Short-Term Psychoanalytic Supportive Psychotherapy for Depressed Patients

Short-Term Psychoanalytic Supportive Psychotherapy (SPSP) is a face-to-face, individual psychotherapy, consisting of sixteen sessions in six months (first eight weekly, then eight fortnightly sessions). It is rooted in psychoanalytic theory. Its primary aim is to cure depression. A secondary goal is to reduce a patient's vulnerability to depression. The emphasis is on supportive techniques that counter regression and foster psychological growth. The putative process consists in experiencing a relational dissonance, i.e., feeling two contradictory relationships in the therapeutic situation simultaneously, one determined by the past, the other by the present. We assume an important curative factor is to experience, mostly unconsciously, an adequate gratification of developmental needs inadequately met in early infancy and, therefore, manifesting themselves in the archaic aspects of the therapeutic relationship. SPSP unfolds as a discourse in which we distinguish nine levels. Each regards a specific subject, which at that level is the focus of the interaction between patient and therapist. The efficacy of SPSP in ambulatory patients presenting a DSM-IV defined, mild to moderate major depressive disorder has been tested in five randomized clinical trials. The results have been aggregated in a mega-analysis. They suggest that, in the treatment of outpatients with mild to moderate major depressive disorder, SPSP and pharmacotherapy are equally efficacious and that the combination of SPSP and pharmacotherapy is more efficacious than pharmacotherapy alone but not than SPSP alone. We, therefore, consider SPSP a valuable extension to the existing options for the treatment of depressed patients.     

Suicide Attempts in Major Depressed Patients with Personality Disorder

Suicide attempters who met criteria for borderline personality disorder (BPD) comorbid with major depressive disorder (MDD) were compared to both suicide attempters suffering from MDD alone and to attempters with comorbid MDD and other personality disorders (PD). Participants were 239 (158 patients with comorbid PD and 81 patients with MDD without comorbidity) inpatients consecutively admitted after a suicide attempt made in the last 24 hours. Suicide attempters with comorbid MDD and BPD had more frequent previous suicide attempts and were more likely to have a history of aggressive behaviors and alcohol and drug use disorders compared with patients suffering from MDD without Axis II comorbidity.     

Interaction Process Differences between Groups of Paranoid Schizophrenic and Depressed Patients

Group psychoanalytic treatment has special value for helping people form intimate attachments, in particular, for enabling them to resolve lifelong unconscious resistances to closeness. The group serves both as an amphitheater and as an agent for change.

As group therapists, we may break the task down into three stages. First, we bring the character resistances into play; second, we resolve the fears underlying them; and third, we empower our patients to develop mature ways of expressing intimacy.

Our task requires that we establish a contract with our patients so as to study any breach as a possible resistance to intimacy with other members. We study these resistances, which are expressed in words and attitudes. Beneath such resistances lie various fears, which we bring to the surface. As our patients resolve these fears, they begin to act toward each other as they did toward significant figures in their formative years. We work with these vestigial modes of relating, and help our patients turn them into mature modes of expression.     

Autobiographical Memory Retrieval and Problem-Solving Deficits of Iranian Depressed Patients Attempting Suicide

The underlying hypothesis was that suicide attempters tend to retrieve overgeneral autobiographical memories, with a considerable latency. Two cognitive measures (Autobiographical Memory Test and Means-Ends Problem-Solving Task, Persian versions) were used to assess 20 suicide patients who met DSM-IV criteria for depression, in comparison with a matched control group. The results showed that the suicide attempters produced more overgeneral memories and responded more slowly to positive than negative cue words, compared to the control participants. In the problem-solving task, the depressed patients evidenced less effective strategies, fewer and more irrelevant means, and took longer to respond to the task than the matched healthy participants. Moreover, there were significant correlations between autobiographical memory and problem-solving variables.     

The Coniunctio Gastronomique: Reflections on the Process of Individuation in Culinary Terms

This article is a study of the individuation process expressed in the metaphors of cooking, food, and feasting. The psyche speaks in the language of symbol and myth, and through our enterprise, the language that we give it. The personal story of an education in the culinary arts reveals the analogy between cooking, alchemy, and psychological processes. Fundamentally, this is the transformation of basic ingredients into refined substances. In psychological terms, this process represents the development of the personality. In clinical practice, the basic ingredients are discussed using the imagery of the kitchen, its tools, methods, and environment.

Five dreams are amplified to illustrate significant transitions and experiences that become part of a personal mythology. These archetypal dreams reveal, through the ordinary and mundane imagery of the kitchen and cooking, not only the possibility for healing but glimpses of spiritual truth.

Understanding the psyche through the processes of cooking heals the mind–body split that is the primary wound of modern life. Food, often understood as a symbolic link between human and god, is the medium for incarnation; god becomes flesh through the act of eating and incorporation. We become what we eat. This point is illustrated in a final dream about Jung, in which the operations of the kitchen are performed on the dreamer.     

Delivering a Brief Insomnia Intervention to Depressed VA Primary Care Patients

Primary care is often the place where patients with depression and comorbid insomnia seek treatment. The experience of comorbid insomnia with depression can have a significant impact on the efficacy of other depression treatments and exacerbate depressive symptoms. Using the empirically based Cognitive-Behavioral Treatment for Insomnia (CBT-I) to target the comorbid experience of insomnia in patients with depression can help improve sleep and potentially modify some depressive symptoms. Additional rationale for such an approach includes that a positive therapeutic experience may enhance engagement with or adherence to other psychotherapeutic interventions. Although other brief CBT-I interventions have been developed for primary care, none of them were actually delivered to depressed patients or implemented in primary care. Therefore, this paper describes a brief CBT-I intervention that was designed to be delivered in 4 sessions lasting from 15 to 45 minutes each within a primary care setting to depressed veterans. A case study is provided along with sample materials used in this intervention. In addition, we share implementation tips based on our experiences and feedback from eight veterans who have completed the intervention to date. Overall, the intervention was generally well received and suggests that the intervention may be feasibly delivered in a primary care setting.     

Sudden Gains in Depressed Cancer Patients Treated With Behavioral Activation Therapy

Many patients who receive cognitive-behavioral therapy experience sudden gains that are associated with improved treatment response and decreased risk of relapse. Extending prior research, this study examined sudden gains among depressed cancer patients receiving brief (9-session) behavioral activation therapy. Fifty percent of patients experienced sudden gains of large magnitude (M = 11.8 BDI-II points), with sudden gains associated with improved treatment response and maintenance of gains at 3-month follow-up. Relative to those without sudden gains, at pretreatment assessment, cancer patients with sudden gains were more likely to present with less severe depression, less somatic anxiety, fewer coexistent anxiety disorders, as well as less bodily pain, better overall physical functioning, and fewer problems with daily activities as a result of emotional problems. These findings provide increasing support for behavioral activation with a difficult-to-treat population but raise important questions regarding mechanism of change. Clinical implications for treating depressed cancer patients are discussed.     

Depressed and Anxious COPD Patients: Predictors of Psychotherapy Engagement from a Clinical Trial

This study examined patient-level factors associated with engagement in mental health treatment in a sample of medically ill patients with clinically significant symptoms of depression and/or anxiety. A total of 248 patients was enlisted from a randomized controlled trial of cognitive-behavioral therapy for depression and anxiety in patients with chronic obstructive pulmonary disease (COPD). Logistic regression analysis was used to predict mental health engagement, defined as attending at least one intervention session. Results indicated that patient-perceived mastery over COPD was negatively related to mental health engagement. Further, mastery was the only significant predictor of mental health engagement after controlling for patient demographic characteristics, severity of COPD, depression, and anxiety. To improve engagement for medically ill patients with comorbid mental health difficulties, clinicians should explore patients’ attitudes about their mental health within the context of their perceived ability to cope with their medical disease.     

抑郁症患者识别情绪词时执行功能实验研究

为了研究抑郁症患者识别汉语情绪词时的执行功能特征,采用神经扫描仪STIM刺激反应系统记录16名抑郁症患者和18名正常对照组执行四类Go／No go汉语情绪词识别作业时的反应时和正确率,抑郁自评量表(SDS)评价抑郁严重程度,自动思维问卷(ATQ)评价负性认知偏差程度。结果发现,识别正／负性词时抑郁症组反应时均明显延长,正确率明显降低。组内方差分析显示,随着情绪词识别作业难度增加,正常对照组正／负性词反应时缩短,正确率逐渐提高,且不受双重作业任务的影响。抑郁症组则表现为反应时延长,正确率变化不明显。重复测量多因素方差分析显示。词性、作业、组别间因素对反应时的主效应均有显著性意义;组别间因素对正确率的主效应均有显著性意义。抑郁症患者SDS、ATQ分与反应时、正确率相关无显著性。提示抑郁症患者区分正负性汉语情绪词时存在执行功能障碍。     

The Emergence of Suicidal Ideation During the Post‐Hospital Treatment of Depressed Patients

There is a paucity of research on the emergence of suicidal ideation in recently hospitalized patients undergoing treatment for depression. As part of a larger clinical trial, patients (N = 103) with major depression without suicidal ideation at hospital discharge were followed for up to 6 months while receiving study‐related outpatient treatments. Fifty‐five percent reported the emergence of suicidal ideation during the outpatient period, with the vast majority (79%) exhibiting this problem within the first 2 months post‐discharge. Seventy percent of those reporting severe suicidality prior to hospitalization exhibited a reemergence of suicidal ideation post‐discharge. However, 29% without significant suicidality at the index hospitalization later developed suicidal ideation during the outpatient treatment period. A faster time to the emergence of suicidal ideation was predicted by both higher prehospitalization levels of suicidal ideation as well as greater depression severity at hospital discharge. Overall, rates of emergent suicidal ideation found in the current sample of recently hospitalized patients were higher than those reported in previous outpatient samples.     

Dimensions of Religion Associated with Suicide Attempt and Suicide Ideation in Depressed,Religiously Affiliated Patients

There is substantial evidence to support the claim that religion can protect against suicide ideation, suicide attempts, and completed suicide. There is also evidence that religion does not always protect against suicidality. More insight is needed into the relationship between suicidal parameters and dimensions of religion. A total of 155 in‐ and outpatients with major depression from a Christian Mental Health Care institution were included. The following religious factors were assessed: religious service attendance, frequency of prayer, religious salience, type of God representation, and moral objections to suicide (MOS). Multiple regression analyses were computed. MOS have a unique and prominent (negative) association with suicide ideation and the lifetime history of suicide attempts, even after controlling for demographic features and severity of depression. The type of God representation is an independent statistical predictor of the severity of suicide ideation. A positive‐supportive God representation is negatively correlated with suicide ideation. A passive‐distressing God representation has a positive correlation with suicide ideation. High MOS and a positive‐supportive God representation in Christian patients with depression are negatively correlated with suicide ideation. Both are likely to be important markers for assessment and further development of therapeutic strategies.     

Counseling the Depressed Christian Female Client

Some researchers have suggested that traditional gender-role conditioning for women might relate to depression and, furthermore, that religion has played a major role in defining and reinforcing gender roles. Depressed Christian women, consequently, make up a unique population with special counseling needs. This article addresses these women as a group and offers suggestions for counseling them.     

Depressed mood mediates the relationship between rumination and intrusions

Research suggests that rumination is a causal factor for intrusive memories. These are disturbing autobiographical memories that pop into one's mind involuntarily, spontaneously, and repetitively. A three‐wave longitudinal study was conducted to replicate this finding and to test whether one route via which rumination leads to (an increase in) intrusive memories is via depressed affect. Secondary school students (n = 72) filled out self‐report questionnaires measuring their level of rumination, depressive symptoms (DS), and intrusive memories. These were administered at three different points, with 3 weeks in between each measurement. Two types of rumination were measured, that is, depressive rumination and rumination in response to intrusions. Both bootstrapping analyses and cross‐lagged analyses yielded evidence for DS as a partial mediator of the relationship between rumination and intrusion frequency. Both depressive rumination and rumination about the content of intrusive memories seemed to be maladaptive: They may exacerbate negative emotions, which in turn trigger intrusive memories. Ruminative thinking also directly led to (an increase in) intrusive memories. These findings might suggest that people suffering from intrusive memories may benefit not only from therapies directly aimed at reducing intrusions but also from therapies aimed at reducing rumination and DS.     

Self-Identity and Specific Vulnerability to Depressed Mood

ABSTRACT Four studies were conducted to test the hypothesis that experiencing a life event that disrupts the pursuit of self-defining activities would be associated with depressed mood. Across all four studies, a strong and exclusive identification with the athlete role was related to subjects' affective response to both hypothetical and actual athletic injuries. The results highlight the importance of assessing the match between specific cognitive diatheses and specific life events in predicting depressive reactions.     

When a Mother Is Depressed

Abstract

The literature related to mother-child interaction when a mother is depressed and a framework for addressing mother-child co-occupations for mothers with depression and their young children is provided. An in-depth case example that spans mother-infant occupation- based intervention during a short-term psychiatric hospitalization through home-based occupation-based intervention is provided.     

Stability of the MCMI Among Depressed Psychiatric Outpatients

The Milton Clinical Multiaxial Inventory (MCMI) is a promising, yet somewhat unproven psychometric inventory developed to identify clinical syndromes and personality traits consonant with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed. [DSM-III]; American Psychiatric Association, 1980). The stability of its measures for both the theoretically more stable personality characteristics and the clinical syndromes was investigated in a group of depressed psychiatric outpatients. In this test-retest design with a 3-month interval between tests, clinical syndrome scales of relevance changed significantly as expected. However, many of the personality scales also changed significantly. Only four of the personality scales met a two-fold test of stability. Findings are discussed in terms of characteristics of self-report inventories such as the MCMI, the uniqueness of the depressed population, and characteristics of personality disorders.     

Differentiating Cognitive Content between Depressed and Anxious Outpatients

Quantitative research suggests that depressed and anxious patients can be differentiated based on their cognitive content. This study used qualitative research methods to separate the specific components of open‐ended depressive and anxious thought content in 79 psychiatric outpatients. Patients with major depressive disorder (MDD; n = 36), generalized anxiety disorder (GAD; n = 10), and other psychiatric disorders (PC; n = 33) were instructed to (a) describe their most bothersome problem; (b) imagine the worst possible negative outcome followed by the best possible positive outcome; and (c) describe associated thoughts and emotions for each scenario. The content of patients' responses were coded to examine (a) the types and severity of problems; (b) the presence or absence of hopelessness, catastrophizing, hopefulness, and unrealistic positive expectations; and (c) the presence or absence of particular emotions associated with imagined worst and best outcomes. More GAD patients than MDD and PC patients indicated anticipated anxious emotions associated with imagined worst outcomes, and fewer MDD patients than GAD and PC patients indicated anticipated happiness associated with imagined best outcomes. No group differences emerged for the other variables considered. These findings suggest that depressed and anxious patients differ in their cognitive expectancies about future life events in terms of their own anticipated emotional reactions.     

Evaluating the Effectiveness of Cognitive-Behavioral Teletherapy in Depressed Adults

Telephone psychotherapy is an emerging form of delivery of care that has recently demonstrated utility and efficacy for adult depression when provided as an adjunct to antidepressant treatment in primary care trials. This study constitutes one of the initial evaluations of cognitive behavioral therapy-telephone treatment (CBT-TT) as a stand-alone treatment for adult depression in specialty care. Thirty adults initiating psychotherapy for depression at a mental health clinic participated in the trial. The majority of participants (69%) were very satisfied with the 8-session CBT-TT, reduction in depression severity was significant over 3 and 6 months, and 42% of participants were considered recovered at termination. These outcomes closely parallel the findings from an earlier primary care trial, despite specialty care participants beginning treatment with more severe depression and without adjunctive antidepressant medication. These findings suggest that CBT-TT for adult depression is feasible and has potential as a stand-alone treatment. Implementation of this telephone-based delivery approach in primary and specialty care settings is discussed.