JOURNAL OF CONTEMPORARY PSYCHOTHERAPY最新文献

There is a mental health crisis in the United States that shows no signs of abating. Prevalence rates of mental disorders among both adults and children are rising and there are simply not enough mental health professionals to meet the growing demand. To address this problem, digital programs are being designed to diagnose and treat mental health conditions either adjunctively to a human clinician or as stand-alone treatments. Such developments hold great promise in ameliorating the mental health professional supply shortage. However, certain limitations of digital programs may prevent many users from desiring a digital psychotherapist. This paper surveys both the promise, and limitations, of digital psychotherapies.

Henri Grivois has posited that psychosis involves the subjective experience of oneself as the center or focal point of the world. In this experience, the world that is typically unrelated to oneself becomes incomprehensible, and in its place is the sense that all life events are directly related to oneself or that one is perpetually at the center of all noteworthy activity. We suggest that this experience of centrality can be understood through the lens of the integrated model of metacognition. Specifically, we explore the idea that the metacognitive domain of decentration, or the ability to form ideas about the larger community one is a part of, can be used to operationalize and measure centrality. We propose a three-phase approach to addressing centrality within an integrative psychotherapy focused on subjective and experiential aspects of recovery. These phases focus on the patient’s experience of centrality and include (1) inviting the therapist to join one’s centrality, (2) acknowledging others as different from oneself, and (3) recognizing alternative perspectives in the world. We provide case examples and explore the metacognitive tasks and potential barriers associated with each phase.

The most important lesson that I have learned in my half century as a therapist (and therapy researcher) is that principles matter more than processes. I had the great good fortune to arrive in Philadelphia at a time when Beck and colleagues were just beginning to test the efficacy of cognitive therapy for depression and what I learned was that helping clients (and myself) get the better of depression involved two main principles: (1) when in doubt do whatever you would have done if you were not depressed (behavioral); and (2) do not believe everything you think - check it out (cognitive). A third major principle is that the most powerful way to test an existing belief is to use one’s own behaviors to test its accuracy, which usually means doing whatever you least want to do in that situation (opposite action). I find that focusing on these principles is wholly liberating in the therapy process; I am free to be myself, to follow any line of inquiry, to respond to any request and to comport myself much as I would with any friend outside of therapy. This focus on principles has been good for my clients and even better for me.

Abstract

Panic disorder (PD) affects family members and can be influenced by familial factors. Adverse family events may contribute to anxiety and PD. We examined a family therapy case of a client with PD in South Korea. We used a thematic analysis to analyze therapy transcripts and video recordings and displayed our findings using a network. We identified five stages of the psychological process in the development of PD: (1) formation of anxiety, (2) sheltered life, (3) crisis, (4) loss of haven, and (5) inner breakdown. External situations, family dynamics, and psychological experiences at each stage are examined. Family dynamics that occurred as the family coped with external situations contributed to the client’s psychological experiences, which triggered anxiety that led to PD. This study suggests family dynamics can be associated with one’s internal experiences that could lead to PD, highlighting the importance of functional family dynamics and coping when facing crises.

Psychoanalysis brings some specific aspects of treatment technique to the field of mental health practice today, such as highlighting the dynamics within therapeutic relationship (especially regarding emotional and unconscious elements), the role of defense mechanisms etc. Moreover, by means of taking a particular therapeutic stance, psychoanalysis offers some shared mental space for patients. The present paper argues that this stance is characterized by the capacity to “not act”, that is: by passive receptivity. To view this as some specific “negative skill” in psychotherapy in general means to align common elements of effective psychotherapy with the capacity to explore the uncommon, unfamiliar or unforeseen in particular psychotherapeutic processes. The paper sketches how this can be employed in psychotherapy training as well as in psychotherapy integration.

The term ‘Common Emotional Disorders’ refers to a range of clinical conditions such as anxiety disorders, panic atacs, mild and moderate depressive states, sleep disorders, somatoform disorders and post-traumatic stress disorder. The aim of the present article is to investigate the effectiveness of a specific group psychotherapy protocol for common emotional disorders. The outcome was evaluated in terms of reduction of anxiety-depressive symptoms. The aim is for this protocol to represent a first and valid intervention tool in the public context, in compliance with national indications in terms of cost-effectiveness. The protocol is structured in seven modules, each of which deals with the pivotal points of a psychotherapeutic pathway. It has a total duration of 6 months, and was applied to 61 adult patients afferent to a Mental Health Centre (45 F and 16 M). Results show a significant reduction in overall symptom severity and an extensive improvement in both depressive and anxious symptoms, as well as a self-perceived degree of improvement in subjective well-being. This protocol has the advantage of being able to group together patients with comorbid clinical conditions and symptom heterogeneity and offers them proven cognitive-behavioral treatment.

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.