AMERICAN JOURNAL OF PSYCHOTHERAPY最新文献

Objective: Anxiety among adolescents is pervasive, necessitating novel treatment approaches, such as DNA-v (Discoverer, Noticer, Advisor, along with values), a developmental adaptation of acceptance and commitment therapy (ACT).

Methods: This study was a preliminary test of group DNA-v with a racially diverse sample of youths (N=7; mean age=16.28 years) already receiving mental health services for anxiety. Treatment comprised eight 90-minute weekly group sessions. Participants completed measures of psychological flexibility weekly, as well as anxiety and psychological inflexibility at pretreatment, posttreatment, and follow-up. Data were analyzed at the individual and aggregate level via means, percentage change, and reliable change indices.

Results: Psychological flexibility remained relatively stable, and psychological inflexibility and anxiety decreased slightly. Participants rated the treatment as acceptable and positive.

Conclusions: This study offers initial promise for DNA-v as an intervention for racially diverse adolescents with anxiety and points to the need for more research on DNA-v.

Objective: Psychedelic therapies are promising new treatment options in psychiatry. Including the use of physical touch as part of treatment is an area of debate. This study aimed to characterize the viewpoints of practitioners on the use of touch in psychedelic therapy.

Methods: An anonymous survey was distributed via e-mail to the contacts listed on ClinicalTrials.gov for trials of psilocybin and lysergic acid diethylamide, via e-mail to personal contacts of the current authors, and through snowball sampling. Survey items focused on topics related to the facilitation of psychedelic treatments. The survey included Likert-scale, free-response, and demographic items.

Results: Forty respondents completed the survey. The respondents had overseen an average of 41.4 psychedelic sessions (range 2-200 sessions), had varying educational backgrounds (doctorate in medicine or osteopathic medicine, 43%; other degree, 58%), and were affiliated with ≥16 institutions worldwide. Seventy percent of the respondents agreed that therapeutic touch was a crucial component of psychedelic therapy, although a majority felt that specific forms of touch (bodywork, 63%; full-body contact, 98%) were inappropriate. Free-response analysis indicated that 96% of the respondents supported touch of the patient's hand and 58% supported touching of the shoulder. Unprompted, 63% of respondents emphasized the importance of consent.

Conclusions: Classical psychedelic practitioners in research settings believed that physical touch is an important part of psychedelic therapy. However, they also emphasized the importance of professional boundaries. These findings may inform the future practice of psychedelic therapy.

Objective: Current treatment approaches for bipolar disorder work to improve symptoms while preventing relapse. However, quality of life (QoL) is often not addressed, and many individuals struggle to reach stability and recovery. This study aimed to investigate the capacity for adjunctive sources of care that promote evidence-based skills and peer support to improve functioning and QoL for individuals with bipolar disorder.

Methods: Eighteen participants with bipolar disorder completed a 16-week, peer-led Mood Lifters for Bipolar Disorder (ML-BD) program as a part of this uncontrolled feasibility trial. Measures of feasibility, acceptability, and appropriateness were collected at the end of the program. Symptoms of depression and mania, in addition to QoL, were measured before and after program completion.

Results: ML-BD was considered generally feasible, acceptable, and appropriate by participants. Quantitative and qualitative data showed high satisfaction with ML-BD, although dropout rates and qualitative feedback were key areas for improvement. Exploratory analyses showed that participants experienced significant increases in QoL. Symptoms of depression and mania remained statistically similar from pre- to posttreatment.

Conclusions: ML-BD is an adjunctive source of care that is potentially feasible, acceptable, and appropriate for individuals with bipolar disorder. It may support symptom management and improve QoL. Future studies should optimize this program on the basis of stakeholder feedback and investigate its formal efficacy in broader samples.

Objective: Despite the efficacy of current therapies, a significant proportion of patients with schizophrenia, a complex mental disorder marked by both positive (present) and negative (absent) symptoms, are considered to have treatment-resistant schizophrenia. Avatar therapy (AT) allows patients to interact with a three-dimensional representation of their most distressing voices in a virtual reality setting. The therapy shows promise in reducing impairments and improving quality of life through the establishment of a therapeutic alliance and the exploration of dyadic interactions (verbal exchanges) between patients and their avatar. The purpose of this study was to investigate differences in dyadic interactions throughout the immersive sessions of AT and to clarify the relationship between these interactions and therapeutic success by analyzing dyads as predictive indicators of positive outcomes in AT.

Methods: Mean frequencies for the 10 most prevalent dyads identified in previous AT research were reported for 35 patients. A logistic regression model was implemented, and these dyads were used to predict variances in Psychotic Symptom Rating Scales-auditory hallucination scores 1 month after the completion of AT.

Results: Variances in mean frequencies were reported for the dyads. A positive relation between the avatar (provocation)-patient (self-affirmation) dyad and the therapeutic outcome was found to be significant (OR=2.29, p=0.049).

Conclusions: This research is pioneering in its in-depth examination of therapeutic interactions in AT, with a particular focus on dyadic interactions. Future studies should prioritize the quality rather than quantity of these interactions to more accurately forecast their effects on potential indicators of positive outcomes in AT.

Delusional disorder is a challenging mental health condition given its resistance to conventional treatment with antipsychotic medications. Although patients with delusional disorder often retain good functioning outside of their delusional theme, they often become functionally impaired as delusional ideas become more central in their lives. Psychotherapy represents an important treatment modality for these patients, in that it may be the most effective treatment option to date. Theorists from both the psychodynamic and cognitive-behavioral schools have offered frameworks for understanding and treating delusions and delusional disorder, and both models appear to be useful in working with this difficult-to-treat condition. In this Psychotherapy Tools article, the authors briefly review delusional disorder, assess current research data on its psychodynamic and cognitive-behavioral treatment, and offer practical suggestions for integrating these models from a unified biopsychosocial perspective.

Objectives: Mental health providers who profess competence in psychotherapy include people with M.D.s, Ph.D.s, and Psy.D.s; an assortment of master's-level providers; and advanced practice registered nurses (APRNs). Training requirements and individual training experiences in psychotherapy vary widely across and within these specialties. In this article, the author aims to identify practical approaches that employers and patients can use to identify competent practitioners and weed out those who are ineffective or dangerous.

Methods: To supplement clinical observations, a narrative review was conducted that examined systematic and scoping reviews and other articles that have addressed the assessment of competence and quality in psychotherapy practice.

Results: Existing measures of competence and quality in psychotherapy practice have largely been developed within, rather than across, mental health disciplines. Psychiatrists have been less involved in these efforts in the 21st century than in prior years, and few studies have explicitly involved APRNs. Most published measures have been based on assorted logs, self-reports, and observations of simulated or actual therapy sessions. After initial development, few have been deployed as ongoing measures for the purpose of screening applicants for psychotherapy positions or quality assurance. All have significant limitations.

Conclusions: No available measure of psychotherapy competence has achieved gold-standard status. Several published measures could contribute to quality-assurance efforts. Practically speaking, to assess therapist competence, employers and patients must still largely rely on an assortment of certifications, personal references, and patients' accounts of experiences with their therapists. All these sources are increasingly accessible, thanks to web-based technologies.

Objective: Transdiagnostic treatments are needed to address the diverse manifestations and effects of trauma-related psychopathology. Acceptance and commitment therapy (ACT) is a promising intervention, although little is known about its application among trauma-exposed civilians. A single-arm pilot study evaluated outcomes of a virtual, group-based ACT intervention for trauma delivered through a training clinic.

Methods: Five female clients (mean age=42.6 years) with a history of criterion A trauma completed an 11-week skills group and repeated measures assessing posttraumatic and related psychopathology symptoms (e.g., depression, anxiety, posttraumatic stress disorder [PTSD]), emotion regulation, quality of life, posttraumatic growth, and experiential avoidance. Paired-samples t tests were used to assess pre- to postintervention effects.

Results: All clients completed the intervention, suggesting high acceptability. Analyses of pre- to postintervention effects demonstrated significant reductions in depression (d=1.16, p=0.03) and anxiety (d=0.95, p=0.05) symptoms but not in PTSD symptoms; effect sizes for significant changes were large. Significant and large increases in effective use of emotion regulation strategies (d=1.02, p=0.04) and posttraumatic growth (d=1.18, p=0.03) were also observed. Experiential avoidance, a hypothesized treatment mechanism in ACT, decreased from pre- to postintervention (d=1.22, p=0.03).

Conclusions: Findings provide initial evidence for acceptability and beneficial clinical outcomes of a virtual, group-based ACT intervention to address the transdiagnostic consequences of traumatic stress.