AMERICAN JOURNAL OF PSYCHOTHERAPY最新文献

Objective: This study aimed to evaluate the efficacy of intensive short-term dynamic psychotherapy (ISTDP) in reducing anger and suicidal ideation among individuals with suicidal behavior.

Methods: A quasi-experimental design was used, with 30 participants randomly assigned to an experimental or a medication-only control group. Participants, recently hospitalized in Kermanshah, Iran, because of suicide attempt, were assessed via the State-Trait Anger Expression Inventory-2 and the Beck Scale for Suicidal Ideation at baseline and posttreatment. Treatment began after group assignment.

Results: ISTDP significantly reduced anger (p<0.05) and suicidal ideation (p<0.05), significantly decreasing the likelihood of suicide reattempts.

Conclusions: ISTDP offers promise in combating suicidal thoughts and behaviors, supporting the psychodynamic hypothesis of anger dynamics and inward anger.

Psychiatry residency programs in the United States and Canada currently require trainees to demonstrate competency in psychodynamic therapy. Developed by Habib Davanloo, intensive short-term dynamic psychotherapy (ISTDP) is a brief psychodynamic therapy with emerging evidence to support its efficacy as an evidence-based, cost-effective treatment for various common psychiatric disorders and personality pathologies. Davanloo's metapsychology of the unconscious offers a way to understand the psychodynamic processes that maintain patients' psychiatric symptoms. Some key clinical processes unique to ISTDP facilitate conceptualization of patients' problems and allow for effective interventions. ISTDP skills can be especially helpful when working with populations with complex and treatment-resistant conditions that are commonly encountered in psychiatric secondary- and tertiary-care settings. This article aims to examine the value of ISTDP training for psychiatrists. First, the benefits of being able to offer formal treatment with ISTDP are examined. Second, the unique skills acquired through ISTDP training, which can be used in general psychiatric care, are reviewed. Finally, the personal and systemic benefits of ISTDP training, including clinician self-monitoring, management of burnout, and team leadership, are discussed.

Public health care systems are tasked with meeting the wide-ranging needs of large patient populations. Interventions that are broadly applicable, clinically effective, and cost-efficient are essential. Intensive short-term dynamic psychotherapy (ISTDP) is an evidence-based psychodynamic therapy that has been successfully applied in the treatment of many mental health conditions and functional somatic disorders. The aim of this scoping review was to describe the health economic data of ISTDP in health care settings. Substantial financial savings and reductions were identified from hospital, physician, medication, disability, and welfare costs following treatment. ISTDP has the potential to deliver significant cost reductions for state funders, health commissioners, and care providers. Additional research is required to confirm the full extent of cost savings that can be achieved with ISTDP.

Psychotherapy supervision is essential to conveying knowledge and protecting patients and is critical to the development of psychiatric trainees. Both supervisors and supervisees generally find it rewarding. The authors describe and discuss two surprising parallel instances in which psychiatric residents at different programs abruptly terminated psychotherapy supervision, declaring it psychologically "unsafe." Psychological safety in supervision requires a supervisory alliance, which when disrupted may lead residents to feel unsafe, impede their ability to learn, and impair outcomes for their patients. Psychotherapy and supervisory encounters require a tolerance of strong affect that not all individuals possess. The authors review these supervisions, discuss the inherent rigors of psychotherapy and supervision, address ways to identify and repair ruptures in the supervisory alliance, and consider the gatekeeping role of the supervisor. They also speculate on secular changes that might be altering residency education.

Dialectical behavior therapy (DBT) is an empirically validated treatment for chronic, difficult-to-treat, life-threatening mental health conditions. DBT can be challenging to implement and maintain in managed care systems because of the need for substantial infrastructure and intensive clinician training. As a result, most clients receive components of DBT, known as DBT-informed care. This model is valuable in its own right, including for individuals with less severe clinical symptoms. Additionally, clinicians who provide DBT experience professional benefit. Cinematherapy, the incorporation of film in therapy, uses psychodynamic and social-cognitive mechanisms of change based on the premise that movies can provide catharsis and validation, enhance self-exploration, and support new learning. This article offers guidance for using the movie Inside Out as a DBT-informed therapy intervention for adults. The film demonstrates the value of accepting, before changing, emotions and of the crucial role of validation in psychosocial development and therapeutic healing.

Objective: The aim of this study was to compare the effectiveness of an artificial intelligence (AI) therapist (ChatGPT-3.5) and a human therapist in delivering text-based cognitive-behavioral therapy (CBT). Cognitive Therapy Rating Scale (CTRS) scores and qualitative responses from participants were used to assess ChatGPT-3.5's capabilities within the limitations of this deployment.

Methods: A cross-sectional survey was administered to 208 mental health professionals and trainees, 75 of whom completed the study. Participants assessed two text-based CBT transcripts (AI therapist and human therapist) using the CTRS and provided qualitative feedback. Both the AI therapist and the human therapist were presented with identical clinical scenarios to ensure consistency.

Results: The human therapist outperformed ChatGPT-3.5 across most CTRS domains (α=0.001). More than half (52%) of the respondents rated the human therapist's agenda setting highest, with a score of 6, compared with 28% who gave this rating to ChatGPT-3.5. In elicited feedback, 29% rated the human therapist as highly effective (score=6), whereas only 9% rated ChatGPT-3.5 similarly (p<0.001). The human therapist also scored higher on guided discovery (24% vs. 12%, p<0.001). ChatGPT-3.5 was rated similarly to the human therapist in understanding the patient's internal reality (36% vs. 19%, p=0.004) but was often seen as less personalized and more rigid.

Conclusions: The findings suggest that although ChatGPT-3.5 may complement human-based therapy, this specific implementation of AI lacked the depth required for stand-alone use. These findings, however, cannot be generalized to all AI-based therapy because the study did not account for the diverse ways therapy can be delivered.

Psychotherapy supervision is an essential aspect of psychiatric residency training, and it is critical in supporting the identity of a psychiatrist as a psychotherapist. However, the number of faculty available to provide psychotherapy supervision, especially in specific modalities, such as psychodynamic psychotherapy, has been significantly reduced. Furthermore, the number of practicing psychiatrists is anticipated to decline, narrowing the supervision pool. Recruiting and retaining psychotherapy supervisors has also become more challenging as compensation models emphasize relative value units. This article describes strategies for developing a robust psychotherapy supervisor pool and helping graduate psychiatric educators to manage the economic, malpractice, and credentialing challenges that the present climate entails. These strategies include recruiting both internally and externally, recruiting supervisors from other disciplines, training advanced residents to supervise, incentivizing external supervisors, and developing a shared curriculum. The development of these relationships and resources will allow training programs to continue to provide outstanding supervision.

Objective: This study aimed to compare suicide mortality rates for patients receiving two evidence-based psychotherapy (EBP) protocols for posttraumatic stress disorder (PTSD): cognitive processing therapy (CPT) and prolonged exposure (PE).

Methods: Suicide mortality was measured among U.S. Department of Veterans Affairs patients with PTSD who received EBP from 2009 through 2019. Regional variation in delivering CPT versus PE was leveraged as an instrumental variable (IV) to compare suicide mortality by using standard adjustment and IV-based analyses.

Results: In total, 62,686 patients received EBP for PTSD; 82.4% were male, and the mean±SD age was 46.9±14.4. Patients were followed for a median of 6 years, and there were 136 deaths by suicide (38.3 and 32.4 per 100,000 person-years among the CPT and PE groups, respectively). The regional rate of CPT versus PE delivery was a strong IV that had greater explanatory power for the type of EBP received than all patient factors combined. The standard adjustment model for CPT produced a hazard ratio of 1.25, whereas the reduced-form IV produced a hazard ratio of 1.22. The probit IV, in which relevant covariates were updated annually, produced an odds ratio of 0.99. The time-to-event IV produced a hazard ratio of 1.20. The differences were not significant.

Conclusions: No statistically significant difference was found between CPT and PE in the outcome of death by suicide. More effective interventions that result in higher remission rates would likely need to be developed to achieve a relative decrease in suicide risk through PTSD treatment.