Talking treatment in general.
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1301 to 1325 of 1,623Mental health service use by patients with dysthymic disorder: treatment use and dropout in a 7 1/2-year naturalistic follow-up study.
Little is known about long-term treatment use among patients with dysthymia. This paper describes patterns of treatment use by 85 outpatients with dysthymic disorder and a comparison group of 36 outpatients with nonchronic (episodic) major depression in a naturalistic follow-up. Patients with dysthymia had higher rates of treatment use across 7 1/2 years compared with patients with episodic major depression. Baseline variables that predicted which patients with dysthymia dropped out of treatment before recovering from dysthymic disorder included age, ethnicity, Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition Axis II pathology as obtained from informant reports, higher self-reported autonomy, and receiving psychotherapy alone as compared to receiving a combination of psychotherapy and medication. Dysthymic disorder places a significant burden on the mental hea…
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Le Roux H, Gatz M, Wetherell JL (2005)MEDLINE-indexed journal, not yet read by usThe American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry58 citations Age at onset of generalized anxiety disorder in older adults.
Objective: The authors explored the distribution and correlates of age-at-onset of late-life generalized anxiety disorder (GAD).
Methods: Authors examined the distribution of age at onset in a sample of 67 older adults with GAD recruited for a psychotherapy study. They compared those with an early onset of symptoms (before age 50) to those with a late onset (after 50) on demographic variables and measures of psychopathology and health-related quality of life.
Results: There was a bimodal distribution of age at onset, with 57% reporting early onset and 43% reporting a late onset. Patients with an early onset of symptoms had a higher rate of psychiatric comorbidity and psychotropic medication use and more severe worry. Patients with a late onset of symptoms reported more functional limitations due to physical problems.
Conclusions: Although most older GAD patients report an onset in childh…
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Acute treatment outcomes in patients with bipolar I disorder and co-morbid borderline personality disorder receiving medication and psychotherapy.
Objective: Patients suffering from both bipolar I disorder and borderline personality disorder (BPD) pose unique treatment challenges. The purpose of this matched case-control study was to compare acute treatment outcomes of a sample of patients who met standardized diagnostic criteria for both bipolar I disorder and BPD (n = 12) to those who met criteria for bipolar I disorder only (n = 58).
Method: Subjects meeting criteria for an acute affective episode were treated with a combination of algorithm-driven pharmacotherapy and weekly psychotherapy until stabilization (defined as four consecutive weeks with a calculated average of the 17-item version of the Hamilton Rating Scale for Depression and Bech-Rafaelsen Mania scale totaling < or = 7).
Results: Only three of 12 (25%) bipolar-BPD patients achieved stabilization, compared with 43 of 58 (74%) bipolar-only patients. Two of the three b…
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Psychological and interpersonal dimensions of sexual function and dysfunction.
Introduction: There are limited outcome data on the efficacy of psychological interventions for male and female sexual dysfunction and the role of innovative combined treatment paradigms.
Aim: To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research.
Methods: An International Consultation assembled over 200 multidisciplinary experts from 60 countries into 17 committees. The recommendations of committee members represent state-of-the-art knowledge and opinions of experts from five continents were developed in a process over a 2-year period. Concerning the Psychological and Interpersonal Committee of Sexual Function and Dysfunction, there were nine experts from five countri…
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Theoretical model of psychotherapy: Eastern Asian-Islamic women with mental illness.
The Muslim immigrant population is increasing in the United States. To provide appropriate psychotherapy for this group, especially Islamic women, treatment professionals must have a deeper understanding of the culture of Eastern Islamic women. Islam is the lifestyle of this population and it influences their thinking, the relationships among themselves and with others, and all other activities of daily life. The holistic approach of the Eastern Islamic population is incompatible with the individualistic approach of Western psychotherapy in treating Islamic women. We explore a theoretical model of psychotherapy for Eastern Asian-Islamic women suffering from mental illness (MI) to develop an effective and appropriate therapy. Health care providers, specifically those dealing with MI patients, will gain insights from the suggested psychotherapeutic model and its relevance to Islamic concep…
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Fazel M (2018)editorial or commentMEDLINE-indexed journal, not yet read by usEpidemiology and psychiatric sciences35 citations Psychological and psychosocial interventions for refugee children resettled in high-income countries.
Large numbers of refugee children are arriving in high-income countries. The evidence to date suggests that they have mental health needs that are higher than for the general population and that these are exacerbated by the numbers of traumatic events they have experienced and the post-migration stressors they continue to be exposed to. The importance of a thorough and thoughtful assessment is discussed. Treatments of note are described for post-traumatic stress disorder, family functioning, general mental health problems and school environments. Future opportunities to operationalise outcome measures, develop multimodal interventions and utilise implementation science methodology are considered.
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The Effect of Brief Supportive Psychotherapy on Prevention of Psychiatric Morbidity in Women with Miscarriage: A Randomized Controlled Trial about the First 24-hours of Hospitalization.
Objectives: Miscarriage is a common pregnancy complication causing substantial psychiatric complications. This study was designed to investigate whether the administration of brief supportive psychotherapy (BSP) is effective on the management of women with miscarriage when conducted in the first 24 hours of hospitalization in order to prevent symptoms of anxiety, depression, and grief at four-months post-miscarriage.
Methods: We conducted a randomized clinical trial on 79 women with miscarriage hospitalized in Ayatollah Rohani teaching hospital. The women were randomly assigned into two groups (39 in the experimental group and 40 in the control group). All interventions were implemented for two study groups during the first 24 hours of hospitalization in a private room in the hospital. The experimental group received a two-hour BSP. The objective outcomes were assessed using Hospital Anx…
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Using Conversational AI to Facilitate Mental Health Assessments and Improve Clinical Efficiency Within Psychotherapy Services: Real-World Observational Study.
Background: Most mental health care providers face the challenge of increased demand for psychotherapy in the absence of increased funding or staffing. To overcome this supply-demand imbalance, care providers must increase the efficiency of service delivery.
Objective: In this study, we examined whether artificial intelligence (AI)-enabled digital solutions can help mental health care practitioners to use their time more efficiently, and thus reduce strain on services and improve patient outcomes.
Methods: In this study, we focused on the use of an AI solution (Limbic Access) to support initial patient referral and clinical assessment within the UK's National Health Service. Data were collected from 9 Talking Therapies services across England, comprising 64,862 patients.
Results: We showed that the use of this AI solution improves clinical efficiency by reducing the time clinicians spend…
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Marmarosh C (2024)MEDLINE-indexed journal, not yet read by usInternational journal of group psychotherapy Spirituality, Security, Compassion, and Play: Innovative Ways Group Psychotherapy Addresses Human Suffering.
We are surrounded by trauma, grief, pandemics, health care inequality, poverty, climate change, and social injustice, not to mention increases in suicide, depression, and loneliness. How can group therapists address these issues and thrive? The current special edition focuses on how groups foster compassion, provide spiritual healing, and address human suffering in effective and innovative ways. Instead of focusing on symptom reduction alone, group therapists and researchers are exploring ways that group therapy can provide healing and resources to people including health care providers, and those who are on the front lines. The current special edition will highlight how spiritual interventions, compassion and attachment-focused interventions, and group interventions can engender positive outcomes for diverse group members that include parents of inner-city children to first responders. …
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Compassion Focused Therapy for Groups: Transdiagnostic Treatment for Turbulent Times.
The concept of compassion has a centuries-long history as a pillar of philosophical and religious discourse as a response to human suffering. More recently, Paul Gilbert, the founder of Compassion Focused Therapy (CFT) has explained compassion evolutionarily as a willingness to enter human suffering and a commitment to alleviating it. In the face of increased (and increasing) suffering in the world, compassion shows promise as both a societal and an individual intervention. In the following article, we discuss the background and theory of CFT, the empirical evidence for CFT delivered in a group therapy format, and present a standardized protocol. We then present an illustrative clinical vignette and discuss the current clinical and research limitations. We call for continued research to expand our understanding of CFT as well as its potential reach, and conclude by recommending CFT as an…
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Spiritually Integrated Group Psychotherapy for First Responders: Forgiveness, Trauma, and Alcohol Use.
First responders (e.g. firefighters, law enforcement, paramedics, corrections officers) experience high rates of comorbid posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). Despite the relevance of both spirituality and forgiveness to PTSD and AUD among first responders, spiritually integrated group interventions for this population are rare. This article discusses a forgiveness session of a spiritually integrated group psychotherapy protocol for first responders (SPIRIT-FR) in acute psychiatric care. This brief group psychotherapy intervention includes (a) psychoeducation about the intersection of PTSD, AUD, and forgiveness (b) discussion of the relevance of forgiveness to PTSD and AUD, and (c) the integration of spiritual beliefs and behaviors to move toward forgiveness. We discuss relevant clinical theory as well as the potential clinical application of this protocol…
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What contributes to good outcomes? The perspective of young people on short-term psychoanalytic psychotherapy for depressed adolescents.
Depression is the fourth leading cause of adolescent illness and disability worldwide. A growing evidence base demonstrates that Short Term Psychoanalytic Psychotherapy [STPP] is an efficacious treatment for moderate to severe adolescent depression. However, with research in its infancy, key factors contributing to efficacy are unknown. Service users' lived experiences provide valuable insight in this area. This study aimed to elucidate what adolescents value in treatment by inductively exploring lived experiences of STPP. Five adolescents with the largest reduction in depressive symptoms scores between baseline and end of treatment, who had taken part in a large-scale randomized controlled trial, were sampled. In-depth interviews carried out soon after the end of therapy were analysed using Interpretative Phenomenological Analysis. Three superordinate themes were identified: "Therapy as…
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Impact of a 12-Week Group-Based Compassion Focused Therapy Intervention on Heart Rate Variability.
Heart rate variability (HRV) is considered an index of self-regulatory capacity, and trait compassion predicts healthy HRV and self-regulation. Compassion focused psychotherapy interventions have been shown to increase levels of compassion in the general population but no studies to date have examined if these interventions also increase HRV in a distressed clinical sample. The present study examined whether a 12-week compassion focused therapy intervention administered in group format would improve resting HRV and impact HRV reactivity during self-critical writing and self-compassion writing tasks administered before and after the intervention. A total of 31 participants in a university counseling center completed the intervention and HRV assessments. Resting HRV did not significantly change over the course of the intervention in the overall sample. Only those who showed a reliable incr…
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Compassionate Mind Training: An 8-week group for the general public.
Objectives: There is an increasing interest in how compassion training, and in particular, the cultivation of self-compassion may be an important component in the reduction of distress and promotion of well-being. Compassion Focused Therapy (CFT) has shown promising results in this area, with positive outcome studies in a wide range of mental health problems. However, following the successful development of short mindfulness-based programmes (e.g., Mindfulness-based Stress Reduction and Mindfulness-based Cognitive Therapy) and compassion/self-compassion programmes (e.g., Mindful Self-Compassion) that can be accessed by the general public, we were keen to develop and research an 8-week Compassionate Mind Training (CMT) course, based on the CFT model.
Design: Within-subjects pre-to-post-group comparison.
Methods: Following an 8-week CMT groups, participants in the general population (n = 5…
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Predictors of dropout among adolescents with borderline personality disorder attending mentalization-based group treatment.
Background: Premature termination from treatment or dropout is prevalent among patients with borderline personality disorder (BPD). To our knowledge, no studies have examined which factors predisposes dropout from therapy among adolescents with BPD. The current study examined sociodemographic, clinical and psychological predictors of dropout among adolescents who attended a one-year treatment program with mentalization-based group treatment (MBT-G).Methods: Participants were 89 female adolescent patients aged 14-18 years who attended MBT-G in a Danish child and adolescent psychiatric service and 56 matched controls who received non-manualized individual sessions (treatment as usual). Forty (45%) dropped out and 49 (55%) completed treatment in MBT-G. Pretreatment predictors included (1) sociodemographic variables such as age, schooling, relationship status and after-school job, (2) clinic…
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Lo C, Hales S, Chiu A, Panday T, Malfitano C, Jung J, Rydall A, Li M, Nissim R, Zimmermann C, Rodin G (2019)MEDLINE-indexed journal, not yet read by usBMJ supportive & palliative care45 citations Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer.
Background: Managing Cancer And Living Meaningfully (CALM) is a brief individual psychotherapy for patients with advanced cancer. In an intervention-only phase 2a trial, CALM showed promising results, leading to the present 2b pilot, which introduces procedures for randomisation and improved rigour in preparation for a phase 3 randomised controlled trial (RCT).
Aims: To test trial methodology and assess feasibility of a confirmatory RCT.
Design: A parallel-arm RCT (intervention vs usual care) with 3 and 6-month follow-ups. Assessment of feasibility included rates of consent, randomisation, attrition, intervention non-compliance and usual care contamination.
Primary outcome: depressive symptoms (Patient Health Questionnaire-9; PHQ-9).
Secondary outcomes: major depressive disorder (MDD), generalised anxiety, death anxiety, spiritual well-being, attachment anxiety and avoidance, self-esteem…
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The relation between outcome expectation, therapeutic alliance, and outcome among depressed patients in group cognitive-behavioral therapy.
Objective: Although patients' expectation for improvement correlates with their treatment outcome, there remains limited information regarding the mechanisms through which outcome expectation influences outcome. Although several studies have revealed alliance as a mediator of the expectancy-outcome relation, most have focused on individual psychotherapy only. More research is needed examining mediators, including alliance quality, of the outcome expectation-outcome relation in group therapy.
Method: This study focused on such associative chains among 91 depressed outpatients who completed 10 weeks of group cognitive-behavioral therapy. We conducted simple and multiple mediation analyses, accounting for the nested data structure.
Results: As predicted, we found: (i) The relations between baseline outcome expectation and both posttreatment anxiety and depression were mediated by alliance q…
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Emotional change process in resolving self-criticism during experiential treatment of depression.
Objective: This study tested emotion-focused therapy (EFT) theory assumptions concerning optimal emotion schematic processing during experiential psychotherapies. Emotion schematic change was investigated in the particular problem context of resolving self-criticism, an emotion schematic vulnerability to depression identified across all major psychotherapy theories.
Method: The sample was nine highly self-critical depressed clients who received experiential treatment (n = 5 resolved while n = 4 did not resolve their self-criticism by termination). Emotion episodes (EEs) were exhaustively sampled from five sessions across three therapy phases (early, working phase, and termination) for each client. All their EEs across therapy were coded using a process measure called the Classification of Affective-Meaning States. Three complementary analytic procedures were used to examine emotion schem…
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One minute of grief: emotional processing in short-term dynamic psychotherapy for adjustment disorder.
Objective: Depth of emotional processing has shown to be related to outcome across approaches to psychotherapy. Moreover, a specific emotional sequence has been postulated and tested in several studies on experiential psychotherapy (Pascual-Leone & Greenberg, 2007). This process-outcome study aims at reproducing the sequential model of emotional processing in psychodynamic psychotherapy for adjustment disorder and linking these variables with ultimate therapeutic outcome.
Method: In this study, 32 patients underwent short-term dynamic psychotherapy. On the basis of reliable clinical change statistics, a subgroup (n = 16) presented with good outcome and another subgroup (n = 16) had a poor outcome in the end of treatment. The strongest alliance session of each case was rated using the observer-rated system Classification of Affective Meaning States. Reliability coefficients for the measur…
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Effects of dialectical behaviour therapy-mindfulness training on emotional reactivity in borderline personality disorder: preliminary results.
Unlabelled: Emotional dysregulation has been proposed as a hallmark of borderline personality disorder (BPD). Mindfulness techniques taught in dialectical behaviour therapy (DBT) appear to be effective in reducing affective symptoms and may enhance emotion regulation in BPD patients. In the present study, we assessed whether 10 weeks of DBT-mindfulness (DBT-M) training added to general psychiatric management (GPM) could improve emotion regulation in BPD patients. A total of 35 patients with BPD were included and sequentially assigned to GPM (n = 17) or GPM plus DBT-M (n = 18). Participants underwent a negative emotion induction procedure (presentation of standardized unpleasant images) both pre-intervention and post-intervention. Clinical evaluation was also performed before and after treatment. No differences were observed in emotional response at the post-treatment session. However, pa…
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Living through distress: a skills training group for reducing deliberate self-harm.
Background: Dialectical Behaviour Therapy (DBT) is an evidence-based treatment effective in reducing deliberate self-harm. However, DBT is resource and time intensive, and few services are able to sustain a programme faithful to all aspects. Thus, modified or adapted versions of DBT have been developed, particularly for delivery in inpatient hospital settings.
Aims: This study presents a description of the "Living Through Distress" (LTD) Group, which is based on the group skills training component of DBT.
Method: Participants (n = 114) were patients of a psychiatric hospital who attended the LTD group. The main inclusion criterion for the LTD group was a history of deliberate self-harm. The outcome measures were frequency of incidents of deliberate self-harm, levels of distress tolerance, and mean numbers of bed days per year.
Results: Upon completion of the group, there were significant…
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A group therapy approach to treating combat posttraumatic stress disorder: interpersonal reconnection through letter writing.
Many who have served in a war zone carry deep emotional wounds that go beyond the typical symptom clusters of reexperiencing, avoidance/numbing, and hyperarousal that comprise a diagnosis of posttraumatic stress disorder (PTSD). Specifically, many combatants experience unresolved grief, guilt, and shame caused by losses and traumatic experiences suffered in war, called "moral injury" by some clinicians and researchers (e.g., Litz et al., 2009; Shay, 1994). We describe the aspects of human attachment that set the stage for grief, guilt, and shame, and outline the 3-phase group therapy model we have implemented in a clinical setting to foster the reconnection of severed human bonds. Special attention is paid to killing and related phenomena that are unique to combat PTSD. The program phases include psychoeducation, trauma-focused therapy, and aftercare, which focuses on assisting the veter…
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The application of group forgiveness intervention for courtship-hurt college students: a Chinese perspective.
Forgiveness intervention has been shown to be effective in dealing with problems caused by interpersonal hurt. Problems caused by courtship hurt could also be resolved by this approach. This paper describes the theoretical foundations and application of a group forgiveness treatment program which reflected some elements of collectivist Chinese culture positivity for individuals hurt in romantic relationships. Thirty-one female students from a Chinese university were randomly assigned to three groups (forgiveness group, general group, and control group). They completed a Scale of Courtship Forgiveness, the Beck Anxiety Inventory, the Beck Depression Inventory, and the Index of Well-Being & Index of General Affect at entry (baseline), at the end of treatment, and at a four-week follow-up. Compared with the control group, clients both from forgiveness and general groups showed significant i…
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Self-compassion and fear of self-compassion interact to predict response to eating disorders treatment: a preliminary investigation.
Gilbert (2005) proposed that the capacity for self-compassion is integral to overcoming shame and psychopathology. We tested this model among 74 individuals with an eating disorder admitted to specialized treatment. Participants completed measures assessing self-compassion, fear of self-compassion, shame, and eating disorder symptoms at admission and every 3 weeks during treatment. At baseline, lower self-compassion and higher fear of self-compassion were associated with more shame and eating disorder pathology. Multilevel modeling also revealed that patients with combinations of low self-compassion and high fear of self-compassion at baseline had significantly poorer treatment responses, showing no significant change in shame or eating disorder symptoms over 12 weeks. Results highlight a new subset of treatment-resistant eating disorder patients.
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An exploration of group compassion-focused therapy for personality disorder.
Background: People with personality disorders, especially those who also experience high self-criticism and shame, are known to be a therapeutic challenge and there is a high dropout rate from therapy. Compassion-focused therapy (CFT) was designed to address shame and self-criticism specifically, and to develop people's ability to be self-reassuring and more compassionate to themselves and others.
Aims: This study explored how CFT affected self-criticism and self-attacking thoughts, feelings, and behaviours, as well as the general symptoms of anxiety, stress, and depression of a personality disordered group within an outpatient group setting, and evaluated the extent of maintenance at a 1-year follow-up. A secondary objective was to identify some of the key characteristics that such an intervention would require. This was a pilot study exploring the feasibility, acceptability, and potent…
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