Therapy Expectations of Adolescents with Depression Entering Psychodynamic Psychotherapy: A Qualitative Study

Patient expectations about therapy have been regarded as a common factor affecting the course and outcome of psychotherapy. However, little is known about the expectations of adolescents. We aimed to explore the therapy expectations of young people (YP) with depression prior to psychotherapy. We conducted semi-structured interviews with six YP (5 female, 15–19 years old) entering psychodynamic outpatient treatment. Interviews were transcribed verbatim and analyzed using Interpretative Phenomenological Analysis. The careful analysis of the YPs’ accounts yielded the following four key themes: not knowing but being cautiously hopeful; therapy as a long and difficult process; therapy as a place to understand oneself and to develop; and the importance of the professional and interpersonal skills of the therapist. The findings suggest to foster realistic treatment and outcome expectations while at the same time individual therapists should pay careful attention to the specific expectations that YP bring into therapy.     

Effect of treatments for depression on quality of life: a meta-analysis*

Cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are the two first-line treatments for depression, but little is known about their effects on quality of life (QOL). A meta-analysis was conducted to examine changes in QOL in adults with major depressive disorder who received CBT (24 studies examining 1969 patients) or SSRI treatment (13 studies examining 4286 patients) for their depression. Moderate improvements in QOL from pre to post-treatment were observed in both CBT (Hedges’ g = .63) and SSRI (Hedges’ g = .79) treatments. The effect size remained stable over the course of the follow-up period for CBT. No data were available to examine follow-ups in the SSRI group. QOL effect sizes decreased linearly with publication year, and greater improvements in depression were significantly associated with greater improvements in QOL for CBT, but not for SSRIs. CBT and SSRIs for depression were both associated with moderate improvements in QOL, but are possibly caused by different mechanisms.     

Facial gender confirmation surgery—review of the literature and recommendations for Version 8 of the WPATH Standards of Care

Facial gender confirmation surgery (FGCS), also popularly known and referred to in the scientific literature as facial feminization surgery (FFS), was previously treated as a collection of aesthetic procedures complementing other aspects of gender-confirming surgery. Recent literature on quality-of-life outcomes following FGCS has supported the substantial impact these procedures have on overall well-being and reduction of psychosocial sequelae in patients. The World Professional Association for Transgender Health Standards of Care, Version 7 (WPATH SOC 7), did not deem FGCS a medical necessity. Based on these new studies, increasing evidence points to the need to include FGCS among medically necessary gender-confirming surgeries, though more-prospective studies are needed. Updates to the WPATH SOC 8 are proposed based on available quality of life studies.     

Effects of compassionate thinking on negative emotions

The present study compared the effect of compassionate thinking with other methods traditionally used in cognitive behavioural therapy (cognitive reappraisal, responsibility reattribution, and self-deflection). An instructional manipulation was used, and 207 undergraduate students were randomly assigned to one of these thinking styles or a control condition. The results revealed that participants who engaged in compassionate thinking and cognitive reappraisal reported significantly lower levels of negative emotions compared to those in the responsibility reattribution and control conditions. Furthermore, results of hierarchical regression analyses suggested that habitual use of self-compassion reduced negative emotions in all conditions. These findings suggest that self-compassion and reappraisal reduce negative emotions more than reattribution and self-deflection.     

Making Sense of Interlevel Causation in Mechanisms from a Metaphysical Perspective

According to the new mechanistic approach, an acting entity is at a lower mechanistic level than another acting entity if and only if the former is a component in the mechanism for the latter. Craver and Bechtel (Biol Philos 22(4):547–563, 2007. doi: 10.1007/s10539-006-9028-8) argue that a consequence of this view is that there cannot be causal interactions between acting entities at different mechanistic levels. Their main reason seems to be what I will call the Metaphysical Argument: things at different levels of a mechanism are related as part and whole; wholes and their parts cannot be related as cause and effect; hence, interlevel causation in mechanisms is impossible. I will analyze this argument in more detail and show under which conditions it is valid. This analysis will reveal that interlevel causation in mechanisms is indeed possible, if we take seriously the idea that the relata of the mechanistic level relation are acting entities and accept a slightly modified notion of a mechanistic level that is highly plausible in the light of the first clarification.     

Reciprocal relations between cognitive neuroscience and formal cognitive models: opposites attract?

Cognitive neuroscientists study how the brain implements particular cognitive processes such as perception, learning, and decision-making. Traditional approaches in which experiments are designed to target a specific cognitive process have been supplemented by two recent innovations. First, formal cognitive models can decompose observed behavioral data into multiple latent cognitive processes, allowing brain measurements to be associated with a particular cognitive process more precisely and more confidently. Second, cognitive neuroscience can provide additional data to inform the development of formal cognitive models, providing greater constraint than behavioral data alone. We argue that these fields are mutually dependent; not only can models guide neuroscientific endeavors, but understanding neural mechanisms can provide key insights into formal models of cognition.