Psychodynamic-interpersonal Psychotherapy Research Articles

Change in Defensive Functioning Following Group Psychodynamic-Interpersonal Psychotherapy in Women With Binge-Eating Disorder

ABSTRACT We examined change in defensive functioning following group psychodynamic-interpersonal psychotherapy (GPIP) for binge-eating disorder (BED) compared to a waitlist control. We hypothesized that defensive functioning will improve to a greater extent at posttreatment for those in GPIP compared with those in a waitlist control condition. Participants were women with BED assigned to GPIP (n = 131) or a waitlist control (n = 44) condition in a quasi-experimental design. Those who received GPIP had significantly greater improvements in defensive functioning from pretreatment to six months posttreatment compared to the control group. GPIP may be effective for improving defensive functioning in individuals with BED. A randomized controlled trial is needed to confirm that GPIP is efficacious for addressing defensive functioning among women with BED.

Trainee therapist personality and the rating of cognitive behavioural and dynamic interpersonal therapy processes.

Therapist factors are generally thought to be important predictors of the capacity to understand and respond to clinical material. The current study aims to identify which features of personality and clinical symptomatology predict a trainee therapist's rating of cognitive behavioural (CB) and psychodynamic interpersonal (PI) processes in video recordings of these therapies. Eighty psychology trainees completed the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and watched two video recordings of therapy sessions showing prototypical examples of CB and PI psychotherapy, rating the processes they could identify using the Comparative Psychotherapy Process Scale (CPPS). Trainees accurately differentiated CB from PI process while viewing the CB session but rated the CB video higher in PI processes than the PI video itself. Bayesian regression models showed that the most consistent MMPI-2-RF scale that predicted variance in ratings was hypomanic activation (RC9) predicting higher ratings of all psychotherapy processes in both conditions, while clinical scale factors such as Aggressiveness-Revised (AGGR-r) and personality scale factors of Psychoticism-Revised (PSYC-r) and Negative Emotionality/Neuroticism-Revised (NEGE-r) showed some notable but less consistent predictions. The variances in psychotherapy process ratings accounted for by MMPI-2-RF scales ranged from 15% to 51%. The study suggests that some clinical symptoms and personality factors do influence the rating of psychotherapy processes by psychology trainees, but further studies would be required to substantiate such findings. These findings have relevance to therapist training and selection for clinical training and therapist mental health.

A group's level of defensive functioning affects individual outcomes in group psychodynamic-interpersonal psychotherapy.

We used an actor-partner interdependence model (APIM) to study the association between the individual group member and other group therapy members' defensive functioning on an individual group member's treatment outcome. We hypothesized that (a) more adaptive individual defensive functioning at pretreatment will be significantly related to better treatment outcomes (i.e., lower binge-eating and interpersonal distress) at 6 months post-treatment; and (b) more adaptive other group members' defensive functioning at pretreatment will be significantly related to better treatment outcomes at 6 months post-treatment. Participants (N = 136) were individuals with BED enrolled in group psychodynamic-interpersonal psychotherapy (GPIP). Participants completed attachment interviews and were assessed on interpersonal distress and days binged at pretreatment and 6 months post-treatment. The interview audio recordings were transcribed and used to code defensive functioning. We found that individual overall defensive functioning (ODF) scores at pretreatment were not significantly associated with binge-eating frequency or interpersonal distress at 6 months post-treatment. Other group members' mean ODF scores at pretreatment were significantly associated with individual interpersonal distress at 6 months post-treatment. However, the other group members' mean ODF scores were not significantly associated with individual binge-eating outcomes at 6 months post-treatment. Defensive functioning of other members of a therapy group may be particularly important for improving interpersonal functioning in individuals with BED. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Supplemental Material for A Group’s Level of Defensive Functioning Affects Individual Outcomes in Group Psychodynamic-Interpersonal Psychotherapy

Supplemental Material for A Group’s Level of Defensive Functioning Affects Individual Outcomes in Group Psychodynamic-Interpersonal Psychotherapy

Expert clinicians’ prototypes of an adolescent treatment: Common and unique factors among four treatment models

Objective: To investigate (1) whether expert clinicians within psychodynamic therapy (PDT), mentalization-based treatment (MBT), cognitive-behavioral therapy (CBT), and interpersonal psychotherapy (IPT) agree on the essential adolescent psychotherapy processes using the Adolescent Psychotherapy Q-Set (APQ); (2) whether these four session prototypes can be empirically distinguished; and (3) whether mentalization is a shared component in expert clinicians’ conceptualizations of these four treatment models. Method: Thirty-nine raters with expertize in PDT, MBT, CBT, and IPT provided ratings of the 100 APQ items to characterize a prototypical session that adheres to the principles of their treatment model. A Q-factor analysis with varimax rotation was conducted. Results: Expert clinicians reached a high level of agreement on their respective session prototypes, which loaded onto five independent factors. The PDT session prototype straddled two different factors, suggesting more variability in PDT expert clinicians’ understanding of PDT process for adolescents than in the views of the expert clinicians representing the other treatment models. Mentalization process was shared among all four session prototypes; however, the correlation between the CBT and IPT session prototypes remained significant after controlling for the MBT session prototype. Conclusions: Researchers can now assess adherence to four adolescent treatments and identify change processes beyond these labels.

Stress, depression, and the therapeutic alliance as mediators on the outcome of brief psychodynamic-interpersonal psychotherapy for multisomatoform disorder

Objective: The aim of this study was to identify and explore mediators of psychodynamic-interpersonal psychotherapy (PIT) on treatment outcome in multisomatoform disorders (MSD). Methods: Data from 164 patients with MSD who took part in a randomized control trial of PIT (n = 88) vs. enhanced medical care (EMC; n = 76) were re-analyzed. A parallel mediation analysis was performed to investigate whether the beneficial effect of PIT vs. EMC on physical quality of life (physical component summary (PCS) of the SF-36 Health Survey) nine months post-treatment is mediated by post-treatment scores of stress, depression, and therapeutic alliance. The potential mediators were operationalized with the Helping Alliance Questionnaire (HAQ; therapeutic alliance), the Patient Health Questionnaire (PHQ)-stress module (perceived stress) and the PHQ-depression module (PHQ-9; depression). Results: Stress partially mediated the effect of PIT vs. EMC on the follow-up outcome. PIT (as compared to EMC) led to lower post-treatment stress-levels, which in turn led to higher physical quality of life at follow-up. Neither depression nor the alliance had a mediating effect. Conclusions: Stress mediated the outcome of PIT for MSD. Future studies are needed to extend the scope of research regarding which specific psychotherapeutic mechanisms of change are beneficial in PIT treatment of MSD patients.

Testing a stepped care model for binge-eating disorder: a two-step randomized controlled trial.

A stepped care approach involves patients first receiving low-intensity treatment followed by higher intensity treatment. This two-step randomized controlled trial investigated the efficacy of a sequential stepped care approach for the psychological treatment of binge-eating disorder (BED). In the first step, all participants with BED (n = 135) received unguided self-help (USH) based on a cognitive-behavioral therapy model. In the second step, participants who remained in the trial were randomized either to 16 weeks of group psychodynamic-interpersonal psychotherapy (GPIP) (n = 39) or to a no-treatment control condition (n = 46). Outcomes were assessed for USH in step 1, and then for step 2 up to 6-months post-treatment using multilevel regression slope discontinuity models. In the first step, USH resulted in large and statistically significant reductions in the frequency of binge eating. Statistically significant moderate to large reductions in eating disorder cognitions were also noted. In the second step, there was no difference in change in frequency of binge eating between GPIP and the control condition. Compared with controls, GPIP resulted in significant and large improvement in attachment avoidance and interpersonal problems. The findings indicated that a second step of a stepped care approach did not significantly reduce binge-eating symptoms beyond the effects of USH alone. The study provided some evidence for the second step potentially to reduce factors known to maintain binge eating in the long run, such as attachment avoidance and interpersonal problems.

Moderating Effects of Alexithymia on Associations between the Therapeutic Alliance and the Outcome of Brief Psychodynamic-Interpersonal Psychotherapy for Multisomatoform Disorder.

This secondary analysis of a trial on brief psychodynamic-interpersonal therapy (PIT) for patients with multisomatoform disorder investigated whether alexithymia moderates the associations between the therapeutic alliance and the outcome of PIT and whether moderating effects of alexithymia remain significant when controlling for depression. Eighty-three patients with multisomatoform disorder receiving PIT were statistically analyzed. Moderation analyses were performed with the SPSS macro PROCESS. The primary outcome (Y), self-reported physical quality of life at 9-month after the end of PIT, was measured with the physical component summary (PCS) of the SF-36 Health Survey. The potential moderator (M) alexithymia was operationalized with the Toronto Alexithymia Scale (TAS-20) at pre-treatment and the predictor (X) the therapeutic alliance was rated by both patients and therapists via the Helping Alliance Questionnaire (HAQ) at the end of PIT. Moreover, the PCS at pre-treatment functioned as covariate in all moderation models. When the patients’ alliance ratings were analyzed, alexithymia did not moderate associations between the alliance and the outcome. When the therapists’ alliance ratings were evaluated, alexithymia moderated the relationship between the alliance and the outcome (p < 0.05): a stronger alliance in the therapists’ perspective was beneficial for the outcome only for patients scoring above 61 on the TAS-20. This moderating effect of alexithymia was, however, not statistically significant anymore when adding the pre-treatment depression scores (PHQ-9) as a covariate to the moderation model. The results underline the importance of a good therapists’ view of the alliance when treating alexithymic patients and highlight the complex interaction between alexithymia and depression. Future studies are needed to extend the scope of research regarding which psychotherapeutic mechanisms of change are beneficial for which patients.

Change in attachment states of mind of women with binge-eating disorder.

Insecure and unresolved/disorganized attachment states of mind may impact affect regulation and interpersonal functioning that contribute to binge eating in women with binge-eating disorder (BED). Group psychological treatment may facilitate changes from insecure to secure and from unresolved-disorganized to non-unresolved/disorganized attachment states of mind. This study used attachment theory to understand better the psychopathology of BED and co-morbid overweight status and to understand better the treatment response of patients with BED who receive group psychotherapy. Women with BED attended group psychodynamic interpersonal psychotherapy and completed the Adult Attachment Interview pretreatment and 6months posttreatment. Matched samples of overweight women without BED and normal-weight women without BED completed the Adult Attachment Interview at 1 time point. Women with BED had significantly higher rates of preoccupied and unresolved/disorganized attachment states of mind compared to normal-weight women without BED and had similar rates of insecure and unresolved/disorganized attachment states of mind compared to overweight women without BED. Of the women with BED who had an insecure and/or unresolved/disorganized attachment states of mind at pretreatment, about 60% demonstrated clinically relevant changes to secure and to non-unresolved/disorganized states of mind at 6months post group psychodynamic interpersonal psychotherapy. Results indicated that some women with BED may benefit from interventions that help them regulate hyperactivated affect and create coherent narratives. Both women with BED and overweight women without BED may benefit from treatments that help them develop more adaptive affect regulation strategies related to unresolved/disorganized attachment states of mind.

Change in attachment dimensions in women with binge-eating disorder following group psychodynamic interpersonal psychotherapy

Objective: To examine the role of attachment dimensions, including coherence of mind and reflective functioning, in developing and maintaining binge-eating disorder (BED) and in determining group psychotherapy outcomes for women with BED. We hypothesize that higher pre-treatment attachment dimension scores will predict better treatment outcomes for women with BED and will increase at follow-up. Method: Women with BED attended 16 sessions of group therapy and completed the Adult Attachment Interview (AAI) at pre-treatment. Participants completed outcome measures (i.e., binge-eating frequency and symptoms of depression) at pre-, post-, six months, and 12 months post-treatment. Treatment completers completed the AAI at six months post-treatment. Results: Treatment outcomes improved significantly from pre- to 12 months post-treatment. Greater Reflective Functioning scores at pre-treatment were related to greater decreases in binge eating across the four time points, whereas Coherence of Mind scores were not. For treatment completers, there were significant increases in Reflective Functioning at six months post-treatment, and about a third of treatment completers experienced clinically significant increases in both attachment dimensions at six months post-treatment. Conclusions: Greater reflective functioning at the outset is important for improvements in binge eating in the longer term and group psychotherapy can facilitate change in reflective functioning.

The systematic use of homework in psychodynamic-interpersonal psychotherapy for depression: An assimilative integration approach.

The systematic use of homework in psychodynamic-interpersonal psychotherapy for depression: An assimilative integration approach.

Corrective relational experiences in psychodynamic-interpersonal psychotherapy: Antecedents, types, and consequences.

In posttherapy interviews with 31 clients who had recently terminated from individual open-ended psychodynamic-interpersonal psychotherapy, 18 reported having had at least 1 corrective relational experience (CRE) during psychotherapy, whereas 13 did not report any CREs. CREs typically occurred in the context of therapeutic relationships that were primarily positive but also had minor difficulties. Therapists typically facilitated CREs by identifying or questioning client behavior patterns and conveying trustworthiness. Corrective shifts for clients typically involved a new understanding of the therapy experience and variantly involved gaining a new understanding of behavior patterns. Consequences generally included improvements in the therapy relationship and intrapersonal well-being. Qualitatively, the 13 non-CRE clients more frequently reported wishing the therapist's theoretical orientation was a better match than did the 18 CRE clients. Quantitatively, the CRE clients rated themselves as having more interpersonal problems at intake on the Inventory of Interpersonal Problems-32 (Barkham, Hardy, & Startup, 1996), had marginally significant improvements in interpersonal functioning over time, rated their therapy alliances higher on the Working Alliance Inventory-Short Revised (Hatcher & Gillaspy, 2006) midtherapy, and rated their therapy alliances higher over time compared with the non-CRE clients. Implications for practice and research are discussed.

Changes in Defense Mechanism Functioning During Group Therapy for Binge-Eating Disorder

Objective: This study examined change in defensive mechanism functioning during group psychodynamic interpersonal psychotherapy (GPIP) for women with binge-eating disorder (BED). Procedure: Women with BED (N = 85) received 16 weeks of GPIP. Five group therapy sessions (sessions 1, 3, 8, 12, and 16) from each of the 12 groups were video recorded and transcribed. Participants were rated on an observer-based measure of defensive functioning, the Defense Mechanism Rating Scale (DMRS). Symptom outcomes were assessed pre- and posttreatment. Results: Overall defensive functioning (ODF) scores improved significantly during group treatment, with specific defense level improvements in high adaptive, major image distorting, and action defenses. The linear increase in ODF mediated a decrease in binge-eating episodes and depressive symptoms. Reverse mediation was also noted. A cubic growth curve best modeled ODF data such that ODF improved in the early stage, followed by a slower rate of improvement in the middle stage, and a further increase in rate of improvement at the end of treatment. Discussion: Change in defense mechanism functioning may be an important aspect of group psychotherapy that is related to improved symptoms for women with BED who receive GPIP. The cubic trend that represented nonlinear growth in ODF is consistent with psychodynamic theory and a stage model of psychotherapy.

Psychological and pharmacological interventions for social anxiety disorder in adults: a systematic review and network meta-analysis

SummaryBackgroundSocial anxiety disorder—a chronic and naturally unremitting disease that causes substantial impairment—can be treated with pharmacological, psychological, and self-help interventions. We aimed to compare these interventions and to identify which are most effective for the acute treatment of social anxiety disorder in adults.MethodsWe did a systematic review and network meta-analysis of interventions for adults with social anxiety disorder, identified from published and unpublished sources between 1988 and Sept 13, 2013. We analysed interventions by class and individually. Outcomes were validated measures of social anxiety, reported as standardised mean differences (SMDs) compared with a waitlist reference. This study is registered with PROSPERO, number CRD42012003146.FindingsWe included 101 trials (13 164 participants) of 41 interventions or control conditions (17 classes) in the analyses. Classes of pharmacological interventions that had greater effects on outcomes compared with waitlist were monoamine oxidase inhibitors (SMD −1·01, 95% credible interval [CrI] −1·56 to −0·45), benzodiazepines (−0·96, −1·56 to −0·36), selective serotonin-reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors (SSRIs and SNRIs; −0·91, −1·23 to −0·60), and anticonvulsants (−0·81, −1·36 to −0·28). Compared with waitlist, efficacious classes of psychological interventions were individual cognitive–behavioural therapy (CBT; SMD −1·19, 95% CrI −1·56 to −0·81), group CBT (−0·92, −1·33 to −0·51), exposure and social skills (−0·86, −1·42 to −0·29), self-help with support (−0·86, −1·36 to −0·36), self-help without support (−0·75, −1·25 to −0·26), and psychodynamic psychotherapy (−0·62, −0·93 to −0·31). Individual CBT compared with psychological placebo (SMD −0·56, 95% CrI −1·00 to −0·11), and SSRIs and SNRIs compared with pill placebo (−0·44, −0·67 to −0·22) were the only classes of interventions that had greater effects on outcomes than appropriate placebo. Individual CBT also had a greater effect than psychodynamic psychotherapy (SMD −0·56, 95% CrI −1·03 to −0·11) and interpersonal psychotherapy, mindfulness, and supportive therapy (−0·82, −1·41 to −0·24).InterpretationIndividual CBT (which other studies have shown to have a lower risk of side-effects than pharmacotherapy) is associated with large effect sizes. Thus, it should be regarded as the best intervention for the initial treatment of social anxiety disorder. For individuals who decline psychological intervention, SSRIs show the most consistent evidence of benefit.FundingNational Institute for Health and Care Excellence.

Change in attachment insecurity is related to improved outcomes 1-year post group therapy in women with binge eating disorder.

An interpersonal model of Binge Eating Disorder (BED) posits that difficulties with social functioning precipitate negative affect, which in turn causes binge eating as a means of coping. Thus, long-term decreases in attachment insecurity may be important for women with BED. No research has assessed if long-term change in attachment insecurity is associated with sustained change in other outcomes. In the current study, we hypothesized that changes in attachment anxiety and avoidance will decrease at posttreatment and will be maintained up to 12 months after Group Psychodynamic Interpersonal Psychotherapy (GPIP). We further hypothesized that long-term stability of these changes in attachment insecurity will be related to other long-term outcomes. Women with BED (N = 102) attended 16 sessions of GPIP. Measures were completed pretreatment, posttreatment, at 6 and 12 months follow-up. Attachment anxiety, attachment avoidance, and the other outcome variables decreased significantly at 12 months posttreatment. Reductions in attachment anxiety and avoidance were significantly related to decreases in interpersonal problems up to 12 months posttreatment, and reduction in attachment anxiety was significantly related to decreases in depressive symptoms 12 months posttreatment. Further, the significant relationship between reduced attachment avoidance and decreased interpersonal problems strengthened over the long term. This is the first study to show an association between change in attachment insecurity and change in other outcomes in the long term, and to show an adaptive spiral in which greater reduction in attachment avoidance is increasingly associated with ongoing improvement of interpersonal problems.

Change in attachment to the therapy group generalizes to change in individual attachment among women with binge eating disorder.

Attachment to groups is analogous to attachment to individuals, and may play an important role in group functioning and in group psychotherapy outcomes. This study examined whether attachment to the therapy group can change during treatment, and whether such change predicts improvements in treatment outcomes, including individual attachment, up to 1 year posttreatment. Eighty-seven women with binge eating disorder (BED) attended Group Psychodynamic Interpersonal Psychotherapy (GPIP). Participants were assigned to one of two conditions in which groups were homogeneously composed of women with either higher or lower individual attachment anxiety. Outcomes were assessed pre, post, 6 months, and 1 year posttreatment. Attachment to the group was assessed at weeks 4, 8, 12, and 16 of GPIP. Group attachment insecurity decreased significantly during treatment. Reductions in group attachment avoidance predicted decreases in individual attachment insecurity at 1 year posttreatment. Study condition did not moderate these associations. These results indicate that women with BED who receive GPIP are able to generalize improvements in group attachment security to their individual attachment relationships outside of therapy up to 1 year post group treatment.

Attachment anxiety moderates the relationship between growth in group cohesion and treatment outcomes in Group Psychodynamic Interpersonal Psychotherapy for women with binge eating disorder.

Attachment anxiety moderates the relationship between growth in group cohesion and treatment outcomes in Group Psychodynamic Interpersonal Psychotherapy for women with binge eating disorder.

Interpersonal learning is associated with improved self-esteem in group psychotherapy for women with binge eating disorder.

Yalom and Leszcz (2005) indicated that interpersonal learning is a key therapeutic factor in group psychotherapy. In this study, we conceptualized interpersonal learning as the convergence over time between an individual's and the group's perception of the individual's cohesion to the group. First, we developed parallel measures of: (a) an individual's self-rated cohesion to the group (Cohesion Questionnaire-Individual Version [CQ-I]), and (b) the group's rating of the individual's cohesion to the group (CQ-G) based on the original Cohesion Questionnaire (CQ; Piper, Marache, Lacroix, Richardsen, & Jones, 1983). Second, we used these parallel scales to assess differences between an individual's self-rating and the mean of the group's ratings of the individual's cohesion to the group. Women with binge eating disorder (N = 102) received Group Psychodynamic Interpersonal Psychotherapy. Participants were assigned to homogeneously composed groups of either high or low attachment anxiety. Outcomes were measured pre- and post-treatment, and the CQ-I and CQ-G were administered every fourth group session. We found significant convergence over time between the CQ-I and mean CQ-G scale scores in both attachment anxiety conditions. Participants with higher attachment anxiety had lower individual self-ratings of cohesion and had greater discrepancies between the CQ-I and CG-G compared with those with lower attachment anxiety. There was a significant relationship between greater convergence in cohesion ratings and improved self-esteem at post-treatment. More accurate self-perceptions through feedback from group members may be a key factor in facilitating increased self-esteem in group therapy. Group therapists may facilitate such interpersonal learning, especially for those higher in attachment anxiety, by noting discrepancies and then encouraging convergence between an individual and the group in their perceptions of cohesion to the group.

Characterization of IGF-II Isoforms in Binge Eating Disorder and Its Group Psychological Treatment

IntroBinge eating disorder (BED) affects 3.5% of the population and is characterized by binge eating for at least 2 days a week for 6 months. Treatment options include cognitive behavioral therapy, interpersonal psychotherapy, and pharmacotherapy which are associated with varied success.Little is known about the biology of BED. Since there is evidence that the insulin like growth factor system is implicated in regulation of body weight, insulin sensitivity and feeding behavior, we speculated it may be involved in BED.MethodsA cross-sectional comparison was made between three groups of women: overweight with BED, overweight without BED and normal weight without BED. Women were assigned to Group Psychodynamic Interpersonal Psychotherapy. Blood was collected before therapy, at completion and at 6months follow up for evaluation of IGF-II using Western blot.Results97 overweight women with BED contributed to the cross-sectional comparison. The two control groups comprised 53 overweight women without BED, and 50 age matched normal weight women without BED. Obese women had significantly lower Big IGF-II than normal weight women, p = .028; Overweight women with BED had higher Mature IGF-II than normal weight women, p<.05.Big IGF-II showed a significant decreasing slope from pre- to post- to six months post-group psychological treatment, unrelated to changes in BMI (p = .008).ConclusionLevels of IGF-II isoforms differed significantly between overweight and normal weight women. Overweight women with BED display abnormal levels of circulating IGF-II isoforms. BED is characterized by elevated mature IGF-II, an isoform shown to carry significant bioactivity. This finding is not related to BMI or to changes in body weight. The results also provide preliminary evidence that BIG IGF-II is sensitive to change due to group psychological treatment. We suggest that abnormalities in IGF-II processing may be involved in the neurobiology of BED.

Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder: randomised controlled trial

Brief psychodynamic interpersonal psychotherapy for patients with multisomatoform disorder: randomised controlled trial