Psychodynamic Interpersonal Therapy Research Articles

Randomised controlled trial of a psychotherapeutic intervention to improve quality of life and other outcomes in people who repeatedly self-harm: FReSH START study protocol

BackgroundSelf-harm is a major public health challenge, and repeated self-harm is common in those attending hospital following an episode. Evidence suggests psychological interventions could help people who self-harm, but few definitive studies have assessed their clinical and cost-effectiveness. Repeated self-harm is associated with poor quality of life, depression, suicide and increased health service costs which justify the development of psychotherapeutic interventions tailored for people with repeated self-harm.MethodsFReSH START is a multicentre individually 1:1 randomised controlled trial evaluating the clinical and cost-effectiveness of standard care plus psychological therapy or standard care alone for adults (≥ 18 years) presenting at an emergency department (ED) with repeated self-harm. Recruiting 630 participants, it includes an internal pilot, economic evaluation and process evaluation. The intervention will be delivered by mental health staff working in acute settings, with experience of assessing and managing risk in people presenting to emergency services with self-harm. Staff will be trained and supervised to deliver one of three specially adapted therapies: psychodynamic interpersonal therapy, cognitive behavioural therapy or acceptance and commitment therapy. Participants allocated to the intervention will receive one of the adapted therapies according to therapist allocation for up to 6 months via 12 weekly, one to one, 45–50-min sessions. The primary outcome is quality of life measured by the Clinical Outcomes in Routine Evaluation Outcome Measure at 12 months post-randomisation. Secondary outcomes include suicidal intent, depression and cost-effectiveness. Data are collected using hospital attendance records and online/postal/telephone questionnaires at 6 and 12 months post-randomisation, with resource use additionally collected at 3 and 9 months.DiscussionThis protocol outlines a randomised controlled trial to investigate whether modified therapies are cost-effective and improve quality of life for people who repeatedly self-harm. Few interventions are proven to be deliverable in the NHS for this population. This study is strengthened by the involvement of qualified mental health workers experienced in managing risk as therapists.Trial registrationRegistered on August 03, 2021.IRAS number: 297939.ISRCTN: https://doi.org/10.1186/ISRCTN73357210.REC reference: 21/EE/0145.Sponsor: University of Leeds.

Pilot Evaluation of a Remote Psychotherapy Service for Students Who Self-Harm: University-Community Outpatient Psychotherapy Engagement (U-COPE).

Self-harm is becoming increasingly common in student populations. Brief psychological therapies might be helpful for those who have recently self-harmed. The current paper reports on an evaluation of a brief psychotherapy service delivered via remote means, namely University-Community Outpatient Psychotherapy Engagement (U-COPE). The service combines elements of psychodynamic interpersonal and cognitive analytic therapy to help students who present with self-harm related difficulties. The primary aim was to understand students' and practitioners' experiences of a remote psychotherapy service. Semi-structured interviews were conducted with a total of nine participants (seven students and two practitioners). Interview data were analysed using thematic analysis. Analyses of the interviews across the stakeholders revealed three overarching themes: 'Accessibility'; 'Therapeutic experiences'; and 'Spaces and places of therapy'. Students appreciated the rapid access to intervention, especially as student services are typically characterised by long waiting lists. Despite the brief nature of the intervention, many students reported feeling a sense of control over the direction and pace of the therapeutic sessions, which is an important consideration for those who self-harm. The findings suggest that U-COPE may be helpful to students with difficulties related to self-harm. Further investigation of this brief intervention is warranted in order to ascertain whether U-COPE has a long-term impact on difficulties and distress-related behaviours.

Irritable Bowel Syndrome: Treating the Gut and Brain/Mind at the Same Time.

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal (GI) disorders in the world. Although IBS does not affect a person's life span, it can significantly influence their quality of life. The treatment of IBS should be tailored to each patient's specific symptomatology because it can often be difficult to manage. Given that the pathogenesis of IBS is not well understood, it places a tremendous load on healthcare resources. Over the years, IBS has been described as either a simple GI disorder or a more complex multi-symptomatic gut-brain axis disorder. Many persons with IBS have psychological issues in addition to gastrointestinal symptoms, offering the door to non-pharmacological therapies such as cognitive behavioral therapy, gut-directed hypnosis, or psychodynamic interpersonal therapy. Non-pharmacological therapies with no side effects should be used as first-line therapy. Diet, exercise, microbiota-targeted therapies, and psychological treatments are among the most significant interventions. This review goes into the details of all the non-pharmacological interventions that can be used to treat IBS.

Modèles de soins validés pour les patients souffrant de troubles neurologiques fonctionnels

Functional neurological disorder (FND) is a common cause of persistent and disabling neurological symptoms. Diagnostic delay may lead to no treatment, inappropriate treatment or even iatrogenic symptoms. Yet, several treatments significantly reduce physical symptoms and improve functioning in FND patients even though not all patients respond to the currently available treatments. This review aims to describe the range of evidence-based rehabilitative and/or psychological therapeutic approaches available for FND patients. The most effective treatments are multidisciplinary and coordinated; using an outpatient or inpatient setting. Building a network of FND-trained healthcare professionals around the patient is an essential aspect of optimal patient management. Indeed, a supportive environment coupled with a collaborative therapeutic relationship improves understanding of FND and appears to help patients engage in appropriate treatments. Patients need to be invested in their own care and have to understand that recovery may depend on their commitment. The conventional treatment combines psychoeducation, physical rehabilitation and psychotherapy (cognitive and behavioral therapy, hypnosis, psychodynamic interpersonal therapy). Early referral of patients to physical therapy is recommended; however, the optimal parameters of treatment, duration and intensity are unknown and seem to vary with the severity and chronicity of symptoms. The goal is to minimize self-awareness by diverting attention or by stimulating automatically generated movements with non-specific and gradual exercises. The use of compensatory technical aids should be avoided as much as possible. Psychotherapeutic management should encourage self-evaluation of cognitive distortions, emotional reactions and maladaptive behaviors while empowering the patient in managing symptoms. Symptom management can use anchoring strategies to fight against dissociation. The aim is to connect to the immediate environment and to enrich one's sensoriality. The psychological interventions should then be adapted to the individual psychopathology, cognitive style and personality functioning of each patient. There is currently no known curative pharmacological treatment for FND. The pharmacological approach rather consists of progressively discontinuing medication that was introduced by default and that could lead to undesirable side effects. Finally, neurostimulation (transcranial magnetic stimulation, transcranial direct current stimulation) can be effective on motor FND.

Does cognitive behavioral therapy without pharmacotherapy improve eating disorder remission rates?

Does cognitive behavioral therapy without pharmacotherapy improve eating disorder remission rates?

Effects of cognitive-behavioral and psychodynamic-interpersonal treatments for eating disorders: a meta-analytic inquiry into the role of patient characteristics and change in eating disorder-specific and general psychopathology in remission

BackgroundCognitive behavior therapy (CBT) and psychodynamic-interpersonal therapies (PIT) are two widely used and conceptually different outpatient treatments for eating disorders (EDs). To better understand how these treatments works, for whom, and under what circumstances, there is a need for knowledge about how outcomes are affected by diagnosis, comorbidity, changes in psychopathology, and study design.MethodReports on the effects of CBT and PIT for eating disorders were searched. Rates of remission and changes in ED specific- and general psychopathology were computed. Regression models were made to predict event rates by changes in specific- and general psychopathology, as well as ED diagnosis and study design.ResultsThe remission rate of CBT for binge eating disorder was 50%, significantly higher than the effect for other diagnostic groups (anorexia = 33%, bulimia: 28%, mixed samples 30%). The number of studies found for PIT was limited. All effect sizes differed from zero (binge eating disorder = 27%, anorexia = 24%, bulimia = 18%, mixed samples = 15%), but the precision of the estimates was low, with some lower-bound confidence intervals close to zero. For CBT, change in ED specific psychopathology predicted remission only when controlling for ED diagnosis, while change in general psychopathology did not predict remission at all. The predictive value of change in psychopathology for PIT, and the potential impact of comorbid personality disorders could not be analyzed due to a lack of studies. There was no difference in effects between randomized controlled trials and observational studies.ConclusionsCBT showed consistent remission rates for all EDs but left a substantial number of patients not in remission. Extant evidence suggest that PIT is not consistently effective in achieving remission for patients with EDs, although this finding is uncertain due to a small number of eligible studies. A group of patients with eating disorders may, however, require therapy aimed at strengthening deficits in self functions not easily ameliorable by cognitive behavioral techniques alone. Further research should be aimed at identifying treatment interventions that helps patients change behavior, while strengthening self-functions to substitute eating-disordered behavior in the long-term.

Expert opinion in psychotherapy: The transformation of psychotherapy practice in the Covid-19 era

Personalized medicine is generally defined as the tailoring of medical treatment to the individual genetic features of each patient. In the practice of psychotherapy, where links between the genetic profile of the patient and the efficacy of a particular form of psychotherapy have yet to be established, clinicians nevertheless are faced with adjusting the psychotherapeutic strategy to the particular characteristics of the patient. “Brands”, such as psychodynamic psychotherapy, CBT, or interpersonal therapy can be tailored to patients with particular symptom profiles, conflicts, and subjective distress.

Psychodynamic interpersonal therapy as a brief telephone crisis intervention during coronavirus lockdown: Experiences of both the help seekers and the helper

Brief psychodynamic interpersonal therapy (PIT) was offered by telephone during Coronavirus lockdown, for people feeling psychologically unsafe. People testified that remote PIT created a safe space to connect with feelings, building hope and clarity after crisis. Flexible service provision of PIT with modest resources is discussed.

Behavioural activation therapy for depression in adults.

Behavioural activation therapy for depression in adults.

Pilot service evaluation of a brief psychological therapy for self-harm in an emergency department: Hospital Outpatient Psychotherapy Engagement Service.

Brief psychological therapies may be helpful for people who have recently self-harmed. The current paper reports on a service evaluation of a novel brief therapy service based within an Emergency Department, Hospital Outpatient Psychotherapy Engagement (HOPE) Service. This service combines elements of psychodynamic interpersonal and cognitive analytic therapy to help people who present with self-harm-related difficulties. The primary aim of this service evaluation was to ascertain the feasibility of HOPE in terms of attendance rates. The study also examined variables associated with engagement, and change over time in psychological distress for those attending the service. The HOPE service was evaluated over a ten-month period. Consenting patients completed measures of psychological distress and working alliance across four therapy sessions and one follow-up session. Measures of emotion regulation style and self-harm function were also completed at the point of referral. Eight-nine patients were referred to the service (83 eligible referrals). Fifty-three (64%) attended at least one therapy session. Baseline variables did not distinguish people who attended and people who did not. Psychological distress decreased significantly across the sessions. Most people reported a good working alliance with their therapist. The results of this service evaluation support the feasibility of the HOPE service, demonstrating good engagement rates given the complexity of the population and context. Whilst there was evidence of reductions in distress, randomized controlled trials are needed to determine if HOPE has clinical efficacy. Rates of engagement with HOPE suggest the service is feasible in an Emergency Department context Working alliance scores were positive for the majority of patients The HOPE service shows promise as a brief intervention for people who self-harm but requires further evaluation Randomized controlled trials are needed to determine the clinical efficacy of the HOPE service.

PI‐E: An Empathy Skills Training Package to Enhance Therapeutic Skills of IAPT and Other Therapists

This paper describes a condensed version of psychodynamic interpersonal therapy (PIT), Psychodynamic Interpersonal Empathy (PI‐E), which consists of the first level of competencies of the PIT model. The intention is to use basic psychodynamic principles and skills to enhance delivery of manualized, cognitive therapy based treatments. The intervention is designed to improve two common factors of therapy: the bond between client and therapist, and the ability of the therapist to create positive expectations through an explanation and understanding of the person's problems. Both of these so‐called common factors are consistently associated with clinical outcomes. Training has been developed specifically for low‐intensity therapists who are employed in the Improving Access to Psychological Treatment programme. Training focuses upon five basic components of PI: negotiation; picking up cues; using statements rather than questions; focusing on feelings; and understanding hypotheses. When used skilfully together, these simple components offer a powerful way of empathizing and deepening the collaborative work with the client. They all help the therapist to focus upon how the client is feeling ‘here and now’ in the session. Training in the model has the potential to improve outcomes and reduce dropout rates by enabling therapists to manage problem scenarios in an empathic way.

The theoretical basis of the Conversational Model of Therapy

The Conversational Model of Therapy, which is also known as Psychodynamic-Interpersonal Therapy is an evidence-based psychological treatment. The model has a set of distinctive therapist behaviours, which can be taught and learnt in a short space of time. Although the model can be practised without an appreciation of the theory which underpins it, the theoretical basis of the model is rooted in psychodynamic ideas, and it shares many common theoretical approaches with other psychodynamic models. In this article, we describe the theoretical underpinnings of the model, include a description of basic model behaviours, an explanation of why these behaviours are important, and how they directly relate to and are derived from the theoretical stance. We also provide a case example, and show why the model can be practised without detailed theoretical knowledge to good effect, if its common guiding principles are followed.

Psychotherapy of depressive disorders : Procedures, evidence and perspectives

Depressive disorders are associated with ahigh burden of suffering and significantly reduce the well-being and the self-esteem of affected patients. Psychotherapy is one of the main treatment options for depressive disorders. The aim of this article is to present the current evidence for antidepressive psychotherapeutic treatments. During the revision of the German S3- and National Disease Management Guideline (NDMG) on unipolar depression in 2015, acomprehensive and systematic evidence search was conducted. The results of this search along with asystematic update are summarized. The most intensively investigated psychotherapeutic method is cognitive behavioral therapy (CBT), which proved to be effective in many trials. Evidence also exists for psychodynamic psychotherapy and interpersonal therapy (IPT), followed by systemic therapy and client-centered psychotherapy; however, the evidence is less robust. Psychotherapy alone or in combination with pharmacotherapy was shown to be an effective treatment option. Psychotherapy represents akey element in the treatment of depressive disorders.

Changes in Emotion Processing following Brief Augmented Psychodynamic Interpersonal Therapy for Functional Neurological Symptoms

Functional neurological symptoms (FNS) are considered non-volitional and often very disabling, but are not explainable by neurological disease or structural abnormalities. Brief Augmented Psychodynamic Interpersonal Therapy (BAPIT) was adapted to treat the putative emotion processing deficits thought to be central to FNS aetiology and maintenance. BAPIT for FNS has previously been shown to improve levels of distress and functioning, but it is unknown whether improvements on such measures correlate with changes in emotion processing ‒ which this treatment focuses on. To determine (a) whether the recently developed Emotional Processing Scale-25 can be used to demonstrate BAPIT-associated changes in patients with FNS, and (b) whether changes in the EPS-25 are associated with changes in previously validated outcome measures. 44 patients with FNS completed questionnaires including the EPS-25 and measures of clinical symptomology (health-related quality of life (SF-36), somatic symptoms (PHQ-15), psychological distress (CORE-10) and illness understanding (BIPQ)) pre- and post-therapy. At group level, emotion processing improved following therapy (p = .049). Some measures of clinical symptomology also improved, namely health-related quality of life (p = .02) and illness understanding (p = .01). Improvements in the EPS-25 correlated with improvements in mental health-related quality of life and psychological distress. Emotion processing and some measures of clinical symptomology improved in patients with FNS following BAPIT. The EPS-25 demonstrated changes that correlated with previously validated outcome measures. The EPS-25 is a suitable measure of psychotherapy-associated change in the FNS patient population.

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.

7 Changes in emotion processing associated with brief augmented psychodynamic interpersonal therapy for functional neurological symptoms

Objective The putative links between abnormal emotion processing and Functional Neurological Symptoms (FNS) suggest that this patient group might benefit from a psychotherapeutic intervention targeting the perception, naming, tolerance, and expression of emotions. Brief Augmented Psychodynamic Interpersonal Therapy, an intervention designed to address emotion processing difficulties, has previously been associated with improvements in health-related quality of life and psychological distress in patients with FNS. The objective of this study was therefore to determine whether improvements in clinical symptomology following Brief Augmented Psychodynamic Interpersonal Therapy, were associated with improvements in emotion processing. A second exploratory objective was to see if there were any identifying characteristics of patients who made a clinically significant improvement in emotion processing. Method battery of self-report questionnaires was administered to patients with FNS (n=44), prior to and following a course of Brief Augmented Psychodynamic Interpersonal Therapy. Emotion Processing was measured using the Emotion Processing Scale (EPS-25). The Short Form 36 (SF-36), Clinical Outcomes in Routine Evaluations (CORE 10), Patient Health Questionnaire (PHQ-15), and the Brief Illness Perception Questionnaire (BIPQ) measured health-related quality of life, psychological distress, somatic symptom severity, and illness perception respectively. Clinically significant improvements on the EPS-25 were identified using the Reliable Change Index. Patients were subsequently categorised as making a clinically significant improvement or not, and compared on all available demographic and clinical symptomology variables. Results We observed a significant reduction on the EPS-25 (p=0.049) following Brief Augmented Psychodynamic Interpersonal Therapy for FNS. Change scores on the EPS-25 correlated positively with improvements on the mental health subscale of the SF-36 (r=0.634) and the CORE-10 (r=0.673). BIPQ scores were significantly lower (p=0.013) and SF-36 scores were significantly higher (p=0.020) post-therapy. 22% of patients made a clinically significant improvement on the EPS-25. However, we were unable to identify any demographic or clinical symptomology variables which differed significantly between patients who made a clinically significant improvement in emotion processing and those who did not. Conclusion Emotion processing in patients with FNS improved following treatment with Brief Augmented Psychodynamic Interpersonal Therapy. This improvement was related to a reduction in psychological distress and improved mental health-related quality of life. Patients also perceived their symptoms as less threatening and experienced an improved health-related quality of life following intervention. Further work is required to establish characteristics which could identify patients who are particularly likely to improve in emotion processing with Brief Augmented Psychodynamic Interpersonal Therapy for FNS.

Treating functional non-epileptic attacks - Should we consider acceptance and commitment therapy?

Patients who experience functional non-epileptic attacks (FNEA) are frequently seen in Neurology clinics. Diagnosis alone can result in cessation of attacks for some patients, but many patients require further treatment. There is evidence that certain psychological therapies, like cognitive-behavioral therapy (CBT) and psychodynamic interpersonal therapy (PIT) can be beneficial. Acceptance and commitment therapy (ACT) is a type of CBT that has been found to be effective at treating other somatic disorders, like epilepsy and chronic pain. In this paper, we explain what ACT is, the current evidence-base for its use, and the rationale for why it may be a beneficial treatment for patients who experience FNEA. We conclude that ACT is a potential treatment option for FNEA, and further research is required.

The WORSHIP II study: a pilot of psychodynamic interpersonal therapy with women offenders who self-harm

The Women Offenders Self Harm Intervention Pilot II (WORSHIP II) study was conducted in three female prisons in England and piloted a treatment intervention for self-harm. WORSHIP II specifically aimed to reduce thoughts and actions of self-harm and suicide risk, through an evidence-based intervention Psychodynamic Interpersonal Therapy (PIT), which is also known as the conversational model. This paper provides an outline of this pilot evaluation of using the PIT approach in prison settings. Therapeutic obstacles associated with implementing WORSHIP II in a correctional environment are discussed, together with successful strategies to overcome these difficulties. Finally, examination of some of the quantitative outcomes suggests that WORSHIP II is a promising approach for this difficult area.

A Qualitative Study of Good-Bye Letters in Prison Therapy.

Self-harm rates among imprisoned women in the UK are extremely high and there are limited psychological therapies available to support them in prison. This paper presents women's subjective accounts of receiving good-bye letters at the end of brief psychodynamic interpersonal therapy (PIT) and how these letters positively impacted on their incidents of self-harm. This study presents the accounts of 13 imprisoned women who self-harmed and received letters following completion of a minimum of four sessions of brief PIT in prison. A semi-structured interview covered several aspects of their experience, which included details of self-harm since completing brief therapy as well as usage of a good-bye letter and its impact. The interviews were analyzed using thematic analysis. Three themes emerged from the analysis: connecting with the therapist: receiving the letter; connecting to self: understanding and awareness; and connecting to others: sharing the good-bye letter. Findings show the positive impact the letters had for the women following therapy. The preliminary impressions suggest that letters may be a helpful tool enhancing the benefits of brief PIT therapy with imprisoned women who self-harm.

Heart rate variability predicts therapy outcome in pain-predominant multisomatoform disorder

BackgroundAutonomic imbalance establishes an important model to understand organically unexplained physical complaints. Our study aimed to investigate whether the functioning of the autonomous nervous system corresponds with somatoform symptoms and predicts the outcome of brief psychotherapy in these patients. MethodAs a part of multicenter study assessing effects of brief psychodynamic interpersonal therapy on multisomatoform disorder (PISO-study), 106 patients participated in a stress experiment investigating autonomic reactivity during application of the Stroop-test. Patients were randomized receiving either enhanced medical care (EMC, N=49) or psychotherapy (N=57). Autonomic baseline functioning as well as stress reactivity of heart rate (HR) and heart rate variability (HRV) were analyzed in their relation to symptom measures and as potential predictors of the primary outcome (Physical Component Score of the SF-36) during 9-month follow-up. ResultsAfter therapy patients markedly and sustainably improved in physical quality of life, and this long-term improvement was predicted by baseline HR and HRV. HRV also predicted change in pain symptoms following psychotherapy. A responder analysis revealed a significant better treatment outcome in patients with high pre-treatment HRV (OR 3.4, CI: 1.2–9.9, p=.0035). No significant associations between HR or HRV and outcome measures were found in the EMC group. ConclusionIn our study, the adaptability of the autonomous nervous system as indicated by low pretreatment HR and high HRV was associated with a more pronounced benefit from psychotherapy. This finding can be explained by a possible association between autonomic self-regulation and emotional learning capacities.