What's in a name? A data-driven method to identify optimal psychotherapy classifications to advance treatment research on co-occurring PTSD and substance use disorders.

Background/Objective: The present study leveraged the expertise of an international group of posttraumatic stress and substance use disorder (PTSD+SUD) intervention researchers to identify which methods of categorizing interventions which target SUD, PTSD, or PTSD+SUD for populations with both PTSD+SUD may be optimal for advancing future systematic reviews, meta-analyses, and comparative effectiveness studies which strive to compare effects across a broad variety of psychotherapy types. Method: A two-step process was used to evaluate the categorization terminology. First, we searched the literature for pre-existing categories of PTSD+SUD interventions from PTSD+SUD clinical trials, systematic and literature reviews. Then, we surveyed international trauma and substance use subject matter experts about their opinions on pre-existing intervention categorization and ideal categorization nomenclature. Results: Mixed method analyses revealed that a proliferation of PTSD+SUD treatment research over the last twenty years brought with it an abundance of ways to characterize the treatments that have been evaluated. Results from our survey of experts (N = 27) revealed that interventions for PTSD+SUD can be classified in many ways that appear to overlap highly with one another. Many experts (11/27; 41%) selected the categories of 'trauma-focused and non-trauma focused' as an optimal way to distinguish treatment types. Although several experts reinforced this point during the subsequent meeting, it became clear that no method of categorizing treatments is without flaws. Conclusion: One possible categorization (trauma-focused/non-trauma focused) was identified. Revised language and nomenclature for classification of PTSD+SUD treatments are needed in order to accommodate the needs of this advancing field.

Antecedentes/Objetivo: El presente estudio aprovechó la experticia de un grupo internacional de investigadores de intervención en trastorno de estrés postraumático y trastorno por uso de sustancias (TEPT+TUS) para identificar qué métodos de categorización de las intervenciones con foco en TUS, TEPT y TEPT+TUS para poblaciones con ambos TEPT+TUS serían óptimos para avanzar en futuras revisiones sistemáticas, meta-análisis y estudios comparativos de efectividad que busquen comparar efectos en una amplia variedad de tipos de psicoterapia.Método: Se utilizó un proceso de dos etapas para evaluar la terminología de categorización. Primero, buscamos en la literatura categorías pre-existentes de intervenciones para TEPT+TUS en ensayos clínicos de TEPT+TUS, revisiones sistemáticas y de la literatura. Después, entrevistamos a expertos internacionales en la materia de trauma y uso de sustancias sobre su opinión de la categorización pre-existente de las intervenciones y la nomenclatura ideal de categorización.Resultados: Métodos de análisis mixtos revelaron que una proliferación de investigación de tratamientos para TEPT+TUS en los últimos veinte años trajo consigo una abundancia de formas de categorizar los tratamientos que han sido evaluados. Los resultados de nuestra encuesta de expertos (N = 27) revelaron que las intervenciones para TEPT+TUS pueden ser clasificadas en muchas formas que parecen sobreponerse altamente entre sí. Muchos expertos (11/27; 41%) seleccionaron las categorías de 'centrados en el trauma y no centrados en el trauma' como una forma óptima de distinguir los tipos de tratamiento. Aunque varios expertos reforzaron este punto en la reunión subsecuente, quedó claro que ningún método de categorización de los tratamientos está libre de defectos.Conclusión: Se identificó una posible categorización (centrado en el trauma/No centrado en el trauma). Se necesita lenguaje y nomenclatura revisada para la clasificación de tratamientos de TEPT+TUS a fin de acomodar las necesidades de este campo en desarrollo.

Potential interactions between psychotropic drugs and alcohol and tobacco dependence

Abstract The aim of this study was to identify and analyze the potential interactions between psychotropic drugs and alcohol and tobacco addiction. A cross-sectional study was carried out on secondary data collection in a Center for Psychosocial Care in Alcohol and Other Drugs. Subjects aged 18 years old and over, with alcohol and tobacco dependence, who were taking psychotherapies were included. Medical records with the most recent prescriptions were reviewed. Potential interactions between psychotropic drugs and alcohol and tobacco were analyzed using the Micromedex database and stratified according to clinical risks and mechanisms of action. The Pearson's Chi-square test was used to find significant associations between the variables of interest. The significance level was set at 5%. Between the 2010-2018 period, 2,322 subjects were treated at the care center. Of these, 1,020 fulfilled the inclusion criteria, out of whom 515 (50.5%) were dependent on alcohol and 310 (30.4%) were dependent on tobacco. We found 1,099 potential interactions between psychotropic drugs and alcohol and 160 potential interactions between psychotropic drugs and tobacco. In relation to alcohol dependence, psychotropic drugs interacted largely with moderate clinical risk, and pharmacokinetic mechanisms of action. In relation to tobacco dependence, high clinical risk interactions and pharmacodynamic mechanisms of action predominated.

Psicoterapia breve dinámica y su aplicación en pacientes con trastorno mental severo en una unidad de alta dependencia psiquiátrica / Brief dynamic psychotherapy and its application in patients with severe mental disorder in a high dependency psychiatric unit

El objetivo de este artículo es hacer una revisión de las principales características de la teoría y la técnica de la Psicoterapia Breve Psicoanalítica: conceptos básicos, historia,origen, diferentes definiciones, objetivos, indicaciones y contraindicaciones, así como lasmodificaciones en la técnica con sus característicaspropias y definitorias. Se muestrasu aplicabilidad y utilidad en una Unidad deAlta Dependencia Psiquiátrica (UADP), conresultados efectivos y eficientes en un entornoestructurado en el que paralelo a la psicoterapia,cada uno de los miembros de la Unidadejerce una función terapéutica necesariaen pacientes con un Trastorno Mental Severo.Por último se expone una experiencia en psicoterapia dinámica breve en nuestra UADP. (AU)

The goal of this article is to review the main characteristics of the theory and technique of Brief Psychoanalytic Psychotherapy: basic concepts, history, origin, different definitions, objectives, indications and contraindications,as well as the modificationsin the technique with its own and definingcharacteristics. Its applicability and usefulnessin a Highly Dependent Psychiatric Unitis shown, with effective and efficient resultsin a structured environment, in which, in parallelto psychotherapy, each one of the Unitmembers exercises a necessary therapeuticfunction in patients with a severe mental disorder.Finally, an experience in brief dynamicpsychotherapy in our UADP is exposed. (AU)

Review of "Common Factors," Personal Reflections, and Introduction of the Shaving Brush Model of Integrated Psychotherapies.

This column reviews and updates "common factors" in psychotherapy, as originally described by Saul Rosenzweig in 1936. The author, a psychiatrist who has used multiple modalities of psychotherapeutic treatment over 4 decades, shares personal reflections concerning these "common factors" and introduces a model of integrated psychotherapies named for his grandfather's shaving brush.

¿Puede la memética resolver el "veredicto del pájaro Dodo"? Pautas para analizar la evolución del código memético en psicoterapeutas / Can memetics solve the "Dodo bird verdict"? Guidelines for analyzing the evolution of the memetic code in psychotherapists

El debate acerca de la eficacia diferencial de los distintos modelos de psicoterapia y el conocido como "veredicto del pájaro Dodo", el hecho de que se haya encontrado una eficacia equivalente entre diferentes enfoques terapéuticos, es analizado en ese trabajo desde una nueva óptica cultural: la memética. Un meme es una unidad de información cultural que se replica y evoluciona por mecanismos de selección. La memética es el campo que se ocupa del estudio de los memes y de cómo se distribuyen y evolucionan. En este artículo nos proponemos analizar conceptos importantes de la psicoterapia y la psicología clínica desde el enfoque de la memética. Consideramos que esta perspectiva tiene importantes implicaciones en la conceptualización, estudio y mejora de la psicoterapia, arrojando luz sobre aspectos estancados y ofreciendo nuevas posibilidades investigadoras

The debate about the differential effectiveness of the different models of psychotherapy and the so-called "Dodo Bird Verdict", the fact that equivalent efficacy has been found between different therapeutic approaches, is analyzed in this work from a new perspective: memetics. A meme is a unit of cultural information that is replicated and evolved by selection mechanisms. Memetics is the field that deals with the study of memes and how they are distributed and evolved. The aim of this article is to analyze important issues of psychotherapy and clinical psychology based on a memetics approach. We consider this perspective to have important implications for the conceptualization, research, and improvement of psychotherapy, shedding light on stagnant issues and offering new research possibilities

Ciencia, pseudociencia y la Revista de la AEN / Science, pseudoscience and the AEN Journal

No disponible

Identifying critical psychotherapy targets in serious cardiac conditions: The importance of addressing coping with symptoms, healthcare navigation, and social support.

OBJECTIVE: In seriously ill cardiac patients, several psychotherapy efficacy studies demonstrate little to no reduction in depression or improvement in quality of life, and little is known about how to improve psychotherapies to best address the range of patient needs. An interpersonal and behavioral activation psychotherapy was a key component of the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) multisite randomized clinical trial. Although depressive symptoms did improve in the CASA trial, questions remain about how best to tailor psychotherapies to the needs of seriously ill patient populations. The study objective was to describe psychosocial needs emerging during a clinical trial of a palliative care and interpersonal and behavioral activation psychotherapy intervention that were not specifically addressed by the psychotherapy. METHOD: During the CASA trial, patient needs were prospectively tracked by the psychotherapist in each visit note using an a priori code list. Preplanned analysis of study data using directed content analysis was conducted analyzing the a priori code list, which were collapsed by team consensus into larger themes. The frequency of each code and theme were calculated into a percentage of visits. RESULT: A total of 150 patients received one or more visits from the therapist and were included in the analysis. Participants screened positive for depressive disorder (47%), had poor heart failure-specific health status (mean Kansas City Cardiomyopathy Questionnaire score = 48.6; SD = 17.4), and multiple comorbidities (median 4.3). Common needs that emerged during the therapy included difficulty coping with fatigue (48%), pain (28%), and satisfaction issues with medical care (43%). The following broader themes emerged: social support (77% of sessions), unmet symptom needs (67%), healthcare navigation (48%), housing, legal, safety, and transportation (32%), and end of life (12%). SIGNIFICANCE OF RESULTS: Coping with chronic symptoms and case management needs commonly emerged during psychotherapy visits. Future psychotherapy interventions in seriously ill populations should consider the importance of coping with chronic symptoms and case management.

Sobre el psicoanálisis y las psicoterapias de orientación psicoanalítica / On Psychoanalysis and Psychoanalytically Oriented Psychotherapies

Ante la presentación del "Plan para la Protección de la Salud frente a las pseudoterapias" del Ministerio de Sanidad, Consumo y Bienestar Social compartimos el necesario objetivo de regular y actualizar la práctica profesional de la Salud Mental tanto en el ámbito público como en el privado, ya que forma parte de la responsabilidad deontológica de nuestras profesiones y en este sentido, también lo es, el realizar una serie de puntualizaciones sobre la consideración del Psicoanálisis, en respuesta a la citada necesidad y a opiniones tópicas que desde hace años se vierten en medios de comunicación, redes sociales y algunos medios profesionales. De acuerdo con esto, aclaramos que el Psicoanálisis actual es una psicología eminentemente centrada en los fenómenos relacionales y que parte de una concepción bio-psico-social del ser humano y, por tanto, está basado en una multicausalidad compleja. Evoluciona continuamente en nuevos modelos que intentan aportar comprensión sobre el funcionamiento humano, así como en nuevas técnicas y formatos de intervención que logran buenos resultados, al menos tan buenos como, y en algunos aspectos, mejores que otros tratamientos basados en la evidencia en psiquiatría

Reacting to the presentation of the "Plan for the Protection of Health Against Pseudotherapies" of the Spanish Ministry of Health, Consumption and Social Welfare, the Spanish Sociey of Psychoanalysis shares the necessary objective of regulating and updating the professional practice of Mental Health both in the public and private spheres , since it is part of the deontological responsibility of our professions. In this sense, we consider that it is also necessary to respond in order to clarify some topical opinions about Psychoanalysis that have been poured into media of communication, social networks and some professional media. The current Psychoanalysis is a Psychology eminently focused on relational phenomena, from a bio-psycho-social conception of the human being in wich therefore, a complex multicausality is assumed. Psychoanalysis continuously evolves in new models that try to provide understanding about human functioning, as well as in new techniques and intervention formats that achieve good results, at least as good as, and in some aspects, better than other evidence-based treatments in Psychiatry

Therapist-delivered and self-help interventions for gambling problems: A review of contents.

Background and aims To date, no systematic approach to identifying the content and characteristics of psychological interventions used to reduce gambling or problem gambling has been developed. This study aimed to develop a reliable classification system capable of identifying intervention characteristics that could, potentially, account for greater or lesser effectiveness. Methods Intervention descriptions were content analyzed to identify common and differentiating characteristics. A coder manual was developed and applied by three independent coders to identify the presence or absence of defined characteristics in 46 psychological and self-help gambling interventions. Results The final classification taxonomy, entitled Gambling Intervention System of CharacTerization (GIST), included 35 categories of intervention characteristics. These were assigned to four groups: (a) types of change techniques (18 categories; e.g., cognitive restructuring and relapse prevention), (b) participant and study characteristics (6 categories; e.g., recruitment strategy and remuneration policy), and (c) characteristics of the delivery and conduct of interventions (11 categories; e.g., modality of delivery and therapist involvement), and (d) evaluation characteristics (e.g., type of control group). Interrater reliability of identification of defined characteristics was high (κ = 0.80-1.00). Discussion This research provides a tool that allows systematic identification of intervention characteristics, thereby enabling consideration, not only of whether interventions are effective or not, but also of which domain-relevant characteristics account for greater or lesser effectiveness. The taxonomy also facilitates standardized description of intervention content in a field in which many diverse interventions have been evaluated. Conclusion Application of this coding tool has the potential to accelerate the development of more efficient and effective therapist-delivered and self-directed interventions to reduce gambling problems.

Patient experience of negative effects of psychological treatment: results of a national survey†.

BACKGROUND: To make informed choices, patients need information about negative as well as positive effects of treatments. There is little information about negative effects of psychological interventions. AIMS: To determine the prevalence of and risk factors for perceived negative effects of psychological treatment for common mental disorders. METHOD: Cross-sectional survey of people receiving psychological treatment from 184 services in England and Wales. Respondents were asked whether they had experienced lasting bad effects from the treatment they received. RESULTS: Of 14 587 respondents, 763 (5.2%) reported experiencing lasting bad effects. People aged over 65 were less likely to report such effects and sexual and ethnic minorities were more likely to report them. People who were unsure what type of therapy they received were more likely to report negative effects (odds ratio (OR) = 1.51, 95% CI 1.22-1.87), and those that stated that they were given enough information about therapy before it started were less likely to report them (OR = 0.65, 95% CI 0.54-0.79). CONCLUSIONS: One in 20 people responding to this survey reported lasting bad effects from psychological treatment. Clinicians should discuss the potential for both the positive and negative effects of therapy before it starts.

The motivational foundations of different therapeutic orientations as indicated by therapists' value preferences.

OBJECTIVE: The present study investigates the relationships between therapists' value preferences and their beliefs in the efficacy of the four main therapeutic orientations (cognitive behavior, psychodynamic, client-centered, and eco-systemic). METHOD: The study was conducted in Israel. Social workers practicing individual therapy in different psychosocial services participated in the study (n = 528). RESULTS: Personal value preferences explained a significant proportion of the variance in the social workers' beliefs in the efficacy of different therapeutic orientations. Each therapeutic orientation was associated with a specific pattern of value preferences, thus indicating that different therapeutic orientations promote or impede the attainment of the therapists' specific motivational goals. CONCLUSIONS: The study results' implications for understanding the motivational foundations of different therapeutic orientations are discussed, as well as their possible application for therapist training and practice.

[Current therapies of borderline personality disorder]. / Thérapies actuelles du trouble de personnalité borderline.

Borderline personality disorder (BPD) is a highly prevalent disorder characterized by identity disturbance, emotion dysregulation, interpersonal difficulties and self-damaging behaviours. Mental health professionals most of the time encounter difficulties in the care of these hard-to-treat patients mainly due to the frequent crises often leading to drop-outs. In this perspective, technical and theoretical changes to traditional psychotherapeutic approaches were developed. We here give the major principles that should be considered when treating BPD patients in order not only to reduce the risk of being iatrogenic but also to apply the current psychotherapeutic and psychiatric modalities internationally recognized to be efficient.

Is treatment-resistance in psychiatric disorders a trap for polypharmacy?

BACKGROUND: Nowadays, more and more mental health professionals manage patients who fail treatment for major psychiatric disorders. There is not a consensus on how to deal with treatment-resistance patients, but usually psychiatrists result to polypharmacy. METHOD: In reviewing the evidence based clinical research we will try to answer some questions about treatment-resistant psychiatric disorders. Treatment-resistant symptoms complicate the clinical course of all psychiatric disorders especially schizophrenia, causing the patients not to reach the therapeutical goal and enter remission. In consequence, polypharmacy is used to try to deal with the remaining symptoms, raising other issues. SUMMARY: We will try to deal with this problematic issue through clinical studies and major research done to try and answer the question posed.

[Management documentation of therapeutic units on inpatient treatment for people with dementia--does it allow conclusion to be drawn them about inpatient services? An exploratory analysis]. / Leistungsdokumentation durch Therapieeinheiten bei stationär behandelten Menschen mit dementieller Erkrankung--erlauben sie Rückschlüsse auf das Leistungsgeschehen? Eine explorative Analyse.

BACKGROUND: Against the background of the continuously growing incidence rates of gerontopsychiatric disorders, their economic dimen-sions, and the effects on persons affected as well as their social environments, the present study focuses on an analysis of the services provided in acute psychiatric care settings for patients with dementia. RESULTS are based on secondary data. AIM OF THE STUDY: We aim to compare therapeutic service units of different clusters of occupational groups (physicians/psychologists, nurses/special therapists) for the ICD-10 diagnostic groups F00-F03 and G30 in the years 2010 (starting with July) and 2011. Main research question is how many patients are mappable with 'therapeutic units' (Therapieeinheiten, TE) of the operation and procedures catalogue (OPS). METHODS: The present study is based on an analysis of the §21 KHEntgG data record of 35 acute psychiatric facilities. Data collection took place within the project "Versorgungsindikatoren für die Psychiatrie und Psychosomatik (VIPP)", "Supply indicators for psychiatric and psychosomatic settings". The data record implies statewide data of specialised hospitals, university hospitals and departments of psychiatry of the Federal Republic of Germany. RESULTS: In total, 5 111 cases were included in the analysis. Nurses and special therapists carried out significantly more therapeutic units in the main diagnoses groups (F01, F03 and G30) and the care groups (regular vs. intensive) than physicians and psychologists (p<0.05). It was not possible to map all patients with the use of therapeutic units (G30 78.8%, F01 83.4%, F03 81.2%). Mapping of patients was significantly higher in the intensive care compared to regular care in both occupational clusters (p<0.05). CONCLUSIONS: We demonstrated that the "therapeutic units" of the OPS codes are now used in the routine data (§21 KHEntgG), and that they are able to portray relevant aspects of non-medication therapeutic service. The present study provides a preliminary/exploratory overview on the services provided, mapped by therapeutic units. Future research should focus on the overlap between the category "therapeutic" units and the services actually provided.

Towards a taxonomy of common factors in psychotherapy-results of an expert survey.

BACKGROUND: How change comes about is hotly debated in psychotherapy research. One camp considers 'non-specific' or 'common factors', shared by different therapy approaches, as essential, whereas researchers of the other camp consider specific techniques as the essential ingredients of change. This controversy, however, suffers from unclear terminology and logical inconsistencies. The Taxonomy Project therefore aims at contributing to the definition and conceptualization of common factors of psychotherapy by analyzing their differential associations to standard techniques. METHODS: A review identified 22 common factors discussed in psychotherapy research literature. We conducted a survey, in which 68 psychotherapy experts assessed how common factors are implemented by specific techniques. Using hierarchical linear models, we predicted each common factor by techniques and by experts' age, gender and allegiance to a therapy orientation. RESULTS: Common factors differed largely in their relevance for technique implementation. Patient engagement, Affective experiencing and Therapeutic alliance were judged most relevant. Common factors also differed with respect to how well they could be explained by the set of techniques. We present detailed profiles of all common factors by the (positively or negatively) associated techniques. There were indications of a biased taxonomy not covering the embodiment of psychotherapy (expressed by body-centred techniques such as progressive muscle relaxation, biofeedback training and hypnosis). Likewise, common factors did not adequately represent effective psychodynamic and systemic techniques. CONCLUSION: This taxonomic endeavour is a step towards a clarification of important core constructs of psychotherapy. KEY PRACTITIONER MESSAGE: This article relates standard techniques of psychotherapy (well known to practising therapists) to the change factors/change mechanisms discussed in psychotherapy theory. It gives a short review of the current debate on the mechanisms by which psychotherapy works. We provide detailed profiles of change mechanisms and how they may be generated by practice techniques.

Polarity index of psychological interventions in maintenance treatment of bipolar disorder.

BACKGROUND: Although several adjunctive psychological interventions are effective in the maintenance of bipolar disorders (BD), no attempt has been made to classify them according to their ability to prevent manic versus depressive episodes. Our study aims to rank the adjunctive psychotherapies for the prophylaxis of BD by means of their polarity index (PI). METHODS: Randomized controlled trials comparing the efficacy of a psychological intervention with a comparator in BD maintenance treatment in patients aged over 18 were systematically reviewed. Exclusion criteria were a small sample size, a study sample not exclusively composed of bipolar patients and the absence of a control group. PI is a novel metric indicating the relative antimanic versus antidepressive preventive efficacy of treatments. PI was retrieved by calculating the ratio of the number needed to treat (NNT) for prevention of depression and the NNT for prevention of mania. PI >1.0 indicates a relatively higher antimanic prophylactic efficacy and PI <1.0 a greater antidepressive efficacy. RESULTS: A total of 9 studies were included. PI was 0.33, 0.63 and 0.89 for cognitive-behavioral therapy, 0.42 for family-focused therapy, 0.73 and 0.78 for psychoeducation, 1 for enhanced relapse prevention, 1.78 for caregiver group psychoeducation and 3.36 for brief technique-driven interventions. With regard to the PI for 1 cognitive-behavioral study, enhanced relapse prevention and brief technique-driven interventions may not be reliable since those trials were negative. CONCLUSIONS: The PI provides a measure of how much depression-preventive or (hypo) mania-preventive an intervention is and may guide the choice of adjunctive psychotherapy in the context of individualized long-term treatment of BD.