Specific Therapeutic Processes Research Articles

Artificial intelligence (AI)-enhanced electrocardiography: a machine-learning model for differential diagnosis between hypertrophic cardiomyopathy, cardiac amyloidosis and Anderson-Fabry disease

Abstract Background The differential diagnosis between Hypertrophic Cardiomyopathy (HCM) and phenocopies is challenging and relies on a comprehensive approach, which includes clinical and instrumental data, as well as laboratory exams and genetic testing. In this setting, 12-lead electrocardiogram (ECG) represents a valuable tool, but although typical patterns have been described, their diagnostic ability to discriminate between different etiologies is limited and requires considerable clinical experience. However, a correct diagnosis is of pivotal importance, allowing the prompt initiation of phenotype-specific therapies and consequently improving patient survival. Purpose Aim of this study was to develop a machine-learning model based on human-based ECG features to support the differential diagnosis between HCM, Cardiac Amyloidosis (CA) and Anderson-Fabry Disease (AFD). Methods We retrospectively examined ECGs of 200 patients, 50 affected by HCM, 100 affected by CA (50 AL CA and 50 transthyretin CA) and 50 with a diagnosis of AFD cardiomyopathy. The patients were then divided in sinus rhythm (SR) subgroup (158 patients) and atrial fibrillation (AF) subgroup (42 patients). For each subgroup, patients were randomly split into a training (80%) and a testing cohort (20%), and a random forest (RF) model was trained on the training cohort, with hyperparameter tuning via 10-fold cross validation. The resulting model was then tested on the testing cohort to assess its predictive accuracy. Results Both RF models (SR and AF) showed good discriminative performance in this multiclass classification task on the testing cohort [SR: accuracy 67%; multiclass area under the curve (AUC) 0.797, 95% confidence interval (CI) 0.472 -0.827; AF: accuracy 75%; multiclass AUC 0.792, 95% CI 0.349 – 0.968]. Figure 1 and figure 2 report for each model the rank of the most important variables for class prediction. Conclusions An AI-based ECG interpretation based on human-derived ECG features can predict the etiology underlying an hypertrophic phenotype, helping to perform a correct diagnosis and consequently to set a specific therapeutic process.

Learning clinical skills: an ecological perspective

The pedagogy underpinning clinical psychology training is often reliant upon the acquisition and transmission of knowledge and the practice of skills. The dominant paradigm in the training of clinical psychologists emphasises competence-based training drawing upon a scientist practitioner model of practice, often underpinned by knowledge of evidence-based interventions. Little has changed over the past 40 years. Training is predicated upon the assumption that effective therapy is attributed to the therapist’s skills to implement specific therapeutic processes and her or his capacity to form an effective working alliance with the client or patient. We provide an argument for an alternative paradigm in which ecological principles are privileged with a view to enhancing clinical training of psychologists in health settings responsive to the trainee as well as the broader societal context in which they practice, by adopting a pedagogy which prioritizes the relationship between the person and the environment. The proposed approach brings an ecological set of assumptions to the learning experience in clinical contexts. Key principles, drawn from an ecological perspective includes: affordances, the emergence of self-organisation in clinical learning, constraints and rate limiters. The approach is supported by examples applied to clinical learning contexts. Implications for clinical training are discussed. The ways in which an ecological approach may contribute to more effective learning outcomes through the use of representative learning contexts may inform learning design, how learning is actioned in clinical psychology as well as future research on the pedagogy of clinical training.

The role of pre-treatment interpersonal problems for in-session emotional processing and long-term outcome in emotion-focused psychotherapy

Objective: Interpersonal problems may lead to, uphold, or follow from depression. However, we know little of how depressed patients’ different interpersonal problems are associated with patients’ emotional processing during psychotherapy and whether distinct processes are helpful for their long-term reduction. Method: 23 adult outpatients who received emotion-focused therapies lasting 16–20 sessions filled the Inventory of Interpersonal Problems at pre- and post-treatment and 18-month follow-up. These problems were related to emotional processing in two mid-therapy sessions, rated by observers with the Classification of Affective-Meaning States. Results: All pre-treatment interpersonal problems were clearly associated with patients’ negative evaluations of themselves during therapy. Self-experiences of vindictiveness were most pronouncedly linked to in-session emotional expressions of rejecting anger, and self-experiences of social inhibition to expressions of fear and shame, following a circumplex model. In the long-term reduction of interpersonal problems, especially reaching emotional states of hurt and grief seemed beneficial for patients who experienced themselves as socially inhibited, non-assertive, self-sacrificing, or overly accommodating. Conclusions: For clients suffering from particular interpersonal problems, accessing particularly beneficial emotional processes, such as hurt and grief, may form specific therapeutic process goals. Further studies should verify these findings, which link interpersonal theory with research on emotional processing in psychotherapy.

Trauma and the Family: A Systems‐oriented Approach

Since at least the middle of the 19th century clinicians have been interested in the symptoms expressed by individuals following exposure to situations inducing severe and chronic stress (trauma). The symptom cluster has been labelled differently over the years. The current diagnosis of post‐traumatic stress disorder (PTSD) refers to these symptoms. Although not formally noted in the diagnostic categories, the literature has included much discussion of complex of PTSD (C‐PTSD), also often referred to as disorders extreme stress not otherwise specific (DESNOS). The linking of PTSD and C‐PTSD to early developmental environments represents an important step in understanding the individual's susceptibility to subsequent stress. The focus of clinical assistance has generally settled on the symptomatic individual. Various treatment approaches and techniques have been applied with varying results. The notion that the individual symptoms might be addressed with therapeutic processes applied beyond the individual to the relationship systems, particularly the family, in which the symptomatic individual lives and functions, has received less attention. The idea of chronic anxiety, included in Bowen's discussion of the relationship between anxiety and family relational activity (Bowen, ), provides a conceptual framework from which specific therapeutic processes directed to the relationship system itself can be hypothesised and implemented.

Psychological therapies for auditory hallucinations (voices): current status and key directions for future research.

This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation.

Interaction structures between a child and two therapists in the psychodynamic treatment of a child with Asperger's disorder

Leading the charge to link intervention research with clinical practice is the development of process research, which involves a detailed analysis of specific therapeutic processes over the course of treatment. The delineation of interaction structures – repetitive patterns of interactions between patient and therapist over the course of treatment – can inform therapists of what may be expected from patients with particular patterns of symptoms or behaviours in their clinical practice and how interactions change over time. Using the Child Psychotherapy Q-Set, this study aims to compare the different interaction structures that emerged in the two-year psychotherapy of a six-year-old child conducted, for one year each, by two doctoral-student therapists in a university-based community mental health clinic. The study allows for exploration of the independent role of the therapist in the psychodynamic therapy of a child diagnosed with Asperger's disorder. The results suggest that four distinct interaction structures between child and therapist could be identified in this psychotherapy and that the interaction structures differed between the two therapists and also differed over time within each treatment. The implications of these findings for training and clinical practice are discussed.

Mythe endopsychique et possession

This text tries to demonstrate in what the phenomenon of ownership is a psychopathologique fact with what we can seize the mechanisms of expression without locking itself for all that into ethnological considerations of set. In this that the culture is not explanatory, in itself, of such or such psychological trouble, even if it is dedicated to establish the way of admitting it and the specific therapeutic processes in its treatment. Leaning on the analysis of the case, he insists on the singular ramifications, which suppose the situation of the subject confronted with the psychic suffering.

Patient Opinions on the Helpfulness of External Rehabilitative Activities in Residential Psychiatric Care: A Pilot Study

Introduction:This study explores the patient opinions about the helpfulness of the External Rehabilitative Activities (ERA) delivered in two residential facilities for psychiatric rehabilitation.Methods:We administered a Questionnaire developed to assess general helpfulness, helpfulness of specific therapeutic processes and satisfaction with the ERA to a sample of 46 psychiatric patients participating in at least three external activities.Results:The External Rehabilitative Activities, tested by the ERA-Questionnaire, were considered helpful or very helpful by most of the patients. The therapeutic process with the highest score was “relaxation”, followed by “general helpfulness”, “socialization”, “knowledge of social context”, “community integration”. The least-valued process was “autonomy”. Conclusion:This pilot study has shown that psychiatric patients consider ERA helpful and rate more helpful the specific therapeutic processes, such as relaxation and socialization, that assure symptomatic relief and interaction with the outside world.

Healing Processes in Trauma Narratives: A Review

Re-tellings of the trauma story are a standard component of most current therapeutic interventions with trauma survivors. However, the exact therapeutic processes whereby trauma narratives may facilitate change are not always clearly explicated in the literature. In order to identify these processes, a review was conducted of the published literature on those psychotherapeutic interventions for trauma that centralise the role of the trauma narrative in the recovery process. The review indicates that six therapeutic processes have consistently been proposed through which producing a trauma narrative as part of the therapy process may facilitate recovery from post-trauma pathology: emotional catharsis; the creation of linguistic representation; the habituation of anxiety; empathic witnessing of injustice; developing an explanatory account; and the identification of purpose and value in adversity. The role of the therapist during the trauma re-telling may differ in important ways, depending on the specific therapeutic process that the therapist and client are concerned with at a particular point in therapy. The implications for trauma counsellors, and for future research, are discussed.

Group properties and outcomes: a study of group norms in self-help groups for widows and widowers.

Despite the nearly universally shared agreement among group therapists about the importance of group norms, empirical studies have rarely demonstrated a positive relationship between specific norms in psychotherapy groups and patient benefit. The study explored this relationship by examining the linkages between norms, a specific therapeutic process, and patient outcome. Examined were seventy-two spousal bereavement groups. Subjects' responses to a thirty-one item behavioral inventory were used to define norms; outcomes were based upon Time 1/Time 2 differences on a series of eleven measures indexing depression, anxiety, somatic symptoms, abuse of psychotropic medication, coping mastery, well-being, self-esteem, target problem rating, several measures of role stress and strain, and stigma. The findings suggest that normative characteristics were linked to a process, reciprocal social exchange, that influences positive outcomes. The results are preliminary, since they only serve to demonstrate such a relationship can exist.