Testimony psychotherapy in Bosnian refugees: a pilot study

OBJECTIVE: The authors sought to describe the use of the testimony method of psychotherapy in a group of traumatized adult refugees from genocide in Bosnia-Herzegovina. METHOD: The subjects were 20 Bosnian refugees in Chicago who gave written informed consent to participate in a case series study of testimony psychotherapy. All subjects received testimony psychotherapy, averaging six sessions, approximately 90 minutes, weekly or biweekly. Subjects received standardized instruments for posttraumatic stress disorder (PTSD), depression, traumatic events, global functioning, and prior psychiatric history. The instruments were administered before treatment, at the conclusion of the treatment, and at the 2- and 6-month follow-ups. RESULTS: The posttreatment assessments demonstrated significant decreases in the rate of PTSD diagnosis, PTSD symptom severity, and the severity of reexperiencing, avoidance, and hyperarousal symptom clusters. Depressive symptoms demonstrated a significant decrease, and there was a significant increase in scores on the Global Assessment of Functioning Scale. Two-month and 6-month follow-up assessments demonstrated further significant decreases in all symptoms and an increase in scores on the Global Assessment of Functioning Scale. CONCLUSIONS: This pilot study provides preliminary evidence that testimony psychotherapy may lead to improvements in PTSD and depressive symptoms, as well as to improvement of functioning, in survivors of state-sponsored violence.     

Diagnostic value of intravenous cholangiography within the scope of laparoscopic cholecystectomy

This work aimed to see whether (1) biofeedback is useful and (2) whether it needs to be combined with psychotherapy in sexually abused patients with anismus. Fifteen women aged 41.2 +/- 4.1 years who had experienced sexual abuse in childhood (9 cases) or adulthood (6 cases) and complained of symptoms of irritable bowel disease were studied. Anismus was recorded during anorectal manometry in all cases. Patients were free to choose biofeedback and/or group psychotherapy and/or individual psychotherapy. When necessary, psychoactive drugs were prescribed after a psychiatric evaluation. Initially all the patients chose biofeedback and none accepted psychotherapy. Eight patients accepted psychotherapy after several weeks of biofeedback. Thirteen patients completed the study: 5 treated by biofeedback alone, 5 with biofeedback and group therapy, and 3 with biofeedback and individual psychotherapy. Eight women recovered completely from their symptoms, only two of whom had had biofeedback without psychotherapy. Conclusion: Biofeedback alone was not always sufficient to cure abused patients, but was chose initially by all the patients. It could initially be a middle path between somatic treatment and psychotherapy, at a time when patients are not yet ready to undertake the latter.     

Effectiveness of a client pretherapy orientation videotape.

Examined the effects of a videotaped psychotherapy orientation on clients' response to therapy, knowledge about therapy, utilization of services, and satisfaction with services and on therapist ratings of client attractiveness. 62 psychotherapy clients (mean age 29 yrs) at an urban community mental health center were randomly assigned to an oriented group, which viewed a pretherapy orientation videotape at admission, or to a control group. 14 therapists participated. The 11-min videotape described the relationship between client and therapist, encouraged clients to attend appointments, and stated that, although progress is rarely immediate, most clients find that therapy can lead to a reduction in anxiety and depression. Clients and therapists completed questionnaire and rating scales at intake and at 1-mo follow-up. It was found that oriented clients were able to understand and recall the information in the videotape, and the oriented group showed a greater decrease in self-reported symptoms than the control group after 1 mo. Client feedback regarding the videotape was favorable. In general, the 2 groups did not differ in their satisfaction with services, service utilization, or therapist ratings of client symptoms and functioning. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The value of efficiency in psychotherapy.

While modern psychotherapies have often demonstrated a significant degree of effectiveness, in that they help clients overcome their presenting symptoms, their degree of "efficiency" may not measure up to their "effectiveness." Efficiency in psychotherapy includes several issues that are often neglected in research on "effectiveness." These criteria include such ingredients as depth-centeredness, pervasiveness, extensiveness, thoroughgoingness, maintenance of therapeutic progress, preventive psychotherapy, minimization of therapeutic harm, and encouragement of scientific flexibility. It is contended that these aspects of psychotherapy are of profound importance to therapists and clients and that such aspects should be consciously included as values in psychotherapy. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patterns of symptomatic recovery in psychotherapy.

Using the psychotherapy dosage model in which effect was probability of recovery, this study compared treatment response rates for psychological symptoms. Symptom checklists were administered to 854 psychotherapy outpatients at intake and during treatment. 62 symptoms were grouped into 3 classes on the basis of probit analysis results. Chronic distress symptoms demonstrated the fastest average response rate, whereas characterological symptoms demonstrated the slowest. Acute distress symptoms showed the highest average percentage of patients recovered across doses. A typical outpatient needed about a year of psychotherapy to have a 75% chance of symptomatic recovery. The model holds promise for establishing guidelines for the financing of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychotherapy in moderately severe COPD: a pilot study

Anxiety is common in the "pink puffer" syndrome associated with chronic obstructive pulmonary disease (COPD). The degree of anxiety correlates well with perceived dyspnoea. This pilot study examines the effect of group psychotherapy on anxiety, exercise tolerance, dyspnoea and quality of life. Ten patients with moderately severe, stable COPD (mean forced expiratory volume in one second (FEV1)-1.15 L) had six 90 min sessions of cognitive and behavioural psychotherapy at weekly intervals. Patients completed the Hospital Anxiety and Depression Scale (HADS), Medical Research Council Questionnaire (MRCQ) and St George's Respiratory Questionnaires (SGRQ), 1 week before and after therapy. FEV1, forced vital capacity (FVC), slow vital capacity (SVC), blood gas tensions and 6 min walking distance (6MWD) were measured. Eight control patients attended weekly for lung function and 6MWD for 6 weeks, but had no psychotherapy. Mean baseline HADS score was significantly higher in the psychotherapy group (12) than in controls (7), but otherwise there were no differences in lung function, blood gas tensions, 6MWD, or the other questionnaire scores between groups. After treatment, the physiological and psychological parameters where unchanged in both groups with the exception of the mean 6MWD, which had improved in the psychotherapy group only, from 351 to 423 m (p<0.001), an increase of 24%. Three months after treatment, the 6MWD was still 16% above the baseline value (p=0.02). In conclusion, six sessions of cognitive and behavioural psychotherapy produced a sustained improvement in exercise tolerance in a group of 10 anxious patients with severe chronic obstructive pulmonary disease, without any change in anxiety scores on the Hospital Anxiety and Depression Scale. Further studies of more prolonged, intensive psychotherapy would establish whether better symptom and quality of life scores accompany more dramatic increases in exercise tolerance in "pink puffers".     

"Clinical significance of psychotherapy for unipolar depression: A meta-analytic approach to social comparison": Correction to Nietzel et al.

Reports an error in "Clinical significance of psychotherapy for unipolar depression: A meta-analytic approach to social comparison" by Michael T. Nietzel, Robert L. Russell, Kelly A. Hemmings and Monica L. Gretter (Journal of Consulting and Clinical Psychology, 1987[Apr], Vol 55[2], 156-161). The data presented in Table 2 were incorrect because a row and a column were inadvertently omitted. The corrected Table 2 appears in the erratum. (The following abstract of the original article appeared in record 1987-28817-001.) This study used meta-analysis to study the clinical significance of psychotherapy for symptoms of unipolar depression. The following questions were addressed: How similar is the posttherapy adjustment of depressed adults to that of nondepressed adults? Is this adjustment maintained at follow-up? What dimensions of treatment, therapists, or design are associated with clinical significance? Using the Beck Depression Inventory (BDI), we calculated composite BDI norms from 28 published studies. Sixty effect sizes (from 31 outcome studies utilizing the BDI) were calculated. The results indicated that psychotherapy produces outcomes that have moderate clinical significance and that are well-maintained at follow-up, that individual therapy is associated with greater clinical significance than group treatment, and that type of therapy is not related to improvement. Alternative approaches for operationalizing clinical significance as the return of individuals to normal levels of functioning are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudes of psychiatrists toward elderly patients

A group of 179 psychiatrists responded to a questionnaire requesting their opinions concerning four clinical vignettes. Analysis of their responses indicated that these psychiatrists, at a highly statistically significant level, regarded older patients as less ideal for their practices than younger patients with identical symptoms. The respondents viewed the older patients as having a poorer prognosis, and their treatment plans for them were less likely to emphasize psychotherapy. In general, there was a negative correlation between the age of the respondent psychiatrists and their estimate of the "idealness" of and favorable prognosis for older patients.     

The psychotherapy of schizophrenia: Patient and therapist factors related to continuance.

The influence of pretreatment patient and therapist characteristics on continuance in individual psychotherapy was investigated using a sample of 143 nonchronic schizophrenic patients. Results showed that 1) most of the usual indicators of patient suitability for psychotherapy were not related to continuance; 2) patients with positive symptoms of schizophrenia were most likely to remain in supportive therapy, whereas patients with negative symptoms were more likely to remain in insight-oriented therapy; and 3) all patients were more likely to continue in treatment with therapists who had a strong commitment to a well-defined treatment approach, be it supportive or insight oriented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Panic disorder. Recent concepts of etiology and diagnosis

In the light of recent research, panic disorder, for many years considered to have biological etiology, seems to be psychologically conditioned. The psychological part of etiology consists of distorted cognitive interpretation of somatic and emotional symptoms, which lead to the phenomenon of "fear of fear". "Fear of fear" reinforces vulnerability to experience subsequent attacks and intensity of their symptoms. The research work described in the article changed the diagnostic attitude towards panic disorder, both in DSM IV (APA 1994) and ICD-10 (WHO 1994). That change urges to search for new models of psychotherapy, specific to panic disorder.     

Geriatric psychosomatic disorders and psychotherapy of the elderly. Current concept and approaches to treatment

In a geriatric acute hospital, a minimum of 20% of the patients aged 60 or older fulfilled the case criteria for a psychogenic illness. Previously published epidemiological investigations had presented similar results. However, due to the limited theoretical training and treatment experience, psychotherapists continue to show extreme reluctance to formulate an indication for psychotherapy in elderly patients. The paper gives an overview of current concepts in development psychology for the second half of life drawing attention to the role of physical aging processes as an "organiser" of development. Sexuality in late life and approaches to dealing with chronic pain are presented as somatic-psychosomatic aspects of aging that challenge present old age stereotypes. Taking typical symptoms into consideration, a basis is established for the discussion of a differentiated therapy indication for elderly patients. Emphasis is on psychoanalytical and cognitive behavioural psychotherapy methods. Finally, perspectives of research are presented.     

Psychotherapists view their personal therapy.

Studied the long-term effects of intensive psychotherapy or psychoanalysis on a sophisticated group of patients—practicing psychotherapists who had previously been in treatment. A comprehensive questionnaire was distributed to 97 30–60 yr old psychotherapists preselected by having completed personal psychotherapy or psychoanalysis. The items focused on subjective experiences in psychotherapy, the elucidation of intrapsychic effects, and Ss' perception of outcome. Positive benefits of treatment involved improvements in self-esteem as well as interpersonal relations. Symptom alleviation was ranked as the least important benefit. Improvement in all areas (including self-esteem, work function, sex life, social relations, character change, and alleviation of symptoms) positively correlated with the feeling of being liked by and liking the therapist. The emotional "tone" of the treatment situation as exemplified by aspects of the patient–therapist relationship appeared to be critical to a positive outcome. 21% of the Ss reported that their treatment was also harmful in some fashion. Data suggested that unresolved transference issues were central to a negative effect. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A transvaluation of psychotherapy: a reply to Hans Eysenck.

In an attempt to answer Eysenck's contention that "the figures fail to support the hypothesis that psychotherapy facilitates recovery from neurotic disorder," the author re-examines three vital questions: What is psychoneurosis? What is psychotherapy? and What is improvement or recovery? (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive-Behavioral Analysis System of Psychotherapy as a Maintenance Treatment for Chronic Depression.

Although the efficacy of maintenance pharmacotherapy for the prevention of recurrence in major depressive disorder (MDD) is well documented, few studies have tested the efficacy of psychotherapy as a maintenance treatment. The authors examined the efficacy of the cognitive-behavioral analysis system of psychotherapy (CBASP) as a maintenance treatment for chronic forms of MDD. Eighty-two patients who had responded to acute and continuation phase CBASP were randomized to monthly CBASP or assessment only for 1 year. Significantly fewer patients in the CBASP than assessment only condition experienced a recurrence. The 2 conditions also differed significantly on change in depressive symptoms over time. These findings support the use of CBASP as a maintenance treatment for chronic forms of MDD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of drug solubility, drug loading, and polymer molecular weight on drug release from Polyox tablets

BACKGROUND: This study augments a randomized controlled trial to analyze the cost-effectiveness of 2 standardized treatments for major depression relative to each other and to the "usual care" provided by primary care physicians. METHODS: A randomized controlled trial was conducted in which primary care patients meeting DSM-III-R criteria for current major depression were assigned to pharmacotherapy (where nortriptyline hydrochloride was given) or interpersonal psychotherapy provided in a standardized framework or a primary physician's usual care. Two outcome measures, depression-free days and quality-adjusted days, were developed using information on depressive symptoms over time. The costs of care were calculated. Cost-effectiveness ratios comparing the incremental outcomes with the incremental costs for the different treatments were estimated. Sensitivity analyses were performed. RESULTS: In terms of both economic costs and quality-of-life outcomes, patients assigned to the pharmacotherapy group did slightly better than those assigned to interpersonal psychotherapy. Both standardized therapies provided better outcomes than primary physician's usual care, but each consumed more resources. No meaningful cost-offsets were found. The incremental direct cost per additional depression-free day for pharmacotherapy relative to usual care ranges from $12.66 to $16.87 which translates to direct cost per quality-adjusted year gained from $11270 to $19510. CONCLUSIONS: Standardized treatments for depression lead to better outcomes than usual care but also lead to higher costs. However, the estimates of the cost per quality-of-life year gained for standardized pharmacotherapy are comparable with those found for other treatments provided in routine practice.     

A-B therapist distinction, patient diagnosis, and outcome of brief psychotherapy in a college clinic.

Prior studies suggest that therapists' A-B status (types catagorized by the Whitehorn-Betz A-B scale) interacts with patient diagnosis in determining the outcome of psychotherapy (A > B with schizophrenics, B > A with neurotics). To discern whether the hypothesis would apply to brief psychotherapy in a college clinic, the "outcomes" obtained by 3 A and 3 B therapists with their schizoid and neurotic patients (N = 57) were examined in a 2 * 2 factorial design. Analysis of 3 dependent measures based on therapists' and patients' posttherapy ratings reveal considerable support for the hypothesis, particularly for therapists' appraisals of their own effectiveness (interaction, p     

Psychotherapy and the recovery from neurosis.

"Available evidence suggests that psychotherapy can be effective in alleviating minor maladjustments characterized by such objective states as 'unhappiness,' 'anxiety,' and tension' that often accompany neurosis. But the evidence does not yet support the view that psychotherapy is effective in relieving those gross and persistent maladjustments (neuroses) that are characterized by definite, palpable symptoms. Whether it has any effect on these is a question which only future research can settle." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The functional autonomy of psychotherapy.

Psychotherapy's initial function was to provide a service to troubled people who asked for help. Later evidence of its efficacy was unimpressive, but the method did not die out. "Psychotherapy had, it appeared, achieved functional autonomy." Various criticisms of the value of psychotherapy have been controverted. The efficacy of psychotherapy is not considered in the American Psychological Association ethical principles. Chapters on psychotherapy in the Annual Review of Psychology from 1955 to 1960 dismiss the question of efficacy. Experts are convinced that psychotherapy works. We "can be sure that the principle of functional autonomy will permit psychotherapy to survive long after it has outlived its usefulness as a personality laboratory." From Psyc Abstracts 36:02:2IE75A. (PsycINFO Database Record (c) 2010 APA, all rights reserved)