Year Of Psychotherapy Research Articles

Alternation in functional connectivity within default mode network after psychodynamic psychotherapy in borderline personality disorder

BackgroundBorderline personality disorder (BPD) is characterized by impairments in emotion regulation, impulse control, and interpersonal and social functioning along with a deficit in emotional awareness and empathy. In this study, we investigated whether functional connectivity (FC) within the default mode network (DMN) is affected by 1-year psychodynamic psychotherapy in patients with BPD.MethodsNine BPD patients filled out the demography, Interpersonal Reactive Index (IRI), Toronto Alexithymia Scale 20 (TAS 20), the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and the Borderline Evaluation Severity over Time (BEST) questionnaire. The BPD group (9F) and the control group (9F) had a mean ± SD age of 28.2 ± 5.3 years and 30.4 ± 6.1 years, respectively. BPD subjects underwent longitudinal resting-state fMRI before psychodynamic psychotherapy and then every 4 months for a year after initiating psychotherapy. FC in DMN was characterized by calculating the nodal degree, a measure of centrality in the graph theory.ResultsThe results indicated that patients with BPD present with aberrant DMN connectivity compared to healthy controls. Over a year of psychotherapy, the patients with BPD showed both FC changes (decreasing nodal degree in the dorsal anterior cingulate cortex and increasing in other cingulate cortex regions) and behavioral improvement in their symptoms and substance use. There was also a significant positive association between the decreased nodal degree in regions of the dorsal cingulate cortex and a decrease in the score of the TAS-20 indicating difficulty in identifying feelings after psychotherapy.ConclusionIn BPD, there is altered FC within the DMN and disruption in self-processing and emotion regulation. Psychotherapy may modify the DMN connectivity and that modification is associated with positive changes in BPD emotional symptoms.

A participatory study of patient views on psychotherapy for complex post-traumatic stress disorder, CPTSD

Background A new diagnosis of Complex Post-traumatic Stress Disorder, CPTSD, is included in ICD-11 which was adopted in May 2019 by the World Health Organisation, WHO. In addition to the symptoms of PTSD, CPTSD includes emotional dysregulation, negative self-concept, and disturbances in relationships. It may be a helpful diagnosis for trauma survivors with experiences of human mistreatment such as torture and abuse. Aims This study explores the views of patients in the community on psychotherapy for the diagnosis of CPTSD, taking a qualitative, participatory approach. Method Twenty-four former patients from an NHS secondary mental health service in London interviewed each other about their treatment. Participants also collaborated in data analysis. All had a diagnosis of PTSD, with additional symptoms of CPTSD identified at assessment. Results The key factor in recovery was rebuilding relationships, beginning with the therapist. Groupwork was helpful in promoting relationships with others, as it may result in shame reduction. Involvement in the wider community through peer support groups was also valuable. Conclusions The rebuilding of relationships based on trust was an active mechanism of change and recovery from CPTSD. Participants felt that sufficient time, at least one year of psychotherapy with weekly sessions, was needed.

Intensive psychotherapy and case management for Karen refugees with major depression in primary care: a pragmatic randomized control trial

BackgroundDespite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. We studied the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in St Paul, Minnesota) with depression.MethodsA pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to 1 year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU). Eligibility criteria included Major Depression diagnosis determined by structured diagnostic clinical interview, Karen refugee, ages 18–65. IPCM (n = 112) received a year of psychotherapy and case management coordinated onsite between the case manager, psychotherapist, and primary care providers; CAU (n = 102) received care-as-usual from their primary care clinic, including behavioral health referrals and/or brief onsite interventions. Blinded assessors collected outcomes of mean changes in depression and anxiety symptoms (measured by Hopkins Symptom Checklist-25), PTSD symptoms (Posttraumatic Diagnostic Scale), pain (internally developed 5-item Pain Scale), and social functioning (internally developed 37-item instrument standardized on refugees) at baseline, 3, 6 and 12 months. After propensity score matching, data were analyzed with the intention-to-treat principle using repeated measures ANOVA with partial eta-squared estimates of effect size.ResultsOf 214 participants, 193 completed a baseline and follow up assessment (90.2%). IPCM patients showed significant improvements in depression, PTSD, anxiety, and pain symptoms and in social functioning at all time points, with magnitude of improvement increasing over time. CAU patients did not show significant improvements. The largest mean differences observed between groups were in depression (difference, 5.5, 95% CI, 3.9 to 7.1, P < .001) and basic needs/safety (difference, 5.4, 95% CI, 3.8 to 7.0, P < .001).ConclusionsAdult Karen refugees with depression benefited from intensive psychotherapy and case management coordinated and delivered under usual conditions in primary care. Intervention effects strengthened at each interval, suggesting robust recovery is possible.Trial registrationclinicaltrials.gov Identifier: NCT03788408. Registered 20 Dec 2018. Retrospectively registered.

Understanding the group process in the first year of psychotherapy: the walk, the basic assumptions and the challenges of young adults

This article aims to explore the dynamics of a small psychotherapy group, whose members, all young adults, began to wait for each other at the end of the sessions to walk down a stretch of road before going their separate ways. Clinical material selected from some sessions of the first year of the therapy is presented and commented on. From the possible meanings attributed to the walk, the authors highlight the group process characterized by the oscillation between the basic assumption of fight-flight and that of dependency. The work shows that the group’s walk becomes, from attack to clinician, to creation of a transitional area where it is possible to experience being a young adult.

Changes in Attachment Representation in Psychotherapy: Is Reflective Functioning the Crucial Factor?

The study analyzed the interdependence of change in attachment representation and reflective functioning (RF) in psychotherapy. RF data from 63 female borderline personality disorder (BPD) patients were analyzed with respect to change of attachment representation (from insecure to secure and from unresolved to resolved) fromthree angles: (1) RF as a moderator variable, (2) RF as an outcome variable, and (3) RF changes over one year of treatment. Patients who changed to a resolved attachment classification showed higher RF before treatment and at follow-up than patients who remained unresolved (RF = 3.0 vs. RF = 2.14, p = 0.039; and RF = 3.4 vs. RF = 2.36, p = 0.002). Similar results were found for changes from insecure to secure. A higher RF level before psychotherapy proved to be a moderator for change in attachment representation. Patients with unresolved attachment and low-level RF at the outset had the least chance for representational change during the first year of psychotherapy.

Analysis of psychiatric problems in burn patients in a tertiary burn unit: a prospective study

Background: Burn injuries in our part of the world generally occurs in the lower socio-economic groups. A large part of these patients suffers from underlying psychiatric disorders. This study is to see the prevalence rates and clinical diagnosis of psychiatric disorders and psychosocial problems as a predisposing factor to burns and squeal to burns in our population, hence necessitate the consultation with the psychiatric team management to improve the outcome from the time of critical phase recovery to the rehabilitation phase.Methods: 114 patients admitted with suicidal burns above the age of 15 years were included in the study at Dept. of Plastic, Reconstructive and Burn Surgery, Govt. Kilpauk Medical College and Hospital for a period of 2 years and evaluated.Results: The patients were mostly married females in the 2nd to 3rd decade of life. Most of them had some form of pre-morbid psychopathology. 60% of patients had &gt;50% burns and only 17% were survivors. After 1 year of psychotherapy, most patients had returned to normalcy.Conclusions: In our study deformity related depression were more after recovery hence prevention of deformity with usage of appropriate splintage, wound management, early grafting and intense physiotherapy will produce a drastic change in their wellbeing and coping ability and help long term rehabilitation and return to normalcy.

The Over-Patologization and Over-Medicalization of Children: a Current Problem

Currently vertiginous modifications carve tense coexistence between old and new paradigms. Embedded in the hasty, unprecedented subjective expressions appear on the scene, with such celerity that the existing linguistic categories are not enough to embrace them, to name them, to describe them as such - at best - are partially thought out. The empty spaces left by language promote the languages of segregation. The over-patologization and over-medicalization of children due to school difficulties and / or attentional difficulties are privileged ways of expressing exclusion movements. The Argentina Mental Health law (Nº 26657) open spaces for reworking the parameters and conceptual matrices involved in psychodiagnostics, in order to promote readings of transdisciplinary interrelations centered on human rights. In order to understand the theoretical and clinical complexity of the psychodiagnosis of children, the ongoing research project, endorsed of the San Luis University (Argentina) included: 1. Epidemiological studies of the consultation. 2. Development of diagnostic and therapeutic resources. 3. Etiological review of the symptom. 4. Analysis of therapeutic effectiveness. 5. Comparison of two psychoanalytic psychotherapeutic modalities (parallel group of parents and children versus individual treatment of the child. The clinical and empirical studies allow us to propose, within the framework of an extended diagnostic device, a new diagnostic indicator: the evolution of attentional difficulties - after six months to one year of psychotherapy - before resorting to pharmacological treatments. It is emphasized that diagnosis in a person's life is never neutral, therapeutic or iatrogenic.

Relationship representations and change in adolescents and emerging adults during psychodynamic psychotherapy

Objective: Two groups of clients at sequential developmental stages, adolescents and emerging adults, were compared regarding their presenting problems, psychological distress, and relationship representations over one year of psychotherapy. Method: Thirty adolescents aged 14–18 years and 30 emerging adults aged 22–28 years, with similar demographic background, completed outcome measures and interviews according to the Core Conflictual Relationship Theme (CCRT) method. Results: The groups differed significantly in the presenting problems but did not differ in their initial levels of distress; their symptoms improved to a similar extent after one year of psychotherapy; differences between the groups in the representations of others were consistent with age-specific developmental challenges; levels of representations were associated with levels of symptoms at the end-point of treatment. Conclusion: Clinicians need to be attuned to the specific difficulties and challenges of these continuous yet distinct developmental stages.

Use of Stellate Ganglion Block for Refractory Post-Traumatic Stress Disorder: A Review of Published Cases

Introduction: The lifetime prevalence of post-traumatic stress disorder (PTSD) is estimated to be 7.3% in the U.S. population, 10-20% among active duty service members and 35-40% among veterans. Overall success rates of evidence-based therapies for PTSD are low, leading clinicians to explore new therapeutic options. This study evaluated all published articles on the use of stellate ganglion block (SGB) as an adjunctive therapy for treatmentrefractory PTSD. Methods: EMBASE, PubMed, PsychINFO and Cochrane databases were searched using keyword combinations including stellate ganglion block, SGB, post-traumatic stress disorder, and PTSD. Articles were restricted to English language with no date delimiter. Twelve publications were identified, seven of which were eliminated due to lack of case data, duplicate patient sample, or descriptive reports with no standardized PTSD symptom assessment. Twenty-four cases from five articles were examined further by two independent evaluators who extracted data on sociodemographic and clinical characteristics including PTSD symptoms, comorbidities, and treatment history. Interrater reliability showed complete agreement (κ=1.0). Results: Cases were predominantly male (n=21, 88%) and active duty military (n=14, 58%) or veterans (n=8, 33%) with combat-related PTSD. The average age was 40.5 years (±10.0 SD). All cases had received >1 year of psychotherapy and pharmacotherapy before SGB. Seventeen cases (71%) received one SGB, seven (29%) received multiple SGBs. Clinically meaningful improvements were observed in 75% (n=18) of cases after SGB, with significant differences in mean PTSD scores pre- (69.5 ± 26.6) and post-SGB (34.2 ± 32.5) across cases (p<0.001). The effect size was relatively large (d=1.2). On average, PTSD improved by 50.4% (± 30.9 SD; range: 6.3-98.4) for cases with one SGB and 69.0% (± 28.0 SD; range: 9.2-93.5) for cases with multiple SGBs. Conclusions: Most patients with treatment-refractory PTSD experienced rapid improvement after SGB. Robust clinical trials are needed to determine SGB’s treatment efficacy for PTSD.

Rorschach and the WAIS-III after one and two years of psychotherapy

This study aimed at identifying what aspects of personality are modified after one and two years of psychoanalytic psychotherapy in adults attending a free university healthcare service in Sao Paulo, Brazil. The instruments were the Rorschach and the WAIS-III tests which were administered before and after one and two years of treatment. The participants were 34 adult individuals, both genders. After one year of psychotherapy in the Rorschach method there was an increase in effective and adaptive interpersonal relationship, an enhancement in sensitiveness related to the capacity of modulating affect, the need for close contact as well as the arousal of feelings of discomfort associated with intensification of self-regard, and a decrease in narcissistic tendencies. As well as in WAIS-III, there was an increase in motivation, attention and speed processing.

Rorschach Sistema Compreensivo na avaliação de psicoterapia psicodinâmica

A proposta foi avaliar mudanças decorrentes de psicoterapia psicanalítica em pessoas assistidas em um serviço universitário. Assim, 68 pessoas adultas, de ambos os sexos, foram avaliadas antes e depois de um ano de psicoterapia. Os protocolos de Rorschach Sistema Compreensivo foram analisados de acordo com seu grau de complexidade, metade em "menor" [R↓+F↑] e metade em "maior" [R↑+F↓]. Diferenças estatisticamente significantes foram encontradas com (a) aumento no grupo de "menor" complexidade e diminuição no grupo de "maior" complexidade em: R; EA; es; SumY; SumShd; FC+CF+C; CF+C; M; ativo; FD; H+(H)+Hd+(Hd); H puro, DEPI, (b) diminuição no "menor" e aumento no "maior" em Lambda e F puro. Observou-se confluência dos resultados, com o grupo de "maior" complexidade com menos turbulência em suas emoções e o de "menor" complexidade expressando abertura às experiências, mesmo se desconfortáveis. A terapia mostrou trazer benefícios a essas pessoas.

Midbrain serotonin and striatum dopamine transporter binding in double depression: A one-year follow-up study

Data on neurobiological differences between major depression (MD) and double depression (DD) are scarce. We examined the striatum dopamine (DAT) and midbrain serotonin transporter (SERT) binding of [123I] nor-beta-CIT in DD patients (n=8) and compared it to that in MD patients (n=11) and healthy controls (n=19). Drug-naïve patients and controls were imaged by single-photon emission computed tomography at baseline, and the patients also after one year of psychodynamic psychotherapy. Both DD and MD groups had lower midbrain [123I] nor-beta-CIT binding compared with the controls. Baseline 17-item Hamilton Depression Rating Scale (HAM-D-17) scores significantly decreased in both groups after one year of psychotherapy (DD: t=3.55, p=0.009; MD: t=5.86, p<0.001). No differences between the DD and MD groups were observed in age-adjusted baseline striatum or midbrain [123I] nor-beta-CIT binding or its change during psychotherapy. Age-adjusted baseline striatum [123I] nor-beta-CIT binding correlated inversely with the duration of both dysthymia (rho=-0.76, p=0.03) and MD (rho=-0.83, p=0.01) in the DD group. No such finding was observed in the MD group (rho=0.26, p=0.44). Baseline HAM-D-17 did not correlate with the change in striatum or midbrain [123I] nor-beta-CIT binding in either group. In conclusion, our findings suggest that when using midbrain [123I] nor-beta-CIT binding as a marker of SERT binding, no differences are detectable between patients with DD and MD. However, low striatum [123I] nor-beta-CIT binding, a marker of DAT binding, may be associated with a longer illness duration in dysthymia.

Poor metacognition in Narcissistic and Avoidant Personality Disorders: four psychotherapy patients analysed using the Metacognition Assessment Scale

AbstractPersonality Disorders (PDs) are hypothesized to involve a decrement in the capacity to understand one's own thoughts and feelings. Patients may not, for example, recognize their own emotions or put together integrated representations of self with other. Some researchers have suggested that this deficit varies between the different PDs. However, empirical evidence that might confirm or disconfirm this hypothesis is scarce. The goal of the present research is to evaluate the metacognitive capacity in four participants, two with Narcissistic Personality Disorder and two with Avoidant Personality Disorder. Using the Metacognition Assessment Scale to analyse the transcripts of their first year of psychotherapy, we have found that three of the four participants displayed difficulties in recognizing their inner states and in linking them to the environmental and psychological causes behind them. There was, additionally, a milder deficit in the ability to integrate multiple images of self with other. Copyright © 2007 John Wiley &amp; Sons, Ltd.

Changes in midbrain serotonin transporter availability in atypically depressed subjects after one year of psychotherapy

Background Psychotherapy is an effective treatment method for depression, but no differences in the psychotherapy response have been found between the subtypes of depression. The effect of psychotherapy on neurotransmitter transporter functions has never been recorded in depressed subjects. Methods Depressive outpatients ( N = 19) received psychodynamic psychotherapy for 12 months. All subjects fulfilled the DSM-IV criteria for depression, and 8 were classified as having atypical depression. The severity of depression was assessed with the 29-item Hamilton Depression Rating Scale (HAM-D-29). Midbrain serotonin transporter (SERT) and striatum dopamine transporter (DAT) densities were recorded using single photon emission computed tomography (SPECT) brain imaging with the [ 123I]nor-β-CIT radioligand before and after psychotherapy. Results Midbrain SERT density significantly increased during psychotherapy in atypicals but not in nonatypicals. There were no changes in the levels of DAT. Conclusions The psychotherapy-related SERT elevation of atypically depressed subjects may be due to some unknown adaptive mechanisms inducing an increase in either the levels of SERT or serotonergic nerve terminals and therefore enhancing serotonergic activity and improving mood.

Psychotherapy of Self-Criticism in a Case of Mixed Anaclitic-Introjective Depression

In this case study, the year-long psychotherapy of a depressed and self-critical 34-year-old women is described. Her depression was conceptualized as a “mixed” anaclitic and introjective type according to the model of Sidney Blatt. Anaclitic depression involves a preoccupation with the integrity of interpersonal relatedness (e.g., issues of dependency and abandonment), whereas introjective depression involves a preoccupation with autonomy and self-esteem (e.g., self-criticism and feelings of worthlessness). Given the potentially destructive nature of self-criticism, the therapist systematically confronted the patient’s use of this trait in a supportive manner. Changes in the patient’s functioning were assessed at the beginning and at the end of treatment using the Shedler-Westen Assessment Procedure and the Diagnostic and Statistical Manual of Mental Disorders (4th edition) Global Assessment of Functioning Scale. After 1 year of psychotherapy combining both cognitive and psychodynamic interventions, the patient evidenced significant changes in both anaclitic and introjective personality dimensions and showed significant improvements in adaptive functioning.

Review of the Somatic Response: Formation in Child Development

���������� A charming five year old boy was undergoing psychotherapeutic treatment owing to restlessness and lack of independence. In addition, he suffered from epilepsy, which began at the age of three. Since this time the boy had periodically fallen into epileptic states which could last almost a day. Conventional medicine alleviated the intensity of the fits, but did not prevent them from recurring. His parents sought help from an osteopathic physician, and after two years of treatment the frequency of the fits decreased to once or twice a month, and the fits manifested only as tongue clicking after which the boy fell asleep. After an additional year of psychotherapy this somatic response ceased as well, and has not returned. A nine year old girl, who looked her age, spoke on a three or four year old level. She suffered enuresis and occasional encopresis. A seven year old boy had an exceptionally unfavorable destiny because he had had surgery as an infant. Then, there were surgeries at three, five, and seven years. The last surgical intervention was undertaken due to an intestinal obstruction complicated by severe vascular and renal disease. A very lovely, cheerful five year old girl had a genetic illness, which had been diagnosed in infancy. She frequently suffered illnesses accompanied by high fevers, and a cough that frightened all the doctors. All of the children presented above are psychotherapeutic patients. These are only four examples of my patients from 5 to 9 years of age, who suffered somatic illnesses in addition to psychological manifestations of their problems. In this paper I would like to draw the attention of the psychotherapists to the somatic manifestations of the various conditions of poor health, that are exceptionally widely presented in children, as

Case history of Farida: A year of psychotherapy with a girl who said she was sexually abused

(1994). Case history of Farida: A year of psychotherapy with a girl who said she was sexually abused. Journal of Child Psychotherapy: Vol. 20, No. 3, pp. 359-388.

Auditing a year of psychotherapy

Auditing a year of psychotherapy

Patterns of symptomatic recovery in psychotherapy.

Using the psychotherapy dosage model in which effect was probability of recovery, this study compared treatment response rates for psychological symptoms. Symptom checklists were administered to 854 psychotherapy outpatients at intake and during treatment. Sixty-two symptoms were grouped into 3 classes on the basis of probit analysis results. Chronic distress symptoms demonstrated the fastest average response rate, whereas characterological symptoms demonstrated the slowest. Acute distress symptoms showed the highest average percentage of patients recovered across doses. A typical outpatient needed about a year of psychotherapy to have a 75% chance of symptomatic recovery. The model holds promise for establishing guidelines for the financing of psychotherapy.

DERMATITIS ARTEFACTA AND SEXUAL ABUSE

Case 1: This 16‐year‐old woman was referred for psychiatric management of her dermatitis artefacta that presented as superficial linear abrasions on her thighs and arms. During psychotherapy, the patient disclosed that her father had started sexually molesting her when she was about 8 years old. By age 10 years her father was having sexual intercourse with her. Initially, the patient confused her father's sexual advances with affection, but by age 10 years she became acutely aware of the abusive nature of their relationship. At this time, the father threatened to leave the family if the patient disclosed the sexual abuse. This was very threatening for the patient, since it would mean that her mother and her siblings would end up on welfare. The father then blamed the patient for “seducing him” and continued to abuse her sexually; the patient felt guilty and “bad.”The patient started making superficial linear abrasions on the anterior aspects of her thighs. She described that it helped her “release tension” because the pain helped her to cope with her guilt. The patient was essentially “punishing herself” by inflicting the lesions on herself. The patient also felt “very fat and ugly” and the scars on her body helped to validate this. During the course of therapy, the patient had much difficulty coping with the unresolved anger that began to surface as she acknowledged her feelings regarding the sexual abuse. Initially, she could cope with her anger only by cutting herself, and the symptoms of her dermatitis artefacta became worse. After about 1 year of psychotherapy she was able to acknowledge her feelings more effectively and became much more assertive. This was associated with a marked decrease in the frequency of her self‐mutilative behavior. Case 2: This 29‐year‐old woman was referred for psychiatric management of her dermatitis artefacta. The patient would typically present to her family doctor with rectangular abrasions on her forearms. The self‐inflicted nature of the lesions was obvious on inspection, but the patient denied remembering that she caused the injury. The patient entered psychotherapy once weekly, and after approximately 6 months, she began to have flashbacks about being sexually abused regularly by an older brother when she was between ages 5–8 years. The patient described dissociative experiences when she was being subjected to the abuse. For example, she felt like “she was watching someone else being abused” and remembers “not feeling anything” while her brother was raping her. Over several months she was able to recognize that she would dissociate whenever faced with emotionally disturbing situations, especially those involving anger. During these dissociative states she would inflict the rectangular abrasions on herself. The patient experienced a significant improvement in the frequency of her dissociative experiences and her self‐mutilative behavior as she acknowledged her anger toward her brother more directly. Chlorpromazine, 25 mg qid, prn, also proved to be a valuable adjunct in her therapy, as it helped her to cope with her very strong anger, and decreased the frequency of her dissociative reactions.