Transcranial Direct Current Stimulation improves word production in Conduction Aphasia: Electroencephalographic and behavioral evidences

A Conduction Aphasic patient, RH, with many difficulties at the level of phonological output, was subjected to Transcranial Direct Current Stimulation (tDCS) therapy six months after suffering a stroke. Fifteen daily sessions were administered (five days per week). The treatment led to a better intra-hemispheric electrical coherence and inter-hemispheric balance, as shown by the quantitative EEG analysis. Transcranial Direct Current Stimulation therapy was shown to be effective in inhibiting irregular activation of the right hemisphere, offering the healthy areas of the left hemisphere the possibility of reassuming their linguistic processing abilities. Also, the number of errors in picture naming and repetition of words and pseudowords dropped considerably following treatment. The recovery was greater for long stimuli and was not affected by semantic or lexical variables such as familiarity. These results suggest that the Phonological Output Buffer, a mechanism dedicated to the maintenance, ordering and production of phoneme strings, was the processing stage modified by the treatment.     

Long-term outcomes of Acceptance and Commitment Therapy in drug-dependent female inmates: A randomized controlled trial

The general aim of this randomized controlled trial was to test the long-term efficacy of acceptance and commitment therapy (ACT) compared to a cognitive behavioural therapy (CBT) condition in the treatment of drug abuse. Participants were 37 polydrug incarcerated females assessed with Mini International Neuropsychiatric Interview, Addiction Severity Index-6, Anxiety Sensitivity Index (ASI) and Acceptance and Action Questionnaire II at pre, post, and at 6-, 12- and 18-months follow-ups. The mixed lineal model analyses showed reductions in drug abuse, ASI levels and avoidance repertoire in both conditions, without any differences between groups. However, the percentages of mental disorders were reduced only in ACT participants. At the 18-month follow-up, ACT was better than CBT in the maintaining of abstinence rates. This data support the incubation pattern showed in previous ACT studies. To conclude, the ACT intervention seems to be an adequate treatment option for addictive behaviours and co-occurring disorders in incarcerated women.     

Oedipal aspirations and phallic fears: on fetishism in childhood and young adulthood

The main theoretical position on fetishism remains that outlined by Freud, the splitting of the ego and castration anxiety being central to the establishment of the fetish. The dangers and attractions of an oedipal resolution are outlined in the case of 'Stanley', an older adolescent whose nappy wearing, transvestism and obsession with pregnant mothers and their babies brought him to therapy. The paper demonstrates some of the technical difficulties in such work, the slow ego-structuring that is necessary, the patient's swift perception of danger at any failure of attunement by the therapist and subsequent flight to the perverse defence, and the impetus that acceptance of oedipal gain may bring to development. Die wesentliche theoretische Position bezüglich Fetischismus bleibt die von Freud umrissene, dass Ichspaltung und Kastrationsangst bei der Etablierung des Fetischs zentral sind. Es werden die Gefahren und Anziehungspunkte einer ödipalen Lösung im Fall von 'Stanley' dargestellt, einem älteren Jugendlichen, den sein Windeltragen, Transvestismus und Besessenheit mit schwangeren Müttern und ihren Babies zu Therapie brachte. Der Artikel zeigt einige der technischen Schwierigkeiten in solch einer Arbeit, das langsame Ich-strukturieren, das notwendig ist, die schnelle Gefahrenwahrnehmung des Patientens bei jeglicher Missanpassung des Therapeutens und die darauffolgende Flucht in perverse Abwehr, und den Antrieb, den das Akzeptieren des ödipalen Gewinns zur Entwicklung bringen kann, auf. Des conceptions théoriques du fétichisme, la plus connue reste encore celle proposée par Freud, dans laquelle le clivage du moi et l'angoisse de castration sont à l'origine de la mise en place de l'objet fétiche. Les dangers et les charmes d'une résolution ?dipienne sont esquissés à travers le cas de û Stanley ý, garçon en fin d'adolescence qui entreprend une thérapie en raison de certains de ces comportements?:?il aime porter des couches, il se travestit et il est obsédé par les femmes enceintes et leurs bébés. L'auteur souligne quelques-unes des difficultés techniques posées par ce travail, la lenteur avec laquelle il faut laisser se structurer le moi, la perception rapide par le patient d'un danger imminent dès que sa thérapeute n'est plus tout à fait en accordage avec lui, sa fuite alors vers une défense perverse, et la stimulation que l'acceptation des enrichissements ?dipiens peut entraîner pour son développement. La posizione teorica principale sul feticismo resta quella illustrata da Freud, secondo la quale la scissione dell'Io e le ansie di castrazione sono determinanti alla formazione del feticcio. I pericoli e le attrazioni di una risoluzione del complesso edipico sono illustrate nel caso di 'Stanley', un tardo adolescente arrivato in terapia perche' usava i pannolini, si travestiva e aveva un' ossessione per le donne incinte e i loro bambini. L'articolo tratta di alcune delle difficolta' tecniche in questo tipo di lavoro, della lenta e necessaria ricostruzione dell'Io, della rapida percezione del pericolo del paziente quando egli sente una mancanza di sintonia con il terapeuta e la conseguente fuga verso difese perverse, e dell'impeto che l'accettazione dei vantaggi edipici possono portare allo sviluppo.     

The Milan Approach,History, and Evolution

The two authors intend to underline the continuities and discontinuities that organize the Milan Approach, after the splitting from Selvini Palazzoli and Prata; they intend to tell the teachings of Luigi Boscolo and Gianfranco Cecchin from the beginning of training in 1978 till nowadays. After having spoken of some important stages in the work till the death of the two masters, the article underlines two major new aspects. 1. We speak about the corporeal turn: embodied experience as preconceptual know‐how from which concepts are structured. We speak about the connections between bodies and social issues that enact forms of knowledge and understanding. 2. In this period of war, violence, and tyranny, we speak about epistemology and ontology as complementary stances: the need to let others disclose themselves, by allowing them to speak their own terms of engagement. The therapeutic effort is one of deactivating the dangers of one’s own presuppositions and prejudices that limit one’s capacity to describe and make hypothesis. There are social ontologies, communities with strong moral intensity, historical and social realities that need therapists to take position, since they need to take side and be aware of the categories they utilize. Historical and social ontology deals with the continuous change of symptoms in connection to the continuous change of the social panorama in the context we live in. We live by the bodies we are.     

Suicide ideation as a predictor of treatment outcomes in cognitive-behavioral therapy for unipolar mood disorders

Background/Objective: Suicide ideation is common in depressed patients. However, no studies to date have examined whether pretreatment suicide ideation is associated with poorer outcomes after cognitive-behavioral therapy for adult depression. Method: 475 depressed outpatients (age: M = 39.9 years, SD = 11.71; 60.2% female) took part in a pre-treatment and a post-treatment assessment. Pre-treatment suicide ideation measured with the BDI suicide item was considered as a predictor of treatment outcomes – controlling for age, gender, number of attended therapy sessions, as well as pre-treatment depression severity. Results: Hierarchical regression revealed that age, gender, number of completed therapy sessions and depression severity at baseline could explain 25% of the variance in post-treatment BDI-scores. Adding suicide ideation significantly improved the amount of variance explained to 27%. Treatment outcomes were worse for patients with more severe depression, suicidal patients, patients receiving more therapy-sessions and older patients. Conclusions: Suicide ideation added only little incremental variance to the prospective prediction of post-treatment depression severity. Depressed patients with suicide ideation can attain almost as good treatment outcomes as patients without suicide ideation, which is a clinically encouraging result.     

A randomized clinical trial of group and individual Cognitive-Behavioral Therapy approaches for Social Anxiety Disorder

To compare the effectiveness of two Cognitive-Behavioral Therapy (CBT) interventions—an individual and a group intervention—in Social Anxiety Disorder therapy. We compared the two treatment groups against a waitlist condition in a randomized clinical trial with 86 young adults. The individual CBT intervention was Trial-Based Cognitive Therapy (TBCT) developed by De-Oliveira, a novel technique in which the therapist engages the patient in a simulated judicial trial with the goal of identifying and changing core dysfunctional beliefs. The group intervention consisted of exposition therapy based on the Hofmann and Otto protocol (Group CBT) to restructure negative and dysfunctional cognitions regarding social situations. Both interventions reduced psychiatric symptoms from pre- to post-test and primary social anxiety and depression symptoms relative to waitlist controls. The interventions were recently introduced in Brazil, and this is the first randomized control trial to compare TBCT and this Group CBT, which were effective in assessing changes in social anxiety symptoms as well as co-occurring psychiatric symptoms.     

Helping Couples in the Shadow of COVID-19

The pandemic caused by the SARS-CoV-2 virus (coronavirus) and the associated illness, COVID-19, has caused a level of worldwide upheaval unlike any most people now living have seen in their lifetimes. This crisis affects people in their most important, committed, and intimate relationships. Although this crisis has damaged the health and well-being of individuals, crushed economies, and led to an extensive period of uncertainty about the future, there may also be positive outcomes in the motivation people have to protect their relationships. In this paper, we focus on strategies that therapists and relationship educators can use to help couples preserve and protect their relationships during such a time. We describe four foundations of safety that allow relationships to thrive: physical, emotional, commitment, and community. We then highlight three keys from our body of work that can help guide individuals and couples in protecting their relationships on a day-to-day and moment-to-moment basis: (1) decide, don’t slide; (2) make it safe to connect; (3) do your part.     

Comparing Cognitive Behavioral Therapy and Systemic Therapy for Social Anxiety Disorder: Randomized Controlled Pilot Trial (SOPHO-CBT/ST)

This randomized controlled trial (RCT) aimed to pilot the newly developed manualized and monitored systemic therapy (ST) for social anxiety disorder (SAD), as compared to manualized and monitored cognitive behavioral therapy (CBT). We conducted a prospective multicenter, assessor-blind pilot RCT on 38 outpatients (ICD F40.1; Structured Clinical Interview for DSM (SCID); Liebowitz Social Anxiety Scale, LSAS-SR >30). The primary outcome was level of social anxiety (LSAS-SR) at the end of treatment. A total of 252 persons were screened, and 38 patients were randomized and started therapy (CBT: 20 patients; ST: 18 patients; age: M = 36 years, SD = 14). Within-group, simple-effect intent-to-treat analyses (ITT) showed significant reduction in LSAS-SR (CBT:d = 1.04; ST:d = 1.67), while ITT mixed-design ANOVA demonstrated the advantage of ST (d = 0.81). Per-protocol analyses supported these results. Remission based on reliable change indices also demonstrated significant difference (LSAS-SR: 15% in CBT; 39% in ST;h: 0.550), supported by blind diagnosticians’ ratings of those who completed therapy (SCID; 45% in CBT, 78% in ST,p = .083). No adverse events were reported. CBT and ST both reduced social anxiety, supporting patient improvement with the newly developed ST for SAD; this has yet to be verified in a subsequent confirmatory RCT.     

Differential efficacy between cognitive-behavioral therapy and mindfulness-based therapies for chronic pain: Systematic review

Background/Objective: To assess the differential efficacy between mindfulness-based interventions and cognitive-behavioral Therapy (CBT) on chronic pain across medical conditions involving pain. Method: ProQuest, Science Direct, Google Scholar, Pubmed, and Embase databases were searched to identify randomized clinical trials. Measurements of mindfulness, pain, mood, and further miscellaneous measurements were included. Results: 18 studies met the inclusion criteria (fibromyalgia, n = 5; low back pain, n = 5; headache/migraine, n = 4; non-specific chronic pain, n = 4). In fibromyalgia, mindfulness based stress reduction (MBSR) was superior to the usual care and Fibroqol, in impact and symptoms. In low back pain, MBSR was superior to the usual care, but not to CBT, in physical functionality and pain intensity. There were no studies on differential efficacy between mindfulness and CBT for headache and non-specific chronic pain, but Mindfulness interventions were superior to the usual care in these syndromes. Conclusions: Mindfulness interventions are superior to usual cares in all diagnoses, but it is not possible to conclude their superiority over CBT. Comparisons between mindfulness interventions are scarce, with MBSR being the most studied. In central sensitization syndromes, variables associated with pain tend to improve with treatment. More research is needed to differentiate diagnosis and intervention.     

Effectiveness of Couple Therapy in Practice Settings and Identification of Potential Predictors for Different Outcomes

Even though couple therapy is efficacious, there is no improvement in up to 50% of the couples. Also effect sizes found in effectiveness studies in real-world settings are considerably lower than those found in efficacy studies. There is a need to understand more about couple therapy effectiveness in practice settings and the factors responsible for different outcomes. A German nationwide study on the effectiveness of couple counseling including 554 couples applied the same methodology as two earlier studies in the same field. A remarkable consistency was found over the three independent studies in the burden with individual and relationship distress as well as in the rates of improvement. This supports the insight that the improvements reached through couple therapy in practice settings are only about half of the effect sizes reached in efficacy trials. Additionally this study investigated 64 factors, which were found to be influential for relationship quality and stability in earlier studies, for their impact on outcome. Factors present at initiation and termination of therapy were found, which correlate significantly with outcome and with separation of the couple in the follow-up. These factors could be included in prediction models for improvement and separation of the couple. The implications for the practice of couple therapy and for future research are discussed.