy Results: We describe several dynamics: 1) Following up the so-called "third wave of cognitive behavioral therapy", new interventions arise that have at their core fostering interpersonal virtues, such as compassion, forgiveness, and gratitude; 2) Based on technological quantum leaps, new interventions arise that exploit current developments in the field of new media, information, and communication technologies, as well as brain imaging, such as digital interventions for mental disorders and new forms of neurofeedback; 3) Inspired by the field of positive psychology, there is a revival of the promotion of strength and resilience in therapeutic contexts; 4) In light of the new paradigm "precision medicine", the issue of differential and adaptive indication of psychotherapy, addressed with new methods, regains relevance and drives a new field of "precision psychotherapy". 5) Last but not least, the "embodied turn" opens the door for body psychotherapy to gain relevance in academic psychotherapy. Conclusion: These and further developments, such as the use of systemic and network approaches as well as machine learning techniques, outline the vivid activities in the field of psychotherapy. Georg Thieme Verlag KG Stuttgart · New York.

Self-reported immature defense style as a predictor of outcome in short-term and long-term psychotherapy.

PubMed

Laaksonen, Maarit A; Sirkiä, Carlos; Knekt, Paul; Lindfors, Olavi

2014-07-01

Identification of pretreatment patient characteristics predictive of psychotherapy outcome could help to guide treatment choices. This study evaluates patients' initial level of immature defense style as a predictor of the outcome of short-term versus long-term psychotherapy. In the Helsinki Psychotherapy Study, 326 adult outpatients with mood or anxiety disorder were randomized to individual short-term (psychodynamic or solution-focused) or long-term (psychodynamic) psychotherapy. Their defense style was assessed at baseline using the 88-item Defense Style Questionnaire and classified as low or high around the median value of the respective score. Both specific (Beck Depression Inventory [BDI], Hamilton Depression Rating Scale [HDRS], Symptom Check List Anxiety Scale [SCL-90-Anx], Hamilton Anxiety Rating Scale [HARS]) and global (Symptom Check List Global Severity Index [SCL-90-GSI], Global Assessment of Functioning Scale [GAF]) psychiatric symptoms were measured at baseline and 3-7 times during a 3-year follow-up. Patients with high use of immature defense style experienced greater symptom reduction in long-term than in short-term psychotherapy by the end of the 3-year follow-up (50% vs. 34%). Patients with low use of immature defense style experienced faster symptom reduction in short-term than in long-term psychotherapy during the first year of follow-up (34% vs. 19%). Knowledge of patients' initial level of immature defense style may potentially be utilized in tailoring treatments. Further research on defense styles as outcome predictors in psychotherapies of different types is needed.

Review of Self-disclosure in psychotherapy.

PubMed

Hamilton, Rachel A; Del Castillo, Darren M; Stiles, William B

2007-09-01

Reviews the book, Self-disclosure in psychotherapy by Barry A. Farber (see record 2006-11792-000). At one point or another, most therapists have wondered how much their patients are telling them and wrestled with how much they should reveal themselves to their patients. This book aims to provide an integrative and up-to-date review of the literature that has addressed these kinds of questions. By looking at patient, therapist, supervisee, and supervisor self-disclosure, Farber attempts to show both common and unique aspects of self-disclosure across the different parties involved in psychotherapy. Work from historical, clinical, research, and cultural perspectives comes together to provide readers with a multifaceted view of self-disclosure in psychotherapy. This book will be of interest to therapists, researchers, psychotherapy supervisors, and therapists-in-training. Farber's discussion of self-disclosure offers a nuanced perspective on the dilemmas involved in the psychotherapy process. By highlighting the features of self-disclosure across patients, therapists, supervisees, and supervisors, Farber enriches understanding of the phenomenon and encourages empathy for the perspectives of those in other psychotherapy roles. We believe that Farber has successfully synthesized work from various perspectives to create an illuminating review of self-disclosure in psychotherapy. The book condenses a broad range of literature into clearly organized and digestible chapters. The integration of research and theory with clinical vignettes, quotations from books and movies, and popular song lyrics make this work an unusually engaging and accessible read. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Should we reconsider the routine use of placebo controls in clinical research?

PubMed

Avins, Andrew L; Cherkin, Daniel C; Sherman, Karen J; Goldberg, Harley; Pressman, Alice

2012-04-27

Modern clinical-research practice favors placebo controls over usual-care controls whenever a credible placebo exists. An unrecognized consequence of this preference is that clinicians are more limited in their ability to provide the benefits of the non-specific healing effects of placebos in clinical practice. We examined the issues in choosing between placebo and usual-care controls. We considered why placebo controls place constraints on clinicians and the trade-offs involved in the choice of control groups. We find that, for certain studies, investigators should consider usual-care controls, even if an adequate placebo is available. Employing usual-care controls would be of greatest value for pragmatic trials evaluating treatments to improve clinical care and for which threats to internal validity can be adequately managed without a placebo-control condition. Intentionally choosing usual-care controls, even when a satisfactory placebo exists, would allow clinicians to capture the value of non-specific therapeutic benefits that are common to all interventions. The result could be more effective, patient-centered care that makes the best use of both specific and non-specific benefits of medical interventions.

Effects of a brief education and treatment-planning group on evidence-based PTSD treatment utilization and completion among veterans.

PubMed

DeViva, Jason C; Bassett, Gwendolyn A; Santoro, Gia M; Fenton, Lisa

2017-08-01

Veterans with posttraumatic stress disorder (PTSD) presenting for care with Veterans Affairs Health Care System (VA) tend not to engage in evidence-based psychotherapies (EBPs) despite widespread availability of these treatments. Though there is little evidence that "readiness for treatment" affects treatment choice, many VA providers believe that interventions to increase readiness would be helpful. This naturalistic study examined the effects of a 4-session education/treatment-planning group on treatment choice among veterans in a VA outpatient PTSD treatment program. Treatment choices and completion rates of 114 veterans who received at least 1 session of the group (EG) were compared with those of 68 veterans who did not receive the group and received PTSD program treatment as usual (TAU). TAU and EG cases were matched on gender and service era. Of 114 EG cases, 52 (45.6%) chose to receive EBPs, compared with 10 of 68 TAU cases (14.7%). These rates were significantly different, χ2(1) = 18.1, p < .0001. Among cases choosing EBPs, 52.2% of EG cases completed the EBPs as planned, compared with 60% of TAU cases. These percentages were not significantly different. Among EG cases choosing EBPs, lower likelihood of treatment completion was related to psychiatric medication prescription, presence of PTSD service connection, and higher overall service-connection level. The education/treatment-planning group was associated with higher likelihood of selecting but not completing EBPs for PTSD. The decision to engage in trauma-focused treatment may be a different process from the decision to complete such treatment. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Psychosocial Treatment Efficacy for Disruptive Behavior Problems in Very Young Children: A Meta-Analytic Examination

PubMed Central

Comer, Jonathan S.; Chow, Candice; Chan, Priscilla T.; Cooper-Vince, Christine; Wilson, Lianna A.S.

2012-01-01

Objective Service use trends showing increased off-label prescribing in very young children and reduced psychotherapy use raise concerns about quality of care for early disruptive behavior problems. Meta-analysis can empirically clarify best practices and guide clinical decision making by providing a quantitative synthesis of a body of literature, identifying the magnitude of overall effects across studies, and determining systematic factors associated with effect variations. Method We used random-effects meta-analytic procedures to empirically evaluate the overall effect of psychosocial treatments on early disruptive behavior problems, as well as potential moderators of treatment response. Thirty-six controlled trials, evaluating 3,042 children, met selection criteria (mean sample age, 4.7 years; 72.0% male; 33.1% minority youth). Results Psychosocial treatments collectively demonstrated a large and sustained effect on early disruptive behavior problems (Hedges’ g = 0.82), with the largest effects associated with behavioral treatments (Hedges’ g = 0.88), samples with higher proportions of older and male youth, and comparisons against treatment as usual (Hedges’ g = 1.17). Across trials, effects were largest for general externalizing problems (Hedges’ g =0.90) and problems of oppositionality and noncompliance (Hedges’ g = 0.76), and were weakest, relatively speaking, for problems of impulsivity and hyperactivity (Hedges’ g = 0.61). Conclusions In the absence of controlled trials evaluating psychotropic interventions, findings provide robust quantitative support that psychosocial treatments should constitute first-line treatment for early disruptive behavior problems. Against a backdrop of concerning trends in the availability and use of supported interventions, findings underscore the urgency of improving dissemination efforts for supported psychosocial treatment options, and removing systematic barriers to psychosocial care for affected youth. PMID:23265631

Hospitalization cost of conventional psychiatric care compared to broad-spectrum micronutrient treatment: literature review and case study of adult psychosis.

PubMed

Kaplan, Bonnie J; Isaranuwatchai, Wanrudee; Hoch, Jeffrey S

2017-01-01

Healthcare costs are skyrocketing, with mental health treatment amongst the most expensive, especially when hospitalization is involved. According to the Mental Health Commission of Canada, one in five Canadians is living with a mental disorder in any given year, at an annual cost of $50 billion. In light of this societal burden, alternative approaches are being evaluated, such as brief psychotherapy by phone, peer support, and, as part of the emerging field of nutritional mental health, treatment with micronutrients (minerals and vitamins). Effectiveness of micronutrients has been demonstrated for many types of psychiatric symptoms, in about 45 studies of formulas that are either multinutrient (e.g., several B vitamins) or broad-spectrum (usually over 20 minerals and vitamins). Although this literature demonstrates therapeutic benefits, the potential economic impact of micronutrient treatment has been evaluated in only one case study of childhood psychosis. The current case study was initiated to evaluate mental health-related hospitalization costs from 1997 to 2003 for a female adult diagnosed with various mood and psychotic symptoms. She was treated for the first 5 years with conventional methods and then subsequently with a broad-spectrum micronutrient formula. The patient's annual mental health hospitalization costs during conventional treatment averaged $59,864 across 5 years (1997-2001), with a peak annual cost of about $140,000. Since transitioning to broad-spectrum micronutrients, she has incurred no provincial hospitalization costs for mental health care, though her self-funded costs are currently $720/year for the micronutrients. Further exploration of the treatment of mental health problems with broad-spectrum micronutrient formulas has the potential to make two significant contributions: improved mental health, and decreased costs for governments.

Gamified Cognitive Control Training for Remitted Depressed Individuals: User Requirements Analysis

PubMed Central

Van Looy, Jan; Hoorelbeke, Kristof; Baeken, Chris; Koster, Ernst HW

2018-01-01

Background The high incidence and relapse rates of major depressive disorder demand novel treatment options. Standard treatments (psychotherapy, medication) usually do not target cognitive control impairments, although these seem to play a crucial role in achieving stable remission. The urgent need for treatment combined with poor availability of adequate psychological interventions has instigated a shift toward internet interventions. Numerous computerized programs have been developed that can be presented online and offline. However, their uptake and adherence are oftentimes low. Objective The aim of this study was to perform a user requirements analysis for an internet-based training targeting cognitive control. This training focuses on ameliorating cognitive control impairments, as these are still present during remission and can be a risk factor for relapse. To facilitate uptake of and adherence to this intervention, a qualitative user requirements analysis was conducted to map mandatory and desirable requirements. Methods We conducted a user requirements analysis through a focus group with 5 remitted depressed individuals and individual interviews with 6 mental health care professionals. All qualitative data were transcribed and examined using a thematic analytic approach. Results Results showed mandatory requirements for the remitted sample in terms of training configuration, technological and personal factors, and desirable requirements regarding knowledge and enjoyment. Furthermore, knowledge and therapeutic benefits were key requirements for therapists. Conclusions The identified requirements provide useful information to be integrated in interventions targeting cognitive control in depression. PMID:29622525

[Guideline-oriented inpatient psychiatric psychotherapeutic/psychosomatic treatment of anxiety disorders : How many personnel are need?].

PubMed

Bandelow, B; Lueken, U; Wolff, J; Godemann, F; Menzler, C W; Deckert, J; Ströhle, A; Beutel, M; Wiltink, J; Domschke, K; Berger, M

2016-03-01

The reimbursement of inpatient psychiatric psychotherapeutic/psychosomatic hospital treatment in Germany is regulated by the German personnel ordinance for psychiatric hospitals (Psych-PV), which has remained unchanged since 1991. The aim of this article was to estimate the personnel requirements for guideline-adherent psychiatric psychotherapeutic hospital treatment. A normative concept for the required psychotherapeutic "dose" for anxiety disorders was determined based on a literature review. The required staffing contingent was compared to the resources provided by the Psych-PV based on category A1. According to the German policy guidelines for outpatient psychotherapy, a quota of 25 sessions of 50 min each (as a rule plus 5 probatory sessions) is reimbursed. This approach is supported by studies on dose-response relationships. As patients undergoing inpatient treatment for anxiety disorders are usually more severely ill than outpatients, a contingent of 30 sessions for the average treatment duration of 5 weeks seems appropriate in order to fully exploit the costly inpatient treatment time (300 min per patient and week). In contrast, only 70 min are reimbursed according to the Psych-PV. The total personnel requirement for the normative concept is 624 min per patient and week. The Psych-PV only covers 488 min (78 %). Currently, the time contingents for evidence-based psychiatric psychotherapeutic/psychosomatic hospital care are nowhere near sufficient. In the development of future reimbursement systems this needs to be corrected.

Consequences of Psychotherapy Clients' Mental Health Ideology.

ERIC Educational Resources Information Center

Milling, Len; Kirsch, Irving

Current theoretical approaches to understanding emotional difficulties are dominated by the medical model of mental illness, which assumes that emotional dysfunction can be viewed the same way as physical dysfunction. To examine the relationship between psychotherapy clients' beliefs about the medical model of psychotherapy and their behavior…

Gestalt Therapy: Student Perceptions of Fritz Perls in "Three Approaches to Psychotherapy"

ERIC Educational Resources Information Center

Reilly, Joe; Jacobus, Veronica

2009-01-01

The "Three Approaches to Psychotherapy" ("TAP") videotape series introduces students to three major schools of psychotherapy: client-centered therapy, Gestalt therapy, and rational-emotive therapy. A sample of undergraduate students viewed the "TAP" series. The students were surveyed about their observations of…

Insights about Psychotherapy Training and Curricular Sequencing: Portal of Discovery

ERIC Educational Resources Information Center

McGowen, K. Ramsey; Miller, Merry Noel; Floyd, Michael; Miller, Barney; Coyle, Brent

2009-01-01

Objective: The authors discuss the curricular implications of a research project originally designed to evaluate the instructional strategy of using standardized patients in a psychotherapy training seminar. Methods: The original project included second-year residents enrolled in an introductory psychotherapy seminar that employed sequential…

Using Media to Teach How Not to Do Psychotherapy

ERIC Educational Resources Information Center

Gabbard, Glen; Horowitz, Mardi

2010-01-01

Objective: This article describes how using media depictions of psychotherapy may help in teaching psychiatric residents. Methods: Using the HBO series "In Treatment" as a model, the authors suggest how boundary transgressions and technical errors may inform residents about optimal psychotherapeutic approaches. Results: The psychotherapy vignettes…

A Critique of Behavioral Psychotherapy: The Groundwork for an Integrated Model of Intervention.

ERIC Educational Resources Information Center

Wright, John; Sabourin, Stephane

1984-01-01

Discusses several strengths and weaknesses of the behavioral approach in psychotherapy. Possible remediation of some of the weaknesses are explored through integration of contributions from client-centered or psychodynamic approaches. Risks associated with an integrated model of psychotherapy are considered. (Author)

Usual Primary Care Provider Characteristics of a Patient-Centered Medical Home and Mental Health Service Use.

PubMed

Jones, Audrey L; Cochran, Susan D; Leibowitz, Arleen; Wells, Kenneth B; Kominski, Gerald; Mays, Vickie M

2015-12-01

The benefits of the patient-centered medical home (PCMH) over and above that of a usual source of medical care have yet to be determined, particularly for adults with mental health disorders. To examine qualities of a usual provider that align with PCMH goals of access, comprehensiveness, and patient-centered care, and to determine whether PCMH qualities in a usual provider are associated with the use of mental health services (MHS). Using national data from the Medical Expenditure Panel Survey, we conducted a lagged cross-sectional study of MHS use subsequent to participant reports of psychological distress and usual provider and practice characteristics. A total of 2,358 adults, aged 18-64 years, met the criteria for serious psychological distress and reported on their usual provider and practice characteristics. We defined "usual provider" as a primary care provider/practice, and "PCMH provider" as a usual provider that delivered accessible, comprehensive, patient-centered care as determined by patient self-reporting. The dependent variable, MHS, included self-reported mental health visits to a primary care provider or mental health specialist, counseling, and psychiatric medication treatment over a period of 1 year. Participants with a usual provider were significantly more likely than those with no usual provider to have experienced a primary care mental health visit (marginal effect [ME] = 8.5, 95 % CI = 3.2-13.8) and to have received psychiatric medication (ME = 15.5, 95 % CI = 9.4-21.5). Participants with a PCMH were additionally more likely than those with no usual provider to visit a mental health specialist (ME = 7.6, 95 % CI = 0.7-14.4) and receive mental health counseling (ME = 8.5, 95 % CI = 1.5-15.6). Among those who reported having had any type of mental health visit, participants with a PCMH were more likely to have received mental health counseling than those with only a usual provider (ME = 10.0, 95 % CI = 1.0-19.0). Access to a usual provider is associated with increased receipt of needed MHS. Patients who have a usual provider with PCMH qualities are more likely to receive mental health counseling.

Do You Really Expect Me to Get MST Care in a VA Where Everyone is Male Innovative Delivery of Evidence Based Psychotherapy to Women with Military Sexual Trauma

DTIC Science & Technology

2016-08-01

this  burden  to  Department  of  Defense,  Washington  Headquarters  Services,   Directorate  for  Information  Operations  and  Reports  (0704-­0188...the self-report packet in half, offered to split the intake appointment over two days, and increased the remuneration for completed assessments by

Does Evidence-Based PTS Treatment Reduce PTS Symptoms And Suicide in Iraq And Afghanistan Veterans Seeking VA Care

DTIC Science & Technology

covariate balance, using matching. We found that Veterans who completed EBP for PTS experienced a significant improvement in PTSD Checklist (PCL...To compare effectiveness of evidence-based psychotherapy (EBP) for PTS in Iraq and Afghanistan War Veterans who use Veterans Health Administration...scores compared to the non-completers (i.e., 5.4-point improvement on the PCL). We also completed an analysis of factors associated with completing EBP

Mental Health and Resilience: Soldiers’ Perceptions about Psychotherapy, Medication, and Barriers to Care in the United States Military

DTIC Science & Technology

2012-10-01

Dr. Benham caused a shut down of all research activities at Fort Drum. This research embargo caused a 6-month delay while we awaited decisions from...as race, gender, and socio-demographic variables. To ourknowledge there have not been any systematic investigations into what soldiers believe...systematic investigations into what soldiers believe about mental health treatment. Moreover, there have been no studies examining how beliefs about

Mental Health and Resilience: Soldiers’ Perceptions about Psychotherapy, Medication, and Barriers to Care in the United States Military

DTIC Science & Technology

2011-10-01

research group that was also collaborating with Dr. Benham caused a shut down of all research activities at Fort Drum. This research embargo caused a 6...variables. To ourknowledge there have not been any systematic investigations into what soldiers believe about mental health treatment.Results from...knowledge there have not been any systematic investigations into what soldiers believe about mental health treatment. Moreover, there have been no

New tools in cybertherapy: the VEPSY web site.

PubMed

Castelnuovo, Gianluca; Buselli, Claudio; De Ferrari, Roberta; Gaggioli, Andrea; Mantovani, Fabrizia; Molinari, Enrico; Villamira, Marco; Riva, Giuseppe

2004-01-01

In the last years the rapid development of the Internet and new communication technologies has had a great impact on psychology and psychotherapy. Psychotherapists seem to rely with more and more interest on the new technological tools such as videophone, audio and video chat, e-mail, SMS and the new Instant Messaging Tools (IMs). All these technologies outline a stimulating as well as complex scenario: in order to effectively exploit their potential, it is important to study which is the possible role played by the Internet-based tools inside a psychotherapeutic iter. Could the technology substitute the health care practitioners or are these tools only a resource in addition to the traditional ones in the therapist's hand? The major aim of this chapter is to provide a framework for the integration of old and new tools in mental health care. Different theoretical positions about the possible role played by e-therapy are reported showing the possible changes that psychotherapy will necessarily face in a cyber setting. The VEPSY website, an integration of different Internet-based tools developed within the VEPSY UPDATED Project, is described as an example of clinical application matching between old (and functional) practices with new (and promising) media for the treatment of different mental disorders. A rationale about the possible scenarios for the use of the VEPSY website in the clinical process is provided.

Neurotic disorders and the receipt of psychiatric treatment.

PubMed

Bebbington, P E; Brugha, T S; Meltzer, H; Jenkins, R; Ceresa, C; Farrell, M; Lewis, G

2000-11-01

Access to psychiatric treatment by people with neurotic disorders in the general population is likely to be affected both by the severity of disorder and by sociodemographic differences. In the household component of the National Surveys of Psychiatric Morbidity > 10,000 subjects in Great Britain with psychiatric symptoms were interviewed using the CIS-R. They were also asked about difficulties experienced in performing seven types of everyday activity. All subjects classed as having an ICD-10 disorder were questioned about their experience of treatment with antidepressants, hypnotics, and counselling or psychotherapy. Less than 14% of people with current neurotic disorders were receiving treatment for them. Within the previous year, only a third had made contact with their primary care physician for their mental problem: of these < 30% were receiving treatment. Overall, 9% of people with disorders were given medication and 8% counselling or psychotherapy. A diagnosis of depressive episode was that most associated with antidepressant medication. Treatment access was affected by employment status, marital status, and age, but the major determinant was symptom severity. Neither sex nor social class influenced which people received treatment. People with psychiatric disorders seldom receive treatment, even when they have consulted their primary care physician about them. In many cases, this must represent unmet needs with a strong claim on health resources. There are also inequalities in the receipt of treatment, although the major influence is the severity of disorder.

Neurotic disorders and the receipt of psychiatric treatment.

PubMed

Bebbington, P; Brugha, T; Meltzer, H; Jenkins, R; Ceresa, C; Farrell, M; Lewis, G

2003-01-01

Access to psychiatric treatment by people with neurotic disorders in the general population is likely to be affected both by the severity of disorder and by sociodemographic differences. In the household component of the National Surveys of Psychiatric Morbidity >10,000 subjects in Great Britain with psychiatric symptoms were interviewed using the CIS-R. They were also asked about difficulties experienced in performing seven types of everyday activity. All subjects classed as having an ICD-10 disorder were questioned about their experience of treatment with antidepressants, hypnotics, and counselling or psychotherapy. Less than 14% of people with current neurotic disorders were receiving treatment for them. Within the previous year, only a third had made contact with their primary care physician for their mental problem: of these <30% were receiving treatment. Overall, 9% of people with disorders were given medication and 8% counselling or psychotherapy. A diagnosis of depressive episode was that most associated with antidepressant medication. Treatment access was affected by employment status, marital status, and age, but the major determinant was symptom severity. Neither sex nor social class influenced which people received treatment. People with psychiatric disorders seldom receive treatment, even when they have consulted their primary care physician about them. In many cases, this must represent unmet needs with a strong claim on health resources. There are also inequalities in the receipt of treatment, although the major influence is the severity of disorder.

Management of alcohol misuse in patients with liver diseases

PubMed Central

Peng, Jennifer L; Patel, Milan Prakash; McGee, Breann; Liang, Tiebing; Chandler, Kristina; Tayarachakul, Sucharat; O’Connor, Sean; Liangpunsakul, Suthat

2017-01-01

Excessive alcohol use not only causes alcoholic liver disease (ALD) but also increases the risk of liver-related mortality in patients who already have other chronic liver diseases. Screening for alcohol misuse or alcohol use disorder (AUD) among patients with underlying liver disease is essential. This clinical review covers what is known about ALD, the impact of alcohol in patients with underlying liver diseases, current management of alcohol misuse and AUD, and the management of alcohol misuse and AUD specifically in patients with liver diseases. Several treatment options for alcohol misuse and AUD exist such as psychosocial intervention and behavioral and pharmacological therapies. The strategies used in the treatment of alcohol misuse and AUD are still applicable in those who consume alcohol and have underlying liver disease. However, certain medications still need to be carefully used due to potentially worsening already compromised liver function. Screening of ongoing alcohol use in subjects with liver disease is important, and prompt intervention is needed to prevent the associated morbidity and mortality from the detrimental effects of continued alcohol use on underlying liver disease. Considering alcoholism is a complex disease, probably a multidisciplinary approach combining psychotherapy and comprehensive medical care will be the most effective. Future research could focus on identifying additional treatment options for addressing the psychotherapy component since the self-determination and will to quit drinking alcohol can play such a crucial role in promoting abstinence. PMID:27940551

Ethical Considerations for Cognitive-Behavioral Therapists in Psychotherapy Research Trials

ERIC Educational Resources Information Center

Haman, Kirsten L.; Hollon, Steven D.

2009-01-01

Psychotherapy research studies, which balance the pursuit of knowledge with the provision of treatment, can place unique demands on clinicians, patients, and research staff. However, the literature on ethical considerations in psychotherapy trials is minimal. The current paper depicts CBT community standards of practice in the context of two…

Psychotherapy and Schizophrenia

PubMed Central

BUCKLEY, PETER F.; LYS, CHRISTINE

1996-01-01

Psychotherapy for patients with schizophrenia, although almost universally practiced in some form with clinical management of schizophrenia, has not been the present focus of such rigorous scientific inquiry as has been afforded to other current treatment modalities. This review highlights areas of potential progress and opportunities for clearer definition of psychotherapies for schizophrenia. PMID:22700288

Interpersonal Psychotherapy for Depressed Adolescents (IPT-A): A Case Illustration

ERIC Educational Resources Information Center

Hall, Elisabeth Baerg; Mufson, Laura

2009-01-01

This article describes the treatment of a depressed adolescent (15 years of age) boy using Interpersonal Psychotherapy for depressed adolescents (IPT-A). IPT-A is an empirically supported psychosocial intervention for adolescents suffering from a depressive episode. It is delivered as an individual psychotherapy with a minimum of parental…

45 CFR 164.508 - Uses and disclosures for which an authorization is required.

Code of Federal Regulations, 2012 CFR

2012-10-01

... must be consistent with such authorization. (2) Authorization required: psychotherapy notes... must obtain an authorization for any use or disclosure of psychotherapy notes, except: (i) To carry out... psychotherapy notes for treatment; (B) Use or disclosure by the covered entity for its own training programs in...

Therapy 101: A Psychotherapy Curriculum for Medical Students

ERIC Educational Resources Information Center

Aboul-Fotouh, Frieda; Asghar-Ali, Ali Abbas

2010-01-01

Objective: This pilot project, designed and taught by a resident, created a curriculum to introduce medical students to the practice of psychotherapy. Medical students who are knowledgeable about psychotherapy can become physicians who are able to refer patients to psychotherapeutic treatments. A search of the literature did not identify a…

Conceptual Frame for Selecting Individual Psychotherapy in the Schools

ERIC Educational Resources Information Center

Hughes, Tammy L.; Theodore, Lea A.

2009-01-01

Psychotherapy is a service-delivery that is provided for both general and special education students. This manuscript examines a conceptual framework for determining when to employ psychotherapy within the school-based setting. Decisions are informed by the relationship between problem behavior, therapeutic techniques, short-term outcomes, and…

45 CFR 164.508 - Uses and disclosures for which an authorization is required.

Code of Federal Regulations, 2014 CFR

2014-10-01

... must be consistent with such authorization. (2) Authorization required: Psychotherapy notes... must obtain an authorization for any use or disclosure of psychotherapy notes, except: (i) To carry out... psychotherapy notes for treatment; (B) Use or disclosure by the covered entity for its own training programs in...

45 CFR 164.508 - Uses and disclosures for which an authorization is required.

Code of Federal Regulations, 2013 CFR

2013-10-01

... must be consistent with such authorization. (2) Authorization required: Psychotherapy notes... must obtain an authorization for any use or disclosure of psychotherapy notes, except: (i) To carry out... psychotherapy notes for treatment; (B) Use or disclosure by the covered entity for its own training programs in...

Psychiatric Residents' Views of Quality of Psychotherapy Training and Psychotherapy Competencies: A Multisite Survey

ERIC Educational Resources Information Center

Calabrese, Christina; Sciolla, Andres; Zisook, Sidney; Bitner, Robin; Tuttle, Jeffrey; Dunn, Laura B.

2010-01-01

Objective: Few studies of residents' attitudes toward psychotherapy training exist. The authors examined residents' perceptions of the quality of their training, support for training, their own competence levels, and associations between self-perceived competence and perceptions of the training environment. Methods: An anonymous, web-based…

Is There Room for Criticism of Studies of Psychodynamic Psychotherapy?

ERIC Educational Resources Information Center

Thombs, Brett D.; Jewett, Lisa R.; Bassel, Marielle

2011-01-01

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler. Shedler declared unequivocally that "empirical evidence supports the efficacy of psychodynamic therapy" (p. 98). He did not mention any specific criticisms that have been made of evidence on psychodynamic psychotherapies or address possible distinctions…

Zen Buddhism and the Psychotherapy of Milton Erickson: A Transcendence of Theory and Self.

ERIC Educational Resources Information Center

Becker, Susan Kelly; Forman, Bruce D.

1989-01-01

Compares Zen Buddhism and psychotherapy of Milton Erickson. Explores their similarities with respect to theory, change relationship between teacher/student and therapist/client, and acceptance of nature. Compares Ericksonian psychotherapy with Zen-based Morita therapy to concretize philosophical underpinnings of both systems. (Author/ABL)

Multilingualism and Psychotherapy: Exploring Multilingual Clients' Experiences of Language Practices in Psychotherapy

ERIC Educational Resources Information Center

Rolland, Louise; Dewaele, Jean-Marc; Costa, Beverley

2017-01-01

This study investigates bi- and multilingual clients' self-reported language practices in counselling and psychotherapy. Quantitative and qualitative data were collected through an international web survey inviting adults who had experienced one-to-one therapy to describe their experiences. Analysis of responses by 109 multilingual clients…

Power Politics of Family Psychotherapy.

ERIC Educational Resources Information Center

Whitaker, Carl A.

It is postulated that the standard framework for psychotherapy, a cooperative transference neurosis, does not validly carry over to the successful psychotherapy of a two-generation family group. In many disturbed families, the necessary and sufficient dynamics for change must be initiated, controlled, and augmented by a group dynamic power-play,…

Use of Psychotherapy by Rural and Urban Veterans

ERIC Educational Resources Information Center

Cully, Jeffrey A.; Jameson, John P.; Phillips, Laura L.; Kunik, Mark E.; Fortney, John C.

2010-01-01

Purpose: To examine whether differences exist between rural and urban veterans in terms of initiation of psychotherapy, delay in time from diagnosis to treatment, and dose of psychotherapy sessions. Methods: Using a longitudinal cohort of veterans obtained from national Veterans Affairs databases (October 2003 through September 2004), we extracted…

Outcome Research on Short-Term Psychodynamic Psychotherapy: A Preliminary Review.

ERIC Educational Resources Information Center

White, Scott Allyn

This paper reviews the empirical research on short-term psychodynamic psychotherapy (STDP). It begins with a brief history of STDP, identifying current developers and researchers of STDP and listing commonalities among various short-term dynamic psychotherapies. In this review, research is grouped broadly into two categories: controlled…

[Marketing of psychotherapy--small advertisements in the "market" of psychology today].

PubMed

Finzen, A; Hoffmann-Richter, U

1996-02-01

Beyond traditional psychotherapy many new psychotherapeutic schools and methods strive for recognition. Many of them offer psychotherapeutic training by advertisement in Psychologie heute, a popular psychological magazine. These advertisements are analysed. Possible consequences of this flouristing market of methods on social representation of psychotherapy are discussed.

A Critical Review of Psychotherapy Outcome Studies with Adolescents: 1978-1988.

ERIC Educational Resources Information Center

Mann, Barton J.; Borduin, Charles M.

1991-01-01

Reviews methods and findings of adolescent psychotherapy outcome studies published from 1978 to 1988. Concludes that evaluations of individual psychotherapy with adolescents generally reveal positive short-term outcomes, but long-term outcomes are still to be determined; evaluations of systemic therapies with adolescents often reveal positive…

The Play of Psychotherapy

ERIC Educational Resources Information Center

Marks-Tarlow, Terry

2012-01-01

The author reviews the role of play within psychotherapy. She does not discuss the formal play therapy especially popular for young children, nor play from the Jungian perspective that encourages the use of the sand tray with adults. Instead, she focuses on the informal use of play during psychotherapy as it is orchestrated intuitively. Because…

Can Independent Judges Recognize Different Psychotherapies? An Experience with Manual-Guided Therapies.

ERIC Educational Resources Information Center

Luborsky, Lester; And Others

1982-01-01

Tested whether independent judges could recognize three different manual-guided psychotherapies, drug counseling, supportive-expressive psychotherapy, and cognitive-behavioral using a special rating form containing scales for the characteristic aspects of each type. Results indicated that manual-guided therapies can be reliably recognized.…

A Review of Psychotherapy Outcome Research: Considerations for School-Based Mental Health Providers

ERIC Educational Resources Information Center

Zirkelback, Emily A.; Reese, Robert J.

2010-01-01

Evaluating psychotherapeutic outcome is an important endeavor given psychology's focus on identifying effective treatments. There is ample evidence to suggest that psychotherapy interventions for children and adolescents are effective. Unfortunately, the child and adolescent psychotherapy outcome literature lags behind the adult-focused outcome…

FAPRS Manual: Manual for the Functional Analytic Psychotherapy Rating Scale

ERIC Educational Resources Information Center

Callaghan, Glenn M.; Follette, William C.

2008-01-01

The Functional Analytic Psychotherapy Rating Scale (FAPRS) is behavioral coding system designed to capture those essential client and therapist behaviors that occur during Functional Analytic Psychotherapy (FAP). The FAPRS manual presents the purpose and rules for documenting essential aspects of FAP. The FAPRS codes are exclusive and exhaustive…

Functional Analytic Psychotherapy for Interpersonal Process Groups: A Behavioral Application

ERIC Educational Resources Information Center

Hoekstra, Renee

2008-01-01

This paper is an adaptation of Kohlenberg and Tsai's work, Functional Analytical Psychotherapy (1991), or FAP, to group psychotherapy. This author applied a behavioral rationale for interpersonal process groups by illustrating key points with a hypothetical client. Suggestions are also provided for starting groups, identifying goals, educating…

Promoting Efficacy Research on Functional Analytic Psychotherapy

ERIC Educational Resources Information Center

Maitland, Daniel W. M.; Gaynor, Scott T.

2012-01-01

Functional Analytic Psychotherapy (FAP) is a form of therapy grounded in behavioral principles that utilizes therapist reactions to shape target behavior. Despite a growing literature base, there is a paucity of research to establish the efficacy of FAP. As a general approach to psychotherapy, and how the therapeutic relationship produces change,…