JOURNAL OF CONTEMPORARY PSYCHOTHERAPY最新文献

Case formulation is at the heart of personalised care in psychotherapy. Scientific research into case formulations can provide new insights in the heterogeneity of psychopathology which are relevant for advances in personalised psychopathology research and practice. This mixed-methods study examined the content of 483 fully personalised network-based case formulations in psychotherapy in terms of uniqueness (i.e., frequencies of concepts) and commonality (i.e., the presence of common themes over the different case formulations). In a real-world clinical care setting, patients co-created network-based case formulations with their therapist as part of their routine diagnostic process. These case formulations feature concepts that are relevant to individual patients and their current situation. We assessed how often concepts were used by different patients to quantify uniqueness. We applied a bottom-up thematic analysis to identify patient-relevant themes from the concepts. The case formulations of 483 patients diagnosed with mood and/or anxiety disorders contained a total of 4908 interpretable concepts of which 4272 (87%) were completely unique. Through thematic analysis, we identified seven overarching themes in the concepts: autonomy, connectedness, emotions, self-care, identity, self-efficacy, and bodily sensations. Case formulations were highly unique, thereby illustrating the importance of personalised diagnostics. The unique concepts could be grouped under seven overarching themes which seem to encompass basic human needs. Current advancements in personalised diagnostics and assessment should have a broader scope than symptoms alone, and could use the themes identified here as part of a topic list in the generation of (network-based) case formulations.

Research suggests that best-practice psychotherapies only have moderate effects on reducing anxiety in youths. Such limitations in outcomes prompt consideration of alternative conceptualisations of anxiety and its treatment. Based upon the metacognitive model, we propose a novel therapy targeting metacognitive knowledge (beliefs about emotions and emotion regulation) for the treatment of anxiety in adolescents. The current case series study aimed to provide a proof of concept for the effectiveness of Meta-Emotion Therapy for adolescents (MET-A) for the treatment of adolescent anxiety. Four adolescents with elevated anxiety participated in this case series study. All participants received 10 individual sessions of MET-A. Participants and a parent completed the Revised Children’s Anxiety and Depression Scale at baseline, weekly and at one-month follow-up. The participants also completed the Beliefs About Emotions Questionnaire and the Difficulties with Emotion Regulation Scale at baseline, post-therapy and one-month follow-up. The results showed that all participants improved or recovered from symptoms of anxiety and depression from pre- to post-treatment, when taking into consideration both self- and parent-reported ratings (however, these ratings were often non-concordant). Gains were maintained at one-month follow-up. Further, participants who self-reported reductions in anxiety and depression also cited reductions in several maladaptive beliefs about emotions and improvements in aspects of emotion regulation. The participants endorsed the therapy as highly acceptable, appropriate, and feasible. Overall, the results of this study provide preliminary proof of concept for MET-A as a promising intervention for the treatment of adolescent anxiety Further investigation of MET-A is warranted to optimise treatment outcomes and measurement of change.

Clinical Trial Registration: Registered with the Australian and New Zealand Clinical Trial Registry number 382327.

Several psychotherapeutic interventions are recommended for Eating Disorders (EDs), chiefly individual cognitive-behavioral therapy and family-based treatments. Manualized individual psychodynamic treatments are recommended for adults with Anorexia Nervosa (AN). Evaluation of psychodynamic group treatments in treating EDs requires further assessment, and recent reviews focused only marginally on this topic. To fill this gap, a narrative review through APA PsychInfo, PubMed and Scopus was carried out. Psychodynamic group treatments appear to improve some ED symptoms at the end of the treatment; however, most of the studies cited were not manualized and lacked control groups and follow-ups. The differences in therapeutic methods and the criteria used to measure remission across the studies included, as well as the incorporation of diverse interventions (including psychodynamic group therapy and elements of BT/CBT or psychoeducation), create difficulties when it comes to forming conclusive judgments about the effectiveness of psychodynamic group therapies for Eating Disorders. The need for more rigorous research and Randomized Controlled Trials (RCTs) is evident.

Abstract

Suicide is the 11th leading cause of death in the U.S. It is estimated that one third of people who died by suicide received mental health services in the year preceding their death and one fifth had received services in the previous month. Given these statistics, many mental health professionals are very likely to work with a client who dies by suicide at some point in their career. This qualitative study aimed to investigate the experiences of therapists after a client suicide and to identify those supports and responses the therapist found helpful in the aftermath. The nine participants were licensed mental health providers. Each had a client die by suicide at least 2 years prior and was actively providing treatment or had been providing treatment in the 6 months prior to the client’s death. Findings revealed that a client’s death by suicide can have a profound impact on the provider, including sadness, anger and anxiety about litigation. Such reactions speak to the importance of intentional self care for individuals who work with high risk populations. Additionally, results indicated that discussing client suicide in advance helps prepare clinicians to be better able to cope and heal following the actual event. This study enhances our understanding of this experience and fosters the development of actionable postvention steps clinicians, supervisors, and mental health agencies can take to support providers after a client suicide.

Therapists and the public are becoming increasingly aware that psychotherapy can have side effects. The prevalence varies depending on the patients, treatments, settings, assessment methods and the researched type of side effect. Objective of this study is to assess side effects of routine outpatient psychodynamic and cognitive behaviour therapy. In a cross-sectional study cognitive behaviour therapist (n = 73) and psychodynamic psychotherapists (n = 57) were asked in a semi-structured interview about unwanted events and side effects in reference to their most recent patients (N = 276) using a domain inspection method. Their reports were cross-checked by an expert assessor. Multiple random-intercept models were conducted to investigate the influence of various variables. Therapists reported in 170 patients (61.4%) a total of 468 unwanted events. There was at least one side effect in 33.2% of the cases. Most frequent side effects were “strains in family relations” and “deterioration of symptoms”. Illness severity has a significant influence on the amount of side effects reported. The data confirm that side effects of psychotherapy are frequent. The difference between side effects and unwanted events shows the importance of such a distinction. The reporting of side effects for one in three patients may indicate an under recognition of side effects or reporting of only relevant or disturbing side effects.

Bipolar disorder (BD) can be especially challenging to treat due to the dynamic nature of its presentation; there is a critical need for a multimodal approach to adequately address patients’ symptoms and quality of life concerns. However, most mental health professionals have not implemented a multimodal approach due to limited dissemination of evidence-based psychosocial interventions for BD and bias towards psychopharmacology-centered treatment. This is despite clear findings from numerous studies that medication alone fails to fully address most patients’ needs and that psychosocial interventions lead to fewer relapses and a higher quality of life. This paper aims to review the evidence in support of psychosocial interventions as a key component of the treatment of BD and to highlight obstacles to the implementation of psychosocial treatment approaches. Additionally, we aim to make a case for an increase in the utilization of psychosocial interventions to improve quality of life and functioning for individuals with BD and their families, and to mitigate societal costs.

Self-help may help fill the large treatment gap in individuals with body-focused repetitive behaviors (BFRBs). We examined the efficacy of three self-help techniques for BFRBs: habit reversal training (HRT), decoupling (DC), and decoupling in sensu (DC-is) and also tested whether a video demonstration is more efficacious to written instructions. A total of 224 participants with at least one BFRB were randomly assigned to two intervention groups (video, manual) receiving access to all techniques or a wait-list control group (1:1:1). A 6-week follow-up assessment was conducted. The Generic Body-Focused Repetitive Behavior Scale (GBS-9) served as primary outcome. The intention-to-treat analysis showed significant improvements for the manual group compared to the wait-list control group on GBS total score and severity and impairment scores. For the per-protocol analyses (i.e., participants had at least read/watched the manual/video), 26.9% of completers in the manual group improved at least 35% in GBS compared to 23.3% (video group) and 15.9% (control). A dose–response relationship emerged for the video group. Subjective ratings by the video and manual groups did not differ; treatment satisfaction was greater for HRT and DC than for DC-is. Results suggest that the manual group showed somewhat stronger effects than the video group when usage frequency was low. With more frequent usage, improvements in the video condition increased. Future studies should investigate potential order effects of the techniques as well as add-on effects when techniques are used along with other treatment approaches.

The present paper aims to introduce a constructivist narrative intervention for Narrative Identity Reconstruction (NIR) in working with clients with a history of stressful life events (SLE). This intervention is based on a proposed conceptual framework explaining how SLE affects narrative identity. First, we provide a conceptual model to show the theoretical links between SLE and narrative identity through the three functions of making meaning, unity, and purpose. The present conceptualization proposes that concepts of meaning-making, self-concept clarity, and agency should improve for narrative identity reconstruction. For designing therapy steps, we were inspired by the procedure of the Life Design process for reconstructing narrative identity. We defined the following steps: (a) construct self-story through small stories, (b) deconstruct these stories, (c) reconstruct them into an identity narrative or life portrait, and (d) co-construct intentions that lead to the next action episode in the real world. We hope NIR can help clients construct a robust self-narrative in which the SLE is not a confusing and distressing experience leading to a broken narrative; instead, it can make sense and integrate into the bigger picture of self-narrative. It is suggested that future research empirically examine the NIR to explore the feasibility and effectiveness of the intervention in mental health settings.

Eye Movement Desensitization and Reprocessing (EMDR), while recognized as evidence-based, continues to be viewed as a novel and controversial treatment. At the same time, numerous alternative eye movement therapies have been introduced, each of which requires its own set of randomized controlled trials (RCTs) to assess remarkable claims of cure. The present situation is untenable in our opinion because any clever entrepreneur can claim a new method and trademark a new acronym. Recommendations are made for more stringent criteria to establish science-based methods that guide clinical practice.

Trichophagia, or eating one’s own hair, commonly occurs in individuals with trichotillomania. Minimizing the symptoms of trichotillomania and trichophagia and maintaining remission can encourage them to have healthy lives. Conduct a scoping review to investigate the efficacy of using psychotherapy interventions to minimize symptoms of trichotillomania and trichophagia among individuals with trichotillomania. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines to screen 19,552 studies published between 2010 and 2022. A total of 19 studies that fulfill the eligibility criteria reported that psychotherapy interventions had been effective and applicable approaches to minimizing the symptoms of trichotillomania and trichophagia. Psychotherapy interventions are a promising treatment that is regarded as a credible treatment approach to ensure long-term positive outcomes among individuals with trichotillomania. This scoping review verifies the formalization and incorporation of psychotherapy interventions into standard practice and highlights the importance of mental health practitioners using them to ensure long-term positive outcomes for individuals with trichotillomania. Moreover, practitioners need further specialized training on a variety of psychotherapy interventions because not all of them are familiar with these interventions.