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1.
Psychother Res ; : 1-12, 2023 Aug 23.
Artículo en Inglés | MEDLINE | ID: mdl-37611202

RESUMEN

OBJECTIVE: The primary purported change process in emotion-focused therapy for couples (EFT-C) involves partners accessing and revealing their underlying vulnerable emotions and responding empathically when their partners disclose their vulnerable emotions. One main intervention to facilitate vulnerability sharing is enactment - guiding partners to interact directly with each other. The objective of the current study was to identify interventions therapists can use to help partners share vulnerability in the context of enactment. The primary hypothesis of this study was that promoting these interventions would lead to more vulnerability expressions during enactments. METHOD: One hundred and five vulnerability enactment events were identified from videod therapy sessions of 33 couples dealing with a significant emotional injury who received 12 sessions of EFT-C. Four therapists' interventions were coded: setting a meaningful systemic context, promoting the revealing partner's emotional engagement, preparing the revealing partner for enactment, and promoting the listening partner's emotional engagement in the enactment. In addition, vulnerability expression was coded. RESULTS: Multilevel regression models showed that two interventions were significantly associated with greater levels of expressed vulnerability: setting a meaningful systemic context, and preparing the revealing partner for enactment. CONCLUSION: These findings suggest that therapists can facilitated vulnerability sharing using specific preparatory interventions.

2.
BMC Psychiatry ; 21(1): 287, 2021 06 02.
Artículo en Inglés | MEDLINE | ID: mdl-34078324

RESUMEN

BACKGROUND: Major depressive disorder (MDD) is the leading cause of disability worldwide and one of the most heterogeneous mental health disorders. Although there are effective treatments for MDD, about 50% of patients do not respond to treatment. One of the greatest challenges in improving current treatments is identifying the mechanisms responsible for therapeutic change in MDD. The proposed study aims to identify patient-specific mechanisms of change in two treatments for MDD by investigating whether subpopulations of patients differ in the mechanisms of change that operate when receiving a given treatment. Based on theories of targeting weakness and building on strength, we will examine whether the mechanism of change operating when a treatment is provided depends on whether the treatment targets the patient's strength or weakness. METHOD: To test our hypothesis that two treatments, supportive-expressive treatment (SET) and emotion-focused treatment (EFT), differ in their mechanisms of change and to explore whether focusing on the patient's strength or weakness will result in better treatment outcome, we conduct a mechanistic randomized controlled trial. One hundred and twenty-four individuals diagnosed with MDD are randomized to 16 sessions of either SET or EFT. The two treatments are theorized to differ in their main mechanism of change: SET places emphasis on insight as its main mechanism of change, and EFT places emphasis on emotional processing. Both can serve as strength- or weakness-focused treatments, based on the patient's baseline levels of insight and emotional processing. The primary outcome is the Hamilton Rating Scale for Depression. Additional measures include self-report measures and clinical interviews, hormonal, motion, acoustic, physiological, and neuroimaging assessments, performance on cognitive tasks, and narrative material (collected from the sessions and interviews). DISCUSSION: The RCT will expand our understanding of mechanisms of change in psychotherapy, from one-size-fits-all to patient-specific mechanisms of change. By informing therapists about which of the two approaches is most effective with patients based on their baseline characteristics, the RCT will contribute to progress toward personalized treatment. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT04576182 submitted on October 1st 2020. FUNDING: The Israel Science Foundation. Trial status: Recruitment is ongoing.


Asunto(s)
Trastorno Depresivo Mayor , Depresión , Trastorno Depresivo Mayor/terapia , Emociones , Humanos , Israel , Psicoterapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento
3.
Clin Psychol Psychother ; 26(1): 1-13, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30255535

RESUMEN

Anxiety disorders are characterized by high levels of anxiety and avoidance of anxiety-inducing situations and of negative emotions such as anger. Emotion-focused therapy (EFT) and psychodynamic psychotherapy (PP) have underscored the therapeutic significance of processing and transforming repressed or disowned conflicted or painful emotions. Although PP provides sophisticated means of processing intrapsychic and interpersonal conflict, EFT has empirically tested a set of techniques to access, deepen, symbolize, and transform emotions consistent with current conceptualizations of emotions and memory. Based on our clinical experience, we propose that an integrative emotion-focused and psychodynamic approach opens new avenues for treating anxiety disorders effectively, and we present a transdiagnostic manual for emotion-focused psychodynamic psychotherapy. The therapeutic approach takes into account both the activation, processing, and modification of emotion and the underlying intrapsychic and interpersonal conflicts. The short-term treatment is based on the three phases of initiating treatment, therapeutic work with anxiety, and termination. Emotional poignancy (or liveliness) is an important marker for emotional processing throughout treatment. Instead of exposure to avoided situations, we endorse enacting the internal process of generating anxiety in the session providing a sense of agency and access to warded-off emotions. Interpretation serves to tie together emotional experience and insight into the patterns and the nature of underlying intrapersonal and interpersonal conflict. Treatment modules are illustrated by brief vignettes from pilot treatments.


Asunto(s)
Trastornos de Ansiedad/terapia , Terapia Centrada en la Emoción/métodos , Psicoterapia Psicodinámica/métodos , Humanos
4.
Healthc Q ; 22(3): 54-60, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31845859

RESUMEN

The need for increased capacity in primary care to treat the growing numbers of patients with complex chronic health conditions is well established (Roberts et al. 2015). Meeting that need requires not only more family physicians but also more support and resources to handle challenging cases. The Collaborative Mentoring Networks (CMNs), created in 2001 by the Ontario College of Family Physicians and funded by the Ontario government, have provided that support and proven particularly successful in improving physicians' competence and confidence in caring for patients struggling with mental health, addictions and chronic pain. The networks give family physicians timely, ongoing access to mentors with greater clinical expertise. In 2017, the networks expanded from two to seven, spreading support to palliative and end-of-life care and medical assistance in dying and focusing on leadership in primary care, early years in practice and rural medicine. CMNs' early impact involved increased primary care capacity in family practice, better-supported family physicians treating more patients with complex conditions, fewer specialist referrals, less isolation and greater retention.


Asunto(s)
Tutoría/organización & administración , Médicos de Familia/educación , Atención Primaria de Salud/organización & administración , Creación de Capacidad , Dolor Crónico , Humanos , Trastornos Mentales , Ontario , Médicos de Familia/psicología , Trastornos Relacionados con Sustancias , Cuidado Terminal
5.
Psychother Res ; 28(3): 406-422, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-27728998

RESUMEN

OBJECTIVE: To investigate the pattern of change in emotional states over a course of emotion-focused therapy using the model of sequential emotional processing as an initial framework for analysis. METHOD: This was a single case study observational design examining 15 sessions of therapy with one client. A qualitative analysis of moment-to-moment shifts in client emotional events was conducted. This conceptualised the interplay between experienced emotions using the sequential emotional processing model as an interpretative framework. The analysis was triangulated by using existing observer-based rating scales and reliability assessed with an independent rater. RESULTS: The sequential emotional processing model was found to be an effective means to explain the sequence of expressed emotional events, although some emotional events and emotion scheme change processes pertaining to this particular case required additional explanation than provided in the original model descriptions. CONCLUSIONS: Observed nuances in this specific case included highlighting triggers to emotional experience and avoidance processes fuelled by anticipatory fear. The observations included a process of change through accessing core feelings of shame, fear, and loneliness and their transformation through the generation of self-compassion and assertive anger. Implications for practice are discussed in terms of case conceptualisation and therapeutic strategy.


Asunto(s)
Trastorno Depresivo/terapia , Terapia Centrada en la Emoción/métodos , Evaluación de Procesos y Resultados en Atención de Salud/métodos , Adulto , Femenino , Humanos
6.
Psychother Res ; 27(6): 692-709, 2017 11.
Artículo en Inglés | MEDLINE | ID: mdl-27092727

RESUMEN

OBJECTIVE: This research explored the consolidation phase of emotion-focused therapy (EFT) for depression and studies-through a task-analysis method-how client-therapist dyads evolved from the exploration of the problem to self-narrative reconstruction. METHOD: Innovative moments (IMs) were used to situate the process of self-narrative reconstruction within sessions, particularly through reconceptualization and performing change IMs. We contrasted the observation of these occurrences with a rational model of self-narrative reconstruction, previously built. RESULTS: This study presents the rational model and the revised rational-empirical model of the self-narrative reconstruction task in three EFT dyads, suggesting nine steps necessary for task resolution: (1) Explicit recognition of differences in the present and steps in the path of change; (2) Development of a meta-perspective contrast between present self and past self; (3) Amplification of contrast in the self; (4) A positive appreciation of changes is conveyed; (5) Occurrence of feelings of empowerment, competence, and mastery; (6) Reference to difficulties still present; (7) Emphasis on the loss of centrality of the problem; (8) Perception of change as a gradual, developing process; and (9) Reference to projects, experiences of change, or elaboration of new plans. CONCLUSIONS: Central aspects of therapist activity in facilitating the client's progression along these nine steps are also elaborated.


Asunto(s)
Trastorno Depresivo/terapia , Terapia Centrada en la Emoción/métodos , Evaluación de Procesos y Resultados en Atención de Salud/métodos , Narrativas Personales como Asunto , Procesos Psicoterapéuticos , Adulto , Femenino , Humanos , Persona de Mediana Edad
7.
Psychother Res ; 26(2): 178-95, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-25265453

RESUMEN

OBJECTIVE: This investigation examined the relationship between in-session types of emotional experience operationalized by the emotion category coding system and the reduction of depressive symptoms in emotion-focused therapy (EFT). METHOD: Segments of videotaped sessions were coded and the different emotion categories were related to reduction in depressive symptoms in a sample of 30 clients who received EFT for depression. RESULTS: Both fewer secondary and more primary adaptive emotions, in the working phases of therapy, were found to significantly predict outcome. Moderate levels of primary maladaptive emotion in the middle working session were associated with outcome and the frequency with which clients moved from primary maladaptive to primary adaptive emotions in this session-predicted outcome. CONCLUSIONS: Results of this study support a transformational model of changing emotion with emotion.


Asunto(s)
Depresión/terapia , Emociones/fisiología , Psicoterapia/métodos , Adulto , Humanos , Resultado del Tratamiento
8.
Z Psychosom Med Psychother ; 62(3): 207-23, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27594599

RESUMEN

OBJECTIVES: Affective change has been considered the hallmark of therapeutic change in psychoanalysis. Psychoanalytic writers have begun to incorporate theoretically the advanced understanding of emotional processing and transformation of the affective neurosciences. We ask if this theoretical advancement is reflected in treatment techniques addressing the processing of emotion. METHODS: We review psychoanalytic models and treatment recommendations of maladaptive affect processing in the light of a neuroscientifically informed model of achieving psychotherapeutic change by activation and reconsolidation of emotional memory. RESULTS: Emotions tend to be treated as other mental contents, resulting in a lack of specific psychodynamic techniques to work with emotions. Manualized technical modifications addressing affect regulation have been successfully tested in patients with personality pathology, but not for psychodynamic treatments of axis I disorders. CONCLUSIONS: Emotional memories need to be activated in order to be modified, therefore, we propose to include techniques into psychodynamic therapy that stimulate emotional experience.


Asunto(s)
Afecto , Ajuste Emocional , Modelos Psicológicos , Teoría Psicoanalítica , Psicoterapia Psicodinámica , Nivel de Alerta , Concienciación , Femenino , Humanos , Recuerdo Mental , Adulto Joven
9.
Behav Brain Sci ; 38: e1, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-24827452

RESUMEN

Since Freud, clinicians have understood that disturbing memories contribute to psychopathology and that new emotional experiences contribute to therapeutic change. Yet, controversy remains about what is truly essential to bring about psychotherapeutic change. Mounting evidence from empirical studies suggests that emotional arousal is a key ingredient in therapeutic change in many modalities. In addition, memory seems to play an important role but there is a lack of consensus on the role of understanding what happened in the past in bringing about therapeutic change. The core idea of this paper is that therapeutic change in a variety of modalities, including behavioral therapy, cognitive-behavioral therapy, emotion-focused therapy, and psychodynamic psychotherapy, results from the updating of prior emotional memories through a process of reconsolidation that incorporates new emotional experiences. We present an integrated memory model with three interactive components - autobiographical (event) memories, semantic structures, and emotional responses - supported by emerging evidence from cognitive neuroscience on implicit and explicit emotion, implicit and explicit memory, emotion-memory interactions, memory reconsolidation, and the relationship between autobiographical and semantic memory. We propose that the essential ingredients of therapeutic change include: (1) reactivating old memories; (2) engaging in new emotional experiences that are incorporated into these reactivated memories via the process of reconsolidation; and (3) reinforcing the integrated memory structure by practicing a new way of behaving and experiencing the world in a variety of contexts. The implications of this new, neurobiologically grounded synthesis for research, clinical practice, and teaching are discussed.


Asunto(s)
Emociones/fisiología , Memoria/fisiología , Procesos Psicoterapéuticos , Humanos
10.
Clin Psychol Psychother ; 22(1): 75-82, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-23913713

RESUMEN

UNLABELLED: Family-based therapy (FBT) is regarded as best practice for the treatment of eating disorders in children and adolescents. In FBT, parents play a vital role in bringing their child or adolescent to health; however, a significant minority of families do not respond to this treatment. This paper introduces a new model whereby FBT is enhanced by integrating emotion-focused therapy (EFT) principles and techniques with the aims of helping parents to support their child's refeeding and interruption of symptoms. Parents are also supported to become their child's 'emotion coach'; and to process any emotional 'blocks' that may interfere with their ability to take charge of recovery. A parent testimonial is presented to illustrate the integration of the theory and techniques of EFT in the FBT model. EFFT (Emotion-Focused Family Therapy) is a promising model of therapy for those families who require a more intense treatment to bring about recovery of an eating disorder. KEY PRACTITIONER MESSAGE: More intense therapeutic models exist for treatment-resistant eating disorders in children and adolescents. Emotion is a powerful healing tool in families struggling with an eating disorder. Working with parent's emotions and emotional reactions to their child's struggles has the potential to improve child outcomes.


Asunto(s)
Emociones , Terapia Familiar/métodos , Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Adolescente , Niño , Humanos
11.
Psychother Res ; 24(5): 594-607, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24188051

RESUMEN

OBJECTIVE: While the individual contributions of narrative and emotion processes to psychotherapy outcome have been the focus of recent interest in psychotherapy research literature, the empirical analysis of narrative and emotion integration has rarely been addressed. The Narrative-Emotion Processes Coding System (NEPCS) was developed to provide researchers with a systematic method for identifying specific narrative and emotion process markers, for application to therapy session videos. METHOD: The present study examined the relationship between NEPCS-derived problem markers (same old storytelling, empty storytelling, unstoried emotion, abstract storytelling) and change markers (competing plotlines storytelling, inchoate storytelling, unexpected outcome storytelling, and discovery storytelling), and treatment outcome (recovered versus unchanged at therapy termination) and stage of therapy (early, middle, late) in brief emotion-focused (EFT), client-centred (CCT), and cognitive (CT) therapies for depression. RESULTS: Hierarchical linear modelling analyses demonstrated a significant Outcome effect for inchoate storytelling (p = .037) and discovery storytelling (p = .002), a Stage × Outcome effect for abstract storytelling (p = .05), and a Stage × Outcome × Treatment effect for competing plotlines storytelling (p = .001). There was also a significant Stage × Outcome effect for NEPCS problem markers (p = .007) and change markers (p = .03). CONCLUSION: The results provide preliminary support for the importance of assessing the contribution of narrative-emotion processes to efficacious treatment outcomes in EFT, CCT, and CT treatments of depression.


Asunto(s)
Depresión/terapia , Emociones/fisiología , Narración , Evaluación de Procesos y Resultados en Atención de Salud/métodos , Psicoterapia/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad
12.
Prim Care ; 51(3): 483-494, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39067973

RESUMEN

Multiple endocrine neoplasia type 1 is a rare genetic neuroendocrine syndrome caused by over 1500 different germline mutations. It can cause 20 different endocrine tumors affecting primarily the parathyroid glands, gastroenteropancreatic tract, and the anterior pituitary gland. Multiple endocrine neoplasia type 2A (MEN2A) and Multiple endocrine neoplasia type 2B (MEN2B) are autosomal dominant genetic syndromes because of a germline variant in the 'rearranged during transfection' (RET) proto-oncogene. There are common RET mutations causing receptor hyperactivation and induction of downstream signals that cause oncogenesis. Common conditions with MEN2A are medullary thyroid cancer (MTC), pheochromocytoma, and primary hyperparathyroidism. Common conditions with MEN2B include MTC, pheochromocytomas, and benign ganglioneuromas.


Asunto(s)
Neoplasia Endocrina Múltiple Tipo 2a , Neoplasia Endocrina Múltiple Tipo 2b , Feocromocitoma , Proto-Oncogenes Mas , Neoplasias de la Tiroides , Humanos , Neoplasia Endocrina Múltiple Tipo 2a/diagnóstico , Neoplasia Endocrina Múltiple Tipo 2a/genética , Neoplasia Endocrina Múltiple Tipo 2a/terapia , Neoplasia Endocrina Múltiple Tipo 2b/diagnóstico , Neoplasia Endocrina Múltiple Tipo 2b/genética , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/terapia , Feocromocitoma/diagnóstico , Feocromocitoma/genética , Feocromocitoma/terapia , Neoplasia Endocrina Múltiple Tipo 1/diagnóstico , Neoplasia Endocrina Múltiple Tipo 1/terapia , Neoplasia Endocrina Múltiple Tipo 1/genética , Proteínas Proto-Oncogénicas c-ret/genética , Neoplasias de las Glándulas Suprarrenales/diagnóstico , Neoplasias de las Glándulas Suprarrenales/genética , Neoplasias de las Glándulas Suprarrenales/terapia , Hiperparatiroidismo Primario/diagnóstico , Hiperparatiroidismo Primario/terapia , Atención Primaria de Salud , Mutación de Línea Germinal , Carcinoma Neuroendocrino
13.
JAMA Netw Open ; 7(9): e2435901, 2024 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-39320887

RESUMEN

Importance: Most patients with pathogenic or likely pathogenic (P/LP) variants for breast cancer have not undergone genetic testing. Objective: To identify patients meeting family history criteria for genetic testing in the electronic health record (EHR). Design, Setting, and Participants: This study included both cross-sectional (observation date, February 1, 2024) and retrospective cohort (observation period, January 1, 2018, to February 1, 2024) analyses. Participants included patients aged 18 to 79 years enrolled in Renown Health, a large health system in Northern Nevada. Genotype was known for 38 003 patients enrolled in Healthy Nevada Project (HNP), a population genomics study. Exposure: An EHR indicating that a patient is positive for criteria according to the Seven-Question Family History Questionnaire (hereafter, FHS7 positive) assessing familial risk for hereditary breast and ovarian cancer (HBOC). Main Outcomes and Measures: The primary outcomes were the presence of P/LP variants in the ATM, BRCA1, BRCA2, CHEK2, or PALB2 genes (cross-sectional analysis) or a diagnosis of cancer (cohort analysis). Age-adjusted cancer incidence rates per 100 000 patients per year were calculated using the 2020 US population as the standard. Hazard ratios (HRs) for cancer attributable to FHS7-positive status were estimated using cause-specific hazard models. Results: Among 835 727 patients, 423 393 (50.7%) were female and 29 913 (3.6%) were FHS7 positive. Among those who were FHS7 positive, 24 535 (82.0%) had no evidence of prior genetic testing for HBOC in their EHR. Being FHS7 positive was associated with increased prevalence of P/LP variants in BRCA1/BRCA2 (odds ratio [OR], 3.34; 95% CI, 2.48-4.47), CHEK2 (OR, 1.62; 95% CI, 1.05-2.43), and PALB2 (OR, 2.84; 95% CI, 1.23-6.16) among HNP female individuals, and in BRCA1/BRCA2 (OR, 3.35; 95% CI, 1.93-5.56) among HNP male individuals. Being FHS7 positive was also associated with significantly increased risk of cancer among 131 622 non-HNP female individuals (HR, 1.44; 95% CI, 1.22-1.70) but not among 114 982 non-HNP male individuals (HR, 1.11; 95% CI, 0.87-1.42). Among 1527 HNP survey respondents, 352 of 383 EHR-FHS7 positive patients (91.9%) were survey-FHS7 positive, but only 352 of 883 survey-FHS7 positive patients (39.9%) were EHR-FHS7 positive. Of the 29 913 FHS7-positive patients, 19 764 (66.1%) were identified only after parsing free-text family history comments. Socioeconomic differences were also observed between EHR-FHS7-negative and EHR-FHS7-positive patients, suggesting disparities in recording family history. Conclusions and Relevance: In this cross-sectional study, EHR-derived FHS7 identified thousands of patients with familial risk for breast cancer, indicating a substantial gap in genetic testing. However, limitations in EHR family history data suggested that other identification methods, such as direct-to-patient questionnaires, are required to fully address this gap.


Asunto(s)
Predisposición Genética a la Enfermedad , Pruebas Genéticas , Neoplasias Ováricas , Humanos , Femenino , Persona de Mediana Edad , Adulto , Estudios Transversales , Estudios Retrospectivos , Anciano , Pruebas Genéticas/métodos , Pruebas Genéticas/estadística & datos numéricos , Neoplasias Ováricas/genética , Neoplasias Ováricas/epidemiología , Neoplasias de la Mama/genética , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/diagnóstico , Nevada/epidemiología , Adulto Joven , Síndrome de Cáncer de Mama y Ovario Hereditario/genética , Síndrome de Cáncer de Mama y Ovario Hereditario/epidemiología , Síndrome de Cáncer de Mama y Ovario Hereditario/diagnóstico , Adolescente , Masculino , Proteína del Grupo de Complementación N de la Anemia de Fanconi
14.
Fam Process ; 52(1): 62-82, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-25408090

RESUMEN

This paper will outline new developments in Emotion-Focused Therapy for Couples (EFT-C) (Greenberg & Goldman, Emotion-focused couples therapy: The dynamics of emotion, love, and power, Washington, DC, American Psychological Association, 2008). People are seen as primarily motivated by their affective goals and the regulation of emotional states. The three motivational systems of attachment, identity, and attraction/liking, viewed as reflective of the core concerns people bring to therapy, are briefly outlined and elaborated. The five-stage model of EFT-C is briefly described. The paper will then provide two illustrations, one that demonstrates how EFT-C therapists work with core issues related to identity, and the other that shows how therapy can promote self-soothing. In the first example, annotated transcripts taken from therapy sessions illustrate how an EFT therapist addresses issues of identity in a highly distressed couple. The second example demonstrates how to facilitate work with individuals within the couples' context to engender and develop capacities for self-soothing, seen as fundamental for the promotion of healthy emotion regulation and couples' overall health.


Asunto(s)
Terapia de Parejas/métodos , Adulto , Emociones , Humanos , Relaciones Interpersonales , Apego a Objetos , Autoimagen
15.
Psychother Res ; 23(6): 732-46, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23848974

RESUMEN

OBJECTIVE: The goal of this investigation was to examine the predictive validity of Client Emotional Productivity (CEP), an operationalization of optimal client in-session emotional processing, possessing seven features: Attending, symbolization, congruence, acceptance, regulation, agency and differentiation. METHOD: CEP was related to improvement in depressive and general symptoms, in 74 clients (66% female, 34% male) who received experiential therapy of depression and this was compared to the relationship between client high expressed emotional (CHEEA) arousal and the working alliance (WAI) and outcome. RESULTS: Hierarchical regression analyses revealed that working phase CEP predicted significant reduction of depressive and general symptoms over and above that predicted by beginning phase CEP, the working alliance and working phase CHEEA. Working phase CEP emerged as the sole, independent predictor of outcome for both depressive and general symptoms. CONCLUSION: Productive emotional processing, thus, mediates the relationship between the alliance and outcome and seems to go beyond mere activation and expression of emotional experience. It rather seems to involve an increase in the ability to process activated primary emotion in a productive manner specified by CEP.


Asunto(s)
Trastorno Depresivo Mayor/terapia , Emociones/fisiología , Evaluación del Resultado de la Atención al Paciente , Relaciones Profesional-Paciente , Psicoterapia/métodos , Adulto , Femenino , Guías como Asunto , Humanos , Masculino , Persona de Mediana Edad , Psicoterapia/normas , Ensayos Clínicos Controlados Aleatorios como Asunto , Adulto Joven
16.
BMJ Open ; 13(6): e072076, 2023 06 19.
Artículo en Inglés | MEDLINE | ID: mdl-37336539

RESUMEN

INTRODUCTION: Interprofessional teams and funding and payment provider arrangements are key attributes of high-performing primary care. Several Canadian jurisdictions have introduced team-based models with different payment models. Despite these investments, the evidence of impact is mixed. This has raised questions about whether team-based primary care models are being implemented to facilitate team collaboration and effectiveness. Thus, we present a protocol for a rapid scoping review to systematically map, synthesise and summarise the existing literature on the impact of provider remuneration mechanisms and extrinsic and intrinsic incentives in team-based primary care. This review will answer three research questions: (1) What is the impact of provider remuneration models on team, patient, provider and system outcomes in primary care?; (2) What extrinsic and intrinsic incentives have been used in interprofessional primary care teams?; and (3) What is the impact of extrinsic and intrinsic team-based incentives on team, patient, provider and system outcomes? METHODS AND ANALYSIS: We will conduct a rapid scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. We will search electronic databases (Medline, Embase, CINAHL, PsycINFO, EconLit) and grey literature sources (Google Scholar, Google). This review will consider all empirical studies and full-text English-language articles published between 2000 and 2022. Reviewers will independently perform the literature search, data extraction and synthesis of included studies. The Mixed Methods Appraisal Tool will be used to appraise the quality of evidence. The literature will be synthesised, summarised and mapped to themes that answer the research question of this review. ETHICS AND DISSEMINATION: Ethics approval is not required. Findings from this study will be written for publication in an open-access peer-review journal and presented at national and international conferences. Knowledge users are part of the research team and will assist with disseminating findings to the public, clinicians, funders and professional associations.


Asunto(s)
Motivación , Remuneración , Humanos , Canadá , Atención Primaria de Salud , Proyectos de Investigación , Revisiones Sistemáticas como Asunto , Literatura de Revisión como Asunto
17.
Psychother Res ; 22(4): 389-401, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22417171

RESUMEN

Previous studies have used the Innovative Moments Coding System (IMCS) to describe the process of change in Narrative Therapy (NT) and in Emotion-Focused Therapy (EFT). This study aims to extend this research program to a sample of Client-Centered Therapy (CCT). The IMCS was applied to six cases of CCT for depression to track the Innovative Moments (IMs) which are exceptions to the problematic self-narrative in therapeutic conversation. Results suggest that IMCS can be applied to CCT, allowing the tracking of IMs' emergence. The analysis based on a generalized linear model revealed that the overall amount of IMs is significantly associated with symptom improvement, which is congruent with former studies done with the IMCS.


Asunto(s)
Trastorno Depresivo Mayor/terapia , Psicoterapia Centrada en la Persona/métodos , Procesos Psicoterapéuticos , Adaptación Psicológica , Adulto , Femenino , Humanos , Persona de Mediana Edad , Modelos Psicológicos , Narración , Psicoterapia Centrada en la Persona/estadística & datos numéricos , Evaluación de Procesos, Atención de Salud , Resultado del Tratamiento
18.
Sci Rep ; 12(1): 14061, 2022 08 18.
Artículo en Inglés | MEDLINE | ID: mdl-35982133

RESUMEN

Serology provides tools for epidemiologic studies, and may have a role in vaccine prioritization and selection. Automated serologic testing of saliva, especially specimens that are self-collected at home and sent to a laboratory via the mail without refrigeration, could be a highly-scalable strategy for population-wide testing. In this prospective study, non-vaccinated patients were recruited after PCR testing to self-collect saliva and return their specimens via mail. Longitudinal specimens were analyzed in order to monitor seroconversion in the weeks after a diagnostic PCR test for SARS-CoV-2. Diverse users self-collected saliva and returned specimens via mail in compliance with shipping regulations. At our pre-established threshold (0.963 AU/mL), salivary IgG reactivity to full-length spike protein achieved 95.8% sensitivity and 92.4% specificity at 2-4 weeks after diagnostic testing, which is comparable to the typical sensitivity and specificity achieved for serum testing. Reactivity to N antigen also was detected with 92.6% sensitivity and 90.7% specificity at 4-8 weeks after diagnostic testing. Moreover, serologic testing for endemic coronaviruses performed in multiplex with SARS-CoV-2 antigens has the potential to identify samples that may require retesting due to effects of pre-analytical factors. The easy-to-use saliva collection kit, coupled with thresholds for positivity and methods of flagging samples for retest, provides a framework for large-scale serosurveillance of SARS-CoV-2.


Asunto(s)
COVID-19 , SARS-CoV-2 , COVID-19/diagnóstico , Técnicas de Laboratorio Clínico/métodos , Humanos , Servicios Postales , Estudios Prospectivos , Saliva , Sensibilidad y Especificidad
19.
Psychother Res ; 21(3): 304-15, 2011 May.
Artículo en Inglés | MEDLINE | ID: mdl-21480051

RESUMEN

Innovative moments (IMs) are exceptions to a client's problematic self-narrative in the therapeutic dialogue. The innovative moments coding system is a tool which tracks five different types of IMs-action, reflection, protest, reconceptualization and performing change. An in-depth qualitative analysis of six therapeutic cases of emotion-focused therapy (EFT) investigated the role of two of the most common IMs-reflection and protest-in both good and poor outcome cases. Through this analysis two subtypes (I and II) of reflection and protest IMs were identified, revealing different evolution patterns. Subtype II of both reflection and protest IMs is significantly higher in the good outcome group, while subtype I of both IMs types does not present statistically significant differences between groups. The evolution from subtype I to subtype II across the therapeutic process seems to reflect a relevant developmental progression in the change process.


Asunto(s)
Emociones , Narración , Psicoterapia/métodos , Adaptación Psicológica , Comprensión , Humanos , Modelos Psicológicos , Evaluación de Procesos y Resultados en Atención de Salud , Solución de Problemas , Procesos Psicoterapéuticos , Autoimagen
20.
J Eat Disord ; 9(1): 2, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407948

RESUMEN

BACKGROUND: Research into psychotherapy for binge-eating disorder (BED) has focused mainly on cognitive behavioural therapies, but efficacy, failure to abstain, and dropout rates continue to be problematic. The experience of negative emotions is among the most accurate predictors for the occurrence of binge eating episodes in BED, suggesting benefits to exploring psychological treatments with a more specific focus on the role of emotion. The present study aimed to explore the feasibility of individual emotion-focused therapy (EFT) as a treatment for BED by examining the outcomes of a pilot randomised wait-list controlled trial. METHODS: Twenty-one participants were assessed using a variety of feasibility measures relating to recruitment, credibility and expectancy, therapy retention, objective binge episodes and days, and binge eating psychopathology outcomes. The treatment consisted of 12 weekly one-hour sessions of EFT for maladaptive emotions over 3 months. A mixed model approach was utilised with one between effect (group) using a one-way analysis of variance (ANOVA) to test the hypothesis that participants immediately receiving the EFT treatment would demonstrate a greater degree of improvement on outcomes relating to objective binge episodes and days, and binge eating psychopathology, compared to participants on the EFT wait-list; and one within effect (time) using a repeated-measures ANOVA to test the hypothesis that participation in the EFT intervention would result in significant improvements in outcome measures from pre to post-therapy and then maintained at follow-up. RESULTS: Recruitment, credibility and expectancy, therapy retention outcomes indicated EFT is a feasible treatment for BED. Further, participants receiving EFT demonstrated a greater degree of improvement in objective binge episodes and days, and binge eating psychopathology compared to EFT wait-list control group participants. When participants in the EFT wait-list control group then received treatment and outcomes data were combined with participants who initially received the treatment, EFT demonstrated significant improvement in objective binge episodes and days, and binge eating psychopathology for the entire sample. CONCLUSIONS: These findings provide further preliminary evidence for the feasibility of individual EFT for BED and support more extensive randomised control trials to assess efficacy. TRIAL REGISTRATION: The study was retrospectively registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12620000563965 ) on 14 May 2020.

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