The therapeutic alliance in psychodynamic-interpersonal and cognitive-behavioral therapy

This study was performed to determine the fluoride concentration of the various cementum surfaces in different tooth groups to find out the most proper teeth and tooth surfaces for different cementum studies. For this purpose, direct measurements of phosphorus and fluoride were carried out in an acid etch biopsy solution. The findings indicate that incisors with exposed cementum are the most inappropriate teeth in comparison with the other groups. According to the results obtained it may be recommended that the studies related to fluoride uptake for cementum should be performed on teeth with no gingival recession or on the unerupted teeth.     

Comparative study of emotional experiencing in psychodynamic-interpersonal and cognitive-behavioral therapies.

Despite increased interest in the role of emotion in the process of psychotherapy, a valid gauge of its importance in the change process is currently lacking. Significant sessions obtained from 13 experienced psychodynamic-interpersonal and 17 experienced cognitive-behavior therapists were examined to determine the extent of affective exploration and therapists' views of these client states. Results indicate that affective experiencing was present in equivalent amounts in the change sessions of these 2 orientations. However, therapists' clinical views were dissimilar. Psychodynamic-interpersonal therapists viewed portions containing higher affective experiencing as more critical to the change process, whereas cognitive-behavior therapists viewed lower levels of experiencing as being therapeutically more significant. These findings suggest that, with regard to emotional experiencing, psychodynamic-interpersonal therapists may share common ground with experiential therapists, whereas cognitive-behavior therapists appear to have a unique perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal exchange structure of brief psychodynamic-interpersonal and cognitive-behavioral psychotherapy.

A verbal exchange is a set of 2 people's co-occurring speech-act categories that accomplish some subtask within an interpersonal encounter. Factor analysis of verbal response mode (speech act) frequencies in 1,630 segments (each approximately 10 to 12 min) drawn from the brief psychodynamic-interpersonal or cognitive-behavioral treatment of 39 mainly depressed clients identified 6 exchanges in each treatment—4 that were the same in both treatments (Revealing, Storytelling, Explaining, and Inquiring) and 2 that distinguished each treatment (Exploring and Interpreting in psychodynamic–interpersonal treatment; Prescribing and Reframing in cognitive–behavioral treatment). The exchanges showed distinctive temporal patterns across segments of sessions and across sessions of each time-limited treatment. The verbal exchange is a midsize concept that links atomistic verbal codes with clinical or theoretical concepts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comprehensive process analysis of insight events in cognitive-behavioral and psychodynamic-interpersonal psychotherapies.

Comprehensive Process Analysis (CPA) is an interpretive, qualitative research method for analyzing significant therapy events. CPA was used to analyze 6 client-identified significant insight events in 2 treatments. Two events are presented in depth. The psychodynamic-interpersonal therapy event documented the existence of 2-part significant events and the value of key words. The cognitive-behavioral therapy event illustrated the role of context in transforming small therapy events into significant events. Events in both therapies involved therapist interpretations of recent difficult life events that were delivered in a firm but interactive style. Interpersonal therapy events were distinguished by links to themes from previous sessions and led to awareness of painful emotions. Cognitive therapy events were externalizing reattributions given to more clinically distressed clients. A revised 5-stage microprocess model of the insight is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of behavioral and cognitive-behavioral interventions for bulimia nervosa.

Examined the relative efficacy of cognitive-behavioral and behavioral treatment approaches for bulimia nervosa. Female bulimic Ss were randomly assigned to cognitive-behavioral, behavioral, or attention placebo conditions. At posttreatment, 92% of the cognitive-behavioral group, 100% of the behavioral group, and 69% of the nonspecific self-monitoring group were abstinent from binge eating–purging. At 6-mo follow-up, 69% of the cognitive-behavioral group, 38% of the behavioral group, and 15% of the nonspecific self-monitoring group were abstinent from binge eating and purging. The results support the conceptualization of bulimia nervosa as a multifaceted disorder best treated with an approach that directly addresses maladaptive cognitions, problematic behaviors, and the development of more adaptive coping skills. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional and paraprofessional group treatments for depression: A comparison of cognitive-behavioral and mutual support interventions.

The relative efficacy of professional and paraprofessional therapists in providing group cognitive-behavioral therapy (CBT) and mutual support group therapy (MSG) was examined. Depressed outpatients (N?=?98) were randomly assigned to CBT or MSG led by either 2 professional or 2 paraprofessional therapists. Results suggest that nonprofessionals were as effective as professionals in reducing depressive symptoms and that clients in the CBT and MSG conditions improved equally. Clinically significant improvement was demonstrated for both conditions. However, following treatment, more patients in the professionally led CBT groups were classified as nondepressed and alleviated than in the paraprofessionally led CBT groups. Additionally, therapist adherence to manual-based treatments was associated with greater improvement in clinician-rated depressive symptoms in both conditions and skills in cognitive restructuring were associated with greater improvement among clients in CBT. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sudden gains and critical sessions in cognitive-behavioral therapy for depression.

In this study of cognitive-behavioral therapy for depression, many patients experienced large symptom improvements in a single between-sessions interval. These sudden gains' average magnitude was 11 Beck Depression Inventory points, accounting for 50% of these patients' total improvement. Patients who experienced sudden gains were less depressed than the other patients at posttreatment, and they remained so 18 months later. Substantial cognitive changes were observed in the therapy sessions preceding sudden gains, but few cognitive changes were observed in control sessions, suggesting that cognitive change in the pregain sessions triggered the sudden gains. Improved therapeutic alliances were also observed in the therapy sessions immediately after the sudden gains, as were additional cognitive changes, suggesting a three-stage model for these patients' recovery: preparation?→?critical session/sudden gain?→?upward spiral. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparative analysis of the therapeutic focus in cognitive–behavioral and psychodynamic–interpersonal sessions.

This study compared therapeutic foci in a sampling of 30 cognitive-behavioral and 27 psychodynamic-interpersonal manual-driven treatments for depression. High- and low-impact sessions were coded for each client, with the Coding System of Therapeutic Focus. Results indicated that psychodynamic-interpersonal sessions focused more on such variables as emotion, patterns, incongruities, the impact that others made on clients, clients' expected reaction of others, the tendency to avoid therapeutic progress, therapists themselves, clients' parents, and links between people and time periods in clients' lives. Cognitive-behavioral sessions placed greater emphasis on external circumstances and clients' ability to make decisions, gave more support and information and encouraged between-session experiences, and focused more on the future. Relatively few differences emerged as a function of session impact. Results are discussed in terms of the different and similar theoretical conceptions of the change process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cognitive, emotional, and relational characteristics of master therapists.

Cognitive, emotional, and relational characteristics among 10 peer-nominated master therapists were identified through qualitative research methods. Results suggest that master therapists (a) are voracious learners; (b) draw heavily on accumulated experiences; (c) value cognitive complexity and ambiguity; (d) are emotionally receptive; (e) are mentally healthy and mature and attend to their own emotional well-being; (f) are aware of how their emotional health impacts their work; (g) possess strong relationships skills; (h) believe in the working alliance; and (i) are experts at using their exceptional relational skills in therapy. These findings suggest that researchers studying therapist expertise may want to explore emotional and relational characteristics in addition to an almost exclusive focus on the therapist's cognitive attributes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of treatment duration and severity of depression on the effectiveness of cognitive-behavioral and psychodynamic-interpersonal psychotherapy.

A total of 117 depressed clients, stratified for severity, completed 8 or 16 sessions of manualized treatment, either cognitive-behavioral psychotherapy (CB) or psychodynamic-interpersonal psychotherapy (PI). Each of 5 clinician-investigators treated clients in all 4 treatment conditions. On most measures, CB and PI were equally effective, irrespective of the severity of depression or the duration of treatment. However, there was evidence of some advantage to CB on the Beck Depression Inventory. There was no evidence that CB's effects were more rapid than those of PI, nor did the effects of each treatment method vary according to the severity of depression. There was no overall advantage to 16-session treatment over 8-session treatment. However, those presenting with relatively severe depression improved substantially more after 16 than after 8 sessions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of treatment duration and severity of depression on the maintenance of gains after cognitive-behavioral and psychodynamic-interpersonal psychotherapy.

104 clients completed a mailed follow-up 1 year after completing 8 or 16 sessions of treatment. Either cognitive-behavioral (CB) or psychodynamic-interpersonal (Pl) psychotherapy. Although mean scores on outcome measures at 1 year suggested that gains were, in general, well maintained, only 29% of clients were asymptomatic on all 3 occasions of testing without recourse to further treatment. However, only 11% of those asymptomatic at end of treatment experienced relapse or recurrence of depression, albeit on the limited evidence of just two follow-up assessments. The results of comparisons among treatment conditions at 1 year differed substantially from those obtained earlier. These findings confirm the importance of follow-up in evaluation of psychotherapies for depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of acute stress disorder: a comparison of cognitive-behavioral therapy and supportive counseling

Acute stress disorder (ASD) is a precursor of chronic posttraumatic stress disorder (PTSD). Twenty-four participants with ASD following civilian trauma were given 5 sessions of either cognitive-behavioral therapy (CBT) or supportive counseling (SC) within 2 weeks of their trauma. Fewer participants in CBT (8%) than in SC (83%) met criteria for PTSD at posttreatment. There were also fewer cases of PTSD in the CBT condition (17%) than in the SC condition (67%) 6 months posttrauma. There were greater statistically and clinically significant reductions in intrusive, avoidance, and depressive symptomatology among the CBT participants than among the SC participants. This study represents the 1st demonstration of successful treatment of ASD with CBT and its efficacy in preventing chronic PTSD.     

Hypnotic enhancement of cognitive-behavioral interventions for pain: An analogue treatment study.

Recent meta-analyses have shown that adding hypnosis enhances the effectiveness of cognitive behavioral psychotherapy. This hypnotic enhancement effect was evaluated in the analogue treatment of pain. Individuals scoring in the high (n=135) and low (n=150) ranges of hypnotic suggestibility were randomly assigned to 1 of 6 conditions: Stress Inoculation Training, the same treatment provided hypnotically, nonhypnotic analgesia suggestions, hypnotic analgesia suggestions, a hypnotic induction treatment, or a control condition. The 5 analogue treatments reduced experimental pain more than the control condition, but were not different from one another. Under circumstances optimized to detect an enhancement effect, neither Stress Inoculation Training nor analgesia suggestions produced more relief when delivered in a hypnotic context than identical treatments provided nonhypnotically. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group cognitive-behavioral treatment of binge eating disorder: a comparison of therapist-led versus self-help formats

A new enzymatic assay for selectively measuring conjugated bilirubin concentration in serum with use of bilirubin oxidase (BOD) has been developed. At pH 5.5 BOD can oxidize only conjugated bilirubin in the presence of reagents such as sodium fluoride and N-acetylcysteine which can decrease BOD reactivity to unconjugated bilirubin and bilirubin covalently bound to albumin (delta bilirubin). The resulting decrease in absorbance at 450 nm is linearly related to the concentration of conjugated bilirubin in serum. The BOD in this new assay was confirmed to oxidize conjugated bilirubin, and neither unconjugated nor delta bilirubin, based on both its reactivity to unconjugated bilirubin and HPLC results. This assay was found to give satisfactory results, such as in terms of the range of measurement, the reproducibility of the results, the lack of interference with coexisting substances in serum and the stability of the reagent solutions, in practical applications. The serum conjugated bilirubin concentrations determined using this assay correlate well with those determined by the HPLC analysis. This assay can be used for accurate monitoring of changes in the conjugated bilirubin concentration in patient sera. These findings suggest that the conjugated bilirubin assay is useful for fractional determination of bilirubin in icteric sera.     

Client perceptions of therapists: A study of the therapeutic relation.

A study was designed to identify the main ways that clients perceive their psychotherapists. An inventory of 65 statements was constructed to measure 8 postulated interpersonal behavior patterns. The inventory was administered to 523 patients in treatment for at least 3 mo. A factor analysis disclosed 5 dimensions of perceived therapist behaviors. The dimensions were labeled Accepting, Understanding, Authoritarian, Independence-Encouraging, and Critical-Hostile. The findings were shown to be consistent with constructs proposed by Fiedler, Apfelbaum, and Rausch and Bordin. Patient and therapist ratings of improvement were found to relate significantly to therapist Acceptance and Understanding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some stable characteristics of family therapists' interventions in real and simulated therapy sessions.

Coded the interventions of 19 family therapy trainees with a videotaped simulated family and with families they were treating, and compared them at 3 points in time. The coding categories were drive, interpretation, average length of speech, number of speeches, and average silence. Spearman rhos revealed stability over time for all categories except drive and interpretation, within real and simulated situations. Drive was stable only in the real situation and interpretation only in the simulated one. Correlations between situations within categories were largely nonsignificant, suggesting that therapists differ in their responses to the absence of feedback from a family. Available evidence suggests that the frequency with which family therapists trained in the dynamic interactional approach use interpretation might predict their success with families otherwise likely to terminate treatment prematurely. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' emotional processing in psychotherapy: A comparison between cognitive-behavioral and process-experiential therapies.

The authors compared clients' emotional processing in good and bad outcome cases in cognitive behavioral therapy (CBT) and process-experiential therapy (PET) and investigated whether clients' emotional processing increases over the course of therapy. Twenty minutes from each of 3 sessions from 40 clients were rated on the Experiencing Scale. A 2 × 2 × 3 analysis of variance showed a significant difference between outcome and therapy groups, with clients in the good outcome and PET groups showing significantly higher levels of emotional processing than those in the poor outcome and CBT groups, respectively. Clients' level of emotional processing significantly increased from the beginning to the midpoint of therapy. The results indicate that CBT clients are more distant and disengaged from their emotional experience than clients in PET. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analysis of cognitive-behavioral interventions on HIV-positive persons' mental health and immune functioning.

Objective: To evaluate the efficacy of cognitive-behavioral interventions (CBIs) for improving the mental health and immune functioning of people living with HIV (PLWH). Design: Comprehensive searches of electronic databases from 1988 to 2005, hand searches of journals, reference lists of articles, and contacts with researchers. Meta-analytic approaches were used in synthesizing findings. Main Outcome Measures: Intervention effects on symptoms of depression, anxiety, and anger, stress, and CD4 cell counts were assessed. Results: Data from 15 controlled trials were analyzed. Significant intervention effects were observed for improving symptoms of depression (d = 0.33), anxiety (d = 0.30), anger (d = 1.00), and stress (d = 0.43). There is limited evidence suggesting intervention effects on CD4 cell counts (d = 0.08). The aggregated effect size estimates for depression and anxiety were statistically significant in trials that provided stress management skills training and had more than 10 intervention sessions. Conclusion: CBIs are efficacious in improving various psychological states of PLWH. Future research should examine the relationship among interventions, psychological states, medication adherence, and immune functions, and identify other relevant factors associated with intervention effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributional biases among clinicians: A comparison of psychoanalysts and behavior therapists.

Assessed the attributional style of 30 psychoanalysts, 32 behavior therapists, and 78 nontherapist undergraduates by using a mail survey. Ss listed causal explanations for 3 hypothetical problems experienced by either themselves, their friends, or their clients. Results indicate that (a) psychoanalysts gave more dispositional explanations than situational explanations, whereas the reverse was true for behavior therapists and nontherapists; (b) psychoanalysts gave psychological explanations for problems hypothetically experienced by their friends or clients, but then gave physical explanations for the same problems hypothetically experienced by themselves; and (c) psychoanalysts holding medical degrees gave fewer psychological attributions and more physical attributions than behavior therapists or psychoanalysts with doctorate degrees. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)