Psychotherapy and Psychosomatics最新文献

Introduction: Psychotherapy is the primary treatment for adolescent borderline personality pathology (BPP), yet its mechanisms remain unclear. Given potential self-report biases due to alexithymia and impaired interoception, this study examined cortisol responses as a physiological stress marker alongside session ratings from adolescent BPP patients and their therapists to assess its potential as a complementary measure in psychotherapy process research.

Methods: N = 56 adolescents (94.6% female) with BPP (≥3 DSM-IV BPD criteria) receiving Adolescent Identity Treatment or Dialectical Behavioral Therapy and their therapists provided pre- and post-session salivary cortisol samples and completed the Session Evaluation Questionnaire. Residual Dynamic Structural Equation Modeling examined associations between cortisol responses and session ratings, with moderation by age, depression, BPP severity, identity diffusion, and trauma.

Results: Cortisol responses did not correlate with session ratings in patients. In therapists, higher cortisol responses were associated with lower session smoothness (r = -0.164; p < 0.001) and deepness (r = -0.086; p = 0.004), as well as with lower positivity (r = -0.145; p < 0.001) and higher arousal (r = 0.072; p = 0.012) post-session. Higher depression levels moderated the association between cortisol responses and session deepness in patients (β = -0.009, p = 0.007).

Conclusion: While session ratings and cortisol responses correlated in therapists, no such correlation was found in patients. Possible mechanisms include altered interoceptive abilities, dysregulated hypothalamic-pituitary-adrenal (HPA) axis function, or increased variability in self-ratings or cortisol due to BPP. While physiological markers and self-reports offer complementary insights into psychotherapy processes, future studies should include healthy and clinical controls and baseline investigation of HPA axis function (i.e., stress reactivity) in both groups, along with additional hormonal markers.

Exposure to trauma has been theorized to contribute to the onset and exacerbation of obsessive-compulsive disorder (OCD), yet direct empirical evidence remains limited. This study examined whether individuals directly affected by the trauma of October 7th, 2023, in Israel exhibited higher rates of new-onset or worsening OCD symptoms compared to controls who were not directly affected. A total of 132 adults participated, including 66 survivors from the Gaza envelope who experienced direct exposure to the attacks and 66 matched controls from other areas of Israel who were not directly affected. Data on OCD and PTSD symptoms were collected approximately 4-6 months after the events. Results revealed significantly higher OCD symptoms in the directly affected group and PTSD symptom severity partially mediated the relationship between trauma exposure and increased OCD symptoms. Notably, 39% of individuals in the directly affected group met a priori criteria for probable OCD, 24% reported new-onset symptoms after October 7th, and most others reported worsening of existing symptoms. These findings provide the first direct evidence that acute trauma can trigger new-onset and worsening OCD symptoms. Consistent with the diathesis-stress model, the results underscore the role of environmental stressors in OCD etiology and highlight the need for screening for OCD in trauma-exposed populations.