Ego Function Assessment and Internet Addiction.

This study examined the relationship between trauma, ego functioning, and internet addiction. We recruited 323 participants via Amazon Mechanical Turk, a crowdsourcing platform that can be used for survey research. We gave participants the Internet Addiction Test, the Life Events Checklist, the Ego Function Assessment questionnaire, and a demographic questionnaire. Our results indicate that 41.5% reported no internet addiction, with the majority of our sample reporting behaviors that were consistent with internet addiction: mild internet addiction = 37.8%, moderate internet addiction = 19.8%, and severe internet addiction = 0.9%. The constrictive factor of ego functioning was significantly worse in those with internet addiction. Path analysis showed that the constrictive factor of ego functioning partially mediated the relationship between a self-reported history of trauma and the presence of self-reported internet addiction.

Relationship between defense mechanisms and psychopathic traits in an Internet sample.

The authors compared the defense mechanisms used by a community sample of people with and without self-reported psychopathic traits. Defense mechanisms were assessed using the Defense Style Questionnaire-60 and psychopathy was assessed using the Levinson Self-Report Psychopathy Scale in a sample of 225 adults recruited on the Internet. Results found that people with self-reported psychopathy traits used significantly more immature and neurotic defense mechanisms than people without a psychopathic personality profile. All participants reported equal use of mature defenses.

Supportive-Expressive Psychodynamic Psychotherapy for the Treatment of Opioid Use Disorder.

The United States is in the midst of an opioid epidemic with over 200,000 deaths per year due to opioid overdoses. There are numerous psychotherapeutic and medication-assisted approaches to treating opioid use disorder, but psychodynamic approaches remain underappreciated and underused. The self-medication hypothesis of substance use disorders is a psychodynamic model, which argues that all substance use disorders serve to defend against intolerable affects. In the case of opioid use disorders, opioids are thought to help defend against intense intolerable feelings of rage and depression associated with trauma. Supportive-expressive psychodynamic psychotherapy is an empirically supported psychodynamic treatment for a wide range of psychological problems, including opioid use disorders. Supportive-expressive psychodynamic psychotherapy focuses on transference analysis using an operationalized conceptualization of transference called the core conflictual relational theme method. This article describes supportive-expressive psychodynamic psychotherapy for opioid use disorders and provides clinical examples of its use in practice. The article describes and illustrates the three phases of supportive-expressive psychodynamic psychotherapy, the formulation of the core conflictual relationship theme, how it is applied when treating people with an opioid use disorder, and how supportive-expressive psychodynamic psychotherapy can be used with other therapies, such as medication-assisted treatments and 12-step programs. Last, this article encourages psychodynamic therapists who are not involved in treating people with an opioid use disorder to engage in treating people with one using supportive-expressive psychodynamic psychotherapy.

The relationship between defense mechanisms and religious coping using a new two-factor solution for the Defense Style Questionnaire-40.

This study examined the factor structure of the Defense Style Questionnaire (DSQ-40) and explored the relationships between defense mechanisms and religious coping in a diverse sample of 380 college students. In contrast with the three-factor model of defenses proposed by the developers of the DSQ-40, principal axis factoring yielded two internally consistent components: adaptive and maladaptive defense styles. Endorsement of adaptive defenses was positively correlated with the use of positive religious coping strategies and negatively correlated with negative religious coping. Maladaptive defenses were associated with the endorsement of negative religious coping strategies. Clinical implications of these findings are discussed and recommendations are made for future use of the DSQ-40.

Further evidence of self-medication: personality factors influencing drug choice in substance use disorders.

According to Khantzian's (2003) self-medication hypothesis (SMH), substance dependence is a compensatory means to modulate affects and self-soothe in response to distressing psychological states. Khantzian asserts: (1) Drugs become addicting because they have the power to alleviate, remove, or change human psychological suffering, and (2) There is a considerable degree of specificity in a person's choice of drugs because of unique psychological and physiological effects. The SMH has received criticism for its variable empirical support, particularly in terms of the drug-specificity aspect of Khantzian's hypothesis. We posit that previous empirical examinations of the SMH have been compromised by methodological limitations. Also, more recent findings supporting the SMH have yet to be replicated. Addressing previous limitations to the research, this project tested this theory in a treatment sample of treatment-seeking individuals with substance dependence (N = 304), using more heterogeneous, personality-driven measures that are theory-congruent. Using an algorithm based on medical records, individuals were reliably classified as being addicted to a depressant, stimulant, or opiate by two independent raters. Theory-based a priori predictions were that the three groups would exhibit differences in personality characteristics and emotional-regulation strategies. Specifically, our hypotheses entailed that when compared against each other: (1) Individuals with a central nervous system (CNS) depressant as drug of choice (DOC) will exhibit defenses of repression, over-controlling anger, and emotional inhibition to avoid acknowledging their depression; (2) Individuals with an opiate as DOC will exhibit higher levels of aggression, hostility, depression, and trauma, greater deficits in ego functioning, and externalizing/antisocial behavior connected to their use; and (3) Individuals with a stimulant as DOC will experience anhedonia, paranoia, have a propensity to mania, and display lower levels of emotional inhibition. MANOVAs were used to test three hypotheses regarding drug group differences on the personality variables that were in keeping with the SMH. The MANOVAs for Hypothesis I (Depressant group) and Hypothesis II (Opiate group) were statistically significant. Findings partially support the SMH, particularly in its characterization of personality functioning in those addicted to depressants and opiates.

Biogenetic explanations and stigma: a meta-analytic review of associations among laypeople.

The stigma and social rejection faced by people with a mental disorder constitute a major barrier to their well-being and recovery. Medicalization has been welcomed as a strategy to reduce blame and stigma, although critics have cautioned that attributing mental disorders to biogenetic causes may have unintended side effects that could exacerbate prejudice and rejection. The present study presents a quantitative synthesis of the literature on relationships between biogenetic explanations for mental disorders and three key elements of stigma, namely blame, perceptions of dangerousness, and social distance. A comprehensive search yielded 25 studies meeting the inclusion criteria. Separate meta-analyses (Ns = 4278-23,816) were conducted for the three stigma types, and assessed the consistency of effects across subgroups of studies involving different types of biogenetic explanations, mental disorders, and samples. We found that people who hold biogenetic explanations for mental disorders tend to blame affected persons less for their problems (r = -0.19), but perceive them as more dangerous (r = 0.09) and desire more distance from them (r = 0.05). The negative association with blame was significant for schizophrenia, belief in genetic causation, and in student samples. The positive association with dangerousness was significant for all disorders, belief in general biogenetic causation, and in community samples. The positive association with social distance was significant for schizophrenia, beliefs in neurochemical and general biogenetic causation, and in community samples. Nevertheless, across all analyses, biogenetic explanations were only weakly related to stigma. We conclude that biogenetic explanations for mental disorders confer mixed blessings for stigma.

The 'side effects' of medicalization: a meta-analytic review of how biogenetic explanations affect stigma.

Reducing stigma is crucial for facilitating recovery from psychological problems. Viewing these problems biomedically may reduce the tendency to blame affected persons, but critics have cautioned that it could also increase other facets of stigma. We report on the first meta-analytic review of the effects of biogenetic explanations on stigma. A comprehensive search yielded 28 eligible experimental studies. Four separate meta-analyses (Ns=1207-3469) assessed the effects of biogenetic explanations on blame, perceived dangerousness, social distance, and prognostic pessimism. We found that biogenetic explanations reduce blame (Hedges g=-0.324) but induce pessimism (Hedges g=0.263). We also found that biogenetic explanations increase endorsement of the stereotype that people with psychological problems are dangerous (Hedges g=0.198), although this result could reflect publication bias. Finally, we found that biogenetic explanations do not typically affect social distance. Promoting biogenetic explanations to alleviate blame may induce pessimism and set the stage for self-fulfilling prophecies that could hamper recovery from psychological problems.

Expanding the single-case study: a proposed psychoanalytic research program.

This paper offers a proposed program of research using single-case time-series methods that can be used by practicing clinicians. The paper is written for psychodynamically oriented clinicians who want to get involved in psychotherapy research and make contributions to the scientific literature. How to measure treatment outcomes and psychodynamic constructs are discussed. With few exceptions, conducting single-case time-series research using psychodynamic psychotherapy has far more advantages than disadvantages.

Microprocess examination of therapeutic immediacy during a dynamic research interview.

This study examines the interviewer's use of immediacy during a dynamic interview to enhance the patient's ability to process affective material and deepen personal exploration. Using a microprocess design, immediacy events were identified and rated using the Consensual Qualitative Rating method. Moment-to-moment in-session activity was rated by trained observers with a focus on measuring patient process using the Therapist-Patient Interaction Rating Scale and interviewer process using the Therapeutic Environment Scale. Five immediacy events were identified and were found to range in depth from mundane exchanges to more active exchanges with affective depth. Mundane events were characterized by little attention to the affective component of the here-and-now relationship, dismissive and unsupportive comments, and had either no effect, or a negative effect on patient process. In contrast, immediacy events characterized by even limited affect and acknowledging engagement between patient and interviewer were followed by greater patient disclosure and increased capacity to process emotional information. Thus, attention to the quality of the immediacy intervention in future research appears warranted.

Improving the relationship between the randomized clinical trial and real-world clinical practice.

I comment on the article by Krause (see record 2011-19228-002), which discusses a number of ways for clinical psychotherapy outcome researchers to make the results of randomized controlled trials (RCT) more useful to practicing psychotherapists primarily by making the distributions of raw data from those studies available to the public. In this way, it would be possible for psychotherapists to determine which treatment of an RCT (experimental or control) would be best for a specific patient. Problems with this proposal are discussed and an alternative model that integrates psychotherapy outcome data from group means and clinical case studies is offered.

A critique of the methods and conclusions in the patient outcome research team (PORT) report on psychological treatments for schizophrenia.

The schizophrenia Patient Outcome Research Team (PORT; Lehman and Steinwachs, 1998), a policy paper on the treatment of schizophrenia sponsored by the United States government Agency for Health Care Policy and Research, has minimized the efficacy and utility of psychological treatments for schizophrenia and concluded that some treatments like psychoanalytic psychotherapy are contraindicated and harmful. A critical review of Recommendations 22, 23, 24, 25, and 26 (those addressing the efficacy of psychological treatments) was undertaken. The purpose of this critique was to describe the threats to validity inherent in the PORT report's design and to demonstrate how those threats make the relevant recommendations specious. In addition, empirical evidence from meta-analytic reviews is described to show that, indeed, psychological treatments for schizophrenia are efficacious. Limitations of the available evidence and suggestions for a PORT revision are discussed.