Langzeitwirkungen psychoanalytischer und verhaltenstherapeutischer Langzeitpsychotherapien

The prospective study compares 31 patients in long-term behavior therapy with 31 patients in psychoanalytically oriented long-term therapy. A naturalistic design was applied within the German health system. All patients underwent a diagnostic interview (SCID) by an external interviewer. Only patients who fulfilled the DSM III-R criteria for a depression or an anxiety disorder were included in the study. Although the diagnoses of the patients undergoing long-term behaviour therapy and long-term psychoanalytical psychotherapy were comparable, we found that they differed in various ways. The differences arose in a number of characteristics, such as education, access to psychotherapy (recommended by professionals versus patients introducing themselves), usage of psychotropic medication, and the strain of symptoms. The average duration of long-term behavior therapy was 2.4 years and 64 sessions. The average duration of psychoanalytically oriented long-term therapy was 3.6 years and 209 sessions. Symptoms (SCL-90-R) and interpersonal problems (IIP) were examined at the beginning, after 1 year, 2.5 years, 3.5 years and after 7 years. Both groups showed significant degrees of improvement within the first 3.5 years and remained stabilized in the following 3.5 years regarding the symptomatic aspects. Focussing on the interpersonal problems, group PA showed further improvement after the 3.5-year period. The BT group however, showed no further improvement after 3.5 years but stabilized. The evaluated phase-model of psychotherapeutic change for short-term therapy was confirmed more clearly for long-term therapies of psychoanalytical orientation than for long-term therapies of behavioral orientation.     

Die Effekte psychoanalytisch orientierter und verhaltenstherapeutischer Langzeittherapien

This prospective study compares 31 patients in behavior long-term-therapy (with an average of 63 sessions) with 31 patients in psychoanalytically-oriented long-term-therapy (with an average of 185 sessions) in a naturalistic design. All patients passed a diagnostic interview (SKID) by an external interviewer. Only patients with depression and anxiety problems (Axis I of DSM III – R) were included in the study. Symptoms (SCL-90-R), interpersonal problems (IIP-D) and goals (GAS) were examined at the beginning, after 1 year, after 2.5 and 3.5 years. We found that the characteristics of patients, who choose – or were referred to – psychoanalytically oriented or behaviour long term therapy were different, even when their diagnosis were comparable, in a number of characteristics, such as education, access to psychotherapy (recommended by professionals versus patients introduce themselves), the taking of psychotropic medication, and the strain of symptoms. The results demonstrate how research comparing therapies using parallelized samples do not meet reality in every case: Even if psychoanalists and behavior therapists do treat equal disorders, – and they each do that very successfully, as we could prove – the patients differ in many ways. Effect sizes and clinically significant results about changes of the symptomatic and of interpersonal problems are presented that prove the efficacy of the treatments.     

Comparison of cognitive-behavioural therapy and psychodynamic therapy in the treatment of anxiety among university students: an effectiveness study

The aim of the present study was to compare the effectiveness of cognitive-behavioural (CBT) and psychodynamic (PDT) therapies in the treatment of anxiety among university students. To this aim, the Symptom Questionnaire (SQ) was completed by 30 students assigned to CBT and by 24 students assigned to PDT, both at the beginning and at the end of treatment. The main problem presented by all patients was anxiety. Except for one sub-scale, we observed significant differences in the scores of all sub-scales and scales of SQ, with lower scores at the end of the therapy, indicating lower distress, regardless of the type of treatment. The present findings suggest that both therapies are effective in the treatment of anxiety among university students.     

Therapieabbrüche in der stationären Psychotherapie

This article focuses on the patients’ view of the causes and consequences of premature therapy termination in inpatient psychosomatic setting. In this study, drop-out patients and non-drop-out patients were questioned in semi-structured phone interviews (n=62). The causes of early termination are seen in this study to be connected with an internal, somatic concept of disease, discontent with treatment, and social interaction problems in the hospital. In 80% of the examined cases more than two causes were reported. Consequently, early termination of treatment can be considered as an outcome of multifactorial influences. Furthermore, a group of “inner drop-outs” has been identified within the non-drop-out patients. Despite high discontent, these patients remained in treatment because they often feared possible negative consequences of early treatment termination. Both drop-outs and inner drop-outs scored lower in outcome analysis than the remaining patients. This study points to problem areas that can help identify potential drop-out patients.     

Changes of attachment status among women with personality disorders undergoing inpatient treatment

Background: Attachment has increasingly received attention in psychotherapy and has been used as a predictor of process and outcome. Studies investigating changes of attachment styles during psychotherapy are very rare. Method: Forty women with either borderline (BPD) or avoidant personality disorders (AVPD), treated as inpatients, were investigated using an attachment interview (interpersonal relations assessment (IRA)), and questionnaires to determine therapy outcome at the beginning and after seven weeks of therapy. The IRA uses similar questions as the adult attachment interview (AAI) and is used as the basis for the adult attachment prototype rating (AAPR), a procedure to assign individuals to prototypical categories of attachment. Results: The study showed that the therapy in general was effective. In contrast to other studies, we did not find many women classified as secure at the end of their therapy. Comparisons of pre‐post‐ratings revealed instead that clients within both subgroups received higher ratings for the avoidant prototypes at the end of therapy, indicating deactivation of attachment. Changes from ambivalent to avoidant attachment were linked with better outcome among women with borderline personality disorder (BPD). Conclusions: This study adds further evidence to the result that attachment styles do not change dramatically during a time‐limited psychological treatment of personality disorder. Instead, the study showed that features of preoccupied/ambivalent attachment were less significant after seven weeks of therapy. For women with BPD, these changes were linked with a more favourable outcome which might reflect a more structured and deactivated attachment status as a result of inpatient therapy.     

No ownership of common factors

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler's informative article raised several issues worthy of comment. His choice of the word distinctive (p. 98) in describing aspects of psychodynamic technique is open to at least two interpretations. On the one hand, distinctive can have a qualitative meaning and indicate the presence of a characteristic that is not shared. For example, a sign in the Bronx Zoo distinguishes birds from all other creatures as follows: "If it has feathers it's a bird, if it doesn't, it isn't." On the other hand, distinctive can have a quantitative meaning and indicate that one practice has more of a common element than another practice. Careful reading of Shedler's article and the article by Blagys and Hilsenroth (2000) that forms the basis of the "seven features [that] reliably distinguished psychodynamic therapies from other therapies" (Shedler, 2010, p. 98) shows that Shedler subscribes to the latter, quantitative, definition of distinctive. In other words, the seven features he presented are present in both psychodynamic therapies and the cognitive-behavioral therapies to which he compares them. For example, although Shedler did not mention it, dialectical behavior therapy explicitly focuses on six of the seven features, namely, "focus on affect and expression of emotion," "exploration of attempts to avoid distressing thoughts and feelings," "identification of recurring themes and patterns," "discussion of past experience," "focus on interpersonal relations," and "focus on the therapy relationship" (Shedler, 2010, p. 99). However, in the articles that Blagys and Hilsenroth reviewed, psychodyamic therapists engaged in more of these behaviors than did cognitive-behavioral therapists.     

Psychodynamisches Fallseminar im Masterstudiengang

Stimulated by the discussion about the direct training of psychotherapists, this article presents the concept of a psychodynamic case seminar held by the author in the context of a Master of Science degree in clinical psychology and psychotherapy at the University of Kassel. The seminar was spread over 3 days during which the catalogue of questions on the report to the experts for an application for health insurance was discussed and elaborated on the basis of case examples. To obtain a certificate of performance the students were required to write their own case study at the end of the course. The author outlines the possibilities and limitations of the instruction concerning psychodynamic theories and methods in a university context. In addition, the criticism of the previous training is considered in order to show the necessity for reform.The direct training of psychotherapists opens up an opportunity for retention and further development of psychoanalytically oriented therapies. Particularly because the student’s interest in the seminar was obvious and it is reasonable to expose the students to psychodynamic thinking even at an early stage. At the same time the seminar clearly showed how big the prejudices towards psychoanalytical theories and therapies are. On the one hand there are utopian opinions that a psychotherapy procedure can be quickly learnt and that changes in patients can be achieved in a short time but on the other hand psychotherapeutic methods are devalued because their effectiveness should be doubted for lack of scientific evidence. Reform of the professional training could present the possibility for early prevention of prejudices and to encourage research projects.     

The Love and Fear of Flying by Douglas D. Bond

A study of over 700 referrals for group therapy within a large university hospital setting revealed that such services were primarily provided for moderately to severely disturbed patients, mostly single white females from working and middle class backgrounds, university students, and unemployed, poorly educated minority group members. However, 41 percent of the patients initially referred never actually attended a therapy group. Among those who did begin group therapy, drop-outs occurred most frequently during early sessions. Over half the treated patients were seen for a total of twelve or fewer sessions. Data are interpreted as highlighting the importance of implementing careful referral and preparation procedures, and as underscoring the necessity for developing effective short-term group therapy approaches.     

Group-as-a-whole interpretations in short-term group psychotherapy

The usefulness of therapists making group-as-a-whole interpretations in long-term group therapy was actively debated in the 1960s and 1970s. Advantages and disadvantages were delineated. An often-cited survey study of therapy groups that had emphasized group-as-a-whole interpretations found that many patients were dissatisfied with the therapist’s technique and the outcome of therapy. Although group-as-a-whole concepts subsequently became a part of the theory of many orientations of group therapy, there has appeared to be reluctance among many therapists to make group-as-a-whole interpretations, especially in short-term group therapies. Contrary to this tendency, an argument is made and a case illustration presented, which advocate the use of group-as-a-whole interpretations in short-term group therapies.     

Wirksamkeit bioenergetischer Psychotherapien bei Patienten mit bekannter ICD-10-Diagnose

In this study the efficacy of Bioenergetic Analysis and Therapy (BAT) was evaluated retrospectively by means of two questionnaires. Former patients from private practice with a known ICD-10 F group diagnosis participated in the study. The SCL-90-R was modified to allow assessment of the symptoms at the beginning as well as at the end of therapy. The second questionnaire was self-constructed and contained questions about the quality of the therapeutic work, body work in general, the relationship with the therapist, and the way the therapist worked. Both questionnaires were to be answered anonymously. Eight psychotherapists (medical doctors and psychologists) served as contacts to 103 former patients; 48 patients (46.6%) returned the questionnaires. Ten patients belonged to the F3 group, 26 to the F4, and 12 to the F6 groups. All data could therefore be interpreted for each of the F groups as well as for the sum of all patients. Bioenergetic analysis and therapy reduced the symptoms according to the SCL-90-R considerably in all three F groups. Analysis of the individual symptom scales on the SCL-90-R showed high to very high symptom reduction. These were not related to the F group diagnoses. Insight gained as a result of body work produced an even greater symptom reduction independent of the ICD-10 F group diagnosis. Patients receiving BAT rated their therapy favourably and judged the relationship with the therapist as very good. The efficacy of and the satisfaction with the therapy was rated high. The formulation of a therapeutic goal at the beginning of the therapy was possibly a prerequisite for a positive outcome of the therapy. The present study confirms and complements previous efficacy studies of BAT.     

Le bilan de compétences : effets sur l’état émotionnel des bénéficiaires

Bilan de compétences (BC)’ effects on workers’ emotional states remain little explored. BC may reduce work-related negative emotional states and enhance positive ones. This was tested using a two-study design. In the first study, 38 respondents filled in the POMS-f, a questionnaire on emotional states, at the beginning or/and at the end of their BC. Six of them were also interviewed one week after the end of their BC. In the second study, 59 respondents filled in the same questionnaire at the beginning and at the end of their BC. In both studies, BC significantly reduced most of negative emotional states and increased positive ones.     

It’s not what you said,it’s how you said it: An analysis of therapist vocal features during psychotherapy

Psychotherapy is a conversation, whereby, at its foundation, many interventions are derived from the therapist talking. Research suggests that the voice can convey a variety of emotional and social information, and individuals may change their voice based on the context and content of the conversation (e.g. talking to a baby or delivering difficult news to patients with cancer). As such, therapists may adjust aspects of their voice throughout a therapy session depending on if they are beginning a therapy session and checking in with a client, conducting more therapeutic ‘work’ or ending the session. In this study, we modelled three vocal features—pitch, energy and rate—with linear and quadratic multilevel models to understand how therapists’ vocal features change throughout a therapy session. We hypothesised that all three vocal features would be best fit with a quadratic function—starting high and more congruent with a conversational voice, decreasing during the middle portions of therapy where more therapeutic interventions were being administered, and increasing again at the end of the session. Results indicated a quadratic model for all three vocal features was superior in fitting the data, as compared to a linear model, suggesting that therapists begin and end therapy using a different style of voice than in the middle of a session.     

Critical Incidents in the Professional Lives of First Year MFT Students

First year MFT students engaged in a journaling project, selecting one event daily which captured something about being a student, including the process of therapy, consultation, and supervision, that struck them as important in terms of their professional development. On reflection, the students saw therapeutic success and professional confidence as systemic products of a variety of contextual factors: transient and enduring aspects of the self and the client, faculty, peer, and family influences, and treatment setting and program factors. Students and faculty experienced this formative self study as valuable and believe that it should be done at the beginning, middle, and end of an educational program and the results shared with both faculty and students.     

Serious side effects with D-penicillamine therapy for Wilson's disease]

Immunocomplex nephritis as one of the serious side-effects is dealt with on the basis of 41 patients with Wilson's Disease who have been treated for many years and were stabilised on D-penicillinamine. In one quarter of the patients, proteinuria was found 1 to 5 years after the beginning of the therapy. Until now, an immunocomplex nephritis with diffuse granular, mainly epimembranous IgG and C3 deposits on the glomerular basement membran was found in four patients. No circulating antibodies against cell nuclei were found. The finding of immunocomplex nephritis calls for the discontinuation of the therapy for an at present unknown period of time.     

Individual Versus Group Physical Therapy for Patients with Low Back Pain: Outcomes and Process (Therapeutic Factors)

ABSTRACT

Low back pain (LBP) is a common health problem usually treated individually, and requires costly physical therapy. Group treatment, besides being cost-effective, provides psychological support to the recovery of people who struggle with a physically disabling condition. The current study compares individual and group treatment of LBP, measuring differences in outcomes and process data (therapeutic factors). The study included 158 patients who participated in group (n = 71) and individual (n = 87) physical therapy, using a pre-post-follow-up design. Results indicated a significant improvement in all outcome measures at postintervention in both treatment settings, with no difference between them, which were sustained at follow-up. On a clinical level, a few differences were found: At postintervention, minimal clinically important improvement in perceived functioning and level of pain was greater among patients treated individually. On the other hand, at follow-up, only group participants gained additionally in perceived functioning and in fear avoidance. Therapeutic factors of other- versus self-focus and problem definition–change were more prevalent in group treatment.     

Influence of physical activity on concentration among junior high-school students

The level and quality of concentration were tested before and after each lesson in one class session. Two of the four classes participated in physical education activities, and the other two studied science. Each subject matter was studied the beginning and at the end of the school day. The research design was 2 x 2 x 2 factorial (two subject matters, two times of the school day, and as a repeated measure two times of test for each group at the beginning and end of each lesson). The level and the quality of concentration found at the end of each lesson were significantly higher than at the beginning. The subject matters did not influence concentration. It may be concluded that the time of day was the main influence on concentration, so teachers' claims against physical education activity lessons can be rejected. The increase in concentration toward the end of the lesson implies the need for careful lesson planning or even the consideration of increasing duration of lessons.     

Thérapie cognitive et schémas cognitifs : un aspect du paradoxe

On one hand, schemas responsible for psychopathologies are said to be slowly formed during the childhood which means they become stable, rigid and practically non-modifiable structures. On the other hand, cognitive therapy aims at modifying these schemas, sometimes a few appointments are enough for the shortest techniques. To explain this paradox, we have measured the activity of 13 early maladaptive schemas among 36 patients (20 men and 16 women), suffering from panic disorders with agoraphobia, before and after a 10 weekly session group therapy—the symptoms being totally reduced. We compare these measures with those made on subjects free from any psychiatric disorders. Our results indicate that if therapy modifies symptoms, it has no immediate effect on early maladaptive schemas.     

Group processes and process evaluations in a new treatment setting: inpatient group psychotherapy followed by internet-chat aftercare groups

Little is known about processes characterizing therapeutic Internet-chat groups, which offer a novel way of providing group therapy over distances. In this study group processes and group evaluations were examined in a treatment setting where face-to-face inpatient groups are followed by chat aftercare groups. For a sample of 121 patients who participated in both treatment modalities, group processes and group evaluations were modeled using hierarchical linear modeling. The group evaluations followed a consistent upward course from the beginning of therapy until the end of chat aftercare. For the process measures Activity and Emotional Reactivity, the initial scores at the beginning of the chat groups were lower than at the end of the inpatient treatment, but higher than at admission. During chat aftercare, Activity and Emotional Reactivity scores increased less than during the inpatient phase, but on average Activity and Emotional Reactivity were higher during Internet-chat aftercare. The predictive value of the acquaintance of the therapist from inpatient treatment and the course of group evaluations during inpatient treatment on the course of group evaluations during chat aftercare were examined.     

Treatment of acrophobia in virtual reality: the role of immersion and presence

In this study the effects of virtual reality exposure therapy (VRET) were investigated in patients with acrophobia. Feelings of presence in VRET were systematically varied by using either a head-mounted display (HMD) (low presence) or a computer automatic virtual environment (CAVE) (high presence). VRET in general was found to be more effective than no treatment. No differences were found in effectiveness between VRET using an HMD or CAVE. Results were maintained at 6 months follow-up. Results of VRET were comparable with those of exposure in vivo (Cyberpsychology and Behavior 4 (2001) 335). In treatment completers no relationship was found between presence and anxiety. Early drop-outs experienced less acrophobic complaints and psychopathology in general at pre-test. They also experienced less presence and anxiety in the virtual environment used in session one as compared to patients that completed VRET.     

Evaluation of inpatient dialectical-behavioral therapy for borderline personality disorder--a prospective study

Dialectical-Behavioral Therapy for Borderline Personality Disorder (DBT) developed by M. Linehan is specifically designed for the outpatient treatment of chronically suicidal patients with borderline personality disorder. Research on DBT therapy, its course and its results has focused to date on treatments in an outpatient setting. Hypothesizing that the course of therapy could be accelerated and improved by an inpatient setting at the beginning of outpatient DBT, we developed a treatment program of inpatient therapy for this patient group according to the guidelines of DBT. It consists of a three-month inpatient treatment prior to long-term outpatient therapy. In this pilot study 24 female patients were compared at admission to the hospital, and at one month after discharge with respect to psychopathology and frequency of self-injuries. Significant improvements in ratings of depression, dissociation, anxiety and global stress were found. A highly significant decrease in the number of parasuicidal acts was also reported. Analysis of the average effect sizes shows a strong effect which prompts the development of a randomized controlled design.