Effect Of Psychotherapy In Patients Research Articles

Psychotherapy for comorbid depression and somatic disorders: a systematic review and meta-analysis.

The treatment of depression in patients with somatic disorders is crucial, given its negative impact on quality of life (QoL), functioning, and even on the somatic disease prognosis. We aimed to examine the most updated evidence on the effects of psychotherapy in patients with depression and somatic disorders, including HIV, oncological, cardiometabolic, and neurological disorders. We conducted a meta-analysis of 75 randomized trials (8209 participants) of psychotherapy for adults with somatic disorders and a diagnosis or elevated symptoms of depression. Outcomes included depression, QoL, somatic health-related outcomes, and mortality. Psychotherapy significantly reduced the severity of depression at post-treatment across all categories of somatic disorders (Hedges'g = 0.65; 95% CI 0.52-0.79), with sustained effects at 6-11 months (g = 0.38; 95% CI 0.22-0.53) and at 12 months follow-up or longer (g = 0.13; 95% CI 0.04-0.21). Psychotherapy also showed significant effects on QoL (g = 0.26; 95% CI 0.17-0.35), maintained up to 11 months follow-up (g = 0.25; 95% CI 0.16-0.34). No significant effects were observed on the most frequently reported somatic health-related outcomes (glycemic control, pain), and neither on mortality. Heterogeneity in most analyses was very high, and only 29 (38%) trials were rated at low risk of bias (RoB). Psychotherapy may be an effective treatment option for patients with depression and somatic disorders, with long-term effects on depression severity and QoL. However, these results should be interpreted with caution due to heterogeneity and RoB.

Psychological treatment of depression in institutional settings: A meta-analytic review

Background: Many depressed patients are treated in institutional settings. The number of studies focusing on psychotherapies for depressed patients in institutional settingsis limited, and only a few up-to-date meta-analyses have integrated the results of these studies.Methods: We conducted a meta-analysis of 32 randomized trials with 37 comparisons between psychotherapy and control conditions, examining the effects of psychotherapy for adult patients in institutional settings with depressive disorders.Results: We found that psychotherapy had a significant, small to moderate effect on depressive symptoms (g=0.42; 95% CI: 0.29~0.56), with low to moderate heterogeneity (I2=33; 95% CI: 0~55). The effects remained small but significant after adjustment for publication bias (g=0.27; 95% CI: 0.12~0.42) and in the studies with low risk of bias (g=0.32; 95% CI: 0.11~0.52). The effects were largely retained at 9 to 15 months follow-up and still significant, again after adjustment for publication bias and in studies with low risk of bias. We found no significant difference across types of institutional settings, including psychiatric inpatient settings and nursing homes, although no studies with a low risk of bias were available in nursing homes.Limitations: We included different types of institutional settings, although we did not find a significant difference between settings. The number of studies was small and risk of bias was high in a considerable number of trials.Conclusions: This meta-analysis provides evidence for a small to moderate and sustained effect of psychotherapy in patients in institutional settings with depression.

Outcome of CBT-based multimodal psychotherapy in patients with psychogenic nonepileptic seizures: A prospective naturalistic study

PurposePsychotherapy is recommended in patients with psychogenic nonepileptic seizures (PNES). To date, however, a limited number of studies have attempted to assess the long-term effectiveness of psychotherapy in patients with PNES. Here, we report the short and six-month follow-up seizure and psychopathological outcomes in patients with PNES who have undergone a combination of cognitive–behavioral individual and group therapy. MethodsIn this prospective, naturalistic study, 80 patients with PNES underwent cognitive behavioral psychotherapy in an inpatient setting (mean duration: 64.5 days) and were evaluated prior to treatment (T1) and at its end (T2). Six months after treatment, 55 patients participated in the follow-up assessment (T3). Psychopathology questionnaires and PNES ratings were used at T1, T2, and T3 to determine outcomes. ResultsAt T2, 23% of the patients were free from PNES for ≥2 weeks. At T3, 21.8% were seizure-free for ≥1 month and 10.9% for ≥3 months. Only two patients who were free from PNES at T2 remained free from PNES until T3. Ten further patients achieved seizure freedom during the follow-up period and were free from seizures for ≥1 month at T3. Nevertheless, a subjective improvement of the seizure situation was reported by 74.1% of the patients. Patients' psychopathology scores decreased from T1 to T2 and remained stable after discharge (except for a slight increase of depression score from T2 to T3). Those patients who were PNES-free at T3 had less severe psychopathology, experienced less traumatic events, and PNES were prolonged prior to treatment than those who did not become seizure-free. SignificanceInpatient psychotherapy led to PNES freedom in a minority of patients. Pretreatment psychopathology was the key factor affecting six-month follow-up seizure outcomes. Expectations should be formed in accordance with these perspectives, i.e., seizure freedom is difficult to achieve in many patients, but psychotherapy may be useful to treat underlying psychopathology. As our results stem from a specific patient sample (i.e., patients with chronic and refractory PNES) treated in a very specific setting, the generalizability of our findings is limited.

The Effectiveness of Psychotherapy in the Rehabilitation of Patients with Consequences of Spinal Injury

Objective: to study the effectiveness of psychotherapy in patients with consequences of spinal injury. Material and methods. The research included 113 people, who were divided into two groups: 1a (n = 56) - those who underwent a course of psychotherapy, 1b (n = 57) - those who did not. The Taylor Manifest Anxiety Scale, Montgomery-Åsberg Depression Rating Scale (MADRS), and Toronto Alexithymia Scale (TAS) were applied for the diagnosis. Painful sensations were evaluated by the Visual Analog Scale (VAS), Questionnaire for Neuropathic Pain (DN4 questionnaire). Results. The comparative analysis of groups 1a and 1b revealed significant differences in the input criteria of the MADRS (U = 1105.5, Z = 2.82, p = 0.005) and the Taylor (U = 1105.5, Z = 2.82, p = 0.005), which were leveled after a course of psychotherapy. Significant differences in the consistent comparison of the VAS test results were also found (1a - χ 2 = 7.35, p = 0.025; 1b - χ 2 = 3.63, p 2 = 20.51, p 2 = 1.20, p < 0.55). Conclusion . The analysis of the results obtained in the group of the patients who had undergone psychotherapy, showed lower perception of pain syndrome, decreased alexithymia, anxiety and depression rates.

Psychotherapy for depression among incurable cancer patients

The most common psychiatric diagnosis among cancer patients is depression; this diagnosis is even more common among patients with advanced cancer. Psychotherapy is a patient-preferred and promising strategy for treating depression among cancer patients. Several systematic reviews have investigated the effectiveness of psychological treatment for depression among cancer patients. However, the findings are conflicting, and no review has focused on depression among patients with incurable cancer. To investigate the effects of psychotherapy for treating depression among patients with advanced cancer by conducting a systematic review of randomized controlled trials (RCTs). We searched the Cochrane Pain, Palliative and Supportive Care Group Register, The Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, and PsycINFO databases in September 2005. All relevant RCTs comparing any kind of psychotherapy with conventional treatment for adult patients with advanced cancer were eligible for inclusion. Two independent review authors identified relevant studies. Two review authors independently extracted data from the original reports using standardized data extraction forms. Two independent review authors also assessed the methodological quality of the selected studies according to the recommendations of a previous systematic review of psychological therapies for cancer patients that utilized ten internal validity indicators. The primary outcome was the standardized mean difference (SMD) of change between the baseline and immediate post-treatment scores. We identified a total of ten RCTs (total of 780 participants); data from six studies were used for meta-analyses (292 patients in the psychotherapy arm and 225 patients in the control arm). Among these six studies, four studies used supportive psychotherapy, one adopted cognitive behavioural therapy, and one adopted problem-solving therapy. When compared with treatment as usual, psychotherapy was associated with a significant decrease in depression score (SMD = -0.44, 95% confidence interval [CI] = -0.08 to -0.80). None of the studies focused on patients with clinically diagnosed depression. Evidence from RCTs of moderate quality suggest that psychotherapy is useful for treating depressive states in advanced cancer patients. However, no evidence supports the effectiveness of psychotherapy for patients with clinically diagnosed depression.

Psychotherapy in patients with optic papilledema undergoing optic nerve sheath fenestration

Objective To explore the effect of psychotherapy in patients with optic papilledema undergoing optic nerve sheath fenestration (ONSF) . Methods Using convenience sampling method, a total of 64 patients with intracranial hypertension and optic papillary edema who were diagnosed by Ophthalmology Department of Xuanwu Hospital of Capital Medical University from 2013 to 2017 were selected as the subjects of study. All the subjects were randomly divided into two groups, with 32 patients in each group. Patients in the control group received routine ophthalmic nursing. The patients in the observation group were given six-step psychological intervention. Self-rating Anxiety Scale (SAS) were applied within 2 days after admission and before discharge to evaluate the patients. Results The score of SAS before discharge in the observation group was (46.28±4.48) , which was lower than that in the control group (56.84±8.25) , and the difference was statistically significant (t=6.363, P<0.01) . Conclusions Relevant psychotherapy can improve the anxiety of patients, so that patients can cooperate well with the treatment, which is worthy of clinical application. Key words: Psychotherapy; Papilledema; Optic nerve sheath fenestration; Increased intracranial pressure

It can’t hurt, right? Adverse effects of psychotherapy in patients with depression

Despite growing awareness of occasional adverse effects of psychological treatments, only a few instruments cover side effects and other unwanted effects of psychotherapy. For the present study, the Positive and Negative Effects of Psychotherapy Scale (PANEPS) was evaluated in a population of individuals with depression who had completed at least one course of face-to-face psychotherapy. A total of 135 individuals with a current or previous depressive episode as verified by a diagnostic interview filled out the online version of the PANEPS, which is designed to capture both positive and adverse events. Factor analysis yielded four dimensions: positive effects, side effects, malpractice, and unethical conduct. Internal consistency of the individual subscales was satisfactory to excellent (Cronbach's α: 0.72 and 0.92). Positive effects were reported by virtually all patients (95.6%). At the same time, approximately half of the sample noted at least one adverse event (52.6%). Among these, side effects (38.5%) and malpractice (26.7%) were significantly more prevalent than unethical conduct (8.1%). As expected, positive effects were negatively correlated with adverse events. Our results challenge the common clinical assumption that some degree of destabilization is necessary for symptom improvement. The survey was conducted anonymously, and the sample underwent diagnostic verification. The results indicate a need for improved treatment guidelines and mechanisms to monitor treatment.

Self-critical perfectionism, dependency, and symptomatic distress in patients with personality disorder during hospitalization-based psychodynamic treatment: A parallel process growth modeling approach.

There is growing evidence for the efficacy and effectiveness of psychotherapy in patients with personality disorder (PD), but very little is known about the factors underlying these effects. Two-polarities models of personality development provide an empirically supported approach to studying therapeutic change. Briefly, these models argue that personality pathology is characterized by an imbalance between development of the capacity for self-definition and for relatedness, with an exaggerated emphasis on issues regarding self-definition and relatedness being expressed in high levels of self-critical perfectionism (SCP) and dependency, respectively. This study used data from a study of 111 patients with PD who received long-term hospitalization-based psychodynamic treatment to investigate whether (a) treatment was related to changes in SCP, dependency, and symptomatic distress; (b) these changes could be explained by pretreatment levels of SCP, dependency, and/or symptomatic distress; and (c) changes in these personality dimensions over time were associated with symptomatic improvement. SCP, dependency, and symptomatic distress were assessed at admission (baseline), at 12 and 24 weeks into treatment, and at discharge. Parallel process multilevel growth modeling showed that (a) treatment was associated with a significant decrease in levels of SCP, dependency, and symptomatic distress, whereas (b) pretreatment levels of each of these three factors did not predict the decreases observed, and (c) changes in SCP, but not dependency, were associated with the rate of decrease in symptomatic distress over time. Implications of these findings for our understanding of therapeutic change in the treatment of PD are discussed. (PsycINFO Database Record

The study on the effect of psychotherapy in patients with methadone maintenance treatment

Objective To explore the effect of psychotherapy in patients with methadone maintenance treatment.Methods 60 patients accepted drug and 69 patients accepted drug with psychotherapy treatment were evaluated with Self-Rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS) in the beginning of psychotherapy therapy and 3 months later.All of them were assessed for heroin use at 3 months after the end of a 3-month treatment period.Results SAS、SDS did not show any significant differences between the two groups in the beginning(P ＞0.05).After 3 months of psychotherapy,the differences in SDS and SAS between the two groups showed statistically significant(t =- 2.858,- 2.465,all P ＜0.05).After 2 months of psychotherapy,the number of relapsing again patients of group psychotherapy treatment was significantly lower than control group(x2 =6.906,5.054,5.100,4.247,all P ＜0.05).Conclusion The mental healthy status of patients with heroin dependence is poor.Psychological treatment plays an important role in short-term prevent hernoin addicts from relapse again. Key words: Heroin dependence; Methadone; Psychotherapeutic processes

P02-37 - Comparison of the effect of pharmacotherapy and the combination of psychotherapy and pharmacotherapy in the treatment of depressive disorder

IntroductionSome studies showed auxilary effect of psychotherapy in patients suffering from depression treated by psychopharmacology. The aim of our study was to verify the treatment effect of training psychotherapy under the conditions of The Department of Psychiatry in Olomouc.MethodTotal amount of 40 patients, who were hospitalized at The Psychiatric Department during the time period of years 2003–2004 with the diagnosis of Major Depressive Disorder-mild, moderate and severe form was included. 20 patients received psychiatric medication only (without any systematic psychotherapeutic support) and 20 remaining patients of the open psychotherapeutic department received combination of psychotherapy and pharmacotherapy. Psychopharmacological treatment was comparable in both samples as far as quality and quantity is concerned. We used at the psychotherapeutic department group training therapy and individual psychotherapy. Before the treatment was used HAMD and CGI- Seriousness of the disorder, before the end of the hospitalization and the therapy, we used HAMD and CGI/ Global Improvement.ResultsEvaluation of the obtained data showed decrease on the HAMD scale (0,5 points) for the patients treated with the combination of psychotherapy and pharmacotherapy in the comparison with the group treated only with pharmacotherapy. This finding was even more obvious on the CGI scale, where the difference of the improvement reached up to 0,3 points again for the combined treatment, but were not significant.ConclusionIn the treatment of the acute phase of Major depressive disorder, we did not prove a positive effect of the training psychotherapy.

The effect of psychotherapy in patients with PD: A controlled study

The purpose of this study was to evaluate whether group psychotherapy was effective in improving of quality of life and would decrease the symptoms of anxiety and depression in Parkinson's disease patients. Sixteen subjects, with idiopathic Parkinson's disease recruited from the school clinical Hospital/UNICAMP. Were randomly divided in to two groups, experimental and control. Parkinson's Disease and Quality of Life – PDQL; Beck Depression Inventory – BDI; State-Trait-Anxiety Inventory – STAI were used to evaluate the patients. The statistical analysis showed significant effect of the interaction group vs. time in depression (0.0009), anxiety (<0.0001) and QuoL (0.0018) and positive changes in depression (0.0029), anxiety (0.0009) and QuoL (0.0047) for the treated group.

Effect of mind on brain activity: Evidence from neuroimaging studies of psychotherapy and placebo effect

Mentalistic variables must be considered to reach a correct understanding of the neurophysiological basis of behavior in humans. Confusion regarding the relative importance of neurophysiological and mentalistic variables can lead to important misconceptions about causes and effects in the study of human behavior. In this article, we review neuroimaging studies of the effect of psychotherapy in patients suffering from diverse forms of psychopathology (obsessive–compulsive disorder, panic disorder, unipolar major depressive disorder, spider phobia). We also review neuroimaging studies of the placebo effect in healthy individuals (placebo analgesia, psychostimulant expectation) and patients with Parkinson's disease or unipolar major depressive disorder. Mental functions and processes involved in diverse forms of psychotherapy exert a significant influence on brain activity. With regard to the placebo effect, beliefs and expectations can markedly modulate neurophysiological and neurochemical activity in brain regions involved in perception, movement, pain and various aspects of emotion processing. The findings of the neuroimaging studies reviewed here strongly support the view that the subjective nature and the intentional content of mental processes significantly influence the various levels of brain functioning (e.g. molecular, cellular, neural circuit) and brain plasticity.

Psychotherapy for depression among incurable cancer patients

The most common psychiatric diagnosis among cancer patients is depression; this diagnosis is even more common among patients with advanced cancer. Psychotherapy is a patient-preferred and promising strategy for treating depression among cancer patients. Several systematic reviews have investigated the effectiveness of psychological treatment for depression among cancer patients. However, the findings are conflicting, and no review has focused on depression among patients with incurable cancer. To investigate the effects of psychotherapy for treating depression among patients with advanced cancer by conducting a systematic review of randomized controlled trials (RCTs). We searched the Cochrane Pain, Palliative and Supportive Care Group Register, The Cochrane Controlled Trials Register, MEDLINE, EMBASE, CINAHL, and PsycINFO databases in September 2005. All relevant RCTs comparing any kind of psychotherapy with conventional treatment for adult patients with advanced cancer were eligible for inclusion. Two independent review authors identified relevant studies. Two review authors independently extracted data from the original reports using standardized data extraction forms. Two independent review authors also assessed the methodological quality of the selected studies according to the recommendations of a previous systematic review of psychological therapies for cancer patients that utilized ten internal validity indicators. The primary outcome was the standardized mean difference (SMD) of change between the baseline and immediate post-treatment scores. We identified a total of ten RCTs (total of 780 participants); data from six studies were used for meta-analyses (292 patients in the psychotherapy arm and 225 patients in the control arm). Among these six studies, four studies used supportive psychotherapy, one adopted cognitive behavioural therapy, and one adopted problem-solving therapy. When compared with treatment as usual, psychotherapy was associated with a significant decrease in depression score (SMD = -0.44, 95% confidence interval [CI] = -0.08 to -0.80). None of the studies focused on patients with clinically diagnosed depression. Evidence from RCTs of moderate quality suggest that psychotherapy is useful for treating depressive states in advanced cancer patients. However, no evidence supports the effectiveness of psychotherapy for patients with clinically diagnosed depression.

Religious psychotherapy as management of bereavement.

This study was aimed at determining the effect of psychotherapy in patients in bereavement. Fifteen patients in a control group were given brief psychotherapy and 15 study group patients received psychotherapy with a religious perspective. The patients in the study group showed consistently significant improvements as compared with the control group at the end of 6 months. The results indicate that highly religious patients with grief and bereavement tend to improve faster when a religious psychotherapy is added to a cognitive-behaviour approach.

Complex psychotherapy for patients with bronchial asthma and chronic obstructive bronchitis

We have analyzed the effectiveness of psychotherapy for patients with bronchial asthma and chronic obstructive bronchitis in general hospital conditions.There were 104 patients under observation. 70 patients (27 men and 43 women) at the age of 16-62 years formed the main group. Bronchial asthma was diagnosed in 42 patients, infection-dependent and mixed variants with a severe course, in 28 patients - chronic obstructive bronchitis. The basic disease lasted from 1,5 to 28 years and was complicated by pulmonary emphysema in 9 patients, respiratory failure of I-II degree in 58 patients; 9 persons became disabled.