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3.
J Consult Clin Psychol ; 87(10): 927-940, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31556669

RESUMEN

OBJECTIVE: Despite the heightened urgency of the current prescription opioid crisis, few psychotherapies have been evaluated for chronic pain patients receiving long-term opioid analgesics. Current psychological pain treatments focus primarily on ameliorating negative affective processes, yet basic science suggests that risk for opioid misuse is linked with a dearth of positive affect. Interventions that modulate positive psychological processes may produce therapeutic benefits among patients with opioid-treated chronic pain. The aim of this study was to conduct a theory-driven mechanistic analysis of proximal outcome data from a Stage 2 randomized controlled trial of Mindfulness-Oriented Recovery Enhancement (MORE), an integrative intervention designed to promote positive psychological health. METHOD: Patients with opioid-treated chronic pain (N = 95; age = 56.8 ± 11.7; 66% female) were randomized to 8 weeks of therapist-led MORE or support group (SG) interventions. A latent positive psychological health variable comprised of positive affect, meaning in life, and self-transcendence measures was examined as a mediator of the effect of MORE on changes in pain severity at posttreatment and opioid misuse risk by 3-month follow-up. RESULTS: Participants in MORE reported significantly greater reductions in pain severity by posttreatment (p = .03) and opioid misuse risk by 3-month follow-up (p = .03) and significantly greater increases in positive psychological health (p < .001) than SG participants. Increases in positive psychological health mediated the effect of MORE on pain severity by posttreatment (p = .048), which in turn predicted decreases in opioid misuse risk by follow-up (p = .02). CONCLUSIONS: Targeting positive psychological mechanisms via MORE and other psychological interventions may reduce opioid misuse risk among chronic pain patients receiving long-term opioid therapy. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Dolor Crónico/terapia , Atención Plena , Grupos de Autoayuda , Adulto , Afecto , Anciano , Analgesia/psicología , Analgésicos Opioides/uso terapéutico , Dolor Crónico/tratamiento farmacológico , Dolor Crónico/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Opioides/psicología , Trastornos Relacionados con Opioides/terapia , Procesos Psicoterapéuticos , Resultado del Tratamiento
5.
Pap. psicol ; 40(2): 89-100, mayo-ago. 2019. tab
Artículo en Español | IBECS | ID: ibc-183639

RESUMEN

La Práctica (Clínica) Basada en la Evidencia se define como la integración de la mejor investigación disponible con la pericia clínica y las características, preferencias y cultura del paciente. Del mismo modo, la variable terapeuta empieza a mostrar su influencia decisi-va en el resultado de los tratamientos psicológicos. En este trabajo se pone el énfasis en la figura del terapeuta en el contexto del pro-grama de formación PIR de especialistas en Psicología Clínica de nuestro Sistema Nacional de Salud. Se revisan los constructos pericia, efectos del terapeuta y se presenta la Práctica Deliberada como un sistema de entrenamiento que puede ayudar a mejorar los resultados de los clínicos y sus tratamientos. Se realizan recomendaciones concretas para mejorar el modelo de supervisión durante la residencia PIR y se discuten algunas de las implicaciones y limitaciones del estado actual de la cuestión


Evidence-based (clinical) practice is the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences. Similarly, the therapist factor is beginning to show its decisive influence on the outcome of psychological treatments. This paper emphasizes the therapist factor in the context of the PIR training program of Clinical Psychology specialists within our National Health System. Expertise and therapist effects are reviewed and deliberate practice is presented as a training system that can help clinical psychologists to improve their outcomes and treatments. Specific recommendations are made to improve the supervision model during PIR training and the implications and limitations of the topic are discussed


Asunto(s)
Humanos , Psicología Clínica/métodos , Psicoterapia/métodos , Aptitud/fisiología , Competencia Clínica , Procesos Psicoterapéuticos , Psicología Clínica/instrumentación , Práctica Clínica Basada en la Evidencia , Sistemas Nacionales de Salud
6.
Gerais (Univ. Fed. Juiz Fora) ; 12(2): 371-388, jul.2019.
Artículo en Portugués | LILACS | ID: biblio-1006232

RESUMEN

O artigo toma como objeto de estudo as modalidades disponibilizadas de atendimento à população por serviços-escola de Psicologia. Parte do pressuposto de que a formação e a atuação em Psicologia têm sido perpassadas por significativas mudanças no contexto sócio-histórico-político do Brasil. Das clássicas áreas educação, saúde e trabalho, a Psicologia passa a responder demandas de distintos campos da vida da população. Trata-se de estudo descritivo, quantitativoqualitativo, constituído de levantamento bibliográfico da produção científica (2011 a 2015) sobre o tema. Vinte e quatro artigos foram identificados na pesquisa e sistematizados em três blocos de conteúdo: atividades educacionais, de autoavaliação e clínicas. As publicações versam prioritariamente sobre atividades educacionais e clínicas, sendo estas as que reúnem maior quantidade de artigos. Devido à tarefa dirigida à Psicologia de responder a demandas com as quais historicamente não se envolveu, pelo menos de forma hegemônica, é indispensável problematizar o Serviço-escola em sua função pedagógica, ético-política e social.


This article investigates the types of service available to the population by Psychology Training Clinics. It is based on the assumption that training and practice in Psychology have been permeated by significant changes in the sociohistorical-political context of Brazil. From the classic fields of school, health and work, Psychology starts to respond to demands from different areas of population life. This is a descriptive, quantitative-qualitative study, consisting of a literature review on the subject (2011 to 2015). 24 articles were identified in the search of the literature and analysed in three content blocks: school, self-assessment and clinical activities. The publications are primarily about educational and clinical activities, and they bring together a greater number of articles. Due to the task directed to Psychology to respond to the demands with which it has historically not been involved, at least in a hegemonic way, it is indispensable to problematize the Psychology Training Clinic in its pedagogical, ethical-political and social function.


Asunto(s)
Psicología Aplicada , Procesos Psicoterapéuticos , Práctica Psicológica
7.
Artículo en Inglés | IBECS | ID: ibc-183854

RESUMEN

Members of the Sikh Khalsa who make their residence in the United States represent a psychologically underserved and understudied population. A lack of awareness of psychological services contributes to this status; however, the challenges inherent in reconciling cultural norms within the United States with the native cultures of immigrant populations should not be neglected. As a consequence of the paucity of ethnically Sikh psychotherapists, the number of therapists with a competent cultural understanding of this population is limited. By sharing the insights and observations culled from dialogue with members of a Sikh community recovering in the wake of a national tragedy, we present our insights and an approach to therapeutic intervention developed to facilitate future psychotherapeutic endeavors both in Sikh communities and other ethnic minorities at large. The model developed in this study identifies demographic issues, therapeutic approach, gender bias, language, confidentiality, peer support, and immigrant status as the most important factors when treating this population. Ultimately, it is our intention to elevate awareness of some of the idiosyncratic complexities involved in treatment and research of this underserved minority group, particularly as our population continues to diversify


No disponible


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Grupos Minoritarios/psicología , Trastornos Mentales/terapia , Psicoterapia/estadística & datos numéricos , Trastornos por Estrés Postraumático/terapia , Salud de las Minorías Étnicas , Procesos Psicoterapéuticos , India/etnología , Religión y Psicología , Competencia Cultural , Emigrantes e Inmigrantes/psicología , Estados Unidos/epidemiología , Terrorismo/psicología , Sobrevivientes/psicología
8.
Schmerz ; 33(4): 329-332, 2019 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-31037342

RESUMEN

A patient with long-term fibromyalgia syndrome and concomitant post-traumatic stress disorder is reported. The relocation to a so-called external safe site resulted within a very short time in a sustained remission of the fibromyalgia syndrome, due to psychotherapeutic interventions. This shows that-according to the clinical guidelines-a psychiatric examination and, if necessary, targeted therapy of the psychiatric comorbidity is indispensable in patients with fibromyalgia syndrome.


Asunto(s)
Fibromialgia , Dolor , Trastornos por Estrés Postraumático , Comorbilidad , Fibromialgia/complicaciones , Humanos , Dolor/diagnóstico , Manejo del Dolor/psicología , Procesos Psicoterapéuticos , Trastornos por Estrés Postraumático/complicaciones
9.
Nervenarzt ; 90(7): 690-694, 2019 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-31073672

RESUMEN

BACKGROUND: Mental health professionals use various strategies to prevent involuntarily committed persons from absconding under an open door policy. OBJECTIVE: To provide an ethical framework for the evaluation of the replacement of locked ward doors by formal coercion or treatment pressures. METHODS: Empirically informed conceptual and ethical analysis. RESULTS: The replacement of locked ward doors by formal coercive measures applied to individual persons, such as mechanical restraint or seclusion, is ethically problematic. The use of treatment pressures, for example in the context of intensified observational measures, requires a differentiated ethical evaluation and does not necessarily constitute the milder means in comparison to locked ward doors. CONCLUSION: Unexplored conceptual, empirical and ethical issues surrounding open door policies and treatment pressures should be clarified by means of psychiatric and ethical research. In clinical practice, the choice of the least burdensome and least restrictive measures for involuntarily committed persons should be facilitated by appropriate ethical support services.


Asunto(s)
Coerción , Trastornos Mentales/terapia , Procesos Psicoterapéuticos , Aislamiento de Pacientes/ética , Aislamiento de Pacientes/legislación & jurisprudencia , Psiquiatría/ética , Psiquiatría/normas
10.
Nervenarzt ; 90(7): 724-732, 2019 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-31073674

RESUMEN

BACKGROUND: Implementation of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD). The idea of human rights developed during the era of the Enlightenment. This idea has been publicly discussed since the French Revolution of 1789 and its specification has been demanded politically. Important steps in this process were the General Declaration of Human Rights adopted by the UN in 1948 and the CRPD from 2006, which was especially relevant for psychiatric actions. Meanwhile, the idea of human rights has influenced the legislation in many countries and has thus become normatively binding, e. g. in the Basic Law of Germany, in the regulations for patient care and in the professional rules for physicians. AIM AND QUESTIONS: To sensitize for reflection on one's own actions and to gain a critical distance from the general overall opinion. Then not only the global validity of the CRPD is frequently violated, as in crisis regions but also in the everyday routine when, for example, the workload prevents psychiatric personnel from taking time for essential conversations with psychiatric patients in order to support their self-determination. MATERIAL AND METHODS: These aspects are illustrated and explained with the aid of multifarious examples from the relevant literature and from own experience. RESULTS AND DISCUSSION: Human rights are a regulative idea that provide a framework and direction for psychiatric actions; however, as an idea they compete with other ideas that try to control the trends of the day (the Zeitgeist) that determine daily practice. Not only the suppression of human rights from public consciousness, e. g. with the eugenics in the first third of the previous century but also their absolutization and poor implementation, as in the Italian psychiatry reform of 1978, damage psychiatric patients. Therefore, it appears necessary to sensitize psychiatrists to reflect on the Zeitgeist and its influence on their own actions and to recognize that their own opinions and actions can also influence the Zeitgeist.


Asunto(s)
Derechos Humanos , Procesos Psicoterapéuticos , Personas con Discapacidad/legislación & jurisprudencia , Personas con Discapacidad/psicología , Alemania , Derechos Humanos/tendencias , Humanos , Italia , Naciones Unidas
11.
Neural Plast ; 2019: 7067592, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31065259

RESUMEN

Aging is a physiological process accompanied by cognitive decline, principally in memory and executive functions. Alterations in the connectivity of the default mode network (DMN) have been found to participate in cognitive decline, as well as in several neurocognitive disorders. The DMN has antisynchronic activity with attentional networks (task-positive networks (TPN)), which are critical to executive function and memory. Findings pointing to the regulation of the DMN via activation of TPN suggest that it can be used as a strategy for neuroprotection. Meditation is a noninvasive and nonpharmacological technique proven to increase meta-awareness, a cognitive ability which involves the control of both networks. In this review, we discuss the possibility of facilitating healthy aging through the regulation of networks through meditation. We propose that by practicing specific types of meditation, cognitive decline could be slowed, promoting a healthy lifestyle, which may enhance the quality of life for the elderly.


Asunto(s)
Encéfalo/fisiología , Envejecimiento Saludable/fisiología , Envejecimiento Saludable/psicología , Meditación , Procesos Psicoterapéuticos , Atención/fisiología , Disfunción Cognitiva/prevención & control , Humanos , Metacognición , Atención Plena , Vías Nerviosas/fisiología
12.
Am J Psychother ; 72(2): 38-46, 2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-30945559

RESUMEN

As a complement to multicultural competence, the multicultural orientation (MCO) perspective has been proposed as a pragmatic way to enhance cultural understandings about psychotherapeutic dynamics, processes, and outcomes. Consisting of three core components-cultural humility, cultural comfort, and cultural opportunities-the MCO is considered relevant for both individual and group treatment. However, the MCO perspective has yet to be specifically applied to psychotherapy supervision. Because supervision often provides multicultural oversight for individual and group psychotherapy services, considering the ramifications of MCO for psychotherapy supervision (MCO-S) is important. In this article, the implications of MCO-S are reviewed, with attention given to the impacts of cultural humility, cultural comfort, and cultural opportunities on the supervisor-supervisee relationship. Case examples are provided to illustrate the ways in which MCO can affect the psychotherapy supervision process and outcome. Supervision research possibilities are also proposed.


Asunto(s)
Competencia Cultural , Psicoterapia/métodos , Diversidad Cultural , Grupo de Ascendencia Continental Europea , Femenino , Humanos , Indios Norteamericanos/psicología , Masculino , Procesos Psicoterapéuticos , Psicoterapia de Grupo/métodos , Adulto Joven
13.
J Consult Clin Psychol ; 87(5): 446-456, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30998047

RESUMEN

OBJECTIVE: Although cognitive change has long been posited to drive symptom improvements in cognitive therapy (CT) of depression, whether it does so remains controversial. Methodological challenges have contributed heavily to the lack of resolution on this issue. Using a patient-reported measure of cognitive change, we tested the role of cognitive change in contributing to symptom change in CT. In addition, we tested whether therapists' use of cognitive methods intended to promote cognitive changes predicted these changes. We also tested the specificity of the relation of cognitive methods and cognitive change by examining other psychotherapy process variables. METHOD: In a sample of 126 patients who participated in CT of depression, patients rated immediate cognitive change (CC-Immediate) at the end of each session and sustained cognitive change (CC-Sustained) at the start of each subsequent session. Observers rated therapist adherence and alliance for the first five sessions. Depressive symptoms were assessed at each session. For all predictors, we disaggregated within- and between-patient effects. RESULTS: Focusing on within-patient predictors, CC-Sustained mediated the relation of CC-Immediate and subsequent symptom change. In addition, both CC-Immediate and CC-Sustained predicted symptom change. Therapist adherence to cognitive methods was the only within-patient variable to predict CC-Immediate. CONCLUSIONS: These findings are consistent with the view that cognitive change contributes to symptom reductions in CT, and that therapists' use of cognitive methods contributes to cognitive changes during sessions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Trastorno Depresivo/terapia , Procesos Psicoterapéuticos , Adolescente , Adulto , Anciano , Terapia Cognitivo-Conductual/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
14.
J Consult Clin Psychol ; 87(5): 484-490, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30998049

RESUMEN

OBJECTIVE: Despite a growing body of research supporting the efficacy of cognitive-behavioral therapy (CBT) for depressed adolescents, few studies have investigated the role of the acquisition and use of CBT skills in accounting for symptom improvement. The present study examined the role of cognitive versus behavioral skills in predicting symptom improvement in depressed youth. Analyses considered different raters of patient skills (patient vs. therapist) as well as disaggregated between-patient versus within-patient effects. METHOD: Data were derived from a 12-week clinical trial of CBT for depressed adolescent females (N = 33; ages 13-18 years; 69.7% White). Both therapist-report and patient-report measures of CBT skills (skills of cognitive therapy) were acquired at 5 time points throughout therapy: Sessions 1, 3, 6, 9, and 12. Depressive symptoms (Beck Depression Inventory-II) were assessed at every session. RESULTS: Therapist and patient ratings of CBT skills showed small to moderate associations (rs = .20-.38). Intraclass correlation coefficients indicated that the majority of the variance in skills scores (61-90%) was attributable to within-patient variance from session to session, rather than due to between-patient differences. When disaggregating within-patient and between-patient effects, and consistent with a causal relationship, within-patient variability in both patient-rated (b = -2.55; p = .025) and therapist-rated (b = -2.41; p = .033) behavioral skills predicted subsequent symptom change. CONCLUSIONS: Analyses highlight the importance of the acquisition and use of behavioral skills in CBT for depressed adolescents. Findings also underscore the importance of disentangling within-patient from between-patient effects in future studies, an approach infrequently used in process-outcome research. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Conducta del Adolescente , Terapia Cognitivo-Conductual/métodos , Trastorno Depresivo/terapia , Procesos Psicoterapéuticos , Adolescente , Femenino , Humanos
15.
J Appl Res Intellect Disabil ; 32(4): 792-805, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30687987

RESUMEN

BACKGROUND: Emerging evidence indicates effectiveness of dialectical behaviour therapy (DBT) for people with intellectual disabilities (PWID) in forensic settings; however, little is known about "what works" facilitating engagement and change. METHODS: Eleven interviews were conducted with nine service users across two secure inpatient services. Grounded theory was used to develop a model of perceived engagement and change. RESULTS: The model provides insights into how change occurs during DBT delivered in forensic settings. DBT constitutes a challenging journey, yet provides the motivation and means to address individual's intra-/interpersonal aggression and progress towards release. Participants experienced engaging with DBT as difficult and coercive, moving from compliance and avoidance to acceptance and change. Key factors included participants' motivation, beliefs about safety and ability to change, and interactions with staff. CONCLUSION: Recommendations are made for increasing intrinsic motivation, reducing perceived coercion and distress, and for future research to address potential aversive elements and enhance effectiveness.


Asunto(s)
Terapia Conductual Dialéctica , Discapacidad Intelectual/rehabilitación , Personas con Discapacidad Mental/rehabilitación , Procesos Psicoterapéuticos , Adulto , Inglaterra , Femenino , Psiquiatría Forense , Teoría Fundamentada , Humanos , Discapacidad Intelectual/psicología , Masculino , Personas con Discapacidad Mental/psicología , Persona de Mediana Edad , Investigación Cualitativa , Adulto Joven
16.
Psychotherapy (Chic) ; 56(1): 11-15, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30688483

RESUMEN

As the conceptualization of evidence-based practice expands beyond the phasic application of treatment manuals for specific mental health diagnoses, greater attention is being paid to treatment personalization, including at its very first steps. One approach to such early personalization involves therapist flexible responsivity to patients' presenting nondiagnostic characteristics, such as their treatment-related beliefs, that are known to correlate with treatment outcomes. Such tailoring represents one element of the context-responsive psychotherapy integration framework that privileges the therapist's use of evidence-informed strategies in response to specific patient characteristics and contextual process markers (Constantino, Boswell, Bernecker, & Castonguay, 2013). In this article, we map context-responsive psychotherapy integration principles onto a psychotherapy case illustration. Namely, we describe Alice E. Coyne's attempt to navigate responsively a patient's early outcome expectation and treatment credibility perception, both of which revealed the need to change course from an original treatment plan (despite that plan making good sense vis-à-vis the patient's diagnoses and initial positive reaction to the explanation of a specific treatment protocol). In addition, the case illustrates the influence that patient treatment beliefs can have on other early therapeutic processes, such as patient change ambivalence and resistance to the therapy, that also require therapist responsivity in the service of personalization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Actitud del Personal de Salud , Trastornos Mentales/terapia , Relaciones Profesional-Paciente , Procesos Psicoterapéuticos , Práctica Clínica Basada en la Evidencia , Humanos , Masculino , Persona de Mediana Edad
17.
Clin Psychol Psychother ; 26(2): 241-251, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30511363

RESUMEN

The ability to infer psychological meaning in behaviour-referred to as psychological mindedness-has been posited as a patient characteristic that contributes to the therapy process and consequently to therapeutic success. The present study was developed to examine the relationship between patients' psychological mindedness and improvement in patients' personal treatment goals in interpretive and supportive group therapies for complicated grief, along with patients' importance to group process. The study was conducted with a clinical sample of 109 patients (79% female; average 45 years old) receiving treatment for complicated grief. Patients provided severity of distress ratings for individual target objectives at pretreatment and posttreatment. Psychological mindedness was assessed prior to treatment using the video-based, interviewer-rated Psychological Mindedness Assessment Procedure. Patients' importance to the therapy process was rated by therapists and other patients in interpretive and supportive group therapy for complicated grief. Conditional process modelling tested whether psychological mindedness would contribute to patients' goal achievement through patients' importance to group process, moderated by type of therapy. A significant, conditional indirect effect was observed for psychological mindedness as a predictor of improvement in individual target objectives, through patients' importance to group process as rated by therapists, specifically in interpretive therapy. The findings indicate that patients' psychological mindedness significantly contributes to their achievement of individual goals through their contributions to group process in interpretive group therapy. Further research is needed to understand the facilitation of individual goal achievement in supportive therapy.


Asunto(s)
Objetivos , Pesar , Trastornos Mentales/terapia , Procesos Psicoterapéuticos , Psicoterapia de Grupo/métodos , Adulto , Canadá , Femenino , Procesos de Grupo , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
18.
Clin Psychol Psychother ; 26(2): 167-174, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30303262

RESUMEN

Case formulation is considered important in both the development of the therapeutic relationship and in starting the process of therapeutic change. Cognitive analytic therapy (CAT) describes the developmental origins and maintenance of a client's problems in both written (reformulation letter) and diagrammatic form (sequential diagrammatic reformulation). This study aimed to investigate the effects of these reformulation tools on insight and symptom change. A small-N repeated measures design was employed with quantitative and qualitative measures collected from six therapist/client dyads. Participating therapists kept a record of their delivery of CAT reformulation tools. Participating clients completed the insight subscale of the Self-Reflection and Insight Scale every fourth session and the Clinical Outcomes in Routine Evaluation-10 every session. Qualitative data from client change interviews regarding their experiences of CAT and attributions of change was explored using template analysis. Participants demonstrated improvements (symptom reduction and insight increases) over the course of the intervention. Administration of reformulation tools did not consistently result in significant changes on insight and symptom measures. However, the tools were identified by participants as leading to insight and emotional change within the context of a good therapeutic relationship. These findings suggest that a genuine therapeutic relationship is an important change mechanism operating through, and strengthened by, CAT-specific tools.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Trastornos Mentales/terapia , Relaciones Profesional-Paciente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procesos Psicoterapéuticos
19.
Psychother Res ; 29(3): 383-402, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-28891431

RESUMEN

OBJECTIVE: Within a mixed methods program of research the present study aimed at expanding knowledge about interactions in the initial therapeutic collaboration by combining focus on client interpersonal style and therapist contribution. METHOD: The study involves in-depth analyses of therapist-client interactions in the initial two sessions of good and poor outcome therapies. Based on interpersonal theory and previous research, the Inventory of Interpersonal Problems (IIP-64-C) was used to define poor outcome cases, that is, low proactive agency cases. To compare good and poor outcome cases matched on this interpersonal pattern, cases were drawn from two different samples; nine poor outcome cases from a large multi-site outpatient clinic study and nine good outcome cases from a process-outcome study of highly experienced therapists. RESULTS: Qualitative analysis of therapist behaviors resulted in 2 main categories, fostering client's proactive agentic involvement in change work and discouraging client's proactive agentic involvement in change work, 8 categories and 22 sub-categories. CONCLUSION: The findings revealed distinct and cohesive differences in therapist behaviors between the two outcome groups, and point to the particular therapist role of fostering client agency through engagement in a shared work on change when clients display strong unassertiveness and low readiness for change. Clinical or Methodological Significance Summary: The present analysis combines focus on client interpersonal style, therapist strategies/process and outcome. The categories generated from the present grounded theory analysis may serve as a foundation for identifying interactions that are associated with agentic involvement in future process research and practice, and hence we have formulated principles/strategies that were identified by the analysis.


Asunto(s)
Trastornos Mentales/terapia , Personalidad/fisiología , Relaciones Profesional-Paciente , Psicoterapia/métodos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procesos Psicoterapéuticos , Investigación Cualitativa
20.
Psychother Res ; 29(1): 30-44, 2019 01.
Artículo en Inglés | MEDLINE | ID: mdl-29130400

RESUMEN

BACKGROUND: Emotional processing (EP) is hypothesized to be a key mechanism of change in psychotherapy that may enhance its long-term efficacy. To study the effects of fostering EP in psychotherapy for depression, this randomized-controlled clinical trial compares the efficacy and pattern of change of a cognitive-behavioral therapy that integrates emotion-focused techniques within an exposure framework (Exposure-Based Cognitive Therapy for depression; EBCT-R) to a standard cognitive-behavioral therapy (CBT). METHODS: One hundred and forty-nine depressed outpatients were randomized to a maximum of 22 sessions of manualized EBCT-R (N = 77) or CBT (N = 72). Primary outcomes were self-reported and clinician-rated depressive symptoms at posttreatment and 12-month follow-up. Secondary outcomes were self-esteem, interpersonal problems, and avoidance thoughts and behaviors. RESULTS: Depressive symptoms improved significantly over therapy in both treatments, with large within-group effect sizes for CBT (d = -1.95) and EBCT-R (d = -1.77). The pattern of depression change during treatment did not differ between treatments. Symptom relief lasted over 12 months and did not differ between EBCT-R and CBT. CONCLUSIONS: Results suggest that both treatments produced significant short- and long-term improvement in depression symptoms, but the integration of emotion-focused techniques within an exposure framework did not have added benefit. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01012856 Clinical or methodological significance of this article: This trial compares cognitive-behavioral therapy (CBT) with a similarly structured CBT that was designed to foster emotional processing by integrating emotion-focused techniques within an exposure framework. Results indicate that this form of assimilative integration did not improve outcomes at 12-month follow-up.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Depresión/terapia , Trastorno Depresivo/terapia , Emociones/fisiología , Terapia Implosiva/métodos , Procesos Psicoterapéuticos , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad
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