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.

Background: This study aims to examine the disease burden, risk factors, and temporal trends of Major Depressive Disorder (MDD) in low- and middle-income countries (LMIC) from 1990 to 2021.

Methods: Disability-Adjusted Life Years (DALYs) data for 135 LMIC were obtained from the 2021 Global Burden of Disease (GBD) database. To assess trends in the burden of MDD, segmented regression analysis was applied to calculate the Estimated Annual Percentage Change (EAPC). Spearman correlation analysis was conducted to examine the association between Gross National Income (GNI) and gender disparities in age-standardized DALY rates (ASDR) for MDD. We also explored how key risk factors contributed to observed disparities.

Results: In 2021, LMICs accounted for 80.19% of the global burden of MDD. Age and gender disparities were significant, with DALY rates increasing markedly from adolescence and peaking around age 75. Gender disparities showed a higher burden among females, particularly in countries with higher GNI per capita. Analysis of risk factors revealed that intimate partner violence, bullying victimization, and childhood sexual assault were major contributors to the MDD burden, with notable variations across income levels and age groups. Temporal trends showed a marked increase in MDD burden across all income groups after 2019.

Conclusion: MDD continues to impose a significant health burden in LMIC, disproportionately affecting females, youth, and elderly populations. The significant increase in MDD burden across all income groups after 2019 likely reflects the intensifying effects of global disruptions, with the COVID-19 pandemic being a key contributing factor. Populations with the highest burden also showed greater exposure to key risk factors.