Research in Psychotherapy-Psychopathology Process and Outcome最新文献

Grandiose narcissism is increasingly conceptualized as encompassing two dimensions: admiration and rivalry. Clarifying how these aspects are shaped requires attention to the intrapsychic regulators and interpersonal motivational systems that organize narcissistic functioning. A total of 478 participants completed an online survey including the Narcissistic Admiration and Rivalry Questionnaire (NARQ), the Defense Mechanisms Rating Scale-Self Report-30 (DMRS-SR-30), and the Social Mentalities Scale (SMS). Rivalry showed a stronger negative association with overall defensive functioning (ODF; r=-0.34, p<.001) compared to admiration (r=-0.09, p<.05). At the interpersonal level, rivalry was positively associated with insecurity (r=0.25, p<.001) and agonism (r=0.48, p<.001), and negatively with prosociality (r=-0.30, p<.001), belongingness (r=-0.28, p<.001), and playfulness (r=-0.23, p<.001). Admiration, in contrast, was positively associated with agonism (r=0.42, p<.001) and sexuality (r=0.23, p<.001). The mediation analysis (moderated by gender) indicated that defensive functioning impacted narcissistic expression through specific interpersonal motivational systems: insecurity (βmales=0.036, p=.040; βfemales=0.055, p=.009), prosociality (βmales=-0.033, p=.033; βfemales=-0.085, p=.002), and agonism (βmales=-0.163, p=<.001; βfemales=-0.132, p=.001). The study expands theoretical and clinical knowledge of the underlying motivations and defense mechanisms involved in grandiose narcissism, shedding light on specific intrapsychic and relational processes underpinning narcissistic dynamics.

The paper revisits defense mechanisms as central regulators of emotional life and self-coherence in contemporary clinical practice, showing how a classical psychodynamic construct has evolved into an empirically measurable, transdiagnostic dimension of functioning. After outlining the historical development of the concept, the authors present the hierarchical model of defenses, operationalized through the Defense Mechanisms Rating Scale (DMRS), as the current reference framework for assessment of thirty individual defenses across seven levels of adaptiveness. Empirical studies using the DMRS - also in its observer-rated Q-sort and self-report versions - indicate that shifts toward more mature defenses predict better outcomes across different treatment orientations, suggesting that changes in defensive functioning may represent a common factor underlying psychotherapeutic change. These advances are integrated with dimensional and transdiagnostic approaches, including the Psychodynamic Diagnostic Manual, Third Edition (PDM-3), in which defenses play a pivotal role in evaluating personality organization on Axis P and mental capacities on Axis M, thereby complementing symptom-focused systems such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) and the International Classification of Diseases (ICD-11). The paper also discusses conceptual overlaps with coping and emotion regulation, the limitations of cross-sectional and self-report methodologies, and the need for longitudinal, cultural, and neuro-psychodynamic research, proposing defense mechanisms as a unifying language that links psychodynamic theory, empirical psychology, and neuroscience.

Interpersonal synchrony is increasingly being studied in the context of psychotherapy. The Interpersonal Synchrony (In-Sync) model proposes that patient-therapist synchrony enhances working alliance by promoting emotion regulation (ER). While the link between synchrony and working alliance has been extensively described, its relation to ER in the clinical setting remains underexplored. The present systematic review, therefore, aimed to address this gap by providing a qualitative synthesis of the methods employed and the results reported by studies investigating the relationship between patient-therapist synchrony and ER. A comprehensive search yielded seven studies (out of an initial 2,094), published between 2007 and 2024, encompassing 828 participants (563 patients and 265 therapists). Despite finding highly heterogeneous conceptual frameworks and methodologies employed to assess both synchrony (e.g., motion energy analysis [MEA], electrocardiogram, skin conductance) and ER (e.g., self-report questionnaires and behavioral coding systems), the studies' results revealed a predominantly positive association between synchrony and ER, with in-phase synchrony linked to improved emotional stability and positive emotional experiences. Nonetheless, two studies presented contrasting results, either suggesting a more complex dynamic of co-regulation or finding no direct relationship between nonverbal synchrony and emotional self-regulation. Additionally, a notable research gap was revealed regarding older adults, as no studies included participants over 61 years. Overall, this systematic review highlights the lack of standardized methods and conceptual ambiguity surrounding ER, ultimately limiting cross-study comparability, as well as emphasizing the multiple roles of synchrony in psychotherapy and the need for further research to establish methodological coherence and theoretical consensus in this field.

The present systematic review of the literature aims to provide a comprehensive overview of the state of the art of research in psychoanalysis. The arguments draw a difference between psychoanalytic research and research in psychoanalysis, meaning that in the past decades, there has been an attempt to bridge the gaps between psychoanalysis and broader research in psychology. Major scientific databases for contemporary psychological research (Ebsco PsycINFO, Ebsco CINAHL, Scopus, Web of Science, PubMed, and PEP-Web) were searched to gather psychoanalytic-oriented research, both theoretical and empirical. The PRIMA method provided a total of 36 results, on which a conceptual/reflexive thematic analysis was conducted. The identified themes or dimensions are: i) the epistemological status of psychoanalysis; ii) the research domains in psychoanalysis; iii) the research methodology in psychoanalysis; iv) the research methods in psychoanalysis; and v) the instruments of research in psychoanalysis. We conclude that, despite long-lasting difficulties in the epistemological cohabitation between psychoanalysis and mainstream psychological research, new hybrid ways for future psychoanalysis can be identified.

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.