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Concept: Psychodynamics

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Background: Psychodynamic psychotherapy has been used to treat depression for more than a century. However, not all patients respond equally well, and there are few reliable predictors of treatment outcome. Methods: We used resting (18)F-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) scans immediately before and after a structured, open trial of brief psychodynamic psychotherapy (n = 16) in conjunction with therapy process ratings and clinical outcome measures to identify neural correlates of treatment response. Results: Pretreatment glucose metabolism within the right posterior insula correlated with depression severity. Reductions in depression scores correlated with a pre- to posttreatment reduction in right insular metabolism, which in turn correlated with higher objective measures of patient insight obtained from videotaped therapy sessions. Pretreatment metabolism in the right precuneus was significantly higher in patients who completed treatment and correlated with psychological mindedness. Conclusions: Resting brain metabolism predicted both clinical course and relevant psychotherapeutic process during short-term psychodynamic psychotherapy for depression. © 2014 S. Karger AG, Basel.

Concepts: Psychology, Positron emission tomography, Clinical psychology, Psychotherapy, Insular cortex, Psychoanalysis, Psychodynamic psychotherapy, Psychodynamics

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Aims: This study examined the long-term effectiveness of a treatment model at a Swedish therapeutic community for young adults with severe personality disorders, combining milieu therapy and inpatient long-term psychodynamic psychotherapy. Methods: Data were collected for the 56 residents between 1994 and 2008 at intake, termination and 2-year follow-up. Patient residency ranged from 2 to 60 months, with average psychotherapy duration of 30 months. Self-rated outcome was measured using the Symptom Checklist-90-R. Expert-rated outcomes comprised the Global Assessment of Functioning, the Strauss-Carpenter Outcome Scale and the Integration/Sealing-over Scale. A series of mixed-model analyses of variance with one fixed factor (time) was performed to examine the outcomes for the total sample of completers. Effect sizes for within-group change and percentages of improved, unchanged and deteriorated patients were calculated for patients participating in the data collection on all three time points. Results: All outcome measures showed significant improvement on a group level from intake to discharge. Most patients had maintained the therapeutic gains at the 2-year follow-up. The effect sizes were high and the Reliable Change Index provided evidence of good outcome for 92% of the patients at follow-up. The expert ratings gave somewhat larger effect sizes than the patients' self-ratings. Conclusions: The effect sizes and success rates are at a comparable level with corresponding studies of long-term treatments of personality disorders. Most patients had a substantial individual improvement from intake to termination and follow-up. This indicates the effectiveness of this highly specialized and intensive treatment approach for severely disturbed young adult patients.

Concepts: Time, Psychotherapy, Psychodynamic psychotherapy, Psychodynamics, Milieu therapy, Therapeutic community

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The Task Force on Promotion and Dissemination of Psychological Procedures proposed rigorous criteria to define empirically supported psychotherapies. According to these criteria, 2 randomized controlled trials (RCTs) showing efficacy are required for a treatment to be designated as ‘efficacious’ and 1 RCT for a designation as ‘possibly efficacious’. Applying these criteria modified by Chambless and Hollon, this article presents an update on the evidence for psychodynamic therapy (PDT) in specific mental disorders.

Concepts: Randomized controlled trial, Psychiatry, Psychotherapy, Family therapy, Psychoanalysis, Psychodynamic psychotherapy, Psychodynamics, Depth psychology

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Abstract One requirement for psychotherapy research is an accurate assessment of therapeutic interventions across studies. This study compared frequency and depth of therapist interventions from a dynamic perspective across four studies, conducted in four countries, including three treatment arms of psychodynamic psychotherapy, and one each of psychoanalysis and CBT. All studies used the Psychodynamic Intervention Rating Scales (PIRS) to identify 10 interventions from transcribed whole sessions early and later in treatment. The PIRS adequately categorized all interventions, except in CBT (only 91-93% categorized). As hypothesized, interpretations were present in all dynamic therapies and relatively absent in CBT. Proportions of interpretations increased over time. Defense interpretations were more common than transference interpretations, which were most prevalent in psychoanalysis. Depth of interpretations also increased over time. These data can serve as norms for measuring where on the supportive-interpretive continuum a dynamic treatment lies, as well as identify potentially mutative interventions for further process and outcome study.

Concepts: Therapy, Psychometrics, Cognitive behavioral therapy, Psychotherapy, Psychoanalysis, Sigmund Freud, Psychodynamic psychotherapy, Psychodynamics

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BACKGROUND: Depression in adolescents seems to be a growing problem that causes mental suffering and prevents young people from joining the workforce. There is also a high risk of relapse during adult life. There is emerging evidence for the effect of psychodynamic psychotherapy in adolescents. In-session relational intervention (that is, transference intervention) is a key component of psychodynamic psychotherapy. However, whether depressed adolescents profit most from psychodynamic psychotherapy with or without transference interventions has not been stated. Object The effect of transference interventions in depressed adolescents and the moderator moderating effect of quality of object relations, personality disorder and gender will be explored. Methods and study design The First Experimental Study of Transference Work–In Teenagers (FEST–IT) will be a randomized clinical trial with a dismantling design. The study is aimed to explore the effects of transference work in psychodynamic psychotherapy for adolescents with depression. One hundred patients ages 16 to 18 years old will be randomized to one of two treatment groups, in both of which general psychodynamic techniques will be used. The patients will be treated over 28 weeks with either a moderate level of transference intervention or no transference intervention. Follow-up will be at 1 year after treatment termination. The outcome measures will be the Psychodynamic Functioning Scales (PFS), Inventory of Interpersonal Problems–Circumplex Version (IIP-C), Global Assessment of Functioning (GAF), and the total mean score of Symptom Checklist–90 (Global Severity Index; GSI), Beck Depression Inventory (BDI), and Montgomery Asberg Rating Scale (MADRS). The quality of adolescents' relationships will be a central focus of the study, and the Adolescent Relationship Scales (ARS) and Differentiation–Relatedness Scale (DRS) will also be used. Change will be assessed using linear-mixed models. Gender personality disorder (PD) and quality of object relations (QOR) will be the preselected putative moderators. DISCUSSION: The object of this clinical trial is to explore the effect of transference interventions in psychodynamic psychotherapy in adolescents with a major depressive disorder. Using a randomized and dismantling design, we hope that the study will add more specific knowledge to the evidence base. Trial registration ClinicalTrials.gov Identifier: NCT01531101 First Experimental Study of Transference work Work–In Teenagers (FEST-IT).

Concepts: Clinical trial, Randomized controlled trial, Cognitive behavioral therapy, Major depressive disorder, Seasonal affective disorder, Psychoanalysis, Beck Depression Inventory, Psychodynamics

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Abstract This article examines the practice of organization consultation using the adaptive leadership approach through a case example of a large system intervention in a peacemaking project in Nepal. The authors define core activities of the Adaptive Leadership model and provide parallels to psychodynamic group psychotherapy theory and technique that demonstrate how group therapists can apply their expertise to larger systems and arenas beyond the group therapy office.

Concepts: Scientific method, Psychology, Psychotherapy, Sigmund Freud, Psychodynamics, Psychiatric treatments, Drama therapy, Jacob L. Moreno

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Abstract Empathy has consistently been identified as an important quality of psychotherapists. Understanding unique ways that empathy emerges in group therapy may assist group therapists in fostering empathy. Rogerian and selected psychodynamic and interpersonal perspectives on empathy are discussed. Group psychotherapy poses a challenge for empathic responding, but also a rich opportunity for utilizing a more varied embodied approach to empathy.

Concepts: Psychology, Psychotherapy, Sigmund Freud, Carl Jung, Psychodynamics, Psychiatric treatments, Drama therapy, Jacob L. Moreno

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The number of psychotherapies classified as “empirically supported treatments” has increased significantly. As the number and scope of empirically supported treatments multiply, it has become impossible to train therapists in all of these specific modalities. Although the current Accreditation Council for Graduate Medical Education requirements for psychiatric residents follow an approach based on specific schools of psychotherapy (emphasizing competency in cognitive-behavioral therapy, psychodynamic therapy, and supportive treatments), evidence suggests that we are failing even in these efforts. In developing a specialized Psychotherapy Scholars Track in the residency program at the University of Colorado School of Medicine, we opted to focus initially on teaching the common factors in psychotherapy that positively affect psychotherapy outcomes. This article reviews 6 such broad common factors.

Concepts: Medicine, Clinical psychology, Medical school, Cognitive behavioral therapy, Psychiatry, Psychotherapy, Psychoanalysis, Psychodynamics

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Subclinical narcissism is a personality trait with two faces: According to social-cognitive theories it is associated with grandiosity and feelings of superiority, whereas psychodynamic theories emphasize vulnerable aspects like fluctuating self-esteem and emotional conflicts. The psychodynamic view, however, is commonly not supported by self-report studies on subclinical narcissism. Personality neuroscience might help to better understand the phenomenon of narcissism beyond the limits of self-report research. While social-cognitive theory would predict that self-relevant processing should be accompanied by brain activity in reward-related areas in narcissistic individuals, psychodynamic theory would suggest that it should be accompanied by activation in regions pointing to negative affect or emotional conflict. In this study, extreme groups of high and low narcissistic individuals performed a visual self-recognition paradigm during fMRI. Viewing one’s own face (as compared to faces of friends and strangers) was accompanied by greater activation of the dorsal and ventral anterior cingulate cortex (ACC) in highly narcissistic men. These results suggest that highly narcissistic men experience greater negative affect or emotional conflict during self-relevant processing and point to vulnerable aspects of subclinical narcissism that might not be apparent in self-report research.

Concepts: Psychology, Cerebrum, Emotion, Brodmann area 24, Anterior cingulate cortex, Cingulate cortex, Narcissistic personality disorder, Psychodynamics

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Psychotherapy is the treatment of choice for patients with anorexia nervosa, although evidence of efficacy is weak. The Anorexia Nervosa Treatment of OutPatients (ANTOP) study aimed to assess the efficacy and safety of two manual-based outpatient treatments for anorexia nervosa-focal psychodynamic therapy and enhanced cognitive behaviour therapy-versus optimised treatment as usual.

Concepts: Psychology, Randomized controlled trial, Cognitive behavioral therapy, Psychotherapy, Bulimia nervosa, Psychoanalysis, Psychodynamic psychotherapy, Psychodynamics