Psychotherapeutic Treatment Approaches Research Articles

Addressing psychosocial needs in patients with Long-COVID (PsyLoCo-Study): study protocol of a pilot-study of a specialized modular intervention.

After an acute infection with the corona virus 10-20% of those affected suffer from ongoing or new symptoms. A causal therapy for the phenomenon known as Long/Post-COVID is still lacking and specific therapies addressing psychosocial needs of these patients are imperatively needed. The aim of the PsyLoCo-study is developing and piloting a psychotherapeutic manual, which addresses Long/Post-COVID-related psychosocial needs and supports in coping with persistent bodily symptoms as well as depressive or anxiety symptoms. This pilot trial implements a multi-centre, 2-arm (N=120; allocation ratio: 1:1), parallel group, randomised controlled design. The pilot trial is designed to test the feasibility and estimate the effect of 1) a 12-session psychotherapeutic intervention compared to 2) a wait-list control condition on psychosocial needs as well as bodily and affective symptoms in patients suffering from Long/Post-COVID. The intervention uses an integrative, manualized, psychotherapeutic approach. The primary study outcome is health-related quality of life. Outcome variables will be assessed at three timepoints, pre-intervention (t1), post-intervention (t2) and three months after completed intervention (t3). To determine the primary outcome, changes from t1 to t2 are examined. The analysis will be used for the planning of the RCT to test the efficacy of the developed intervention. The pilot study will evaluate a 12-session treatment manual for Long/Post-COVID sufferers and the therapy components it contains. The analysis will provide insights into the extent to which psychotherapeutic treatment approaches improve the symptoms of Long/Post-COVID sufferers. The treatment manual is designed to be carried out by psychotherapists as well as people with basic training in psychotherapeutic techniques. This approach was chosen to enable a larger number of practitioners to provide therapeutic support for Long/Post-COVID patients. After completion of the pilot study, it is planned to follow up with a randomized controlled study and to develop a treatment guideline for general practitioners and interested specialists. The pilot trial has been registered with the German Clinical Trials Register (Deutsches Register Klinischer Studien; Trial-ID: DRKS00030866; URL: https://drks.de/search/de/trial/DRKS00030866) on March 7, 2023.

Mitigating the impact of intimate partner violence in pregnancy and early childhood: A dyadic approach to psychotherapy

AbstractIntimate partner violence (IPV) is often considered an adult problem despite profound consequences for the children who are exposed toviolent relational patterns. About a third of children and adolescents report past exposure to parental IPV, and a majority were first exposed as infants. Exposure to IPV during pregnancy through the first 5 years of a child's life has consequences ranging from adverse birth outcomes to diagnosable emotional problems and lasting physiological dysregulation. This article reviews risks and consequences of IPV in pregnancy and early childhood and discusses a relational psychotherapeutic treatment approach (Child–Parent Psychotherapy) applied to both developmental stages to mitigate the adverse consequences of family violence on parents and their children. Research evidence for the effectiveness of Child–Parent Psychotherapy (CPP) among IPV‐exposed families is reviewed as are specific treatment components which seek to restore relational safety following familial violence. Additionally, clinical considerations unique to families with histories of or ongoing exposure to IPV are discussed. Finally, recommendations are presented to improve the integration between medical and early childhood behavioral health systems for families at highest risk for chronic IPV.

The importance and limitations of polysomnography in insomnia disorder-a critical appraisal.

The importance polysomnography (PSG) in the diagnosis and treatment process of insomnia disorder (ID) remains highly disputed. This review summarises the state of the science regarding PSG indications and findings in ID, and the indications to conduct PSG in ID as stated by relevant guidelines. It then highlights the most relevant questions regarding the topic, including the relevance of ID subtyping, to allow an individualised pharmacological or psychotherapeutic treatment approach.

Viswanathan Chosen APA’s Next President-Elect

Back to table of contents Previous article Next article APA & MeetingsFull AccessViswanathan Chosen APA’s Next President-ElectCatherine BrownCatherine BrownSearch for more papers by this authorPublished Online:24 Feb 2023https://doi.org/10.1176/appi.pn.2023.03.3.65AbstractAPA’s next president-elect is a nationally known researcher and clinician and has worked tirelessly on such issues as access to care, social justice, empowerment of minorities and women, physician wellness, positive psychiatry, and environmental psychiatry. He has held numerous leadership positions at APA and other organizations.APA’s voting members have elected Ramaswamy Viswanathan, M.D., Dr.Med.Sc., of Brooklyn, N.Y., as APA’s next president-elect. He ran against Robert L. Trestman, Ph.D., M.D., of Roanoke, Va.Ramaswamy Viswanathan, M.D., Dr.Med.Sc. (left), will become president-elect of APA at the end of APA’s Annual Meeting in May, when Petros Levounis, M.D., M.A., becomes president.Viswanathan is professor, interim chair of psychiatry, director of the consultation-liaison psychiatry and fellowship, and co-chair of the Faculty Wellness Committee at SUNY Downstate Health Sciences University. His research has been in physician communication, ethics, innovations in psychotherapy and pharmacotherapy, treatment adherence in gynecologic cancers, children’s sickle cell disease, HIV, and substance use.Viswanathan has held numerous leadership positions within APA and other national organizations. He currently serves as the Brooklyn Psychiatric Society representative in the APA Assembly and is chair of the Committee on Consultation-Liaison Psychiatry for the Group for the Advancement of Psychiatry.“I am honored that my colleagues in psychiatry have elected me to the APA presidency,” said Viswanathan. “I look forward to working together to further develop and expand our workforce and to keeping up our momentum on research and development of cutting-edge psychopharmacologic, neuro-interventional, and psychotherapeutic treatment and preventive approaches. We will also work together to advance physician wellness, reduce practice burdens, advocate for our patients and our profession, address inequities in health care, and promote appreciation of diversity and inclusion.”“Congratulations to Dr. Viswanathan and the other candidates on their election,” said APA President Rebecca Brendel, M.D., J.D. “I look forward to working with him and all the newly elected APA leaders to advance psychiatric practice and APA’s leadership role in increasing access to care and improving the quality of mental health care.”APA CEO and Medical Director Saul Levin, M.D., M.P.A., echoed those sentiments. “APA members and the profession of psychiatry will be well served by Dr. Viswanathan’s leadership and commitment. I want to congratulate Dr. Viswanathan and all the newly elected APA leaders.”The race for secretary, which has a two-year term, was up for election this cycle. Gabrielle L. Shapiro, M.D., of New York City defeated Jenny L. Boyer, M.D., Ph.D., J.D., of Norman, Okla., and C. Freeman, M.D., M.B.A., of Marina Del Rey, Calif.In the race for minority/underrepresented representative trustee, Kamalika Roy, M.D., M.C.R., of Seattle emerged the winner. Her opponent was Dora-Linda Wang, M.D., of New York City. The term for minority/underrepresented representative trustee is two years.Two of APA’s seven geographic Areas voted for their trustee in this cycle. Area trustees hold three-year terms. In the race for Area 2 trustee, Kenneth B. Ashley, M.D., of New York City defeated Glenn A. Martin, M.D., of Forest Hills, N.Y. The winner of the Area 5 trustee race was Heather Hauck, M.D. She defeated Sudhakar Madakasira, M.D., of Flowood, Miss.The winner of the race for resident-fellow member (RFM) trustee-elect was Sarah El Halabi, M.D., M.S., a psychiatry resident at Westchester Medical Center in New York. She defeated Sarah A. Friedrich, D.O., M.B.A., M.S., chief resident at Jefferson Health’s Albert Einstein Medical Center in Philadelphia, and Sarin Pakhdikian, D.O., a psychiatry resident at the Kirk Kerkorian School of Medicine at the University of Nevada. El Halabi will serve for a year in the RFM trustee-elect position and then rotate into the RFM trustee position.Election results were approved by the Tellers Committee in February, but the results are not official until the Board of Trustees reviews them at its meeting this month. All of the winning candidates will assume their positions on the Board at the close of APA’s Annual Meeting in May. ■ResourcesComplete results, including vote counts for each race ISSUES NewArchived

Evidence-based inpatient psychotherapy of bipolar disorders

Although psychotherapy is an important pillar in the treatment of bipolar disorders, alongside pharmacotherapy, non-drug and complementary procedures, there is no up to date evidence synthesis for inpatient psychotherapeutic treatment and work with caregivers. To review and evaluate the current study situation on evidence-based inpatient psychotherapy for bipolar disorders. 1.Summary of the evidence for inpatient psychotherapy in adolescents and adults with bipolar disorders from current review articles and guidelines (German S3 guidelines, Australian, Canadian, and British NICE guidelines). 2.Systematic literature search (PRISMA) in Cochrane trials and Medline (via PubMed). 2a.Identification of original articles using the following search term: "bipolar fft" OR "bipolar ipsrt" OR "bipolar cbt" OR "bipolar cognitive remediation" OR "bipolar psychotherapy inpatient". 2b.Screening of n = 942 publications on the following inclusion criteria: randomized controlled efficacy trials, inpatient treatment/recruitment in the inpatient setting, adolescent or adult patients with bipolar disorder or caregivers. The guidelines recommend acombination of pharmacotherapy and psychotherapy for the treatment of patients with bipolar disorders (so far no evidence-based presentation of inpatient psychotherapy). The results from reviews and original papers are heterogeneous. Recently described evidence-based psychotherapeutic approaches for inpatient treatment are family focused therapy (FFT), interpersonal and social rhythm therapy (IPSRT) and psychoeducation. Although the current evidence is heterogeneous and further systematic studies are necessary, the results indicate that psychotherapy should be started or initiated in the inpatient setting with inclusion of caregivers.

1.2 Anxiety in ASD

Anxiety disorders are common among children with ASD, affecting 40% to 50% of this population. The objective of this presentation is to describe the assessment of anxiety in children with ASD as well as psychotherapeutic and pharmacologic treatment approaches.

Emotional Reactivity, Emotion Regulation, and Social Emotions in Affective Disorders

Abstract. Affective disorders, specifically Major Depressive Disorder and Bipolar Disorders, show high prevalence, relapse rates, and a high likelihood to develop a chronic course. For the past two decades, research has investigated the neural correlates of emotion processing and emotion regulation in patients with affective disorders. Putative underlying causal mechanisms of dysregulated affect have been informed by knowledge from the intersection of neuroimaging and clinical psychology. More recent investigations also consider processing the role of mostly negative, self-blaming social emotions, which have been linked to treatment resistance and, hence, provide a prolific target for intervention. Several psychotherapeutic treatment approaches already focus on emotion, and here specific knowledge about the mechanisms underlying persistent changes in affect bears the potential to improve the treatment of affective disorders. In this narrative review, we delineate why and how our insights into the neural correlates of emotion processing and regulation can be applied to the treatment of patients with affective disorders.

Electroconvulsive therapy for negative symptoms in schizophrenia: a literature review from 2000 to 2021

Negative symptoms in schizophrenia remain a clinical challenge with small effect sizes and evidence for pharmacological or psychotherapeutic treatment approaches. Studies suggest that electroconvulsive therapy (ECT) holds some promise as a treatment option of often persistent negative symptoms with clinically meaningful effects. This review summarizes the existing evidence on the efficacy of ECT on negative symptoms in patients with schizophrenia. Thirty-five publications were included in this literature review comprising 21 studies, two meta-analyses, eight reviews and four case reports. Conclusions should be interpreted cautiously, given the small number and methodological shortcomings of the included publications with a variation of study designs and missing standardized protocols. Implications for future research and practice are critically discussed. Recommendations are given to provide more evidence that will meet the clinical challenge of reducing the negative symptoms in schizophrenia. Study designs that focus explicitly on negative symptoms and assess patients over longer follow up periods could be helpful. Future research should include control groups, and possibly establish international multicentered studies to get a sufficient study population. Findings suggest that patients with schizophrenia resistant to pharmacological treatment might benefit from ECT. A risk and benefit assessment speaks in favour of the ECT treatment. Future practice of ECT should include a combination treatment with antipsychotics. Whereas the use of anaesthetics and electrode placement does not seem to play a role, the recommendation regarding frequency of ECT treatments is currently three times a week, For the assessment of negative symptoms the assessment tool should be chosen carefully.

A Behavior Analytic Perspective on Treatment of Problem Gaming and Problem Social Media Use

To characterize treatment studies for some forms of problematic internet use and identify ways behavior analysts might contribute, we reviewed published treatment studies for two subtypes of problematic internet use, problem gaming and problem social media use. Our search identified 41 treatment studies for problem gaming and none for problem social media use. Problem gaming treatment studies used a range of pharmaceutical, psychotherapeutic, and other treatment approaches and a variety of methods to measure problem gaming. None of the treatment approaches were primarily behavior analytic. Because there is no published research that focuses in particular on treating problem social media use, any research on interventions for problem social media use would be a novel contribution. Behavior analytic approaches could help to clarify the mechanisms involved in gaming, social media use, and related behaviors, and to differentiate problematic from healthy use. Behavior analysts could also contribute to this field by recording response patterns directly, developing standardized functional assessment questionnaires, and applying functional analysis to problem gaming and problem social media use. This is an emerging area of study that presents many opportunities for behavior-analytic research and practice.

Current state of research on psychotherapy for home-living vulnerable older adults with depression.

Older home-living vulnerable adults often suffer from chronic conditions accompanied by restrictions in mobility, social participation and reduced independence. Among this rapidly growing population depression is a common and serious health problem; however, there are shortcomings in the diagnosis of depression and provision of psychotherapy. Despite growing evidence in treating depression among the group of nursing home residents or the “young-old”, there is a research gap regarding needs-oriented healthcare strategies for very old, frail or care-dependent older adults living at home. The present article provides an overview of different outpatient psychotherapeutic treatment approaches for vulnerable older adults with depression, in particular adaptations tailored to those who are homebound or in need of care. Based on the current state of research, this article derives recommendations for psychotherapy in this special setting to consider the physical and psychosocial resources of this patient group. Furthermore, healthcare strategies for embedding psychotherapy in collaborative, telehealth or home-delivered healthcare services are described and their applicability as psychosocial support for older adults during the coronavirus disease 2019 (COVID-19) pandemic is discussed. Psychotherapy is an efficacious treatment for depression in home-living vulnerable older adults. Further implementing telehealth or home delivered settings, individually tailored psychotherapeutic approaches as well as collaborative and stepped care approaches can increase utilization and medical supply of this patient group. More research and innovative programs are needed to improve access to and provision of psychotherapeutic care as well as their social inclusion.

Pharmacotherapy for Treatment-Resistant Obsessive-Compulsive Disorder.

Obsessive-compulsive disorder (OCD) is a disabling illness affecting approximately 2–3% individuals worldwide that is marked by recurrent, distressing intrusive thoughts (obsessions) and repetitive behaviors (compulsions).1,2 The underlying pathophysiology is incompletely understood, but OCD symptoms are thought to emerge partly from aberrant functionality in cortico-striato-thalamo-cortical neural circuits.3 Though OCD is a major cause of functional disability and impairment,4 the only medications currently approved by the US Food and Drug Administration (FDA) are serotonin reuptake inhibitors (SRIs, i.e. the selective SRIs [SSRIs] and clomipramine).5 Extensive evidence supports that SRIs are effective for treating OCD symptoms, and with a favorable side effect profile relative to clomipramine, SSRIs are currently the first-line pharmacotherapy.6 However, around half of patients will respond incompletely to SSRIs,7 and at least eight weeks of sustained treatment are typically needed before meaningful clinical improvement is seen.6 SSRI treatment is associated with dose-dependent side effects including GI upset and sexual dysfunction, which may be particularly problematic given that patients with OCD tend to require treatment with higher doses to achieve symptomatic relief compared to those with anxiety and depressive disorders.8 When patients do not respond to or are cannot tolerate SSRIs, the evidence supports several next steps. Here, I briefly review options for pharmacological management of treatment-resistant OCD, summarizing the evidence supporting each. What constitutes “responsiveness” to OCD treatment remains controversial, though improvement from baseline of 25–35% on the Yale-Brown Obsessive-Compulsive Scale (YBOCS) is a commonly-used definition. Experts similarly disagree on the definition of “treatment resistance”, but have generally quantified it based on the number of failed treatment trials.9 A comprehensive review of this topic, including a review of psychotherapeutic and somatic treatment approaches, is beyond the scope of this article; more detailed discussions can be found in the following references (6,9,10,11).

Psychosocial therapy in psychiatry : Update of the DGPPN-S3 guidelines "Psychosocial therapies for severe mental illnesses"

Severe mental illnesses are often associated with substantial impairments of psychosocial functioning and ahigh risk of social exclusion. Along with somatic and psychotherapeutic treatment approaches, psychosocial interventions are an integral component of treatment. Psychosocial therapies aim to improve participation and enable patients to live self-determined lives as far as possible. This paper provides an overview of the structure and recommendations of the German S3guidelines "Psychosocial therapies for severe mental illnesses" of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN). In the DGPPN S3 guidelines psychosocial therapies are systematically described for the first time and recommendations are formulated on the basis of asystematic processing of scientific evidence and a formalized consensus process. The evidence-based and consensus-based guidelines formulate atotal of 33recommendations and 12statements. For many psychosocial interventions there is abroad evidence base. In the field of individual interventions psychoeducation, social skills training and health-promoting interventions have been given the highest recommendation strength(A). In the field of system level interventions, team-based, multiprofessional community psychiatric approaches, supported employment and self-determined housing with mobile support (supported housing) are given A level recommendations. For other interventions, the current evidence base is less robust. The successful implementation of guidelines depends not only on the quality but also on the dissemination. Therefore, in addition to the treatment guidelines ashort version, apatient version and awaiting room version were developed.

What are the Key Characteristics of a 'Good' Psychotherapy? Calling for Ethical Patient Involvement.

ObjectiveThe evidence-based practice movement clearly defines the relevant components of a good treatment. In the present article, we elaborate on how the active involvement of patients within psychotherapy can and should be increased in order to respect ethical considerations. Our arguments complement the requirements of evidence-based practice, and are independent of the actual psychotherapeutic treatment approach being used.MethodTheoretical and ethical analysis.ResultsIn order to respect patient autonomy, psychotherapy needs to be transparent and honest when it comes to disclosing the relevant factors for promoting therapeutic change. It has been argued that ethical informed consent needs to include empirically supported patient information. In this paper we go one step further: we outline that fully respecting ethical considerations in psychotherapeutic treatment necessarily calls for acknowledging and strengthening the active role of patients in the course of psychotherapy. Accordingly, patients need not only to be informed openly and transparently about the planned treatment, the treatment rationale, and the expected prognosis of improvement in the course of psychotherapy, but they also need to be actively involved in the decision-making process and during the entire process of psychotherapeutic treatment.ConclusionsOur arguments support the tendency that can be observed in health care in recent years towards more active patient involvement across different health-care domains, but also in clinical research. This article offers an ethical perspective on the question what defines a ‘good psychotherapy', which, hopefully, will help to leave behind some of the ongoing psychotherapy debates and move the field forward.

The Role of Psychotherapy in the German Health Care System: Training Requirements for Psychological Psychotherapists and Child and Adolescent Psychotherapists, Legal Aspects, and Health Care Implementation

In Germany every citizen must acquire either public or private health insurance from companies which then cover the expenses for psychotherapeutic in-patient and out-patient treatments within a given set of regulations. Since the commencement of the Psychotherapists' Law in 1999, psychological psychotherapists and child and adolescent psychotherapists are permitted to diagnose and treat mental disorders with psychotherapy under their own responsibility as a legally defined healing profession. Psychotherapists have to use scientifically approved psychotherapeutic approaches for treatment. The qualification and licensure of psychotherapists are highly regulated by the Psychotherapists' Law, which is currently undergoing a process of change. 2.86 million patients are in outpatient or inpatient psychotherapeutic care per year in Germany, tendency rising. Psychotherapeutic care is highly regulated, only scientifically approved approaches are admitted. Psychological and child and adolescent psychotherapists treat patients under their own responsibility. Future courses of study and advanced training for psychotherapists will be similarly structured to those of the medical profession. 2.86 million patients are in outpatient or inpatient psychotherapeutic care per year in Germany, tendency rising. Psychotherapeutic care is highly regulated, only scientifically approved approaches are admitted. Psychological and child and adolescent psychotherapists treat patients under their own responsibility. Future courses of study and advanced training for psychotherapists will be similarly structured to those of the medical profession.

Psychotherapeutic Treatments for Depression During Pregnancy.

Depression during pregnancy is a significant public health problem that is associated with adverse consequences for women and children. Despite the availability of treatment options, depression during pregnancy is often undertreated. Most pregnant women prefer nonpharmacological interventions over antidepressant medications. We review the evidence base for psychotherapeutic treatment approaches to depression during pregnancy. Treatments reviewed include interpersonal therapy, cognitive-behavioral therapy, behavioral activation, and mindfulness-based cognitive therapy. We review both traditional face-to-face delivery and digital interventions. We conclude with recommendations for treatment preferences, collaborative decision-making, and strategies to improve uptake of such services among prenatal women.

Please Don't Leave Me-Separation Anxiety and Related Traits in Borderline Personality Disorder.

In light of the apparent symptomatic resemblance of separation anxiety disorder (SAD) symptoms on the one hand and abandonment fears, anxiousness, and separation insecurity central to borderline personality disorder (BPD) on the other hand, a comprehensive overview of separation anxiety and related traits in BPD is provided. Epidemiological, environmental, psychological, and neurobiological data connecting BPD to separation events, feelings of loneliness, insecure attachment styles, dimensional separation anxiety as well as SAD per se suggest a partly shared etiological pathway model underlying BPD and SAD. Differential diagnostic aspects and implications for treatment are discussed, highlighting separation anxiety as a promising transdiagnostic target for specific psychotherapeutic and pharmacological treatment approaches in BPD. This innovative angle on cross-disorder symptomatology might carry potential for novel preventive and therapeutic avenues in clinical practice by guiding the development of interventions specifically targeting separation anxiety and attachment-related issues in BPD.

Mending the heart and mind during times of loss: A review of interventions to improve emotional well-being during spousal bereavement.

Spousal loss is one of life's greatest stressors. Bereaved spouses are at risk for aberrant cognitive and affective processing. Recent work in psychoneuroimmunology and cognitive neuroscience reveals physiological biomarkers and neural mechanisms underlying acute distress and grief during bereavement that may represent targets for future interventions. We review evidence from existing pharmacological and psychotherapeutic treatment approaches for normal bereavement, complicated grief, and bereavement-related depression. We propose promising future directions, namely the development and empirical validation of novel, personalised cognitive and neurostimulatory interventions to promote adaptive emotion regulation and reduce depressive symptoms following spousal loss. Future work may substantiate which interventions to improve emotional and physical health will be best matched to the needs of a particular surviving spouse.

Psychotherapeutic Treatment for Anorexia Nervosa: A Systematic Review and Network Meta-Analysis.

Background: The aim of the study was a systematic review of studies evaluating psychotherapeutic treatment approaches in anorexia nervosa and to compare their efficacy. Weight gain was chosen as the primary outcome criterion. We also aimed to compare treatment effects according to service level (inpatient vs. outpatient) and age group (adolescents vs. adults).Methods:The data bases PubMed, Cochrane Library, Web of Science, Cinahl, and PsychInfo were used for a systematic literature search (until Feb 2017). Search terms were adapted for data base, combining versions of the search terms anorexia, treat*/therap* and controlled trial. Studies were selected using pre-defined in- and exclusion criteria. Data were extracted by two independent coders using piloted forms. Network-meta-analyses were conducted on all RCTs. For a comparison of service levels and age groups, standard mean change (SMC) statistics were used and naturalistic, non-randomized studies included.Results: Eighteen RCTs (trials on adults: 622 participants; trials on adolescents: 625 participants) were included in the network meta-analysis. SMC analyses were conducted with 38 studies (1,164 participants). While family-based approaches dominate interventions for adolescents, individual psychotherapy dominates in adults. There was no superiority of a specific approach. Weight gains were more rapid in adolescents and inpatient treatment.Conclusions: Several specialized psychotherapeutic interventions have been developed and can be recommended for AN. However, adult and adolescent patients should be distinguished, as groups differ in terms of treatment approaches considered suitable as well as treatment response. Future trials should replicate previous findings and be multi-center trials with large sample sizes to allow for subgroup analyses. Patient assessment should include variables that can be considered relevant moderators of treatment outcome. It is desirable to explore adaptive treatment strategies for subgroups of patients with AN. Identifying and addressing maintaining factors in AN remains a major challenge.

Psychotherapeutic approaches for treatment of the elderly

This article focusses on the possibilities, varieties, indications, and benefits of psychotherapy with elderly patients. Which basic principles can be differentiated, what theoretical rationales are helpful for psychotherapy with the elderly and what kind and forms of psychotherapy are available? Based on relevant references and research, clinically relevant and evidence-based psychotherapies are described, to understand the theoretical rationale, the goals, the procedure and main strategies. Cognitive behavior therapy, problem solving therapy, life review therapy, interpersonal psychotherapy, and psychodynamic psychotherapy are available to treat various psychological and somatic problems in elderly patients. In particular, cognitive behavior therapy, problem solving therapy, and life review therapy are evidence-based and empirically validated. Evidence for interpersonal psychotherapy is mixed and for psychodynamic psychotherapy is missing. Psychotherapy with old and very old patients is possible, well received, and successful. Age per se is no longer considered to be arelevant variable for indications of psychotherapy.

Internet addiction and the virtual self-image

BackgroundInternet gaming disorder appears to be associated with self-concept deficits and increased identification with one's avatar. For increased social network use, the few existing studies suggest striatal-related positive social feedback as an underlying factor. Furthermore, few study findings indicate that internet addicts generally have problems in emotional inhibitory control processing.MethodsPathological and addicted internet gamers as well as social network users were compared with healthy controls regarding psychometric and neurobiological measures of self-concept-related characteristics, avatar identification and emotional inhibitory control processing.Results and conclusionPsychometric results indicated that both subgroups showed higher self-concept deficits compared to healthy controls. Neurobiologically, different brain activation patterns were observed in the subgroups during self-knowledge retrieval and inhibition of emotional stimuli. Furthermore, addicted internet gamers showed a higher identification with the own avatar, mirrored in an increased left angular gyrus activation, a region functionally associated with identification processing and feelings of empathy.These findings provide a starting point for the deduction of specific psychotherapeutic treatment approaches for addicted internet gamers and social network users.Disclosure of interestThe authors have not supplied their declaration of competing interest.