No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Intensive Short-Term Dynamic Psychotherapy: A Systematic Review and Meta-analysis of Outcome Research
Abstract
Habib Davanloo has spent his career developing and teaching methods to accelerate dynamic psychotherapy, including his technique of intensive short-term dynamic psychotherapy (ISTDP). Over the past 20 years, outcome studies using this treatment have been conducted and published. We performed a systematic review of the literature to obtain studies presenting ISTDP outcome data. We found 21 studies (10 controlled, and 11 uncontrolled) reporting the effects of ISTDP in patients with mood, anxiety, personality, and somatic disorders. Using the random-effects model, we performed meta-analyses including 13 of these studies and found pre- to post-treatment effect sizes (Cohen's d) ranging from 0.84 (interpersonal problems) to 1.51 (depression). Post-treatment to follow-up effect sizes suggested that these gains were maintained at follow-up. Based on post-treatment effect sizes, ISTDP was significantly more efficacious than control conditions (d = 1.18; general psychopathology measures). Study quality was highly variable, and there was significant heterogeneity in some analyses. Eight studies using various measures suggested ISTDP was cost-effective. Within limitations of study methodologies, this evidence supports the application of ISTDP across a broad range of populations. Further rigorous and targeted research into this method is warranted.
... Using these 3 parameters, we evaluated a specialized treatment model intensive short-term dynamic psychotherapy (ISTDP) (Abbass et al., 2014;Abbass, 2015;Davanloo, 2000), whose efficacy has been widely studied for a broad range of common mental disorders demonstrating large treatment effect sizes that continue or even increase in longterm follow-up (Abbass, Kisely, Rasic, & Katzman, 2013;Lilliengren, Johansson, Lindqvist, Mechler, & Andersson, 2016). Recent studies of ISTDP show that it is effective with depression, panic disorder, somatic symptom disorders and personality disorders (Abbass, Town, & Driessen, 2012, 2013Lilliengren, Cooper, Town, Kisely, & Abbass, 2020). A recent study found ISTDP effective and cost-effective with generalized anxiety disorder and 2 recent randomized controlled trials found ISTDP to be efficacious for social anxiety disorder (Rahmani, Abbass, Hemmati, Ghaffari, & Rezaei Mirghaed, 2020a;Abbass, Hemmati, Mirghaed, & Ghaffari, 2020b). ...
... The first objective of this study is to examine the effectiveness of the ISTDP (Abbass et al., 2012;Davanloo, 2000) in outpatients with anxiety disorders. In addition to symptom reduction we will examine deeper changes in underlying psychological and personality processes that give rise to symptoms. ...
... This objective offers an implicit evaluation of the degree to which the ISTDP approach is transmissible while maintaining the effectiveness already recognized in the literature (Abbass et al., 2012;Abbass et al., 2013b;Rhamani et al., 2020b). ...
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 effec�tiveness 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 di�agnoses 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.
... Pesquisas comprovam a efetividade e eficácia geral da PPB (Abbass, Town, & Driessen, 2012;Driessen et al., 2015;Lilliengren, Johansson, Town, Kisely, & Abbass 2017). No entanto, existe ainda a necessidade de estudos que evidenciem melhor os resultados das diferentes modalidades de intervenção em diferentes indivíduos e contextos (o que funciona para quem) e também os processos de mudança, ou seja, como e por que determinada psicoterapia funciona (Roth & Fonagy, 2013). ...
... Segundo Ferreira-Santos (2013), um dos principais objetivos da PPB é desaparecimento dos sintomas, a capacidade de perceber suas limitações interiores e sua etiologia; pensar em soluções mais adequadas aos seus conflitos; ser capaz de tolerar frustrações e lidar as dificuldades do cotidiano. Esta modalidade de psicoterapia vem ganhando cada vez mais espaço no campo das psicoterapias, uma vez que diversos estudos comprovam a sua efetividade e melhora em níveis sintomáticos, relacionais e utilização de mecanismos de defesa mais adaptativos (Abbass et al., 2012;Driessen et al., 2015;Lilliengren et al., 2017;Lindfors, Knekt, Heinonen, Härkänen, Virtala, & Helsinki, 2015). ...
... Em consonância com os estudos que apontam que a PPB é eficaz numa ampla variedade de condições clínicas e contextos (Abbass et al., 2012;Driessen et al., 2015;Lindfors et al., 2015), o presente estudo verificou que a PPB se mostrou efetiva no contexto institucional. Os resultados sugerem que esta modalidade de intervenção pode ser uma ferramenta de promoção e reabilitação da saúde mental de trabalhadores e contribuir para a redução dos diversos ônus associadas às doenças ocupacionais. ...
Esse estudo de casos múltiplos investigou a efetividade da psicoterapia psicodinâmica breve (PPB) e o processo de mudança intra e interpessoal de pacientes atendidos em uma empresa. Participaram do estudo 03 funcionários com queixas psicológicas diversas. A coleta dos dados incluiu medidas de auto relato para a avaliação da mudança da psicoterapia (OQ-45 - Outcome Questionnaire), sintomas psicopatológicos (BSI - Brief Symptom Inventory), mecanismos de defesa (DSQ- 40-Defensive Style Questionnaire) e empatia (EMRI-Escala Multidimensional de Reatividade Interpessoal), aplicadas na 1ª, 6ª e na 12ª sessão (término do tratamento). Em todos os casos foi constatado abrandamento sintomatológico e melhora nos relacionamentos interpessoais e em dois casos as mudanças sintomáticas foram clinicamente significativas e confiáveis. O estudo sugere que a PPB pode promover mudanças significativas na saúde mental dos trabalhadores e que as intervenções mais efetivas são aquelas que incidem sobre crises. Estudos em maior escala são necessários para generalizar os achados.
... Intensive Short-Term Dynamic Therapy (ISTDP; 1, 2, 3) is an evidence-based psychotherapy founded on psychodynamic principles. Current literature indicates that ISTDP is effective in treating various psychological disorders, including depression, anxiety, and personality disorders (4,5,6,7). Current process-oriented ISTDP research has focused on using the clinical judgement of expert raters to identify the accurate and timely use of interventions according to Davanloo's Central Dynamic Sequence (Davanloo, 1990). To further elucidate the processes of ISTDP, this pilot study examined the use of a scale profile to identify the accurate application of a central intervention in ISTDP unlocking the unconscious (unlocking). ...
... As with all psychotherapies, it is difficult to identify causal relationships between hypothesised mechanisms of change, the interventions that are central to the therapy to engender change, and symptom improvement (9,10). A small body of literature has examined the association between episodes of unlocking and therapeutic change (e.g., 4,8,11). These studies provide initial indications that unlocking is associated with positive therapeutic outcome. ...
Objective:
Intensive short-term dynamic therapy (ISTDP) is an evidence-based psychotherapy supported by a growing literature base. "Unlocking" of the unconscious is a central process in ISTDP. This study sought to operationalize the concept of unlocking by adopting a detailed process analysis of the early phase of therapy for four patients by using a structured measure, the Achievement of Therapeutic Objectives Scale (ATOS).
Methods:
The ATOS is a measure of psychotherapy processes. A profile of the scale's cutoff scores was developed to identify episodes of unlocking in videos of 28 ISTDP therapy sessions. Expert raters assessed for episodes of unlocking for up to the first 10 recorded psychotherapy sessions of four participants in a naturalistic private practice setting. Sessions were then rated with the ATOS profile, and these ratings were compared with expert ratings to assess the sensitivity of the ATOS in identifying episodes of unlocking.
Results:
Using the profile of subscale cutoff scores, the ATOS successfully identified seven of 11 episodes of unlocking. A visual analysis of descriptive data indicated that average ATOS subscale scores consistently identified episodes of unlocking and the presence of complex feelings of rage and guilt about the rage. Expert ratings of unlocking and the ATOS ratings were found to have high interrater reliability.
Conclusions:
This pilot study suggests that the ATOS may be adapted to provide a profile that can identify episodes of unlocking of the unconscious. The proposed measure is worthy of further study, representing an initial step toward operationalizing a central process associated with positive outcomes in ISTDP.
... Meta-analytic studies on psychodynamic psychotherapy have shown that patients maintained their therapeutic gains in both general symptoms and interpersonal functioning (Abbass et al., 2012;Town et al., 2020). Ellison et al. (2009) reported 6-and 18-months follow-up of experiential therapies, both emotion-focused and client-centered, for depression. ...
... Overall, present findings support the long-term effectiveness of AEDP at 6-and 12-month follow-up. These results showing the long-term effectiveness of AEDP are consistent with the long-term effectiveness of other experiential and psychodynamic psychotherapies, such as emotion focused therapy (EFT) for depression (Ellison et al., 2009), and short-and long-term psychodynamic psychotherapy for a variety of psychological issues (Abbass et al., 2012;Town et al., 2022), including treatment-resistant depression (Town et al., 2020). The results are also comparable with the long-term effectiveness of cognitive behavioral therapy (CBT; Karyotaki et al., 2016). ...
Accelerated experiential dynamic psychotherapy (AEDP; Fosha, 2000, 2021b) is an integrative, healing-oriented, mind-body, affect-focused therapy. A posttreatment outcome study demonstrated AEDP's effectiveness (Iwakabe et al., 2020) on a variety of measures of psychological functioning. This study sought to address AEDP's long-term effectiveness. As previously reported, 63 adult patients completed a 16-session AEDP treatment with qualified therapists in private practice in the United States, Canada, Israel, Japan, and Sweden. Forty patients responded to 6-month follow-up and 52 responded to 12-month follow-up. Results indicate that patients maintained their posttreatment therapeutic gains, both 6 and 12 months later. Large effect sizes (d = 0.74 to d = 1.60) both for reductions on measures of psychopathology (e.g., depression, negative automatic thoughts, experiential avoidance) and improvements on measures of positive mental health (e.g., well-being, self-compassion) were obtained. Patients with more pervasive and severe problems tended to have larger effect sizes (all ds > 1.0) and a larger proportion of them achieved clinically significant change over 6 and 12 months than patients with subclinical symptomatology. Piecewise growth modeling was used to confirm these results, with attrition over the follow-up period taken into account. Consistent with the above findings, piecewise growth modeling similarly showed that patients significantly improved from pre- to posttreatment and maintained gains from posttreatment through the 6- and 12-month follow-up. These results provide empirical support for the long-term effectiveness of AEDP for alleviating a variety of psychological problems and enhancing positive functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... ISTDP is a psychodynamic treatment that focuses on facilitating emotional processing, understanding client's attachment and unconscious anxiety pathways as well as psychological defences (Abbass et al., 2008;Davanloo, 1995). There is no pre-established treatment length for ISTDP as each course is tailored to the patient functioning, but on average, treatments are less than 40 sessions across disorders (Abbass et al., 2012). Research has shown that the first sessions in therapy are crucial to therapeutic outcomes (Lutz et al., 2009) and there is further evidence to suggest that 2-3-hour ISTDP extended assessment sessions are cost-effective Russell et al., 2016). ...
... ISTDP is an evidence-based psychological intervention for a range of mental health and functional presentations (Abbass et al., 2012;Russell et al., 2016;Town & Driessen, 2013). Evidence for the treatment of DS using ISTDP is in its infancy and studies evaluating this treatment in NHS settings are limited. ...
Purpose: Intensive Short Term Psychodynamic Therapy (ISTDP) has demonstrated promising evidence for the treatment of several Functional Neurological Disorders (FND) including dissociative seizures. However, its implementation in secondary mental health and specialist services within the English National Health Service (NHS) is scarce. The aim of this pilot study was to explore the estimates of the therapeutic effects of a 3-session course of this treatment as well as establish safety and acceptability for a complex patient group. Method: The study followed a mixed methods case series design and recruited 18 patients from secondary adult mental health care and specialist neurology services. Participants completed self-report outcome measures at the start, at the end and 1-month following the completion of therapy. Three open ended questions examined their therapy experiences qualitatively and these were analysed through thematic analysis. Results: All participants who started the treatment (N=17) completed the intervention and attendance rates were very high (95%). No serious adverse effects were observed, and the CORE-OM and BSI showed improvements both at the end of the treatment and at follow-up. Healthcare utilisation was also reduced including acute medications, A&E attendances, and crisis line usage. Conclusions: The results provide preliminary support for the safe use of ISTDP in this complex group of participants but further evidence from controlled and randomized studies is warranted.
... Solms' view of defence might also potentially address apparent findings claiming to undo "repression" (or in Solms' terms, "defence"), whereby unconscious but declarative content becomes conscious (e.g. Abbass et al., 2012). ...
... If so, however, his position is then incongruent with clinical reports whereby unconscious, defended-against fantasies and wishes become recoverable in therapy (e.g. Abbass et al., 2012). ...
Mark Solms provides a sophisticated extension and clarification of Freud's Project in light of current neuropsychoanalytic thinking and Friston's free-energy principle. This commentary focuses upon Solms' view of repression and defence in his updated Project, whereby Solms extends his recent work on the topic. After noting similarities and differences between Freud's and Solms' views on repression and defense, the commentary addresses the proposed mechanism of repression in Solms' revised Project. An analysis of Solms' account indicates there is not as yet a coherent mechanism of repression in his revised Project, although some type of plausible neural mechanism may nevertheless still be theoretically possible. Consequently, although there is likely merit in Solms' position on repression and defence, there are still outstanding questions that need addressing before this merit can be fully recognised.
... Intensive short-term dynamic psychotherapy (ISTDP) is an evidence-based form of STPP that uses the treatment relationship to explore emotions and their expression, as well as a patient's attempts to avoid these emotions (Lilliengren, Johansson, Lindqvist, Mechler, & Andersson, 2016). Although ISTDP has not been studied in PTSD, meta-analyses of the efficacy of ISTDP show significant improvements in general psychopathology, depression, anxiety, interpersonal functioning and somatic symptoms while outperforming other control conditions (Abbass, Town, & Driessen, 2012;Town & Driessen, 2013) and this method has also been shown to be broadly cost-effective (Abbass & Katzman, 2013). ...
... ISTDP is an evidence-based form of STPP specifically focused on restructuring emotional deficits and anxiety intolerance (Davanloo, 2000;Abbass & Town, 2013;Abbass, 2015) enabling the experiencing and working through of unprocessed emotions related to trauma. This method has been found to be efficacious in the treatment of personality disorders, medically unexplained symptoms, and treatment resistant depression (Abbass et al., 2012;Town & Driessen, 2013;Town, Abbass, Bernier, & Stride, 2017). The current exploratory study now provides preliminary Sample size for self-reports at intake was n = 13 cases; post-intake it was n = 6, and at termination it was n = 4 for the BSI and n = 5 for the IIP. ...
Introduction
Posttraumatic stress disorder (PTSD) is associated with significant psychiatric morbidity and high healthcare costs.
Objective
The aim of this pilot study was to evaluate changes in healthcare costs and general psychiatric symptom severity in patients with PTSD following intensive short-term dynamic psychotherapy (ISTDP).
Method
Healthcare services cost and utilization data were compiled at intake, prior to starting ISTDP and then assessed annually for three years thereafter. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination.
Results
Results showed significant reductions in physician costs and physician visits at one-year post-treatment, with these persisting over the three-year follow-up period. There were also large but statistically non-significant reductions in hospital costs. At termination, self-reported psychiatric symptoms and interpersonal problems were reduced.
Conclusion
These preliminary findings suggest that ISTDP may lead to healthcare cost reductions and general psychiatric symptom improvement in patients with PTSD, with healthcare utilization benefits maintained at long-term follow up. Future research directions were discussed.
... One of the modalities available in the clinic is Intensive Short-Term Dynamic Psychotherapy (ISTDP). This is a contemporary brief psychodynamic approach with an emerging evidence-base demonstrating long-term amelioration of symptoms alongside significant savings in healthcare costs for patients with mental health difficulties and/or somatic disorders (Abbass et al., 2012;Abbass et al., 2015;Town & Driessen, 2013;Abbass et al., 2008). ...
... Mean pre-therapy Mean post-therapy et al., 2010) and with the growing evidence base for ISTDP as an effective treatment for patients with somatic conditions (Abbass et al., 2012;Abbass et al., 2015). It is of particular interest that amongst this small cohort there was evidence of very significant improvements in energy levels and general health alongside a reduction in fatigue and pain. ...
This outcome study evaluated the quality of life and emotional wellbeing of patients referred with functional neurological symptoms (FNS) to an NHS Community Neuropsychology Service and treated with a course of Intensive Short-Term Dynamic Psychotherapy (ISTDP). Measures of quality of life and emotional wellbeing demonstrated significant improvement amongst the eleven patients treated. These outcomes support the view that ISTDP may be a helpful psychological treatment option for patients with FNS.
... These approaches, however, do not directly target the trauma, life adversity, or conflicts that appear to drive primary pain. In contrast, there are many general psychotherapies that focus on trauma and psychological conflict and yield substantial improvements in symptoms [23][24][25][26][27]. A common mechanism of these psychotherapies is that they help patients engage and process stimuli (e.g., memories, experiences, relationships, and emotions) that patients typically avoid by using defenses such as suppression, distraction, intellectualization, and other cognitive and behavioral strategies. ...
... Thus, the authors developed a treatment approach to psychological trauma or conflict in patients with primary pain, which they labeled emotional awareness and expression therapy (EAET; in some trials, it was called "training" or "interview" rather than "therapy"). This therapy draws from many other psychological techniques or therapies, including as follows: (a) pain neuroscience education or the "explaining pain" model, which identifies the brain as the primary pain organ and posits the reversibility of pain following changes in beliefs [30•, 31]; (b) pain exposure therapy, which encourages patients to engage in pain-eliciting behaviors so that they can unlearn their pain-related fear [32]; (c) exposure-based cognitive-behavioral therapies, which help patients process emotions underlying PTSD and other anxiety disorders [27]; (d) intensive short-term psychodynamic therapy, which challenges patients' defenses to help them experience and express unconscious emotions [24]; (e) experiential therapies, which use techniques such as focusing, empty chair, and two-chair dialog to empathically facilitate patients' awareness and expression of emotions [25]; (f) written emotional disclosure or expressive writing, which appears to have some benefit for centralized pain [33]; (g) assertiveness training, which has a long history of helping patients overcome their fears of expressing their power and strength in relationships [34]; and (h) rescripting therapy, which helps patients imagine and voice new, more powerful or less frightening endings to recurrent nightmares or intrusive memories [35]. ...
Purpose of Review
Patients with chronic pain, especially primary or centralized pain, have elevated rates of psychosocial trauma and intrapersonal or intrapsychic conflict. To address these risk factors and potentially reduce pain, the authors developed emotional awareness and expression therapy (EAET). This article presents the rationale for EAET, describes its principles and techniques, reviews its development and early testing as well as recent clinical trials, and critically analyzes the evidence base.
Recent Findings
Four initial trials (between 2006 and 2011) demonstrated the efficacy of earlier versions of EAET. Four recent randomized, controlled trials of different EAET durations (1 to 8 sessions) and formats (individual or group) in patients with fibromyalgia, irritable bowel syndrome, pelvic pain, or medically unexplained symptoms support the earlier findings. EAET reliably reduces pain and interference, although improvements in anxiety and depression are less reliably achieved and may be delayed. The largest and best conducted trial found superiority of EAET over cognitive-behavioral therapy for fibromyalgia. Patient retention in EAET is high, and adverse events are rare.
Summary
EAET merits inclusion as a treatment option for primary pain conditions, and it may be the preferred treatment for some patients. Research is needed on EAET with other pain conditions and samples, using better controls and comparison conditions, and on additional ways to motivate and help patients engage in successful emotional processing.
... It is specifically used to treat alexithymia by focusing on the awareness and experience of feelings. Previous studies found these benefits with stabilized patients with psychotic disorders, major depression, treatment-resistant depression, personality disorders, and anxiety disorders, with evidence of long-term maintenance of gains in follow-up (Abbass et al., 2012;Abbass, Kisely, Rasic, & Town, 2015;Ajilchi, Nejatai, Town, Wilson, & Abbass, 2016;Lilliengren, Johansson, Lindqvist, Mechler, & Andersson, 2016;Town, Abbass, Stride, & Bernier, 2017;. ...
... This service receives referrals from mental health secondary and tertiary services, family doctors, and medical-surgical specialists. It is a teaching and research service specializing in assessing and treating emotional contributors to diverse clinical presentations using ISTDP (Abbass et al., 2012). ...
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 follow-up. Future research directions are discussed.
... The findings on the effectiveness of psychodynamic psychotherapy in comparison to other treatments are equivocal. Generally, psychodynamic psychotherapy has been found to be superior to TAU (e.g., Abbass, Town, & Driessen, 2012) and equivalent to other psychotherapies (e.g., Cuijpers, van Straten, Andersson, & van Oppen, 2008;Leichsenring & Leibing, 2007). This finding replicates that of a recent quality-based review of RCTs of psychodynamic psychotherapy (Gerber et al., 2011). ...
The purpose of this research was to determine the effectiveness of psychodynamic psychotherapy, both generally and in Australian settings. A systematic review of recent (last five years) and Australian (last 10 years) papers using MEDLINE Complete and PsycINFO was performed. For the review of recent literature, 59 papers (56 studies) met the inclusion criteria. The search for Australian literature identified four papers on one quasi-experimental study. Research supports the use of psychodynamic psychotherapy for the treatment of depressive disorders, some anxiety disorders (especially generalised anxiety disorder), somatic symptoms and some somatoform disorders (e.g., hypochondriasis), and some personality disorders (primarily borderline and Cluster C personality disorders). Improvements made through psychodynamic psychotherapy typically endure beyond the completion of treatment. Psychodynamic psychotherapy is generally superior to treatment as usual and equivalent to other psychotherapies.
... For example, implicit self-concept, measured by reaction times to words or ideas, may or may not relate to a person's more explicitly expressed self-concept (Greenwald et al., 2002). Also, clinical experiences in Short-Term Dynamic Psychotherapy (based on psychodynamic principles), show how the lifting of unconscious defense mechanisms such as repression can result in unconscious content emerging that has been unprocessed (Davanloo, 1987;Abbass et al., 2012;Town et al., 2013;Johansson et al., 2014). ...
This article explains how psychoanalytic principles, namely Jungian ego inflation, can contribute to distinguishing between the philosophical distinction between willfully ignoring knowledge in a foolish manner and rationally avoiding knowledge in a wise manner.
... This approach uses brain imaging methods to explore potential structural or functional effects of the talking cure on the brain, finding similar dysfunction in limbic structures, amygdala, hippocampus, frontal cortex, cingulate cortex, and basal ganglions (Sözeri-Varma and Karadaǧ, 2012). Abbass et al. (2012) described a meta-analysis of brain imaging studies from 11 sources analyzing any form of PDT treatment. The sample was composed of 2 randomized controlled trials, 5 controlled trials and 4 case series. ...
Background
The COVID-19 pandemic has exacerbated the ongoing crisis in psychiatric and psychological care, contributing to what we have identified as a new psychological and psychiatric pandemic . Psychotherapy is an effective method for easing the psychological suffering experienced also by the various impacts of COVID-19. This treatment can be examined from a neurological perspective, through the application of brain imaging techniques. Specifically, the meta-analysis of imaging studies can aid in expanding researchers' understanding of the many beneficial applications of psychotherapy.
Objectives
We examined the functional brain changes accompanying different mental disorders with functional Magnetic Resonance Imaging (fMRI), through a meta-analysis, and systematic review in order to better understand the general neural mechanism involved in psychotherapy and the potential neural difference between psychodynamic and non-psychodynamic approaches.
Data sources
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were employed for our systematic review and meta-analysis. We conducted a computer-based literature search, following the Population, Intervention, Comparison and Outcomes (PICO) approach, to retrieve all published articles in English regarding the above-described topics from PubMed (MEDLINE), Scopus, and Web of Science.
Study eligibility criteria, participants, and interventions
We combined terms related to psychotherapy and fMRI: (“psychotherapy” [All Fields] OR “psychotherapy” [MeSH Terms] OR “psychotherapy” [All Fields] OR “psychotherapies” [All Fields] OR “psychotherapy s” [All Fields]) AND (“magnetic resonance imaging” [MeSH Terms]) OR (“magnetic”[All Fields] AND “resonance”[All Fields] AND “imaging”[All Fields]) OR (“magnetic resonance imaging”[All Fields] OR “fmri”[All Fields]). We considered (1) whole brain fMRI studies; (2) studies in which participants have been involved in a clinical trial with psychotherapy sessions, with pre/post fMRI; (3) fMRI results presented in coordinate-based (x, y, and z) in MNI or Talairach space; (4) presence of neuropsychiatric patients. The exclusion criteria were: (1) systematic review or meta-analysis; (2) behavioral study; (3) single-case MRI or fMRI study; and (4) other imaging techniques (i.e., PET, SPECT) or EEG.
Results
After duplicates removal and assessment of the content of each published study, we included 36 sources. The map including all studies that assessed longitudinal differences in brain activity showed two homogeneous clusters in the left inferior frontal gyrus, and caudally involving the anterior insular cortex ( p < 0.0001, corr.). Similarly, studies that assessed psychotherapy-related longitudinal changes using emotional or cognitive tasks (TASK map) showed a left-sided homogeneity in the anterior insula ( p < 0.000) extending to Broca's area of the inferior frontal gyrus ( p < 0.0001) and the superior frontal gyrus ( p < 0.0001). Studies that applied psychodynamic psychotherapy showed Family-Wise Error (FWE) cluster-corrected ( p < 0.05) homogeneity values in the right superior and inferior frontal gyri, with a small cluster in the putamen. No FWE-corrected homogeneity foci were observed for Mindful- based and cognitive behavioral therapy psychotherapy. In both pre- and post-therapy results, studies showed two bilateral clusters in the dorsal anterior insulae ( p = 0.00001 and p = 0.00003, respectively) and involvement of the medial superior frontal gyrus ( p = 0.0002).
Limitations
Subjective experiences, such as an individual's response to therapy, are intrinsically challenging to quantify as objective, factual realities. Brain changes observed both pre- and post-therapy could be related to other factors, not necessary to the specific treatment received. Therapeutic modalities and study designs are generally heterogeneous. Differences exist in sample characteristics, such as the specificity of the disorder and number and duration of sessions. Moreover, the sample size is relatively small, particularly due to the paucity of studies in this field and the little contribution of PDT.
Conclusions and implications of key findings
All psychological interventions seem to influence the brain from a functional point of view, showing their efficacy from a neurological perspective. Frontal, prefrontal regions, insular cortex, superior and inferior frontal gyrus, and putamen seem involved in these neural changes, with the psychodynamic more linked to the latter three regions.
... The conceptualization and operationalization of unconscious integrative complexity involving the intuitive, non-rational, and symbolic dimensions of the human psyche is consistent with a historical take on the study of the unconscious, which recognizes a mythopoetic function of it (Ellenberger, 1970). It is also consistent with empirical work with Short-Term Dynamic Psychotherapy where lifting defense mechanisms can result in unconscious imagery emerging that symbolizes deeper emotions behind the conscious defenses (Davanloo, 1987;Abbass et al., 2012;Town et al., 2013;Johansson et al., 2014). This is similar to how wisdom, in its very nature, requires a person to explore their negative emotions openly in a way that bypasses their defense mechanisms (Glück and Bluck, 2013;Weststrate and Glück, 2017;Glück et al., 2019). ...
There has been much progress in the scientific study of wisdom on both conceptual and empirical fronts in the past few decades. Despite all the progress being made, there are still gaps that can be filled to provide even more explanatory power and coherence. Although academic discourse on wisdom has included the ability to integrate issues in a complex manner, there is still room for improved theorizing on wisdom's integrative complexity. Since integrative complexity has both conscious and unconscious dimensions, including the latter in discussions on wisdom will add a valuable aspect to its conceptualization. This article will argue how unconscious integrative complexity is the variable in wisdom's conceptual equation that involves paradox, which is a well-known sign of wisdom. Explanations contrasting conscious integrative complexity and unconscious integrative complexity in reference to wisdom will be discussed. Then, the Archetypal Test of the Nine Elements will be proposed as a testing instrument to operationalize unconscious integrative complexity. After the conceptualization and operationalization are worked through, we will conclude with a couple examples to illustrate our reflections.
... There is a large and growing evidence-based supporting the effectiveness of ISTDP with diverse psychological problems, including mood, anxiety, personality, somatic, eating, and substance use disorders, as well as chronic pain (see Abbass, 2020 for a list of studies to date). A 2012 meta-analysis of outcome studies in ISTDP, including both RCTs and more naturalistic designs, found highly significant effect sizes post-treatment for general psychopathology (Cohen's d ¼ 1.16), depression (Cohen's d ¼ 1.51), and anxiety (Cohen's d ¼ 0.98) (Abbass et al., 2012). ...
This paper reviews some of the theoretical and empirical literature on maternal ambivalence and suggests that greater attention to this phenomenon in clinical work with mothers can foster more empowered mothering. Two clinical vignettes using Intensive Short-Term Dynamic Psychotherapy (ISTDP) with mothers are presented as examples of working with maternal ambivalence in session. The vignettes demonstrate how techniques from this model can help mothers face and integrate complex mixed feelings toward their children. Such work not only helps individual mothers improve their well-being and relationships, but can also serve to counter internalized cultural ideologies and dominant discourses about motherhood.
... Both unconscious dimensions can be brought to awareness and subsequently loosened. Research supports this as studies show that lifting unconscious repression (which involves unconscious thoughts, and feelings (Erdelyi, 2006)) and therapeutically unlocking defense mechanisms lead to unconscious images relating to trauma becoming accessible, which, in turn, can lead to interpersonal improvement and mental illness symptom reduction (Abbass et al., 2012;Davanloo, 1987;Johansson et al., 2014;Town et al., 2013). These studies show that short-term psychodynamic therapy which "unlocks the unconscious" in this manner has greater treatment effects for "major unlockings" (Abbass et al., 2017). ...
Personality fixations that have had utility in the past can later become problematic for holistic psychological development. Adult Ego Development research combined with psychoanalytic assumptions provide a way to understand multidimensional maturity through addressing and transforming the unconscious. The Enneagram and Gilbert Durand’s Anthropological Structures of the Imaginary (ASI) are two frameworks that can be integrated to help clients experience transformation in unconscious self-limiting phenomena. The Enneagram can address unconscious thoughts and feelings while the ASI can address unconscious images. Given that different personality types have different deeply structured characteristics, combining these two models can provide specifically tailored guidance to varying personalities towards multidimensional wholeness. A case study as well as implications for clinical work will be provided.
... Why should we be interested in how clients experience having predetermined time limits for therapy? Both shortterm (<25 sessions, e.g., Knekt et al., 2008) and long-term psychotherapy (>40 sessions, e.g., Abbass et al., 2014) have been found to be effective for reducing mental health problems, and many therapeutic approaches have developed versions that are adopted for a short-term format: for example, EFT for depression (Greenberg, 2017), cognitive behavioral therapy for anxiety disorders (Clark & Beck, 2011), Affect Phobia Therapy , and intensive short-term psychodynamic therapy (Abbass et al., 2012). Therapists in the late 1990s expected efficient psychotherapy to take between 30 and 40 sessions (Lowry & Ross, 1997), with the expectations of young adults about therapy duration matching those of therapists (Constance et al., 2008). ...
Limited capacity and high demand for mental health care drive efforts to improve the efficiency of treatment and increasingly result in predetermined time limits for treatment, even in government-covered treatment in welfare systems. How do clients experience having predetermined time limits for psychotherapy? We analyzed the transcripts of interviews with 18 participants who had completed a return to work (RTW) intervention based on emotion-focused therapy (EFT) that had predetermined time limits. The analysis identified four experiential trajectories through therapy with predetermined time limits, representing four narrative themes: Trajectory A: It is ok to stop here—Not wanting more therapy; Trajectory B: Seeing the benefits of continued therapy, but ready to give life a go without treatment; Trajectory C: Being on one’s own too early—Economic obstacles hindering the continuation of therapy; and Trajectory D: I need more than this—Securing continued therapy. Having the therapist communicate the timeframes for therapy clearly, while leaving room for individual tailoring of therapy, was experienced as very important by clients receiving psychotherapy with predetermined time limits.
... El resultado de esta investigación es similar al obtenido por Michel et al., (2004), en cuanto a una menor presencia de síntomas de depresión y ansiedad en los jóvenes después de la aplicación de una psicoterapia breve psicoanalíticamente orientada. Esto abre a la reflexión de que los hallazgos de este estudio apoyarían la utilidad y eficacia de este tipo de psicoterapia ya estudiada en su aplicación para el malestar depresivo en adultos (Abbass, Town y Driessen 2012;Driessen, Hegelmaier, Abbass et al., 2015;Town, Abbass, Stride y Bernier, 2017). No sólo eso, los resultados obtenidos en esta investigación tienen implicaciones para la práctica en el trabajo con los jóvenes, un grupo vulnerable en el padecimiento de depresión (IHME, 2018). ...
El estudio tiene como objetivo evaluar los efectos de una psicoterapia breve focal psicoanalíticamente orientada en una muestra de 38 jóvenes universitarios con sintomatología depresiva leve o moderada y malestar emocional general de una Facultad de la UNAM. Se utilizó un diseño cuasiexperimental pretest-postest y seguimientos.
... Building upon this, Sahli et al. (2015) found that accuracy of therapist interpretative interventions in rupture resolution sessions related to outcome. In addition to process research, ISTDP has been evaluated through over 50 studies and shown effective (Abbass et al, 2012) and cost effective (Abbass & Katzman, 2013) ...
Intensive short‐term dynamic psychotherapy (ISTDP) was developed to manage treatment impasses preventing the experiencing of feelings related to childhood attachment interruptions, such as parental loss. According to ISTDP theory, certain categories of patients will exhibit habitual patterns of responding within the treatment relationship (called defenses) to certain anxiety‐provoking thoughts and feelings. Such defensive behaviors interrupt awareness of one's own feelings, self‐directed compassion and engagement in close human attachments, including the bond with the therapist. Rupture‐repair sequences in ISTDP are primarily considered in the context of a patient's defenses and the responses a therapist has to these defenses. By understanding and clarifying these defenses, this risk of subsequent misalliance, that is negative shifts or ruptures in the alliance, are minimized. In this paper we summarize ISTDP theory and technique through the use of clinical vignettes to illustrate defense management as a rupture‐repair equivalent in ISTDP.
... As the current pandemic leads to more cases and greater time in lockdown, individual defensive functioning may slip and distress increase. This suggests the importance of considering the use of interventions that foster adaptive implicit emotion regulation (46)(47)(48). ...
Pandemics and government-mandated quarantining measures have a substantial impact on mental health. This study investigated the psychological impact of the coronavirus disease 2019 (COVID-19) crisis on Italian residents during the first week of government-imposed lockdown and the role of defense mechanisms as protective factors against distress. In this cross-sectional study, 5,683 Italians responded to an online survey assessing socio-demographics, overall psychological distress, post-traumatic symptoms, and defense mechanisms using validated measures as the Symptom Checklist-90 (SCL-90), the Impact of Event Scale-Revised (IES-R), and the Defense Mechanisms Rating Scale-Self-Report-30 (DMRS-SR-30). Data were collected from March 13 to March 18, within the first week of lockdown in Italy. Results showed that younger age and female gender were associated with increased psychological distress. Having positive cases nearby, more days on lockdown, and having to relocate were also associated with greater distress. Higher overall defensive functioning (ODF) was associated with lower levels of depression (r = −.44, 95% CI −0.48, −0.40), anxiety (r = −.38, 95% CI −0.42, −0.35), and post-traumatic stress symptoms (PTSS) (r = −.34, 95% CI −0.38, −0.30). Conversely, less adaptive defensive functioning was related to greater affective distress across all domains. Each increased unit of ODF decreased the chances of developing post-traumatic stress symptoms (PTSS) by 71% (odds ratio = 0.29, p < 0.001, 95% CI.026,.032). The psychological impact of COVID-19 among Italians during the early weeks of government lockdown has been significant. The pandemic continues to have extraordinary mental health impact as it moves across the globe. Given the salience of defensive functioning in psychological distress, consideration of interventions that foster the use of more adaptive defenses may be an important component of building resilience amidst a pandemic.
... This finding from an eight-session treatment implies that longer term psychodynamic treatments relying on interpretation maybe be less efficient because of their moreso cognitive, exploratory nature, rather than because of any theoretical limited effects of interpretation itself. Because of the intensive emphasis on emotional experiencing using the transference relationship to mobilize the past, unprocessed feelings, ISTDP is among distinct frameworks that appear to be broadly efficacious and efficient; even though they are brief (Abbass et al., 2012;Lilliengren et al., 2016). ...
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.
... The process of the relationship between the emotions, anxiety, and deep-seated defenses is what allows symptom amelioration and behavioral change to take place (Davanloo, 1990). The beneficial work that this type of psychotherapy acts on tolerance of anxiety makes it particularly appropriate for treatment of patients affected by affective disorders including MDD and BD (Abbass et al., 2012). ...
Background
Intensive Short-Term Dynamic Psychotherapy (ISTDP) is an intervention introduced by Davanloo in order to treat affective and somatic symptoms, and personality disorders. It is a brief intervention aimed to reach awareness of painful or forbidden emotions and consequently to override symptoms and self-destructive tendencies. In this review we examine the efficacy of ISTDP on symptoms of 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 maybe 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-behavioural therapy.
... Intensive short-term dynamic psychotherapy (ISTDP) is a short form of psychodynamic treatment developed by Habib Davanloo during the 1970s (1)(2)(3)(4). The efficacy of ISTDP has an increasingly strong evidence base across a broad range of clinical presentations, including personality disorders, psychosomatic disorders, and treatment-resistant depression (5)(6)(7)(8)(9). Despite increasing evidence regarding ISTDP's effectiveness, its underlying mechanisms of change have been difficult to explore. ...
Objective:
Despite increasing evidence for the effectiveness of intensive short-term dynamic psychotherapy (ISTDP), evidence supporting the purported mechanisms of change in ISTDP is lacking. This systematized review aimed to describe the major theorized mechanisms of change in ISTDP, critically evaluate the emerging literature pertaining to its purported mechanisms, and explore directions for future research.
Methods:
A systematized search of the literature was conducted by using online databases (PsychInfo, PubMed, EMBASE, and CINAHL).
Results:
Fourteen studies met inclusion criteria. The included studies explored at least one theorized ISTDP mechanism of change and attempted to operationalize or otherwise empirically examine the mechanism in relation to the therapeutic process. Examined mechanisms included "unlocking the unconscious" and specific therapist interventions.
Conclusions:
The current body of literature has several limitations, most notably the lack of a consensus definition for unlocking the unconscious. This difficulty in measuring mechanisms of change is common across therapeutic modalities and limits the validity and comparability of findings. Despite these limitations, the literature suggests a possible association between theorized mechanisms of change and positive therapy outcomes. Future research directions are discussed.
... Further, treatments that emphasize interpersonal dysfunction-rather than personality disorder symptoms-may be more intuitively understood and less stigmatizing for patients, increasing patient commitment to treatment. For these reasons, improving interpersonal functioning has frequently been the primary aim of personality disorder treatments (e.g., Abbass et al., 2012;Pilkonis, 1997). ...
Background
While there is some evidence that patients with elevated depression symptoms experience greater benefits from negative-affect expression, this amplifying effect has not been investigated within a psychotherapeutic context. This is particularly notable considering the substantial evidence linking affect expression with desired outcomes across psychotherapeutic approaches. The primary purpose of the present study was to investigate if depression symptoms amplified (i.e., moderated) the association between negative-affect expression and reductions in interpersonal problems for patients in a psychiatric day treatment for personality disorders. The secondary purpose was to investigate milieu (i.e., other patients concurrently enrolled) negative-affect intensity and its association with patients’ reductions in interpersonal problems.
Methods
Participants (N = 239) were patients consecutively admitted into a psychiatric day treatment program for people with personality disorders. Patients completed measures of (1) depression symptoms at pre-treatment, (2) interpersonal problems at pre- and post-treatment, and (3) negative-affect expression each week of treatment.
Results
The association between patient negative-affect expression and reductions in interpersonal problems was amplified by depression symptoms. Depression symptoms also amplified the association between milieu negative-affect intensity and reductions in interpersonal problems.
Conclusions
Our findings indicate that depression symptoms amplified the therapeutic value of negative-affect expression and amplified the value of an affectively intense milieu. Practical and theoretical implications are discussed.
... Short-term psychotherapies with 4-18 sessions have proven successful (e.g. Abbass et al., 2012;Muschalla, 2017). The level of change in psychotherapy is reached by a log linear rather than a constant pattern of change, which means that the first 4-6 sessions hold importance in terms of an initial improvement (Stulz et al., 2013). ...
In slow-open groups as well as therapies of less than ten sessions, each group session holds importance. Patients, therapists and co-therapists have different perspectives and may gain different experiences from a group session. This study investigates the perspectives of patients, therapists and co-therapists on alliance, new insights and therapist techniques in the same group session. Do the three actors perceive these group aspects similarly or differently? Which group aspects are related with the outcome coping? One hundred and forty-nine sessions of a cognitive behaviour therapy group have been investigated. Patients, therapists and co-therapists gave ratings on their perceived alliance, group topics and insights as well as therapists’ technique competency. Concerning new insights, there was concordance between patients and co-therapists ( r = .211, p < .05). Concerning alliance, there was a concordance between patients and therapists ( r = .327, p < .01). Therapists focusing on alliance building was associated with lower patient outcomes in terms of work coping (β = –.391). The quality of therapeutic techniques was the same in groups with higher and lower outcomes. Patients’ perception of whether they felt good in the group session was explanative for session outcome, while therapists’ perceptions and context conditions (supervision, number of participants) was not. Patients, therapists and co-therapists have different perspectives on the same group therapy session. Patients’ perceptions are associated with session outcomes. A lower session outcome must not be associated with a poor technique performance of the therapist. Therapists should not only be aware of alliance building and correct technical performance, but they must also be aware of patients’ perceptions of the group process and outcome.
Key learning aims
The present research is the first evaluation of group session aspects and session outcomes in rehabilitation patients with work anxieties in slow-open groups. We will learn: (1) Whether patients’, therapists’ and co-therapists’ perceptions of the same group session are similar or different;
(2) Whether group sessions that result in worse outcomes are different from group sessions resulting in a better outcome;
(3) Which aspects of the group session are predictive for a better outcome.
... The current study indicated that ISTDP is an effective treatment for SAD. This finding concurs with all previous research showing ISTDP to be effective for a wide range of mental disorders (Abbass, 2016;Abbass et al., 2008a;Abbass et al., 2008b;Abbass et al., 2012;Davanloo, 1995;Town et al., 2012), including anxiety disorders (Lilliengren et al., 2017;Solbakken and Abbass, 2016). ...
This research examined the efficacy of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of social anxiety disorder (SAD) and compared the therapeutic outcomes of ISTDP when feeling focus or defense work is emphasized. A three-group randomized design with 6-month follow-up was used. Forty-one subjects were selected among volunteer college students diagnosed with SAD. They were assigned randomly into three groups; 14 cases to feeling-focused ISTDP (FF-ISTDP) group, 14 cases to defense-focused ISTDP (DF-ISTDP) group, and 13 cases to a control group. All subjects were evaluated at pretest, posttest, and six-month follow-up through clinical interviewing using DSM-5 criteria for SAD along with the Liebowitz Social Anxiety Scale. Each experimental group had a course of 8 to 10 sessions of ISTDP treatment. Analysis of variance showed that ISTDP is an effective treatment for SAD compared with a control group. No outcome differences were found between FF-ISTDP and DF-ISTDP in treating SAD.
... One of the areas of focus in ISTDP is improving clients' emotional connection with significant others (Abbass, Sheldon, Gyra, & Kalpin, 2008) and restructuring their attachment styles (Abbass, Town, & Driessen, 2012). The structure of emotional connectedness, known to ISTDP as internal objects relations, refers to self-representations in interaction with a significant other's representation during an infant's grandiose exhilaration. ...
... They found these models offer strong treatment gains across symptoms domains that increased in follow-up and that were superior to other bona fide models in follow-up. Specifically, for ISTDP, a systematic review and meta-analysis of outcome research found ISTDP efficacious for patients with mood, anxiety, personality, and somatic disorders (Abbass, Town & Driessen, 2012) with large effects. Perhaps the strongest evidence for the efficacy of ISTDP is found in the treatment of personality disorders as demonstrated by significant findings of three independent RCTs (Abbass, Sheldon, Gyra, & Kaplin, 2008;Hellerstein et al., 1998;Winston et al., 1994). ...
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.
... 16), since the dynamic unconscious provides psychoanalysis with explanations of various phenomena such as dreams and psychoneurotic symptoms (Axmacher et al., 2010;Boag, 2012Boag, , 2017Kehyayan et al., 2018;Shevrin et al., 2013). Clinically, some view therapeutic success in terms of "changes produced in defense mechanism functioning" (Cramer, 2015, p. 545), while therapies aimed at "unlocking the unconscious" (e.g., intensive short-term dynamic psychotherapy) appear to demonstrate successful treatment gains (Abbass, Town, & Driessen, 2012;Town, Abbass, & Bernier, 2013). ...
The importance of reflective awareness for clinical practice is generally well recognised across a variety of therapeutic approaches. Psychodynamic approaches traditionally also recognise that defense mechanisms provide major impediments to reflective awareness. Recently, however, the neuropsychoanalyst Mark Solms proposes that the dynamic unconscious can be understood in terms of the nondeclarative cognitive unconscious. One consequence of Solms’s proposal is that there is no possibility of lifting repression because nondeclarative content is simply incapable of becoming conscious. This paper addresses whether the dynamic unconscious can be sufficiently addressed by the cognitive unconscious. Cases of anosognosia (denial of illness) are discussed in the context of satisfactorily addressing the complexity of psychodynamic phenomena. This paper contends that while the cognitive unconscious provides an important addition to psychoanalytic thinking, the cognitive view does not adequately account for the dynamic unconscious. The paper proposes retaining the concept of the traditional dynamic unconscious and acknowledging the distinction between motivated and non-motivated impediments to reflective awareness. Clinical implications of the conceptual distinction between motivated and non-motivated impediments are further considered.
... To further facilitate the interpersonal processes that enable insight and change, psychodynamic psychotherapy for patients with personality disorders has been extended into group contexts (Piper et al., 1996). Several studies have demonstrated that group psychodynamic treatments for personality disorders have been linked with a number of desired outcomes including reduced anxiety, depression, somatic concerns, and interpersonal problems (see Abbass, Town, & Driessen, 2012 for a review). Within psychodynamic group theory, a major pathway to change is the evocation and expression of powerful feelings in the presence of others followed by cognitive integration that leads to increased awareness and clarity (Rutan, Stone, & Shay, 2014). ...
Across a breadth of psychotherapeutic approaches, feeling affect intensely and then talking about those feelings is a common means for increasing insight and other desired outcomes. While several naturalistic and laboratory studies have found that depression symptoms attenuate (i.e., weaken) the association between negative-affect intensity and negative-affect expression, depression's attenuating effect has not been examined in a psychotherapeutic context. The first aim of the present study was to examine if depression symptoms' attenuating effect on the association between negative-affect intensity and negative-affect expression extended into group psychotherapy. Our second aim was to examine group effects on patients' negative-affect expression. Participants ( N ± 239) were patients consecutively admitted into a psychodynamic group-psychotherapy day treatment program for people with personality disorders. Patients indicated their negative-affect intensity and negative-affect expression each week that they were in treatment. Depression symptoms were assessed at baseline. Results indicated that depression symptoms attenuated (i.e., moderated) the association between negative-affect intensity and negativeaffect expression. Further, while the association between patient intensity and expression increased over the course of treatment, the moderating effect of depression on this association did not vary over treatment. Regarding group effects, group negative-affect intensity was associated with higher levels of patient negative-affect expression. Inversely, group affect expression was associated with lower levels of patient affect expression. Patient depression symptoms did not moderate the association between group negative-affect intensity and patient negative-affect expression. Our findings indicate that while group affect intensity and affect expression impacts patients' expression, depression's attenuating effect on negative-affect expression extends to patient effects but not group effects.
... Intensive Short-Term Dynamic Psychotherapy (ISTDP) é a combinação de várias técnicas de psicoterapia de curto prazo que compartilham de uma série de características comuns, e que incluem um maior foco terapêutico, tendo um curto período de tratamento, entre 1 e 40 sessões para a maioria dos pacientes, e até 150 sessões para pacientes com psicopatologia grave (Kenny, 2016, p. 127). Os efeitos do ISTDP têm mostrado, a longo prazo, eficiência em seus resultados, e incluem pacientes com transtornos de personalidade, depressão, transtorno de pânico e uma série de distúrbios somáticos (Abbass, Town, & Driessen, 2012). ...
Music Performance Anxiety (MPA) is described as a persistent apprehension that compromises performative skills, both in solo and group performances. In addition to physiological symptoms, such as increased heart rate, hyperventilation, sweating or nausea, it is associated with psychological and cognitive symptoms of negative impact on performance. The present work intends to study the effectiveness of biofeedback training in the context of chamber music performance, following a quasi-experimental design, 2 quartets of trombonists were selected, quartet (1) being the experimental group, and quartet (2) the control group. Both made public presentations, before and after the intervention. Group (1) underwent a program of 8 biweekly sessions of biofeedback training, in order to verify if it contributed to diminish the effects of MPA. The questionnaires State Trait Anxiety Inventory (STAI), Kenny Music Performance Anxiety Inventory (K-MPAI) and Kessler Psychological Distress Scale were used to evaluate the intervention’s efficacy. The results suggest that this type of intervention is favorable with regard to the decrease of APM levels in the context of chamber music. Some implications of this study are mentioned for the reduction of performance anxiety in contexts of training and teaching of music and in contexts of professional practice.
... A number of systematic reviews have now been published (e.g. Palmer et al., 2012), as well as a meta-analysis of short-term psychodynamic therapies for young people (Abbass et al., 2012). A recent systematic review (Midgley et al., in press) gives as complete a picture as possible of the existing evidence base for individual psychodynamic psychotherapy for children aged between 3 and 18. ...
A brief introduction to psychodynamic counselling and therapy with children and young people.
Psychiatry, which in the 1870s was to become the youngest of all medical disciplines, was late to incorporate prevailing medical information and ideas. It took its time to entertain physiological hypotheses to account for the causal chain of severe psychiatric disorders, and hesitated for far too long, to use the same conceptual framework that was being successfully applied to the rational understanding of practically all other medical disorders. Sigmund Freud, at the beginning of the twentieth century, discovered a method of scientific inquiry (psychoanalysis) from which, in addition to psychoanalysis proper, a torrent of other therapeutic applications evolved over the years under such generic names as psychoanalytic psychotherapies and psychodynamic psychotherapies. Since World War II (WWII) the growth of the discipline has been extraordinary. Numerous new effective medications have allowed patients to achieve clinical successes on par with those obtained in other areas of clinical medicine. In parallel, many other psychosocial interventions, anchored in disciplines such as systems theory, family dynamics, cultural formulations of health and illness, and many others have reached scientific recognition and therapeutic prowess. Their extraordinary diversity found an intellectual and pragmatic home under the umbrella of the biopsychosocial paradigm, first fully articulated by Gorge Engel in a seminal paper published in 1977 (Engel, Science. 196:129–136, 1977). Psychiatry started the twenty-first century fully equipped to produce more and better evidence-based therapies for the large and growing number of disorders that afflict contemporary societies. A few additional transformative steps are already visible on the horizon. The full application of neuroimaging to psychiatric clinical practice, now in development in the hands of a few pioneers, will bring Psychiatry closer to Freud’s long-delayed dream for our profession: to be able to anchor its findings about the mind on the secure footing of solid neurobiological knowledge.
Psychoanalysis is indispensable when writing and discussing traumatic stress, but in the treatment of these conditions it is ultimately disregarded. Since they are considered long-term treatments, therapies derived from psychoanalysis, such as Psychodynamic Psychotherapy (PDT), are not the first choice in health centers and clinics, which may be also a reflection of a scarcity of publications on its effectiveness. Through a literature review, focused on the effect size of PDT in the treatment of Posttraumatic Stress Disorder (PTSD), we have confirmed this scarcity. However, in the few studies conducted on this topic, findings have shown similarities between PDT and other therapies in reducing PTSD symptoms, both in post-therapy and follow-up assessments. The time of psychoanalytic psychotherapies is often pointed out as an obstacle, although studies have indicated that patients treated through these techniques present a continuous state of improvement.
Objective:
To determine the feasibility of implementing a community-based, multi-family group intervention in a semi-rural population in Aranzazu, northern Caldas, Colombia.
Methods:
Qualitative study. A convenience sample was taken of 10 families with children with affective and behavioural disorders, previously identified by the Child Behaviour Checklist (CBCL). The Multifamily Psychoeducational Psychotherapy (MF-PEP) model was adapted to the culture and needs of the families.
Results:
The contents of the sessions and the topics and experiences that were most significant for the children and their families are described.
Conclusions:
The adaptation to the cultural context of the multi-family intervention had a very good acceptability by all participants: caregivers, children and therapists.
COVID-19 has not only killed and infected millions of people worldwide but has also resulted in unprecedented psychosocial stressors that continue to have profound mental health consequences for many people, exacerbating pre-existing psychological suffering and contributing to the onset of new stress related conditions. It has also resulted in a major revolution in the delivery of mental health treatment abruptly shifting psychotherapeutic practice to online technology. Psychotherapists need to be prepared for how their clinical work may change. This qualitative research study has been phenomenological in nature, attempting to capture and contribute to the literature on the lived experience of psychotherapists in navigating the transition through a global pandemic and exploring how the accompanying shift to telehealth has impacted clinical practice and the therapeutic relationship, if at all. A single-session, semi-structured interview lasting approximately one hour was conducted over Zoom with 15 mental health clinicians certified in an integrative psychotherapeutic attachment-based treatment model Accelerated Experiential Dynamic Psychotherapy (AEDP). Research findings and data were analyzed using a thematic coding process and principles of grounded theory. Significant findings of this study included the identification of factors that might negatively impact the online therapeutic relationship and the recognition of ways to strengthen and enhance telehealth effectiveness with an attachment-based and relational lens. Advantages and disadvantages of telehealth practice were identified and explored in addition to the effects of shared trauma on the therapeutic relationship and the post-traumatic growth and resilience of the therapist. Implications for theory, practice and social work education are discussed. Limitations included the small size and homogeneity of the study sample.
Closed-circuit training is a unique setting developed by Habib Davanloo, the founder of intensive short-term dynamic psychotherapy. The purpose of this setting is to achieve therapeutic benefits for the patient while providing valuable educational opportunities to the trainee. In this article, the authors present an intensive short-term dynamic psychotherapy session that was conducted in a closed-circuit setting at McGill University Health Center. The primary goal of the article is to highlight several aspects of Davanloo's metapsychological principles and the application of their corresponding technical interventions. Another goal is to convey the trainee's reflection on his experience and perception of the closed-circuit training. The authors propose that closed-circuit training could be considered a potential alternative, or at least a complementary method, to the traditional settings of psychotherapy training and supervision.
Resumen
Objetivo
Determinar la factibilidad de implementar una intervención grupal multifamiliar, basada en la comunidad, en una población semirrural en Aranzazu, en el norte de Caldas, Colombia.
Métodos
Estudio cualitativo. Se tomó una muestra de conveniencia de 10 familias con niños con alteraciones afectivas y conductuales, previamente identificados mediante la Child Behavior Checklist (CBCL). Se adaptó a la cultura y a las necesidades de las familias el modelo de Psicoterapia Psicoeducativa Multifamiliar (MF-PEP).
Resultados
Se describen los contenidos de las sesiones, los temas y las experiencias que fueron más significativos para los niños y sus familias.
Conclusiones
La adecuación al contexto cultural de la intervención multifamiliar tuvo una muy buena aceptación de los participantes, tanto cuidadores como niños y terapeutas.
Background: Major depressive disorder is a debilitating disease that is significantly associated with personal, social and economic injury. Various therapies such as laser acupuncture and short-term intensive dynamic psychotherapy have been used in this area, but is the combination of these therapies more effective than either of them? Aims: The aim of this study was to investigate the effectiveness of acupuncture scanning and laser therapy on depression. Method: This was a quasi-experimental study. The statistical population of this study consisted of people with major depressive disorder referring to New Vision Center in Tehran (2018-2019). 10 patients with major depressive disorder referred to New Vision Center were selected by random sampling. Research instruments included Beck Depression Inventory (1961) and revised Symptom Checklist (SCL-90-R; Drogatis, 1975), short-term intensive scanning psychotherapy sessions (Davanlo, 1997), and laser medicine therapy. Traditional. Data were analyzed using multivariate analysis of variance. Results: Both laser therapy and laser therapy combined with dynamic psychotherapy reduced depression (P
Seit den 1960er Jahren entwickelt, forscht und lehrt Habib Davanloo die Intensive Psychodynamische Kurzzeittherapie. Er gilt als einer der Pioniere für die Entwicklung von psychodynamischer Kurzzeittherapie. Davanloo nutzte von Beginn an audiovisuelle Aufnahmen, um die Interaktionen zwischen Therapeut und Patient genau zu analysieren und zu verstehen. Seine Konzepte basieren auf psychoanalytischem Wissen und sind erweitert und verändert durch seine „Metapsychologie des Unbewussten“ mit dem „Erschließen des Unbewussten“. Die therapeutische Herangehensweise stellt die affektive über die kognitive Arbeit, konzentriert sich auf die Übertragungsbeziehung, fokussiert auf die Überwindung der Widerstände und ermöglicht den Patienten das Erleben der unbewussten gemischten Gefühle mit dem Ziel einer inneren Versöhnung mit den frühen Bezugspersonen. Das Kapitel bietet – ausgehend von den Wurzeln der dynamischen Kurzzeittherapien – eine Einführung in die Geschichte der IS-TDP und ermöglicht einen Einblick in die aktuellen Entwicklungen.
In diesem Kapitel wird zunächst eine Übersicht über verschiedene Wirksamkeitsnachweise für die Intensive Psychodynamische Kurzzeittherapie nach Davanloo (IS-TDP) gegeben. Im Anschluss werden die aktuellen Forschungsaktivitäten der Deutschen Gesellschaft für IS-TDP beschrieben.
Cancer can lead to many psychological issues. Although most of the research has
focused on post-cancer problems, this study has been carried out focusing on normal
and abnormal personality patterns that may result in cancer. This study is based on biopsychosocial
model of health, and dynamic model of personality. The patient’s normal
and abnormal personality patterns were evaluated by using Shedler and Westsen’s Assessment
Procedure (SWAP). The SWAP results did match patient’s normal and abnormal
personality patterns. In other words, the patient’s dependent and obsessive-compulsive
personality disorder patterns were consistent with low self-knowledge, high
narcissism, low Machiavellianism, low psychopathy, low self-esteem, high religious
fundamentalism, high repression, low mindfulness, low self-compassion, and high social
desirability. Identifying and managing the side effects of these kinds of personality
patterns could empower psychotherapeutic protocols and also increase therapeutic
compliance in leukemia patients.
Cancer can lead to many psychological issues. Although most of the research has focused on post-cancer problems, this study has been carried out focusing on normal and abnormal personality patterns that may result in cancer. This study is based on biopsychosocial model of health, and dynamic model of personality. The patient’s normal and abnormal personality patterns were evaluated by using Shedler and Westsen’s Assessment Procedure (SWAP). The SWAP results did match patient’s normal and abnormal personality patterns. In other words, the patient’s dependent and obsessive-compulsive personality disorder patterns were consistent with low self-knowledge, high narcissism, low Machiavellianism, low psychopathy, low self-esteem, high religious fundamentalism, high repression, low mindfulness, low self-compassion, and high social desirability. Identifying and managing the side effects of these kinds of personality patterns could empower psychotherapeutic protocols and also increase therapeutic compliance in leukemia patients
This randomized clinical trial with a sample of adults (N = 129) from India explored the effects of a single core‐transformation session on symptom experience and psychological growth. The results over the total 8‐week study period indicated significant, moderate overall effect sizes (ds = 0.63 and 0.52) for symptom experience, emotional stability, affect balance, global well‐being, and purpose in life. Implications for research and clinical practice are discussed.
Music performance anxiety (MPA) can end the musical aspirations of even the most talented and dedicated musician. Mastering MPA can be almost as challenging as the most difficult concerto or operatic role. Yet there are currently very few evidence-based treatments for this potentially debilitating conditions. In this book, Dianna Kenny synthesizes 15 years of research in MPA. First, she explores underlying factors that contribute to MPA, then presents ways of assessing and treating MPA using a highly individualized approach based on the musician's presentation. A must for musicians, clinicians, teachers and music psychologists.
Tests for experiments with matched groups or repeated measures designs use error terms that involve the correlation between the measures as well as the variance of the data. The larger the correlation between the measures, the smaller the error and the larger the test statistic. If an effect size is computed from the test statistic without taking the correlation between the measures into account, effect size will be overestimated. Procedures for computing effect size appropriately from matched groups or repeated measures designs are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Urethral syndrome (urinary symptoms and pain without organic lesions) is a frequent female pathology but its aetiology is obscure and its treatment undetermined. A number of studies have highlighted emotional disturbances in these patients. To assess the efficacy of psychotherapy in the treatment of this syndrome, the authors studied 36 patients diagnosed with urethral syndrome. Of these, 13 were randomly selected for short-term dynamic psychotherapy. The remaining 23 patients were treated with traditional urological therapies and used as the control group. After the medical diagnosis and during follow-up at 6 months and 4 years, one psychological questionnaire (SQ) was administered together with a specially prepared clinical questionnaire. The urinary symptomatology and pain disappeared completely in over 70 per cent of the patients who had completed the psychotherapy. For the remaining patients, at the termination of the treatment the symptomatology had improved to the point that it was no longer a problem. These results proved stable in time and were associated with a general improvement in psychic status, particularly for the depression, anxiety and hostility levels. In the controls, on the other hand, no significant improvement was noted in the parameters examined.
Short-term dynamic psychotherapy is a group of well-researched brief treatments with over 50 published controlled trials testing its effectiveness against a range of treatment and nontreatment controls. Studied samples are often high users of medical services, hospital services, mental health services and disability insurance. If short-term dynamic psychotherapy is effective, it should translate into demonstrable reductions in medical and social system costs. This review examines whether or not short-term dynamic psychotherapy is a cost-effective treatment.
Somatic symptom disorders are common, disabling and costly. Individually provided short-term psychodynamic psychotherapies (STPP) have shown promising results. However, the effectiveness of STPP for somatic symptom disorders has not been reviewed.
We undertook a systematic review of randomized controlled trials and controlled before and after studies. The outcomes included psychological symptoms, physical symptoms, social-occupational function, healthcare utilization and treatment continuation.
A total of 23 studies met the inclusion criteria and covered a broad range of somatic disorders. Thirteen were RCTs and 10 were case series with pre-post outcome assessment. Of the included studies, 21/23 (91.3%), 11/12 (91.6%), 16/19 (76.2%) and 7/9 (77.8%) reported significant or possible effects on physical symptoms, psychological symptoms, social-occupational function and healthcare utilization respectively. Meta-analysis was possible for 14 studies and revealed significant effects on physical symptoms, psychiatric symptoms and social adjustment which were maintained in long-term follow-up. Random-effect modeling attenuated some of these relationships. There was a 54% greater treatment retention in the STPP group versus controls.
STPP may be effective for a range of medical and physical conditions underscoring the role of patients' emotional adjustment in overall health. Future research should include high-quality randomized and clinical effectiveness studies with attention to healthcare use and costs.
• Current emphasis on early case finding, outpatient care, and on longitudinal studies of asymptomatic patients has focused attention on the community adjustment of psychiatric patients. Thus, simple and inexpensive methods such as self-report scales, which allow the routine assessment of patient adjustment, are potentially useful.
The derivation and testing of such a method, the Social Adjustment Scale Self-Report, is described. This scale covers the patient's role performance, interpersonal relationships, friction, feelings and satisfaction in work, and social and leisure activities with the extended family, as a spouse, parent, and member of a family unit. Self-report results based on 76 depressed outpatients were comparable to those obtained from relatives as well as by a rater who interviewed the patient directly.
The efficacy of short-term psychotherapy has become an area of increasing interest. The primary objective of this study was to assess the results of two forms of short-term psychotherapy in patients with personality disorders.
Eighty-one patients with personality disorders were randomly assigned to brief adaptive psychotherapy, short-term dynamic psychotherapy, or a waiting list for therapy. Outcome at termination of therapy for the treatment groups and at the end of the waiting period for the waiting list group was evaluated by means of ratings of target complaints and scores on the SCL-90 and the Social Adjustment Scale. In addition, for 38 of the treated patients, target complaints were reevaluated an average of 1.5 years after treatment ended.
Patients in the two therapy conditions improved significantly on all measures in comparison with the patients on the waiting list. There was no significant difference between the results in the two therapy conditions. The waiting list period averaged approximately 15 weeks; treatment averaged 40 weeks. At follow-up, after an average of 1.5 years, target complaint ratings were not significantly different from those at the termination of therapy.
These data indicate that brief adaptive psychotherapy and short-term dynamic psychotherapy are effective for patients with certain types of personality disorder and that the two therapy approaches do not differ in overall outcome.
The authors report preliminary results of Brief Supportive Psychotherapy (BSP) in the Beth Israel Brief Psychotherapy Program for a sample with primarily Cluster C Axis II disorders. This study compares 24 patients treated with BSP with 25 patients treated with Short-Term Dynamic Psychotherapy (STDP). STDP was chosen because its confrontational methods contrast dramatically to BSP, which emphasizes building self-esteem, reducing anxiety, and enhancing coping mechanisms. Videotaped therapies were based on manualized 40-session protocols. Similar degrees of improvement were seen in BSP and STDP at termination and at 6-month follow-up. A study of therapeutic alliance in BSP showed stable and high levels of alliance in good-outcome cases and more variability in poor-outcome cases. These preliminary findings are consistent with other studies and suggest supportive psychotherapy may be effective for many patients, leading to significant and lasting change.
To assess the cost and clinical effectiveness of psychiatrist-provided Intensive Short-term Dynamic Psychotherapy (ISTDP) of patients referred to a private office.
ISTDP was provided to 89 patients referred to a private psychiatric office in Vancouver, Canada. Pretherapy self-report scores, (BDI, BAI, BSI, IIP [see full names in text]) medication costs, disability costs and healthcare costs were compared with posttherapy values and normative values.
Patients' mean self-report scores went from the abnormal to normal range after an average of 14.9 hours of therapy. Returns to work, reduced healthcare utilization, and medication stopping accounted for a cost reduction of over Cdn$400,000 at one year after therapy.
ISTDP appears to be an effective and cost-effective form of intervention when provided by a psychiatrist in a private office. Randomized controlled studies are warranted to further examine the cost benefits and efficacy of ISTDP.
Cochrane Reviews have recently started including the quantity I 2 to help readers assess the consistency of the results of studies in meta-analyses. What does this new quantity mean, and why is assessment of heterogeneity so important to clinical practice?
Systematic reviews and meta-analyses can provide convincing and reliable evidence relevant to many aspects of medicine and health care.1 Their value is especially clear when the results of the studies they include show clinically important effects of similar magnitude. However, the conclusions are less clear when the included studies have differing results. In an attempt to establish whether studies are consistent, reports of meta-analyses commonly present a statistical test of heterogeneity. The test seeks to determine whether there are genuine differences underlying the results of the studies (heterogeneity), or whether the variation in findings is compatible with chance alone (homogeneity). However, the test is susceptible to the number of trials included in the meta-analysis. We have developed a new quantity, I 2, which we believe gives a better measure of the consistency between trials in a meta-analysis.
Assessment of the consistency of effects across studies is an essential part of meta-analysis. Unless we know how consistent the results of studies are, we cannot determine the generalisability of the findings of the meta-analysis. Indeed, several hierarchical systems for grading evidence state that the results of studies must be consistent or homogeneous to obtain the highest grading.2–4
Tests for heterogeneity are commonly used to decide on methods for combining studies and for concluding consistency or inconsistency of findings.5 6 But what does the test achieve in practice, and how should the resulting P values be interpreted?
A test for heterogeneity examines the null hypothesis that all studies are evaluating the same effect. The usual test statistic …
Psychotherapy instructors have used video technology to train residents for over 40 years. Though it has met with some controversy, many will argue that videotape review is essential for self-directed learning and accurate psychotherapy supervision.
The author describes a technique of small-group videotape training as provided in a psychiatry residency training program.
He reviews the merits and limitations of this format and suggests simple and inexpensive technical approaches to augment this training.
The author concludes that small-group videotape training is an efficient psychotherapy training format that encourages self-monitoring and the exchange of supportive peer feedback.
This study examined the effects of therapist confrontations and clarifications on patient defensive and affective responding in short-term dynamic psychotherapy. Four videotaped therapy sessions from each of 16 patients were coded on a per-minute basis for the occurrence of selected patient and therapist variables. Contrary to prediction, no significant differences were found regarding the effects of confrontation and clarification of defense on immediate patient affective responding. In addition, therapist confrontation of patient defensive behavior elicited significantly more defensive responding than did clarification. Results also indicated that, within a 3-minute frame, patients' affective and defensive responding in minute 3 is most closely related to their own behavior in minute 1 regardless of the intervening therapist activity. Future research, it is suggested, needs to focus on a longer time frame as well as on the cumulative effects of persistent confrontations on patient affective responding.
The objective is to study the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) trial therapies. In a tertiary psychotherapy service, Brief Symptom Inventory (BSI), Inventory of Interpersonal Problems (IIP) medication use, and need for further treatment were evaluated before versus 1-month post trial therapy in a sequential series of 30 clients. Trial therapies were interviews with active focus on emotions and how they are experienced. The interviews resulted in statistically significant improvements on all BSI subscales and one of the IIP subscales. One-third of clients required no further treatment, seven stopped medications, and two returned to work following trial therapy. The ISTDP trial therapy appeared tobe clinicallyeffectiveandcosteffective. Future researchdirections arediscussed. (Brief Treatment and Crisis Intervention 8:164-170 (2008))
The present study investigated change in patient resistance in the transference relationship in Davanloo's (1990) STDP by assessing change in patient BECAs, from early to late therapy. A clinical sample (n=6) significantly differed between early and late therapy on anxiety, BECAs, and GAF ratings. Change, from early to late therapy, in GAF ratings (indexing therapeutic improvement) correlated marginally significantly with change, from early to late therapy, in BECAs (indexing reduction of resistance in the transference). Results are seen as consistent with Davanloo's (1990) theory that positive therapeutic outcomes are caused by positive changes in alliance, from early to late therapy, and by related negative change in resistance, from early to late therapy. Results also are seen as consistent with Westerman et al's (1995) model of linearly increasing alliance in successful STDP, and with other research implicating reduced resistance as a factor in STDP's efficacy.
Discusses the process of working through in patients who are resistant and suffer from diffuse disturbances, using H. Davanloo's technique of Intensive Short-Term Dynamic Psychotherapy and the protocol of partial unlocking in the initial interview. Systematic analysis of the transference (Davanloo; 1984, 1986) and of the 2 triangles is an integral part of this process, which systematically restructures the patient's unconscious ego's defensive psychological organization, and reduces the forces of the resistance. Transcriptions from the 5th–20th sessions of a resistant 34-yr-old married female patient are presented to illustrate the process. The major task of working through in the 1st phase of therapy consists of repeated breakthrough into the unconscious until the patient's character resistances become sufficiently weakened and a major de-repression of repressed instinctual impulses and feelings occurs. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Describes a new instrument, the Inventory of Interpersonal Problems (IIP), which measures distress arising from interpersonal sources. The IIP meets the need for an easily administered self-report inventory that describes the types of interpersonal problems that people experience and the level of distress associated with them before, during, and after psychotherapy. In Study 1, psychometric data are presented for 103 patients who were tested at the beginning and end of a waiting period before they began brief dynamic psychotherapy. On both occasions, a factor analysis yielded the same six subscales; these scales showed high internal consistency and high test–retest reliability. Study 2 demonstrated the instrument's sensitivity to clinical change. In this study, a subset of patients was tested before, during, and after 20 sessions of psychotherapy. Their improvement on the IIP agreed well with all other measures of their improvement, including those generated by the therapist and by an independent evaluator. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
reviewed the theoretical and technical aspects of cognitive therapy with depressed children and adolescents / the cognitive model offers a useful paradigm for the study of depression in this age group (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper attempts to provide an overview of a variation of Davanloo's Intensive Short-Term Dynamic Psychotherapy known as the Graded Format. This format is the appropriate choice for therapists who wish to treat particular diagnostic groups such as depressive disorders, functional disorders, panic disorder, certain psychosomatic conditions, syntonic character pathology, patients with low capacity to tolerate anxiety and those with mild to moderate degrees of fragility. A summary of key conceptual and technical aspects of the Graded Technique is provided along with some clinical vignettes, followed by a brief overview of why some therapists fail to apply this method, the consequences of such failure and the method's overall advantages.
The current study examined changes in the ratio of patients' affective and defensive behaviors during the course of brief psychodynamic psychotherapy. Treatments of 16 patients were videotaped. For each patient, four sessions were evaluated with a minute-by-minute coding system of process variables. When patients were grouped according to outcome scores, significant differences between the high outcome and the average-to-low outcome groups emerged. During the early phase of treatment, patients in both groups showed an average of one affective response per five defensive responses. By the late phase of treatment, the high outcome patients showed a marked shift to one affective response per two defensive responses, while the low outcome patients remained the same. An incidental finding was a negative correlation between good outcome and the ratio of defensive behavior to total patient activity.
The development of a 21-item self-report inventory for measuring the severity of anxiety in psychiatric populations is described. The initial item pool of 86 items was drawn from three preexisting scales: the Anxiety Checklist, the Physician’s Desk Reference Checklist, and the Situational Anxiety Checklist. A series of analyses was used to reduce the item pool. The resulting Beck Anxiety Inventory (BAI) is a 21-item scale that showed high internal consistency (α = .92) and test—retest reliability over 1 week, r (81) = .75. The BAI discriminated anxious diagnostic groups (panic disorder, generalized anxiety disorder, etc.) from nonanxious diagnostic groups (major depression, dysthymic disorder, etc). In addition, the BAI was moderately correlated with the revised Hamilton Anxiety Rating Scale, r (150) = .51, and was only mildly correlated with the revised Hamilton Depression Rating Scale, r (153) = .25.
The research evidence for Short-Term Psychodynamic Psychotherapy (STPP) in the treatment of personality disorders (PD) was examined through consideration of studies utilizing randomized controlled designs. An extensive literature search revealed eight published Randomized Controlled Trials (RCT) of moderate study quality. A critical review of this literature is offered to provide an evidence-based guidance for clinicians and implications for treatments are discussed. Preliminary conclusions suggest STPP may be considered an efficacious empirically-supported treatment option for a range of PDs, producing significant and medium to long-term improvements for a large percentage of patients. Further research is recommended to allow comparisons with alternative evidence-based approaches.
Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as "empirically supported" and "evidence based." In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.
Somatization of emotions accounts for excess emergency department (ED) visits in the form of medically unexplained symptoms (MUS). Intensive short-term dynamic psychotherapy (ISTDP) has been used to diagnose and manage somatization. We examined the effectiveness of this procedure for ED patients with MUS.
We implemented a service that included staff education, timely access to consultation and gathering of outcome data.
Patients were assessed and treated shortly after referral. There was a mean reduction of 3.2 (69.0%) ED visits per patient (standard deviation [SD] 6.4) the year afterward (95% confidence interval [CI] 1.3-5.0, p< 0.001). In comparison revisit rates during the same time interval for 3 available ED populations (i.e., those matched by visit rates, those with matching complaints and all patients referred to the service but never seen) showed either smaller reductions or higher ED use (ranging from a 15% reduction to a 43% increase). Treatments averaged 3.8 sessions per patient (SD 5.3). Self reported symptoms improved significantly with the Brief Symptom Inventory global rating, which changed from a mean of 1.21 (SD 0.58) before assessment to 0.86 (SD 0.63) ( p< 0.01) at the end of contact with the service. The service appeared acceptable to both emergency physicians and patients.
This emotion-focused assessment and treatment method appeared to be feasible and may be effective in reducing both symptoms and repeat ED use.
Typescript (photocopy). "Graduate Program in Psychology." Vita. Thesis (Ph. D.)--Rutgers University, 1988. Includes bibliographical references.
Typescript. Thesis (Ph. D.)--New York University, School of Education, 2003. Includes bibliographical references (leaves 152-172).
It remains largely unclear, firstly whether short-term psychodynamic psychotherapy (STPP) is an effective treatment for depression, and secondly, which study, participant, or intervention characteristics may moderate treatment effects. The purpose of this study is to assess the efficacy of STPP for depression and to identify treatment moderators.
After a thorough literature search, 23 studies totaling 1365 subjects were included. STPP was found to be significantly more effective than control conditions at post-treatment (d=0.69). STPP pre-treatment to post-treatment changes in depression level were large (d=1.34), and these changes were maintained until 1-year follow-up. Compared to other psychotherapies, a small but significant effect size (d=-0.30) was found, indicating the superiority of other treatments immediately post-treatment, but no significant differences were found at 3-month (d=-0.05) and 12-month (d=-0.29) follow-up. Studies employing STPP in groups (d=0.83) found significantly lower pre-treatment to post-treatment effect sizes than studies using an individual format (d=1.48). Supportive and expressive STPP modes were found to be equally efficacious (d=1.36 and d=1.30, respectively).
We found clear indications that STPP is effective in the treatment of depression in adults. Although more high-quality RCTs are necessary to assess the efficacy of the STPP variants, the current findings add to the evidence-base of STPP for depression.
Somatization, anxiety, depression and personality disorders are common features of many patients with chronic headaches. Intensive short-term dynamic psychotherapy (ISTDP) is a brief therapy method developed specifically to treat patients with this cluster of somatic problems, symptoms and maladaptive behaviours through focusing on how the patient handles emotional experiences. It also contains a direct method of assessing the somatic discharge pathways of both emotions and anxiety, thus allowing direct observation of somatization in the case of many chronic headache sufferers. In this review, we summarize the extant literature on emotional factors in headache, review the evidence for short-term dynamic therapies in somatic problems and describe the assessment and treatment method of ISTDP we use routinely with chronic headache sufferers.
This article reviews the cognitive therapy of depression. The psychotherapy based on this theory consists of behavioral and verbal techniques to change cognitions, beliefs, and errors in logic in the patient's thinking. A few of the various techniques are described and a case example is provided. Finally, the outcome studies testing the efficacy of this approach are reviewed.
The Global Assessment Scale (GAS) is a rating scale for evaluating the overall functioning of a subject during a specified time period on a continuum from psychological or psychiatric sickness to health. In five studies encompassing the range of population to which measures of overall severity of illness are likely to be applied, the GAS was found to have good reliability. GAS ratings were found to have a greater sensitivity to change over time than did other ratings of overall severity or specific symptom dimensions. Former inpatients in the community with a GAS rating below 40 had a higher probability of readmission to the hospital than did patients with higher GAS scores. The relative simplicity, reliability, and validity of the GAS suggests that it would be useful in a wide variety of clinical and research settings.
Thirty-two patients with personality disorder diagnoses were randomly assigned to two treatment conditions that vary on several techniques of brief dynamic psychotherapy. Seventeen patients constituted a waiting list control group. The two brief psychotherapies showed significant improvement on target complaints, SCL-90, and Social Adjustment Scale-SR compared with the control subjects. The two therapy groups were similar in overall outcome but showed interesting differences on several subscale measures. Process measurements of videotaped sessions revealed significant variations in frequencies of therapist interventions across the two treatment conditions, which validated planned differences in the treatment techniques.
This is an account of further work on a rating scale for depressive states, including a detailed discussion on the general problems of comparing successive samples from a ‘population’, the meaning of factor scores, and the other results obtained. The intercorrelation matrix of the items of the scale has been factor-analysed by the method of principal components, which were then given a Varimax rotation. Weights are given for calculating factor scores, both for rotated as well as unrotated factors. The data for 152 men and 120 women having been kept separate, it is possible to compare the two sets of results. The method of using the rating scale is described in detail in relation to the individual items.
Compared 4 forms of psychoanalytically oriented psychotherapy involving 3 male experienced psychiatrists and 106 18–56 yr old psychiatric outpatients. Patients received either individual therapy or group therapy that lasted either 6 or 24 mo. A comprehensive set of