AMERICAN JOURNAL OF PSYCHOTHERAPY最新文献

Epigenetic modifications play a pivotal role in the regulation of gene expression and cell function, offering potential markers of disease states and therapeutic outcomes. Recent advancements in neuroscience have spurred interest in studying the epigenetic underpinnings of psychosomatic medicine. This review presents a new perspective on the role of epigenetic regulation in the realms of psychosomatics and psychotherapy. The authors first highlight epigenetic patterns associated with prevalent psychosomatic disorders, including irritable bowel syndrome, fibromyalgia, psoriasis, and lichen planus. For these conditions, psychotherapy serves as a treatment modality and can be conceptualized as an epigenetic intervention that beneficially affects the epigenome as part of the therapeutic process. Focusing on cognitive-behavioral and mindfulness-based therapies, the authors highlight evidence on psychotherapy-associated epigenetic signatures occurring at genes that are involved in stress response, inflammation, neurotransmission, neuroplasticity, and aging. Educating patients about the potential of psychotherapy to affect the epigenome may enhance patient engagement with and adherence to treatment, and psychotherapy-induced epigenetic changes have the potential to promote transgenerational disease prevention, underscoring the far-reaching implications of this therapeutic approach. Challenges persist in epigenetic studies, and this review aimed to catalyze further research in this burgeoning field, with the goal of enhancing patient care.

There is an inevitable limit to understanding the internal experience of patients with whom therapists work in psychotherapy. The farther their experience is from that of their therapist, the more challenging this endeavor can be. Accepting that therapists cannot exactly know a patient's internal experience invites them to explore novel ways of appreciating another person's way of perceiving relationships, deriving meaning from them, and using their experience to motivate behavior. The concept of umwelt can be used as a metaphor to help therapists imagine the internal world of their patients, as shaped by patients' developmental, interpersonal, and traumatic experiences. Umwelt refers to the unique worldview created by a species' idiosyncratic perceptual organs and survival strategies. This first Psychotherapy Musings describes the concept of umwelt, applies it to the case of a patient with difficult-to-treat mental health problems, and explicates the benefit of this novel perspective.

The year 2024 celebrates the 15th anniversary of nationally organized training in and delivery of intensive short-term dynamic psychotherapy (ISTDP) in Norway. Accordingly, the authors provide an overview of the implementation of ISTDP in Norway, examine ISTDP's impact on mental health delivery, review research, reflect on practice, and discuss future directions for ISTDP in the country. Since its introduction in Norway, ISTDP has gained significant popularity and recognition in the mental health field. The training of Norwegian trainers and the founding of the Norwegian Institute for ISTDP allowed for the expansion and scalability of the ISTDP training program. Alignment of the training program with the existing framework for postgraduate specialization for psychologists and its accreditation by the Norwegian Psychological Association has ensured recognition and relevance in the mental health field. Private- and public-sector applications have further contributed to the growth and dissemination of the method in Norway. ISTDP has thus become an integral and important part of the therapeutic landscape, providing hope and healing to individuals facing various emotional challenges. ISTDP's influence is likely to keep growing, both within Norway and internationally, thus contributing to the advancement of effective psychotherapy practices worldwide.

Good psychiatric management (GPM) for borderline personality disorder is a generalist strategic case management approach used by helping professionals of different training backgrounds to work with patients with borderline personality disorder. GPM includes a flexibly administered once-weekly psychotherapy for which a brief introductory course in GPM alone is considered sufficient preparation. GPM integrates concepts from specialized evidence-based treatments for borderline personality disorder, including transference-focused psychotherapy (TFP). This article describes the TFP elements that John Gunderson acknowledged as influential to his development of GPM. A basic introduction to TFP is provided, and elements in GPM that interweave with TFP's theoretical foundation are elucidated and then illustrated in a clinical vignette that captures the GPM clinician's interventions influenced by these ideas. The vignette is then used to illustrate clinical tools informed by TFP principles and common to both GPM and TFP.

The broad acceptance of evidence-based psychosocial interventions as adjuncts to pharmacotherapy for bipolar disorder has been inhibited by the extensive training, supervision, and fidelity requirements of these approaches. Interventions that emphasize evidence-based strategies drawn from these modalities-rather than the full manualized protocols-may broaden the availability of psychotherapy for patients with bipolar disorder. In this article, psychosocial risk factors relevant to the course of bipolar disorder (stressful life events that disrupt social rhythms, lack of social support, family criticism and conflict, and lack of illness awareness or literacy) are reviewed, along with evidence-based psychosocial interventions (e.g., interpersonal and social rhythm therapy, cognitive-behavioral therapy, family-focused therapy, and group psychoeducation) to address these risk factors. The results of a component network meta-analysis of randomized psychotherapy trials in bipolar disorder are discussed. Manualized psychoeducation protocols-especially those that encourage active skill practice and mood monitoring in a family or group format-were found to be more effective, compared with individual psychoeducation or routine care, in reducing 1-year recurrence rates. Cognitive restructuring, regulation of daily and nightly routines, and communication skills training were core components associated with stabilization of depressive symptoms. The authors describe a novel psychoeducational approach-practical psychosocial management (PPM)-that integrates these core strategies into the personalized care of patients with bipolar disorder to reduce recurrences and enhance mood stability. PPM is designed to be implemented, without time-intensive training and oversight, by physician or nonphysician clinicians. Evaluating the efficacy and coverage of PPM will require implementation trials in community settings.

Objective: Dialectical behavior therapy for adolescents (DBT-A) is an evidence-based treatment for adolescents with multiple emotional and behavioral problems. Research has demonstrated the posttreatment acceptability of DBT-A by parents and adolescents. However, no study has systematically explored the expectations and preferences of adolescents before beginning DBT-A treatment. The goals of this study were to investigate adolescents' pretreatment expectations for DBT-A by developing the Adolescent Expectancies for Therapy Scale (AETS), adapted from the Parent Expectancies for Therapy Scale, and to explore their preferences regarding treatment delivery format.

Methods: Participants were 21 adolescents (ages 13-18) with varying race-ethnicities who were referred for DBT-A in either a group private practice or a community mental health clinic. Participants completed the AETS and the Preferences Rating Form, which examined the extent to which participants preferred each of seven treatment modifications or preferred to keep DBT-A as is.

Results: Findings indicated that, before beginning DBT-A, adolescents had moderate expectations for the outcome and process of the therapy, and approximately half reported that they preferred to be separate from their parents during multifamily skills group sessions (for at least part of the time) and to add weekly teen-only support groups to DBT-A. The AETS had adequate internal consistency (Cronbach's α=0.88).

Conclusions: Understanding adolescents' pretreatment expectations and preferences for the format in which DBT-A is delivered can help clinicians better engage adolescents during the intake and orientation process.

Significant gains have been made in the treatment of personality disorder among young people. However, effect sizes for evidence-based treatments have been modest, and emerging evidence suggests the potential of generalist approaches to improve outcomes in this population. The aim of this review was to highlight how generalist approaches such as good psychiatric management for adolescents (GPM-A) hold promise for early intervention for personality disorders among young people. The authors discuss recent advances in clinical understanding of the diagnosis and treatment of personality disorder among youths and demonstrate how these advances align with GPM-A. Specifically, the authors show how several of GPM-A's guiding principles-most notably the need for access, common-factor approaches, and a focus on interpersonal hypersensitivity and restoring general functioning-align with these advances. This review suggests that GPM-A provides a timely and promising framework for innovating early interventions for personality disorder among young people.

Considering the escalating gap between the population-level need for substance use services and the availability of board-certified addiction specialty physicians, all psychiatrists must be equipped to treat substance use disorders. Residency training programs must therefore ensure that graduates are equipped with a sufficient knowledge base and skill set to treat substance use disorders, including an understanding of medications for addiction treatment and appropriate selection and utilization of psychotherapy for substance use disorders. Resources for teaching psychiatric residents about psychotherapeutic approaches to substance use disorders are often limited, and many programs may struggle to include this content in their curricula. The authors highlight the core evidence-based psychotherapeutic approaches relevant to the care of patients with substance use disorders and identify supervised experiential learning opportunities for psychiatric residents to practice psychotherapy for substance use disorders during existing clinical rotations within their general psychiatry residency programs.