1
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Heim N, Abbass A, Luyten P, Leichsenring F. Controversies in recommending treatments for depression-A debate. Bipolar Disord 2024. [PMID: 38644504 DOI: 10.1111/bdi.13438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Affiliation(s)
- Nikolas Heim
- International Psychoanalytic University (IPU), Berlin, Germany
| | - Allan Abbass
- Department of Psychiatry and The Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
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2
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Standal K, Solbakken OA, Rugkåsa J, Halvorsen MS, Abbass A, Wirsching C, Brakstad IE, Heiervang KS. Medication-Free Treatment in Mental Health Care How Does It Differ from Traditional Treatment? Patient Prefer Adherence 2024; 18:315-335. [PMID: 38327730 PMCID: PMC10849138 DOI: 10.2147/ppa.s435610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 12/18/2023] [Indexed: 02/09/2024] Open
Abstract
Background Norwegian authorities have implemented treatment units devoted to medication-free mental health treatment nationwide to improve people's freedom of choice. This article examines how medication-free treatment differs from treatment as usual across central dimensions. Methods The design was mixed methods including questionnaire data on patients from a medication-free unit and two comparison units (n 59 + 124), as well as interviews with patients (n 5) and staff (n 8) in the medication-free unit. Results Medication-free treatment involved less reliance on medications and more extensive psychosocial treatment that involved a culture of openness, expression of feelings, and focus on individual responsibility and intensive work. The overall extent of patient influence for medication-free treatment compared with standard treatment was not substantially different to standard treatment but varied on different themes. Patients in medication-free treatment had greater freedom to reduce or not use medication. Medication-free treatment was experienced as more demanding. For patients, this could be connected to a stronger sense of purpose and was experienced as helpful but could also be experienced as a type of pressure and lack of understanding. Patients in medication-free treatment reported greater satisfaction with the treatment, which may be linked to a richer psychosocial treatment package that focuses on patient participation and freedom from pressure to use medication. Conclusion The findings provide insights into how a medication-free treatment service might work and demonstrate its worth as a viable alternative for people who are not comfortable with the current medication focus of mental health care. Patients react differently to increased demands and clinicians should be reflexive of the dimensions of individualism-relationism in medication-free treatment services. This knowledge can be used to further develop and improve both medication-free treatment and standard treatment regarding shared decision-making. Trial Registration This study was registered with ClinicalTrials.gov (Identifier NCT03499080) on 17 April 2018.
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Affiliation(s)
- Kari Standal
- District Psychiatric Center Nedre Romerike, Akershus University Hospital, Lørenskog, Norway
| | | | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Department of Mental Health, Oslo Metropolitan UniversityOslo, Norway
- Centre for Care Research, University of Southeastern Norway, Porsgrunn, Norway
| | | | - Allan Abbass
- Faculty of Medicine, Dalhousie University, Nova Scotia, Canada
| | | | | | - Kristin S Heiervang
- Research and Development Department, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Centre of Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
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3
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Hagen AEF, Rodriguez LM, Neighbors C, Nogueira-Arjona R, Sherry SB, Lambe L, Deacon SH, Meier S, Abbass A, Stewart SH. Drinking to Cope Mediates the Association between Dyadic Conflict and Drinking Behavior: A Study of Romantic Couples during the COVID-19 Pandemic. Int J Environ Res Public Health 2023; 20:6332. [PMID: 37510565 PMCID: PMC10379069 DOI: 10.3390/ijerph20146332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023]
Abstract
The COVID-19 pandemic spurred public health measures to reduce viral spread. Concurrently, increases in alcohol consumption and conflict in romantic partnerships were observed. Pre-pandemic research demonstrated a bidirectional association between couples' conflict and drinking. Recent research shows one's drinking motives (proximal predictors of drinking behavior) can influence another person's drinking in close relationships. It is possible that individuals are drinking to cope with distress following romantic conflict. The current study examined 348 cohabitating couples during the first lockdown in the spring of 2020. Our analyses examined coping motives as a mediator between dyadic conflict and drinking behavior using actor-partner interdependence models. Results showed that conflict was associated with greater reports of own drinking in gendered (distinguishable) and nongendered (indistinguishable) analyses through coping motives. Further, in mixed-gender couples, men partners' coping motives predicted less drinking in women, while women partners' coping motives predicted marginally more drinking in men. Partner effects may have been observed due to the increased romantic partner influence during the COVID-19 lockdown. While these results suggest that men's coping motives may be protective against women's drinking, more concerning possibilities are discussed. The importance of considering dyadic influences on drinking is highlighted; clinical and policy implications are identified.
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Affiliation(s)
- Amanda E F Hagen
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | | | - Clayton Neighbors
- Department of Psychology, University of Houston, Houston, TX 77204, USA
| | | | - Simon B Sherry
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Laura Lambe
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - S Hélène Deacon
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Sandra Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Allan Abbass
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
| | - Sherry H Stewart
- Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
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4
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Imbabi T, El-Garhy O, Moustafa M, Sabeq I, Osman A, Sitohy M, Refaat M, Samir A, Abdel Moneim U, El-Badawy M, Abbass A. Author reply to the expression of concern on "Supplementing rabbit diets with butylated hydroxyanisole affects oxidative stress, growth performance, and meat quality" [Animal 16(9) (2021) 100339]. Animal 2023:100868. [PMID: 37357091 DOI: 10.1016/j.animal.2023.100868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023] Open
Affiliation(s)
- T Imbabi
- Faculty of Agriculture, Benha University, Moshtohor 13736, Egypt
| | - O El-Garhy
- Faculty of Agriculture, Benha University, Moshtohor 13736, Egypt
| | - M Moustafa
- Faculty of Agriculture, Benha University, Moshtohor 13736, Egypt
| | - I Sabeq
- Faculty of Veterinary Medicine, Benha University, Moshtohor 13736, Egypt
| | - A Osman
- Faculty of Agriculture, Zagazig University, Zagazig 44511, Egypt
| | - M Sitohy
- Faculty of Agriculture, Zagazig University, Zagazig 44511, Egypt.
| | - M Refaat
- Vice-Dean for Postgraduate and Research Affairs & Ethics Committees, Benha University, Moshtohor 13736, Egypt
| | - A Samir
- Vice-Dean for Postgraduate and Research Affairs, Benha University, Moshtohor 13736, Egypt
| | - U Abdel Moneim
- Dean of Faculty of Agriculture, Zagazig University, Zagazig 44511, Egypt
| | - M El-Badawy
- Dean of Faculty of Agriculture, Benha University, Moshtohor 13736, Egypt
| | - A Abbass
- Dean of Faculty of Veterinary Medicine, Benha University, Moshtohor 13736, Egypt
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5
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Leichsenring F, Abbass A, Heim N, Keefe JR, Kisely S, Luyten P, Rabung S, Steinert C. The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders - an umbrella review based on updated criteria. World Psychiatry 2023; 22:286-304. [PMID: 37159376 PMCID: PMC10168167 DOI: 10.1002/wps.21104] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
To assess the current status of psychodynamic therapy (PDT) as an empirically supported treatment (EST), we carried out a pre-registered systematic umbrella review addressing the evidence for PDT in common mental disorders in adults, based on an updated model for ESTs. Following this model, we focused on meta-analyses of randomized controlled trials (RCTs) published in the past two years to assess efficacy. In addition, we reviewed the evidence on effectiveness, cost-effectiveness and mechanisms of change. Meta-analyses were evaluated by at least two raters using the proposed updated criteria, i.e. effect sizes, risk of bias, inconsistency, indirectness, imprecision, publication bias, treatment fidelity, and their quality as well as that of primary studies. To assess the quality of evidence we applied the GRADE system. A systematic search identified recent meta-analyses on the efficacy of PDT in depressive, anxiety, personality and somatic symptom disorders. High quality evidence in depressive and somatic symptom disorders and moderate quality evidence in anxiety and personality disorders showed that PDT is superior to (inactive and active) control conditions in reducing target symptoms with clinically meaningful effect sizes. Moderate quality evidence suggests that PDT is as efficacious as other active therapies in these disorders. The benefits of PDT outweigh its costs and harms. Furthermore, evidence was found for long-term effects, improving functioning, effectiveness, cost-effectiveness and mechanisms of change in the aforementioned disorders. Some limitations in specific research areas exist, such as risk of bias and imprecision, which are, however, comparable to those of other evidence-based psychotherapies. Thus, according to the updated EST model, PDT proved to be an empirically-supported treatment for common mental disorders. Of the three options for recommendation provided by the updated model (i.e., "very strong", "strong" or "weak"), the new EST criteria suggest that a strong recommendation for treating the aforementioned mental disorders with PDT is the most appropriate option. In conclusion, PDT represents an evidence-based psychotherapy. This is clinically important since no single therapeutic approach fits all psychiatric patients, as shown by the limited success rates across all evidence-based treatments.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | | | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - John R Keefe
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, NY, USA
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sven Rabung
- Department of Psychology, University of Klagenfurt, Klagenfurt, Austria
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
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6
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Heim N, Abbass A, Luyten P, Rabung S, Steinert C, Leichsenring F. Contradictions, methodological flaws, and potential for misinterpretations in ranking treatments of depression. Bipolar Disord 2023; 25:335-336. [PMID: 36949603 DOI: 10.1111/bdi.13323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Affiliation(s)
- Nikolas Heim
- International Psychoanalytic University (IPU), Berlin, Germany
| | - Allan Abbass
- Department of Psychiatry and The Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sven Rabung
- Department of Psychology, University of Klagenfurt, Klagenfurt, Austria
| | - Christiane Steinert
- International Psychoanalytic University (IPU), Berlin, Germany
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
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7
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Malda-Castillo J, Howell B, Russell L, Town J, Abbass A, Perez-Algorta G, Valavanis S. Intensive Short-Term Dynamic Psychotherapy (ISTDP) associated with healthcare reductions in patients with functional seizures. Epilepsy Behav 2023; 141:109147. [PMID: 36924611 DOI: 10.1016/j.yebeh.2023.109147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/30/2023] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
Intensive Short-Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of Functional Neurological Disorders (FND) including functional seizures. This paper aimed to further examine the therapeutic effects of a 3-session course of this treatment focusing on its potential to maintain reduced healthcare utility within a group of patients with complex difficulties, across an extended time period, post-therapy. The original study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Seventeen participants completed the intervention and attendance rates were very high (95%). In this follow-up study, which was solely focused on the utilization of healthcare resources, results showed decreases when comparing 12 months prior and 12 months post three sessions of ISTDP. The results provide further support for the use of ISTDP in this group of participants with complex clinical presentations, specifically, its capacity to reduce healthcare usage over 12 months post-therapy. Further evidence from controlled and randomized studies with larger sample sizes is warranted.
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Affiliation(s)
- Javier Malda-Castillo
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK.
| | - Bethany Howell
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK.
| | - Leo Russell
- Functional Neurological Disorder Service, Devon Partnership NHS Trust, Exeter, UK.
| | - Joel Town
- The Centre for Emotions and Health, Dalhousie University, Halifax, Canada.
| | - Allan Abbass
- The Centre for Emotions and Health, Dalhousie University, Halifax, Canada.
| | | | - Sophie Valavanis
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK.
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8
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Basso NL, Lambe LJ, Kim AJ, Rodriguez LM, Deacon H, Nogueira-Arjona R, Sherry SB, Abbass A, Stewart SH. Effects of mandatory homeschooling during COVID-19 on conflict in romantic couples. J Fam Psychol 2023; 37:275-281. [PMID: 36634007 DOI: 10.1037/fam0001052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
In early 2020, schools across Canada closed due to the COVID-19 pandemic, requiring parents to homeschool their children. We examined the association between homeschooling and romantic conflict among couples during the COVID-19 pandemic. Canadian couples (N = 756) completed online measures, including whether they were homeschooling, hours spent homeschooling, and romantic conflict during the month of April 2020. Two hundred ten couples (27.8%) reported that they were homeschooling their children during this period, with 173 (22.9%) couples homeschooling due to the pandemic. Multilevel regressions were used to examine the association between homeschooling status and romantic conflict, and actor-partner interdependence models (APIMs) were used to examine the association between homeschooling hours and romantic conflict among homeschoolers. In our APIM analyses, significant links between hours spent homeschooling and romantic conflict were observed, even when controlling for demographic variables. We found significant actor effects, where an individual's own homeschooling hours were positively related to the conflict they enacted toward their partner, and significant partner effects, where the partner's homeschooling hours were positively related to conflict received by the individual. Among all couples, we found significant positive associations between homeschooling status (i.e., nonhomeschooler or homeschooler) and both types of romantic conflict. However, these associations were nonsignificant when controlling for demographic variables. Our findings suggest the number of hours spent in homeschooling may be an important contributor to romantic conflict between partners during the pandemic. We discuss implications for schools and governments in providing additional support for families homeschooling children during mandated school closures. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Nicole L Basso
- Department of Psychology and Neuroscience, Dalhousie University
| | - Laura J Lambe
- Department of Psychology and Neuroscience, Dalhousie University
| | - Andy J Kim
- Department of Psychology and Neuroscience, Dalhousie University
| | | | - Hélène Deacon
- Department of Psychology and Neuroscience, Dalhousie University
| | | | - Simon B Sherry
- Department of Psychology and Neuroscience, Dalhousie University
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9
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Leichsenring F, Steinert C, Rost F, Abbass A, Heim N, Ioannidis JP. A critical assessment of NICE guidelines for treatment of depression. World Psychiatry 2023; 22:43-45. [PMID: 36640399 PMCID: PMC9840485 DOI: 10.1002/wps.21039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and PsychotherapyUniversity of GiessenGiessenGermany,Department of Psychosomatics and PsychotherapyUniversity of RostockRostockGermany
| | | | | | | | - Nikolas Heim
- International Psychoanalytic UniversityBerlinGermany
| | - John P.A. Ioannidis
- Department of MedicineStanford University School of MedicineStanfordCAUSA,Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCAUSA,Department of Biomedical Data ScienceStanford University School of MedicineStanfordCAUSA,Department of StatisticsStanford University School of Humanities and SciencesStanfordCAUSA,Meta‐Research Innovation Center at StanfordStanfordCAUSA
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10
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Kim AJ, Smith MM, Sherry SB, Rodriguez LM, Meier SM, Nogueira-Arjona R, Deacon H, Abbass A, Stewart SH. Depressive Symptoms and Conflict Behaviors: A Test of the Stress Generation Hypothesis in Romantic Couples During the COVID-19 Pandemic. Journal of Social and Clinical Psychology 2022. [DOI: 10.1521/jscp.2022.41.6.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: In early 2020, North American jurisdictions required households (e.g., romantic couples) to isolate together to help mitigate the spread of COVID-19. This study provides a first look at the interplay of depressive symptoms and conflict behaviors among isolating couples, including tests of predictions of the stress generation hypothesis. Methods: Mixed-gender couples residing in Canada (N = 711) completed online measures across two waves. We used the actor-partner interdependence mediation model, with Wave 1 depressive symptoms as the predictor, Wave 1 conflict enactment as the mediator, and Wave 2 depressive symptoms as the outcome. Results: Depressive symptoms showed stability across Wave 1 and 2. Wave 1 depressive symptoms showed associations with Wave 1 conflict enactment. For men (but not women), Wave 1 conflict enactment was associated with their own and their partner's Wave 2 depressive symptoms. For both partners, Wave 1 conflict enacted by men mediated the association between Wave 1 depressive symptoms and Wave 2 depressive symptoms. Discussion: Our study confirms and extends the stress generation hypothesis to the pandemic context, showing that depressive symptoms may partially contribute to conflict for isolating couples and that conflict behaviors enacted by men toward their partner can exacerbate depressive symptoms in both partners.
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11
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Leichsenring F, Luyten P, Abbass A, Steinert C. In Reply: Psychodynamic therapy of depression. Aust N Z J Psychiatry 2022; 56:1202-1204. [PMID: 35786011 DOI: 10.1177/00048674221108637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany.,Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Allan Abbass
- Department of Psychiatry and The Centre for Emotions and Health, Dalhousie University, Halifax, NS, Canada
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany.,International Psychoanalytic University Berlin (IPU), Berlin, Germany
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12
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Thoma NC, Abbass A. Intensive short-term dynamic psychotherapy (ISTDP) offers unique procedures for acceptance of emotion and may contribute to the process-based therapy movement. Journal of Contextual Behavioral Science 2022. [DOI: 10.1016/j.jcbs.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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13
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Russell L, Abbass A, Allder S. A review of the treatment of functional neurological disorder with intensive short-term dynamic psychotherapy. Epilepsy Behav 2022; 130:108657. [PMID: 35390566 DOI: 10.1016/j.yebeh.2022.108657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 11/16/2022]
Abstract
The purpose of this article was to raise awareness of an under-recognized but well-supported treatment for Functional Neurological Disorders (FND) termed Intensive Short-term Dynamic Psychotherapy (ISTDP). There has been significant interest in the role of psychological mechanisms in FND onset and maintenance with specific evidence for maladaptive emotional processing. We outline how this supports the theoretical basis for ISTDP as an option in FND treatment and undertake a literature review of the current evidence base. We describe the application of ISTDP to FND illustrated through direct therapy transcripts. We conclude with reflections on the strengths and limitations of ISTDP as well as recommendations regarding future research.
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Affiliation(s)
- Leo Russell
- Clinical Health and Neuropsychology Department, Devon Partnership NHS Trust, Exeter, United Kingdom.
| | - Allan Abbass
- Centre for Emotions and Health, Dalhousie University, Halifax, Canada
| | - Steven Allder
- Neurological Services, Re:Cognition Health, London, United Kingdom
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14
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Malda Castillo J, Beton E, Coman C, Howell B, Burness C, Martlew J, Russell L, Town J, Abbass A, Perez Algorta G, Valavanis S. Three sessions of intensive short-term dynamic psychotherapy (ISTDP) for patients with dissociative seizures: a pilot study. Psychoanalytic Psychotherapy 2022. [DOI: 10.1080/02668734.2021.2018623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Javier Malda Castillo
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK
| | - Ella Beton
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK
| | - Conor Coman
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK
| | - Bethany Howell
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK
| | - Chrissie Burness
- Functional Neurological Disorder Pathway, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Jayne Martlew
- Functional Neurological Disorder Pathway, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Leo Russell
- Functional Neurological Disorder Service, Devon Partnership NHS Trust, Exeter, UK
| | - Joel Town
- The Centre for Emotions and Health, Dalhousie University, Halifax, Canada
| | - Allan Abbass
- The Centre for Emotions and Health, Dalhousie University, Halifax, Canada
| | | | - Sophie Valavanis
- Personality Disorder & Psychotherapy Hub, Mersey Care NHS Foundation Trust, Merseyside, UK
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15
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Leichsenring F, Abbass A, Heim N, Keefe JR, Luyten P, Rabung S, Steinert C. Empirically supported psychodynamic psychotherapy for common mental disorders-An update applying revised criteria: Systematic review protocol. Front Psychiatry 2022; 13:976885. [PMID: 36186863 PMCID: PMC9520618 DOI: 10.3389/fpsyt.2022.976885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/26/2022] [Indexed: 11/25/2022] Open
Abstract
The approach of evidence-based medicine has been extended to psychotherapy. More than 20 years ago, criteria for empirically supported psychotherapeutic treatments (ESTs) were defined. Meanwhile a new model for empirically supported psychotherapeutic treatments has been proposed. While the empirical status of psychodynamic therapy (PDT) was assessed in several reviews using the previous criteria, the proposed new model has not yet been applied to PDT. For this reason, we will carry out a systematic review on studies of PDT in common mental disorders applying the revised criteria of ESTs. As suggested by the new model we will focus on recent systematic quantitative reviews. A systematic search for meta-analyses on the efficacy of PDT in common mental disorders will be carried out. Meta-analyses will be selected and evaluated by at least two raters along the criteria of the new proposed model. In addition, systematic reviews and individual studies addressing mechanisms of change in PDT, effectiveness under real-world conditions, cost-effectiveness and adverse events will be systematically searched for and evaluated. Finally, quality of evidence, the extent to which benefits exceed harms and strength of recommendations will be assessed per disorder using GRADE.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany.,Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Allan Abbass
- Department of Psychiatry and The Centre for Emotions and Health, Dalhousie University, Halifax, NS, Canada
| | - Nikolas Heim
- International Psychoanalytic University (IPU), Berlin, Germany
| | - John R Keefe
- Department of Psychiatry, Weill Medical College of Cornell University, New York, NY, United States
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Sven Rabung
- Department of Psychology, University of Klagenfurt, Klagenfurt, Austria
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany.,International Psychoanalytic University (IPU), Berlin, Germany
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16
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and
Psychotherapy, Justus Liebig University Giessen, Giessen, Germany,Department of Psychosomatics and
Psychotherapy, University of Rostock, Rostock, Germany,Falk Leichsenring, Department of Psychosomatics and
Psychotherapy, Justus Liebig University Giessen, Ludwigstrasse 76, Giessen 35392, Germany.
| | - Patrick Luyten
- Faculty of Psychology and Educational
Sciences, University of Leuven, Leuven, Belgium,Research Department of Clinical, Educational
and Health Psychology, University College London, London, UK
| | - Allan Abbass
- Department of Psychiatry, Dalhousie
University, Halifax, NC, Canada,Centre for Emotions and Health, Dalhousie
University, Halifax, NC, Canada
| | - Christiane Steinert
- Department of Psychosomatics and
Psychotherapy, Justus Liebig University Giessen, Giessen, Germany,International Psychoanalytic University
(IPU), Berlin, Germany
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17
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Affiliation(s)
- Allan Abbass
- Dalhousie University, Halifax, Nova Scotia, Canada
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18
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Town JM, Falkenström F, Abbass A, Stride C. The anger-depression mechanism in dynamic therapy: Experiencing previously avoided anger positively predicts reduction in depression via working alliance and insight. J Couns Psychol 2021; 69:326-336. [PMID: 34591500 DOI: 10.1037/cou0000581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A central tenet of psychodynamic theory of depression is the role of avoided anger. However empirical research has not yet addressed the question of for which patients and via what pathways experiencing anger in sessions can help. The therapeutic alliance and acquisition of patient insight are important change processes in dynamic therapy and may mediate the anger-depression association. This study was embedded into a randomized trial testing the efficacy of Intensive Short-Term Dynamic Psychotherapy (ISTDP) for treatment resistant depression. In-session patient affect experiencing (AE) was coded for every available session (475/481) by blinded observers in 27 patients randomized to ISTDP. Dynamic Structural Equation Modeling was used to examine within-person associations between variation in depression scores session-by-session and both patient ratings (alliance) and observer ratings (AE and insight) of the treatment process. Alliance and insight were independent mediators of the effect of anger on next-session depression. However, the relative importance of these two indirect effects of anger on depression was conditional on pretreatment patient personality pathology (PP). In patients with higher PP, in-session anger was negatively related to depressive symptoms next session, with this effect operating through higher alliance. In patients with low PP, in-session anger was negatively related to depressive symptoms next session, with this effect operating through enhanced patient insight. These findings highlight an anger-depression mechanism of change in dynamic therapy. Depending upon patient personality, either an "insight pathway" or a "relational pathway" may promote the effectiveness of facilitating arousal and expression of patients' in-session feelings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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19
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Roggenkamp H, Abbass A, Town JM, Kisely S, Johansson R. Healthcare cost reduction and psychiatric symptom improvement in posttraumatic stress disorder patients treated with intensive short-term dynamic psychotherapy. European Journal of Trauma & Dissociation 2021. [DOI: 10.1016/j.ejtd.2019.100122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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20
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Abbass A, Town J, Holmes H, Luyten P, Cooper A, Russell L, Lumley MA, Schubiner H, Allinson J, Bernier D, De Meulemeester C, Kroenke K, Kisely S. Short-Term Psychodynamic Psychotherapy for Functional Somatic Disorders: A Meta-Analysis of Randomized Controlled Trials. Psychother Psychosom 2021; 89:363-370. [PMID: 32428905 DOI: 10.1159/000507738] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 04/04/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Functionalsomatic disorders (FSD) are common and costly, thereby driving the need for the development of effective brief treatment options. Short-term psychodynamic psychotherapy (STPP) is one candidate treatment method. OBJECTIVE To review and meta-analyze, where possible, randomized controlled trials (RCTs) of STPP for FSD. METHODS Following a systematic search of the literature, we performed a meta-analysis of available RCT groups to determine the effects of STPP on a range of outcomes after treatment, and medium- and long-term follow-ups. RESULTS In meta-analyses of 17 RCTs, STPP significantly outperformed minimal treatment, treatment as usual, or waiting list controls on somatic symptom measures at all time frames, with small to large magnitude effect sizes. Descriptive reviews of 5 RCTs suggest that STPP performed at least as well as other bona fide psychological therapies. Limitations of this meta-analysis include small samples of studies and possible publication bias. CONCLUSIONS STPP is a valid treatment option for diverse FSD conditions resulting in somatic symptom reductions that persist over time. STPP should be included in FSD treatment guidelines.
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Affiliation(s)
- Allan Abbass
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada,
| | - Joel Town
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hannah Holmes
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Patrick Luyten
- University of Leuven, Leuven, Belgium.,University College London, London, United Kingdom
| | - Angela Cooper
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leo Russell
- Devon Partnership NHS Trust, Devon, United Kingdom
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Howard Schubiner
- Ascension Providence Hospital and Michigan State University College of Human Medicine, Southfield, Michigan, USA
| | | | - Denise Bernier
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kurt Kroenke
- Indiana University and Regenstrief Institute, Indianapolis, Indiana, USA
| | - Steve Kisely
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada.,University of Queensland, Woolloongabba, Queensland, Australia
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21
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Standal K, Solbakken OA, Rugkåsa J, Martinsen AR, Halvorsen MS, Abbass A, Heiervang KS. Why Service Users Choose Medication-Free Psychiatric Treatment: A Mixed-Method Study of User Accounts. Patient Prefer Adherence 2021; 15:1647-1660. [PMID: 34326632 PMCID: PMC8315812 DOI: 10.2147/ppa.s308151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Medication has been a central part of treatment for severe mental disorders in Western medicine since the 1950s. In 2015, Norwegian Health Authorities decided that Norwegian health regions must have treatment units devoted to medication-free mental health treatment to enhance service users' freedom of choice. The need for these units has been controversial. The aim of this study was to examine why service users choose medication-free services. This article examines what purpose these units serve in terms of the users' reasons for choosing this service, what is important for them to receive during the treatment, and what factors lay behind their concerns in terms of medication-related views and experiences. METHODS Questionnaires were answered by 46 participants and 5 participants were interviewed in a mixed-method design integrated with a concurrent triangulation strategy applying thematic analysis and descriptive statistics. RESULTS Negative effects of medications and unavailable alternatives to medication in ordinary health care were important reasons for wanting medication-free treatment. Medication use may conflict with personal values, attitudes, and beliefs. CONCLUSION This study broadens the understanding of why the demand for separate medication-free units has arisen. The findings may contribute to making medication-free treatment an option in mental health care in general. To this end, clinicians are advised to communicate all treatment alternatives to service users and to be mindful of the effect of power imbalances in their interactions with them.
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Affiliation(s)
- Kari Standal
- District Psychiatric Center Nedre Romerike, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | | | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Centre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
| | - Astrid Ringen Martinsen
- District Psychiatric Center Nedre Romerike, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Allan Abbass
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristin Sverdvik Heiervang
- Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Centre of Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
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22
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Rocco D, Calvo V, Agrosi V, Bergami F, Busetto LM, Marin S, Pezzetta G, Rossi L, Zuccotti L, Abbass A. Intensive short-term dynamic psychotherapy provided by novice psychotherapists: effects on symptomatology and psychological structure in patients with anxiety disorders. ACTA ACUST UNITED AC 2021; 24:503. [PMID: 33937111 PMCID: PMC8082537 DOI: 10.4081/ripppo.2021.503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/27/2020] [Indexed: 12/25/2022]
Abstract
This study examines the effectiveness of psychotherapy provided by novice therapists, in an attempt to clarify the controversial relationship between treatment effectiveness and therapist experience. To achieve this, we examined the short- and long-term effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with the Diagnostic and Statistical Manual of Mental Disorder, IV edition - Text Revision anxiety disorders, as provided by novice psychology trainees. Twenty-two patients with anxiety disorders were provided ISTDP. Patients improved significantly on all outcome indices, including the global assessment of functioning, the symptom checklist and the inventory of interpersonal problems, at the end of the treatment and at 6 and 12 month follow-up. In addition to these results, there was marked structural personality change as evidenced by ratings on the Shedler Westen assessment procedure (SWAP-200), at the same assessment moments; the SWAP-200 psychological health index score showed a meaningful increase in adaptive psychological resources and capacities, while the mean number of personality diagnoses decreased from the beginning to the end of therapy, and all patients maintaining their gains in 6-12 month follow-up. We conclude that ISTDP provided by novice psychotherapists is efficacious in bringing broad and in-depth change to pathology that can perpetuate anxiety disorders and other psychiatric conditions.
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Affiliation(s)
- Diego Rocco
- Department of Developmental and Social Psychology, University of Padova, Padova, Italy
| | - Vincenzo Calvo
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padova, Italy
| | - Vito Agrosi
- C.I.S.S.P.A.T. Centro Italiano Studio Sviluppo Psicoterapie A breve Termine, Padova, Italy
| | - Francesca Bergami
- C.I.S.S.P.A.T. Centro Italiano Studio Sviluppo Psicoterapie A breve Termine, Padova, Italy
| | - Luce Maria Busetto
- C.I.S.S.P.A.T. Centro Italiano Studio Sviluppo Psicoterapie A breve Termine, Padova, Italy
| | - Silvia Marin
- C.I.S.S.P.A.T. Centro Italiano Studio Sviluppo Psicoterapie A breve Termine, Padova, Italy
| | - Giovanna Pezzetta
- C.I.S.S.P.A.T. Centro Italiano Studio Sviluppo Psicoterapie A breve Termine, Padova, Italy
| | - Luca Rossi
- C.I.S.S.P.A.T. Centro Italiano Studio Sviluppo Psicoterapie A breve Termine, Padova, Italy
| | - Lorenzo Zuccotti
- C.I.S.S.P.A.T. Centro Italiano Studio Sviluppo Psicoterapie A breve Termine, Padova, Italy
| | - Allan Abbass
- Centre for Emotions and Health, Dalhousie University, Canada
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23
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Stewart S, King F, Rodriguez L, Meier S, Sherry S, Abbass A, Deacon H, Nogueira-Arjona R, Hagen A. The effects of excessive and compulsive online searching of COVID-19 information (“cyberchondria”) on general and COVID-19-specific anxiety and fear in romantic couples during lockdown. Eur Psychiatry 2021. [PMCID: PMC9471794 DOI: 10.1192/j.eurpsy.2021.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Cyberchondria involves excessive and uncontrollable online searching of information about a perceived illness. This behavior can cause or maintain distress. Objectives Little is known about cyberchondria during the COVID-19 pandemic or how cyberchondria in one individual may cause distress in their significant other if they are self-isolating together; our study sought to fill these gaps. Methods We conducted a Qualtrics Panel survey with 760 cohabitating Canadian couples; in June 2020, participants retrospectively reported on their cyberchondria behavior, general anxiety, and COVID-19 fears during the month of April 2020, while adhering to stay-at-home advisories. Two separate actor-partner interdependence models (APIMs) used cyberchondria excessiveness and compulsion to predict generalized anxiety and COVID-19 danger/contamination fears in the actor and partner. Results Both cyberchondria excessiveness and compulsion were associated with higher general anxiety and higher COVID-19 danger/contamination fears in the individual (actor effects). Partner cyberchondria compulsion was associated with higher general anxiety in the individual whereas partner cyberchondria excessiveness was associated with higher COVID-19 danger/contamination fears in the individual (partner effects). Conclusions Findings suggest that excessive and uncontrollable searching of information about COVID-19 on the internet during lockdown may contribute to distress in both the individual engaging in the cyberchondria behavior, and in their romantic partner. Moreover, different aspects of cyberchondria in the partner (compulsion vs. excessiveness) appears to contribute to general vs. COVID-19-specific anxiety/fears in the partner, respectively. Future research should examine mechanisms underlying the observed partner effects (e.g., co-rumination, social contagion) and reasons for the differential partner effects of cyberchondria components.
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24
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Leichsenring F, Luyten P, Abbass A, Rabung S, Steinert C. Treatment of depression in children and adolescents. Lancet Psychiatry 2021; 8:96-97. [PMID: 33485417 DOI: 10.1016/s2215-0366(20)30492-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, 35392 Giessen, Germany; Center for Mind, Brain and Behaviour, University of Marburg and Justus Liebig University Giessen, Marburg, Germany; Department of Psychosomatics and Psychotherapy, University of Rostock, Germany.
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Belgium; Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Allan Abbass
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada; Centre for Emotions and Health, Halifax, NS, Canada
| | - Sven Rabung
- Department of Psychology, Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, 35392 Giessen, Germany; International Psychoanalytic University (IPU), Berlin, Germany
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25
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Lilliengren P, Cooper A, Town JM, Kisely S, Abbass A. Clinical- and cost-effectiveness of intensive short-term dynamic psychotherapy for chronic pain in a tertiary psychotherapy service. Australas Psychiatry 2020; 28:414-417. [PMID: 32093498 DOI: 10.1177/1039856220901478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study is to assess the clinical- and cost-effectiveness of intensive short-term dynamic psychotherapy (ISTDP) for patients with chronic pain. METHOD A sample of 228 pain patients was drawn from a larger naturalistic study of ISTDP. They received an average of 6.1 sessions delivered by 31 therapists. Psychiatric symptoms and interpersonal problems were assessed at three time points. Healthcare data from baseline year and three years following treatment came from independent governmental databases. RESULTS Multilevel models indicated significant reductions in symptoms and interpersonal problems during treatment, including a moderate to large pre-post effect size (d = 0.76) for somatization. Further, the sample had successive reductions in yearly healthcare costs, reaching the normal population mean two years post-treatment. CONCLUSION Within the limitations of the uncontrolled design, our study suggests that ISTDP may be both clinically effective and cost-effective for patients with chronic pain.
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Affiliation(s)
- Peter Lilliengren
- Department of Health Care Sciences, St Lukas Educational Institute, Ersta Sköndal Bräcke University College, Sweden
| | - Angela Cooper
- Centre for Emotions and Health, Dalhousie University, Canada
| | - Joel M Town
- Centre for Emotions and Health, Dalhousie University, Canada
| | - Steve Kisely
- School of Medicine, The University of Queensland, Australia
| | - Allan Abbass
- Centre for Emotions and Health, Dalhousie University, Canada
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26
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Caldiroli A, Capuzzi E, Riva I, Russo S, Clerici M, Roustayan C, Abbass A, Buoli M. Efficacy of intensive short-term dynamic psychotherapy in mood disorders: A critical review. J Affect Disord 2020; 273:375-379. [PMID: 32560931 DOI: 10.1016/j.jad.2020.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/14/2020] [Accepted: 04/01/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intensive Short-Term Dynamic Psychotherapy (ISTDP) is an intervention introduced by Davanloo in order to treat anxiety, mood and somatic symptom, and personality disorders. It is a brief intervention aiming to identify and process painful or forbidden emotions and consequently to override symptoms and self-destructive tendencies. In this review we examine the efficacy of ISTDP on symptoms in patients with Major Depressive Disorder (MDD) and Bipolar Disorder (BD). METHODS A thorough search of articles in Pubmed, PsycINFO, Isi Web of Knowledge was carried out in order to obtain available studies of ISTDP for BD and MDD. We included all studies conducted on patients with a diagnosis of MDD or BD and who received ISTDP. RESULTS Eight studies were included. These were two randomized controlled trials and six observational studies. Overall the results of the included manuscripts suggest a positive effect of ISTDP on depressive symptoms for patients affected by mood disorders. Furthermore, they suggest ISTDP may be cost-effective through reducing doctor visits and hospitalizations in follow-up. LIMITATIONS Most studies had small samples and consisted of non-randomized trials. CONCLUSIONS These are preliminary positive results on the effectiveness of this approach for the treatment of depressive symptoms. They have to be confirmed by studies with larger sample sizes and by comparing this technique with other psychological treatments such as cognitive-behavioral therapy.
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Affiliation(s)
- Alice Caldiroli
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Enrico Capuzzi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Irene Riva
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, Monza, MB, 20900, Italy
| | - Stefania Russo
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, Monza, MB, 20900, Italy
| | - Massimo Clerici
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy; Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 38, Monza, MB, 20900, Italy
| | | | - Allan Abbass
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
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27
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Town JM, Abbass A, Stride C, Nunes A, Bernier D, Berrigan P. Efficacy and cost-effectiveness of intensive short-term dynamic psychotherapy for treatment resistant depression: 18-Month follow-up of the Halifax depression trial. J Affect Disord 2020; 273:194-202. [PMID: 32421603 DOI: 10.1016/j.jad.2020.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/01/2020] [Accepted: 04/24/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Depressed patients with chronic and complex health issues commonly relapse; therefore, examining longer-term outcomes is an important consideration. For treatment resistant depression (TRD), the post-treatment efficacy of time-limited Intensive Short-Term Dynamic Psychotherapy (ISTDP) has been demonstrated but longer-term outcomes and cost-effectiveness are unclear. METHOD In this superiority trial, 60 patients referred to Community Mental Health Teams (CMHT) were randomised to 2 groups (ISTDP=30 and CMHT=30). The primary outcome was Hamilton Depression Rating scale (HAM-D) scores at 18 months. Secondary outcomes included Patient Health Questionnaire (PHQ-9) depression scores and dichotomous measure remission. A health economic evaluation examined mental health costs with quality-adjusted life years (QALYs). RESULTS Statistically significant treatment differences in depression previously found at 6 months favouring ISTDP were maintained at 18-month follow-up. Group differences in depression were in the moderate to large range on both the observer rated (Cohen's d = .64) and self-report measures (Cohen's d = .70). At 18 months follow-up the remission rate in ISTDP patients was 40.0%, and 23.4% had discontinued antidepressants. Health economic analysis suggests that ISTDP was more cost-effective than CMHT at 18 months. Probabilistic analysis suggests that there is a 64.5% probability of ISTDP being cost-effective at a willingness to pay for a QALY of $25,000 compared to CMHT at 18 months. LIMITATIONS Replication of these findings is necessary in larger samples and future cost analyses should also consider indirect costs. CONCLUSIONS ISTDP demonstrates long-term efficacy and cost-effectiveness in TRD.
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Affiliation(s)
- Joel M Town
- Department of Psychiatry, Dalhousie University, Halifax, Canada.
| | - Allan Abbass
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Chris Stride
- The Institute of Work Psychology, University of Sheffield, Sheffield, UK
| | - Abraham Nunes
- Department of Psychiatry & Faculty of Computer Science, Dalhousie University, Halifax, Canada
| | - Denise Bernier
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Patrick Berrigan
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Canada
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28
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Rahmani F, Abbass A, Hemmati A, Ghaffari N, Rezaei Mirghaed S. Challenging the role of challenge in intensive short-term dynamic psychotherapy for social anxiety disorder: A randomized controlled trial. J Clin Psychol 2020; 76:2123-2132. [PMID: 32567708 DOI: 10.1002/jclp.22993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/13/2020] [Accepted: 05/20/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Intensive short-term dynamic psychotherapy (ISTDP) requires the technique of challenge to defenses when treating resistant patients. As the technique of challenge is difficult for some therapists to practice, it leads us to question whether challenge can be replaced by clarification of defenses without losing treatment effectiveness. This study compared ISTDP with two different technical emphases while treating social anxiety disorder (SAD). METHOD Forty-two subjects with DSM-5 SAD were randomly assigned to either a waitlist control, 10 sessions of ISTDP with the use of challenge or 10 sessions of ISTDP without the use of challenge. RESULTS ISTDP led to significant, sustained symptom reduction on the Liebowitz Social Anxiety Scale (LSAS-SR) compared with the control group. There were no significant outcome differences between standard ISTDP and ISTDP where challenge was restricted. CONCLUSION ISTDP is efficacious for SAD. ISTDP may be effective for SAD without the use of challenge elements.
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Affiliation(s)
- Fateh Rahmani
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
| | - Allan Abbass
- Centre for Emotions and Health, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Azad Hemmati
- Department of Psychology, University of Kurdistan, Sanandaj, Iran
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Luyten P, Leichsenring F, Abbass A, Hilsenroth M, Rabung S, Steinert C. What to conclude from a non-randomized clinical trial comparing dialectical behavior therapy and mentalization-based treatment in patients with borderline personality disorder? Psychol Med 2019; 49:2810-2811. [PMID: 31535604 DOI: 10.1017/s0033291719001922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Tiensestraat 102 - PO Box 3722, 3000 Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK
| | - Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Ludwigstr. 76, 35392 Giessen, Germany
| | - Allan Abbass
- Department of Psychiatry, Dalhousie University, Centre for Emotions and Health, Halifax, 8203 5909 Veterans Memorial Lane, Halifax, NS, Canada B3H 2E2
| | - Mark Hilsenroth
- Derner School of Psychology, Adelphi University, Hy Weinberg Center, 1 South Avenue, Garden City, NY 11530-0701, USA
| | - Sven Rabung
- Department of Psychology, Alpen-Adria-Universität Klagenfurt, Universitätsstr. 65-67, A-9020 Klagenfurt, Austria
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Ludwigstr. 76, 35392 Giessen, Germany
- Department of Psychology, MSB Medical School Berlin, Calandrellistr. 1-9, 12247 Berlin, Germany
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30
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Iyar MM, Kealy D, Giannone Z, Ogrodniczuk J, Abbass A, Joyce AS. Where does it hurt? Location of pain, psychological distress, and alexithymia among outpatients seeking psychotherapy. Int J Psychiatry Clin Pract 2019; 23:293-296. [PMID: 31271073 DOI: 10.1080/13651501.2019.1617883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Objectives: Physical pain is prevalent among psychiatric outpatients, yet there has been little research regarding the types of pain reported. The purpose of this study was to survey outpatients seeking psychotherapy regarding pain locations and to examine associations between number of pain locations and psychiatric distress and alexithymia.Methods: Two hundred and seventeen patients were recruited from three Canadian hospitals that offer outpatient psychiatry services and short-term therapies. Participants were surveyed about their current physical pain using the Brief Pain Inventory. Participants also completed measures of psychiatric distress (Brief Symptom Inventory-18) and alexithymia (Toronto Alexithymia Scale-20).Results: The three most commonly reported pain locations were lower back, head, and neck. Findings revealed that anxiety, depression and alexithymia were associated with number of reported pain locations. Specifically, participants with three or more pain locations reported significantly higher depression, anxiety and alexithymia in comparison to those with no pain.Conclusions: Back, head and neck pains are highly prevalent among psychiatric outpatients. Multiple pain sites may reflect higher levels of psychiatric distress and greater impairment in emotional processing among psychiatric outpatients.
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Affiliation(s)
- Megumi M Iyar
- St. Paul's Hospital Eating Disorders Program, Vancouver, Canada.,Department of Psychology, University of British Columbia, Kelowna, Canada
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Zarina Giannone
- Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, Canada
| | - John Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Allan Abbass
- Department of Psychiatry, The Centre for Emotions and Health, Dalhousie University, Halifax, Canada
| | - Anthony S Joyce
- Department of Psychiatry, University of Alberta, Edmonton, Canada
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Watt P, Abbass A. A Comparative Case Study of the Impact of Psychotherapy on Inflammatory Bowel Disease Patients. Inflamm Bowel Dis 2019; 25:e130-e131. [PMID: 31318415 DOI: 10.1093/ibd/izz160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Frederickson J, DenDooven B, Abbass A, Solbakken OA, Rousmaniere T. Pilot study: An inpatient drug rehabilitation program based on intensive short-term dynamic psychotherapy. J Addict Dis 2019; 37:195-201. [PMID: 31507253 DOI: 10.1080/10550887.2019.1658513] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Addiction programs are plagued with high dropout and relapse rates. A large proportion of patients suffering from addiction also suffer from personality disorders. A 30-day inpatient program based on intensive short-term dynamic psychotherapy was developed to address features of personality disorders such as anxiety regulation, emotion recognition, and handling of fear responses and projective processes. The hypothesis was that addressing comorbid symptoms of personality disorder might improve recovery from drug addiction. We used a pilot randomized controlled trial design with six-month follow-up of both cases and controls. Rates of remission, relapse and drop out were recorded at each time point. N-1 chi-squared (χ2) tests were conducted to examine the statistical significance of differences in outcomes in patients receiving the experimental treatment and controls. A control group of 20 patients and an experimental group of 42 patients were treated. Dropout: control group 40%; experimental group 23.8%. Sobriety at six months: control group 17.6%, experimental group 48.8%. Future study is warranted to examine intensive short-term dynamic psychotherapy's long-term effects, study moderators of effects, and study its efficacy using a randomized controlled design.
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Affiliation(s)
| | - Bonnie DenDooven
- Bridges Drug Rehabilitation Center, Bridges Network, Prescott, AZ, USA
| | - Allan Abbass
- Centre for Emotions and Health, Dalhousie University, Halifax, Canada
| | - Ole Andre Solbakken
- Department of Psychology, Universitetet i Oslo Det Samfunnsvitenskapelige Fakultet, Oslo, Norway
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Sorensen B, Abbass A, Boag S. ISTDP and Its Contribution to the Understanding and Treatment of Psychotic Disorders. Psychodyn Psychiatry 2019; 47:291-316. [PMID: 31448983 DOI: 10.1521/pdps.2019.47.3.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this article, we review Davanloo's metapsychology of the unconscious and how it can contribute to the current psychodynamic understanding and treatment of psychosis. In this framework, current attachment and emotions become connected with unconscious conflict-laden feelings about early attachment trauma at the core of the unconscious conflict. These conflict-laden feelings mobilize unconscious anxiety and defenses, which are alongside or, in and of themselves, constitute the entire picture of psychosis. Those patients with low emotional capacities are provided specific therapeutic techniques to bolster anxiety tolerance while those more defended patients are offered means to begin to accept and experience the feelings they have about present and past adverse experiences including those caused by psychosis itself. Case and case series research have shown this model to be clinically effective and cost effective as an adjunct to care. Case vignettes will describe the assessment of capacities and treatment frame for patients with a history of psychosis. Davanloo's metapsychology of the unconscious offers an important contribution to the current psychodynamic understanding of psychosis by considering the role of attachment, emotions and unconscious conflict and addressing these through specific psychodynamic interventions.
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Affiliation(s)
| | - Allan Abbass
- Professor, Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Simon Boag
- Associate Professor, Department of Psychology, Macquarie University, NSW, Australia
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Abbass A, Leichsenring F, Steinert C. Re: Jing et al., the efficacy of cognitive behavioural therapy in somatoform disorders and medically unexplained physical symptoms: A meta-analysis of randomized controlled trials. J Affect Disord 2019; 255:S0165-0327(18)33197-5. [PMID: 30819582 DOI: 10.1016/j.jad.2019.02.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/19/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Allan Abbass
- Psychiatry Dalhousie University, Rm 7507, 5909 Veterans Memorial Lane, Halifax, NS B3H 2E2, Canada.
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Leichsenring F, Abbass A, Hilsenroth M, Luyten P, Rabung S, Steinert C. Equivalence testing: reversed hypotheses, margins, and the need for controlling researcher allegiance. Psychol Med 2019; 49:876-878. [PMID: 30460890 DOI: 10.1017/s0033291718003380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy,Justus-Liebig-University Giessen,Ludwigstr. 76, 35392 Giessen,Germany
| | - Allan Abbass
- Department of Psychiatry,Dalhousie University, Centre for Emotions and Health,Halifax, 8203 5909 Veterans Memorial Lane, Halifax, NS, Canada, B3H 2E2,Canada
| | - Mark Hilsenroth
- Derner School of Psychology, Adelphi University, Hy Weinberg Center,1 South Avenue, Garden City, NY 11530-0701,USA
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences,University of Leuven, Klinische Psychologie (OE),Tiensestraat 102 - bus 3722, 3000 Leuven,Belgium
| | - Sven Rabung
- Department of Psychology,Alpen-Adria-Universität Klagenfurt,Universitätsstr. 65-67, A-9020 Klagenfurt,Austria
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy,Justus-Liebig-University Giessen,Ludwigstr. 76, 35392 Giessen,Germany
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Abbass A, Town J, Johansson R, Lahti M, Kisely S. Sustained Reduction in Health Care Service Usage after Adjunctive Treatment of Intensive Short-Term Dynamic Psychotherapy in Patients with Bipolar Disorder. Psychodyn Psychiatry 2019; 47:99-112. [PMID: 30840559 DOI: 10.1521/pdps.2019.47.1.99] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to evaluate changes in long-term health care costs and symptom severity after adjunctive intensive short-term dynamic psychotherapy (ISTDP) individually tailored and administered to patients with bipolar disorder undergoing standard psychiatric care. Eleven therapists with different levels of expertise delivered an average of 4.6 one-hour sessions of ISTDP to 29 patients with bipolar disorders. Health care service costs were compiled for a one-year period prior to the start of ISTDP along with four one-year periods after termination. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination of ISTDP. Hospital cost reductions were significant for the one-year post-treatment period relative to baseline year, and all cost reductions were sustained for the follow-up period of four post-treatment years. Self-reported psychiatric symptoms and interpersonal problems were significantly reduced. These preliminary findings suggest that this brief adjunctive psychotherapy may be beneficial and cost-effective in select patients with bipolar disorders, and that gains may be sustained in long-term followup. Future research directions are discussed.
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Affiliation(s)
- Allan Abbass
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joel Town
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Melissa Lahti
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steve Kisely
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.,School of Medicine, The University of Queensland, Australia
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Abbass A, Kisley S, Town J. Cost-Effectiveness of Intensive Short-Term Dynamic Psychotherapy Trial Therapy. Psychother Psychosom 2018; 87:255-256. [PMID: 29635230 DOI: 10.1159/000487600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/11/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Allan Abbass
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Steve Kisley
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Joel Town
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Abbass A, Burke N, Clarke DD. Psychotherapeutics for Chronic Pain Extends Beyond Cognitive Behavioral Therapy. JAMA Intern Med 2018; 178:1432-1433. [PMID: 30285137 DOI: 10.1001/jamainternmed.2018.5332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Allan Abbass
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nancy Burke
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Ludwigstr 76, D-35392 Giessen, Germany
| | - Allan Abbass
- Department of Psychiatry, Dalhousie University, Centre for Emotions and Health, Halifax 8203-5909 Veterans Memorial Lane, Halifax, NS B3H 2E2, Canada
| | - Ellen Driessen
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Mark Hilsenroth
- Derner School of Psychology, Adelphi University, Hy Weinberg Center, 1 South Avenue, Garden City, NY 11530-0701, USA
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Klinische Psychologie (OE), Tiensestraat 102 - bus 3722, 3000 Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London WC1E 6BT, UK
| | - Sven Rabung
- Department of Psychology, Alpen-Adria-Universität Klagenfurt, Universitätsstr, 65-67, A-9020 Klagenfurt, Austria
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Ludwigstr 76, D-35392 Giessen, Germany
- Department of Psychology, MSB Medical School Berlin, Calandrellistr. 1-9, 12247 Berlin, Germany
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40
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McPherson S, Rost F, Town J, Abbass A. Epistemological flaws in NICE review methodology and its impact on recommendations for psychodynamic psychotherapies for complex and persistent depression. Psychoanalytic Psychotherapy 2018. [DOI: 10.1080/02668734.2018.1458331] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, UK
| | - Felicitas Rost
- Portman Clinic, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Joel Town
- Faculty of Medicine, Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Allan Abbass
- Faculty of Medicine, Centre for Emotions and Health, Dalhousie University, Halifax, Canada
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41
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Leichsenring F, Abbass A, Hilsenroth MJ, Luyten P, Munder T, Rabung S, Steinert C. "Gold Standards," Plurality and Monocultures: The Need for Diversity in Psychotherapy. Front Psychiatry 2018; 9:159. [PMID: 29740361 PMCID: PMC5928423 DOI: 10.3389/fpsyt.2018.00159] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/09/2018] [Indexed: 12/26/2022] Open
Abstract
For psychotherapy of mental disorders, presently several approaches are available, such as interpersonal, humanistic, systemic, psychodynamic or cognitive behavior therapy (CBT). Pointing to the available evidence, proponents of CBT claim that CBT is the gold standard. Some authors even argue for an integrated CBT-based form of psychotherapy as the only form of psychotherapy. CBT undoubtedly has its strengths and CBT researchers have to be credited for developing and testing treatments for many mental disorders. A critical review, however, shows that the available evidence for the theoretical foundations of CBT, assumed mechanisms of change, quality of studies, and efficacy is not as robust as some researchers claim. Most important, there is no consistent evidence that CBT is more efficacious than other evidence-based approaches. These findings do not justify regarding CBT as the gold standard psychotherapy. They even provide less justification for the idea that the future of psychotherapy lies in one integrated CBT-based form of psychotherapy as the only type of psychotherapy. For the different psychotherapeutic approaches a growing body of evidence is available. These approaches have their strengths because of differences in their respective focus on interpersonal relationships, affects, cognitions, systemic perspectives, experiential, or unconscious processes. Different approaches may be suitable to different patients and therapists. As generally assumed, progress in research results from openness to new ideas and learning from diverse perspectives. Thus, different forms of evidence-based psychotherapy are required. Plurality is the future of psychotherapy, not a uniform "one fits all" approach.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany
| | - Allan Abbass
- Department of Psychiatry, Centre for Emotions and Health, Dalhousie University, Halifax, NS, Canada
| | - Mark J Hilsenroth
- The Derner Institute of Advanced Psychological Studies, Adelphi University, Hy Weinberg Center, Garden City, NY, United States
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | | | - Sven Rabung
- Department of Psychology, Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University Giessen, Giessen, Germany.,Department of Psychology, Medical School Berlin, Berlin, Germany
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Cooper A, Abbass A, Town J. Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting. J Clin Med 2017; 6:jcm6120109. [PMID: 29186054 PMCID: PMC5742798 DOI: 10.3390/jcm6120109] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 12/24/2022] Open
Abstract
Medically unexplained symptoms (MUS) are known to be costly, complex to manage and inadequately addressed in primary care settings. In many cases, there are unresolved psychological and emotional processes underlying these symptoms, leaving traditional medical approaches insufficient. This paper details the implementation of an evidence-based, emotion-focused psychotherapy service for MUS across two family medicine clinics. The theory and evidence-base for using Intensive Short-Term Dynamic Psychotherapy (ISTDP) with MUS is presented along with the key service components of assessment, treatment, education and research. Preliminary outcome indicators showed diverse benefits. Patients reported significantly decreased somatic symptoms in the Patient Health Questionnaire-15 (d = 0.4). A statistically significant (23%) decrease in family physicians’ visits was found in the 6 months after attending the MUS service compared to the 6 months prior. Both patients and primary care clinicians reported a high degree of satisfaction with the service. Whilst further research is needed, these findings suggest that a direct psychology service maintained within the family practice clinic may assist patient and clinician function while reducing healthcare utilization. Challenges and further service developments are discussed, including the potential benefits of re-branding the service to become a ‘Primary Care Psychological Consultation and Treatment Service’.
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Affiliation(s)
- Angela Cooper
- Centre for Emotions & Health, Departments of Psychiatry & Family Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada.
| | - Allan Abbass
- Centre for Emotions & Health, Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada.
| | - Joel Town
- Centre for Emotions & Health, Department of Psychiatry, Dalhousie University, Halifax, NS B3H 2E2, Canada.
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Luyten P, Keefe JR, Hilsenroth M, Abbass A, Barber J. Science is what we need in the treatment of anxiety disorders. Lancet 2017; 390:229. [PMID: 28721877 DOI: 10.1016/s0140-6736(17)31802-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 06/12/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London WC1E 6BT, UK; Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.
| | - John R Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Hilsenroth
- Derner School of Psychology, Adelphi University, Garden City, NY, USA
| | - Allan Abbass
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jacques Barber
- Derner School of Psychology, Adelphi University, Garden City, NY, USA
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Lilliengren P, Johansson R, Town JM, Kisely S, Abbass A. Intensive Short-Term Dynamic Psychotherapy for generalized anxiety disorder: A pilot effectiveness and process-outcome study. Clin Psychol Psychother 2017; 24:1313-1321. [DOI: 10.1002/cpp.2101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 05/16/2017] [Accepted: 05/23/2017] [Indexed: 11/12/2022]
Affiliation(s)
| | - Robert Johansson
- Department of Clinical Neuroscience; Karolinska Institute; Stockholm Sweden
| | - Joel M. Town
- Plymouth University Peninsula Schools of Medicine and Dentistry; Plymouth UK
- Centre for Emotions and Health; Dalhousie University; Nova Scotia Canada
| | - Steve Kisely
- School of Medicine; The University of Queensland; Queensland Australia
| | - Allan Abbass
- Centre for Emotions and Health; Dalhousie University; Nova Scotia Canada
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Town JM, Abbass A, Stride C, Bernier D. A randomised controlled trial of Intensive Short-Term Dynamic Psychotherapy for treatment resistant depression: the Halifax Depression Study. J Affect Disord 2017; 214:15-25. [PMID: 28266318 DOI: 10.1016/j.jad.2017.02.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/14/2017] [Accepted: 02/28/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND While short-term psychodynamic psychotherapies have been shown effective for major depression, it is unclear if this could be a treatment of choice for depressed patients, many of whom have chronic and complex health issues, who have not sufficiently responded to treatment. METHOD This superiority trial used a single blind randomised parallel group design to test the efficacy of time-limited Intensive Short-Term Dynamic Psychotherapy (ISTDP) for treatment resistant depression (TRD). Patients referred to secondary care community mental health teams (CMHT) who met DSM-IV criteria for major depressive episode, had received antidepressant treatment ≥6 weeks, and had Hamilton Depression Rating Scale (HAM-D) scores of ≥16 were recruited. The effects of 20 sessions of ISTDP were judged through comparison against secondary care CMHT treatment as usual (TAU). The primary outcome was HAM-D scores at 6 months. Secondary outcomes included the Patient Health Questionnaire (PHQ-9) self-report measures for depression and dichotomous measures of both remission (defined as HAM-D score ≤7) and partial remission (defined as HAM-D score ≤12). RESULTS Sixty patients were randomised to 2 groups (ISTDP=30 and TAU=30), with data collected at baseline, 3, and 6 months. Multi-level linear regression modelling showed that change over time on both depression scales was significantly greater in the ISTDP group in comparison to TAU. Statistically significant between-group treatment differences, in the moderate to large range, favouring ISTDP, were observed on both the observer rated (Cohen's d=0.75) and self-report measures (Cohen's d=0.85) of depression. Relative to TAU, patients in the ISTDP group were significantly more likely after 6 months to achieve complete remission (36.0% vs. 3.7%) and partial remission (48.0% vs. 18.5%). LIMITATIONS It is unclear if the results are generalizable to other providers, geographical locations and cultures. CONCLUSIONS Time-limited ISTDP appears an effective treatment option for TRD, showing large advantages over routine treatment delivered by secondary care services.
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Affiliation(s)
- Joel M Town
- Centre for Emotions & Health, Department of Psychiatry, Dalhousie University, Halifax, Canada; Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.
| | - Allan Abbass
- Centre for Emotions & Health, Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Chris Stride
- The Institute of Work Psychology, University of Sheffield, Sheffield, UK
| | - Denise Bernier
- Department of Psychiatry, Dalhousie University, Halifax, Canada
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Leichsenring F, Abbass A, Hilsenroth MJ, Leweke F, Luyten P, Keefe JR, Midgley N, Rabung S, Salzer S, Steinert C. Biases in research: risk factors for non-replicability in psychotherapy and pharmacotherapy research. Psychol Med 2017; 47:1000-1011. [PMID: 27955715 DOI: 10.1017/s003329171600324x] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Replicability of findings is an essential prerequisite of research. For both basic and clinical research, however, low replicability of findings has recently been reported. Replicability may be affected by research biases not sufficiently controlled for by the existing research standards. Several biases such as researcher allegiance or selective reporting are well-known for affecting results. For psychotherapy and pharmacotherapy research, specific additional biases may affect outcome (e.g. therapist allegiance, therapist effects or impairments in treatment implementation). For meta-analyses further specific biases are relevant. In psychotherapy and pharmacotherapy research these biases have not yet been systematically discussed in the context of replicability. Using a list of 13 biases as a starting point, we discuss each bias's impact on replicability. We illustrate each bias by selective findings of recent research, showing that (1) several biases are not yet sufficiently controlled for by the presently applied research standards, (2) these biases have a pernicious effect on replicability of findings. For the sake of research credibility, it is critical to avoid these biases in future research. To control for biases and to improve replicability, we propose to systematically implement several measures in psychotherapy and pharmacotherapy research, such as adversarial collaboration (inviting academic rivals to collaborate), reviewing study design prior to knowing the results, triple-blind data analysis (including subjects, investigators and data managers/statisticians), data analysis by other research teams (crowdsourcing), and, last not least, updating reporting standards such as CONSORT or the Template for Intervention Description and Replication (TIDieR).
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Affiliation(s)
- F Leichsenring
- Department of Psychosomatics and Psychotherapy,Justus-Liebig-University Giessen,Giessen,Germany
| | - A Abbass
- Department of Psychiatry,Dalhousie University,Centre for Emotions and Health,Halifax,NS,Canada
| | - M J Hilsenroth
- The Derner Institute of Advanced Psychological Studies,Adelphi University,NY,USA
| | - F Leweke
- Department of Psychosomatics and Psychotherapy,Justus-Liebig-University Giessen,Giessen,Germany
| | - P Luyten
- Faculty of Psychology and Educational Sciences,University of Leuven,Klinische Psychologie (OE),Leuven,Belgium
| | - J R Keefe
- Department of Psychology,University of Pennsylvania,Philadelphia,PA,USA
| | | | - S Rabung
- Department of Psychology,Alpen-Adria-Universität Klagenfurt,Universitätsstr,Klagenfurt,Austria
| | - S Salzer
- Clinic of Psychosomatic Medicine and Psychotherapy,Georg-August-Universität Goettingen,Göttingen,Germany
| | - C Steinert
- Department of Psychosomatics and Psychotherapy,Justus-Liebig-University Giessen,Giessen,Germany
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Abbass A. Review of Transference focused psychotherapy for borderline personality disorder: A clinical guide. Psychoanalytic Psychology 2017. [DOI: 10.1037/pap0000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Town JM, Abbass A, Driessen E, Luyten P, Weerasekera P. Updating the Evidence and Recommendations for Short-Term Psychodynamic Psychotherapy in the Treatment of Major Depressive Disorder in Adults. Can J Psychiatry 2017; 62:73-74. [PMID: 28055257 PMCID: PMC5302114 DOI: 10.1177/0706743716676751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Joel M Town
- PenCLAHRC, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK.,Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia
| | - Allan Abbass
- Centre for Emotions and Health, Dalhousie University, Halifax, Nova Scotia
| | - Ellen Driessen
- Department of Clinical, Neuro, and Developmental Psychology, VU University Amsterdam, Amsterdam, The Netherlands EMGO Institute for Health and Care Research, VU University Amsterdam and VU University Medical Center, Amsterdam, The Netherlands
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium.,Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
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Kenny DT, Arthey S, Abbass A. Identifying attachment ruptures underlying severe music performance anxiety in a professional musician undertaking an assessment and trial therapy of Intensive Short-Term Dynamic Psychotherapy (ISTDP). Springerplus 2016; 5:1591. [PMID: 27652164 PMCID: PMC5026982 DOI: 10.1186/s40064-016-3268-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 09/08/2016] [Indexed: 11/11/2022]
Abstract
Introduction Kenny has proposed that severe music performance anxiety that is unresponsive to usual treatments such as cognitive-behaviour therapy may be one manifestation of unresolved attachment ruptures in early life. Intensive Short-Term Dynamic Psychotherapy specifically targets early relationship trauma. Accordingly, a trial of Intensive Short-Term Dynamic Psychotherapy with severely anxious musicians was implemented to assess whether resolution of attachment ruptures resulted in clinically significant relief from music performance anxiety. Methods Volunteer musicians participating in a nationally funded study were screened for MPA severity. Those meeting the critical cut-off score on the Kenny Music Performance Anxiety Inventory were offered a trial of Intensive Short-Term Dynamic Psychotherapy. In this paper, we present the theoretical foundations and rationale for the treatment approach, followed by sections of a verbatim transcript and process analysis of the assessment phase of treatment that comprised a 3-h trial therapy session. Case description The ‘case’ was a professional orchestral musician (male, aged 55) who had suffered severe music performance anxiety over the course of his entire career, which spanned more than 30 years at the time he presented for treatment following his failure to secure a position at audition. Discussion and evaluation The participant was able to access the pain, rage and grief associated with unresolved attachment ruptures with both parents that demonstrated the likely nexus between early attachment trauma and severe music performance anxiety. Conclusion Intensive Short-Term Dynamic Psychotherapy is a potentially cost-effective treatment for severe music performance anxiety. Further research using designs with higher levels of evidence are required before clinical recommendations can be made for the use of this therapy with this population.
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Affiliation(s)
- Dianna T Kenny
- Faculty of Arts and Social Sciences, The University of Sydney, Room 468, Building H04, Sydney, 2006 Australia
| | | | - Allan Abbass
- Centre for Emotions and Health, Dalhousie University, Halifax, NS Canada
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Leichsenring F, Abbass A, Gottdiener W, Hilsenroth M, Keefe JR, Luyten P, Rabung S, Steinert C. Psychodynamic therapy: a well-defined concept with increasing evidence. Evid Based Ment Health 2016; 19:64. [PMID: 27102215 PMCID: PMC10699421 DOI: 10.1136/eb-2016-102372] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 04/12/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University, Giessen, Germany
| | - Allan Abbass
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Emotions and Health, Halifax, Nova Scotia, Canada
| | - William Gottdiener
- Department of Psychology, The City University of New York, New York, USA
| | - Mark Hilsenroth
- Derner Institute of Advanced Psychological Studies, Adelphi University, Hy Weinberg Center, Garden City, New York, USA
| | - John R Keefe
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sven Rabung
- Department of Psychology, Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, Justus-Liebig-University, Giessen, Germany
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