Impact Of Psychotherapy Research Articles

Study of a PST-trained voice-enabled artificial intelligence counselor for adults with emotional distress (SPEAC-2): Design and methods

BackgroundNovel and scalable psychotherapies are urgently needed to address the depression and anxiety epidemic. Leveraging artificial intelligence (AI), a voice-based virtual coach named Lumen was developed to deliver problem solving treatment (PST). The first pilot trial showed promising changes in cognitive control measured by functional neuroimaging and improvements in depression and anxiety symptoms. MethodsTo further validate Lumen in a 3-arm randomized clinical trial, 200 participants with mild-to-moderate depression and/or anxiety will be randomly assigned in a 2:1:1 ratio to receive Lumen-coached PST, human-coached PST as active treatment comparison, or a waitlist control condition where participants can receive Lumen after the trial period. Participants will be assessed at baseline and 18 weeks. The primary aim is to confirm neural target engagement by testing whether compared with waitlist controls, Lumen participants will show significantly greater improvements from baseline to 18 weeks in the a priori neural target for cognitive control, right dorsal lateral prefrontal cortex engaged by the go/nogo task (primary superiority hypothesis). A secondary hypothesis will test whether compared with human-coached PST participants, Lumen participants will show equivalent improvements (i.e., noninferiority) in the same neural target from baseline to 18 weeks. The second aim is to examine (1) treatment effects on depression and anxiety symptoms, psychosocial functioning, and quality of life outcomes, and (2) relationships of neural target engagement to these patient-reported outcomes. ConclusionsThis study offers potential to improve the reach and impact of psychotherapy, mitigating access, cost, and stigma barriers for people with depression and/or anxiety.Clinicaltrials.gov #: NCT05603923

Exploring the Effects of Major Depressive Disorder on Daily Occupations and the Impact of Psychotherapy: A Literature Review.

Major depressive disorder (MDD) is a prevalent psychological mood disorder that can disrupt one's functioning and result in decreased engagement in daily activities. Psychotherapy, in different approaches, is a common approach for individuals experiencing MDD. Nevertheless, a literaturereview of the research supporting the effectiveness of psychotherapeutic interventions in patients with MDD-impacted areas of their daily occupations, such as back to work, cognitive deficits, and well-being, has not been conducted. A literature review was carried out to evaluate the effectiveness of psychotherapy on daily occupations for individuals diagnosed with MDD. Due to variations in study design and outcome measures, a best evidence synthesis was carried out instead of a meta-analysis. Forty-one identified articles were fully assessed in total. These studies were conducted in various countries so that a global approach could be considered comprehensive. The findings showed strong evidence supporting the effectiveness of psychotherapy on return-to-work interventions in improving depressive symptoms. There was limited evidence for the effectiveness of psychotherapy on lifestyle interventions in reducing anxiety and suicidal ideation, as well as limited evidence for enhancing work participation. Notably, there were no studies evaluating individualized client-centered psychotherapy interactions with occupations, revealing a research gap. Challenges such as incomplete reporting within studies and study heterogeneity prevented a meta-analysis. While the overall evidence base for the effectiveness of psychotherapy for MDD in treating functionality is limited, the findings provide strong support for the efficacy of occupational therapy return-to-work interventions. This is particularly important given the economic costs associated with mental health issues and work-related absences. Further research is required to strengthen the existing evidence base.

Impact of Psychotherapy and Cognitive restructuring on wellbeing of Geriatric Survivors of Covid-19 pandemic

The present study documents the impact of Psychotherapy on wellbeing of geriatric survivors of Covid -19, who were dealing with post covid complications both physiological and psychological. Some were referred by counsellors and some by family members and some were referred through their physicians as they refused to continue medication and were emotionally shattered. This document is about twenty such elderly people. Present psychological condition was comorbid with pre-existing medical condition of chronic Diabetes, hypertension and Arthritis. There routine medication as prescribed by their physicians continued and were not altered in any respect. They were only worked on the psychologically morbid symptoms that were affecting their wellbeing. A pre-test was done by administering WHO-5, a reliable and valid measure to screen wellbeing of individuals. The findings showed poor wellbeing. Psychotherapy and cognitive restructuring strategies were used in the intervention process. Psychotherapy helped in developing a deeper insight into the past events that were causing psychological turbulences in the present. Cognitive restructuring strategies were used to address the cognitive distortions. The findings indicated a significantly positive outcome and improvement in wellbeing when tested pre-post on WHO-5 scale. These techniques helped in alleviating symptoms of stress, depressive episodes, generalised anxiety and helped in regulating emotions, behaviour, and cognitions. They were also able to get to a functional state in dealing with loss of their loved ones. They moved on from helplessness to strength to self-acceptance. Conclusively, Psychotherapy and cognitive restructuring are effective in improving wellbeing of geriatric survivors dealing with psychological, affective and cognitive issues in post covid recovery period.

Epigenetic Studies in Psychotherapy: A Systematic Review

Background: Epigenetic modifications appear to be dynamic and they might be affected by environmental factors. The possibility of influencing these processes through psychotherapy has been suggested. Objective: To analyse the impact of psychotherapy on epigenetics when applied to mental disorders. The main hypothesis is that psychological treatments will produce epigenetic modifications related to the improvement of treated symptoms. Methods: A computerised and systematic search was completed throughout the time period from 1990 to 2019 on the PubMed, ScienceDirect and Scopus databases. Results: In total, 11 studies were selected. The studies were evaluated for the theoretical framework, genes involved, type of psychotherapy and clinical challenges and perspectives. All studies showed detectable changes at the epigenetic level, like DNA methylation changes, associated with symptom improvement after psychotherapy. Conclusion: Methylation profiles could be moderating treatment effects of psychotherapy. Beyond the detected epigenetic changes after psychotherapy, the epigenetic status before the implementation could act as an effective predictor of response.

Psychotherapy versus treatment as usual and other control interventions in children and adolescents with overweight and obesity: a protocol for systematic review with meta-analysis and Trial Sequential Analysis

IntroductionThe prevalence of children with overweight and obesity is increasing worldwide. Multicomponent interventions incorporating diet, physical activity and behavioural change have shown limited improvement to body mass index (BMI). However,...

On The Impact of Psychotherapy on Psychological Growth: The Waning of Defenses

ABSTRACT A discussion of Micheal Reison’s “The Subjective Importance of Accommodation and Non-Accommodation: Expanding Brandchaft’s Ideas of Pathological Accommodation” explicates Dr. Bernard Brandchaft’s signature contribution—the defense of pathological accommodation. The imperative need to maintain attachment is seen as the primary goal of this defense. Pathological Accommodation is seen as a mode of maintaining attachments to caretakers, an unconscious, compulsively self-limiting behavior which occurs when a child experiences threats to his bond with a needed parent. In Kohutian terms, pathological accommodation functions to protect the self a child has been able to construct despite formidable obstacles. The term “accommodation” is traced through writings by Atwood, Stolorow, and Brandchaft. Accommodation, in Brandchaft’s terms, refers to the child’s response to relational trauma suffered when his or her emotional expressions and/or actions regularly evoke profoundly malattuned parental responses which threaten the child’s attachment bond. Dr. Reison’s case is reviewed through the lens of these ideas and Dr. Reison’s emotional attunement and genuine appreciation of his patient is appreciated. His genuine empathic understanding of his patient is seen as the foundation of the considerable psychological development and growth demonstrated in Reison’s very fine case report. Indeed, the genuine psychological growth demonstrated eventually made the defense of pathological accommodation unnecessary.

A systematic review of service user's experience of cognitive analytic therapy (CAT).

It is increasingly acknowledged that understanding of the process and impact of psychotherapy is enhanced by awareness of the experience of service users. Cognitive analytic therapy (CAT) was developed as a time-limited and integrative psychotherapeutic approach. Although reviews have been published on CAT outcome studies, no reviews are currently available on service users' experience of CAT. This paper aims to systematically review and synthesize what is known about service users' experience of CAT. A systematic search of HDAS, Cochrane, and Ethos databases was conducted. Following this, fourteen papers were selected for review, appraised using CASP tools, and then thematically synthesized. CAT therapy enabled service users to acquire useful knowledge and skills. Most service users found CAT tools helpful in gaining insight into their reciprocal roles and patterns. However, CAT was experienced by some service users as a painful, frightening, and upsetting process, particularly in relation to the sequential diagrammatical reformulation (SDR) and reformulation letter. The importance of the therapeutic relationship was highlighted, as well as difficulties some service users had with trusting their therapist. CAT is helpful in supporting service users to understand their patterns and to identify useful coping skills. However, some service users can experience strong emotions in therapy and struggle to trust their therapist. Greater attention to working within the service users' zone of proximal development (ZPD) and engendering hope during the reformulation stage may attenuate some of these risks. Recommendations are made for future research directions. CAT therapy enables users to develop insight to their reciprocal roles and patterns and helpful coping skills. The service user's ZPD should be worked with when delivering CAT to manage risk of distress and reciprocal role enactments and enhance the working alliance. CAT therapists should explore ways to engender hope by attending to any helpful reciprocal roles, patterns, and exits.

Modifiability of Depression’s Impact on Early Revision, Narcotic Usage, and Outcomes After Total Hip Arthroplasty: The Impact of Psychotherapy

BackgroundDepression is known to negatively influence functional recovery, patient satisfaction, narcotic requirements, implant survivorship, and perioperative resource utilization after total hip arthroplasty (THA). The degree to which this effect is modifiable is largely unknown, with mixed results on preoperative pharmacological intervention, and concomitant concerns over side effects. We aim to investigate the influence of psychotherapy before THA on surgical outcomes, medical complications, and resource utilization. MethodsA retrospective chart review of Truven MarketScan Databases was performed to generate 3 cohorts: patients without depression, patients with depression who did not receive preoperative psychotherapy, and patients with depression who received psychotherapy before surgery. Outcomes of interest were resource utilization, surgical and medical complications, narcotic requirements, and 1-year and 3-year revision rates. ResultsOn multivariate analysis, depressed patients who did not receive psychotherapy were more likely to be discharged to inpatient rehabilitation facility (odds ratio [OR] 1.28, 95% confidence interval [CI] 1.10-1.48, P < .001) and require 2 or more postoperative narcotic prescriptions (OR 1.20, 95% CI 1.06-1.37, P = .004) than depressed patients who received psychotherapy. Patients who did not receive psychotherapy were more likely to have continued narcotic requirements within 1 year after surgery (OR 1.23, 95% CI 1.08-1.39, P < .001) and undergo revision at 1 year (OR 1.74, 95% CI 1.17-2.58, P = .006) and 3 years (OR 1.92, 95% CI 1.10-3.34, P = .021) than depressed patients who received psychotherapy. ConclusionThe negative influence of depression on narcotic requirements, resource utilization, and implant survivorship after THA appears to be modifiable with preoperative psychotherapy.

Impact of Psychotherapy on School Performance in School Going Adolescent

Background: Psychotherapy is the use of psychological methods particularly when based on interpersonal interaction to help a person to change behavior and overcome emotional problems like aggression, low self-esteem, anxiety .As a part of Psychotherapy,counseling is a learning oriented process which usually occurs in an interactive relationship with the aim of helping students to learn more about him or herself..Subjects and Methods:The study was conducted in department of Paediatrics Dr SushilaTiwari Hospital HaldwaniUttarakhand.It was a school based study and students of 9th and 10th class (13-17 years) with normal IQ were included.The result was analysed on the basis of a preformed questionnaire filled by children, teacher, parents before and after counseling and taking record of previous school performance.Result:150 students 39 female and 111 male participated in the study.84.7% agreed that counseling sessions were helpful to them.72% students have shown good improvement in academic performance and 64% have shown increment of 6 to 10% marks.Conclusion:Counseling programmes create a positive impact on the academic performances, career choices, course selection, college and career planning. This study shows that use of excessive social media and poor concentration in studies are among the major causes of poor performances.

P900The long-term impact of psychotherapy in patients with refractory angina

P900The long-term impact of psychotherapy in patients with refractory angina

The short- and long-term impact of psychotherapy in patients with chronic, refractory angina

The short- and long-term impact of psychotherapy in patients with chronic, refractory angina

Biographical Sketch of Guest Editors

Susan G. Lazar, M.D. has been systematically reviewing the medical literature, writing, and speaking on the topic of the cost-effectiveness of all kinds of psychotherapy since 1993 when she served as a consultant to Tipper Gore’s Mental Health Work Group of the White House Task Force for National Health Care Reform. She edited and coauthored the 2010 volume Psychotherapy Is Worth It: A Comprehensive Review of Its Cost-Effectiveness with The Committee on Psychotherapy of the Group for the Advancement of Psychotherapy, which she served as Chair. Many other publications include coauthoring a 1997 cover article in The American Journal of Psychiatry, “The Economic Impact of Psychotherapy: A Review.” She also edited and coauthored a special issue of the journal Psychoanalytic Inquiry in 1997, “Extended Dynamic Psychotherapy: Making the Case in an Era of Managed Care.” Dr. Lazar is Clinical Professor of Psychiatry at Georgetown University School of Medicine, George Washington University School of Medicine, The Uniformed Services University of the Health Sciences, and Supervising and Training Analyst at the Washington Psychoanalytic Institute. She served as the American Psychoanalytic Association’s Visiting Woman Scholar in 2010.

Insight as a common and specific impact of psychotherapy: Therapist-reported exploratory, directive, and common factor interventions.

The facilitation of insight-broadly defined as forming new connections about one's self, others, and emotions-is viewed as a key process in many forms of psychotherapy. However, relatively little empirical work has addressed what types of therapeutic techniques may facilitate or hinder insight, especially in applied settings. In this practice-research network study, 31 clients and 16 therapists completed questionnaires after 401 sessions of psychotherapy. Multilevel linear modeling was used to explore whether insights are associated with various types of treatments and therapist-reported interventions, while taking into account differences between clients, therapists, and sessions. The results indicate that the types of treatment, as defined by the theoretical orientation of therapists' supervision, were not related to client-rated insight, although this analysis requires more statistical power. However, sessions that included more therapist-reported exploratory interventions than usual for a given client were found to be lower in insight than other sessions for the same client. Similarly, therapists who reported using more exploratory interventions than other therapists had clients who reported experiencing less insight after sessions than other clients. In contrast, therapists who reported using more directive interventions than other therapists, on average, had clients who reported more insight. However, interaction effects revealed that a more complex interpretation of the data was necessary. Specifically, therapists who reported using more directive interventions than their peers, on average, had clients who reported more insight only if the therapists did not also report using high levels of exploratory interventions. Furthermore, directive interventions were associated with insight only when they were used in sessions that also had high levels of common factors. Overall, this study shows that there are both treatment-specific interventions and common factors that are associated with insight, suggesting that understanding differences between types of psychotherapy may require more nuanced analyses within and between treatments.

Psychotherapy outcome: An issue worth re-revisiting 50 years later.

Responding to an invitation to celebrate the 50th anniversary of the journal Psychotherapy, the goal of this article is to describe three general ways by which the impact of psychotherapy might be improved: (a) clinically, by encouraging the assimilation of empirically based principles of change and psychopathology research into day-to-day practice; (b) empirically, by fostering process and outcome research focused on a wide range of common factors and basic findings; as well as (c) clinically and empirically, by facilitating active collaboration of practitioners and researchers in various types of practice-oriented research. Reflected in these three potential avenues of growth are the assumptions that (a) we can improve our understanding and impact of psychotherapy by building on convergences and complementarities across different theoretical orientations, domains of research, and professional expertise, and that (b) most of the clinical and research suggestions derived by such convergence and plurality may not require drastic changes in the practice of many psychotherapists.

Uma experiência de psicoterapia de grupo dentro da Estratégia Saúde da Família

Este trabalho avaliou um Grupo de Saúde Mental desenvolvido na Estratégia Saúde da Família, baseado na análise transacional associada à terapia cognitivo-comportamental, descrevendo o impacto desta intervenção na melhoria da qualidade de vida da população atendida. Na Unidade Básica de Saúde Cruz das Almas, da Prefeitura de São Paulo, desde janeiro de 2007, realiza-se um grupo de Saúde Mental, com a frequência de uma vez por semana, com duração de uma hora. Neste grupo, os participantes discutem temas de seus interesses e aprendem técnicas de psicoterapia para lidarem com eventos do cotidiano e manejarem suas emoções e comportamentos de forma construtiva. O grupo é aberto aos interessados em participar das sessões de terapia, constituindo-se, em sua maioria, de pacientes acompanhados pelas equipes do Programa Saúde da Família e encaminhados ao Grupo de Saúde Mental. Ao ingressarem ao grupo, os pacientes preenchem o questionário sobre a saúde do(a) paciente, versão brasileira, conhecida pela sigla PHQ-9. Após frequentarem o grupo por, no mínimo, 12 sessões, os participantes preenchem um questionário de autoavaliação, informando sobre sua sensação de melhora em relação à sua saúde, melhora na autoestima e nos relacionamentos pessoais, e a visão mais positiva da vida e das outras pessoas. Dos participantes avaliados, 40 preencheram o questionário PHQ-9. Destes, nove (22,5%) tiveram pontuação de zero a quatro (sem depressão); seis (15%) tiveram pontuação de cinco a nove (depressão leve); dez (25%) tiveram pontuação de 10 a 14 (depressão moderada); sete (17,5%) tiveram pontuação de 15 a 19 (depressão moderada a grave); e oito (20%) tiveram pontuação de 20 ou mais (depressão grave). Dos 65 pacientes que responderam ao questionário de autoavaliação após pelo menos 12 sessões de terapia, 51 (78%) relataram visão mais positiva da vida e dos outros com a terapia; 44 (67%) referiram melhora da autoestima; 52 (80%), melhora nos relacionamentos e 53 (81%), melhora em relação à saúde. A melhora relatada pelos pacientes nas diversas áreas de suas vidas aponta para a importância desse tipo de abordagem dentro da Estratégia Saúde da Família, e para o impacto positivo da Psicoterapia baseada na Análise Transacional associada a técnicas cognitivo-comportamentais no tratamento de pacientes com transtornos mentais na Atenção Primária à Saúde.

The Impact of Psychotherapy, Pharmacotherapy, and Their Combination on Quality of Life in Depression

Quality of life (QOL) is known to be negatively affected during the course of major depressive disorder. Various studies have documented the benefits of pharmacotherapy or psychotherapy alone on QOL in depression, with few studies examining combined treatment. This review will examine the evidence for the impact of each modality, as well as their combination, on QOL in depression. Using the key terms depression, depress*, major depress*, quality of life, antidepressant*, and psychotherapy, MEDLINE and PsycINFO searches were conducted to identify treatment-outcome studies that used known QOL measurements over the past twenty-six years (1984 to 2010). Significant improvements in depressive symptomatology and QOL measurements were found with pharmacotherapy, psychotherapy, and their combination, with some studies showing greater improvement following combined treatment than with either intervention alone. Substantial evidence suggests that psychotherapy, pharmacotherapy, and their combination have favorable effects on QOL in depression. While some studies have shown that combined therapy is superior than either of the two forms alone in improving QOL, additional research is needed to elucidate this effect. QOL measurement is an important dimension of treatment-outcome assessment in patients with depression.

Psychotherapy, psychopathology, research and practice: Pathways of connections and integration

This paper describes three pathways of connections between different communities of knowledge seekers: integration of psychotherapeutic approaches, integration of psychotherapy and psychopathology, and integration of science and practice. Some of the issues discussed involve the delineation and investigation of common factors (e.g., principles of change), improvement of major forms of psychotherapy, clinical implications of psychopathology research, as well as current and future directions related to practice-research networks. The aim of this paper is to suggest that building bridges across theoretical orientations, scientific fields, professional experiences, and epistemological views may be a fruitful strategy to improve our understanding and the impact of psychotherapy.

Stratégie thérapeutique des épisodes dépressifs. Prévention du risque de récidive

Prevention of the risk of recurrence of depressive episodes is a dynamic process that begins early in the management. Although complete remission is obtained for almost half of the treated depressive episodes, a heuristic conceptual thinking apprehends depression as a potentially chronic disorder when considering relapse and recurrence prevention. Multiple actions of care have to be initiated. They are formalised, but also adjustable to the needs of a critical management period throughout the follow-up. These actions include the prescription of an antidepressant at an effective dosage. They also consider the preventative and therapeutic impact of psychotherapy. The search for residual symptoms of depression is the rule, and addition of other medication should be considered if needed. These recommendations are evidence-based in the context of recurrence prevention. Nevertheless, many other initiatives are equally important recommendations in terms of therapeutic impact. Thus, rigorous evaluation of the initial symptomatology, promotion of information on disease, health-care advices, as well as implementation of family and other networks are good-practices. Such actions should be conducted in a relationship based on a therapeutic alliance. These elements need to be adjusted and contextualised in line with the Health System, mode of medical practice and unique style of the therapist. Proactive and sustainable implementations of these guidelines are required in the context of a unique and open therapeutic relationship for both therapist and patient.

Impact of psychotherapy on insomnia symptoms in patients with depression and multiple sclerosis

The purpose of the study was to evaluate the prevalence of insomnia in multiple sclerosis patients with comorbid depression, associations between psychological symptoms, multiple sclerosis symptoms and insomnia, and to test effects of a 16-week protocol-based psychotherapy intervention for depression on insomnia symptoms. Participants with multiple sclerosis and depression (n=127) were randomized to telephone administered cognitive behavioral therapy and telephone administered supportive emotion-focused therapy. Multiple sclerosis functional limitation was measured at baseline. Depression, insomnia, anxiety and quality of life were evaluated at pre treatment, mid treatment (8weeks), and post treatment (16weeks). Prevalence of insomnia ≥3 times per week was 78% at pre treatment and 43% at post treatment. Insomnia at baseline was associated with depression, multiple sclerosis related mood symptoms and anxiety. Middle of the night awakenings were associated with swallowing and speech problems. Improvements in insomnia were associated with improvement in depression and anxiety. Participants with residual insomnia were more likely to have major depressive disorder, greater multiple sclerosis severity, elevated anxiety and lower mental components of quality of life. Results demonstrate rates of insomnia in patients with comorbid multiple sclerosis and depression are higher than those reported in the general multiple sclerosis population and additional insomnia treatment is indicated beyond the treatment of comorbid psychological disorders.

Toward a Neurobiology of Child Psychotherapy

Brain imaging studies have demonstrated that psychotherapy alters brain structure and function. Learning and memory, both implicit and explicit, play central roles in this process through the creation of new genetic material that leads to increased synaptic efficiency through the creation of new neuronal connections. Although there is substantial evidence supporting some of the neurobiological effects of psychotherapy in adult patients, little exists on the impact of psychotherapy in children. Research has supported the enduring effects of early childhood trauma as represented by alterations in stress response, for example, which has important implications for early intervention through psychotherapy. Presently, the major questions facing the field of child and adolescent psychotherapy are identical to those in the study of adults. These can be reduced to four questions: what type of therapy, for what type of problem, in what type of child, and by what type of therapist. Areas needing further research are discussed.