Psychotherapy and Psychosomatics最新文献

Background: Brief concentrated exposure and response prevention (cERP) has shown promise as an efficacious treatment for obsessive-compulsive disorder (OCD). with higher response and remission rates compared to the first-line treatment. However, the mechanisms driving this success remain unclear.

Methods: This longitudinal study included 56 patients with OCD who underwent cERP (Bergen four-day treatment; B4DT). Treatment mechanisms (e.g., willingness to engage in ERP, confidence in future self-guided ERP, leaning into anxiety) were assessed before and after each of the four treatment days by the Pre- and Post-Session Questionnaire (PPSQ-cERP). Changes in the PPSQ-cERP were used to predict treatment response assessed from baseline to post-treatment and three-month follow-up.

Results: All variables assessed by the PPSQ-cERP showed improvement throughout the cERP, as calculated using linear mixed models. Several variables, including willingness to engage in ERP and self-efficacy, improved after day 3, with small to medium effects (0.34-0.70). Confidence in future self-guided ERP improved on day 4 (the day on which it was addressed), with a small effect (0.31). Leaning into anxiety during ERP tasks on day 3 was identified as a predictor of OCD symptom improvement ( = 0.516, p = .050) by lasso regression, while group cohesion reached trend level ( = 0.239, p = .081).

Conclusion: This study highlights day-specific effects across all treatment mechanism variables. Notably, leaning into anxiety during ERP tasks was a key predictor of symptom improvement, offering new insights into refining OCD treatment strategies and enhancing clinical outcomes.

Introduction: Borderline personality disorder (BPD) is marked by emotional instability, interpersonal dysfunction, and high comorbidity, posing significant treatment challenges. Metacognitive Interpersonal Therapy (MIT) targets core features of BPD, including metacognitive impairments and emotional dysregulation. This study uses Latent Transition Analysis (LTA) to assess changes in BPD symptoms and psychological factors over a 12-month MIT intervention, hypothesizing that MIT will reduce symptom severity and improve emotional regulation, metacognitive abilities, and interpersonal functioning.

Methods: This single-center, retrospective observational study included 98 patients, all diagnosed with BPD according to DSM-IV-TR criteria, without severe psychiatric comorbidities or concurrent psychotherapy. These patients underwent a 12-month MIT intervention, delivered in five phases targeting metacognitive and emotional regulation skills. Clinical assessments included SCID-II for BPD diagnosis, SCL-90-R for symptom severity, MAI for metacognitive abilities, and IIP for interpersonal difficulties.

Results: Latent Class Analysis (LCA) identified three baseline profiles: "Affective dysregulation and anger" (14.3%), "Low symptomatic" (7.1%), and "Identity and interpersonal sensitivity" (78.6%). After 12 months of treatment, most participants (58.2%) transitioned to a "Recovered" class, with significant reductions in BPD symptoms. The "Recovered" class showed the greatest improvements in metacognitive abilities, emotional regulation, and interpersonal functioning compared to other groups.

Conclusions: MIT was associated with significant improvements in BPD symptoms, with over half of participants achieving full recovery. These findings suggest that MIT may play a role in enhancing emotional regulation and interpersonal functioning. However, residual symptoms in some participants confirm the complexity of BPD, suggesting the need for further research into long-term outcomes and comorbidities.

Introduction: This study aimed to assess the benefit of integrating the Diagnostic Criteria for Psychosomatic Research-Revised (DCPR-R) into the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). Specifically, it examined whether this integration enhances the understanding of psychopathologies and quality of life (QOL) in psychosomatic medicine.

Methods: In this cross-sectional study conducted in Taiwan, 277 patients from psychosomatic clinics and 225 community participants were included. Standardized interview tools based on DCPR-R and DSM-5 were used to assess the presence of various diagnoses. Participants also completed several scales related to persistent somatic symptoms, negative emotions, and QOL. Latent class analysis was used to explore the clustering of diagnoses, and multiple linear regression analysis was employed to investigate the relationship between diagnoses, psychopathologies, and QOL under conditions of possible comorbidity.

Results: Three classes were identified via latent class analysis: somatic symptoms, demoralization and stress, and insomnia. In the multivariate analysis considering multiple diagnoses simultaneously, the number of diagnoses significantly associated with psychopathologies and QOL was greatly reduced compared to the univariate analysis. Persistent somatization was more strongly associated with somatic distress than somatic symptom disorder. Several DCPR-R constructs showed significant associations with illness-related anxiety. The DCPR-R diagnoses with broader influences on QOL were demoralization, demoralization with hopelessness, and irritable mood.

Conclusions: The results suggest the potential clinical significance of integrating DCPR-R and DSM-5 in Eastern societies. The DCPR-R diagnoses with significant findings mentioned above may contribute to the personalized treatment plans for patients in psychosomatic medicine.

Introduction: Insomnia is common, but access to its first-line treatment, Cognitive Behavioral Therapy for Insomnia (CBT-I), is limited. To explore a scalable alternative, we investigated the efficacy of Sleep Restriction Therapy (SRT), a core component of CBT-I, delivered via telephone.

Methods: In a randomized controlled trial, 147 adults with insomnia were allocated to 6 weeks of telephone-guided SRT (n = 76) or a sleep diary control group (n = 71). The SRT group received weekly supporting phone calls lasting 10 to 15 minutes. At baseline and post-test, we measured insomnia severity (primary outcome), sleep diary measures, anxiety symptoms, depressive symptoms, pre-sleep arousal, sleep-safety behaviors, daytime sleepiness, and dysfunctional sleep-related cognitions (secondary outcomes). The SRT group repeated these measures at 3- and 6-month follow-up.

Results: Telephone-guided SRT showed large between-group effects on insomnia severity at post-test relative to the sleep diary control group (d = 1.52; p < .001). Based on intention-to-treat, 36 (47%) participants randomized to SRT achieved clinical improvement, and 23 (30%) achieved insomnia remission. We found medium-to-large between-group effects at post-test (d = 0.53 to 1.18) for all secondary outcomes except daytime sleepiness and total sleep time. At 3- and 6-month follow-up, the primary and all secondary outcomes, including daytime sleepiness and total sleep time, improved relative to baseline within the SRT group (d = 0.50 to 1.93).

Conclusion: This trial shows that telephone-guided SRT is an effective insomnia treatment requiring minimal therapist guidance. If direct comparisons with CBT-I corroborate these findings, SRT could be an interesting scalable alternative to CBT-I as a first-line insomnia treatment.

Trial registry: NCT05548907.

Introduction: Comorbidity between posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD) is prevalent. Despite evidence-based therapies, high rates of non-response and dropout persist. This study therefore aimed to examine whether the concurrent application of eye movement desensitization and reprocessing (EMDR) for PTSD and dialectical behavior therapy (DBT) for BPD yields better results than EMDR alone.

Methods: Patients with a PTSD diagnosis and at least four BPD symptoms were randomly assigned to EMDR (n = 63) or concurrent EMDR-DBT (n = 61). Over one year, changes in PTSD symptoms were measured using the Clinician-Administered PTSD Scale for DSM-5. Secondary outcomes included BPD symptoms, global functioning and quality of life.

Results: Both treatments led to large reductions in PTSD symptoms, without significant differences after one year (p = .312, d = -0.23, 95% CI = -0.6, 0.1). Both treatments also yielded large and comparable reductions in BPD symptoms and improved quality of life. Global functioning improved only in the EMDR condition according to one measure (WHODAS 2.0), while the other measure (OQ-45) showed improvements in both groups. Additionally, patients in the EMDR-DBT condition were twice as likely to drop out from EMDR treatment compared to those in the EMDR-only condition.

Conclusion: Stand-alone EMDR demonstrated safety and efficacy in alleviating PTSD and BPD symptoms, as well as enhancing quality of life. These findings support the use of EMDR as a strong therapeutic option for patients with PTSD and comorbid BPD symptoms. Further research is needed to assess longer-term outcomes beyond one year.

Introduction: Many physical complaints cause long-term bodily distress. Meta-analyses show that cognitive behavioral therapy (CBT) and acceptance- and mindfulness-based treatments (AMBT) reduce somatic symptom severity, but evidence on differential efficacy is limited.

Objective: This study evaluates the efficacy of CBT and AMBT for bodily distress (e.g., somatoform disorders, functional somatic syndromes, and related disorders).

Methods: A network meta-analysis of randomized controlled trials on adults with bodily distress compared CBT and AMBT either directly or with non-specific control groups. Cohen's d based on between-group effect sizes was aggregated using a random effects model. Primary outcome was somatic symptom severity; secondary outcomes included depression, anxiety, and perceived health status.

Results: Based on 74 studies (N = 8,277), CBT (d = -0.50, 95%CI -0.70 to -0.29; between-group effect sizes vs. wait-list) and AMBT (d = -0.55, 95%CI -1.06 to -0.23; between-group effect sizes vs. wait-list) were equally effective in reducing somatic symptoms at post-treatment. AMBT were more effective than CBT in reducing depression (d = -0.31, -0.58 to -0.04; between-group effect sizes) and anxiety (d = -0.42, -0.73 to -0.11; between-group effect sizes) post-treatment. At long-term follow-up, effects were partly maintained; AMBT remained more effective than CBT for anxiety, with no differential effects for other outcomes.

Conclusions: Both treatments showed benefits compared to various controls. Evidence suggests potential differential treatment effects, indicating some patient groups may benefit more from AMBT. Clinicians should view CBT as foundational but remain open to variations, especially for comorbid pathology.