Addressing nicotine dependence in psychodynamic psychotherapy: perspectives from residency training

[Psychodynamic psychotherapy, lifestyle and prevention]

OBJECTIVES

Patients with mental disorders frequently manifest unhealthy behavior, which contributes to their increased risk for chronic mental and somatic diseases as well as excess mortality rates of 10 years and more. It also impairs their well-being and the course of mental disorders.We analyzed whether by addressing unhealthy behavior prevention can be integrated into psychodynamic psychotherapy.

METHODS

We reviewed the literature on the role of unhealthy behavior for mental disorders, on the role of lifestyle risk factors in psychodynamic theory, and on barriers to the integration of addressing lifestyle in psychodynamic psychotherapy.

RESULTS

Smoking, unhealthy dietary habits, and physical inactivity constitute dysfunctional behavior, resulting from maladaptive self-representations and an impairment of emotion-regulation capacities. In psychodynamic psychotherapy this maladaptive behavior can be addressed and treated as a kind of defensive behavior and resistance.

CONCLUSION

We believe that by addressing unhealthy behavior prevention can become a crucial task for psychodynamic psychotherapists today.

Designing for dissemination: development of an evidence-based tobacco treatment curriculum for psychiatry training programs

Psychiatry training programs provide a unique arena for affecting professional norms and increasing access to tobacco cessation services among smokers with mental illness. Psychiatry Rx for Change emphasizes evidence-based patient-oriented tobacco treatments relevant for tobacco users with psychiatric disorders. Following Diffusion of Innovations theory and the RE-AIM framework, the curriculum is being disseminated to psychiatry residency and graduate psychiatric nursing programs in the Western United States with plans to study curriculum adoption, implementation, and maintenance on a broad scale. Psychiatry Rx for Change aims to increase the likelihood that smokers with co-occurring disorders will receive evidence-based cessation treatment.

Evaluation of an evidence-based tobacco treatment curriculum for psychiatry residency training programs

OBJECTIVE

Smokers with mental illness and addictive disorders account for nearly one in two cigarettes sold in the United States and are at high risk for smoking-related deaths and disability. Psychiatry residency programs provide a unique arena for disseminating tobacco treatment guidelines, influencing professional norms, and increasing access to tobacco cessation services among smokers with mental illness. The current study evaluated the Rx for Change in Psychiatry curriculum, developed for psychiatry residency programs and focused on identifying and treating tobacco dependence among individuals with mental illness.

METHODS

The 4-hour curriculum emphasized evidence-based, patient-oriented cessation treatments relevant for all tobacco users, including those not yet ready to quit. The curriculum was informed by comprehensive literature review, consultation with an expert advisory group, faculty interviews, and a focus group with psychiatry residents. This study reports on evaluation of the curriculum in 2005-2006, using a quasi-experimental design, with 55 residents in three psychiatry residency training programs in Northern California.

RESULTS

The curriculum was associated with improvements in psychiatry residents' knowledge, attitudes, confidence, and counseling behaviors for treating tobacco use among their patients, with initial changes from pre- to posttraining sustained at 3-months' follow-up. Residents' self-reported changes in treating patients' tobacco use were substantiated through systematic chart review.

CONCLUSION

The evidence-based Rx for Change in Psychiatry curriculum is offered as a model tobacco treatment curriculum that can be implemented in psychiatry residency training programs and disseminated widely, thereby effectively reaching a vulnerable and costly population of smokers.