Intensive Psychotherapy Research Articles

Music-instruction intervention for treatment of post-traumatic stress disorder: a randomized pilot study

BackgroundPost-traumatic Stress Disorder (PTSD) is a common sequelae of severe combat-related emotional trauma that is often associated with significantly reduced quality of life in afflicted veterans. To date, no published study has examined the effect of an active, music-instruction intervention as a complementary strategy to improve the psychological well-being of veterans with PTSD. The purpose of this study was to examine the feasibility and potential effectiveness of an active, music-instruction intervention in improving psychological health and social functioning among Veterans suffering from moderate to severe PTSD.MethodsThe study was designed as a prospective, delayed-entry randomized pilot trial. Regression-adjusted difference in means were used to examine the intervention’s effectiveness with respect to PTSD symptomatology (primary outcome) as well as depression, perceptions of cognitive failures, social functioning and isolation, and health-related quality of life (secondary outcomes).ResultsOf the 68 Veterans who were self- or provider-referred to the program, 25 (36.7%) were ineligible due to (i) absence of a PTSD diagnosis (n = 3); participation in ongoing intense psychotherapy (n = 4) or inpatient substance abuse program (n = 2); current resident of the Domiciliary (n = 8) and inability to participate due to distance of residence from the VA (n = 8). Only 3 (4.4%) Veterans declined participation due to lack of interest. The mean age of enrolled subjects was 51 years old [range: 22 to 76]. The majority was male (90%). One-quarter were African American or Black. While 30% report working full or part time, 45% were retired due to disability. Slightly over one-quarter were veterans of the OEF/OIF wars. Estimates from regression-adjusted treatment effects indicate that the average PTSD severity score was reduced by 9.7 points (p = 0.01), or 14.3% from pre- to post-intervention. Similarly, adjusted depressive symptoms were reduced by 20.4% (− 6.3 points, p = 0.02). There were no statistically significant regression-adjusted effects on other outcomes, although the direction of change was consistent with improvements.ConclusionsOur findings suggest that the active, music-instruction program holds promise as a complementary means of ameliorating PTSD and depressive symptoms among this population.Trial registrationTrial registered at ClinicalTrials.gov with protocol number Medical College of Wisconsin PRO00019269 on 11/29/2018 (Retrospectively registered).

Relationships, Emotions, and Defenses Among Patients with Substance Use Disorders, Assessed with Karolinska Psychodynamic Profile: Possibilities to use Intensive Short-Term Dynamic Psychotherapy in Substance Abuse Treatment

ABSTRACTSubstance use disorders (SUDs) are connected to emotional and relational difficulties. Intensive Short-Term Dynamic Psychotherapy (ISTDP) aims at supporting emotion regulation and relational capacity through confronting the patient’s defenses. The authors assessed relational capacity, emotion regulation, and defenses in nine patients with severe SUD and a history of childhood maltreatment, using the semistructured method Karolinska Psychodynamic Profile. All participants had difficulties in handling interpersonal dependence and separations. Functioning in other areas varied. ISTDP could be useful in substance abuse treatment. Thorough assessment before starting ISTDP is however recommended so that treatment is planned according to the patients’ level of functioning.

Pilot study: An inpatient drug rehabilitation program based on intensive short-term dynamic psychotherapy

Addiction programs are plagued with high dropout and relapse rates. A large proportion of patients suffering from addiction also suffer from personality disorders. A 30-day inpatient program based on intensive short-term dynamic psychotherapy was developed to address features of personality disorders such as anxiety regulation, emotion recognition, and handling of fear responses and projective processes. The hypothesis was that addressing comorbid symptoms of personality disorder might improve recovery from drug addiction. We used a pilot randomized controlled trial design with six-month follow-up of both cases and controls. Rates of remission, relapse and drop out were recorded at each time point. N-1 chi-squared (χ2) tests were conducted to examine the statistical significance of differences in outcomes in patients receiving the experimental treatment and controls. A control group of 20 patients and an experimental group of 42 patients were treated. Dropout: control group 40%; experimental group 23.8%. Sobriety at six months: control group 17.6%, experimental group 48.8%. Future study is warranted to examine intensive short-term dynamic psychotherapy’s long-term effects, study moderators of effects, and study its efficacy using a randomized controlled design.

Introducing a Conversational Model Therapy Approach as a Team Model of Care: The Clinician Experience in a Sexual Assault Service

This article examines clinician experience in adopting a contemporary psychodynamic model of care by exploring the experiences and perspectives of staff at an Australian hospital-based sexual assault service (SAS), reflecting then on implications for how to best engage clinicians in a model of care change and training. The Conversational Model of Therapy (CMT) is a contemporary psychodynamic approach integrating evidence from developmental psychology, neuroscience and trauma. Training was provided in the CMT approach to Short-Term Intensive Psychodynamic Psychotherapy seeking to enable the service to better provide for the needs of adult clients with less recent sexual assault experiences and/or those able to receive a short-term psychotherapy. Five semi-structured individual interviews and one focus group (with four participants) were undertaken to identify SAS staff perceptions of their experiences after initial training of up to 13 sessions with CMT. Thematic analysis was performed to identify, analyse and report patterns in the responses with the following themes emerging: the challenges staff face in providing a service to clients; coping mechanisms staff utilise in their work; the current service structure and how this compares with their experiences of CMT, and; feelings and thoughts on SAS staff being evaluated. Findings provide evidence that the majority of staff understood the need for change and were able to undertake training towards this due to effective coping mechanisms within their work and good support from within their team. The research also highlights the need to ensure effective training to evaluate participants’ understanding of the model being taught. In the context of training experience elsewhere, learning and synthesis of all of the knowledge relevant to a psychodynamic model of care may require experiential learning through supervision of audio-recorded sessions, although this has challenges in the SAS context.

The impact of substance use disorders on recovery from bipolar depression: Results from the Systematic Treatment Enhancement Program for Bipolar Disorder psychosocial treatment trial.

Up to 60% of patients with bipolar disorder develop a substance use disorder during their lifetime. The purpose of this paper was to assess the impact of substance use disorders on depression recovery among bipolar patients randomly assigned to different psychotropic medications and psychosocial interventions. We hypothesized that patients with a comorbid substance use disorder would benefit less from psychotherapy regardless of treatment intensity/length compared to patients without a comorbid substance use disorder. We conducted post hoc analyses among bipolar disorder patients ( n = 270) with and without comorbid substance use disorders enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder randomized psychosocial intervention trial. All patients entered during or shortly after the onset of a bipolar depressive episode. Logistic regression and Cox proportional hazard models were used to assess whether current or past substance use disorders moderated the response of patients to intensive psychosocial intervention or brief psychoeducation with collaborative care, operationalized as full recovery from an episode of bipolar depression. Current comorbid substance use disorders significantly predicted likelihood of recovery (odds ratio = 2.25, p = 0.025) and time to recovery (odds ratio = 1.71, p = 0.006) from bipolar depression. We found that 74.5% of patients with a current substance use disorder, compared to 56.5% without a current substance use disorder, recovered from bipolar depression. Past substance use disorders did not predict likelihood of recovery or time to recovery. Current substance use disorders did not significantly moderate response to intensive psychotherapy versus collaborative care. Contrary to our hypotheses, bipolar disorder participants with a current comorbid substance use disorder were more likely to recover from psychosocial treatment for bipolar depression than patients without a current comorbid substance use disorder. If this finding is replicated, it has implications for the ordering of treatment for patients with comorbid bipolar disorder and substance use disorders.

Effects of intensive short-term dynamic psychotherapy on social cognition in major depression

Background: Social cognition is commonly affected in psychiatric disorders and is a determinant of quality of life. However, there are few studies of treatment.Objective: To investigate the efficacy of intensive short-term dynamic psychotherapy on social cognition in major depression.Method: This study used a parallel group randomized control design to compare pre-test and post-test social cognition scores between depressed participants receiving ISTDP and those allocated to a wait-list control group. Participants were adults (19–40 years of age) who were diagnosed with depression. We recruited 32 individuals, with 16 participants allocated to the ISTDP and control groups, respectively. Both groups were similar in terms of age, sex and educational level.Results: Multivariate analysis of variance (MANOVA) demonstrated that the intervention was effective in terms of the total score of social cognition: the experimental group had a significant increase in the post-test compared to the control group. In addition, the experimental group showed a significant reduction in the negative subjective score compared to the control group as well as an improvement in response to positive neutral and negative states.Conclusion: Depressed patients receiving ISTDP show a significant improvement in social cognition post treatment compared to a wait-list control group.

Psychological therapies for treatment-resistant depression in adults.

Psychological therapies for treatment-resistant depression in adults.

Intensive Transactional Analysis Psychotherapy (ITAP): A Single-Case Time Series Study

Intensive Transactional Analysis Psychotherapy (ITAP) integrates Transactional Analysis and brief psychodynamic approaches for the intensification of therapist intervention based on the moment-by-moment analysis of intrapsychic and interpersonal process of the patient. We present a quantitative and qualitative, time series study to evaluate ITAP therapy effectiveness in a single case. Quantitative outcome data were collected using the Clinical Outcome in Routine Evaluation – Outcome Measure, in 3 baseline measures, after each session and in 3 follow-up evaluations. Qualitative data were collected using the Change Interview that allows the documentation of more relevant changes for the patients and a scoring of their relevance. Quantitative results provide evidence of ITAP effectiveness, with very large ES of self-reported change. Qualitative results are consistent with the recovery observed in self-reported measures and confirm that the perception of the patient is consistent in several points with ITAP theory.

The meta-psychology of guilt and redemption: A case study of Dickens’s Pip

ABSTRACTComplex guilt is the most insidious force within the unconscious. It both fuels and exacerbates psychopathology. This article explores complex guilt. The lens of examination will be the guilt-ridden character Pip, in Charles Dickens, Great Expectations. The pathway of redemption and healing found in Dickens, parallels the intentional work of Habib Davanloo, the father of Intensive Short Term Dynamic Psychotherapy (ISTDP). In addition to drawing from Dickens and Davanloo, the paper employs a clinical case vignette as a way of elucidating the theory and underscoring the importance of directly accessing the complex guilt in the course of treatment.

Beyond Midlife and Before Retirement: A Short-Term Women’s Group

ABSTRACTAs women move into the second half of life and towards retirement, they may experience many changes and transitions, including in health, relationships, career choices, and spirituality. Some of those changes can be distressing, such as serious health problems for themselves or their families, increased isolation, multiple losses of important people, feelings of uselessness and lack of a meaningful role, and growing questions or struggles around spirituality. Time is often seen as moving faster and increasingly limited. This short-term group offers an opportunity for women to reflect upon issues of identity, values, choices, desires, and hopes regarding relationships, work and other activities, spirituality, and health to create new visions. We describe an integrated theoretical framework that includes existentialism, mindfulness, adult development, object relations, attachment, and relational cultural therapy. We discuss the group’s underlying assumptions in terms of its short-term and semi-structured nature and its format, and suggest exercises, with examples highlighting important learning and/or group interaction. Finally, we address the need for more intensive psychotherapy, outliers, ensuring participation, and our own responses.

Changes in ego strength in patients with neurotic and personality disorders treated with a short-term comprehensive psychodynamic psychotherapy.

Analysis of changes in ego strength in the course of group psychotherapy in patients treated with neurotic and selected personality disorders (F40-F61, ICD-10). 82 patients (61 women and 21 men) participated in the study. They underwent intensive short-term group psychotherapy treatment in a day hospital for neurotic and behavioural disorders. The assessment of the patients' personality functioning was carried out at the onset and the end of the psychotherapy. The assessment was reported as a value on the ego strength scale by means of the MMPI-2 questionnaire. The comparative analysis with the use of the t-Student test for related measurements, which was carried out for the measurement of ego strength values at the onset and the end of the therapy, demonstrated a statistically significant positive change both for the entire examined group and the groups which considered the gender and diagnosis distribution. Short-term intensive comprehensive group psychotherapy with elements of individual psychotherapy results in obtaining the desired changes in the personality functioning manifested through the increase in ego strength.

Frank in mind: a journey to self

This paper describes two years’ intensive psychotherapy with an 11 year old boy I shall call Lou, who as a result of traumatic experiences in his early life, struggled to integrate a robust sense of self and in particular to find accord with a sense of himself as male. The impact of maternal depression, paternal gender dysphoria and domestic violence are discussed in relation to this young boy’s capacity to resolve the ordinary Oedipal challenge and find narcissistic value in a male body image to consolidate his gender identity. Concomitant difficulties with separation from his mother and aggression towards himself and others significantly impacted his ability to manage in a mainstream school environment and he was excluded at the time the therapy began. A clinical narrative is presented which illustrates Lou’s journey in psychotherapy, where he began to engage and allow links to be made. He sought to understand his position in a world that did not make sense to him, to face a hitherto ‘unthinkable’ past and to integrate disparate aspects of himself including a male gender identity. Notably Lou’s creation of ‘Frank’ constructed from dead, lost and reanimated objects is described and the actual and symbolic functions of this therapy object are discussed in relation to his internal development and the progress of the work. Parallels are drawn with Mary Shelley’s novel Frankenstein, where the creature strives for psychological birth and understanding. Lou and I struggled in the paradox of the themes of his narrative; a male/female father; potency and castration; corruption and repair and how to be a boy, held and helped in part through the paternal function of a female therapist.

Trait and state anxiety in patients treated with intensive short-term group psychotherapy for neurotic and personality disorders.

The study aimed to determine the severity of trait and state anxiety in patients treated for neurotic and personality disorders with intensive, short-term group psychotherapy and to analyse the change of anxiety intensity in the course of treatment. 116 patients (81 females and 35 males) participated in the study. The measurement of anxiety intensity was conducted with the State-Trait Anxiety Inventory (STAI) at the beginning and at the end of treatment. The majority of patients (69% of the study group) demonstrated a high intensity of state anxiety at the beginning of the treatment with 47.4% being classified as very high. High intensity of trait anxiety was observed in 64.7% of participants (50.9% -very high). RCI (Reliable Change Index) and RCV (Reliable Change Value) indicated a significant change in state anxiety intensity in 62.1% of participants (48.3% - significant decrease, 13.8% increase). At the end of treatment more than a half of patients manifested medium and low intensity of both trait and state anxiety. At the beginning of psychotherapy the majority of patients demonstrated high intensity of both trait and state anxiety. In the course of therapy a considerable reduction of intensity of trait and state anxiety is observed. Significant deterioration in trait anxiety is observed in one out of every thirteen treated patients. Polish adaptation of STAI questionnaire is a useful tool for monitoring effectiveness of psychotherapy and may be successfully applied for screening and detailed diagnosis of neurotic and personality disorders.

Three-year follow-up after psychotherapy for young people with bipolar disorder.

(1) To examine the differences between interpersonal and social rhythm therapy (IPSRT) and specialist supportive care (SSC) in the longer term impacts of IPSRT and SSC on cumulative depression and mania symptoms over a further 78-week follow-up period post treatment. (2) To calculate the survival time before recurrence of a new mood episode over the 3-year period. One hundred young people with bipolar disorder aged between 15 and 36years who had been randomized to treatment with either IPSRT or SSC for 78weeks were followed up for a subsequent 78weeks. The Longitudinal Interval Follow-up Evaluation was completed at 26-week intervals. A Mann-Whitney U test was used to determine if there were significant differences between therapy types and a Kaplan-Meier survival analysis was used to determine time to recurrence. Cox regression was used to assess the association between time to relapse and therapy type. There were no significant differences between therapies at each of the data points for either depression or mania scores. The mean change in depression and mania in both groups was significantly different for all three follow-up data points. The actuarial cumulative recurrence rates were 53% for IPSRT and 49% for SSC. There was no significant difference between the groups in time to recurrence. While there were no significant differences between the two therapies, there was an overall reduction in symptoms in both therapies. There may be sustained benefits in providing intensive psychotherapies in conjunction with pharmacotherapy for young people with bipolar disorder.

Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting.

Medically unexplained symptoms (MUS) are known to be costly, complex to manage and inadequately addressed in primary care settings. In many cases, there are unresolved psychological and emotional processes underlying these symptoms, leaving traditional medical approaches insufficient. This paper details the implementation of an evidence-based, emotion-focused psychotherapy service for MUS across two family medicine clinics. The theory and evidence-base for using Intensive Short-Term Dynamic Psychotherapy (ISTDP) with MUS is presented along with the key service components of assessment, treatment, education and research. Preliminary outcome indicators showed diverse benefits. Patients reported significantly decreased somatic symptoms in the Patient Health Questionnaire-15 (d = 0.4). A statistically significant (23%) decrease in family physicians’ visits was found in the 6 months after attending the MUS service compared to the 6 months prior. Both patients and primary care clinicians reported a high degree of satisfaction with the service. Whilst further research is needed, these findings suggest that a direct psychology service maintained within the family practice clinic may assist patient and clinician function while reducing healthcare utilization. Challenges and further service developments are discussed, including the potential benefits of re-branding the service to become a ‘Primary Care Psychological Consultation and Treatment Service’.

Examining changes in personality disorder and symptomology in an adolescent sample receiving intensive mentalization based treatment: a pilot study

ObjectiveTo examine changes in personality disorders and symptomology and the relation between personality disorder variables and treatment outcomes in an adolescent sample during partial residential mentalization based treatment.MethodsIn a sample of 62 (out of 115) adolescents treated for personality disorders, assessment was done pre- and post-treatment using the Structured Clinical Interview for DSM personality disorders and the Symptom Check List 90.ResultsSignificant reductions in personality disorder traits (t = 8.36, p = .000) and symptoms (t = 5.95, p = .000) were found. During pre-treatment, 91.8% (n = 56) of the patients had one or more personality disorders, compared to 35.4% (n = 22) at post-treatment. Symptom reduction was not related to pre-treatment personality disorder variables.ConclusionDuring intensive psychotherapy, personality disorders and symptoms may diminish. Future studies should evaluate whether the outcomes obtained are the result of the treatment given or other factors.

A preliminary evaluation of intensive short-term dynamic psychotherapy within a functional neurological symptoms service

This outcome study evaluated the quality of life and emotional wellbeing of patients referred with functional neurological symptoms (FNS) to an NHS Community Neuropsychology Service and treated with a course of Intensive Short-Term Dynamic Psychotherapy (ISTDP). Measures of quality of life and emotional wellbeing demonstrated significant improvement amongst the eleven patients treated. These outcomes support the view that ISTDP may be a helpful psychological treatment option for patients with FNS.

ONYCHOPHAGIA- A CASE REPORT

Body focused repetitive behaviors are frequently seen in individuals with obsessive compulsive disorders. These behaviors range from repetitive hand washing to more severe forms such as onychophagia. We report a case of severe onychophagia wherein the patient despite receiving pharmacological treatment for obsessive compulsive disorder was unable to control her impulse to compulsively bite her nails. Repetitive nail biting led to the patient being treated for bacterial infections, debridement and subsequent digital amputations. Cases of severe onychophagia are seldom seen in clinical practice therefore an awareness regarding early identification of the signs and symptoms and up to date management are crucial for practicing clinicians. As illustrated in this case report, pharmacotherapy as well as intense psychotherapy is essential for the long-term effective management of this chronic ailment that can gravely affect the quality of an individual’s life . Keywords: Onychophagia, nail biting, obsessive compulsive disorder, Onychtillomania.

An Unfortunate Comparison of Apples to Oranges: Comment on Jensma (2016)

In reporting the findings of her outcome study of Along-side's intensive outpatient psychotherapy (IOP) program for Christian missionaries and clergy, Jensma (2016) offered an unfortunate “apples-to-oranges” comparison to my outcome data on Link Care's IOP, which resulted in a largely erroneous discussion section. In this comment, I briefly describe the nature of the problematic comparison and provide some additional analyses of my earlier outcome research to highlight my concerns. I close with the assertion that extant data can only support the conclusion that Alongside and Link Care IOP programs both appear to be beneficial to participants and equivalently so at three month follow up.

Patients with Borderline Personality Disorder in Emergency Departments.

Borderline personality disorder (BPD) patients, when in crisis, are frequent visitors of emergency departments (EDs). When these patients exhibit symptoms such as aggressiveness, impulsivity, intense anxiety, severe depression, self-harm, and suicidal attempts or gestures, diagnosis, and treatment of the BPD becomes challenging for ED doctors. This review will, therefore, outline advice to physicians and health-care providers who face this challenging patient population in the EDs. Crisis intervention should be the first objective of clinicians when dealing with BPD in the emergency. For the patients with agitation, symptom-specific pharmacotherapy is usually recommended, while for non-agitated patients, short but intensive psychotherapy especially dialectical behavior therapy (DBT) has a positive effect. Although various psychotherapies, either alone or integrated, are preferred modes of treatment for this group of patients, the effects of psychotherapies on BPD outcomes are small to medium. Proper risk management along with developing a positive attitude and empathy toward these patients will help them in normalizing in an emergency setting after which treatment course can be decided.