Aging, Dying, and the Analytic Process.

The panel discussion presented at the New York Psychoanalytic Society and Institute's 1066th Scientific Meeting held on June 8, 2023, takes up aging and dying of an analyst and their impact on patients and on the nature of analytic process. Participants reflect on conflicts and challenges arising with more analysts and patients living to an advanced age, on the unregulated nature of analysts' retirement, and on multilayered meanings of analysts' ethical commitment to their work.

A systematic review of dramatherapy interventions used to support adults with psychosis.

BACKGROUND: Psychiatric treatment of psychosis often comprises therapeutic and psychotropic combinations. Dramatherapy is often utilised in health services with this population, particularly when clients struggle to engage with talking therapies because of complex presentations, experience preverbal trauma, neurodiversity challenges and/or communication difficulties. Dramatherapy as a therapeutic intervention is recognised by health regulating bodies but as yet has not yet been systematically reviewed. AIMS: To synthesise existing peer-reviewed empirical research literature and gather evidence regarding dramatherapy used to support adults with psychosis; To collate and understand the intervention methods of dramatherapy as a treatment to support adults experiencing psychosis; To assess the effect of dramatherapy on adults with psychosis, by collating qualitative and quantitative outcome measures, where reported in included research. METHODS: Literature was sourced through database searches (CINAHL, EMBASE, COCHRANE, PsycINFO, PubMed, Scopus, and APA PsycNet) and hand searches. 8541 papers were screened, and 11 met inclusion criteria for synthesis. Findings related to aims were narratively synthesised, before being thematically analysed. RESULTS: Participant characteristics of age, gender, ethnicity, and socio-economic background were heterogeneous. Participants across studies often had multiple diagnoses, and unknown complexities making recovery through standard treatment unachievable. Presentations included episodes of psychosis, schizophrenia, and dual-diagnoses of mental health challenges and intellectual difficulties. Positive effects found the use of dramatherapy include: New perspectives; Improved relationships; Ability to make choices with reduced anxiety; Understanding of self; Reduced psychotic symptoms. Quantitative data substantiated qualitative findings, and effect indicated changes in social functioning, behaviours, and symptoms following dramatherapy intervention. IMPLICATIONS: Systematic findings will support practitioners to implement evidence-based practice and to improve treatment provision for adults with psychosis. Further methodologically sound research into the field is encouraged to advance understanding of dramatherapy interventions for adults with psychosis.

[Effectiveness of psychotherapy on dissociative symptoms in adult populations: A PRISMA systematic review]. / Efficacité des psychothérapies sur les symptômes dissociatifs en population adulte : une revue de la littérature PRISMA.

INTRODUCTION: Dissociation is a psychological process in reaction to threat which can be found in many psychiatric conditions. Dissociative symptoms can become very disabling, whether in daily life or in care. Nevertheless, few studies seem to have examined the efficacy of psychotherapy on the latter and its relevance as a therapeutic target. METHOD: A systematic review of the literature (PRISMA) on the efficacy of psychotherapy on dissociative symptoms in adults with mental disorders was conducted. Effectiveness was considered in terms of reduction in dissociative symptomatology. The search was conducted on Scopus, PubMed and PsycInfo. Overall, 50 full-text articles were evaluated. RESULTS: Fourteen studies were included in the review. In all, 711 adult subjects with post-traumatic stress disorder, borderline personality disorder or dissociative disorder were included. Overall, this systematic review reports a reduction in dissociative symptoms associated with a variety of psychotherapeutic interventions, without allowing any conclusions to be drawn on the superiority of one psychotherapy over another. DISCUSSION: The conclusions of this work highlight three possible therapeutic orientations for reducing dissociative symptoms: (i) by reintegrating the dynamic subsystems, (ii) by treating the cognitive processes underlying dissociation, and (iii) by acting on the processes identified as common to the effectiveness of psychotherapy.

Cultural adaptations of third-wave psychotherapies in Gulf Cooperation Council countries: A systematic review.

The effectiveness of third-wave psychotherapies has been demonstrated in a range of mental and physical health conditions in Western cultures. However, little is known about the cultural appropriateness and effectiveness of third-wave psychotherapies for Gulf Cooperation Council (GCC) populations. This review aimed to critically evaluate cultural adaptations to third-wave psychotherapies and explored the effectiveness of these interventions on physical and mental health outcomes in GCC populations. Five bibliographic databases and grey literature were searched; both English and Arabic studies conducted in the GCC were included. Mental and physical health-related outcomes were included. Eleven studies were identified. The overall degree of cultural adaptation ranged from 2 to 5, based on Bernal et al.'s cultural adaptation framework. Language and assessment tools were most frequently adapted. Several studies incorporated goal, method, and context adaptations, whereas metaphor and content were least frequently adapted. None of the studies incorporated person or concept adaptations. Culturally adapted third-wave psychotherapies were associated with improvement in numerous mental health outcomes, including psychological distress, well-being, and psychological traits. No physical health outcomes were identified. Although findings are promising with respect to the effectiveness of third-wave psychotherapies for GCC populations, they should be interpreted with caution due to the small number of studies conducted, cultural adaptation evaluations relying on explicit reporting in studies, and the weak methodological quality of studies. Future rigorous research is needed in the evaluation of culturally adapted third-wave psychotherapies in GCC populations, with more comprehensive reporting of cultural considerations.

Effectiveness of prolonged exposure (PE) after implementation at a crime victim support centre.

Background: Recent practice guidelines strongly recommend evidence-based psychotherapies (EBPs) as the first-line treatment for post-traumatic stress disorder (PTSD). However, previous studies found barriers to the implementation of EBPs and a relatively high dropout rate in clinical settings. After proving the efficacy of prolonged exposure (PE) in Japan [Asukai, N., Saito, A., Tsuruta, N., Kishimoto, J., & Nishikawa, T. (2010). Efficacy of exposure therapy for Japanese patients with posttraumatic stress disorder due to mixed traumatic events: A randomized controlled study. Journal of Traumatic Stress, 23(6), 744-750. https://doi.org/10.1002/jts.20589], we began implementing PE in a real-world clinical setting at the Victim Support Center of Tokyo (VSCT).Objective: We aimed to investigate the effectiveness and benefit of PE for crime-induced PTSD among VSCT clients and what causes dropout from treatment.Method: Of 311 adult clients who received counselling from clinical psychologists at VSCT due to violent or physical crime victimization from April 2008 through December 2019, 100 individuals received PE and participated in this study. Their PTSD symptoms were evaluated before and after treatment using the Impact of Event Scale-Revised and the Clinician-Administered PTSD Scale for DSM-IV.Results: A total of 93 participants completed PE and seven dropped out after six sessions or less. The completers group improved in PTSD symptoms with significant score differences between pre- and post-treatment in IES-R and CAPS-IV. Participants' symptoms did not exacerbate after treatment. Forty of 49 completers who left their workplace or college/school after victimization returned to work or study shortly after treatment. Compared to the completers, all dropout participants were women and younger. The majority were rape survivors, with significantly shorter intervals between victimization and treatment. The reasons for dropout were difficulty scheduling treatment between work/study schedules and manifestation of bipolar disorder or physical illness.Conclusions: PE can be implemented with significant effectiveness and a low dropout rate in a real-world clinical setting if advantages in the system and policies, local organizational context, fidelity support and patient engagement are fortified.

We conducted prolonged exposure (PE) with a low dropout rate for crime-induced PTSD in a non-Western real-world practice setting.Patient outcomes and low dropout rate of PE for PTSD in this study may be due to advantages in the following areas: system and policies, local organizational context, fidelity support and patient engagement.When introducing PE for PTSD, it is important to confirm that patients can be reasonably engaged with PE, and to carefully assess the status of other psychiatric and physical illnesses.

Can new approaches to synthesising evidence help achieve a consensus in psychotherapy research?

OBJECTIVE: The recent debate around the College's Clinical Practice Guidelines on mood disorders have highlighted differences in opinion on interpreting evidence from randomised control trials (RCTs) for psychodynamic psychotherapy. This paper discusses new techniques of synthesising research evidence (e.g., umbrella reviews) that may help minimise disagreements in the interpretation of RCTs and foster greater consensus on treatment guidelines. CONCLUSIONS: Findings from the latest umbrella review suggest that psychodynamic therapy is an evidence-based approach, among several, for common mental disorders.

Psychotherapies in opioid use disorder: toward a step-care model.

Opioid use disorder (OUD) is characterized by a lack of control in opioid use, resulting in psychological distress and deficits in interpersonal and social functioning. OUD is often associated with psychiatric comorbidities that increase the severity of the disorder. The consequences of OUD are dramatic in terms of increased morbi-mortality. Specific medications and psychotherapies are essential tools not only in the treatment of OUD but also in the prevention of suicide and overdoses. In our review, we assess the different types of psychotherapies (counseling, motivational interviewing, contingency management, cognitive-behavioral therapy, and dialectical-behavior therapy) that are delivered to opioid users, either associated or un-associated with OUD medications and/or medications for psychiatric disabilities. We describe the application of these therapies first to adult opioid users and then to adolescents. This work led us to propose a stepped-care model of psychotherapies for OUD which provided information to assist clinicians in decision-making regarding the selection of psychotherapeutic strategies according to patients' OUD severity.

Psychotherapies for eating disorders: findings from a rapid review.

BACKGROUND: Psychotherapy is considered central to the effective treatment of eating disorders-focusing on behavioural, psychological, and social factors that contribute to the illness. Research indicates psychotherapeutic interventions out-perform placebo, waitlist, and/or other treatments; but, outcomes vary with room for major improvement. Thus, this review aims to (1) establish and consolidate knowledge on efficacious eating disorder psychotherapies; (2) highlight select emerging psychotherapeutic interventions; and (3) identify knowledge gaps to better inform future treatment research and development. METHODS: The current review forms part of a series of Rapid Reviews published in a special issue in the Journal of Eating Disorders to inform the development of the Australian-government-funded National Eating Disorder Research and Translation Strategy 2021-2031. Three databases were searched for studies published between 2009 and 2023, published in English, and comprising high-level evidence studies (meta-analyses, systematic reviews, moderately sized randomised controlled studies, moderately sized controlled-cohort studies, and population studies). Data pertaining to psychotherapies for eating disorders were synthesised and outlined in the current paper. RESULTS: 281 studies met inclusion criteria. Behavioural therapies were most commonly studied, with cognitive-behavioural and family-based therapies being the most researched; and thus, having the largest evidence-base for treating anorexia nervosa, bulimia nervosa, and binge eating disorder. Other therapies, such as interpersonal and dialectical behaviour therapies also demonstrated positive treatment outcomes. Emerging evidence supports specific use of Acceptance and Commitment; Integrative Cognitive Affective; Exposure; Mindfulness; and Emotionally-Focused therapies; however further research is needed to determine their efficacy. Similarly, growing support for self-help, group, and computer/internet-based therapeutic modalities was noted. Psychotherapies for avoidant/restrictive food intake disorder; other, and unspecified feeding and eating disorders were lacking evidence. CONCLUSIONS: Currently, clinical practice is largely supported by research indicating that behavioural and cognitive-behavioural psychotherapies are most effective for the treatment of eating disorders. However, the efficacy of psychotherapeutic interventions varies across studies, highlighting the need for investment and expansion of research into enhanced variants and novel psychotherapies to improve illness outcomes. There is also a pressing need for investigation into the whole range of eating disorder presentations and populations, to determine the most effective interventions.

Evaluating the efficacy of treatment options for eating disorders (EDs) is important and necessary to inform both treatment guidelines and clinical practice. However, treatment outcomes in studies, and in clinical practice, can vary widely. Therefore, this review aimed to pool evidence related to a wide range of psychological treatments to help better understand what gaps in treatment need to be addressed. Using a rapid review method, three academic databases were searched, and 281 articles were identified and analysed. Results indicated that cognitive-behavioural approaches had the most evidence for well-defined EDs (such as anorexia nervosa, bulimia nervosa, and binge eating disorder). However, little research was found on other types of EDs. There was emerging evidence that provided support for self-help, group, and computer/internet-based therapies. Overall, the findings highlighted that more research is required on novel eating disorder treatments beyond what is currently available and being used as 'gold standard'.

Efficacy and acceptability of third-wave psychotherapies in the treatment of depression: a network meta-analysis of controlled trials.

Introduction: In recent decades, various new psychotherapy approaches have been developed in an effort to overcome issues of non-response, referred to as "third-wave psychotherapies." How third-wave therapies perform in comparison to each other, to classical CBT, or other common comparators in the treatment of depression has not yet been systematically assessed. Methods: We firstly determined the scope of the term "third-wave" by conducting a systematic search. The identified approaches were then used as search terms for the systematic review and network meta-analysis (NMA). We searched MEDLINE, CENTRAL, PsychINFO and Web of Science from inception until 31 July 2022. We assessed randomized controlled trials comparing third-wave psychotherapies to each other, CBT, treatment as usual (TAU), medication management, active control conditions, or waitlist (WL) in adult populations with depressive disorders. The treatments included were acceptance and commitment therapy, behavioral activation, cognitive behavioral analysis system of psychotherapy, dialectical behavioral therapy, mindfulness-based cognitive therapy, meta-cognitive therapy, positive psychotherapy and schema therapy. The primary outcome was depression severity (efficacy) at study endpoint, and the secondary outcome was all-cause discontinuation (acceptability). This review was registered in PROSPERO, identifier CRD42020147535. Results: Of 7,971 search results, 55 trials were included in our NMA (5,827 patients). None of the third-wave therapies were more efficacious than CBT but most were superior to TAU [standardized mean differences (SMD) ranging between 0.42 (95% CI -0.37; 1.19) and 1.25 (0.48; 2.04)]. Meta-cognitive therapy (MCT) was more efficacious than three other third-wave therapy approaches. None of the third-wave treatments were more acceptable than WL or CBT. Twenty-seven percent of the trials were rated as low risk of bias. Confidence in the evidence was largely low according to GRADE. Inconsistency emerged for a small number of comparisons. Interpretations: Third-wave therapies are largely efficacious and acceptable alternatives to CBT when compared to TAU, with few differences between them. The evidence so far does not point toward superiority or inferiority over CBT. Patient-level research may offer possibilities for tailoring individual psychotherapies to the needs of individual patients and future trials should make this data available. The evidence base needs to be broadened by sufficiently powered trials.

The lived experience of depression: a bottom-up review co-written by experts by experience and academics.

We provide here the first bottom-up review of the lived experience of depression, co-written by experts by experience and academics. First-person accounts within and outside the medical field were screened and discussed in collaborative workshops involving numerous individuals with lived experience of depression, family members and carers, representing a global network of organizations. The material was enriched by phenomenologically informed perspectives and shared with all collaborators in a cloud-based system. The subjective world of depression was characterized by an altered experience of emotions and body (feeling overwhelmed by negative emotions, unable to experience positive emotions, stuck in a heavy aching body drained of energy, detached from the mind, the body and the world); an altered experience of the self (losing sense of purpose and existential hope, mismatch between the past and the depressed self, feeling painfully incarcerated, losing control over one's thoughts, losing the capacity to act on the world; feeling numb, empty, non-existent, dead, and dreaming of death as a possible escape route); and an altered experience of time (experiencing an alteration of vital biorhythms, an overwhelming past, a stagnation of the present, and the impossibility of the future). The experience of depression in the social and cultural context was characterized by altered interpersonal experiences (struggling with communication, feeling loneliness and estrangement, perceiving stigma and stereotypes), and varied across different cultures, ethnic or racial minorities, and genders. The subjective perception of recovery varied (feeling contrasting attitudes towards recovery, recognizing recovery as a journey, recognizing one's vulnerability and the need for professional help), as did the experience of receiving pharmacotherapy, psychotherapy, and social as well as physical health interventions. These findings can inform clinical practice, research and education. This journey in the lived experience of depression can also help us to understand the nature of our own emotions and feelings, what is to believe in something, what is to hope, and what is to be a living human being.

Facing and Overcoming Pain Through Scientific Evidence: The Imperative of Exposure as a Psychological Technique for Cognitive Behavioral Treatments in Buenos Aires, Argentina.

On the basis of a research study on cognitive behavioral psychotherapies conducted between 2016 and 2020, this article analyzes exposure as a psychological technique focused on facing and overcoming distressing situations that interfere with everyday life and cause pain. Said psychotherapies have gained more relevance in Argentina in recent years. Their development and institutionalization continued during the first decades of the new millennium. By the late 1990s, there were social and economic transformations that modified people's lives and produced different types of suffering. In addition, that scenario was set with subjectivity models based on the importance of being autonomous and responsible in different spheres of daily life (including healthcare). Accordingly, current social imperatives such as "you can do it" or "give it another try" become values linked to personal realization that are assimilated by these psychotherapies through techniques such as exposure. In that respect, this article aims at analyzing exposure as a psychological technology with evidence-based epistemological presuppositions and problem-solving models based on the subjects' individual commitment. Unlike most social-anthropological studies that connect the notion of exposure to that of risk, from a cognitive behavioral standpoint, self-exposing and overcoming the cause of distress is associated with a successful therapeutic process. This study used a qualitative methodology, and the technique was the analysis drawn from 30 semi-structured interviews with cognitive behavioral psychologists from the Autonomous City of Buenos Aires, Argentina.

Comparison of two psychotherapies in cortisol response and their efficacy in reducing symptoms of anxiety and depression in women victims of intimate partner violence / Comparación de dos psicoterapias en la respuesta del cortisol y en su eficacia para reducir los síntomas de ansiedad y depresión en mujeres víctimas de violencia de pareja

Abstract Introduction There is a growing need to implement evidence-based psychological treatments for women victims of intimate partner violence (IPV) who commonly experience stress-related disorders such as anxiety, depression, or suicide risk, as well as altered cortisol reactivity. Objective 1. To compare the changes in depressive and anxious symptomatology, quality of life, and cortisol reactivity after two different interventions, Acceptance and Commitment Therapy (ACT, based on psychological flexibility) or Interpersonal Therapy (IPT, based on empowerment) in women exposed to IPV. 2. To compare the changes in relation to the presence of suicide thoughts. Method A clinical sample of 50 women (ages 21-74) randomly assigned to attend ACT or IPT, completed pre- and post-intervention questionnaires about intimate partner violence, quality of life, depression, anxiety, and measurements of salivary cortisol reactivity (basal, 15, 30, and 45 minutes after a cognitive challenge). We used Generalized Estimating Equation Models for data analysis. Results There was a significant improvement post-intervention in all variables, regardless of the type of psychotherapy or the presence of suicide thoughts. Before interventions, women that reported suicide thoughts had severe symptoms of depression, anxiety, worse quality of life, and a cortisol hyper-response profile, in contrast to women without suicide thoughts who had moderate symptoms and no cortisol response. Cortisol response to the cognitive test decreased in all women after both therapies. Discussion and conclusion Although different psychological approach, ACT, and IPT effectively improved mental health, quality of life, and changed cortisol reactivity of women exposed to IPV, including women at suicide risk.

Resumen Introducción Son necesarios tratamientos basados en evidencia para mujeres víctimas de violencia de pareja (IPV), con trastornos relacionados con estrés como ansiedad, depresión y riesgo suicida y alteraciones en la reactividad del cortisol. Objetivo Comparar los cambios en la sintomatología depresiva, ansiosa, calidad de vida y reactividad del cortisol después de aplicar Terapia de Aceptación y Compromiso (ACT, basada en la flexibilidad psicológica) o Terapia Interpersonal (IPT, basada en el empoderamiento) en mujeres expuestas a IPV y compararlos en función al pensamiento suicida. Método Una muestra clínica de 50 mujeres (entre 21 y 74 años) fueron asignadas aleatoriamente a recibir ACT o IPT, completaron antes y después, cuestionarios sobre IPV, calidad de vida, depresión y ansiedad, y mediciones de cortisol (basal, 15, 30 y 45 minutos después de un reto cognitivo) en saliva en respuesta a un reto cognitivo. Utilizamos modelos de Ecuaciones de Estimación generalizada para analizar los datos. Resultados Mejoraron significativamente todas las variables, independientemente del tipo de psicoterapia y del pensamiento suicida. Antes de la intervención, las mujeres con ideación suicida presentaron depresión y ansiedad severas, peor calidad de vida e hiper-respuesta de cortisol, en contraste con las mujeres sin ideación, quienes presentaron síntomas moderados y una respuesta de cortisol plana. El cortisol disminuyó en todas las mujeres después de ambas terapias. Discusión y conclusión Ambas terapias IPT y ACT mejoraron la salud mental y calidad de vida de las mujeres con IPV y modificaron la reactividad del cortisol, incluyendo a las pacientes que reportaron ideación suicida.

The status of psychodynamic psychotherapy as an empirically supported treatment for common mental disorders - an umbrella review based on updated criteria.

To assess the current status of psychodynamic therapy (PDT) as an empirically supported treatment (EST), we carried out a pre-registered systematic umbrella review addressing the evidence for PDT in common mental disorders in adults, based on an updated model for ESTs. Following this model, we focused on meta-analyses of randomized controlled trials (RCTs) published in the past two years to assess efficacy. In addition, we reviewed the evidence on effectiveness, cost-effectiveness and mechanisms of change. Meta-analyses were evaluated by at least two raters using the proposed updated criteria, i.e. effect sizes, risk of bias, inconsistency, indirectness, imprecision, publication bias, treatment fidelity, and their quality as well as that of primary studies. To assess the quality of evidence we applied the GRADE system. A systematic search identified recent meta-analyses on the efficacy of PDT in depressive, anxiety, personality and somatic symptom disorders. High quality evidence in depressive and somatic symptom disorders and moderate quality evidence in anxiety and personality disorders showed that PDT is superior to (inactive and active) control conditions in reducing target symptoms with clinically meaningful effect sizes. Moderate quality evidence suggests that PDT is as efficacious as other active therapies in these disorders. The benefits of PDT outweigh its costs and harms. Furthermore, evidence was found for long-term effects, improving functioning, effectiveness, cost-effectiveness and mechanisms of change in the aforementioned disorders. Some limitations in specific research areas exist, such as risk of bias and imprecision, which are, however, comparable to those of other evidence-based psychotherapies. Thus, according to the updated EST model, PDT proved to be an empirically-supported treatment for common mental disorders. Of the three options for recommendation provided by the updated model (i.e., "very strong", "strong" or "weak"), the new EST criteria suggest that a strong recommendation for treating the aforementioned mental disorders with PDT is the most appropriate option. In conclusion, PDT represents an evidence-based psychotherapy. This is clinically important since no single therapeutic approach fits all psychiatric patients, as shown by the limited success rates across all evidence-based treatments.

Meaning-formation and sense of purpose in Morita therapy.

Morita therapy is one of the leading alternative psychotherapeutic approaches that has emerged from Japan and has adapted with notable success to the mores and demands of the Western medical establishment. Although still on the margin, Morita therapy has the potential to offer a viable option for those who seek therapeutic assistance for various neuroses and psychosomatic illnesses that culminate in psychiatric symptoms such as generalized anxiety disorder, obsessive-compulsive disorder, or posttraumatic stress disorder. Diverging considerably from conventional Western psychiatric approaches, Morita therapy has its own modes of conceiving mental illness and offers distinct curative methods that are in some ways akin to the techniques of meaning-centred psychotherapies, but in many other ways are rather different. In this paper, the meaning-formation and the building of a constant sense of purpose in Morita therapy is explored, with a special focus on how these relate to creating a stable psychological framework for the client.

Could negative outcomes of psychotherapies be contributing to the lack of an overall population effect from the Australian Better Access initiative?

OBJECTIVE: We examine deterioration in psychotherapies, as reported in the recent evaluation of the Australian Medicare Better Access initiative. CONCLUSION: A focus on patients who experience poor clinical outcomes helps programs minimise harm and improve quality of care. The Better Access evaluation found the mental health of 20-40% of patients deteriorated. This may partly explain why population distress and suicide rates were not reduced by the introduction of the Better Access initiative. Deterioration was more likely for milder conditions, and less likely for severe conditions, which also improved the most. Using severity as a criterion for priority setting and resource allocation may minimise patient risk and maximise benefits. Patients with severe conditions may require considerably more sessions than the current average for Better Access psychotherapies.

Evaluation of Implementation Strategies for Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Mindfulness-Based Stress Reduction (MBSR): a Systematic Review.

BACKGROUND: Improving access to evidence-based psychotherapies (EBPs) is a Veterans Health Administration (VHA) priority. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and mindfulness-based stress reduction (MBSR) are effective for chronic pain and several mental health conditions. We synthesized evidence on implementation strategies to increase EBP access and use. METHODS: We searched MEDLINE, Embase, PsycINFO, and CINAHL from inception until March 2021 for articles on EBP implementation within integrated health systems to treat chronic pain or chronic mental health conditions. Reviewers independently screened articles, extracted results, coded qualitative findings, and rated quality using modified criteria from Newcastle-Ottawa (quantitative results) or Critical Appraisal Skills Programme (qualitative results). We categorized implementation strategies using the Expert Recommendations for Implementing Change (ERIC) framework and classified outcomes using RE-AIM domains (Reach, Effectiveness, Adoption, Implementation, Maintenance). RESULTS: Twelve articles (reporting results from 10 studies) evaluated CBT (k = 11) and ACT (k = 1) implementation strategies in large integrated healthcare systems. No studies evaluated MBSR implementation. Eight articles evaluated strategies within VHA. Six articles reported on national VHA EBP implementation programs; all involved training/education, facilitation, and audit/feedback. CBT and ACT implementation demonstrated moderate to large improvements in patient symptoms and quality of life. Trainings increased mental health provider self-efficacy in delivering EBPs, improved provider EBP perceptions, and increased provider EBP use during programs, but had unclear impacts on Reach. It was unclear whether external facilitation added benefit. Provider EBP maintenance was modest; barriers included competing professional time demands and patient barriers. DISCUSSION: Multi-faceted CBT and ACT implementation programs increased provider EBP Adoption but had unclear impacts on Reach. Future implementation efforts should further evaluate Reach, Adoption, and Maintenance; assess the added value of external facilitation; and consider strategies targeting patient barriers. Future work should use implementation frameworks to guide evaluations of barriers and facilitators, processes of change, and outcomes. REGISTRATION: PROSPERO registration number CRD42021252038.

[The effects of the pandemic on students in a psychodynamic setting]. / Les effets de la pandémie sur un dispositif psychodynamique pour les étudiants.

The health crisis brought on by the Covid-19 pandemic has resulted in a particularly severe impact on the mental health of students. This period of their lives, between adolescence and adulthood, is fraught with decisive issues: changes in familial relationships, self-reliance, involvement in romantic and erotic relationships, essential choices: profession, partner. For some students, we could add to the list mobility or exile when studies require it, as well as economic concerns. It is therefore a pivotal period, which for the most part is productive, but also one of great psychological vulnerability. This vulnerability was heightened by the isolation and disruption of their education. These were the most striking effects of the health crisis on students. BAPU FSEF Paris V's mission is to provide students with access to psychodynamic psychotherapy. The team had to adapt its protocols to the qualitative and quantitative changes in demand during the health crisis. We discuss these changes by illustrating them with a clinical example. The long-term effects of the crisis are also discussed.

Maintenance Psychotherapies for Older Adults: A Scoping Review.

BACKGROUND/OBJECTIVE: Given the chronicity of depression and anxiety disorders in late life, maintenance treatments may have a role in preserving healthy functioning. This study aims to understand the state of the science on maintenance psychotherapies for Black, Asian, and Latinx older adults. DESIGN: Scoping review. METHODS: A priori protocol was prospectively published. Four databases were searched up to December 1, 2021. Eligible studies were conducted in the United States or Puerto Rico and focused on maintenance psychotherapies treating depression, anxiety, or both in adults 60+. Due to the underrepresentation of Black, Asian, and Latinx participants, studies were included irrespective of the participant's racial or ethnic background. RESULTS: A total of 3,623 unique studies were retrieved, and eight studies were included. Two studies represented randomized clinical trials, and six were studies of post hoc analyses. All studies were from the same research team, had similar maintenance treatments, and focused on depression. Studies included racially homogenous samples (94-98% White). The primary outcome was the recurrence of a major depressive episode. Across studies, maintenance psychotherapy shows promise in preventing the recurrence of depression in some older adults. CONCLUSION: Expanding the scope of knowledge from achieving optimal functioning to sustaining those changes in older adults is a significant public health challenge given symptom recurrence. The small body of knowledge on maintenance psychotherapies shows a promising direction in maintaining healthy functioning following recovery from depression. However, opportunities remain to expand the evidence of maintenance psychotherapies with a more significant commitment to the inclusion of diverse populations.

Cognitive behavior therapy vs. control conditions, other psychotherapies, pharmacotherapies and combined treatment for depression: a comprehensive meta-analysis including 409 trials with 52,702 patients.

Cognitive behavior therapy (CBT) is by far the most examined type of psychological treatment for depression and is recommended in most treatment guide-lines. However, no recent meta-analysis has integrated the results of randomized trials examining its effects, and its efficacy in comparison with other psychotherapies, pharmacotherapies and combined treatment for depression remains uncertain. We searched PubMed, PsycINFO, Embase and the Cochrane Library to identify studies on CBT, and separated included trials into several subsets to conduct random-effects meta-analyses. We included 409 trials (518 comparisons) with 52,702 patients, thus conducting the largest meta-analysis ever of a specific type of psychotherapy for a mental disorder. The quality of the trials was found to have increased significantly over time (with increasing numbers of trials with low risk of bias, less waitlist control groups, and larger sample sizes). CBT had moderate to large effects compared to control conditions such as care as usual and waitlist (g=0.79; 95% CI: 0.70-0.89), which remained similar in sensitivity analyses and were still significant at 6-12 month follow-up. There was no reduction of the effect size of CBT according to the publication year (<2001 vs. 2001-2010 vs. >2011). CBT was significantly more effective than other psychotherapies, but the difference was small (g=0.06; 95% CI: 0-0.12) and became non-significant in most sensitivity analyses. The effects of CBT did not differ significantly from those of pharmacotherapies at the short term, but were significantly larger at 6-12 month follow-up (g=0.34; 95% CI: 0.09-0.58), although the number of trials was small, and the difference was not significant in all sensitivity analyses. Combined treatment was more effective than pharmacotherapies alone at the short (g=0.51; 95% CI: 0.19-0.84) and long term (g=0.32; 95% CI: 0.09-0.55), but it was not more effective than CBT alone at either time point. CBT was also effective as unguided self-help intervention (g=0.45; 95% CI: 0.31-0.60), in institutional settings (g=0.65; 95% CI: 0.21-1.08), and in children and adolescents (g=0.41; 95% CI: 0.25-0.57). We can conclude that the efficacy of CBT in depression is documented across different formats, ages, target groups, and settings. However, the superiority of CBT over other psychotherapies for depression does not emerge clearly from this meta-analysis. CBT appears to be as effective as pharmacotherapies at the short term, but more effective at the longer term.

Comparative effectiveness of psychotherapies in adults with posttraumatic stress disorder: a network meta-analysis of randomised controlled trials.

BACKGROUND: Evidence on the long-term comparative effectiveness of posttraumatic stress disorder (PTSD) psychotherapies in adults remains unknown. Therefore, we performed an extensive network meta-analysis of randomised controlled trials (RCTs) to determine the comparative effectiveness of psychotherapies for people diagnosed with PTSD. METHODS: A comprehensive search was conducted in Cochrane library, Embase, Medline-OVID, PubMed, Scopus, and Psych-Info until March 2021. Studies on the effectiveness of cognitive processing therapy (CPT), cognitive therapy (CT), eye movement desensitisation reprocessing (EMDR), narrative exposure therapy (NET), prolonged exposure (PE), cognitive behavioural therapy (CBT), present-centred therapy (PCT), brief eclectic psychotherapies (BEP), psychodynamic therapy (PDT) or combination therapies compared to no treatment (NT) or treatment as usual (TAU) in adults with PTSD were included. Frequentist and Bayesian approaches were used for analysis in R-software. RESULTS: We included 98 RCTs with 5567 participants from 18 897 studies. CPT, EMDR, CT, NET, PE, CBT, and PCT were significant to reduce PTSD symptoms (SMD range: -1.53 to -0.75; Certainty: very low to high) at immediate post-treatment and ranked accordingly. Longitudinal analysis found EMDR (1.02) and CPT (0.85) as the significant therapies with large effect size in short-term and long-term follow-up, respectively. NET and CPT showed higher proportion of loss of PTSD diagnosis (RR range: 5.51-3.45) while there were no significant psychotherapies for retention rate compared to NT. CONCLUSIONS: Our findings provide evidence for improving current guidelines and informing clinical decision-making for PTSD management. However, the best PTSD treatment plan should be tailored to patients' needs, characteristics, and clinician expertise. REGISTRATION: PROSPERO CRD42020162143.