Research in Psychotherapy-Psychopathology Process and Outcome最新文献

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.

Shame is a complex negative emotion and transdiagnostic feature of psychopathology in which one feels there is something inherently wrong with oneself due to a negative self-evaluation. However, there are self-reflective capacities, such as mentalized affectivity and self-reassurance, that assist us in managing the emotional and cognitive impact. Mentalized affectivity, a component of mentalization, is a complex form of emotion regulation that involves an interest and appreciation of the internal states of self and others through the lens of one's past experiences. Similarly, self-criticism and self-reassurance are both processes in which one reflects and evaluates the self through either judgment or compassion. However, when mentalized affectivity and self-evaluation are maladaptive, individuals are subject to increased negative emotions and psychological distress. This study investigates how mentalized affectivity, self-criticism, and self-reassurance predict perceptions of empathy from others when faced with recall of shame-based experiences. Participants (N=246; 54.5% male) completed measures of mentalized affectivity, self-criticism, self-reassurance, and perceptions of empathy from others based on autobiographical memories of shame. Multiple regression revealed expressing emotions and self-reassurance as significant predictors of perceptions of empathy from others, suggesting how a combination of these forms of self-reflection may protect against the negative impact of shame. Our findings support the use of both mentalization-based and compassion-focused treatment to restore mentalization capacities and self-reassurance to reduce the impact of memories of shame.

The therapist's self-disclosure (TSD) interventions are considered beneficial and often used by psychotherapists. However, their use remains controversial for several reasons, including the use of broad definitions neglecting the distinction between the TSD and the therapist's self-involving (TSI) interventions. The TSD interventions involve the revelation of personal information to the patient, while the TSI implicates the direct expressions of the therapist's reaction to the patient's statements and behaviors within the session. To compare the immediate therapeutic effects of the TSD and TSI interventions, we conducted a study on 57 total interventions (i.e., 35 TSI and 22 TSD, respectively) performed during 17 psychotherapy sessions in a sample of 6 patients, evaluating the effects of each intervention (TSD or TSI) based on two parameters: patient's cooperative attunement and patient's metacognitive functioning. Results show that, compared to the TSD, the TSI interventions were followed by a higher cooperative attitude and metacognitive functioning of the patients. The difference in the short-term effects of these two interventions suggests the usefulness of considering TSD and TSI distinctly to evaluate their psychotherapeutic effectiveness.

This prospective, naturalistic, longitudinal study examined changes in borderline-specific symptoms in a six-month, manual-based transference-focused psychotherapy (TFP) inpatient treatment for patients with borderline personality disorder (BPD) in comparison to a waitlist control group. Seventy-four patients with BPD received TFP in a multi-professional inpatient setting, of whom 27 patients represented the waitlist control group. Thirty-one patients completed six months of treatment. Borderline-specific symptoms were measured by means of the Borderline Symptom List (BSL-23) prior to treatment (waitlist control group), at the beginning, after 3 months, and at the end of it. BSL-23 scores decreased significantly from the beginning to the end of the six-month inpatient therapy program with a medium effect size of d=0.54. There was no change in symptoms for the waitlist control group. Our findings suggest that inpatient TFP is effective in terms of the reduction of borderline-specific symptoms. In terms of this, the duration of the treatment seems to be a meaningful factor. Further research will investigate changes in specific psychodynamic aspects as well as in the follow-up measurement.

Depression is one of the main reasons for seeking mental health services; however, few studies have focused on the perspective of depressed patients to understand what they expect from this instance. This study aims to develop a comprehensive model of patients' initial expectations regarding psychological treatment in mental healthcare settings. Semi-structured interviews were conducted with sixteen depressed adult patients referred to psychological care before their first session. Data was analyzed using grounded theory and consensual qualitative methods. Patients had expectations regarding the characteristics of psychological treatment, the psychologist, and changes. Patients expect psychological care to have a clear purpose and to last the time required until they feel better. They expect the psychologist to be an active and responsive professional. Regarding changes, patients expect to understand why they have depression, develop personal resources, and improve their self-esteem and mood. Facilitating factors (e.g., preferences for psychological support over medical treatment) and hindering factors (e.g., institutional constraints) were identified in achieving these expectations. Based on patients' expectations, a helping relationship that is more responsive to their needs is underlined. Therapeutic skills and contextual factors are key facilitating elements to meet these expectations. The findings discuss how addressing expectations can serve as input for delivering more satisfactory treatment to patients.

Interpersonal factors and depression are believed to be some of the main drivers of suicidal thoughts and behaviors, but other factors may be equally or more important. Drawing on psychodynamic (mentalization) theory, we propose that personality functioning, in particular an incoherent sense of self, may be an important driver of suicidal thoughts and behaviors over and above factors of interpersonal functioning and depression. To evaluate this, we examined associations between personality functioning and suicidal ideation and suicide attempt in young adults. Participants (N=153; Mage=20.93) were recruited from a college sample (N=90) and a clinical sample with borderline personality disorder (N=63). Personality functioning (self and interpersonal components) was measured with the Level of Personality Functioning Scale - Brief Form 2.0. Suicidal ideation was measured with the Personality Assessment Inventory. Suicide attempt history was assessed with the Columbia-Suicide Severity Rating Scale. Depression symptoms were measured with the Symptom Checklist 90. Regressions examined relationships between personality functioning, depression symptoms, and suicidal ideation or attempt while controlling for age and gender. Overall personality functioning was significantly associated with suicidal ideation (β=.584, p<.001) and suicide attempt (β=.384, p<.001). Overall personality functioning was a stronger predictor than depression symptoms, age, and gender when included in the same model predicting suicidal ideation or attempt. Both the self and interpersonal components of personality functioning were significantly associated with suicidal ideation and attempt, with larger effect sizes for self-functioning. Findings underscore the importance of considering personality functioning, especially self-functioning, in suicide risk assessment and treatment.

Suicide is a major public health concern; therefore, numerous factors have been investigated for their role in increasing suicide risk. Distal factors, such as attachment style, and proximal factors, like unmet interpersonal needs, interact with each other and may influence suicidal ideation. Understanding this interplay is crucial for developing effective interventions for suicide prevention. The present study aimed to investigate the association between attachment and interpersonal needs in suicidal ideation. For this study, we administered the Attachment Style Questionnaire and the Interpersonal Needs Questionnaire-15, and suicide risk was assessed using the Columbia-Suicide Severity Rating Scale. We collected data from 181 psychiatric inpatients at the Sant'Andrea Hospital in Rome. The results indicated that suicidal ideation was negatively and significantly associated with ASQ Confidence and positively associated with ASQ's Need for Approval and Discomfort with Closeness and INQ's perceived burdensomeness. The mediation model showed that perceived burdensomeness mediated the relationship between secure attachment style and suicidal ideation. The results have also shown significant associations among suicidal ideation, some attachment styles, and interpersonal needs. Secure attachment showed a potential protective role in suicidal ideation through lower levels of perceived burdensomeness, highlighting the importance of a careful evaluation of the patient's individual experiences and characteristics that can guide the adaptation of therapeutic goals and strategies. Interventions that promote functional interpersonal beliefs, as well as interventions oriented to limit the negative effects of disruptive models of attachment, may contribute to reconstructing trust towards others, reducing perceived burden, and preventing suicide risk.

Despite recent studies establishing self-compassion and secure attachment to be vital protective factors against suicidality, the role of attachment as a psychological mechanism that may mediate the relationship between self-compassion and suicidality has not been investigated to date. This study aims to address this gap by investigating whether attachment styles, specifically avoidant attachment, mediate the link between self-compassion and suicidality in patients with major depressive disorder (MDD). 273 adult patients with MDD completed the Suicidal Behaviors Questionnaire-Revised (SBQ-R), the Beck Depression Inventory (BDI-II), the Experiences in Close Relationships Scale (ECRS), and the Self-Compassion Scale (SCS) along with sociodemographic and clinical questions. Statistical analyses included correlation analysis and Mann- Whitney U tests to examine the relationships and possible differences between the non-suicidal group and the suicidal group of patients in terms of attachment style, self-compassion, and self-destructive behaviors. A mediation analysis to assess the role of attachment avoidance in the relationship between selfcompassion and suicidality was also conducted. Both attachment anxiety and avoidance were positively associated with suicidality and depression and negatively with self-compassion. The patients with increased suicidality differed significantly in the levels of depression, self-compassion, and attachment compared to those who were non-suicidal. The protective mechanism of self-compassion against suicidality was mediated by attachment avoidance. Research findings highlight the need for considering attachment-related issues to understand suicidality and tailor interventions in the field of suicide prevention and treatment while they gauge treatment priorities in working with depressed patients with suicidal thoughts and behaviors.

The study of suicidal risk has increasingly emphasized the importance of assessing specific suicidal motivations. Motivations express an elaboration of the condition of psychache, representing an effective perspective on the management of suicidal risk in psychotherapy. This study explores suicidal motivations and personality pathology in a clinical sample of adolescents with suicidal ideation or a history of suicide attempts. We aim to investigate how specific motivational factors and personality disorders (PDs) contribute to the foreseeability of suicidal outcomes, such as the occurrence, number, and lethality of suicide attempts and their interaction with the impact of personality disorders. A sample of 134 adolescents aged 12-18, with active suicidal ideation or recent suicide attempts, was assessed using a combination of self-report measures and structured clinical interviews. Binomial logistic regressions and linear regressions were conducted to explore the predictive value of PDs and motivational factors on suicidal behaviors. The results indicate that specific suicidal motivations, such as interpersonal influence, escape fantasy, and absence of fear, provide an additional increase in the foreseeability value beyond personality disorder criteria alone. These findings suggest that assessing suicidal motivations can significantly enhance risk evaluation and inform more effective therapeutic interventions. Beyond identifying certain risk factors, the therapist's ability to diss and process specific suicidal motivations in the context of the therapeutic relationship can be a decisive factor in monitoring and directly intervening on the risk.