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2.
Expert Opin Pharmacother ; 21(1): 47-61, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31693423

RESUMEN

Introduction: The treatment of borderline personality disorder (BPD) remains an open question for clinicians. There is scarce evidence available and the guidelines' conclusions diverge. Together with these factors, the complexity of BPD generates uncertainty in day-to-day practice. This narrative review aims to provide an overview of advances in BPD treatment and posit a critical opinion based on clinical evidence and practice.Areas covered: The authors review the clinical trials concerning the efficacy of the main classes of drugs in BPD: antidepressants, mood stabilizers, first-, second-, and third-generation antipsychotics, and other agents (opiate antagonists, clonidine, oxytocin, omega-3 fatty acids). They also include in this review studies on combinations of drugs and psychotherapies.Expert opinion: An individualized, tailored pharmacotherapy for BPD that targets the prominent symptom clusters can improve relevant aspects of the clinical picture. However, no medication is indicated to treat the global psychopathology of BPD. Polypharmacy should be avoided or strictly limited. To date, pharmacotherapy alone does not suffice to manage the complexity of BPD. Combining medication with psychotherapy may improve specific BPD symptom dimensions. In particular, it may help those aspects that respond slowly or not at all to monotherapy.


Asunto(s)
Trastorno de Personalidad Limítrofe/terapia , Psicoterapia/métodos , Anticonvulsivantes/uso terapéutico , Antidepresivos/uso terapéutico , Antimaníacos/uso terapéutico , Antipsicóticos/uso terapéutico , Ácidos Grasos Omega-3/uso terapéutico , Humanos , Polifarmacia
3.
Psychiatr Prax ; 47(1): 39-42, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31412368

RESUMEN

OBJECTIVE: Assessment of patients' preferences regarding depression treatment using a ranking approach. METHODS: 641 primary care patients (mean age 43.9 years) ranked their primary preference for depression treatment out of 9 options. Logistic Regression analyses were used to determine factors associated with the most prioritized treatment options. RESULTS: The most frequently prioritized treatment options were psychotherapy (30 %), combination treatment of psychotherapy and drug treatment (18.4 %) and sole drug treatment (15.4 %). 12.3 % of women prioritized alternative therapy options. CONCLUSION: Patients with depression report individually different treatment preferences. These findings underline the importance of elucidating patients' preferences within a shared decision making process as recommended by treatment guidelines. There is a need of evidence-based information on the role of alternative therapies in the context of depression treatment.


Asunto(s)
Depresión/terapia , Prioridad del Paciente , Atención Primaria de Salud , Psicoterapia/métodos , Adulto , Toma de Decisiones , Femenino , Alemania , Humanos , Masculino , Participación del Paciente
4.
Support Care Cancer ; 28(1): 163-176, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31001692

RESUMEN

PURPOSE: We designed a novel, manualized intervention called Emotion And Symptom-focused Engagement (EASE) for acute leukemia (AL) and report here on a phase II randomized controlled trial (RCT) to assess its feasibility and preliminary efficacy. METHODS: Patients were recruited within 1 month of hospital admission and randomized to EASE plus usual care (UC) or UC alone. EASE includes (1) EASE-psy, a tailored psychotherapy delivered over 8 weeks, and (2) EASE-phys, weekly physical symptom screening over 8 weeks to trigger early palliative care. The primary outcome was traumatic stress symptoms; secondary outcomes included physical symptom burden and quality of life. Assessments were conducted at baseline and at 4, 8, and 12 weeks. Between-group differences were evaluated using multilevel modeling. RESULTS: Forty-two patients were randomized to EASE (n = 22) or UC (n = 20), with 76% retention at 12 weeks. Predefined feasibility outcomes were met: 86% (19/22) of EASE participants completed ≥ 50% of EASE-psy sessions (goal ≥ 64%); 100% received Edmonton Symptom Assessment System (ESAS, modified for AL) screenings, 64% (14/22) of whom completed ≥ 50% of planned screenings (goal ≥50%); and 100% with scores ≥ 4/10 on any physical ESAS-AL item had ≥ 1 meeting with the EASE-phys team (goal 100%). Significant treatment-group differences favoring EASE were observed in traumatic stress symptoms at 4 and 12 weeks, and pain intensity and interference at 12 weeks (all p < .05). CONCLUSIONS: EASE is feasible in patients newly diagnosed with AL and shows promise of effectiveness. These results warrant a larger RCT to provide evidence for its more routine use as a standard of care.


Asunto(s)
Leucemia/terapia , Cuidados Paliativos/métodos , Psicoterapia/métodos , Estrés Psicológico/terapia , Evaluación de Síntomas/métodos , Enfermedad Aguda , Adulto , Anciano , Intervención Médica Temprana/métodos , Emociones , Estudios de Factibilidad , Femenino , Hospitalización , Humanos , Leucemia/complicaciones , Leucemia/psicología , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Calidad de Vida , Estrés Psicológico/etiología , Adulto Joven
5.
Z Psychosom Med Psychother ; 65(4): 372-383, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31801443

RESUMEN

Difficult situations in psychotherapy and how therapists deal with them Objectives: In theory and research, it is assumed that therapeutic competences are especially relevant in difficult situations. In the present study, we collected and categorized situations that psychotherapists subjectively evaluated as difficult. Additionally, we inspected therapists' reactions to these situations and considered correlations between situations and reactions. Methods: In an online-survey, 101 therapists described difficult situations and their corresponding reactions. The reports were analyzed by qualitative content analysis (Mayring 2015) and resulted in two category systems for the difficult situations and the reactions. Results: Difficult situations reached from everyday conflicts to extreme situations (e. g. threats). The most frequent difficult situations were in context of therapeutic frame, aspects of disorder, and critics, demands, accusations of patients. The most frequent reactions concerned therapeutic frame, external help and supportive interventions. We found significant correlations between difficult situations due to aspects of disorder and asking for external help. Conclusions: Although categories were sometimes difficult to isolate and few cognitive behavioral therapists participated, the collection of difficult situations can be of help for therapists and their training.


Asunto(s)
Terapia Cognitivo-Conductual , Relaciones Profesional-Paciente , Psicoterapia/educación , Psicoterapia/métodos , Humanos , Encuestas y Cuestionarios
6.
Adv Exp Med Biol ; 1180: 233-265, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31784967

RESUMEN

Depression is highly prevalent and causes unnecessary human suffering and economic loss. Therefore, its treatment and prevention are of utmost importance. There are several advantages of using psychotherapy either by itself or combined with pharmacological treatment methods in the treatment of depression. First, it is well known that combining biological treatment with psychosocial methods increases the chances of recovery. Second, in some individuals, psychotherapy continues to be the only solution. Third, the use of antidepressants contains some safety risks and side effects, but psychotherapy does not. Fourth, clinically, depressive patients prefer psychotherapy to drug therapy. Use of a depression-focused psychotherapy alone is recommended as an initial treatment choice for patients with mild to moderate depression, with clinical evidence supporting the use of cognitive behavioral therapy (CBT), interpersonal psychotherapy (IPT), psychodynamic psychotherapy (PDP), and problem-solving therapy (PST) in individual and group formats. Important developments took place within the past 20 years in the psychotherapy of depression. In the present chapter, we introduced several key issues, such as, Are all psychotherapies equally effective? Who benefits from psychotherapies? Is telepsychotherapy effective? Finally, we introduce the psychotherapy for special populations.


Asunto(s)
Trastorno Depresivo/terapia , Psicoterapia/métodos , Antidepresivos , Terapia Cognitivo-Conductual , Humanos , Solución de Problemas , Psicoterapia Psicodinámica
8.
Psychiatr Prax ; 46(8): 468-475, 2019 Nov.
Artículo en Alemán | MEDLINE | ID: mdl-31683337

RESUMEN

The development of treatment guidelines alone does not improve patient care. The implementation of guidelines depends on various conditions, including structural conditions. The update of the S3 guideline "Psychosocial therapies for severe mental illnesses" systematically describes very different psychosocial therapies and reviews their effectiveness. The implementation of the resulting recommendations, which are coordinated in a complex consensus process, is hampered by the structured social legislation in Germany. The present article shows to what extent the recommendations of the update of the S3 Guideline Psychosocial Therapies follow the Federal Participation Act (BTHG).


Asunto(s)
Trastornos Mentales , Guías de Práctica Clínica como Asunto , Psicoterapia/métodos , Medicina Basada en la Evidencia , Alemania , Adhesión a Directriz , Humanos , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Programas Nacionales de Salud , Psicoterapia/normas
9.
Best Pract Res Clin Rheumatol ; 33(3): 101416, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31703789

RESUMEN

Psychological factors such as adverse childhood experiences, traumatic life events, interpersonal conflicts and psychological distress play an important role in the predisposition, onset and severity of chronic widespread pain (CWP) and fibromyalgia syndrome (FMS). Therefore, psychological therapies might have the potential to reduce disability as well as symptom and economic burden in patients with CWP and FMS. Recent interdisciplinary guidelines have suggested different strengths of recommendation for psychological therapies for FMS. The aims of this narrative review are to summarise: • Mechanisms of actions. • Evidence on efficacy, tolerability and safety. • Knowledge gaps and needs for future research of psychological therapies for CWP and FMS for non-mental health professionals.


Asunto(s)
Dolor Crónico/psicología , Fibromialgia/psicología , Psicoterapia/métodos , Humanos
11.
Adv Exp Med Biol ; 1192: 583-627, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31705515

RESUMEN

Mental disorders are highly prevalent and often remain untreated. Many limitations of conventional face-to-face psychological interventions could potentially be overcome through Internet-based and mobile-based interventions (IMIs). This chapter introduces core features of IMIs, describes areas of application, presents evidence on the efficacy of IMIs as well as potential effect mechanisms, and delineates how Artificial Intelligence combined with IMIs may improve current practices in the prevention and treatment of mental disorders in adults. Meta-analyses of randomized controlled trials clearly show that therapist-guided IMIs can be highly effective for a broad range of mental health problems. Whether the effects of unguided IMIs are also clinically relevant, particularly under routine care conditions, is less clear. First studies on IMIs for the prevention of mental disorders have shown promising results. Despite limitations and challenges, IMIs are increasingly implemented into routine care worldwide. IMIs are also well suited for applications of Artificial Intelligence and Machine Learning, which provides ample opportunities to improve the identification and treatment of mental disorders. Together with methodological innovations, these approaches may also deepen our understanding of how psychological interventions work, and why. Ethical and professional restraints as well as potential contraindications of IMIs, however, should also be considered. In sum, IMIs have a high potential for improving the prevention and treatment of mental health disorders across various indications, settings, and populations. Therefore, implementing IMIs into routine care as both adjunct and alternative to face-to-face treatment is highly desirable. Technological advancements may further enhance the variability and flexibility of IMIs, and thus even further increase their impact in people's lives in the future.


Asunto(s)
Inteligencia Artificial , Trastornos Mentales/terapia , Aplicaciones Móviles , Psicoterapia/métodos , Adulto , Humanos , Internet , Telemedicina
12.
Internist (Berl) ; 60(12): 1226-1234, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31664464

RESUMEN

BACKGROUND: Comorbid depression is frequent in internal medicine (e.g. in coronary heart disease, congestive heart failure or diabetes mellitus) and impairs quality of life as well as the prognosis of the somatic illness. AIM: To review evidence based recommendations for the treatment of depressive comorbidity in selected somatic disorders. MATERIALS AND METHODS: Selective literature search based on national and international guidelines. RESULTS: In clinical routine, depressive symptoms are often overseen or misinterpreted. Therefore, a specific diagnostic is recommended. Depressive symptoms should obligatory be screened during the clinical interview or by validated questionnaires. When screened positive, further diagnostic steps are mandatory. The treatment of depressive disorders has three main components: basic psychosomatic care, psychotherapy and antidepressant medication. These interventions are safe and effective for reducing depressive symptoms and enhancing quality of life. However, results regarding the effects on morbidity and mortality of the comorbid somatic disorder are still inconclusive. The greatest effects on depression are obtained by a preference-based, stepped-care approach and an optimal cooperation of all professionals ("collaborative care"). CONCLUSIONS: An effective treatment of depressive comorbidity is relevant for quality of life and possibly also for the prognosis of a somatic disease. Integrating a routine screening for depressive symptoms is the first step toward an effective, evidence-based therapy.


Asunto(s)
Antidepresivos/uso terapéutico , Depresión/terapia , Trastornos Psicofisiológicos/diagnóstico , Trastornos Psicofisiológicos/psicología , Psicoterapia/métodos , Calidad de Vida , Comorbilidad , Depresión/epidemiología , Depresión/psicología , Medicina Basada en la Evidencia , Humanos , Trastornos Psicofisiológicos/epidemiología , Trastornos Psicofisiológicos/terapia
13.
Medicine (Baltimore) ; 98(38): e17228, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31567984

RESUMEN

OBJECTIVE: To determine whether psychological intervention (PI) changes the levels of immune indicators in cancer patients. METHODS: We conducted a systematic search published up to July 2018, followed by a manual search. Randomized controlled trials were included. Two reviewers independently screened and extracted data, which were analyzed using Review manager 5.3. RESULTS: Twenty-nine studies were included including four kinds of PI. Only stress management didn't result in immune changes; only cognitive behavior therapy affect NK cell activity. PI did not change immune indicators on cancer patients who completed therapy. Compared to patients not receiving PI, those received PI had significantly higher NK cell count and activity in whole blood; and serum levels of IL-2, IL-4, IFN-γ, lgA, and lgG. However, the differences in the serum levels of IL-6, IL-10, TNF-α, and IgM were not significant (P > .05), and the changes recorded for the CD3, CD4, and CD8 cell count, and CD4/CD8 ratios were inconsistent. CONCLUSIONS: Although there are considerable evidences of PI's immune effect, but its magnitude was moderate. Therefore, it may be premature to conclude whether PI affects immunity of cancer patients. Further research is warranted, with special focus on the PI types and treatment methods.


Asunto(s)
Neoplasias/psicología , Psicoterapia , Humanos , Inmunidad , Neoplasias/inmunología , Neoplasias/terapia , Psicoterapia/métodos
14.
Pediatrics ; 144(4)2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31570648

RESUMEN

Attention-deficit/hyperactivity disorder (ADHD) is 1 of the most common neurobehavioral disorders of childhood and can profoundly affect children's academic achievement, well-being, and social interactions. The American Academy of Pediatrics first published clinical recommendations for evaluation and diagnosis of pediatric ADHD in 2000; recommendations for treatment followed in 2001. The guidelines were revised in 2011 and published with an accompanying process of care algorithm (PoCA) providing discrete and manageable steps by which clinicians could fulfill the clinical guideline's recommendations. Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published. These publications do not support dramatic changes to the previous recommendations. Therefore, only incremental updates have been made in this guideline revision, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations. Throughout the process of revising the guideline and algorithm, numerous systemic barriers were identified that restrict and/or hamper pediatric clinicians' ability to adopt their recommendations. Therefore, the subcommittee created a companion article (available in the Supplemental Information) on systemic barriers to the care of children and adolescents with ADHD, which identifies the major systemic-level barriers and presents recommendations to address those barriers; in this article, we support the recommendations of the clinical practice guideline and accompanying process of care algorithm.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/terapia , Adolescente , Factores de Edad , Algoritmos , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Estimulantes del Sistema Nervioso Central/efectos adversos , Estimulantes del Sistema Nervioso Central/uso terapéutico , Niño , Preescolar , Terapia Combinada/métodos , Accesibilidad a los Servicios de Salud , Humanos , Pediatría , Psicoterapia/métodos , Sociedades Médicas , Estados Unidos
15.
Psychother Psychosom Med Psychol ; 69(9-10): 413-426, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31600812

RESUMEN

Over the past few years, research and application of internet-based psychotherapeutic interventions has grown rapidly. This kind of new therapeutic format offers a variety of chances for treating patients with psychotherapeutic disorders, but also arouses skepticism and concerns. This overview focuses on different forms of internet-based psychotherapeutic interventions, reflects the current state of research, and points out new areas of development as well as its implementation in daily practice.


Asunto(s)
Internet , Trastornos Mentales/terapia , Psicoterapia/métodos , Adulto , Terapia Combinada , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Autocuidado
16.
PLoS Med ; 16(9): e1002919, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31550249

RESUMEN

BACKGROUND: Torture and other forms of ill treatment have been reported in at least 141 countries, exposing a global crisis. Survivors face multiple physical, psychological, and social difficulties. Psychological consequences for survivors are varied, and evidence on treatment is mixed. We conducted a systematic review and meta-analysis to estimate the benefits and harms of psychological, social, and welfare interventions for torture survivors. METHODS AND FINDINGS: We updated a 2014 review with published randomised controlled trials (RCTs) for adult survivors of torture comparing any psychological, social, or welfare intervention against treatment as usual or active control from 1 January 2014 through 22 June 2019. Primary outcome was post-traumatic stress disorder (PTSD) symptoms or caseness, and secondary outcomes were depression symptoms, functioning, quality of life, and adverse effects, after treatment and at follow-up of at least 3 months. Standardised mean differences (SMDs) and odds ratios were estimated using meta-analysis with random effects. The Cochrane tool was used to derive risk of bias. Fifteen RCTs were included, with data from 1,373 participants (589 females and 784 males) in 10 countries (7 trials in Europe, 5 in Asia, and 3 in Africa). No trials of social or welfare interventions were found. Compared to mostly inactive (waiting list) controls, psychological interventions reduced PTSD symptoms by the end of treatment (SMD -0.31, 95% confidence interval [CI] -0.52 to -0.09, p = 0.005), but PTSD symptoms at follow-up were not significantly reduced (SMD -0.34, 95% CI -0.74 to 0.06, p = 0.09). No significant improvement was found for PTSD caseness at the end of treatment, and there was possible worsening at follow-up from one study (n = 28). Interventions showed no benefits for depression symptoms at end of treatment (SMD -0.23, 95% CI -0.50 to 0.03, p = 0.09) or follow-up (SMD -0.23, 95% CI -0.70 to 0.24, p = 0.34). A significant improvement in functioning for psychological interventions compared to control was found at end of treatment (SMD -0.38, 95% CI -0.58 to -0.18, p = 0.0002) but not at follow-up from only one study. No significant improvement emerged for quality of life at end of treatment (SMD 0.38, 95% CI -0.28 to 1.05, p = 0.26) with no data available at follow-up. The main study limitations were the difficulty in this field of being certain of capturing all eligible studies, the lack of modelling of maintenance of treatment gains, and the low precision of most SMDs making findings liable to change with the addition of further studies as they are published. CONCLUSIONS: Our findings show evidence that psychological interventions improve PTSD symptoms and functioning at the end of treatment, but it is unknown whether this is maintained at follow-up, with a possible worsening of PTSD caseness at follow-up from one study. Further interventions in this population should address broader psychological needs beyond PTSD while taking into account the effect of multiple daily stressors. Additional studies, including social and welfare interventions, will improve precision of estimates of effect, particularly over the longer term.


Asunto(s)
Depresión/terapia , Psicoterapia/métodos , Bienestar Social , Servicio Social/métodos , Trastornos por Estrés Postraumático/terapia , Sobrevivientes/psicología , Tortura/psicología , Depresión/diagnóstico , Depresión/psicología , Femenino , Humanos , Masculino , Salud Mental , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/psicología , Resultado del Tratamiento
18.
Nord J Psychiatry ; 73(8): 532-538, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31524552

RESUMEN

Aims: Patients may experience unfair reception when in contact with psychiatric services. The aims are to illuminate these perceptions, and the extent of inpatients' involvement in their care, and if degree of involvement depends on compulsory or voluntary care. Furthermore, we sought to determine if an educational intervention for staff members, including systematic listening and offering the inpatients involvement using microdecisions, affects the inpatients' experiences and the use of coercion. Materials and methods: We used a naturalistic setting case control design in two psychiatric wards for one year, including all inpatients (n = 685) of which 458 took part of the microdecision intervention. Structured direct interviews were carried out with inpatients based on the Discrimination and Stigma Scale (DISC), Dyadic OPTION, and CollaboRATE instruments before (n = 19) and after (n = 46) the intervention. Frequencies of coercive measures before and after the intervention were compared (n = 685). Results: Respondents subjected to the intervention experienced less discrimination related to psychiatric care compared to responders not subjected. Tendencies of improvements post intervention were found for some aspects of involvement, as attention to concerns and possibilities to ask questions. A decrease in the use of coercive measures at three and six months after the start of the intervention was observed. Conclusion: Results suggest that the intervention could decrease the inpatients' experiences of discrimination during psychiatric care as well as the use of coercion in the service. The Dyadic OPTION instrument showed a mixed picture with results implying improvements in some areas and impairments in others.


Asunto(s)
Coerción , Trastornos Mentales/psicología , Participación del Paciente/psicología , Servicio de Psiquiatría en Hospital , Autoimagen , Discriminación Social/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Toma de Decisiones/fisiología , Femenino , Humanos , Pacientes Internos/psicología , Masculino , Trastornos Mentales/terapia , Persona de Mediana Edad , Participación del Paciente/tendencias , Servicio de Psiquiatría en Hospital/tendencias , Psicoterapia/métodos , Psicoterapia/tendencias , Discriminación Social/tendencias , Adulto Joven
19.
J Consult Clin Psychol ; 87(11): 1043-1055, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31556652

RESUMEN

OBJECTIVE: To examine changes in quality of life (QoL) in adolescents receiving family problem-solving therapy (F-PST) following traumatic brain injury (TBI). METHOD: Adolescents hospitalized for moderate-to-severe TBI were randomized to 1 of 3 ten-session, 6-month long treatments: face-to-face F-PST (n = 34), therapist-guided online F-PST (n = 56), and self-guided online F-PST (n = 60). Participants included 96 boys and 54 girls, of whom 124 were White and 6 were Hispanic. Outcomes were assessed pretreatment and 6 and 9 months later. Adolescents and parents rated adolescent QoL and TBI-related symptoms on the PedsQL and Health and Behavior Inventory (HBI), respectively. We used mixed modeling to examine changes over time and moderators of treatment efficacy. RESULTS: Therapist- and self-guided online groups demonstrated improvements in parent-proxy QoL from baseline to 9 months, Cohen's d = 0.75; p = .004 and Cohen's d = 1.30; p < .001, respectively. The face-to-face group had poorer parent-proxy QoL at 6 months (M = 62, SE = 3.4) than either the therapist- (M = 70.9, SE = 2.8) or self-guided online group (M = 71.1, SE = 2.6). There were no changes or group differences in self-reported QoL over time. Similar findings were observed on the HBI. Differential treatment effects on parent-proxy outcomes were found in boys versus girls and in those from single versus 2-parent households. Improvements in parent-proxy HBI ratings mediated QoL improvements. CONCLUSIONS: Both online treatments, but not face-to-face F-PST, were associated with clinical improvements, raising questions about our current delivery paradigm. Individual and family moderators of treatment efficacy underscore the potential of personalized treatment. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Lesiones Traumáticas del Encéfalo/psicología , Terapia Familiar/métodos , Solución de Problemas , Psicoterapia/métodos , Calidad de Vida/psicología , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Padres , Autoinforme , Resultado del Tratamiento , Adulto Joven
20.
J Consult Clin Psychol ; 87(11): 975-988, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31556655

RESUMEN

OBJECTIVE: To examine conformity to prototypical therapeutic principles and its relation with change in reflective functioning in 3 treatments for borderline personality disorder (BPD). METHOD: Early phase videotaped sessions from a randomized-controlled trial of year-long transference-focused psychotherapy (TFP; n = 27), dialectical behavior therapy (DBT; n = 26), and supportive psychodynamic therapy (SPT; n = 29) were coded using the Psychotherapy Q-sort (Jones, 1985). Ratings were compared to experts' ratings of ideal TFP, DBT, and mentalizing-enhancing principles to quantify conformity to ideal treatments. Reflective functioning was assessed at pre- and posttreatment. Differences among treatments in conformity and its relation with change in reflective functioning were examined. RESULTS: Conformity to TFP and mentalizing-enhancing principles was highest in TFP (ps < .01) while conformity to DBT principles was high in DBT and SPT (DBT vs. SPT: p > .40), but lower in TFP (ps < .01). Larger improvements in reflective functioning were predicted by higher conformity to TFP principles during TFP (p = .04) and higher conformity to mentalizing-enhancing principles during SPT (p = .02). CONCLUSIONS: Treatments for BPD differ in conformity to unique principles of specific modalities. Treatments also differ in the processes that predict increase in reflective functioning. The findings point to specificity and multiple pathways in increasing reflective functioning in the treatment of BPD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Trastorno de Personalidad Limítrofe/psicología , Trastorno de Personalidad Limítrofe/terapia , Adhesión a Directriz , Psicoterapia/métodos , Adulto , Terapia Conductista/métodos , Femenino , Humanos , Masculino , Mentalización , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
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