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Ernst M, Beutel ME, Zwerenz R, Krakau L. Seeing the past in a new light: change in reports of childhood abuse and neglect before and after inpatient psychotherapy and its relevance for change in depression symptoms. Psychother Res 2023; 33:222-234. [PMID: 35790188 DOI: 10.1080/10503307.2022.2088313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE As changes in mental representations have been discussed as mechanisms of change in psychotherapy, the question arises whether recollections of childhood abuse and neglect are altered as well and how they relate to symptom changes. METHOD Individuals in psychosomatic inpatient treatment (N = 488, 60.5% women) filled out the Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-9). Changes in both were investigated with correlations and t-tests. Linear regression analysis was used to test whether CTQ changes predicted symptom changes. Network analysis was performed to ascertain structural connections between somatic and emotional-cognitive depression symptoms and CTQ subscales before and after treatment. RESULTS After treatment (duration in days: M = 52.83, SD = 20.94), patients reported fewer depression symptoms (d = 0.84), while CTQ scores increased slightly (d = 0.11). Changes in the CTQ predicted recovery from depression symptoms in a statistically significant way (β = .133, p = .001). We did not observe changes in the overall network structure between baseline assessment and discharge. CONCLUSION The findings suggest that the evaluation of past experiences can change over multiple weeks of psychotherapy. Further, these updated mental representations, indicating a greater recognition of past adversity, may contribute to symptom relief.
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Affiliation(s)
- Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lina Krakau
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Jadhakhan F, Evans D, Falla D. Early interventions for post-traumatic stress following musculoskeletal trauma: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e065590. [PMID: 36153010 PMCID: PMC9511568 DOI: 10.1136/bmjopen-2022-065590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Post-traumatic stress symptoms (PTSS) can be triggered following exposure to a traumatic event, such as violence, disasters, serious accidents and injury. Little is known about which interventions provide the greatest benefit for PTSS. This systematic review aims to estimate the effects of early interventions on PTSS following musculoskeletal trauma. METHODS/ANALYSIS Development of this review protocol was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols checklist. This review will include randomised controlled trials and non-randomised controlled studies evaluating the effect of early (within 3 months of a traumatic event) non-pharmacological and non-surgical interventions on PTSS in adults (aged ≥18 years). MEDLINE, PsycINFO, Embase, CINAHL, Zetoc, PROSPERO, Web of Science, PubMed and Google Scholar, as well as key journals/grey literature, will be searched from inception to 31 July 2022. Only articles published in English will be considered. Two independent reviewers will search, screen studies, extract data and assess risk of bias using the Cochrane Risk of Bias tool V.2 (RoB 2) and the Risk Of Bias in Non-randomised Studies of Interventions (ROBINS-I), respectively. Mean difference or standardised mean difference (SMD) will be extracted with accompanying 95% CIs and p values where these are reported. Group effect size will be extracted and reported. Symptoms of PTSS will be ascertained using SMDs (continuous) and diagnosis of PTSS using risk ratio (dichotomous). If possible, study results will be pooled into a meta-analysis. A narrative synthesis of the results will be presented if heterogeneity is high. The overall quality of evidence and risk of bias will be assessed using the Grading of Recommendations Assessment, Development and Evaluation, RoB 2 and ROBINS-I guidelines, respectively. ETHICS AND DISSEMINATION Ethical approval is not required for this systematic review since data from published studies will be used. This review is expected to provide a better understanding of the effect of early intervention for PTSS following musculoskeletal trauma. Findings of this review will be disseminated in peer-reviewed publications and through national and international conferences. PROSPERO REGISTRATION NUMBER CRD42022333905.
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Affiliation(s)
- Ferozkhan Jadhakhan
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - David Evans
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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Leiderman LM, Klein RH. An Integrative Systems-Oriented Interpersonal/Relational Group Approach to Understanding and Treating Mass Trauma, Dissociation and Enactments During the COVID-19 Pandemic. Int J Group Psychother 2022; 72:34-63. [PMID: 38446567 DOI: 10.1080/00207284.2021.1991234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The coronavirus pandemic (COVID-19) is a new ongoing, long-term mass trauma event occurring simultaneously with overwhelming sociopolitical stressors. We propose an integrative, psychodynamic, systems-oriented, interpersonal/relational trauma group model to address the multiple losses, heightened anxieties, and complicated grief that have resulted from the pandemic, as well as various forms of interpersonal abuse associated with racist and oppressive systems. These manifest as dissociation and unconscious enactments in small and large psychotherapy groups. We examine the role and responsibilities of the group leader in working therapeutically with these phenomena. Case examples for large and small psychotherapy groups are provided.
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Markowitz JC, Milrod B, Heckman TG, Bergman M, Amsalem D, Zalman H, Ballas T, Neria Y. Psychotherapy at a Distance. Am J Psychiatry 2021; 178:240-246. [PMID: 32972202 DOI: 10.1176/appi.ajp.2020.20050557] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The 2020 COVID-19 pandemic has abruptly overwhelmed normal life. Beyond the fear and fatality of the virus itself comes a likely wave of psychiatric disorders. Simultaneously, social distancing has changed overnight how psychiatrists and other mental health professionals must treat patients. Telepsychotherapy, until now a promising but niche treatment, has suddenly become treatment as usual. This article briefly reviews the limited clinical evidence supporting different modes of telepsychotherapy, then focuses on how remote therapy affects clinicians and their patients.
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Affiliation(s)
- John C Markowitz
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Markowitz, Neria); New York State Psychiatric Institute, New York (Markowitz, Bergman, Amsalem, Zalman, Neria); Department of Psychiatry, Weill Cornell Medical College, New York (Milrod); College of Public Health, University of Georgia, Athens (Heckman); School of Psychology, Fairleigh Dickinson University, Teaneck, N.J. (Ballas)
| | - Barbara Milrod
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Markowitz, Neria); New York State Psychiatric Institute, New York (Markowitz, Bergman, Amsalem, Zalman, Neria); Department of Psychiatry, Weill Cornell Medical College, New York (Milrod); College of Public Health, University of Georgia, Athens (Heckman); School of Psychology, Fairleigh Dickinson University, Teaneck, N.J. (Ballas)
| | - Timothy G Heckman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Markowitz, Neria); New York State Psychiatric Institute, New York (Markowitz, Bergman, Amsalem, Zalman, Neria); Department of Psychiatry, Weill Cornell Medical College, New York (Milrod); College of Public Health, University of Georgia, Athens (Heckman); School of Psychology, Fairleigh Dickinson University, Teaneck, N.J. (Ballas)
| | - Maja Bergman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Markowitz, Neria); New York State Psychiatric Institute, New York (Markowitz, Bergman, Amsalem, Zalman, Neria); Department of Psychiatry, Weill Cornell Medical College, New York (Milrod); College of Public Health, University of Georgia, Athens (Heckman); School of Psychology, Fairleigh Dickinson University, Teaneck, N.J. (Ballas)
| | - Doron Amsalem
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Markowitz, Neria); New York State Psychiatric Institute, New York (Markowitz, Bergman, Amsalem, Zalman, Neria); Department of Psychiatry, Weill Cornell Medical College, New York (Milrod); College of Public Health, University of Georgia, Athens (Heckman); School of Psychology, Fairleigh Dickinson University, Teaneck, N.J. (Ballas)
| | - Hemrie Zalman
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Markowitz, Neria); New York State Psychiatric Institute, New York (Markowitz, Bergman, Amsalem, Zalman, Neria); Department of Psychiatry, Weill Cornell Medical College, New York (Milrod); College of Public Health, University of Georgia, Athens (Heckman); School of Psychology, Fairleigh Dickinson University, Teaneck, N.J. (Ballas)
| | - Thomas Ballas
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Markowitz, Neria); New York State Psychiatric Institute, New York (Markowitz, Bergman, Amsalem, Zalman, Neria); Department of Psychiatry, Weill Cornell Medical College, New York (Milrod); College of Public Health, University of Georgia, Athens (Heckman); School of Psychology, Fairleigh Dickinson University, Teaneck, N.J. (Ballas)
| | - Yuval Neria
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York (Markowitz, Neria); New York State Psychiatric Institute, New York (Markowitz, Bergman, Amsalem, Zalman, Neria); Department of Psychiatry, Weill Cornell Medical College, New York (Milrod); College of Public Health, University of Georgia, Athens (Heckman); School of Psychology, Fairleigh Dickinson University, Teaneck, N.J. (Ballas)
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Fontanesi L, Marchetti D, Limoncin E, Rossi R, Nimbi FM, Mollaioli D, Sansone A, Colonnello E, Simonelli C, Di Lorenzo G, Jannini EA, Ciocca G. Hypersexuality and Trauma: a mediation and moderation model from psychopathology to problematic sexual behavior. J Affect Disord 2021; 281:631-637. [PMID: 33229025 DOI: 10.1016/j.jad.2020.11.100] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION . Hypersexuality is a clinical condition regarding the psychopathology of sexual behavior. In this study, we aimed to investigate the role of trauma, through the post-traumatic stress-disorder (PTSD), depression, shame and guilt on the hypersexual behavior. METHODS . Through an online platform, a convenience sample of 1025 subjects was recruited (females: n=731; 71.3%; males: 294; 28.7%; age: 29.62±10.90). Recruited subjects compiled a psychometric protocol composed by the Hypersexual Behavior Inventory (HBI) to assess hypersexuality, the International Trauma Questionnaire (ITQ) for PTSD, the Patient Health Questionnaire (PHQ-9) to evaluate depression and the State Shame and Guilt Scale (SSGS) for shame and guilt. Then a mediation/moderation model was performed for the data analysis. RESULTS . There was a statistically significant direct effect of post-traumatic symptoms (ITQTotal) on hypersexual behavior (HBTotal). Furthermore, indirect effects were also statistically significant, providing support to the hypothesis that depression and guilt would be serial mediators of trauma-hypersexual behavior relations. The paths through depression and guilt have been found to be the most significant with moderate and high indirect effects on hypersexuality. Moreover, male gender, as covariate variable, is a relevant risk factor for hypersexual behavior. CONCLUSION . We found the relationship between hypersexuality and trauma describing a possible etiological pathway mainly involving depression, shame and guilt. Hypersexuality can be considered as a reactive form of a major affective psychopathology representing a tip of the iceberg hiding the real issues of a suffering personality. Clinicians and researchers should therefore consider hypersexual behavior in the light of a symptomatic manifestation of a major psychopathology involving the affective aspects of personality.
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Affiliation(s)
- Lilybeth Fontanesi
- Department of Psychological, Health and Territorial Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Daniela Marchetti
- Department of Psychological, Health and Territorial Sciences, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Erika Limoncin
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rodolfo Rossi
- Chair of Psychiatry Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Filippo M Nimbi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Daniele Mollaioli
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Sansone
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elena Colonnello
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Chiara Simonelli
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy
| | - Giorgio Di Lorenzo
- Chair of Psychiatry Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emmanuele A Jannini
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giacomo Ciocca
- Chair of Endocrinology & Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy.
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