Empirical evaluation of the assumptions in identifying evidence based treatments in mental health
ABSTRACT Extensive analyses of data from the remarkably comprehensive data set established by the Treatment of Depression Collaborative Research Program (TDCRP), initiated and conducted by the National Institute of Mental Health (NIMH), enabled us to examine the contributions of three dimensions of the treatment process (type of treatment, aspects of the therapeutic relationship, and patients' pretreatment personality characteristics) to three assessments of therapeutic change (symptom reduction, reduction of vulnerability, and development of adaptive capacities) evaluated at termination and extended follow-up. The most consistent factors predicting therapeutic gain were the quality of the therapeutic relationship and patients' pretreatment personality dimensions. The implications of these findings for clinical practice, training, and research are discussed.
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- "Tyrka, Waldron, Graber and Brooks-Gunn, 2002; Vohs, Bardone, Joiner, Abramson and Heatherton, 1999). Perfectionism also negatively affects treatment outcome in a number of ways: it interferes with an individual's ability to participate in tasks of exposure, response prevention and cognitive restructuring for obsessive-compulsive disorder (Frost, Novara and Rhéaume, 2002); it decreases response for social anxiety (Lundh and Ost, 2001); it is associated with less reduction in depressive symptoms at the end of treatment for depression and at follow-up (Blatt and Zuroff, 2005; Hawley, Ho, Zuroff and Blatt, 2006). Hence perfectionism has been represented as a transdiagnostic mechanism, a construct of interest across a range of psychopathologies (Egan et al., 2011). "
ABSTRACT: Background: Research indicates that psycho-education and cognitive behavioural interventions can reduce perfectionism but to date no group treatments have been examined. Aims: The current study utilized a case series design to compare psycho-education materials and subsequent eight-week group cognitive behaviour therapy (CBT) to a baseline waitlist in an outpatient community psychiatry sample (n = 21). Method: Participants were assessed on five occasions: baseline, 4 weeks later (waitlist), 4 weeks after receiving psycho-education material, post-treatment (8 weeks after receiving the group intervention), and 3-month follow-up. Results: There was a main effect of time for perfectionism and negative affect from baseline to post-group (effect sizes ranging from 1.46 to 1.91) that were maintained at 3-month follow-up. Conclusions: These results suggested that group CBT for clinical perfectionism may be beneficial, but that psycho-education alone is not effective for reducing perfectionism or negative affect.Behavioural and Cognitive Psychotherapy 08/2012; 41(2):1-15. DOI:10.1017/S1352465812000628 · 1.69 Impact Factor
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- "However, the present findings clearly underscore the interpersonal nature of perfectionism, as counterargued by Hewitt, Flett, Besser, et al. (2003) in their summary of early theoretical work and Dunkley, Blankstein, et al. (2006) in their review of interpersonal processes that might explain the link between SC perfectionism and distress outcomes. It is important to briefly consider the clinical implications of these results, particularly given that SC perfectionism has been found to have a negative impact on the effective treatment of psychological symptoms (e.g., Marshall, Zuroff, McBride, & Bagby, 2008; Rector, Bagby, Segal, Joffe, & Levitt, 2000; see Blatt & Zuroff, 2005, for a review). The broad implications for intervention of the present study are as follows: (1) in addressing the psychosocial problems associated with perfectionism in treatment, clinicians should focus more closely on self-critical evaluative tendencies than on high personal standards (e.g., Dunkley, Blankstein, et al., 2006); (2) in addressing self-critical evaluative tendencies, it is important to target the dispositional and situational influences of SC perfectionism on both intraand interpersonal processes (see Dunkley, Blankstein, et al., 2006; Hewitt, Flett, Besser, et al., 2003; Zuroff et al., 2004); and (3) decreasing SC and PS perfectionists' negative affect might be accomplished by enhancing their self-esteem and, for SC perfectionists only, reducing their attachment fears of closeness with others. "
ABSTRACT: This study of university students (64 men, 99 women) examined the role of self-critical (SC) and personal standards (PS) higher order dimensions of perfectionism in daily self-esteem, attachment, and negative affect. Participants completed questionnaires at the end of the day for 7 consecutive days. Trait and situational influences were found in the daily reports of self-esteem, attachment, and affect. In contrast to PS perfectionism, SC perfectionism was strongly related to aggregated daily reports of low self-esteem, attachment fears (fear of closeness, fear of dependency, fear of loss), and negative affect as well as instability indexes of daily self-esteem, attachment, and negative affect. Multilevel modeling indicated that both SC and PS perfectionists were emotionally reactive to decreases in self-esteem, whereas only SC perfectionists were emotionally reactive to increases in fear of closeness with others. These results demonstrate the dispositional and moderating influences of perfectionism dimensions on daily self-esteem, attachment, and negative affect.Journal of Personality 07/2011; 80(3):633-63. DOI:10.1111/j.1467-6494.2011.00741.x · 2.44 Impact Factor
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- "noted that positive transference (consisting also of such things as the patient's belief in the doctor's salutary intentions, the wish to use the doctor to get better, and the desire to win the doctor's love or esteem by genuinely trying to get better) was, in the end, a key factor in the patient's ability to overcome symptoms. Freud's positive transference we can call today the therapeutic alliance, and it is one of the most potent ingredients of treatment (Blatt & Zuroff 2005). There is a large placebo-controlled, multicenter trial of treatment of depression that showed that patient were most likely to respond when they received the active drug but had a strong therapeutic alliance (Krupnick et al. 1996). "
ABSTRACT: Despite advances in psychiatry, treatment outcomes are still a big problem, and are not always substantially better than it was in the past time. Treatment resistance remains a serious psychiatric problem. One of the reasons for that is that the pendulum has swung from a psychodynamic framework to a biological one, and the impact of meaning (i.e. the role of psychodynamic and psychosocial factors in treatment-refractory illness) has been relatively neglected. Dynamic factors in psychopharmacology play a pivotal role in pharmacological treatment responsiveness. There is a small but impressive evidence base that shows that psychological and interpersonal factors play that role. Psychodynamic psycho pharmacotherapy combines rational prescribing with tools to identify irrational interferences with effective use of medications, i.e. to resolve the problems of the pharmacological-treatment resistance. Psychodynamic psychopharmacology represents an integration of biological psychiatry and psychodynamic insights and techniques.Psychiatria Danubina 06/2010; 22(2):313-6. · 0.65 Impact Factor