Effective Psychotherapeutic Interventions Research Articles

S42-01 Group therapy for adults with ADHD

Adult ADHD is a serious risk factor for co-occuring psychiatric disorders and negative psychosocial consequences. Given this background, instead of or in addition to psychopharmacological treatment there is a need for effective psychotherapeutic treatment options for adults with ADHD. Previous trials on psychotherapeutic concepts were based on cognitive behavioural and/or dialectical behavioural approaches and showed significant effects. In a pilot study, our structured skills training group program for adult ADHD led to significant symptomatic improvements (Hesslinger et al. 2007). The following study evaluated the program's effectiveness, feasibility and patient acceptability in a multicentre setting (N = 72, Philipsen et al. 2007). The therapy was well tolerated and led to significant improvements of ADHD, depressive symptoms and personal health status (p < 0.001). Patients regarded the program topics “behavioural analyses”, “mindfulness” and “emotion regulation” as the most helpful. As in our initial study, patients in the multicentre study rated the group setting as highly effective. This might be explained as result of greater peer support and the opportunity of learning from positive role models (e.g. during homework discussion). Following our staged approach, we are currently running a large randomized multicentre placebo-controlled study for the evaluation of the efficacy of this structured group program in adult ADHD that has been approved by the German Federal Ministry of Research and Education. In this study we compare the effects of purely medical management, specific psychotherapy, and the combination of both, comparable with the Multimodal Treatment Study of Children with ADHD (MTA).

Transforming Couples and Families: A Trans-Formative Therapeutic Model for Working with the Loved-Ones of Gender-Divergent Youth and Trans-Identified Adults

ABSTRACT The recent emergence of gender-divergent youth and trans-identified adults presenting in therapy, in tandem with the scant clinical work with their partners and families, indicates a serious gap in the research literature. In addition, there is a critical need for an increase of clinically-sensitive and culturally-competent therapists who can provide support for these transforming couples and families. To be effective, such treatment interventions must be grounded in a sound body of gender-diverse and transgender knowledge. This paper identifies a number of clinical issues experienced by gender-normative partners and family members (who are often an integral part of the transforming process) who are working towards acceptance of their gender-anormative loved-ones. Effective psychotherapeutic and psychoeducational interventions to help meet the challenges facing these transforming families and couples are outlined by means of the author's Trans-formative Therapeutic Model (TfTM). The model demonstrates ways to support the partner or family member(s) in conjunction with the trans-identified or gender-divergent loved-one as a cohesive and dynamic systemic unit. Specific clinical application of the TfTM are illustrated through a case study of a young gender-divergent child and hir family.

Strategies for designing effective psychotherapeutic gaming interventions for children and adolescents

A range of face-to-face therapies and interventions for children and adolescents with mental health problems have been developed over the years and include cognitive-behavioral therapy, play therapy and applied behavior analysis. The popularity of computer games has grown exponentially in the last decade and has been widely accepted by children, adolescents and adults alike. Mental health professionals have therefore been exploring the use of these games to complement traditional treatment methods. To date however, there has been little known concrete evidence of the effectiveness of computer games for the treatment of children and adolescents with mental health conditions. Key to the success of such games is that at the outset, they must be well-designed. This paper reviews extant relevant computer gaming literature to propose a set of guidelines and strategies for the design of psychotherapeutic games targeted at children and adolescents. The issues raised concern both the game player as well as the game itself. As part of this review, limitations of existing work and areas of future research are also discussed.

Can pill placebo augment cognitive-behavior therapy for panic disorder?

BackgroundIn a number of drug and psychotherapy comparative trials, psychotherapy-placebo combination has been assumed to represent psychotherapy. Whether psychotherapy plus pill placebo is the same as psychotherapy alone is an empirical question which however has to date never been examined systematically.MethodsWe conducted a systematic review and meta-analysis of randomised controlled trials (RCTs) that directly compared cognitive-behavior therapy (CBT) alone against CBT plus pill placebo in the treatment of panic disorder.ResultsExtensive literature search was able to identify three relevant RCTs. At the end of the acute phase treatment, patients who received CBT plus placebo had 26% (95%CI: 2 to 55%) increased chances of responding than those who received CBT alone. At follow-up the difference was no longer statistically significant (22%, 95%CI: -10% to 64%).ConclusionThe act of taking a pill placebo may enhance the placebo effect already contained in the effective psychotherapeutic intervention during the acute phase treatment. Theoretically this is an argument against the recently claimed null hypothesis of placebo effect in general and clinically it may point to some further room for enhancing the psychotherapeutic approach for panic disorder.

Psychological factors in preterm labor and psychotherapeutic intervention

Prematurity is the leading cause of perinatal mortality in developing countries and nearly 50% have no identifiable clinical risk factor. A few studies have enlightened the role of psychological factors in its causation and psychotherapeutic interventions in the form of hypnosis relaxation exercises and anxiety reducing exercises. The following study was conducted to assess the psychological factors in subjects with preterm labor of unknown cause and to compare the effect of psychotherapeutic intervention along with tocolysis to tocolysis alone. Fifty subjects with preterm labor satisfying the inclusion and exclusion criteria were assessed of psychological stress using modified life inventory and abbreviated psychosocial scale. They were randomly assigned to control group (25) who received tocolysis with nifedipine and study group (25) who received nifedipine along with psychotherapeutic intervention in the form of Luthes relaxation technique and transcendental meditation. The endpoints studied were cessation of uterine contractions prolongation of pregnancy and neonatal outcome. Statistical analysis was done using Graphad Instat employing correlation analysis Students t test and Fischers exact test. (excerpt)

Treating persistent adolescent aggression

Adolescent aggressive behavior is a frequently encountered problem for clinicians and society as a whole. Better understanding of biological, social, and familial risk factors for maladaptive aggressive behavior may lead to more effective interventions. The social information processing problems characteristic of this group interfere with treatment and outcome. Although further studies are needed, evidence for the effectiveness of psychopharmacologic treatments is increasing. There is also evidence for several effective psychotherapeutic interventions, especially for those with affective/impulsive aggression. Knowledge of risk factors, psychosocial strategies, and psychopharmacologic treatments can enhance the clinician's ability to intervene with this difficult group.

Interpersonal psychotherapy: An effective psychotherapeutic intervention for mental health nursing practice

Interpersonal psychotherapy (IPT) is well-recognized for the treatment of depression with many efficacy trials supporting its use. However, there is little discussion of its use in mental health nursing practice. This paper explores how IPT can be a useful intervention for mental health nursing practice and demonstrates the process of IPT with reference to a case study. The case study illustrates how IPT facilitates a shift for one woman from a passive subject position to a more self-assertive one. This shift was facilitated by identifying how she was constructing herself in relation to others by utilizing tactics of passivity and avoidance of conflict. The development of more satisfying subject positions facilitated an improvement in mood and recovery from depression.

Motivational interviewing in community-based research: Experiences from the field

Motivational Interviewing (MI) has been established as an effective psychotherapeutic treatment for problem drinking in clinical settings. Consequently, there is a growing interest in applying MI to facilitate change across other health behaviors, such as tobacco use, eating habits, and physical activity in a variety of community-based research settings. These extended applications pose new challenges regarding implementation and evaluation. For instance, investigators must consider how best to train intervention counselors; implement strategies for preserving the MI spirit, despite limited client contact time; incorporate adjunctive strategies that support brief MI sessions; and develop a plan for monitoring and evaluating MI treatment fidelity. This article highlights specific examples of how several behavior change research projects applied MI across a variety of settings and populations, provides lessons learned from our experience as a collaborative workgroup, and offers strategies for consideration in future community-based research.

Interpersonal psychotherapy: An effective psychotherapeutic intervention for mental health nursing practice

Interpersonal psychotherapy (IPT) is well-recognized for the treatment of depression with many efficacy trials supporting its use, however, there is little discussion of its use in mental health nursing practice. This paper explores how IPT can be a useful intervention for mental health nursing practice and demonstrates the process of IPT with reference to a case study. The case study illustrates how IPT facilitates a shift for one woman from a passive subject position to a more self-assertive one. This shift was facilitated by identifying how she was constructing herself in relation to others by utilizing tactics of passivity and avoidance of conflict. The development of more satisfying subject positions facilitated an improvement in mood and recovery from depression.

Prospective Examination of Anxiety Persistence and Its Relationship to Cardiac Symptoms and Recurrent Cardiac Events

Background: The current study builds on previous research demonstrating a link between anxiety and inhospital recurrent ischemic and arrhythmic events, by examining the effects of persistent anxiety on recurrent events 1 year later. Methods: 913 patients with unstable angina (UA) and myocardial infarction (MI) from 12 coronary care units were recruited, and follow-up data were collected at 6 and 12 months after the event. Measures included cardiac symptomatology, healthcare utilization, the anxiety subscale of the Primary Care Evaluation of Mental Disorders , the phobic anxiety subscale of the Middlesex Hospital Questionnaire, and the Beck Depression Inventory. Results: Over one third of participants with UA and MI experienced elevated anxiety at the time of the ischemic event, and these symptoms persisted for 1 year in 50% of anxious participants. Although participants with anxiety reported more atypical cardiac symptomatology, the prevalence of typical cardiac symptoms such as chest pain did not differ based on anxiety. After controlling for the severity of the coronary event, family income, sex, diabetes, and smoking, the following variables were significantly predictive of self-reported recurrent cardiac events at 6 months or 1 year: older age, family history of cardiovascular disease, greater depressive symptomatology at baseline, and anxiety at 6 months. Only 38% of anxious patients were asked about such symptoms, indicating underutilization of effective psychotherapeutic treatment. Conclusions: Over and above the effects of depressive symptomatology (among other confounding variables), nonphobic anxiety appears to have a negative effect on self-reported outcome following an ischemic coronary event. Anxiety symptomatology is underrecognized and undertreated, and examination of effects of treatment on secondary prevention must be pursued.

A balanced psychology and a full life.

Psychology since World War II has been largely devoted to repairing weakness and understanding suffering. Towards that end, we have made considerable gains. We have a classification of mental illness that allows international collaboration, and through this collaboration we have developed effective psychotherapeutic or pharmacological treatments for 14 major mental disorders. However, while building a strong science and practice of treating mental illness, we largely forgot about everyday well-being. Is the absence of mental illness and suffering sufficient to let individuals and communities flourish? Were all disabling conditions to disappear, what would make life worth living? Those committed to a science of positive psychology can draw on the effective research methods developed to understand and treat mental illness. Results from a new randomized, placebo-controlled study demonstrate that people are happier and less depressed three months after completing exercises targeting positive emotion. The ultimate goal of positive psychology is to make people happier by understanding and building positive emotion, gratification and meaning. Towards this end, we must supplement what we know about treating illness and repairing damage with knowledge about nurturing well-being in individuals and communities.

The Use of Narrative Data to Inform the Psychotherapeutic Group Process with Suicide Survivors

While bereavement is considered by many to be among one of the most stressful life events, it becomes even more distressing when it is related to the suicide of a loved one. A synopsis of psychosocial outcomes of suicide survivor bereavement is presented along with an overview of group interventions designed to help these survivors cope with their grief. The structure of an ongoing eight-week bereavement support group is described to lay a foundation for the application of narrative theory within the group process. Using narrative theory and structural analysis, the discourse of group members is presented and various themes are discussed in an effort to contribute to the task of developing effective psychotherapeutic group interventions for survivors of suicide.

The Ghost in the Group Room: Countertransferential Pressures Associated with Conjoint Individual and Group Psychotherapy

Conjoint individual and group therapy is a commonly used, effective psychotherapeutic treatment. The relationship between the conjoint therapists significantly influences the treatment. This article examines countertransference dilemmas of the group and individual therapists arising from the real and fantasied conjoint relationship. Case examples illustrate specific countertransference dilemmas. Therapists are encouraged to consider the possibility of difficulties with each potential conjoint treatment. Consultation and supervision are recommended to help the conjoint therapists identify and manage countertransference pressures.

Current standing of forensic psychotherapy in Germany

Although treatment of inmates already has got a long tradition in Germany, forensic psychotherapy is - especially outside the so-called German "Massregelvollzug" - only at its beginnings, and consistent theories about delinquency and treatment programmes have not yet been established. While international studies show high prevalence of mental disorders in prisons (up to 60 - 70 %), in Germany even basic epidemiological data about the prevalence of mental disorders among inmates is still missing. Thus, the need for psychotherapy can only be roughly estimated. Ethical implications regarding the self-image, an ambivalent assignment for treatment (given by society) and a recent tightening of German law create a difficult framework for forensic psychotherapy, complicating the establishment as well as the evaluation of new treatment programmes, especially since many people still doubt the efficiency of forensic psychotherapy for delinquents despite convincing counter-evidence. It seems obvious that in Germany much research has to be done in the fields of epidemiology as well as in forensic psychotherapy in order to gain basic data and to be then able to provide effective psychotherapeutic treatment facilities aiming at the needs of mentally disturbed offenders.

BASIC PRINCIPLES FOR APPLYING COGNITIVE-BEHAVIORAL THERAPY TO ANOREXIA NERVOSA

Cognitive-behavioral therapy continues to be one of the recommended evidenced-based interventions in the treatment of eating disorders. Cognitive-behavioral therapy is clearly of benefit in anorexia and bulimia nervosa, can be learned in a reasonable time, and is guided by manuals on cognitive-behavioral therapy. This article looks at theoretic and clinical interventions in the treatment of anorexia nervosa and suggests strategies related to effective psychotherapeutic treatment that can be used across a continuum of care.

Treatment for chronic depression: cognitive behavioral analysis system of psychotherapy (CBASP)

Chronic depression is a common disorder in secondary care. Treatment results for this group of depressed patients are often disappointing and the existing treatment protocols are insufficiently tailored to chronic MDD. For this reason, an effective psychotherapeutic treatment will constitute a welcome addition to the range of treatments currently available for chronically depressed patients.To describe 'cognitive behavioral analysis system of psychotherapy' (CBASP), the first form of psychotherapy specifically designed for the treatment of chronic depression.This article describes the evidence, rational and the most important techniques of CBASP.In the United States CBASP has proven to be effective in one trial. As a result of these findings, CBASP is recommended in the Dutch treatment guidelines as an evidence-based treatment option for chronic depression. However, the findings have not yet been replicated and little is known about possible ways of implementing CBASP in the Netherlands. For this reason a randomised controlled trial on the effectiveness of CBASP has started in three psychiatric hospitals in the Netherlands.CBASP is recommended as a treatment option for chronic depression in the Dutch treatment guidelines, but evidence should be further supported by additional research.

Vicarious traumatisation of counsellors and effects on their workplaces

The literature on therapists' reactions to clients' traumatic material is Critically reviewed. The various attempts within this relatively new literature to conceptualise this phenomenon include countertransference, compassion fatigue and vicarious traumatisation. The limited research evidence is evaluated and found to support anecdotal accounts by trauma therapists. Empathic engagement with trauma survivors is necessary for effective psychotherapeutic intervention. However, empathic engagement also makes therapists vulnerable to the detrimental effects of vicarious trauma, with consequent negative effects on individual counsellor effectiveness and organisational dynamics in the workplace.

Psychotherapy integration: its implications for psychiatry.

The proliferation of psychotherapies has been balanced by an equal and opposite tendency towards integration. Integrative approaches are particularly relevant to psychotherapy in psychiatric settings. MEDLINE and manual literature searches yielded over 250 articles on psychotherapy integration, which are reviewed in the light of the authors' experience in a district psychotherapy service. Psychotherapy integration is an umbrella term covering a wide range of meanings: rapprochement between different theoretical positions; convergence of ideas and techniques; eclectic selection from many different methods; and integration proper in specifically integrative therapies. Many effective psychotherapeutic treatments for psychiatric disorders are integrative, including those for depression, schizophrenia, bulimia nervosa and borderline personality disorder. Integration at the level of practice is common and desirable. At the level of theory, clarification and creative conflict are essential. Different therapeutic approaches should work closely together but retain their separate identities.

Cancer and Depression

Half of all cancer patients have a psychiatric disorder, usually an adjustment disorder with depression. Anxiety about illness, such as cancer, often leads to delay in diagnosis, which has been estimated to reduce prospects of long-term cancer survival by 10% to 20%. Although earlier studies showed that depressed individuals were at higher risk for cancer incidence, later studies have not confirmed this predictive relationship. Nonetheless, effective psychotherapeutic treatment for depression has been found to affect the course of cancer. Psychotherapy for medically ill patients results in reduced anxiety and depression, and often pain reduction. In three randomised studies, psychotherapy resulted in longer survival time for patients with breast cancer (18 months), lymphoma, and malignant melanoma. The physiological mechanisms for these findings have not yet been determined, but four fundamental possibilities for psychotherapeutic effects on physiological change include health maintenance behaviour, health-care utilisation, endocrine environment, and immune function. Thus, effective treatment of depression in cancer patients results in better patient adjustment, reduced symptoms, reduced cost of care, and may influence disease course. The treatment of depression in these patients may be considered a part of medical as well as psychiatric treatment.

Examining Psychotherapeutic and Psychosocial Factors in Working with Immigrant Families

In spite of the fact that the United States has been historically associated with immigrants, little is still known about the process of assimilation that immigrant families go through, and a lack of sensitivity to the cultural diversity of immigrant families persists. Some mental health workers still suggest that the same techniques employed in working with American families can be applied to immigrant families. Through years of research, behavioral scientists have come to realize that a different approach to tutelage and psychotherapy is needed if immigrant families are to acculturate smoothly in American society. This paper addresses some problems associated with acculturation, the process of acculturation, immigrant families in transition and perspectives on the effectiveness of psychotherapeutic interventions. Some rudimentary guidelines are presented for understanding immigrant families via a comprehensive assessment battery which can assist in determining the stages of acculturation, the client's social and emotional functioning, as well as any cultural transitional conflicts the client may be experiencing as a result of migration. Moreover, a model for treating immigrant families is suggested.