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Efficacy of an adjunctive brief psychodynamic psychotherapy to usual inpatient treatment of depression: rationale and design of a randomized controlled trial
Gilles Ambresin, Jean-Nicolas Despland, Martin Preisig, Yves de Roten
BMC Psychiatry , 2012, DOI: 10.1186/1471-244x-12-182
Abstract: 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.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.Australian New Zealand Clinical Trial Registry (ACTRN12612000909820)Depression is the largest contributor to the burden of disease in high-income countries, with further increase expected [1]. Depression may not respond to out
Interpersonal Psychotherapy in the Treatment of Perinatal Depression  [PDF]
Gamze Ergil Altin
Psikiyatride Guncel Yaklasimlar , 2012,
Abstract: Perinatal depression is a psychiatric disorder that is not sufficiently diagnosed and directed to treatment. Its acute and chronic outcomes influence not only the mother but also the infant and the relationship between them. Both pregnancy and the postpartum periods are the times of significant physiological and emotional changes which also influence interpersonal relationships. Interpersonal risk factors like insufficient social support and increased social conflict can have an important impact on the women’s mental and physiological health during this period. Studies have shown that women prefer psychological and social management over drugs during this period. Interpersonal psychotherapy is a time-limited treatment approach, especially focusing on interpersonal difficulties with the goal of reducing depressive symptoms and improving interpersonal functioning. Such distressing factors which can occur during pregnancy and delivery are compatible with the four main problem areas that interpersonal psychotherapy addresses so that the therapist can easily use interpersonal psychotherapy in order to solve such difficulties.
The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa - a randomized controlled trial
Beate Wild, Hans-Christoph Friederich, Gaby Gross, Martin Teufel, Wolfgang Herzog, Katrin E Giel, Martina de Zwaan, Henning Schauenburg, Carmen Schade-Brittinger, Helmut Sch?fer, Stephan Zipfel
Trials , 2009, DOI: 10.1186/1745-6215-10-23
Abstract: 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).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".Current Controlled Trials ISRCTN72809357Anorexia nervosa (AN) is a serious eating disorder marked by pronounced, self-induced underweight. Diagnostic criteria regarding weight are defined as maintenance of body weight < 85% of expected weight, or a body mass index (BMI) of < 17.5 kg/m2 (DSM-IV; ICD-10). Weight reduction is induced by abnormal food restriction with or without purging behaviours such as self-induced v
The Biological Effects of Psychotherapy in Major Depressive Disorders: A Review of Neuroimaging Studies  [PDF]
Gülfizar S?zeri-Varma, Filiz Karada?
Psychology (PSYCH) , 2012, DOI: 10.4236/psych.2012.310129
Abstract: Major depressive disorder (MDD) is a syndrome, which is quite frequent in the society, can be recurrent and shows symptoms of emotional, cognitive and behavioral disorder. Brain imaging studies support that patients diagnosed with MDD suffer dysfunction in limbic structures such as frontal cortex, amygdala, hippocampus and cingulate cortex and basal ganglions that regulate these functions. Psychotherapy is an effective treatment option for prevention of recurrent depressive attacks as well as for acute treatment of depression. It is thought that psychotherapy shows its effect by focusing on misleading cognitions and emotional information processing processes that lead to rise and persistence of symptoms of depression, which in turn boosts problem solving and coping skills. Neurobiological reflections of clinical recovery achieved by psychotherapy are not yet well known. In this study, it is aimed to review cognitive behavioral psychotherapy (CBT), interpersonal psychotherapy (IPT) and psychodynamic psychotherapy methods used frequently in treatment of MDD, along with functional brain imaging studies performed on treated depressive patients. Studies show that CBT lead to changes in the prefrontal cortex, cingulate cor- tex and amygdala metabolisms and activities. Activity of the subgenual cingulate cortex, which takes part in the regulation of the limbic activity, seems to play an important role in the response to CBT like in the response to antidepressant treatment. It was found that interpersonal psychotherapy (IPT) ensures recovery of metabolism and blood flow in the prefrontal cortex, cingulate cortex and basal ganglions. It was observed that psychodynamic therapy ensured recovery of abnormal activities in especially the prefrontal cortex and cingulate cortex in MDD, similar to the CBT and IPT. There is need for more long-term, follow-up studies in this area.
The early impact of therapeutic alliance in brief psychodynamic psychotherapy
Marcolino, José Alvaro Marques;Iacoponi, Eduardo;
Revista Brasileira de Psiquiatria , 2003, DOI: 10.1590/S1516-44462003000200006
Abstract: introdction: therapeutic alliance is a key component of the psychotherapeutic process. this study estimated the impact of the therapeutic alliance as measured by calpas-p in an individual brief psychodynamic psychotherapy program. methods: to study the impact of the therapeutic alliance patients in psychotherapy answered to the calpas-p at the first and third session and to the self-report questionnaire (srq-20), to the beck depression inventory (bdi) and to the hamilton anxiety scale at the beginning and at the end of psychotherapy. results: the study of the impact of the therapeutic alliance in brief psychodynamic psychotherapy showed that higher tui scores in the first session were significantly associated to the improvement on the bdi. patients with best scores in the working alliance, measured at the third pwc session had also significant symptomatic changes. discussion: the study of the impact of the therapeutic alliance in brief psychotherapy indicated that patients who perceived that their therapists had the best capability to understand and to be involved in their issues had best results in reducing depressive symptoms and patients with higher capability to form the working alliance reached the best psychotherapy outcomes.
The early impact of therapeutic alliance in brief psychodynamic psychotherapy
Marcolino José Alvaro Marques,Iacoponi Eduardo
Revista Brasileira de Psiquiatria , 2003,
Abstract: INTRODCTION: Therapeutic alliance is a key component of the psychotherapeutic process. This study estimated the impact of the therapeutic alliance as measured by CALPAS-P in an individual brief psychodynamic psychotherapy program. METHODS: To study the impact of the therapeutic alliance patients in psychotherapy answered to the CALPAS-P at the first and third session and to the Self-report Questionnaire (SRQ-20), to the Beck Depression Inventory (BDI) and to the Hamilton Anxiety Scale at the beginning and at the end of psychotherapy. RESULTS: The study of the impact of the therapeutic alliance in brief psychodynamic psychotherapy showed that higher TUI scores in the first session were significantly associated to the improvement on the BDI. Patients with best scores in the working alliance, measured at the third PWC session had also significant symptomatic changes. DISCUSSION: The study of the impact of the therapeutic alliance in brief psychotherapy indicated that patients who perceived that their therapists had the best capability to understand and to be involved in their issues had best results in reducing depressive symptoms and patients with higher capability to form the working alliance reached the best psychotherapy outcomes.
Short-Term Psychodynamic Psychotherapy in Patients with “Male Depression” Syndrome, Hopelessness, and Suicide Risk: A Pilot Study  [PDF]
Gloria Angeletti,Maurizio Pompili,Marco Innamorati,Chiara Santucci,Valeria Savoja,Mark Goldblatt,Paolo Girardi
Depression Research and Treatment , 2013, DOI: 10.1155/2013/408983
Abstract: Objectives and Methods. This was an observational study of the efficacy of short-term psychodynamic psychotherapy (STPP) in a sample of 35 (30 women and 5 men) patients with moderate-to-severe “male depression” (Gotland Scale for Male Depression (GSMD)?≥?13) comorbid with unipolar mood disorder (dysthymia and major depression) or anxiety disorder. Outcome measures were GSMD and BHS (Beck Hopelessness Scale) score changes from baseline. Results. Patients had a strong response to STPP on the GSMD (estimated mean score change ; partial eta squared?? ), but not on the BHS (estimated mean score change ; partial eta squared ? ). BHS score changes were significantly associated with GSMD score changes (Pearson's ; ), even when controlling for the severity of hopelessness at the baseline (partial ; ). Conclusions. STPP proved to be effective in patients suffering from “male depression” although hopelessness was only marginally reduced by this treatment which points to the need to better understand how STPP can be involved in the reduction of suicide risk. 1. Introduction The term “depression” encompasses a wide range of conditions that may occur along a continuum, ranging from milder forms of discomfort to more severe and persistent form, as in the case of major depression. Depression is the leading cause of disability and the 4th leading contributor to the global burden of disease [1, 2] and by the year 2020, it is projected to become the 2nd leading contributor to the global burden of disease in all ages and both sexes [1]. Major depression is the most frequent mental illness in the world [3–6]. For example, in the US, the Epidemiological Catchment Area (ECA) Study indicated a one-month prevalence between 1.7% and 3.4% [7], and more recently, the National Comorbidity Survey Replication (NCS-R) estimated a 12-month prevalence of 6.6% [8]. Nevertheless, prevalence of moderate- to- severe depressive symptoms could be much higher [9–11]. In 2010, the British National Institute for Health and Clinical Excellence (NICE) commissioned the development of an updated version of the guideline on the treatment and management of depression in adults [12]. The NICE guideline pointed out that people who suffer from depression usually prefer psychological treatments to medication [13] and value outcomes beyond symptom reduction [14]. The NICE guideline indicated that it was not possible to demonstrate a consistent picture of any clinically important benefit for short-term psychodynamic psychotherapy (STPP) in depression. While cognitive-behavioral therapy and interpersonal
Treatment of adolescents with depression: the effect of transference interventions in a randomized controlled study of dynamic psychotherapy
Ulberg Randi,Hersoug Anne,H?glend Per
Trials , 2012, DOI: 10.1186/1745-6215-13-159
Abstract: Background Depression in adolescents seems to be a growing problem that causes mental suffering and prevents young people from joining the workforce. There is also a high risk of relapse during adult life. There is emerging evidence for the effect of psychodynamic psychotherapy in adolescents. In-session relational intervention (that is, transference intervention) is a key component of psychodynamic psychotherapy. However, whether depressed adolescents profit most from psychodynamic psychotherapy with or without transference interventions has not been stated. Object The effect of transference interventions in depressed adolescents and the moderator moderating effect of quality of object relations, personality disorder and gender will be explored. Methods and study design The First Experimental Study of Transference Work–In Teenagers (FEST–IT) will be a randomized clinical trial with a dismantling design. The study is aimed to explore the effects of transference work in psychodynamic psychotherapy for adolescents with depression. One hundred patients ages 16 to 18 years old will be randomized to one of two treatment groups, in both of which general psychodynamic techniques will be used. The patients will be treated over 28 weeks with either a moderate level of transference intervention or no transference intervention. Follow-up will be at 1 year after treatment termination. The outcome measures will be the Psychodynamic Functioning Scales (PFS), Inventory of Interpersonal Problems–Circumplex Version (IIP-C), Global Assessment of Functioning (GAF), and the total mean score of Symptom Checklist–90 (Global Severity Index; GSI), Beck Depression Inventory (BDI), and Montgomery sberg Rating Scale (MADRS). The quality of adolescents’ relationships will be a central focus of the study, and the Adolescent Relationship Scales (ARS) and Differentiation–Relatedness Scale (DRS) will also be used. Change will be assessed using linear-mixed models. Gender personality disorder (PD) and quality of object relations (QOR) will be the preselected putative moderators. Discussion The object of this clinical trial is to explore the effect of transference interventions in psychodynamic psychotherapy in adolescents with a major depressive disorder. Using a randomized and dismantling design, we hope that the study will add more specific knowledge to the evidence base. Trial registration ClinicalTrials.gov Identifier: NCT01531101 First Experimental Study of Transference work Work–In Teenagers (FEST-IT)
Psychodynamic psychotherapy for complex trauma: targets, focus, applications, and outcomes
Deborah Spermon, Yvonne Darlington, Paul Gibney
Psychology Research and Behavior Management , 2010, DOI: http://dx.doi.org/10.2147/PRBM.S10215
Abstract: ychodynamic psychotherapy for complex trauma: targets, focus, applications, and outcomes Review (4432) Total Article Views Authors: Deborah Spermon, Yvonne Darlington, Paul Gibney Published Date December 2010 Volume 2010:3 Pages 119 - 127 DOI: http://dx.doi.org/10.2147/PRBM.S10215 Deborah Spermon1, Yvonne Darlington1, Paul Gibney2 1School of Social work and Human Services, The University of Queensland, St. Lucia, QLD, Australia; 2Private Practice, Brisbane, QLD, Australia Abstract: 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.
Cognitive Behavioral Therapy versus Short Psychodynamic Supportive Psychotherapy in the outpatient treatment of depression: a randomized controlled trial
Ellen Driessen, Henricus L Van, Robert A Schoevers, Pim Cuijpers, Gerda van Aalst, Frank J Don, Mari?lle Hendriksen, Simone Kool, Pieter J Molenaar, Jaap Peen, Jack JM Dekker
BMC Psychiatry , 2007, DOI: 10.1186/1471-244x-7-58
Abstract: Adult outpatients with a main diagnosis of major depressive disorder or depressive disorder not otherwise specified according to DSM-IV criteria and mild to severe depressive symptoms (Hamilton Depression Rating Scale score ≥ 14) are randomly allocated to Short Psychodynamic Supportive Psychotherapy or Cognitive Behavioral Therapy. Both treatments are individual psychotherapies consisting of 16 sessions within 22 weeks. Assessments take place at baseline (week 0), during the treatment period (week 5 and 10) and at treatment termination (week 22). In addition, a follow-up assessment takes place one year after treatment start (week 52). Primary outcome measures are the number of patients refusing treatment (acceptability); the number of patients terminating treatment prematurely (feasibility); and the severity of depressive symptoms (efficacy) according to an independent rater, the clinician and the patient. Secondary outcome measures include general psychopathology, general psychotherapy outcome, pain, health-related quality of life, and cost-effectiveness. Clinical predictors of treatment outcome include demographic variables, psychiatric symptoms, cognitive and psychological patient characteristics and the quality of the therapeutic relationship.This study evaluates Short Psychodynamic Supportive Psychotherapy as a treatment for depressed outpatients by comparing it to the established evidence-based treatment Cognitive Behavioral Therapy. Specific strengths of this study include its strong external validity and the clinical relevance of its research aims. Limitations of the study are discussed.Current Controlled Trails ISRCTN31263312Depressive disorders constitute a major health problem in today's world. According to the World Health Organization, in the year 2000 depressive disorders were the leading cause of disability around the world and the fourth leading contributor to the global burden of disease. It is estimated that by the year 2020 depression will compris
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