Research in Psychotherapy-Psychopathology Process and Outcome最新文献

This observational study aimed to investigate the interplay between psychological factors in clinical and non-clinical groups of patients with arterial hypertension. Specifically, the main objectives were: i) to examine associations between personality traits, anger, and psychological symptoms; ii) to explore how coping styles interact with anger in modulating distress; and iii) to compare patients with and without significant psychological distress. One hundred hypertensive patients (mean age 56.04±12.04) were consecutively recruited. Psychological symptoms, anger dimensions, personality traits, and coping strategies were assessed through the Symptom Checklist-90- Revised (SCL-90-R), the State-Trait Anger Expression Inventory-2 (STAXI-2), the 16 Personality Factors Questionnaire (16PF), and the Coping Orientation to Problems Experienced (COPE), respectively. The Global Severity Index (GSI) of the SCL-90-R was used to differentiate a clinical group (T-score≥63) from a non-clinical one. In the overall sample, specific personality traits predicted anxiety, somatization, and paranoid ideation. Symptoms such as psychoticism and hostility were linked to poor anger regulation, and the expression of anger was associated with avoidance-based coping. Patients with higher levels of psychological distress (49% of the patients) were more introverted and emotionally unstable, with symptoms predicted by low liveliness and high rule-consciousness. In contrast, anger expression and control emerged as key modulators of subclinical symptoms even in the non-clinical group (51% of the sample). The integrative and comparative nature of the study described different relationships between personality, anger management, and psychological symptoms between groups of hypertensive patients, divided according to the severity of psychological distress. Additionally, even sub-threshold symptoms proved to be shaped by patterns of emotional regulation, underscoring the need to integrate psychological assessments in the treatment of hypertension.

Identifying predictors of long-term therapy outcome is crucial in shaping effective therapy programs. This study examined sense of meaning in life, religiosity, and spirituality as potential predictors for long-term therapy success following psychiatric-psychotherapeutic inpatient treatment. A total of 127 patients from a psychiatric clinic in Switzerland were included. Standardized self-assessed questionnaires were administered on admission, at discharge, and at a one-year follow-up. The influence of meaning in life, religiosity, and spirituality on the course of depressive symptoms was assessed. Sense of meaning was identified as a significant positive predictor for therapy outcome one year after discharge. Positive associations between sense of meaning, religiosity, and spirituality suggest that there may be indirect effects of religiosity and spirituality on long-term therapy outcomes as well. Boosting a sense of meaning in psychiatric inpatient therapy might enhance long-term treatment outcomes. Possible indirect effects of religiosity and spirituality need further investigation.

Jungian psychotherapy (JP) is an established treatment modality in modern healthcare systems, yet empirical validation remains a key requirement for its continued recognition and insurance coverage. This study aimed to assess the effectiveness of JP by evaluating pre- and post-treatment changes in psychological symptoms, personality structure, and quality of life among 104 participants undergoing supervised therapy at a German training institute. Using a pre-post design, participants completed standardized psychometric assessments, including the International Classification of Diseases - 10th Revision (ICD-10) Symptom Rating (ISR), the Fragebogen zur Lebenszufriedenheit (FLZ; Life Satisfaction Questionnaire), and the Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQ), before and after therapy. Results from paired samples t-tests and Wilcoxon signed-rank tests indicated significant improvements across multiple domains. Participants experienced notable reductions in symptom burden, particularly in depression, anxiety, and obsessive-compulsive symptoms, with effect sizes ranging from moderate to large (d=0.555 to d=1.174). Improvements were also observed in self-perception, interpersonal contact, and relational experiences. However, eating disorder symptoms did not show significant improvement (p=.275), likely due to the need for specialized interventions. Future research should employ randomized controlled trials (RCTs) and long-term follow-ups to establish the durability of treatment effects.

While psychotherapy is generally effective, outcomes can vary significantly across patients, even when treated by the same therapist. This study employed a mixed-methods design to examine early indicators of treatment success by analyzing contrasting outcomes within individual therapists' caseloads. Treatment success was determined by patients achieving a clinically significant change on the Brief Symptom Inventory's Global Severity Index (BSI-GSI). The Reliable Change Index (RCI) was used to calculate these changes, adjusting to account for measurement error and regression to the mean. Unsuccessful cases are defined as those with no reliable change or deterioration. Data from six patients treated by three psychodynamic therapists were analyzed (each therapist having one successful and one unsuccessful case). Quantitative analyses of psychological assessments and early treatment measures, along with qualitative analyses of third session transcripts, were conducted. In successful cases, the patients reported higher levels of depression, interpersonal distress, and social avoidance/anxiety, but also greater personal insight prior to the treatment. Patients in successful cases also rated lower session smoothness compared to their therapists' ratings early in treatment. These divergent views are likely due to higher ratings of therapists' exploration of uncomfortable feelings in the successful treatment sessions. In addition, these external raters observed that in the successful cases, therapists employed higher overall levels of psychodynamic-interpersonal techniques during the third session than in their unsuccessful cases. Results highlight the importance of how initial severity and emotional expression in the early stage of psychotherapy may help lay the foundation for successful treatment outcomes.

Studies suggest that coping strategies (CS) and emotional intelligence (EI) can reduce the impact of suicidal ideation (SI) and help prevent adolescent suicide. However, it remains unclear whether EI mediates the relationship between CS and SI, and whether these effects are consistent across gender and age. The objective of this research was to analyze the direct and indirect effects of CS and EI on SI, as well as their invariance across gender and age. An observational, cross-sectional, analytic study was conducted, involving 598 adolescents (M=14.17, SD=2.01). Participants completed the Inventory of Suicide Orientation (ISO)-30, the Trait Meta-Mood Scale (TMMS), and the Coping Strategies Inventory (CSI). Path analysis revealed that CS explained 48% of the variance in EI. CS of emotional expression, social support, and cognitive restructuring showed significant direct effects (p<0.01). Together, CS and EI explained 39% of the variance in SI. The indirect effects of CS on SI through EI were significant (p<.01) for social support, cognitive restructuring, and problem-solving strategies. EI and adaptive CS are relevant in reducing SI. These results have significant implications for the design of clinical and educational interventions aimed at improving emotional regulation and adaptive coping to reduce suicide risk in adolescents.

Oxytocin is a neuropeptide produced by the hypothalamus and involved in numerous functions, such as labor and breastfeeding. The literature has highlighted the critical role of this hormone in interpersonal relationships - particularly in mother-child and sentimental relationships - implicating it in attachment bonds. Several recent studies have examined the activation of oxytocin in the psychotherapeutic relationship. This narrative review article describes the modulation of the oxytocinergic axis in patients and therapists, based on a review of papers identified through searches of PsycINFO, PubMed, and RivistaWeb, from January 2015 to May 2024. The results of this literature review support the hypothesis that changes in oxytocin levels during interactions between therapist and patient are associated with the therapeutic process by activating the attachment system. Furthermore, this mechanism does not appear to be influenced by the therapist's theoretical model of reference but rather by their ability to empathize with the patient. In conclusion, this mini-review highlights the significant function of oxytocin as a potential biomarker for assessing the patient-therapist relationship, identifying a biological substrate of the therapeutic alliance.

Growing evidence highlights the crucial role of defense mechanisms in the context of chronic diseases. However, few studies have evaluated the impact of these implicit emotion regulation strategies on the adaptation processes related to inflammatory bowel diseases (IBD). This narrative review aimed to explore the role of defense mechanisms in patients with IBD and clarify their association with related psychological and physical symptoms. A literature search was conducted using PubMed and PsycINFO databases to select studies considering defense mechanisms in patients with IBD. Inclusion criteria were English language articles, diagnosis of Crohn's disease or ulcerative colitis, and use of validated assessment instruments specifically related to defense mechanisms. Six studies, including a total of 664 patients, were deemed eligible. Immature defense mechanisms were commonly detected in IBD patients, with significant effects on psychological and physical health. Significant associations were found between defense mechanisms, perceived health-related quality of life (HR-QoL), and psychological distress. Findings suggested that immature defense mechanisms may negatively impact the management of disease, leading to lower perceived HR-QoL, decreased treatment adherence, and increased risk of psychopathological symptoms. Considering these findings, we suggest that an integrated clinical evaluation, including an in-depth investigation of defense mechanisms, may promote more effective psychological treatments and improve psychological well-being in patients suffering from IBD.

Transgender and/or non-binary (TNB) individuals encounter a variety of attitudes from mental healthcare professionals in therapeutic contexts, ranging from micro-affirmations to the reinforcement of cis- and heteronormative stereotypes and even overtly invalidating behaviors or communications. Given the scarcity of literature addressing the therapeutic experiences of TNB individuals, the current mixed-method systematic review aimed at better understanding the factors that promote or adversely impact the therapeutic experiences of TNB individuals in clinical contexts. A comprehensive search for relevant records published before August 1, 2024, was conducted across four databases (i.e., Scopus, Web of Science, PubMed, PsycInfo), following PRISMA guidelines. The inclusion criteria specified that only peer-reviewed, indexed, English-language articles addressing the therapeutic experiences of TNB individuals would be selected. A total of 20 studies (both quantitative and qualitative) met these criteria. A meta-synthesis of the selected studies identified three main themes: (1) factors influencing therapist selection and reasons for seeking psychotherapy (e.g., quality of life, gender-specific concerns); (2) factors contributing to a positive therapeutic relationship (a nurturing therapeutic alliance that, e.g., acknowledges authentic gender and addresses intersectional stigma); and (3) factors contributing to negative encounters with mental healthcare providers (e.g., micro- and/or macro-aggressions, inadequate trans-specific knowledge, pathologization of TNB identities). Recommendations for future research and clinical practice addressing the needs of TNB individuals in psychotherapy are provided.

The COVID-19 pandemic significantly impacted young people's mental health, leading to increased distress and reduced life satisfaction worldwide. Among the worst-hit countries, Italy saw mental health services shift online, prioritizing urgent cases. Consequently, therapy for many individuals was interrupted, leaving young people largely neglected. In response, the Italian government allocated €8 million for youth mental health initiatives during the pandemic, and the Veneto region utilized €2 million to establish the District Functional Unit for Adolescents (UFDA) within its public Child and Adolescent Mental Health Services to provide specialized care for young people. The pilot phase was implemented between April and December 2022. This study reports preliminary findings on UFDA's effectiveness in Padua's Local Health Unit. The main objectives include describing patient characteristics and assessing the intervention outcomes. The study involved 255 youths, representing 71.43% of patients at UFDA (mean: 14.4; range: 12-24 years), and 170 parents. Self- and informant-report versions of the Strengths and Difficulties Questionnaire (SDQ) were administered. A regional questionnaire was used to describe the patient profiles, and the intervention progress record documented anamnestic data and clinical progress of patients. The study revealed positive intervention outcomes despite the limited number of psychotherapy sessions. Results of the SDQ highlighted improvements in all difficulty scales after the intervention. The UFDA pilot project underscores the potential of a preventive, youth-centered approach to address young people's mental health needs. The insights from this study can inform strategies to enhance youth mental health care in post-COVID-19 Italy.

The therapeutic alliance is a predictor of therapy outcome across treatments with adolescents, with ruptures and unresolved ruptures in the alliance being associated with treatment dropout. This study investigated the psychotherapeutic process in short-term psychoanalytic psychotherapy (STPP) with five adolescents with moderate/severe depression who had dropped out of STPP in a large randomized controlled trial and reported dissatisfaction with treatment. In each case, sessions were rated as featuring unresolved ruptures with the therapist. This study aimed to explore the processes characterising ruptures preceding dropout using the Adolescent Psychotherapy Q-set (APQ). Data were analysed using descriptive statistics of the APQ coding; a qualitative reading of the transcripts and clinical vignettes was used to illustrate how the APQ findings manifested in practice. Results revealed a weak alliance preceding the adolescent dropping out of therapy, with a mismatch between self-reliant and disengaged adolescents presenting with strong negative affects and therapists seeking to maintain an active exploration of the adolescents' difficulties. Research and clinical implications are discussed.