Centrality of Self-Criticism in Depression and Anxiety Experienced by Breast Cancer Patients Undergoing Short-Term Psychodynamic Psychotherapy.

INTRODUCTION: Depression and anxiety are prevalent in women suffering from breast cancer. However, the determinants of depression and anxiety in this population are not well known, particularly in the context of psychotherapy. Drawing from Blatt's theory, we examined the role of Depressive Personality Vulnerability (DPV) in depression and anxiety experienced in female sufferers of breast cancer treated for depression as part of a Randomized Clinical Trial. METHODS: Seventy-eight patients were treated by Short-Term Psychodynamic Psychotherapy and 79 patients by Treatment as Usual. Assessments were conducted pre-treatment, at termination, and at six-month follow-up. Main outcomes were the depression and anxiety subscales of the Hospital Depression and Anxiety Scale. Predictors were pre-treatment dependency, self-criticism, and self-efficacy, assessed via the Depressive Experiences Questionnaire. Analyses targeted associations of these dimensions with baseline levels, main effects on pretreatment-termination and pretreatment-follow-up changes in depression and anxiety, and DPV by treatment interactions. RESULTS: Consistent with our hypotheses, self-criticism - implicated in previous research as a serious dimension of vulnerability to psychopathology - predicted elevated levels, as well as pretreatment-follow-up changes, in both depression and anxiety. However, self-criticism also augmented the effect of STPP (compared with TAU) on depression in the pretreatment-termination period. CONCLUSIONS: These findings highlight the centrality of self-criticism for both risk and resilience processes in breast cancer.

Contemporary Supportive Therapy: A Review of History, Theory, and Evidence.

Supportive psychotherapy interventions were developed as a part of psychodynamic psychotherapy work, and supportive psychotherapy was historically considered to be the default form of therapy only for lower-functioning patients. These roots unfortunately have resulted in supportive psychotherapy being viewed as an inferior form of treatment. In reality, supportive psychotherapy is a practical and flexible form of psychotherapy that helps patients with a wide range of psychiatric illnesses, including mood disorders, anxiety disorders, posttraumatic stress disorder, schizophrenia, personality disorders, eating disorders, body dysmorphic disorder, and substance use disorders. In addition, supportive psychotherapy can be well-suited to higher-functioning patients, as well as to patients who are chronically lower-functioning. There is also evidence to support the use of supportive psychotherapy in patients with certain medical illnesses, including coronary artery disease, some gastrointestinal illnesses, HIV infection, and certain types of cancer. The goals of supportive psychotherapy include helping patients to understand emotional experiences, improving affective regulation and reality-testing, making use of their most effective coping strategies, and engaging in collaborative problem solving to reduce stressors and increase effective engagement with support systems.

Vicissitudes of Death Anxiety During the COVID-19 Pandemic.

The author, an experienced psycho-oncologist, offers clinical insights that consider the importance of death anxiety in psychodynamic psychotherapy treatments during the COVID-19 pandemic. He reviews the contributions of Ernst Becker, Wilfred Bion and Sheldon Solomon, and formulates ideas of his own based on decades of experience treating patients with cancer. This short essay focuses on how to help patients during the COVID-19 pandemic work through fear and uncertainty while developing adaptive skills.

Development of Brazilian prototypes for child psychodynamic psychotherapy and cognitive-behavioral therapy / Desenvolvimento de protótipos brasileiros de psicoterapia psicodinâmica e terapia cognitivo-comportamental de crianças

Abstract Introduction This study developed Brazilian psychodynamic psychotherapy (PDT) and cognitive-behavioral therapy (CBT) prototypes for children with internalizing disorders (ID) and externalizing disorders (ED). Method Eighteen Brazilian experts in PDT (n = 9) and CBT (n = 9) rated the 100 items of the Child Psychotherapy Q-Set (CPQ) describing a hypothetical typical session based on their respective theoretical backgrounds for children with ID. They then rated the same items describing a hypothetical typical session for children with ED. A Q-type factor analysis with varimax rotation was performed. Results Expert correlations were high within each theoretical approach and each diagnostic category. The factor analysis identified three independent factors. CBT ratings concentrated on one factor, while PDT ratings loaded onto one factor describing treatment of children with ID and another factor describing treatment of children with ED. Conclusion The sole CBT prototype reflected a general conceptualization of this approach and was undifferentiated regarding treatment of children with ID and ED. The PDT prototype for children with ID provided evidence of a process focused on interpretation, while the PDT prototype for children with ED characterized a supportive process with attention to the therapeutic relationship. This infers greater variation in the PDT setting for children with different conditions.

Resumo Introdução Este estudo desenvolveu protótipos brasileiros de psicoterapia psicodinâmica (PP) e terapia cognitivo-comportamental (TCC) para crianças com transtornos internalizantes (TI) e externalizantes (TE). Método Dezoito experts brasileiros em PP (n = 9) e TCC (n = 9) classificaram os 100 itens do Child Psychotherapy Q-Set (CPQ) descrevendo uma sessão hipotética típica de acordo com suas respectivas abordagens teóricas para crianças com TI. Depois, eles classificaram os mesmos itens descrevendo uma sessão hipotética típica para crianças com TE. Foi realizada uma análise fatorial do tipo Q com rotação varimax. Resultados As correlações dos experts foram altas, considerando ambas as abordagens teóricas e as duas categorias diagnósticas. A análise fatorial gerou três fatores independentes. As avaliações da TCC concentraram-se em um fator, enquanto as avaliações da PP geraram um fator que descreveu o tratamento de crianças com TI e um outro fator que descreveu o tratamento de crianças com TE. Conclusão O protótipo único da TCC refletiu uma conceptualização geral dessa abordagem, indiscriminada em relação aos sintomas da criança. O protótipo da PP para crianças com TI evidenciou um processo focado na interpretação, enquanto o protótipo da PP para crianças com TE caracterizou um processo suportivo com atenção à relação terapêutica. Infere-se uma maior variação no processo em PP para crianças com diferentes sintomatologias.

The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders / O papel da psicoterapia psicodinâmica de longo prazo na melhora de padrões de apego, estilos de defesa e alexitimia em pacientes com transtornos depressivos e de ansiedade

Abstract Introduction Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. Objective To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. Methods In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. Results The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. Conclusion Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

Resumo Introdução A psicoterapia psicodinâmica de longo prazo (PPLP) enfatiza a centralidade dos conflitos intrapsíquicos e inconscientes e sua relação com o desenvolvimento. Apesar da evidência em favor da eficácia da PPLP em transtornos mentais, há poucos dados sobre a eficácia da PPLP em transtornos de depressão/ansiedade. Objetivo Examinar se pacientes com transtornos de depressão/ansiedade demonstram melhora em seus estilos de apego, estilos defensivos, sintomas psiquiátricos, sintomas de ansiedade/depressão e alexitimia com PPLP. Métodos Neste estudo retrospectivo, descritivo, os desfechos psicológicos de pacientes tratados na clínica psicanalítica da Babol University of Medical Sciences foram avaliados. Quatorze pacientes com diagnóstico de transtorno de depressão ou ansiedade participaram do estudo sobre PPLP com abordagem de psicologia do self. O Inventário de Depressão de Beck II, o Inventário de Ansiedade de Beck, a Escala de Apego do Adulto, o Questionário de Estilo de Defesa-40 e a Escala de Alexitimia de Toronto-20 foram administrados antes e após o tratamento e no seguimento de 6 meses. Equações de estimação generalizadas foram usadas para analisar mudanças nos desfechos psicológicos após cada avaliação. Resultados Os escores médios de depressão/ansiedade e apego seguro melhoraram significativamente após PPLP com abordagem de psicologia do self do início do estudo ao pós-tratamento e seguimento. Além disso, os escores médios de defesas neuróticas e imaturas, dificuldade em identificar sentimentos, dificuldade em descrever sentimentos, pensamentos orientados externamente e escores totais de alexitimia diminuíram significativamente do início do estudo ao pós-tratamento e seguimento. Conclusão Sintomas de transtornos de ansiedade, transtornos depressivos, estilos de apego inseguro, alexitimia e estilos de defesa neuróticos/imaturos melhoraram após PPLP com abordagem de psicologia do self. Além disso, as melhoras persistiram no seguimento de 6 meses.

A prospective intervention to improve happiness and reduce burnout in oncologists.

BACKGROUND: There is a paucity of data about effective interventions to improve happiness and reduce burnout in oncologists. Benjamin Franklin developed a 13-week program of "necessary activities" or "virtues" (temperance, silence, order, resolution, frugality, industry, sincerity, justice, moderation, cleanliness, tranquility, chastity, and humility) to follow, in his attempt at self-improvement. In this pilot study, we explored whether using a modified version of this was associated with any discernable impact on physician happiness, burnout, or compliance with each of the virtues. METHODS: Self-reported happiness (Oxford happiness scores) and burnout (Abbreviated Maslach Burnout Inventory) were completed at baseline (pre-study), week 13, and 1 month after completion of the program. Each day during the 13-week program, oncologists were emailed a list of virtues to focus on and scored how they felt they were complying with them. The oncologist's spouses also assessed how they felt the oncologist was complying with the virtues. RESULTS: Thirteen physicians completed the baseline scores, 11 completed Maslach/Oxford scores at the end of the study, and 8 the 1-month post-study assessment. No significant improvements in happiness and burnout (emotional exhaustion, depersonalization, personal accomplishment) scores were observed. Statistically significant changes in self-rated virtue scores were observed for temperance (p = 0.046), order (p = 0.049), and resolution (p = 0.014). Additionally, although not reaching statistical significance, 11 of 13 virtues (excepting sincerity and chastity) assessed by spouses indicated a positive change over time. CONCLUSION: In this hypothesis generating study, daily reflection on personal virtues was not associated with any statistically significant change in happiness or burnout scores. Alternative strategies should be considered.

A psicodinâmica do reconhecimento no trabalho de informática de terceirizados de uma instituição pública / Recognition's psychodynamic at informatics outsurced work in a public institution

Contexto: O trabalho terceirizado tem aumentado no contexto brasileiro, sendo hoje entendido como uma das principais formas de diminuir o custo das instituições empregadoras. O reconhecimento a esses trabalhadores, entretanto, não é proporcional à sua importância para as organizações. Segundo a psicodinâmica do trabalho, reconhecimento é a retribuição simbólica do investimento físico, cognitivo e afetivo. É por meio dele que ocorre a construção da identidade. Objetivo: A pesquisa objetivou analisar o reconhecimento no trabalho de informática de terceirizados de uma instituição pública. Métodos: Foram realizadas três sessões de entrevistas coletivas, com duração de duas horas cada. Os dados foram analisados por meio da interpretação da fala e classificados nos eixos organização do trabalho; vivências de prazer e sofrimento; e dinâmica do reconhecimento. Resultados: Os terceirizados sentem-se reconhecidos, pelos pares e pelos usuários, pela visibilidade e utilidade da sua atividade, mas não são reconhecidos pelos colegas concursados, seus chefes. Os resultados corroboram alguns estudos realizados com trabalhadores terceirizados quanto à precarização e fragilidade socioeconômica. Conclusões: Conclui-se que, apesar da invisibilidade do trabalho para parte do grupo laboral, os terceirizados sentem-se reconhecidos. O estudo contribui para avançar nas pesquisas da psicodinâmica do trabalho e para reflexão dos modelos de gestão e posturas perante a situação da terceirização no serviço público.

Context: Outsourced work has been increasing in Brazil. Nowadays, it is seen as one of the main ways of reducing companies' expenses. The recognition given to these workers, however, does not commensurate with their importance to the organizations they work for. According to the "work psychodynamics" theory, recognition is the symbolic retribution of physical, cognitive and affective investment. It is through appreciation that the shaping of one's identity takes place. Objective: This research aimed to analyze the recognition of outsourced employees who worked in IT for a public institution. Methods: Three sessions of collective interviews were held, lasting two hours each. Data were analyzed through speech interpretation and were classified within the following criteria: work organization, experiences of pleasure and suffering, and dynamics of recognition. Results: Outsourcers feel recognized by their peers and by the system users in light of the visibility and usefulness of their activities. However, they do not feel appreciated by their fellows who are formally employed, who happened to be their bosses. These results corroborate some studies done with outsourced workers concerning socioeconomic fragility and precariousness. Conclusions: It is concluded that, despite the work's invisibility from part of their labor group, outsourcers do feel appreciated. This research helps support the advancement of scientific inquiries on work psychodynamics. It also contributes to the overall considerations regarding management models and postures towards the outsourcing situation in the public service.

Therapeutic alliance and treatment outcome in psychodynamic psychotherapy of depressed breast cancer patients: the same old story or different from other populations?

BACKGROUND: A good therapeutic alliance is associated with better treatment outcomes in diverse types of psychotherapy and patient populations, but little is known about therapeutic alliance in psychotherapies with cancer patients. This study examines the association of therapeutic alliance and treatment outcome in short term psychodynamic psychotherapy (STPP) for breast cancer patients. METHODS: Within a randomized controlled trial, 47 completers of STPP could be included in the analyses. The therapeutic alliance was assessed by patients and therapists at treatment termination with the Helping Alliance Questionnaire. Outcome was defined as no diagnosis of depression assessed with Structured Clinical Interview for DSM-IV (SCID-I) and a reduction of the HADS-depression score by at least two points at treatment termination. RESULTS: Patients' alliance ratings were significantly associated with outcome (r = 0.46, p = 0.015), while, in contrast to findings in non-cancer populations, therapists' ratings were unrelated. There was no association between patients' and therapists' ratings of therapeutic alliance. Especially success and working related aspects of patients' alliance scores were associated with outcome. Patients' and therapists' alliance scores were unrelated to any of their baseline characteristics, therapist characteristic or treatment variables. CONCLUSION: We conclude that therapists should regularly assess the quality of patients' perceived therapeutic alliance in the course of psychotherapy with breast cancer patients to improve psychotherapy outcome. The breast cancer patients' perspective should be actively inquired and considered throughout treatment by therapists. Possible discrepancies between both judgements can be addressed in treatment.

The impact of psychotherapy treatments of different length and type on health behaviour during a five-year follow-up.

OBJECTIVE: The aim of this study was to investigate the influence of psychotherapy treatments of different lengths, number of sessions, and type on health behaviour. METHOD: A total of 367 patients were monitored for their health behaviour (alcohol consumption, body mass index), serum cholesterol (total and HDL), smoking and exercise) for five years from the start of the therapy. The effectiveness of solution-focused therapy, short-term psychodynamic psychotherapy, and long-term psychodynamic psychotherapy (LPP) was examined in a randomized clinical trial, while the LPP group and the non-randomized psychoanalysis (PA) group were compared in a naturalistic design. RESULTS: During the follow-up, an improvement was seen with regard to alcohol consumption, serum HDL cholesterol, and smoking in the LPP and PA groups. No notable differences in health behaviour between the two groups were found, however. During the last two years of the follow-up, changes towards higher alcohol consumption and higher total serum cholesterol levels were observed in the short-term therapy groups. CONCLUSIONS: The impact of PA and LPP on health behaviour did not differ, whereas the changes were less health promoting in short-term psychotherapy. Large-scale studies are needed to confirm these findings.

Complex contexts and relationships affect clinical decisions in group therapy.

Clinical errors tend to be underreported even though examining them can provide important training and professional development opportunities. The group therapy context may be prone to clinician errors because of the added complexity within which therapists work and patients receive treatment. We discuss clinical errors that occurred within a group therapy in which a patient for whom group was not appropriate was admitted to the treatment and then was not removed by the clinicians. This was countertherapeutic for both patient and group. Two clinicians were involved: a clinical supervisor who initially assessed and admitted the patient to the group, and a group therapist. To complicate matters, the group therapy occurred within the context of a clinical research trial. The errors, possible solutions, and recommendations are discussed within Reason's Organizational Accident Model (Reason, 2000). In particular, we discuss clinician errors in the context of countertransference and clinician heuristics, group therapy as a local work condition that complicates clinical decision-making, and the impact of the research context as a latent organizational factor. We also present clinical vignettes from the pregroup preparation, group therapy, and supervision. Group therapists are more likely to avoid errors in clinical decisions if they engage in reflective practice about their internal experiences and about the impact of the context in which they work. Therapists must keep in mind the various levels of group functioning, especially related to the group-as-a-whole (i.e., group composition, cohesion, group climate, and safety) when making complex clinical decisions in order to optimize patient outcomes. (PsycINFO Database Record

Development of Brazilian prototypes for short-term psychotherapies / Desenvolvimento de protótipos brasileiros para psicoterapias de curta duração

Abstract Introduction: The Psychotherapy Process Q-Set (PQS) prototype method is used to measure the extent to which ideal processes of different psychotherapies are present in real cases, allowing researchers to examine how adherence to these models relates to or predicts change. Results from studies of short-term psychotherapies suggest that the original psychodynamic prototype is more suitable for studying psychoanalysis and long-term psychodynamic psychotherapy than its time-limited counterparts. Furthermore, culture probably influences how therapies are typically conducted in a given country. Therefore, it seems appropriate to develop Brazilian prototypes on which to base studies of short-term psychodynamic and cognitive-behavioral processes in this country. Objective: To develop prototypes for studying processes of short-term psychotherapies and to examine the degree of adherence of two real psychotherapy cases to these models. Methods: Expert clinicians used the PQS to rate a hypothetical ideal session of either short-term psychodynamic psychotherapy (STPP) or cognitive-behavioral therapy (CBT). Ratings were submitted to Q-type factor analysis to confirm the two groups. Regressive factor scores were rank ordered to describe the prototypes. These ideal models were correlated with ratings of actual therapy processes in two complete psychotherapy cases, one STPP and the other CBT. Results: Agreement levels between expert ratings were high and the two ideal models were confirmed. As expected, the PQS ratings for actual STPP and CBT cases had significant correlations with their respective ideal models, but the STPP case also adhered to the CBT prototype. Conclusion: Overall, the findings reveal the adequacy of the prototypes for time-limited therapies, providing initial support of their validity.

Resumo Introdução: O método dos protótipos derivados do Psychotherapy Process Q-Set (PQS) mensura em que medida processos de diferentes psicoterapias estão presentes em casos reais, permitindo pesquisadores examinarem como a adesão a esses modelos se relaciona com ou prediz a mudança. Resultados de estudos com psicoterapias breves sugerem que o protótipo psicodinâmico original é mais adequado para estudar psicanálise e psicoterapia psicodinâmica de longo prazo do que suas variantes de tempo limitado. Além disso, a cultura provavelmente influencia o modo como as psicoterapias são tipicamente conduzidas em determinado país. Portanto, parece apropriado o desenvolvimento de protótipos brasileiros para subsidiar estudos de processos psicodinâmicos e cognitivo-comportamentais de curto prazo neste país. Objetivo: Desenvolver protótipos para o estudo dos processos de psicoterapias de curta duração e examinar o grau de adesão de dois casos reais de psicoterapia a esses modelos. Métodos: Especialistas brasileiros usaram o PQS para avaliar uma sessão hipotética ideal de psicoterapia psicodinâmica breve (PPB) ou de terapia cognitivo-comportamental (TCC). A análise fatorial do tipo Q foi realizada para confirmar os dois fatores. Os escores fatoriais regressivos foram ordenados para descrever os protótipos. Os protótipos foram correlacionados com as avaliações de processos reais de terapia em dois casos completos, um de PPB e outro de TCC. Resultados: Houve alta concordância entre especialistas, e os dois modelos ideais foram confirmados. Como esperado, os escores do PQS para os casos reais de PPB e TCC apresentaram correção significativa com seus respectivos modelos ideais, mas o caso de PPB aderiu também ao protótipo TCC. Conclusões: No geral, os resultados revelam a adequação dos protótipos para terapias com tempo limitado, fornecendo suporte inicial de sua validade.

Countertransference and therapeutic alliance in the early stage of adult psychodynamic psychotherapy / Contratransferência e aliança terapêutica no início da psicoterapia psicodinâmica de adultos

Objectives:The primary objective of this study was to assess the relationship between countertransference (CT) and therapeutic alliance (TA) during the early stages of psychodynamic psychotherapy. A secondary objective is to assess associations between CT and variables related to therapist and patient and between CT and other patient variables investigated, which were defense mechanisms, symptomology and functionality.Methodology: This was a cross-sectional study that enrolled 30 patients treated by 17 different therapists at the psychotherapy clinics of two psychiatry centers. Assessments of each patient-therapist pair were conducted between their fourth and 10th sessions.Results: The CT distance domain exhibited a moderate negative correlation with TA, particularly its sub-dimension representing the patient's capacity for work in therapy. Moderate positive correlations were observed between CT distance and the splitting defense mechanism and between CT closeness and suppression defenses, in addition to moderate negative correlation between CT indifference and the fantasy defense mechanism. Another finding was higher scores for CT indifference in association with socioeconomic classes D and E.Conclusions: The quality of CT may provide a source of information about TA. A high degree of CT distance represents a low level of TA, particularly with relation to the patient's working capacity, although presence of the splitting defense mechanism can affect CT, to the extent that it constitutes a confounding variable. The concept of CT is useful to psychotherapists, providing a source of information about the patient's internal world and about certain elements of therapy, such as the quality of TA, which is important for good treatment results.

Objetivos: O objetivo principal desta pesquisa foi avaliar a relação entre a contratransferência (CT) e a aliança terapêutica (AT) no início da psicoterapia psicodinâmica. O objetivo secundário é avaliar a associação da CT com as variáveis da dupla e da CT com as demais variáveis do paciente avaliadas, que foram os mecanismos de defesa, sintomatologia e funcionalidade.Metodologia:Trata-se de um estudo transversal com 30 pacientes do ambulatório de psicoterapia de dois serviços de psiquiatria, atendidos por 17 terapeutas. As avaliações ocorreram entre quarto e décimo encontros da dupla.Resultados:A dimensão da CT distância apresentou correlação negativa moderada com a AT, especialmente sua dimensão que representa a capacidade de trabalho em terapia do paciente. Foram verificadas correlações moderadas positivas entre CT distância e cisão e entre CT proximidade e supressão, além da correlação moderada negativa da CT indiferença com fantasia. Outro dado encontrado foi a presença de maiores níveis da CT indiferença diante de pacientes da classe socioeconômica D e E.Conclusões:A qualidade da CT pode servir de fonte de informações sobre a AT. A presença de alta CT que indica distância está relacionada a baixa AT, sobretudo em relação a capacidade de trabalho do paciente, ainda que a presença de cisão pode influenciar a CT, de forma que representa uma variável de confusão. A CT é um conceito útil ao psicoterapeuta, servindo como fonte de informações sobre o mundo interno do paciente e sobre elementos da psicoterapia, como a qualidade da AT, importante para os bons resultados dos tratamentos.

Does psychodynamic short-term psychotherapy for depressed breast cancer patients also improve fatigue? Results from a randomized controlled trial.

The purpose of this study was to determine (a) the course of fatigue in depressed breast cancer patients, (b) the effect of a depression-focused individual psychodynamic psychotherapy on fatigue, and (c) the associations of fatigue with depression, quality of life and treatment-related variables. In a German multicentre randomized controlled trial in Leipzig and Mainz, depressed early breast cancer patients (UICC stage 0-III, age 18-70 years) were randomly assigned to a short-term psychodynamic psychotherapy (STPP, an adaptation of the Supportive-Expressive psychotherapy by Luborsky for cancer patients) or treatment as usual (TAU) and completed data assessment pre- and post-treatment. Fatigue was assessed with the Multidimensional Fatigue Inventory (MFI-20). All analyses were conducted as complete case analyses including 52 STPP and 54 TAU completers (n = 106). The trial is registered at http://www.controlled-trials.com , number ISRCTN96793588. Fatigue declined significantly from a high level pre-treatment to post-treatment, but remained significantly higher than among population-based controls and a mixed sample of cancer patients. Significant time by group interactions favoured STPP for the subscales reduced activity and physical fatigue and the total scale. The strength of the associations between total fatigue and depression increased from 0.49 pre-treatment to 0.63 (Quality of life -0.52 to -0.63) at follow-up. STPP is beneficial for reducing dimensions of fatigue (particularly reduced activity and physical fatigue) in depressed breast cancer patients. Chronic fatigue needs more clinical attention in this vulnerable group.

A Substance Called Food: Long-Term Psychodynamic Group Treatment for Compulsive Overeating.

Obesity has proven difficult to treat. Many approaches neglect to address the deep-rooted underlying psychological issues. This paper describes a psychodynamically oriented approach to treating compulsive overeating as an addiction. Common to all addictions is a compulsion to consume a substance or engage in a behavior, a preoccupation with using behavior and rituals, and a lifestyle marked by an inability to manage the behavior and its harmful consequences. The approach represents a shift away from primarily medical models of intervention to integrated models focusing on the psychological underpinnings of obesity. Long-term psychodynamic group psychotherapy is recommended as a primary treatment.

Psicoterapia individual em um caso grave de anorexia nervosa: a construção da narrativa clínica / Individual psychotherapy in a severe case of anorexia nervosa: the construction of clinic narrative / Psicoterapia individual en un grave caso de anorexia nerviosa: la construcción de la narrativa clínica

A anorexia nervosa constitui um tipo de transtorno alimentar grave devido ao risco de vida que implica para a pessoa acometida. Ainda pouco se sabe sobre o alcance do trabalho com psicoterapia psicodinâmica nesses casos, a partir do vértice das experiências emocionais vividas pelo psicoterapeuta com o paciente. Este estudo tem por objetivo discutir os limites e possibilidades da intervenção psicoterápica individual em um caso grave de anorexia nervosa, por meio da construção da narrativa clínica focada no desenvolvimento de recursos da paciente para lidar com seus conflitos. Utilizou-se como estratégia metodológica o estudo de caso e o enfoque psicodinâmico como referencial teórico para condução do processo terapêutico e análise dos dados. O caso foi seguido em contexto ambulatorial, sendo destacado por sua relevância clínica e implicações terapêuticas. O processo psicoterapêutico desdobrou-se em profícuo espaço relacional, que favoreceu a superação de dificuldades psicológicas, promovendo transformações nas condições de vida da paciente.

Anorexia nervosa is a serious eating disorder type due to the risk of life that implies for the afflicted person. Yet little is known about the scope of work with psychodynamic psychotherapy in these cases, from the perspective of emotional experiences lived by the psychotherapist with the patient. This study aims to discuss the limits and possibilities of an individual psychotherapeutic intervention in a severe case of anorexia nervosa, through the construction of clinical narrative focused on developing patient’s resources to deal with her conflicts. The case study was used as a methodological strategy and the psychodynamic approach was the theoretical basis to conduct the therapeutic process and data analysis. The case was followed in an outpatient setting, being remarked by its clinical relevance and therapeutic implications. The psychotherapeutic process unfolded in a fruitful relational space, which favored to overcome psychological difficulties, promoting changes in the conditions of life of the patient.

La anorexia nervosa es un grave tipo de trastorno de la alimentación, debido al riesgo de vida que implica para la persona afectada. Sin embargo, poco se sabe sobre el alcance del trabajo con la psicoterapia psicodinámica en estos casos, desde el vértice de las experiencias emocionales vividas por el psicoterapeuta con el paciente. En este sentido, este estudio tiene como objetivo discutir los límites y posibilidades de una intervención psicoterapéutica individual en un caso grave de anorexia nerviosa, a través de la construcción de la narrativa clínica centrada en el desarrollo de recursos de la paciente para hacer frente a sus conflictos. Fue utilizado como estrategia metodológica el estudio de caso y el enfoque psicodinámico como marco teórico para conducir el proceso terapêutico y el análisis de datos. El caso fue seguido en contexto ambulatorial y se destaca por su relevancia clínica e implicaciones terapéuticas. El proceso psicoterapéutico se desdobró em fructífero espacio relacional, lo que favoreció a superar las dificultades psicológicas, por medio de la promoción de cambios en las condiciones de vida de la paciente.

[Psychodynamic psychotherapy, lifestyle and prevention]. / Psychodynamische Psychotherapie, Lebensstil und Prävention.

OBJECTIVES: Patients with mental disorders frequently manifest unhealthy behavior, which contributes to their increased risk for chronic mental and somatic diseases as well as excess mortality rates of 10 years and more. It also impairs their well-being and the course of mental disorders.We analyzed whether by addressing unhealthy behavior prevention can be integrated into psychodynamic psychotherapy. METHODS: We reviewed the literature on the role of unhealthy behavior for mental disorders, on the role of lifestyle risk factors in psychodynamic theory, and on barriers to the integration of addressing lifestyle in psychodynamic psychotherapy. RESULTS: Smoking, unhealthy dietary habits, and physical inactivity constitute dysfunctional behavior, resulting from maladaptive self-representations and an impairment of emotion-regulation capacities. In psychodynamic psychotherapy this maladaptive behavior can be addressed and treated as a kind of defensive behavior and resistance. CONCLUSION: We believe that by addressing unhealthy behavior prevention can become a crucial task for psychodynamic psychotherapists today.

Psychodynamic interventions in cancer care II: a qualitative analysis of the therapists' reports.

BACKGROUND: To investigate the focus of psychodynamic-oriented interventions in cancer patients by means of a qualitative analysis of the therapists' reports. METHODS: One hundred thirty-five reports collected within a controlled psychotherapy trial were analyzed; the themes addressed during the intervention were classified in categories reflecting the focus of the intervention and correlated with sociodemographic and medical data and type of intervention. RESULTS: Twenty main themes were identified and classified in two categories: category 1 corresponded to interventions based on expression and support, and category 2 to interventions based on introspection, with subcategory 2.1 focusing on the patient's psychological functioning and subcategory 2.2 focusing on his way to engage and communicate in relationships. While the most frequently addressed theme was related to the diagnosis of cancer (N = 102/576; 22.6%), the majority of themes were related to other concerns (N = 446/576; 77.4%). Half of the interventions (50.4%) were classified in category 1, 27.4% in category 2.1, and 9.6% in category 2.2. Patients of category 1 entered less often brief psychotherapy (step 2 of the intervention) and more frequently suffered from advances disease. CONCLUSIONS: A wide variety of themes are addressed in psychodynamic interventions in the oncology setting, illustrating that cancer is not the only focus of therapy. Other themes reflect different psychological difficulties triggered by the disease. This study illustrates that cancer patients have different needs, which surpass the event of the disease. Early clarification and comprehension of the demand may therefore be beneficial to adjust the therapeutic approach.

Group therapy in public mental health services: approaches, patients and group therapists.

Group therapy is used extensively within public mental health services, but more detailed knowledge is needed. All 25 health authorities in Norway were invited to describe their groups: theory, primary tasks, interventions, structure, patients and therapists. Four hundred twenty-six groups, 296 in community mental health centres and 130 in hospitals, were categorized into nine types, based on theoretical background. Psychodynamic groups were most frequent, followed by cognitive-behavioural, psycho-educative, social skills/coping and art/expressive groups. Weekly sessions of 90 min and treatment duration <6 or >12 months was most frequent. Main diagnosis for 2391 patients: depression (517), personality disorder (396), schizophrenia/psychosis (313) and social phobia (249). Patients with depression or personality disorder were mostly in psychodynamic groups, psychosis/bipolar disorder in psycho-educative groups. Cognitive-behavioural groups were used across several diagnoses. Most therapists were nurses, only 50% had a formal training in group therapy. There is a plethora of groups, some based on one theoretical school, while others integrate theory from several 'camps'. Patients with similar diagnosis were offered different group approaches, although some trends existed. More research evidence from regular clinical groups is needed, and clinician-researcher networks should be developed. More group therapists with formal training are needed.

Psychodynamic interventions in cancer care I: psychometric results of a randomized controlled trial.

OBJECTIVE: This study aimed to assess the effectiveness of psychodynamic interventions in cancer care. METHODS: Between 2006 and 2009, each consecutive outpatient of the Oncology Center of the University Hospital of Lausanne was invited to participate in a trial evaluating the effects of psychological support. Accepting patients were randomly assigned to an immediate intervention or a delayed intervention [4-month waiting list]. Patients who declined support were asked to participate in an observational group [OG]. Socio-demographic and medical data, anxiety, and depression [HADS], psychological distress [SCL-90], alexithymia [TAS] and quality of life [EORTC] were recorded at baseline, and at 1, 4, 8, and 12-months follow-up. RESULTS: Of the 1973 approached patients, 1057 were excluded, 530 refused, and 386 were included with 196 of them participating in the OG. Of the patients in the intervention group [IG] [N = 190], 94 were randomized to the immediate intervention and 96 to the delayed intervention group (dIG). IG patients were younger, predominantly female, and had more psychological symptoms compared with those in the OG. Although patients of the IG and OG showed significant improvement in quality of life from baseline to 12-months follow-up, other outcomes [anxiety, depression, psychological distress, and alexithymia] remained unchanged. CONCLUSIONS: The intervention was not effective with regards to psychometric outcome. The results have to be interpreted in light of the study design [untargeted intervention], the low levels of psychiatric symptoms, dropout of symptomatic patients, and the high prevalence of alexithymia.

Pragmatic psychodynamic psychotherapy for a patient with depression and breast cancer: functional MRI evaluation of treatment effects.

Time-limited psychodynamic psychotherapy is garnering empirical support as an intervention for clinical depression. However, research is needed to examine the efficacy of psychodynamic approaches among patients presenting with diverse psychiatric and medical problems. This case study examined the efficacy of eight sessions of pragmatic psychodynamic psychotherapy (PPP) in treating a woman with major depression and breast cancer. Pre- to posttreatment assessment indicated significant reductions in depression and weekly assessment indicated increased environmental reward was associated with reduced depression. Secondary aims involved piloting a functional magnetic resonance imaging (fMRI) task as a neurobiological indicator of depression attenuation as a function of PPP. This assessment was conducted to explore alternative means of evaluating treatment responsiveness and addressing the problem of arbitrary metrics in measuring change. Clinical and assessment implications are discussed, with a focus on innovative approaches to evaluate treatment outcome and behavioral and neurobiological mechanisms of change associated with PPP.