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Kindermann D, Rollmann I, Orth M, Friederich HC, Nikendei C. Direct and indirect effects of adverse and protective childhood experiences on symptom improvement in psychotherapy. Psychother Res 2024; 34:774-789. [PMID: 37706484 DOI: 10.1080/10503307.2023.2254917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/29/2023] [Indexed: 09/15/2023] Open
Abstract
To investigate the effects of adverse and protective childhood experiences on symptom improvement in outpatient psychotherapy. We evaluated n = 648 completed outpatient psychodynamic psychotherapies. First, we estimated the rate of symptom improvement for each patient using a two-stage hierarchical linear model. We then calculated the direct and indirect influences of childhood experiences on the improvement rate using a structural equation model. Personality functioning, according to the Operationalized Psychodynamic Diagnosis system, was examined as being a possible mediating factor. The presence of adverse childhood experiences was directly associated with a slower improvement rate in psychotherapy. Moreover, a higher number of adverse childhood experiences was associated with greater impairments in the ability to communicate as one dimension of personality functioning, which in turn was associated with a slower improvement of symptoms. Protective childhood experiences were associated with fewer impairments in specific dimensions of personality functioning, but had no direct effect on the improvement rate. Adverse childhood experiences can directly influence the course of psychotherapy. In addition, the communication dimension of personality functioning appears to be a central mediator on which adverse and protective childhood experiences act antagonistically and can thus indirectly affect the improvement rate in psychotherapy.
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Affiliation(s)
- David Kindermann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Ivo Rollmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Orth
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Nowak J, Nikendei C, Rollmann I, Orth M, Friederich HC, Kindermann D. Examining childhood experiences and personality functioning as potential predictors for the speed of recovery during psychotherapy of patients with anxiety disorders. Front Psychiatry 2024; 15:1381105. [PMID: 38784161 PMCID: PMC11112343 DOI: 10.3389/fpsyt.2024.1381105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
Background Adverse childhood experiences were previously identified as relevant risk factors for the development of anxiety disorders. Furthermore, anxiety disorders were shown to be associated with impairments of personality functioning. The objective of this study was to investigate adverse and protective childhood experiences as well as personality functioning, as defined by the Operationalized Psychodynamic Diagnosis system, as potential predictors for the speed of recovery during psychotherapy for patients with anxiety disorders. Methods The sample consisted of n = 312 completed psychotherapies. The speed of recovery, defined as symptom abatement over time, was calculated using a two-stage hierarchical linear model. The effects of adverse and protective childhood experiences as well as personality functioning on the speed of recovery during psychotherapy were then examined using a structural equation model. Results The presence of adverse childhood experiences predicted a lower speed of recovery during psychotherapy. In addition, a higher number of adverse childhood experiences was associated with greater impairments in the abilities of perception and regulation as dimensions of personality functioning. A higher number of protective childhood experiences was associated with fewer impairments in the communication and attachment dimensions. Impairments in personality functioning in patients with anxiety disorders did not predict the speed of recovery during psychotherapy. Conclusions Among patients with anxiety disorders, adverse childhood experiences lead to a lower speed of recovery during psychotherapy. Therefore, childhood adversity should be routinely assessed before and thoroughly addressed during psychotherapy in patients with anxiety disorders.
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Affiliation(s)
- Jonathan Nowak
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
- DZPG (German Centre for Mental Health – Partner Site Heidelberg/Mannheim/Ulm), Heidelberg, Germany
| | - Christoph Nikendei
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
- DZPG (German Centre for Mental Health – Partner Site Heidelberg/Mannheim/Ulm), Heidelberg, Germany
| | - Ivo Rollmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Maximilian Orth
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
- DZPG (German Centre for Mental Health – Partner Site Heidelberg/Mannheim/Ulm), Heidelberg, Germany
| | - David Kindermann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
- DZPG (German Centre for Mental Health – Partner Site Heidelberg/Mannheim/Ulm), Heidelberg, Germany
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Kaisler RE, Fede M, Diltsch U, Probst T, Schaffler Y. Common mental disorders in Gestalt therapy treatment: a multiple case study comparing patients with moderate and low integrated personality structures. Front Psychol 2023; 14:1304726. [PMID: 38173855 PMCID: PMC10761483 DOI: 10.3389/fpsyg.2023.1304726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Empowerment is central to self-development and growth in Gestalt therapy. The self evolves through interactions with others, forming self- and object-relations, and ego-functions. Underlying structural functions build the ability to regulate, differentiate, and integrate experiences, leading to self-, and emotion-regulation. Our study examined the self-development of seven clients with prevalent mental health issues and structural challenges, all of whom underwent 30 sessions of Gestalt therapy in a real-world individual therapy context. Methods Using a multiple case study approach, we contrasted two client groups: those with moderately integrated and those with low-integrated personality structures, as defined by the operationalised psychodynamic diagnostic manual. Our exploration centered on specific factors of empowerment, therapy processes, and interventions. The study's mixed-method design encompassed quantitative outcome measures (empowerment, wellbeing, psychosocial health, and severity of personality functioning), therapy diaries from both clients and therapists, and semi-structured client interviews about empowering factors in therapy. Results Both groups showed positive therapy outcomes on wellbeing, psychosocial health, and empowerment. Specific empowerment-related factors included promoting experiences, relationships, and self-efficacy in the low-integrated group. Support of self-regulation was reported to be essential for successful outcomes in the moderately integrated group. While the therapy processes proceeded similarly in both groups, we observed a strong focus on body awareness-oriented interventions and promotion of verbalisation in the low-integrated group and a relationship-oriented emphasis in the moderately integrated group. Emotional experience linked to positive experience was limited in the low-integrated group, suggesting an impairment of emotional processing, including bodily felt feelings. No change was reported in the level of personality functioning after 30 sessions in both groups. Discussion These results underscore the need for tailored therapeutic approaches based on the client's level of personality integration. Future research should probe the long-term effects of therapy and delve deeper into shifts in personality functioning, especially concerning emotional and bodily experiences. In practical terms, therapists should prioritize linking bodily sensations with emotions for clients with low-integrated personalities. For those with moderate integration, the emphasis should be on fostering exploration, awareness, and bolstering self-regulation.
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Affiliation(s)
- Raphaela E. Kaisler
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
- Department Psychotherapy, Bertha von Suttner Private University St. Pölten, St. Pölten, Austria
| | - Manfred Fede
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
| | - Ulla Diltsch
- Integrative Gestalttherapie, Österreichischer Arbeitskreis für Gruppentherapie und Gruppendynamik, Vienna, Austria
| | - Thomas Probst
- Division of Psychotherapy, Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Yvonne Schaffler
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
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4
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Nowak J, Nikendei C, Rollmann I, Orth M, Friederich HC, Kindermann D. Characterization of different types of anxiety disorders in relation to structural integration of personality and adverse and protective childhood experiences in psychotherapy outpatients - a cross-sectional study. BMC Psychiatry 2023; 23:501. [PMID: 37438712 DOI: 10.1186/s12888-023-04988-2] [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] [Received: 03/19/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Current research has emphasized the role of structural integration of personality and childhood experiences for the understanding of anxiety disorders. In this study, we examined the relationship between anxiety disorders (generalized anxiety disorder vs. panic disorder vs. phobic disorders), the level of structural integration of personality, and negative and protective childhood experiences at the beginning of outpatient psychodynamic psychotherapy treatment. Differences were characterized in comparison to patients with no anxiety disorders. METHODS The sample included a total of 1646 outpatient psychodynamic psychotherapy treatments, of which 695 treatments included the diagnosis of at least one anxiety disorder. Levels of structural integration of personality were assessed according to the Operationalized Psychodynamic Diagnosis (OPD-2) system. Self-reported negative and protective childhood experiences were examined by using the Questionnaire for the Assessment of Adverse and Protective Childhood Experiences (APC). Associations were tested using single factor ANOVAs. RESULTS Patients with anxiety disorders showed lower levels of structural integration of personality and reported more adverse childhood experiences than patients with no anxiety disorders. Regarding the subscales of structural integration of personality, phobic disorders were associated with impaired external communication, whereas for generalized anxiety disorder, an (uncorrected) association with impaired self-regulation was found. Also, generalized anxiety disorder was associated with sexual abuse and other traumatization (accidents etc.) during childhood, while panic disorder and phobic disorders were associated with emotional neglect, abuse, and fewer protective childhood experiences. CONCLUSIONS Our findings emphasize the need of considering structural integration of personality and childhood experiences in order to understand and treat various types of anxiety disorders.
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Affiliation(s)
- Jonathan Nowak
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany.
| | - Christoph Nikendei
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Ivo Rollmann
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Maximilian Orth
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
| | - David Kindermann
- Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Thibautstraße 4, 69115, Heidelberg, Germany
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Vierl L, Juen F, Benecke C, Hörz-Sagstetter S. Exploring the associations between psychodynamic constructs and psychopathology: A network approach. Personal Ment Health 2023; 17:40-54. [PMID: 35879050 DOI: 10.1002/pmh.1559] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/03/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022]
Abstract
Psychodynamic therapy effectively reduces symptomatology by focusing on underlying (unconscious) processes instead of symptoms. Nevertheless, the exact interrelationship between psychodynamic constructs and psychopathology remains unclear. This study uses network analysis to explore these associations. We computed a cross-sectional partial correlation network between psychodynamic constructs (i.e., personality functioning, interpersonal relations, and active and passive modes of intrapsychic conflicts according to the Operationalized Psychodynamic Diagnostics [OPD] system) and psychopathology (i.e., depression and somatization) in a naturalistic sample of 341 adults registering for psychodynamic outpatient therapy. We estimated node centrality, node predictability, and bridge symptoms and used community detection analysis. Bootstrap methods were applied to assess network stability. Psychodynamic constructs and psychopathology resulted in separate but connected clusters. Personality functioning emerged as the most influential node in the network and was bridging the clusters. The network was found to be highly stable, allowing reliable interpretations. The results offer important insights on how psychodynamic constructs relate to psychopathology, which can be used to inform treatment approaches. The findings suggest that personality functioning may be an important intervention target. However, future research is needed to include a broader range of diagnoses. In addition, longitudinal studies may clarify the direction of causality.
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Affiliation(s)
- Larissa Vierl
- Akademie für Psychoanalyse und Psychotherapie München e.V., Munich, Germany.,Department of Psychology, University of Kassel, Kassel, Germany
| | - Florian Juen
- Akademie für Psychoanalyse und Psychotherapie München e.V., Munich, Germany.,Department of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Cord Benecke
- Department of Psychology, University of Kassel, Kassel, Germany
| | - Susanne Hörz-Sagstetter
- Akademie für Psychoanalyse und Psychotherapie München e.V., Munich, Germany.,Psychologische Hochschule Berlin, Berlin, Germany
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6
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Haller K, Fritzsche S, Kruse I, O’Malley G, Ehrenthal JC, Stamm T. Associations Between Personality Functioning, Childhood Trauma and Non-adherence in Cardiovascular Disease: A Psychodynamically-Informed Cross-Sectional Study. Front Psychol 2022; 13:913081. [PMID: 35814056 PMCID: PMC9260657 DOI: 10.3389/fpsyg.2022.913081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveAlthough treatment adherence and lifestyle changes significantly improve the prognosis of cardiovascular disease, many patients do not comply with clinician recommendations. Personality functioning appears to be of importance and is hypothesized to be superior to symptom-based measures in explaining individual differences in non-adherence.Methods194 cardiology inpatients (mean age = 70.6 years, 60% male) were assessed using self-report measures in a cross-sectional design. Patients were assessed using the short version of the Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS) to measure personality functioning, as well as the Childhood Trauma Screener (CTS), the Patient Health Questionnaire (PHQ-9) for symptoms of depression, and the Generalized Anxiety Disorder Scale-7 (GAD-7). To assess non-adherence we introduced a brief, novel scale.ResultsNon-adherence correlated significant with personality functioning (r = 0.325), childhood trauma (r = 0.204) and depressiveness (r = 0.225). In a stepwise multiple regression analysis with socio-demographic variables inputted into the model, higher deficits in personality functioning, higher levels of childhood trauma, and male gender were associated with non-adherence (adjusted R2 = 0.149, F(3,190) = 12.225, p < 0.01). Level of depressive symptoms, anxiety, age, education, and income showed no significant additional predictive value and were excluded from the model.ConclusionIn cardiovascular disease, personality functioning, childhood trauma and male gender are associated with non-adherence and appear to be more important than symptom reports of depression and anxiety. This highlights the relevance of basic impairments in intra- and interpersonal functioning in chronic disease, where the patient’s adherence is central.
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Affiliation(s)
- Karl Haller
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Department of Hematology, Oncology, and Tumor Immunology, Charité – University Medicine Berlin, Berlin, Germany
- *Correspondence: Karl Haller, ,
| | | | - Irina Kruse
- Cardiology Department, Schlosspark-Klinik, Berlin, Germany
| | - Grace O’Malley
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Department of Pediatrics, Division of Oncology and Hematology, Charité – University Medicine Berlin, Berlin, Germany
| | | | - Thomas Stamm
- Department of Psychology, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Schloss Luetgenhof Hospital, Centre for Personal Medicine, Psychosomatics and Psychotherapy, Dassow, Germany
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7
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Dagnino P, Calderón A. Tracking Psychodynamic Foci: Trajectories Through the Therapeutic Process. Front Psychol 2022; 13:786240. [PMID: 35734465 PMCID: PMC9207400 DOI: 10.3389/fpsyg.2022.786240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Brief psychodynamic psychotherapy has gained importance in current clinical practice. To achieve brevity, a focus must be established and worked through. Different conceptualizations have emphasized the relational patterns and/or conflict foci as central but adopting a mono-schematic approach. However, patients come to treatment with more than one issue that must be addressed. Thus, another focus must be included because of its relevance, i.e., personality functioning. The aims of this study were to identify the presence and depth level of three foci (relational pattern, conflict, and personality functioning) in episodes of change throughout the process, and to evaluate the relationship of each focus with the complexity of patients' change. Initial OPD foci and the presence and depth of each were evaluated in 13 successful brief psychodynamic therapies. Change episodes of those therapies were analyzed as well. Results showed differences between foci in the initial phase with a higher presence of conflict focus. Throughout the process, only the presence and level of personality functioning improved. Also, complexity of patients' change was related to conflict focus, specifically on the emergence of competence feelings. The results provide evidence and enrich process research of brief psychodynamic therapies.
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Affiliation(s)
- Paula Dagnino
- Facultad de Psicología, Universidad San Sebastián, Santiago, Chile
- Millennium Institute for the Study of Personality and Depression, Santiago, Chile
| | - Ana Calderón
- Escuela de Ciencias Sociales y Humanidades, Carrera de Psicología, Universidad Gabriela Mistral, Santiago, Chile
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8
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Hettich N, Beutel ME, Ernst M, Schliessler C, Kampling H, Kruse J, Braehler E. Conspiracy endorsement and its associations with personality functioning, anxiety, loneliness, and sociodemographic characteristics during the COVID-19 pandemic in a representative sample of the German population. PLoS One 2022; 17:e0263301. [PMID: 35089987 PMCID: PMC8797225 DOI: 10.1371/journal.pone.0263301] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In the context of the COVID-19 pandemic, many individuals have been found to endorse conspiracy beliefs. Socio-demographic variables, personality functioning, anxiety, and loneliness could be risk factors for this endorsement. METHODS In a representative sample of the German population (N = 2,503) measures of conspiracy mentality, conspiracy-related beliefs toward COVID-19, personality functioning (OPD-SQS), anxiety (HADS), and loneliness (UCLA) were assessed. Pearson product-moment correlations and multiple linear regression analyses were conducted. RESULTS Conspiracy mentality and conspiracy-related beliefs toward COVID-19 were strongly correlated. Regression analyses found younger age, male gender, lower education, and lower income to be associated with conspiracy mentality. The subscales relationship model and self-perception of the OPD-SQS were positively related to conspiracy mentality whereas interpersonal contact was negatively associated. Higher levels of anxiety were statistically predictive for conspiracy mentality. CONCLUSION Our findings indicate a contribution of personality functioning to the understanding of conspiracy mentality and thus to the advancement of interventions during the pandemic.
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Affiliation(s)
- Nora Hettich
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manfred E. Beutel
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mareike Ernst
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Clara Schliessler
- Else-Frenkel-Brunswik-Institute for Democracy Research, University of Leipzig, Leipzig, Germany
| | - Hanna Kampling
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Justus-Liebig University Giessen, Giessen, Germany
| | - Johannes Kruse
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Justus-Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
| | - Elmar Braehler
- Department for Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Else-Frenkel-Brunswik-Institute for Democracy Research, University of Leipzig, Leipzig, Germany
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9
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Maaßen E, Büttner M, Bröcker AL, Stuke F, Bayer S, Hadzibegovic J, Just SA, Bertram G, Rau R, von Haebler D, Lempa G, Montag C. Measuring Emotional Awareness in Patients With Schizophrenia and Schizoaffective Disorders. Front Psychol 2021; 12:725787. [PMID: 34858263 PMCID: PMC8632138 DOI: 10.3389/fpsyg.2021.725787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
The ability to mentalize (i.e., to form representations of mental states and processes of oneself and others) is often impaired in people with schizophrenia spectrum disorders. Emotional awareness (EA) represents one aspect of affective mentalizing and can be assessed with the Levels of Emotional Awareness Scale (LEAS), but findings regarding individuals with schizophrenia spectrum disorders are inconsistent. The present study aimed at examining the usability and convergent validity of the LEAS in a sample of N = 130 stabilized outpatients with schizophrenia or schizoaffective disorders. An adequacy rating was added to the conventional LEAS rating to account for distortions of content due to, for example, delusional thinking. Scores of the patient group were compared with those of a matched healthy control sample. Correlation with symptom clusters, a self-report measure of EA, a measure of synthetic metacognition (MAS-A-G), and an expert rating capturing EA from the psychodynamic perspective of psychic structure (OPD-LSIA) were examined. Regarding self-related emotional awareness, patients did not score lower than controls neither in terms of conventional LEAS nor in terms of adequacy. Regarding other-related emotional awareness, however, patients showed a reduced level of adequacy compared to controls whereas no such difference was found for conventional LEAS scores. Higher conventional LEAS scores were associated with fewer negative symptoms, and higher structural integration of self-perceptions measured by the OPD-LSIA. Higher adequacy of responses correlated with fewer symptoms of disorganization as well as excitement, higher scores of self-reflection on the MAS-A-G as well as self- and object-perception and internal and external communication as measured by the subscales of the OPD-LSIA. Findings suggest that the LEAS might not be sensitive enough to detect differences between mildly symptomatic patients with schizophrenia or schizoaffective disorders and healthy controls. However, LEAS ratings are still suitable to track intraindividual changes in EA over time. Observing the adequacy of patients’ responses when using the LEAS may be a promising way to increase diagnostical utility and to identify patterns of formal and content-related alterations of mentalizing in this patient group. Methodological indications for future studies are discussed.
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Affiliation(s)
- Eva Maaßen
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marielle Büttner
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna-Lena Bröcker
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frauke Stuke
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Samuel Bayer
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Psychoanalytic University Berlin, Berlin, Germany
| | - Jasmina Hadzibegovic
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sandra Anna Just
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gianna Bertram
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Richard Rau
- Department of Psychology, University of Münster, Münster, Germany
| | - Dorothea von Haebler
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Psychoanalytic University Berlin, Berlin, Germany
| | | | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Psychiatric University Clinic at St. Hedwig Hospital, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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10
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Rosén T, Hau S. Operationalized psychodynamic diagnosis in childhood and adolescence (OPD-CA-2)—A useful tool for improving diagnoses of psychological illnesses. NORDIC PSYCHOLOGY 2021. [DOI: 10.1080/19012276.2021.2001677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Stephan Hau
- Department of Psychology, Stockholm University, Stockholm, Sweden
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11
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Bagattini N. Psychic structure, unconscious conflict and adolescent psychopathology: The contributions of OPD-CA–2. NORDIC PSYCHOLOGY 2021. [DOI: 10.1080/19012276.2021.2001680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Nicolás Bagattini
- Clinical Research Department – Uno, Mental Health Institute, Psychology PhD Program- The Catholic University, Montevideo, Uruguay
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12
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Hörz-Sagstetter S, Ohse L, Kampe L. Three Dimensional Approaches to Personality Disorders: a Review on Personality Functioning, Personality Structure, and Personality Organization. Curr Psychiatry Rep 2021; 23:45. [PMID: 34181116 PMCID: PMC8238706 DOI: 10.1007/s11920-021-01250-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The concept of personality functioning (Alternative DSM-5 Model of Personality Disorders) has led to increased interest in dimensional personality disorder diagnosis. While differing markedly from the current categorical classification, it is closely related to the psychodynamic concepts of personality structure and personality organization. In this review, the three dimensional approaches, their underlying models, and common instruments are introduced, and empirical studies on similarities and differences between the concepts and the categorical classification are summarized. Additionally, a case example illustrates the clinical application. RECENT FINDINGS Numerous studies demonstrate the broad empirical basis, validated assessment instruments and clinical usefulness of the dimensional concepts. Their advantages compared to the categorical approach, but also the respective differences, have been demonstrated empirically, in line with clinical observations. Evidence supports the three dimensional concepts, which share conceptual overlap, but also entail unique aspects of personality pathology, respectively.
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Affiliation(s)
| | - Ludwig Ohse
- Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Germany
| | - Leonie Kampe
- Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Germany
- Zentrum für Psychosoziale Medizin, Klinikum Itzehoe, Germany
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Luyten P, Fonagy P. Integrating and differentiating personality and psychopathology: A psychodynamic perspective. J Pers 2021; 90:75-88. [PMID: 34170512 DOI: 10.1111/jopy.12656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/18/2023]
Abstract
Several strands of research converge to suggest that personality and psychopathology can be integrated in the form of a hierarchical model of individual differences. The notion that personality and psychopathology are intrinsically linked has a long tradition within psychodynamic approaches. In this article, we first summarize empirical evidence supporting two related key assumptions of psychodynamic approaches to personality and psychology: that a developmental, person-centered approach is needed to complement a static, disorder-centered approach in the conceptualization and treatment of psychopathology; and that personality and psychopathology are best conceptualized as dynamic attempts at adaptation. Research in each of these areas supports the notion that personality and psychopathology are difficult to separate and may be moderated by severity (i.e., general psychopathology) such that increasing levels of severity result in increased intrinsic coupling between the two. We then discuss these findings in the context of a newly emerging social-communicative approach to human development that suggests that personality and psychopathology are better conceptualized in terms of a disorder of social communication, and that the purported rigidity and stability typically attributed to them are largely explained by the stability of the environmental mechanisms that underpin them, rather than by stable intrapersonal traits. The implications of these new views for the future of the science of personality and psychopathology, and for treatment strategies, are discussed.
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Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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14
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Koops TU, Wiessner C, Ehrenthal JC, Briken P. Assessing Psychodynamic Conflicts and Level of Personality Functioning in Women Diagnosed With Vaginismus and Dyspareunia. Front Psychol 2021; 12:687369. [PMID: 34248792 PMCID: PMC8264788 DOI: 10.3389/fpsyg.2021.687369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/31/2021] [Indexed: 01/30/2023] Open
Abstract
Knowledge on etiological and risk factors of genito-pelvic pain/penetration disorder, formerly classified as dyspareunia and vaginismus, is limited. The Operationalized Psychodynamic Diagnosis (OPD) system offers a valuable basis for developmental considerations, and has not yet been used to research sexual pain difficulties in women. We conducted an exploratory pilot study of psychodynamic motivational conflicts and level of personality functioning as defined by the OPD system by means of an anonymous online survey among 24 women who had been diagnosed with dyspareunia or vaginismus. We matched them with 24 healthy controls and compared groups using paired-samples t-tests and Wilcoxon tests. Effect sizes were calculated using Pearson's r. Large effect sizes were found for mean or median differences of several OPD Structure Questionnaire (OPD-SQ) scales (self-reflection, p = 0.002/r = 0.59; affect differentiation, p = 0.007/r = 0.53; self-perception, p = 0.002/r = 0.58; impulse control, p = 0.007/r = 0.53; self-worth regulation, p = 0.008/r = 0.52; self-regulation, p = 0.004/r = 0.56; experiencing affect, p = 0.009/r = 0.53; bodily self, p = 0.008/r = 0.54; OPD-SQ total score, p = 0.007/r = 0.52; internal communication, p = 0.001/r = 0.63) and OPD Conflict Questionnaire (OPD-CQ) scales (guilt conflict active, p = 0.004/r = 0.60; Oedipal conflict passive, p = 0.009/r = 0.51; individuation versus dependency conflict active, p = 0.01/r = 0.52; guilt conflict passive, p < 0.001/r = 0.70; self-worth conflict passive, p = 0.001/r = 0.70; passive mode, p < 0.001/r = 0.68). The problems with personality functioning and more pronounced types of conflicts participants displayed suggest proneness for self-invalidation, internalization and restricted self-perception.
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Affiliation(s)
- Thula U Koops
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Wiessner
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Obbarius A, Ehrenthal JC, Fischer F, Liegl G, Obbarius N, Sarrar L, Rose M. Applying Item Response Theory to the OPD Structure Questionnaire: Identification of a Unidimensional Core Construct and Feasibility of Computer Adaptive Testing. J Pers Assess 2020; 103:645-658. [PMID: 33052064 DOI: 10.1080/00223891.2020.1828435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Recent developments in the dimensional assessment of personality functioning have made the implementation of latent measurement models increasingly attractive. In this study, we applied item response theory (IRT) to a well-established personality functioning instrument (the OPD Structure Questionnaire) to identify a unidimensional latent trait and to evaluate the feasibility of computer adaptive testing (CAT). We hypothesized that the use of IRT could reduce the test burden - compared to a fixed short form - while maintaining high precision over a wide range of the latent trait. The OPD-SQ was collected from 1235 patients in a psychosomatic clinic. IRT assumptions were fulfilled. A 9-factor model yielded sufficient fit and unidimensionality in exploratory factor analysis with bifactor rotation. Items were iteratively reduced, and a graded-response IRT model was fitted to the data. Simulations showed that a CAT with approximately 7 items was able to capture an OPD-SQ global severity score with an accuracy similar to that of a fixed 12-item short form. The final item bank and CAT yielded satisfactory content validity. Strong correlations with depression and anxiety replicated previous results on the OPD-SQ. We concluded that IRT applications could be useful to reduce the test burden of personality functioning instruments.
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Affiliation(s)
- Alexander Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Dornsife Center for Self-Report Science, University of Southern California, Los Angeles, California
| | - Johannes C Ehrenthal
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Fischer
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gregor Liegl
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Nina Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lea Sarrar
- Department of Psychology, Medical School Berlin, Berlin, Germany.,Department of Audiology and Phoniatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Quantitative Health Sciences, Medical School, University of Massachusetts, Amherst, Massachusetts
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Wagner-Skacel J, Bengesser S, Dalkner N, Mörkl S, Painold A, Hamm C, Pilz R, Rieger A, Kapfhammer HP, Hiebler-Ragger M, Jauk E, Butler MI, Reininghaus EZ. Personality Structure and Attachment in Bipolar Disorder. Front Psychiatry 2020; 11:410. [PMID: 32477186 PMCID: PMC7233168 DOI: 10.3389/fpsyt.2020.00410] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 04/22/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND An impairment of self and interpersonal functioning has an impact on coping strategies, regulation of affect and stress. Little is known so far about the impairment of personality functioning in patients with bipolar disorder (BD). The aim of this study is to assess the effects of personality structure and attachment in BD patients on the symptom burden. METHODS Forty-six patients with the diagnosis of BD were assessed by the 12-item Operationalized Psychodynamic Diagnosis Structure Questionnaire (OPD-SQS), the short version of Experience in Close Relationship-revised (ECR-R-D), and the Brief Symptom Inventory-18 (BSI 18) to determine the level of personality functioning, attachment patterns, and symptom load. RESULTS We observed positive correlations between personality difficulties, insecure attachment, and symptom load in patients with BD. A low level of structural integration and an insecure attachment style in patients with BD were accompanied by a significantly higher symptom load (r = 0.66, p ≤ 0.01). Interestingly, there were no significant differences in the structural integration (T(1.44) = -0.93, p = 0.357) and in the attachment style attachment related avoidance: (T(1,44) = 1.50, p = 0.140); attachment related anxiety (T(1,44) = -0.781, p = 0.439) of study participants with BD when compared to the normative value of the general population. LIMITATIONS Our limitations are the small sample size of our group and the lack of a control group. CONCLUSION In general, our results suggest that there is a link between personality structure and affective dynamics including depressive, anxiety, and somatization symptoms in BD. These findings underline the increasing importance of assessing personality structure and attachment for diagnosis and treatment planning of BD.
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Affiliation(s)
- Jolana Wagner-Skacel
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
- Department of Medical Psychology and Psychotherapy, MUG, Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Annamaria Painold
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Carlo Hamm
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - René Pilz
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Alexandra Rieger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
| | - Michaela Hiebler-Ragger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
- Gruener Kreis Society, Center for Integrative Addiction Research, Johnsdorf, Austria
| | - Emanuel Jauk
- Institute of Psychology, University of Graz, Graz, Austria
- Clinical Psychology and Behavioral Neuroscience, Technische Universität Dresden, Dresden, Germany
| | - Mary I. Butler
- Department for Psychiatry and Neurobehavioral Science, University College Cork, Cork, Ireland
| | - Eva Z. Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz (MUG), Graz, Austria
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Bröcker AL, Bayer S, Stuke F, Just S, Bertram G, Funcke J, Grimm I, Lempa G, von Haebler D, Montag C. Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach. Front Psychol 2020; 11:269. [PMID: 32153475 PMCID: PMC7047329 DOI: 10.3389/fpsyg.2020.00269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/04/2020] [Indexed: 12/12/2022] Open
Abstract
Synthetic metacognition is defined by integrative and contextualizing processes of discrete reflexive moments. These processes are supposed to be needed to meet intrapsychic as well as interpersonal challenges and to meaningfully include psychotic experience in a personal life narrative. A substantial body of evidence has linked this phenomenon to psychosocial functioning and treatment options were developed. The concept of synthetic metacognition, measured with the Metacognition Assessment Scale-Abbreviated (MAS-A), rises hope to bridge gaps between therapeutic orientations and shares valuable parallels to modern psychodynamic constructs, especially the 'levels of structural integration' of the Operationalized Psychodynamic Diagnosis (OPD-2). As theoretical distinctions remain, aim of this study was to compare the predictive value of both constructs with regard to psychosocial functioning of patients with non-affective psychoses, measured with the International Classification of Functioning, Disability and Health (MINI-ICF-APP). It was further explored if levels of structural integration (OPD-LSIA) would mediate the impact of metacognition (MAS-A) on function (MINI-ICF-APP). Expert ratings of synthetic metacognition (MAS-A), the OPD-2 'levels of structural integration' axis (OPD-LSIA), psychosocial functioning (MINI-ICF-APP) and assessments of general cognition and symptoms were applied to 100 individuals with non-affective psychoses. Whereas both, MAS-A and OPD-LSIA, significantly predicted MINI-ICF-APP beyond cognition and symptoms, OPD-LSIA explained a higher share of variance and mediated the impact of MAS-A on MINI-ICF-APP. Levels of structural integration, including the quality of internalized object representations and unconscious interpersonal schemas, might therefore be considered as valuable predictors of social functioning and as one therapeutic focus in patients with non-affective psychoses. Structural integration might go beyond and form the base of a person's actual reflexive and metacognitive capabilities. Psychotherapeutic procedures specific for psychoses may promote and challenge a patient's metacognitive capacities, but should equally take the need for maturing structural skills into account. Modern psychodynamic approaches to psychosis are shortly presented, providing concepts and techniques for the implicit regulation of interpersonal experience and aiming at structural integration in this patient group.
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Affiliation(s)
- Anna-Lena Bröcker
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Samuel Bayer
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Frauke Stuke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Just
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Gianna Bertram
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jakob Funcke
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Imke Grimm
- International Psychoanalytic University Berlin, Berlin, Germany
| | | | - Dorothea von Haebler
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
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Brants L, Schuy K, Dors S, Horzetzky M, Rau H, Willmund G, Ströhle A, Siegel S. Fighter, Corpsman, Partisan an Attempt to Typify Former Soldiers Based on their Coping and Defense Mechanisms. Integr Psychol Behav Sci 2019; 54:370-391. [PMID: 31792841 PMCID: PMC7260279 DOI: 10.1007/s12124-019-09507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This work strives to develop a typological classification of the use of conscious and unconscious defense and coping mechanisms based on methodically and structurally collected data from a qualitative survey of 43 former soldiers in Germany. Seven coping and defense types were identified: the Fighter, the Comrade, the Corpsman, the Strategist, the Partisan, the Self-Protector and the Infantryman. The types identified differed with regard to the accumulation, combination, and use of their conscious and unconscious defense and coping mechanisms in the superordinate areas of behaviour, relationships, emotions, reflexivity and time focus. The typological classification could offer psychotherapeutic interventions tailored to individuals and their defense and coping mechanisms, which could lead to improved therapy use and compliance.
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Affiliation(s)
- Loni Brants
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.
| | - Katrin Schuy
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Simone Dors
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Marie Horzetzky
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Heinrich Rau
- Psychotraumazentrum, Military Hospital, 10115, Berlin, Germany
| | - Gerd Willmund
- Psychotraumazentrum, Military Hospital, 10115, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Stefan Siegel
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of the Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
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19
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Rohde J, Hofmann T, Voigt B, Rose M, Obbarius A. Measurement of Personality Structure by the OPD Structure Questionnaire Can Help to Discriminate Between Subtypes of Eating-Disorders. Front Psychol 2019; 10:2326. [PMID: 31681116 PMCID: PMC6811657 DOI: 10.3389/fpsyg.2019.02326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 09/30/2019] [Indexed: 12/18/2022] Open
Abstract
Background Differentiation between purging type (AN-P) and restricting type (AN-R) is common in anorexia nervosa (AN) and relevant for clinical practice. However, differences of personality pathology in eating disorders (ED) and their subtypes, which can be captured by the operationalized psychodynamic diagnosis (OPD) system, have not been systematically investigated to date. Objectives The aim of this study was to explore differences in personality structure between the subtypes of AN and bulimia nervosa (BN) using the OPD structure questionnaire (OPD-SQ). In addition, the ability of the instrument to support the classification of eating disorders was examined. Materials and Methods We conducted a retrospective, exploratory study in a subset sample of a larger validation study. The OPD-SQ had been collected from n = 60 patients with AN or BN. Patients were assigned to the ED groups by clinical assessment. Statistical analyses included multivariate analysis of variance (MANOVA) and discriminant analysis. Results Differences between ED groups were observed on 5 OPD-SQ main scales and 9 subscales, as well as on the global scale. AN-P patients demonstrated the lowest personality structure on most of the main scales and subscales, whereas AN-R patients showed a higher personality structure level as compared to both BN and AN-P patients. The OPD-SQ scales with the largest differences include self-perception, object perception, and attachment to internal objects. Discriminant analysis resulted in satisfactory assignment to ED groups by OPD-SQ subscales. Conclusions Personality structure was found to be less developed in patients with BN and AN-P as compared to patients with AN-R. Although the results have to be proven in larger prospective studies, these results suggest that the OPD-SQ may be used to support the clinical assessment and classification in patients with EDs.
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Affiliation(s)
- Jens Rohde
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Hofmann
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Barbara Voigt
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Rose
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Quantitative Health Sciences, Outcomes Measurement Science, University of Massachusetts Medical School, Worcester, MA, United States
| | - Alexander Obbarius
- Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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20
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Operationalized Psychodynamic Diagnosis System and Outcome of Psychodynamic Inpatient Psychotherapy in Male and Female Patients. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2019; 64:281-297. [PMID: 30829160 DOI: 10.13109/zptm.2018.64.3.281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare male and female patients with regard to the Operationalized Psychodynamic Diagnosis (OPD-2) system, treatment variables, and outcome after multimodal psychodynamic inpatient psychotherapy. METHODS At the beginning and at the end of inpatient treatment in a multimodal psychodynamic setting, patients were examined with the OPD-2 systemas well as with three self-assessment questionnaires addressing interpersonal problems (Inventory of Interpersonal Problems, IIP), and psychopathology: Brief SymptomInventory (BSI) and the Hospital Anxiety and Depression Scale (HADS). RESULTS Data of 850 patients (238 males, 28%), 612 females, 72%) were available for analysis. There were differences between men and women in the main diagnoses, with a higher proportion of eating disorders and a longer treatment duration among the women. Therapy discontinuation rates were low and did not differ between the sexes. Women scored higher on psychopathology at admission on the BSIGlobal Score, IIP and anxiety; the pattern of reported interpersonal problems was consistent with sex roles. While the level of structural integration was similar in both sexes, the distribution of the two main conflicts and the level of improvement of awareness and dealing with the psychodynamic foci showed significant differences. Overall, at the end of inpatient psychotherapy, there was a mean improvement in both men and women, with no significant differences between them. Because of higher scores at the start of psychotherapy, the effect sizes for improvement were higher for women. CONCLUSIONS On the whole, both sexes seem to benefit equally from psychodynamic inpatient psychotherapy in terms of symptom improvement.
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21
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Limburg K, Schmid-Mühlbauer G, Sattel H, Dinkel A, Radziej K, Gonzales M, Ronel J, Lahmann C. Potential effects of multimodal psychosomatic inpatient treatment for patients with functional vertigo and dizziness symptoms - A pilot trial. Psychol Psychother 2019; 92:57-73. [PMID: 29603590 DOI: 10.1111/papt.12177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 02/26/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Functional vertigo and dizziness (VD) are frequent and severely distressing complaints that are often described as hard to treat. Our aim was to provide preliminary data on potential effects of multimodal psychosomatic inpatient therapy for patients with functional VD symptoms in reducing vertigo-related handicap and related psychopathology, and to evaluate the role of symptom burden and body-related locus of control in predicting vertigo-related handicap at follow-up. DESIGN We conducted an uncontrolled clinical pilot trial. METHODS We included data of n = 72 inpatients with functional VD as a primary symptom and various psychopathological and/or physical comorbidities admitted for multimodal psychosomatic inpatient treatment. Patients completed self-report questionnaires assessing vertigo-related handicap (VHQ), somatization (PHQ-15), depression (BDI-II), anxiety (BAI), health-related quality of life (HRQOL; SF-36), and body-related locus of control (KLC) at admission (T0), discharge (T1), and 6 months after discharge (T2). RESULTS We observed medium effects for the change of vertigo-related handicap (T0-T1: g = -0.60, T0-T2: g = -0.67) and small effects for the change of somatization (T0-T1: g = -0.29, T0-T2: g = -0.24), mental HRQOL (T0-T1: g = 0.43, T0-T2: g = 0.49), and depression (T0-T1: g = -0.41, T0-T2: g = -0.28) from admission to discharge and admission to follow-up. Body-related locus of control did not predict vertigo-related handicap at follow-up. CONCLUSIONS Findings provide preliminary evidence for the beneficial role of psychosomatic inpatient treatment for patients with functional VD symptoms. Potentially relevant predictors of outcome at follow-up are discussed. PRACTITIONER POINTS The change of vertigo-related handicap and related variables through multimodal psychosomatic inpatient treatment was evaluated in a clinical pilot trial in patients with functional vertigo and dizziness. We observed medium effects for the change of vertigo-related handicap and small effects for the change of somatization, mental health-related quality of life, and depression. Internal body-related locus of control at admission did not predict vertigo-related handicap at follow-up.
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Affiliation(s)
- Karina Limburg
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of the Technical University of Munich, Germany
| | | | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of the Technical University of Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of the Technical University of Munich, Germany
| | - Katharina Radziej
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of the Technical University of Munich, Germany
| | - Melanie Gonzales
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of the Technical University of Munich, Germany
| | - Joram Ronel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of the Technical University of Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Germany
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22
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Leuzinger-Bohleber M, Kaufhold J, Kallenbach L, Negele A, Ernst M, Keller W, Fiedler G, Hautzinger M, Bahrke U, Beutel M. How to measure sustained psychic transformations in long-term treatments of chronically depressed patients: Symptomatic and structural changes in the LAC Depression Study of the outcome of cognitive-behavioural and psychoanalytic long-term treatments. THE INTERNATIONAL JOURNAL OF PSYCHOANALYSIS 2019; 100:99-127. [PMID: 33945717 DOI: 10.1080/00207578.2018.1533377] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Worldwide, the pressure on psychoanalysis to prove the results of its treatments according to the criteria of so-called evidence-based medicine has increased. While a large number of studies on the results of psychoanalytic short-term therapies are now available, such studies are still largely lacking on psychoanalysis and psychoanalytic long-term therapies. In a large multicentre study, the results of psychoanalytical and cognitive-behavioural longterm therapies in chronically depressed patients were compared, Both psychotherapies led to statistically highly significant changes in depressive symptoms three years after the start of the treatments However, the focus of psychoanalytic treatments is not exclusively on reducing psychopathological symptoms, but on changes in the inner world of the patients that are reminiscent of the goal of psychoanalyses that Freud has characterized as developing "the ability to love, work and enjoy life." In the German-speaking community, such transformations are called "structural changes." This article reports results on such structural changes achieved with the help of a sophisticated measuring instrument, the Operationalized Psychodynamic Diagnostics (OPD). These so-called structural changes are compared with symptomatic changes. Three years after the start of the treatments, significantly more patients in psychoanalytical treatments show such structural changes than patients in cognitive-behavioural treatments.
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Affiliation(s)
- Marianne Leuzinger-Bohleber
- IDeA Center (Center for Adaptive and Individual Development and Adaptive Education for Children-at-Risk), Sigmund-Freud-Institut, Frankfurt a.M., Germany.,Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Mainz, Germany
| | | | - Lisa Kallenbach
- Sigmund-Freud-Institut, Frankfurt a.M., Germany.,University of Kassel, Department of Educational Sciences and Psychoanalysis
| | - Alexa Negele
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Mainz, Germany
| | - Mareike Ernst
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Mainz, Germany
| | - Wolfram Keller
- Medical Hospital in the Theodor-Wenzel-Werk, Berlin, Germany
| | - Georg Fiedler
- Hamburg (Center for Suicidal Research), University Hospital Eppendorf, Germany
| | | | - Ulrich Bahrke
- University of Kassel, Department of Educational Sciences and Psychoanalysis.,Ludwig-Maximilian-University of Munich
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Kaufhold J, Bahrke U, Kallenbach L, Negele A, Ernst M, Keller W, Rachel P, Fiedler G, Hautzinger M, Leuzinger-Bohleber M, Beutel M. Wie können nachhaltige Veränderungen in Langzeittherapien untersucht werden? PSYCHE 2019. [DOI: 10.21706/ps-73-2-106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gonçalves L, Barbisan GK, Rebouças CDAV, da Rocha NS. Longitudinal Investigation of Psychotherapy Outcomes (LIPO): Description of the Study Protocol. Front Psychiatry 2019; 10:212. [PMID: 31024364 PMCID: PMC6463494 DOI: 10.3389/fpsyt.2019.00212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Despite extensive research in the field of psychotherapies, few studies have compared the primary psychotherapies of naturalistic design, which represents real-life situations. Objective: The objectives of this study were to evaluate three modalities of evidence-based psychotherapy for clinical, psychosocial, and biological outcomes and to identify the mediators and confounders of this process. Our primary hypothesis is that all psychotherapies will improve clinical and psychosocial outcomes and will increase BDNF levels. Methods: Design: longitudinal, naturalistic. Participants: One hundred twenty-six patients who underwent one of three evidence-based modalities of individual psychotherapy [psychodynamic psychotherapy (PDT), interpersonal psychotherapy (IPT), and cognitive-behavioral psychotherapy (CBT)] were included. Measure: Primary outcomes are divided into three domains of variables: clinical (general psychiatric symptoms), biological (serum BDNF levels), and psychosocial (resilience, quality of life, coping strategies, social support, and quality of life-adjusted years of life). Confounding/mediator variables included clinical (personality traits, type of psychotherapy, number of sessions, concomitant use of pharmacological treatment, history of previous psychotherapeutic treatment, medical and psychiatric comorbidities, and psychiatric diagnosis), psychosocial (psychosocial stressors, therapeutic alliance, and defense mechanism style), and other (religiosity) factors. Procedure: The follow-up period will be baseline and 6 months and 1 year after entering the study. The study will include 42 controls for biological variables only. Sample size calculation considered a significance level of 5% and a power of 80% to detect a difference of 0.22 with a standard deviation of 0.43, assuming losses of 20-30% of patients. The comparison between the modalities of psychotherapy will be by generalized estimating equations (GEE) model, the analysis of mediators by the Hayes method, and confounders by multivariate logistic regression. Discussion: The findings of this study are intended to demonstrate the outcomes of evidence-based psychotherapies for clinical, psychosocial, and biological parameters and to understand the mediators and confounders of this process in a real-life setting for patients with severe mental illness, thus contributing to the establishment of evidence-based public health policies in the field of psychological interventions.
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Affiliation(s)
- Leonardo Gonçalves
- Post-Graduation Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Guillherme Kirsten Barbisan
- Post-Graduation Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Neusa Sica da Rocha
- Post-Graduation Program in Psychiatry and Behavioral Sciences, Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Kotan VO, Kotan Z, Bilgili GÖ. Diagnostic Classification Systems Based on Psychoanalytical Principles. NORO PSIKIYATRI ARSIVI 2018; 55:91-97. [PMID: 30042648 DOI: 10.29399/npa.19505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 06/08/2017] [Indexed: 11/07/2022]
Abstract
The diagnostic classification systems in psychiatry practice which are used worldwide extensively, The Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases and Related Health Problems (ICD) are far away from the psychoanalytical point of view. It is thought that this gap results in the difficulty to understand psychiatric patients in clinical practice for many years. It has also created an obstacle to scientific researches addressing the validity and reliability of the psychoanalytical principles. On the other hand, psychoanalysis has been much criticised for years due to the lack of empirical foundations. As a result of this paucity, psychiatry is led by the biomedical approach. Without enough grounds in evidence-based medicine, psychoanalytical principles could not become widespread in psychiatric practice. To survive criticism and strengthen its place in contemporary psychiatry, empirical research in psychoanalytical discipline has gained momentum in the last two decades. Development of objective psychodynamic diagnostic tools enabled the design of such studies. The aim of this review is to introduce such diagnostic tools, namely Psychodynamic Diagnostic Manual (PDM) and Operationalized Psychodynamic Diagnosis (OPD), and to discuss the possible contributions they provide for psychoanalytical perspective to take its deserved place in the psychiatry discipline.
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Affiliation(s)
- Vahap Ozan Kotan
- Department of Psychiatry, Başkent University Medical Faculty, Ankara, Turkey
| | - Zeynep Kotan
- Department of Psychiatry, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
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Abstract
SummaryAnalysing interpersonal dynamics is an approach through which the multidisciplinary team can develop a shared understanding of their patients. This empirically based method provides an insight into repeated patterns of dysfunctional behaviour, which not only have been evident in the past, but are currently having an impact on the patient's relationships with caring staff. The technique is accessible to any team member with only minimal training required. It provides the team with a coherent map of the patient's relationship patterns that underpins the formulation of an effective strategy for care. The multidisciplinary team is then able to work towards shared goals, supporting all members in their provision of effective interventions within the full range of therapeutic modalities. The approach promotes positive staff–patient interactions and provides an additional dimension to the assessment and management of risk.
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[Conflict dynamics in chronic depression - Results of the conflict and structure axis using the OPD in the LAC Study]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2017; 63:151-162. [PMID: 28585509 DOI: 10.13109/zptm.2017.63.2.151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zeeck A, Hartmann A, Wild B, De Zwaan M, Herpertz S, Burgmer M, von Wietersheim J, Resmark G, Friederich HC, Tagay S, Dinkel A, Loewe B, Teufel M, Orlinsky D, Herzog W, Zipfel S. How do patients with anorexia nervosa "process" psychotherapy between sessions? A comparison of cognitive-behavioral and psychodynamic interventions. Psychother Res 2016; 28:873-886. [PMID: 27808005 DOI: 10.1080/10503307.2016.1252866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Patients' processing of psychotherapy between sessions ("inter-session process" (ISP)) has been repeatedly shown to be related to outcome. The aim of this study was to compare ISP characteristics of cognitive-behavioral vs. psychodynamic psychotherapy in the treatment of anorexia nervosa (AN) and their relation to outcome. METHODS Data of 106 patients participating in a randomized-controlled trial who received either 40 sessions of enhanced cognitive-behavioral therapy (CBT-E) or focal psychodynamic therapy (FPT) were analyzed. The ISP was measured with the Inter-session Experience Questionnaire (IEQ). Three outcome classes were distinguished: full recovery, partial recovery, and still fulfilling all AN criteria. RESULTS Patients receiving CBT-E reported more on "applying therapy" in the initial and the final treatment phase compared to FPT patients. In terms of process-outcome relations, higher levels of "recreating the therapeutic dialogue between sessions," "recreating the therapeutic dialogue with negative emotions" as well as "applying therapy with negative emotions" in the final phase of treatment predicted negative outcome in FPT, whereas overall higher levels of negative emotions predicted negative outcome in CBT-E. CONCLUSIONS In outpatient treatment in AN, the processing of therapy as measured by the IEQ showed surprisingly few differences between CBT-E and FPT. However, different ISP patterns were predictive of outcome, pointing to different mechanisms of change.
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Affiliation(s)
- A Zeeck
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Freiburg , Freiburg , Germany
| | - A Hartmann
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Freiburg , Freiburg , Germany
| | - B Wild
- b Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics , Heidelberg University Hospital , Heidelberg , Germany
| | - M De Zwaan
- c Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Hannover , Hannover , Germany
| | - S Herpertz
- d Department of Psychosomatic Medicine and Psychotherapy , LWL-University Medical Center of the Ruhr-University Bochum , Bochum , Germany
| | - M Burgmer
- e Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Münster , Münster , Germany
| | - J von Wietersheim
- f Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Ulm , Ulm , Germany
| | - G Resmark
- g Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Tübingen , Tübingen , Germany
| | - H-C Friederich
- h Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Düsseldorf , Düsseldorf , Germany
| | - S Tagay
- i Department of Psychosomatic Medicine and Psychotherapy , University Duisburg-Essen , Duisburg , Germany
| | - A Dinkel
- j Department of Psychosomatic Medicine and Psychotherapy , University of Technology München , München , Germany
| | - B Loewe
- k Institute and Outpatient Clinic for Psychosomatic Medicine and Psychotherapy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - M Teufel
- g Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Tübingen , Tübingen , Germany
| | - D Orlinsky
- l Department of Comparative Human Development , University of Chicago , Chicago , IL , USA
| | - W Herzog
- b Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics , Heidelberg University Hospital , Heidelberg , Germany
| | - S Zipfel
- g Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Tübingen , Tübingen , Germany
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- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Freiburg , Freiburg , Germany
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Antonsen BT, Johansen MS, Rø FG, Kvarstein EH, Wilberg T. Is reflective functioning associated with clinical symptoms and long-term course in patients with personality disorders? Compr Psychiatry 2016; 64:46-58. [PMID: 26104432 DOI: 10.1016/j.comppsych.2015.05.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/26/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Mentalization is the capacity to understand behavior as the expression of various mental states and is assumed to be important in a range of psychopathologies, especially personality disorders (PDs). The first aim of the present study was to investigate the relationship between mentalization capacity, operationalized as reflective functioning (RF), and clinical manifestations before entering study treatment. The second aim was to investigate the relationship between baseline RF and long-term clinical outcome both independent of treatment (predictor analyses) and dependent on treatment (moderator analyses). METHODS Seventy-nine patients from a randomized clinical trial (Ullevål Personality Project) who had borderline and/or avoidant PD were randomly assigned to either a step-down treatment program, comprising short-term day-hospital treatment followed by outpatient combined group and individual psychotherapy, or to outpatient individual psychotherapy. Patients were evaluated on variables including symptomatic distress, psychosocial functioning, personality functioning, and self-esteem at baseline, 8 and 18months, and 3 and 6years. RESULTS RF was significantly associated with a wide range of variables at baseline. In longitudinal analyses RF was not found to be a predictor of long-term clinical outcome. However, when considering treatment type, there were significant moderator effects of RF. Patients with low RF had better outcomes in outpatient individual therapy compared to the step-down program. In contrast, patients in the medium RF group achieved better results in the step-down program. CONCLUSION These findings indicate that RF is associated with core aspects of personality pathology and capture clinically relevant phenomena in adult patients with PDs. Moreover, patients with different capacities for mentalization may need different kinds of therapeutic approaches.
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Affiliation(s)
- Bjørnar T Antonsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
| | - Merete S Johansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
| | - Frida G Rø
- Department of Psychology, University of Oslo, Oslo, Norway.
| | - Elfrida H Kvarstein
- Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
| | - Theresa Wilberg
- Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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Simmonds J, Constantinides P, Perry JC, Drapeau M, Sheptycki AR. Assessing Psychodynamic Conflict. Psychodyn Psychiatry 2015; 43:349-377. [PMID: 26301758 DOI: 10.1521/pdps.2015.43.3.349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Psychodynamic psychotherapies suggest that symptomatic relief is provided, in part, with the resolution of psychic conflicts. Clinical researchers have used innovative methods to investigate such phenomenon. This article aims to review the literature on quantitative psychodynamic conflict rating scales. An electronic search of the literature was conducted to retrieve quantitative observer-rated scales used to assess conflict noting each measure's theoretical model, information source, and training and clinical experience required. Scales were also examined for levels of reliability and validity. Five quantitative observer-rated conflict scales were identified. Reliability varied from poor to excellent with each measure demonstrating good validity. However a small number of studies and limited links to current conflict theory suggest further clinical research is needed.
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Affiliation(s)
- Joshua Simmonds
- Licensed Psychologist in Private Practice, Quebec Order of Psychologists, Canada
| | | | - J Christopher Perry
- Department of Psychiatry, Sir Mortimer B. Davis Jewish General Hospital, and McGill University
| | - Martin Drapeau
- Associate Professor of Counselling Psychology and Psychiatry, and Chair (CFI) and Director of Research of the McGill Psychotherapy Research Group
| | - Amanda R Sheptycki
- Student, Department of Counselling Psychology and Psychiatry, McGill University
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Neue Felder in der Operationalisierten Psychodynamischen Diagnostik. PSYCHOTHERAPEUT 2015. [DOI: 10.1007/s00278-015-0046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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[Personal resources in inpatient psychotherapy - Relationships and development]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2015; 61:139-55. [PMID: 26175170 DOI: 10.13109/zptm.2015.61.2.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We examined how personal resources develop during inpatient psychodynamic psychotherapy, their relationship to symptom development, Operationalized Psychodynamic Diagnosis (OPD-2), and sociodemographic aspects. METHODS 483 patients were examined using self-assessment questionnaires (Brief Symptom Inventory (BSI), Hospital Anxiety and Depression Scale (HADS), Inventory of Interpersonal Problems (IIP), Questionnaire of Actual Resource Realization (RES)) as well as the expert ratings Global Assessment of Functioning Scale (GAF), Impairment Score (IS), OPD-2, and the Heidelberg Structural Change Scale (HSCS), both at the beginning and the end of treatment. RESULTS There was a marked improvement in the realization of personal resources during inpatient psychotherapy, which showed significant correlations to the improvement of symptoms. The extent of improvement of resources correlated with the duration of psychotherapy and the assessment of the psychodynamic therapy foci on the HSCS. CONCLUSIONS The results show that personal resources are activated when successfully working on the psychodynamic foci in psychodynamic inpatient treatment, and that this corresponds to an improvement of symptoms.
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Vicente CS, Oliveira RA, Silva F, Ferrajão P, Augusto S, Oliveira S, Senra H, Oliveira R, Krieger D. Cross-cultural adaptation of the Operationalized Psychodynamic Diagnosis (OPD-2) in Portugal. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2015; 34:129-38. [PMID: 25923004 DOI: 10.1590/s2237-60892012000300004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 08/01/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Operationalized Psychodynamic Diagnosis (OPD-2) is internationally established as one of the major instruments available for clinical diagnosis and scientific research, being frequently used as an auxiliary tool in the selection of therapeutic interventions. AIMS 1) To describe the methodological aspects of the adaptation of the OPD-2 into Portuguese (Portugal and Brazil). 2) To assess inter-rater agreement for the different axes of the instrument when scoring clinical interviews. METHOD The cross-cultural adaptation involved translation of the instrument by different independent translators, whose versions were compared in discussion groups in order to develop a final Portuguese version. In the presence of discrepancies regarding the translation of original concepts, the authors of the original instrument were contacted for clarification. Five interviews were used to assess inter-rater agreement. Each subject participated in two interviews, conducted by an experienced clinical psychologist. The interviews were recorded, transcribed and then analyzed by the principal investigator and by three independent examiners. RESULTS Axis IV (Structure) presented the highest inter-rater agreement (78%). Axes I (Experience of illness and prerequisites for treatment) and III (Conflict) showed the lowest inter-rater agreement results (66 and 57.7%, respectively). CONCLUSIONS Our results point in the same direction as previous studies conducted in other countries. In our sample, the OPD-2 presented an acceptable inter-rater agreement; however, further studies are needed to assess the instrument's reliability.
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Affiliation(s)
- Carla S Vicente
- Departamento de Psicologia Clínica, Universidade de Évora, Évora, Portugal
| | - Rui Aragão Oliveira
- Unidade de Investigação em Psicologia e Saúde (UIPES), Instituto Superior de Psicologia Aplicada (ISPA), Lisboa, Portugal
| | | | | | - Sara Augusto
- Departamento de Psicologia Clínica, Universidade de Lisboa
| | | | | | | | - Daniela Krieger
- Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Schneider G, Tiemann M, Stumpf A, Heuft G. Dimensions of the operationalized psychodynamic diagnosis system that predict long-term outcome after inpatient psychotherapy. Psychopathology 2015; 48:101-13. [PMID: 25501867 DOI: 10.1159/000368311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/11/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To determine whether the Operationalized Psychodynamic Diagnosis (OPD) system can be useful in predicting patient outcome in the long term. METHODS OPD was assessed by the therapists prior to and after inpatient treatment. Patients completed psychometric scales at the start and completion of psychosomatic-psychotherapeutic inpatient treatment and at the follow-up. Outcome was defined by the general factor emerging from a principal component analysis of the Brief Symptom Inventory, Hospital Anxiety and Depression Scale and Inventory of Interpersonal Problems at katamnesis, representing individual differences in general distress. RESULTS Several dimensions of the OPD system proved to be predictors of general distress at the follow-up in 253 former inpatients. Negative predictors of long-term outcome were the high internal impediments to change, namely high secondary gains from illness and also less integrated structural abilities. Positive OPD predictors of long-term outcome were the treatment success achieved at the end of inpatient psychotherapy in changing the illness concept towards a psychological understanding of symptoms, lower levels of complaints and a higher functional level. Also the achieved level of awareness for the individual maladaptive behavioral pattern is predictive of a favorable long-term outcome. CONCLUSIONS The results provide evidence for the clinical relevance and the predictive value of OPD. © 2014 S. Karger AG, Basel.
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Affiliation(s)
- Gudrun Schneider
- Department of Psychosomatics and Psychotherapy, University Hospital of Muenster, Muenster, Germany
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Montesano A, López-González MA, Saúl LA, Feixas G. A review of cognitive conflicts research: a meta-analytic study of prevalence and relation to symptoms. Neuropsychiatr Dis Treat 2015; 11:2997-3006. [PMID: 26675503 PMCID: PMC4675636 DOI: 10.2147/ndt.s91861] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Recent research has highlighted the role of implicative dilemmas in a variety of clinical conditions. These dilemmas are a type of cognitive conflict, in which different aspects of the self are countered in such a way that a desired change in a personal dimension (eg, symptom improvement) may be hindered by the need of personal coherence in another dimension. The aim of this study was to summarize, using a meta-analytical approach, the evidence relating to the presence and the level of this conflict, as well as its relationship with well-being, in various clinical samples. A systematic review using multiple electronic databases found that out of 37 articles assessed for eligibility, nine fulfilled the inclusion criteria for meta-analysis. Random effects model was applied when computing mean effect sizes and testing for heterogeneity level. Statistically significant associations were observed between the clinical status and the presence of dilemmas, as well as level of conflict across several clinical conditions. Likewise, the level of conflict was associated with symptom severity. Results highlighted the clinical relevance and the transdiagnostic nature of implicative dilemmas.
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Affiliation(s)
- Adrián Montesano
- Department of Personality, Assessment and Psychological Treatments, University of Barcelona, Barcelona, Spain
| | - María Angeles López-González
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, National Distance Education University, Madrid, Spain
| | - Luis Angel Saúl
- Department of Personality, Assessment and Psychological Treatments, Faculty of Psychology, National Distance Education University, Madrid, Spain
| | - Guillem Feixas
- Department of Personality, Assessment and Psychological Treatments, University of Barcelona, Barcelona, Spain
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Mössler K, Fuchs K. Musical progress towards therapeutic change: A qualitative study on how to develop a focus in music therapy. NORDIC JOURNAL OF MUSIC THERAPY 2014. [DOI: 10.1080/08098131.2014.966748] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Feixas G, Montesano A, Compañ V, Salla M, Dada G, Pucurull O, Trujillo A, Paz C, Muñoz D, Gasol M, Saúl LÁ, Lana F, Bros I, Ribeiro E, Winter D, Carrera-Fernández MJ, Guàrdia J. Cognitive conflicts in major depression: between desired change and personal coherence. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 53:369-85. [PMID: 24734969 PMCID: PMC4231234 DOI: 10.1111/bjc.12050] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 03/04/2014] [Indexed: 12/26/2022]
Abstract
Objectives The notion of intrapsychic conflict has been present in psychopathology for more than a century within different theoretical orientations. However, internal conflicts have not received enough empirical attention, nor has their importance in depression been fully elaborated. This study is based on the notion of cognitive conflict, understood as implicative dilemma (ID), and on a new way of identifying these conflicts by means of the Repertory Grid Technique. Our aim was to explore the relevance of cognitive conflicts among depressive patients. Design Comparison between persons with a diagnosis of major depressive disorder and community controls. Methods A total of 161 patients with major depression and 110 non-depressed participants were assessed for presence of IDs and level of symptom severity. The content of these cognitive conflicts was also analysed. Results Repertory grid analysis indicated conflict (presence of ID/s) in a greater proportion of depressive patients than in controls. Taking only those grids with conflict, the average number of IDs per person was higher in the depression group. In addition, participants with cognitive conflicts displayed higher symptom severity. Within the clinical sample, patients with IDs presented lower levels of global functioning and a more frequent history of suicide attempts. Conclusions Cognitive conflicts were more prevalent in depressive patients and were associated with clinical severity. Conflict assessment at pre-therapy could aid in treatment planning to fit patient characteristics. Practitioner points Cautions/Limitations
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Affiliation(s)
- Guillem Feixas
- Department of Personality, Assessment and Psychological Treatments, University of Barcelona, Spain; Institute for Brain, Cognition and Behaviour, University of Barcelona, Spain
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Doering S, Burgmer M, Heuft G, Menke D, Bäumer B, Lübking M, Feldmann M, Schneider G. Assessment of personality functioning: validity of the operationalized psychodynamic diagnosis axis IV (structure). Psychopathology 2014; 47:185-93. [PMID: 24192300 DOI: 10.1159/000355062] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 08/15/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The assessment of personality functioning has recently become a focus of psychiatric diagnostics. The interview-based Operationalized Psychodynamic Diagnosis (OPD-2) provides a 'structure axis' for the assessment of personality functioning. METHODS One hundred twenty-four psychiatric patients were diagnosed by means of the Structured Clinical Interviews for DSM-IV (SCID-I and SCID-II), underwent OPD-2 interviews, and completed 9 questionnaires. RESULTS The OPD-2 structure axis shows good interrater reliability (intraclass correlation = 0.793). Correlations between the OPD-2 structure axis domains and a priori selected questionnaire scales were of medium size and significant. Patients with a personality disorder (PD) showed significantly worse personality functioning than those without. In cluster B PD, personality functioning was more severely impaired than in cluster C PD. DISCUSSION The OPD-2 structure axis shows good reliability as well as concurrent and discriminant validity and can be recommended for clinical use and research purposes.
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Affiliation(s)
- Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Voderholzer U, Schwartz C, Thiel N, Kuelz AK, Hartmann A, Scheidt CE, Schlegl S, Zeeck A. A comparison of schemas, schema modes and childhood traumas in obsessive-compulsive disorder, chronic pain disorder and eating disorders. Psychopathology 2014; 47:24-31. [PMID: 23689753 DOI: 10.1159/000348484] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 12/26/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND In this study, we investigated early maladaptive schemas (EMS), schema modes and childhood traumas in patients suffering from obsessive-compulsive disorder (OCD) in contrast to patients with other Axis I disorders. Based on cognitive theories on OCD, our main research question was whether schemas belonging to the domain of 'impaired autonomy and performance' are more prevalent in OCD than in both eating disorders (ED) and chronic pain disorder (CPD). SAMPLING AND METHODS EMS, schema modes and traumatic childhood experiences were measured in 60 patients with OCD, 41 with ED, 40 with CPD and 142 healthy controls. To analyze differences between the groups, MANCOVAs were conducted followed by deviation contrasts. Depression level, age and gender were considered as possible covariates. RESULTS OCD patients scored higher on 4 EMS, 2 of which belong to the domain 'impaired autonomy and performance'. ED patients had higher scores in the EMS 'emotional inhibition' and CPD patients on the Childhood Trauma Questionnaire subscale 'physical neglect'. CONCLUSIONS These results suggest that there might be typical schema patterns associated with OCD and ED. We can also conclude that a higher prevalence of traumatic experiences does not necessarily coincide with more EMS and schema modes.
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Affiliation(s)
- Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, University Medical Center, Freiburg, Germany
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Kessler H, Stasch M, Cierpka M. Operationalized psychodynamic diagnosis as an instrument to transfer psychodynamic constructs into neuroscience. Front Hum Neurosci 2013; 7:718. [PMID: 24298247 PMCID: PMC3829565 DOI: 10.3389/fnhum.2013.00718] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/10/2013] [Indexed: 11/13/2022] Open
Abstract
This theoretical article makes a contribution to the field of "psychoanalytically informed neuroscience". First, central characteristics of psychoanalysis and neuroscience are briefly described leading into three epistemic dichotomies. Neuroscience versus psychoanalysis display almost opposing methodological approaches (reduction vs. expansion), test quality emphases (reliability vs. validity) and meaning of results (correlation vs. explanation). The critical point is to reach an intermediate level: in neuroscience an adequate position integrating both aspects-objective and subjective-of dual-aspect monism, and in psychoanalysis the appropriate level for the scientific investigation of its central concepts. As a suggestion to reach that level in both fields the system of Operationalized Psychodynamic Diagnosis (OPD; OPD Task Force, 2008) is presented. Combining aspects of both fields areas, expansion and reduction as well as reliability and validity, OPD could be a fruitful tool to transfer psychodynamic constructs into neuroscience. The article closes with a short description of recent applications of OPD in neuroscience.
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Affiliation(s)
- Henrik Kessler
- 1Department of Psychosomatic Medicine and Psychotherapy, LWL-University, Ruhr-University Bochum Germany
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Kehyayan A, Best K, Schmeing JB, Axmacher N, Kessler H. Neural activity during free association to conflict-related sentences. Front Hum Neurosci 2013; 7:705. [PMID: 24298244 PMCID: PMC3829619 DOI: 10.3389/fnhum.2013.00705] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 10/04/2013] [Indexed: 11/13/2022] Open
Abstract
Psychodynamic conflicts form an important construct to understand the genesis and maintenance of mental disorders. Conflict-related themes should therefore provoke strong reactions on the behavioral, physiological, and neural level. We confronted N = 18 healthy subjects with a vast array of sentences describing typical psychodynamic conflict themes in the fMRI scanner and let them associate spontaneously in reaction. The overt associations were then analyzed according to psychoanalytic theory and the system of operationalized psychodynamic diagnosis and used as a genuinely psychodynamic indicator, whether each potentially conflict-related sentence actually touched a conflict theme of the individual. Behavioral, physiological, and neural reactions were compared between those subjects with an “apparent conflict” and those with “absent conflicts.” The first group reported stronger agreement with the conflict-related sentences, more negative valence in reaction, had higher levels of skin conductance reactivity and exhibited stronger activation in the anterior cingulate cortex, amongst other functions involved in emotion processing and conflict-monitoring. In conjunction, we interpret this activity as a possible correlate of subjects’ inherent reactions and regulatory processes evoked by conflict themes. This study makes a point for the fruitfulness of the neuropsychoanalytic endeavor by using free association, the classical technique most commonly used in psychoanalysis, to investigate aspects of conflict processing in neuroimaging.
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Affiliation(s)
- Aram Kehyayan
- Department of Epileptology, University of Bonn Bonn, Germany
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42
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Boeker H, Richter A, Himmighoffen H, Ernst J, Bohleber L, Hofmann E, Vetter J, Northoff G. Essentials of psychoanalytic process and change: how can we investigate the neural effects of psychodynamic psychotherapy in individualized neuro-imaging? Front Hum Neurosci 2013; 7:355. [PMID: 23935571 PMCID: PMC3731532 DOI: 10.3389/fnhum.2013.00355] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 06/20/2013] [Indexed: 11/13/2022] Open
Abstract
The paper focuses on the essentials of psychoanalytic process and change and the question of how the neural correlates and mechanisms of psychodynamic psychotherapy can be investigated. The psychoanalytic approach aims at enabling the patient to "remember, repeat, and work through" concerning explicit memory. Moreover, the relationship between analyst and patient establishes a new affective configuration which enables a reconstruction of the implicit memory. If psychic change can be achieved it corresponds to neuronal transformation. Individualized neuro-imaging requires controlling and measuring of variables that must be defined. Two main methodological problems can be distinguished: the design problem addresses the issue of how to account for functionally related variables in an experimentally independent way. The translation problem raises the question of how to bridge the gaps between different levels of the concepts presupposed in individualized neuro-imaging (e.g., the personal level of the therapist and the client, the neural level of the brain). An overview of individualized paradigms, which have been used until now is given, including Operationalized Psychodynamic Diagnosis (OPD-2) and the Maladaptive Interpersonal Patterns Q-Start (MIPQS). The development of a new paradigm that will be used in fMRI experiments, the "Interpersonal Relationship Picture Set" (IRPS), is described. Further perspectives and limitations of this new approach concerning the design and the translation problem are discussed.
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Affiliation(s)
- Heinz Boeker
- Department for Psychiatry, Psychotherapy and Psychosomatics, Centre for Depressions, Anxiety Disorders and Psychotherapy, University Hospital of Psychiatry Zurich Zurich, Switzerland
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[Interrater-reliability of the OPD-CA, the axes conflict and structure]. Prax Kinderpsychol Kinderpsychiatr 2013; 62:255-69. [PMID: 23720992 DOI: 10.13109/prkk.2013.62.4.255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The reliability of the meanwhile widely used Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) is only rarely examined. By means of audiovisual recordings of OPD-CA-interviews with 39 adolescents in the context of a randomized-controlled psychotherapy study for the treatment female adolescents with bulimia nervosa and atypical bulimia nervosa the reliability of the axis conflict and the axis structure were examined. This was carried out by the calculation of Intraklassen-correlations of three raters. The rater agreements ranged from good to excellent, except for impulse control in the axis structure, where the results were satisfactory. The relevance of the results for clinical practice is discussed.
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[Inter-rater reliability and construct validity of the OPD-CA axis structure: first study results regarding the integration of OPD-CA into clinical practice]. Prax Kinderpsychol Kinderpsychiatr 2013; 62:270-84. [PMID: 23720993 DOI: 10.13109/prkk.2013.62.4.270] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The axis structure of the Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) has proven to be a reliable and valid diagnostic tool under research conditions. However, corresponding data regarding the integration of OPD-CA axis structure into clinical practice is still lacking. Hence, this aspect was examined as part of a randomized controlled clinical trial realized at Asklepios Fachklinikum Tiefenbrunn. Here, the OPD-CA axis structure has been applied to assess the structural level of 42 adolescent patients (15-19 years). In contrast to previous studies, the assessment was not carried out by independent raters using a videotaped OPD-CA interview, but the rating was part of clinical routine procedures. Also under these conditions, inter-rater reliability was high, in particular regarding the four subscales of the OPD-CA axis structure. With respect to construct validity, the results of our study supported a two-factor solution, which is in accordance with the findings of two previous works. One factor corresponded to the dimension "self-regulation" while the other factor included both the dimension "self-perception and object perception" as well as the dimension "communication skills". Implications of the findings for research and practice are discussed.
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Reliabilität und Konstruktvalidität der OPD-KJ-Achsen Struktur und Behandlungsvoraussetzungen. Prax Kinderpsychol Kinderpsychiatr 2013; 62:243-54. [DOI: 10.13109/prkk.2013.62.4.243] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gastaud MB, Goi JD, Bassols AM, Costa CPD, Krieger D, Machado D, Costa FBPD, Knijnik J, Torres M, Braga P, Teche SP, Wellausen R, Eizirik CL. Is it all grist to the mill? Wandering between indications for psychoanalytic treatment and the analytic field. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2013; 35:12-23. [PMID: 25923182 DOI: 10.1590/s2237-60892013000100003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 10/04/2012] [Indexed: 06/04/2023]
Abstract
Determining the indications and contraindications for psychoanalytic treatment seems crucial to achieve therapeutic success and improve treatment effectiveness. In reviewing the classic literature on the topic, aspects such as age, diagnosis, motivation for treatment, present moment in life, ability to gain insight, psychic suffering when seeking treatment, defensive behaviors, and frustration tolerance are clearly analyzed by therapists/analysts when indicating psychoanalytic treatments. However, traditionally, most criteria underlying such indications date back to a time when the therapeutic relationship was viewed merely as a therapist treating a patient, with no regard to the therapeutic relationship itself. The goal of this article was to critically review the relevance and current adequacy of indications for psychoanalytic treatment, in view of advancements in knowledge on the analytic field. Considering cases that do not evolve as expected according to the indications, patients who are better suited to certain therapists, and therapist-patient pairs that modify their interaction over the course of treatment, the main question remains on how to identify the necessary elements in evaluating a candidate patient for psychoanalytic treatment, as well as the significant elements of therapeutic action.
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Affiliation(s)
- Marina Bento Gastaud
- Centro de Estudos Luis Guedes, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Julia Domingues Goi
- Sociedade Psicanalítica de Porto Alegre, Associação de Psiquiatria do Rio Grande do Sul, CELG, UFRGS, Porto Alegre, RS, Brazil
| | - Ana Margareth Bassols
- Sociedade Psicanalítica de Porto Alegre, Associação de Psiquiatria do Rio Grande do Sul, CELG, UFRGS, Porto Alegre, RS, Brazil
| | | | | | | | | | | | | | - Pricilla Braga
- Centro de Estudos Luis Guedes, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Rafael Wellausen
- Centro de Estudos Luis Guedes, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Claudio Laks Eizirik
- Sociedade Psicanalítica de Porto Alegre, Associação de Psiquiatria do Rio Grande do Sul, CELG, UFRGS, Porto Alegre, RS, Brazil
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Greenfield B, Filip C, Schiffrin A, Bond M, Amsel R, Zhang X. The scales of psychological capacities: adaptation to an adolescent population. Psychother Res 2012; 23:232-46. [PMID: 23113821 DOI: 10.1080/10503307.2012.735776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Given the dearth of pediatric outcome measures, Wallerstein's "scales of psychological capacities" (SPC), measuring psychotherapy changes with adults and reflecting shifts in character without specific adherence to a school of personality, was adapted to adolescents (Ad-SPC) and examined psychometrically. Twelve child psychoanalysts were consulted for content validity. Two investigators determined it to have high face validity after administering it to 40 adolescents. High inter-rater reliability was achieved for individual scale items. Construct validity was determined using Pearson correlations between multiple Ad-SPC items and co-administered validated measures of psychopathology. Preliminary psychometric properties support the Ad-SPC's potential for applicability in adolescent psychotherapy.
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Affiliation(s)
- Brian Greenfield
- Faculty of Medicine , McGill University, Montreal, Quebec, Canada
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Ambresin G, Despland JN, Preisig M, de Roten Y. Efficacy of an adjunctive brief psychodynamic psychotherapy to usual inpatient treatment of depression: rationale and design of a randomized controlled trial. BMC Psychiatry 2012; 12:182. [PMID: 23110608 PMCID: PMC3515480 DOI: 10.1186/1471-244x-12-182] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 10/26/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A few recent studies have found indications of the effectiveness of inpatient psychotherapy for depression, usually of an extended duration. However, there is a lack of controlled studies in this area and to date no study of adequate quality on brief psychodynamic psychotherapy for depression during short inpatient stay exists. The present article describes the protocol of a study that will examine the relative efficacy, the cost-effectiveness and the cost-utility of adding an Inpatient Brief Psychodynamic Psychotherapy to pharmacotherapy and treatment-as-usual for inpatients with unipolar depression. METHODS/DESIGN The study is a one-month randomized controlled trial with a two parallel group design and a 12-month naturalistic follow-up. A sample of 130 consecutive adult inpatients with unipolar depression and Montgomery-Asberg Depression Rating Scale score over 18 will be recruited. The study is carried out in the university hospital section for mood disorders in Lausanne, Switzerland. Patients are assessed upon admission, and at 1-, 3- and 12- month follow-ups. Inpatient therapy is a manualized brief intervention, combining the virtues of inpatient setting and of time-limited dynamic therapies (focal orientation, fixed duration, resource-oriented interventions). Treatment-as-usual represents the best level of practice for a minimal treatment condition usually proposed to inpatients. Final analyses will follow an intention-to-treat strategy. Depressive symptomatology is the primary outcome and secondary outcome includes measures of psychiatric symptomatology, psychosocial role functioning, and psychodynamic-emotional functioning. The mediating role of the therapeutic alliance is also examined. Allocation to treatment groups uses a stratified block randomization method with permuted block. To guarantee allocation concealment, randomization is done by an independent researcher. DISCUSSION Despite the large number of studies on treatment of depression, there is a clear lack of controlled research in inpatient psychotherapy during the acute phase of a major depressive episode. Research on brief therapy is important to take into account current short lengths of stay in psychiatry. The current study has the potential to scientifically inform appropriate inpatient treatment. This study is the first to address the issue of the economic evaluation of inpatient psychotherapy. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry (ACTRN12612000909820).
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Affiliation(s)
- Gilles Ambresin
- Department of Psychiatry-CHUV, Centre for Psychotherapy Research, University Institute of Psychotherapy, The University of Lausanne, Av. de Morges 10, CH-1004, Lausanne, Switzerland
| | - Jean-Nicolas Despland
- Department of Psychiatry-CHUV, Centre for Psychotherapy Research, University Institute of Psychotherapy, The University of Lausanne, Av. de Morges 10, CH-1004, Lausanne, Switzerland
| | - Martin Preisig
- Department of Psychiatry-CHUV, Centre for Psychiatry Epidemiology and Psychopathology, The University of Lausanne, Lausanne, Switzerland
| | - Yves de Roten
- Department of Psychiatry-CHUV, Centre for Psychotherapy Research, University Institute of Psychotherapy, The University of Lausanne, Av. de Morges 10, CH-1004, Lausanne, Switzerland
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Zimmermann J, Ehrenthal JC, Cierpka M, Schauenburg H, Doering S, Benecke C. Assessing the level of structural integration using operationalized psychodynamic diagnosis (OPD): implications for DSM-5. J Pers Assess 2012; 94:522-32. [PMID: 22808938 DOI: 10.1080/00223891.2012.700664] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A key ingredient in the current proposal of the DSM-5 Work Group on Personality and Personality Disorders is the assessment of overall severity of impairment in personality functioning: the Levels of Personality Functioning Scale (LPFS). The aim of this article is to contribute a conceptual and empirical discussion of the LPFS from the perspective of the Operationalized Psychodynamic Diagnosis (OPD) system (OPD Task Force, 2008 ). First, we introduce the OPD Levels of Structural Integration Axis (OPD-LSIA), a measure of individual differences in severity of personality dysfunction that is rooted in psychodynamic theory. We show that the OPD-LSIA is reliable, valid, and highly associated with observer ratings of personality disorders. In the second part, we present results from an OPD expert consensus study exploring potential limitations of the current LPFS item set from the perspective of the OPD-LSIA. We conclude with highlighting implications for future revisions of the DSM-5 proposal.
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Affiliation(s)
- Johannes Zimmermann
- Department of Psychology, University of Kassel, Hollaendische Str. 36–38, 34127 Kassel, Germany.
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Koelen JA, Luyten P, Eurelings-Bontekoe LHM, Diguer L, Vermote R, Lowyck B, Bühring MEF. The impact of level of personality organization on treatment response: a systematic review. Psychiatry 2012; 75:355-74. [PMID: 23244013 DOI: 10.1521/psyc.2012.75.4.355] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper provides a systematic review of extant research concerning the association between level of personality organization (PO) and psychotherapy response. Psychotherapy studies that reported a quantifiable association between level of PO and treatment outcome were examined for eligibility. Based on stringent inclusion and exclusion criteria, we identified 18 studies from 13 original data sources. Participants in these studies had a variety of mental disorders, of which mood, anxiety, and personality disorders were the most common. The results of this systematic review converge to suggest that higher initial levels of PO are moderately to strongly associated with better treatment outcome. Some studies indicate that level of PO may interact with the type of intervention (i.e., interpretive versus supportive) in predicting treatment outcome, which suggests the importance of tailoring the level of interpretive work to the level of PO. Yet, at the same time, the limited number of studies available and the heterogeneity of measures used to assess PO in existing research stress the need for further research. Potential implications for clinical practice and guidelines for future research are discussed.
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