Dynamics of fever and the cytokine network in systemic juvenile arthritis

BACKGROUND: Until the middle of the 20th century available treatment for depressive disorders was largely supportive and palliative. In the following decades, monoamine oxidase inhibitors and tricyclic antidepressants have been introduced. Unfortunately, the limitations of these drugs have been increasingly recognized. Thus, agents must be chosen based on their side effect profile, acceptability for long-term prophylaxis and any clinical lore regarding possible syndromal selectivity of response. The role of combination therapies is well recognized in many cases of major depressive disorders. The author's goal of study was to assess the effectiveness of psychotherapies on hospitalized depressive patients. METHODS: Sixty-two patients with major depressive disorders (MDD) were treated for eight sessions of behavioral, cognitive, or supportive group psychotherapy. During the treatment period, 16 of these subjects were assigned to a 4-week non-psychotherapeutic treatment control condition. All the above depressive patients received tricyclic antidepressants including Amitriptyline, lmipramine or Doxepine. RESULTS: By the end of four weeks patients in the three psychotherapeutic treatment groups showed significant improvement as compared with the controls. Overall, 58% of the psychotherapeutic treatment samples attained remission by termination; another 21% showed significant improvement. The remainder still met the criteria for MDD at the conclusion of therapy. A number of outcome measures indicated no significant difference for any of the three modalities in obtaining positive results. CONCLUSIONS: The therapeutic effect of depressed inpatients responding to these psychotherapies compares favorably with the controls, indicating the efficacy of psychotherapy for treatment of depressive inpatients.     

Psychotherapeutic interventions with traumatically brain-injured patients.

Reviews personality disturbances that can occur after traumatic brain injury (TBI), including neuropsychologically based personality changes, emotional reactions to injury, and preexisting characterological styles. Denial, based in either psychological defensiveness or organic lack of awareness, presents a special rehabilitation problem that may be amenable to therapy. Psychotherapy following TBI is described, focusing on the use of the psychotherapeutic relationship, setting, rationale, and procedures. Psychotherapeutic techniques appropriate for working with TBI patients are noted, including cognitive-behavioral interventions, self-instructional training, dynamically oriented psychotherapies, and group psychotherapy. A comment by M. Rosenthal follows. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy for depression in adults: A meta-analysis of comparative outcome studies.

Although the subject has been debated and examined for more than 3 decades, it is still not clear whether all psychotherapies are equally efficacious. The authors conducted 7 meta-analyses (with a total of 53 studies) in which 7 major types of psychological treatment for mild to moderate adult depression (cognitive-behavior therapy, nondirective supportive treatment, behavioral activation treatment, psychodynamic treatment, problem-solving therapy, interpersonal psychotherapy, and social skills training) were directly compared with other psychological treatments. Each major type of treatment had been examined in at least 5 randomized comparative trials. There was no indication that 1 of the treatments was more or less efficacious, with the exception of interpersonal psychotherapy (which was somewhat more efficacious; d = 0.20) and nondirective supportive treatment (which was somewhat less efficacious than the other treatments; d = -0.13). The drop-out rate was significantly higher in cognitive-behavior therapy than in the other therapies, whereas it was significantly lower in problem-solving therapy. This study suggests that there are no large differences in efficacy between the major psychotherapies for mild to moderate depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rapid response to psychosocial treatment for adolescent depression: a two-year follow-up

OBJECTIVE: To examine the differential course and treatment outcome of patients who participated in a randomized clinical trial, comparing cognitive, family, and supportive psychotherapies for adolescent major depressive disorder. METHOD: In a sample of 100 depressed adolescents, remission, clinical recovery, recurrence, and functional improvement were examined at the end of acute treatment and at 1- and 2-year follow-up, according to their type of response to treatment. Rapid response was defined as a decline of > or = 50% in the Beck Depression Inventory (BDI) score from pretreatment until the beginning of the second session of psychotherapy, intermediate as a decline of < 50% but > 0%, and initial nonresponse as a BDI score that stayed the same or increased. RESULTS: Rapid responders showed a better outcome at acute treatment, 1-year, and in some measures, 2-year follow-up. For those who had recurrences over time, rapid responders showed a longer period before recurrence. Subjects were most likely to respond rapidly, or not at all, in the supportive cell. CONCLUSIONS: These findings suggest that milder forms of depression may benefit from initial supportive therapy or short trials of more specialized types of psychotherapy. The use of a placebo run-in period might help to "wash out" nonspecific responders.     

Social problem solving and depressive symptoms over time: A randomized clinical trial of cognitive-behavioral analysis system of psychotherapy, brief supportive psychotherapy, and pharmacotherapy.

Objective: Depression is associated with poor social problem solving, and psychotherapies that focus on problem-solving skills are efficacious in treating depression. We examined the associations between treatment, social problem solving, and depression in a randomized clinical trial testing the efficacy of psychotherapy augmentation for chronically depressed patients who failed to fully respond to an initial trial of pharmacotherapy (Kocsis et al., 2009). Method: Participants with chronic depression (n = 491) received cognitive-behavioral analysis system of psychotherapy (CBASP; McCullough, 2000), which emphasizes interpersonal problem solving, plus medication; brief supportive psychotherapy (BSP) plus medication; or medication alone for 12 weeks. Results: CBASP plus pharmacotherapy was associated with significantly greater improvement in social problem solving than BSP plus pharmacotherapy, and a trend for greater improvement in problem solving than pharmacotherapy alone. In addition, change in social problem solving predicted subsequent change in depressive symptoms over time. However, the magnitude of the associations between changes in social problem solving and subsequent depressive symptoms did not differ across treatment conditions. Conclusions: It does not appear that improved social problem solving is a mechanism that uniquely distinguishes CBASP from other treatment approaches. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Influence of social support on success of therapeutic interventions: A meta-analytic review.

Researchers view social support as an important extratherapeutic factor in the field of psychotherapeutic research. In an effort to verify the accuracy of this view, and to determine the degree to which social support influences the outcome of psychotherapeutic interventions, the authors conducted an exhaustive review of studies published until 2007. This search yielded 27 studies, including 29 independent samples that composed a meta-analysis. The results demonstrated a small mean correlation of r = .13 between social support and psychotherapy outcome on an almost homogeneous data set. Different operationalizations of social support and forms of interventions did not result in different effect sizes on a statistically significant level. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatry and psychotherapeutic medicine

Starting from a sketch of the basic view points from which the topic will be elucidated, the author focuses on the different logics of psychiatry and psychotherapies. The connections between the topic and the somatopsychosocial model, the intercorrelation of psycho-genetic interpretative models and indication for psychotherapy indicate an approach which is oriented towards the disordered person (and not the disorder). This concept is compared with the often used definition of psychotherapy by Strotzka. The dependence of the concept on traditions in psychiatry (Krafft-Ebing, Jaspers, Kretschmer, E. Bleuler, and M. Bleuler) and its consistency with modern multiaxial diagnostic systems (Frances et al.) are stressed. Finally the border to psychotherapeutic medicine outside psychiatry, both in theory and practice, is stressed.     

Normality, diversity, and psychotherapy.

Argues that psychological health does not conform to a single set of standards, so the "medical model" of specific treatment aimed at restoring homeostatic normality may be misleading when applied to psychotherapy. Current psychotherapeutic treatments are diverse, but no more diverse than successful patterns of living. It is suggested that different psychotherapies may open up different ranges of options for their clients and produce systematically different kinds of healthy personality change. Choice of therapy may be more a matter of personal values than of differential efficacy. (49 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The integration of psychotherapies.

Reviews the book, The integration of psychotherapies by Alvin R. Mahrer with a Foreword by John C. Norcross (see record 1989-97512-000). Mahrer has written the book for those who are learning, teaching, supervising, and trying to integrate psychotherapies. In the book he is trying to answer the following questions: What are the various strategies that are used for integrating psychotherapies? How do the several strategies fare comparatively in their feasibility, workability, and chances for success in integrating psychotherapies? What are the likely consequences for the field of psychotherapy of pursuing each of the strategies? Is integration good or bad for the field of psychotherapy? On the basis of his study of the various strategies for integrating psychotherapies, what recommendations are warranted? This book is a valuable intellectual contribution to the development of theory in psychotherapy. The process of attempting to integrate psychotherapies is inevitable, and by producing this thoughtful and scholarly work Mahrer has helped to raise the quality of the integration effort. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive emotions as generators of therapeutic change.

The purpose of this article is to highlight commonalities and facilitate links between the domains of psychotherapy and positive psychology. The authors describe the Broaden-and-Build theory and suggest that it has heuristic value for understanding psychotherapeutic processes. The authors propose that broadening represents a common factor in intrapersonal therapy that contributes to many helpful change events across different psychotherapies. The upward spiral in which positive emotions and broadening feed one another enlarges current psychotherapeutic conceptualizations by suggesting that positive emotions are not just indicators but also generators of change. The positive emotion-broadening spiral offers new avenues for research and ways to understand existing research, an alternative avenue to therapeutic change, and a method to tailor therapeutic work to individual clients. It also bridges researcher, clinician, and client points of view about key change events. Links between different viewpoints enhance therapeutic work. Links across lines of theorizing and research foster interdisciplinary ties that fertilize both fields. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Schizophrenia and therapist involvement: Changing the practice of four major psychotherapies.

Describes how therapy experience with schizophrenic patients has impacted on 4 therapeutic approaches—existential psychotherapy, psychoanalysis, client-centered psychotherapy, and family therapy. It is suggested that such experience has led to similar therapist-centered modifications in each of the 4 psychotherapies and that a cross-relevancy between the treatment of schizophrenia and all other psychological disorders has emerged. Aspects of therapy considered include the interpersonal nature of the analytic situation, the communication of empathy, and intervention with dysfunctional family systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nonverbal synchrony in psychotherapy: Coordinated body movement reflects relationship quality and outcome.

Objective: The authors quantified nonverbal synchrony—the coordination of patient's and therapist's movement—in a random sample of same-sex psychotherapy dyads. The authors contrasted nonverbal synchrony in these dyads with a control condition and assessed its association with session-level and overall psychotherapy outcome. Method: Using an automated objective video analysis algorithm (Motion Energy Analysis; MEA), the authors calculated nonverbal synchrony in (n = 104) videotaped psychotherapy sessions from 70 Caucasian patients (37 women, 33 men, mean age = 36.5 years, SD = 10.2) treated at an outpatient psychotherapy clinic. The sample was randomly drawn from an archive (N = 301) of routinely videotaped psychotherapies. Patients and their therapists assessed session impact with self-report postsession questionnaires. A battery of pre- and postsymptomatology questionnaires measured therapy effectiveness. Results: The authors found that nonverbal synchrony is higher in genuine interactions contrasted with pseudointeractions (a control condition generated by a specifically designed shuffling procedure). Furthermore, nonverbal synchrony is associated with session-level process as well as therapy outcome: It is increased in sessions rated by patients as manifesting high relationship quality and in patients experiencing high self-efficacy. Higher nonverbal synchrony characterized psychotherapies with higher symptom reduction. Conclusions: The results suggest that nonverbal synchrony embodies the patients' self-reported quality of the relationship and further variables of therapy process. This hitherto overlooked facet of therapeutic relationships might prove useful as an indicator of therapy progress and outcome. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Supportive therapy for borderline patients—A psychodynamic approach.

Reviews the book, Supportive therapy for borderline patients—A psychodynamic approach by Lawrence H. Rockland (see record 1992-97952-000). In this book, the author addresses the supportive psychotherapy of clients with Borderline Personality Disorder (BPD). While there is an abundant literature on expressive and psychoanalytic treatments for the borderline client there is very little on supportive approaches in the psychotherapy literature. Rockland offers a guide to the therapist who, after careful assessment and treatment planning, decides that a primarily supportive psychotherapy is most appropriate for his/her client, either initially or throughout the treatment. Using a practical, how-to format, Rockland applies the principles of Psychodynamically Oriented Supportive Therapy (POST)—an approach that he formulated (Rockland, 1989)—to clients with BPD. This text will assist clinicians in conceptualizing interventions that are often already part of their "supportive" repertoire but are applied in an unorganized and unsystematic fashion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Psychotherapy Research Project of the Menninger Foundation: An overview.

Studied processes and outcomes of psychoanalysis and psychoanalytic psychotherapy, both expressive and supportive. 42 Ss were followed via initial, termination, and follow-up studies over the entire natural course of treatment, with 100% follow-up 2–3 years posttermination. Some follow-ups extended over the 30-year life span of the study. Detailed case histories and life histories were obtained from all 42 Ss. Psychoanalyses achieved more limited outcomes than predicted; psychotherapies often achieved more than predicted. Supportive mechanisms infiltrated all therapies, psychoanalyses included, and accounted for more of the achieved outcomes (including structural changes) than anticipated. An expanded new categorization of supportive therapeutic mechanisms is proposed, along with an elaboration of expressive therapeutic mechanisms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification and analyses of periodontal pathogens in Taiwan by microbiological tests

The effectiveness of transference interpretation in the psychodynamic psychotherapy of patients with borderline personality disorder has been highly controversial. Both highly expressive approaches that stress the value of transference interpretation and supportive strategies that eschew transference work have been advocated in the literature. We review this literature and identify three emerging trends in thought: (1) Primarily interpretive approaches should be reserved for patients with greater levels of ego strength. (2) Whichever technique is used, a strong therapeutic alliance is the foundation of treatment. (3) Expressive and supportive techniques should not be juxtaposed as polarized opposites; supportive interventions often pave the way for transference interpretation. Our psychotherapy process study revealed that transference interpretations tended to have greater impact--both positive and negative--than other interventions made with patients with borderline personality disorder. We conclude that such factors as neuropsychologically based cognitive dysfunction, a history of early trauma, patterns of object relations involving interpersonal distance, masochistic tendencies, and anaclitic rather than introjective psychopathology are among the patient characteristics that influence the impact of transference interpretation on the therapeutic alliance. Bias toward expressive technique and countertransference issues appear to be relevant to the therapist's difficulty in shifting to a more supportive approach when indicated.     

The effect of therapist self-disclosure on patients' perceptions of empathy, competence and trust in an analogue psychotherapeutic interaction.

Psychodynamically oriented clinicians uniformly contraindicate the use of therapist self-disclosure, whereas practitioners disposed toward a humanistic-existential perspective often regard this practice as an essential condition of treatment. In the present study, 57 psychotherapy patients (aged 18–55 yrs) read 1 of 3 patient–therapist dialogs in which the degree of therapist self-disclosure was high, low, or nil. Ss completed the Relationship Inventory and Sorenson Relationship Questionnaire to measure perceived therapist empathy, competence, and trust. Findings confirm the prediction that greater therapist self-disclosure would be related to poorer evaluations of the therapist. Results question the use of self-disclosure as a psychotherapeutic technique and suggest that self-disclosure may adversely affect the perceptions on which the therapeutic alliance is based. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues of self-concept deficit in psychotherapy.

Summarizes common themes of self-concept development found in major psychotherapeutic traditions; outlines adaptive self-concept development from an eclectic, lifespan task perspective; notes common deficits in self-concept found in psychotherapy patients; and discusses ways in which therapy can address these deficits. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dynamics of intergestural timing: a perturbation study of lip-larynx coordination

Cancer is associated with significant psychosocial morbidity. Although psychodynamic psychotherapy is a valuable intervention for some cancer patients, this modality has been underutilized because psychotherapy with medically ill patients has been linked historically to work with patients who have psychosomatic illnesses. Psychotherapy with patients who have cancer has unique features, such as the prominence of illness-related issues during the initial phase of treatment, the mixture of supportive and interpretive therapy, focused goals, and special issues pertaining to the transference/countertransference field. Understanding of those special issues will improve psychiatrists' ability to use long-term psychotherapy as an effective psychosocial intervention for patients with cancer.     

Emotion and cognition in psychotherapy: The transforming power of affect.

Theory and research on emotion in both psychology and psychotherapy are reviewed to demonstrate the importance of emotion in human functioning and psychotherapeutic change. A proposal is made for the importance of integrating empirically supported emotion-focused change processes into psychotherapeutic work. Five principles of change in the emotion domain-emotion awareness; expression; regulation; reflection on emotion; and the more novel principle of emotion transformation, by which emotion is changed by emotion-are offered as processes of change that are rapidly gathering empirical support. The result of emotion coming of age will be the expansion of theories of dysfunction and of treatment to include emotion-focused coping and emotional processes of change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)