Jack R Keefe

Jack R Keefe
Albert Einstein College of Medicine | AECOM · Department of Psychiatry & Behavioral Sciences

PhD

About

56
Publications
26,981
Reads
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1,319
Citations
Additional affiliations
July 2019 - present
Weill Cornell Medical College
Position
  • Fellow
Description
  • NIH-funded Clinical Translational Science Center TL1 Training Grant; working on personalized medicine projects in trial comparing trauma-focused psychodynamic therapy to treatment as usual for veterans in the NYC VA system
August 2013 - May 2018
University of Pennsylvania
Position
  • PhD Student
September 2010 - July 2013
Hospital of the University of Pennsylvania
Position
  • Research Assistant
Description
  • Volunteered under Drs. Jacques Barber & Kevin McCarthy on projects involving intervention research meta-analysis, psychotherapy process coding, and journal article review.
Education
July 2018 - June 2019
Weill Cornell Medical College
Field of study
  • Clinical Psychology
August 2013 - May 2018
University of Pennsylvania
Field of study
  • Clinical Psychology
August 2006 - May 2010
Swarthmore College
Field of study
  • Psychology

Publications

Publications (56)
Article
Objective: Patients with major depressive disorder (MDD) and a comorbid personality disorder (PD) have been found to exhibit relatively poor outcomes in cognitive therapy (CT) and other treatments. Adaptations of CT focusing heavily on patients' core beliefs have yielded promising findings in the treatment of PD. However, there have been no invest...
Article
Objective: Personality disorder (PD) is a negative prognostic indicator for treatment, and absolute improvements in functioning among these patients are often modest. This may be because personality features that give rise to dysfunction in PD are not targeted optimally during most treatments. Method: Attachment, mentalization, core beliefs, and...
Article
Background: Dropout rates for effective therapies for posttraumatic stress disorder (PTSD) can be high, especially in practice settings. Although clinicians have intuitions regarding what treatment patients may complete, there are few systematic data to drive those judgments. Methods: A multivariable model of dropout risk was constructed with ra...
Article
Objective: This study examines whether, in panic-focused psychodynamic psychotherapy (PFPP), interpretations of conflicts that underlie anxiety (panic-focused or PF-interpretations) are specifically associated with subsequent panic disorder (PD) symptom improvement, over and above the provision of non-symptom-focused interpretations. Method: Tec...
Article
In panic-focused psychodynamic psychotherapy (PFPP), exploration and interpretation of avoided and conflicted emotions and fantasies surrounding anxiety are thought to promote panic-specific reflective functioning (PSRF), which drives panic disorder improvements. Patient emotional expression within a session may be a marker of engaged processing an...
Article
Background: Impaired reflective functioning (RF) is common among patients with borderline personality disorder (BPD). Transference-focused psychotherapy (TFP) has been demonstrated to improve RF compared to other common BPD treatments. If RF reflects a treatment mechanism for TFP, differences in pretreatment RF may also serve as a prescriptive fac...
Article
Full-text available
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 assesse...
Article
Cognitive Processing Therapy (CPT) is efficacious in treating PTSD, but there remains a need to improve outcomes for individuals who do not fully respond to treatment. Differences between patient-therapist dyads in the fidelity (i.e., adherence and competence) of CPT delivery and the quality of the therapeutic relationship may partly explain differ...
Article
In this article, we provide an overview of transference-focused psychotherapy for patients with pathological narcissism and narcissistic personality disorder (TFP-N). In TFP-N we have modified and refined the tactics and techniques of TFP, an evidence-based treatment for borderline personality disorder, to meet the specific challenges of working wi...
Article
Introduction: Panic disorder patients who drop out of treatment typically do not remit from their disorder. How patient-level moderators influence dropping out of one panic-focused treatment over another has never been examined, nor in non-CBT treatments. Method: 200 patients with panic disorder with or without agoraphobia were randomized to receiv...
Article
Full-text available
Introduction: Separation anxiety disorder (SAD) comprises one aspect of attachment dysregulation or insecurity. Although SAD aggravates posttraumatic stress disorder (PTSD) risk, no clinical research has tracked how many patients with PTSD have SAD, its clinical associations, or its response to PTSD treatment. Our open trial of interpersonal psych...
Article
Background No evidence-based therapy for borderline personality disorder (BPD) exhibits a clear superiority. However, BPD is highly heterogeneous, and different patients may specifically benefit from the interventions of a particular treatment. Methods From a randomized trial comparing a year of dialectical behavior therapy (DBT) to general psychi...
Article
Personality disorders (PD) carry high psychosocial dysfunction and are associated with treatment resistance in nonspecialized care. Psychodynamic therapies (PDT) are often used to treat PDs, but there has never been a systematic meta-analysis of PDT trials for PD. To evaluate the evidence base for PDTs for PDs across multiple outcome domain, a syst...
Article
Full-text available
Background Psychotherapies for depression are equally effective on average, but individual responses vary widely. Outcomes can be improved by optimizing treatment selection using multivariate prediction models. A promising approach is the Personalized Advantage Index (PAI) that predicts the optimal treatment for a given individual and the magnitude...
Article
Background: It is not known whether common anxiety/mood comorbidities of panic disorder (PD) improve with panic-focused psychological treatment, nor whether there is differential efficacy between therapies in treating comorbidities. Methods: In a randomized controlled trial for PD with and without agoraphobia comparing Cognitive-Behavioral Thera...
Article
Full-text available
1 Background Major depressive disorder (MDD) has a highly recurrent nature. After successful treatment, it is important to identify individuals who are at risk of an unfavorable long‐term course. Despite extensive research, there is no consensus yet on the clinically relevant predictors of long‐term outcome in MDD, and no prediction models are impl...
Article
Individuals with social anxiety disorder (SAD) have difficulties in their romantic relationships, including decreased satisfaction and intimacy, but the reasons for these difficulties are poorly understood. Because fear of negative evaluation is a cardinal feature of SAD, perceived criticism from a romantic partner may play a central role in social...
Preprint
Full-text available
Eligibility in psychotherapy vs. antidepressant studies 1 Running header: Generalizability of unguided-CBT studies The generalizability of randomized controlled trials (RCTs) of self-guided internet-based cognitive-behavioral therapy (iCBT): Effects on study outcomes and a comparison with RCTs of antidepressants and face-to-face therapy Abstract Ba...
Article
Full-text available
Background: Self-guided internet-based cognitive behavioral therapies (iCBTs) for depressive symptoms may substantially increase accessibility to mental health treatment. Despite this, questions remain as to the generalizability of the research on self-guided iCBT. Objective: We sought to describe the clinical entry criteria used in studies of self...
Preprint
Objectives: Dropout rates for effective therapies for posttraumatic stress disorder (PTSD) can be high, especially in practice settings. Although clinicians have intuitions regarding what treatment patients may complete, there are few systematic data to drive those judgments.Methods: A multivariable model of dropout risk was constructed with random...
Article
Background: No studies of psychotherapies for panic disorder (PD) have examined effects on comorbid personality disorders (PersD), yet half such patients have a PersD. Methods: In a randomized trial for PD with and without agoraphobia comparing Cognitive-Behavioral Therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP), PersD was ass...
Article
Objectives: Dysfunctions in stress biology are hypothesized to contribute to anxiety disorders, and to be ameliorated during successful treatment, but limited clinical data exist to support this hypothesis. We evaluated whether increases in morning cortisol and the diurnal cortisol slope, markers of stress biology, are associated with clinical res...
Article
Objective: The aim of this study was twofold: (a) Investigate whether therapists are consistent in their use of therapeutic techniques throughout supportive-expressive therapy (SET) and (b) Examine the bi-directional relation between therapists' use of therapeutic techniques and the working alliance over the course of SET. Method: Thirty-seven d...
Article
Guided internet CBT (iCBT) is a promising treatment for depression; however, it is less well known through what mechanisms iCBT works. Two possible mediators of change are the acquisition of cognitive skills and increases in behavioral activation. We report results of an 8-week waitlist controlled trial of guided iCBT, and test whether early change...
Article
Objective: Premature discontinuation of therapy is a widespread problem that hampers the delivery of mental health treatment. A high degree of variability has been found among rates of premature treatment discontinuation, suggesting that rates may differ depending on potential moderators. In the current study, our aim was to identify demographic a...
Article
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 re...
Article
Social anxiety is associated with difficulties in intimate relationships. Because fear of negative evaluation is a cardinal feature of social anxiety disorder, perceived criticism and upset due to criticism from partners may play a significant role in socially anxious individuals’ intimate relationships. In the present study, we examine association...
Article
Full-text available
Prior studies have suggested that the association between the alliance and depression improvement varies as a function of prior history of depression. We sought to replicate these findings and extend them to short-term psychodynamic supportive psychotherapy (SPSP) in a sample of patients who were randomized to one of these treatments and were admin...
Article
Background: Conventional drug treatments for Generalized Anxiety Disorder (GAD) are often accompanied by substantial side effects, dependence, and/or withdrawal syndrome. A prior controlled study of oral chamomile (Matricaria chamomilla L.) extract showed significant efficacy versus placebo, and suggested that chamomile may have anxiolytic activit...
Article
Background: Generalized Anxiety Disorder (GAD) is one of the most common anxiety disorders treated in primary care, yet current therapies have limited efficacy and substantial side effects. Purpose: To evaluate long-term chamomile (Matricaria chamomilla L.) use for prevention of GAD symptom relapse. Methods: Outpatients from primary care pract...
Article
Full-text available
Since the introduction of Beck’s cognitive theory of emotional disorders, and their treatment with psychotherapy, cognitive-behavioral approaches have become the most extensively researched psychological treatment for a wide variety of disorders. Despite this, the relative contribution of cognitive to behavioral approaches to treatment are poorly u...
Chapter
A primary departure between schema theory and new-wave cognitive behavioural treatments concerns the role of maladaptive beliefs in depressive change: whether they are the wellspring of depression and whether it is helpful, harmful, or beside the point to try to change them. Cognitive therapy, as represented by both Beck's and Young's conceptions o...
Article
Psychodynamic therapy (PDT) is an umbrella concept for treatments that operate on an interpretive-supportive continuum and is frequently used in clinical practice. The use of any form of psychotherapy should be supported by sufficient evidence. Efficacy research has been neglected in PDT for a long time. In this review, we describe methodological r...
Article
Full-text available
Objectives: Greater symptom change is often assumed to follow greater technique use, a "more is better" approach. We tested whether psychodynamic techniques, as well as common factors and techniques from other orientations, had a curvilinear relation to outcome (i.e., whether moderate or "just right" intervention levels predict better outcome than...
Article
Recent randomized controlled trials (RCTs) suggest that psychodynamic therapy (PDT) may be useful in the treatment of anxiety disorders. This paper presents the most comprehensive meta-analysis to date examining the controlled effects of PDT for anxiety disorders. 14 RCTs totaling 1,073 patients were included. PDT was found to be significantly more...
Article
The Philadelphia Neurodevelopmental Cohort (PNC) is a large-scale, NIMH funded initiative to understand how brain maturation mediates cognitive development and vulnerability to psychiatric illness, and understand how genetics impacts this process. As part of this study, 1,445 adolescents ages 8-21 at enrollment underwent multimodal neuroimaging. He...
Article
The common methionine (met) for valine (val) at codon 158 (val(158)met) polymorphism in the catechol-O-methyltransferase (COMT) gene has been associated with nicotine dependence, alterations in executive cognitive function, and abstinence-induced working memory deficits in smokers. We sought to replicate the association of the COMT val allele with...
Chapter
Full-text available
This chapter summarizes the empirical research on psychodynamic therapies focusing on 3 main questions: 1) what is the evidence for the efficacy of dynamic therapy? 2) what do we know about the role of the therapeutic alliance in dynamic therapy? 3) what do we know about the main mechanisms of change in dynamic therapy?
Article
Recent studies on the effect of stress on modulation of fear memory in our laboratory have uncovered endogenous opioid and adrenergic based modulation systems, working in concert, that limit the strengthening or weakening of newly acquired fear memory during consolidation under conditions of mild or intense stress, respectively. The present study s...

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Projects

Projects (2)
Project
This special interest group brings together a network of researchers who are actively working in the area of stratified and precision mental healthcare. This log will help to communicate updates about current projects and to share results of concluded studies. The studies included in this log aim to determine which patients are most likely to respond to specific psychological treatment options, using a data-driven approach. This work is fundamentally guided by the question: What works for whom? These studies examine the potential benefits of personalized treatment selection, which involves making specific treatment recommendations based on each patient's unique characteristics.
Project
The aims of STEP-D are to investigate the effectiveness of cognitive therapy (CT) and interpersonal psychotherapy (IPT) for depression (in both the acute phase and the long term), study the predictors and moderators of therapy outcome, and identify the underlying working mechanisms that account for the effects of therapy. In total 181 depressed patients were randomized to CT, IPT or a waiting-list condition. We have reported on the acute phase data and are now working on papers using the long-term data.