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American Journal of Psychotherapy Mar 2024The aim of this report is to describe how trainees and instructors skew their performance of psychotherapies when sessions are observed by third parties and to discuss... (Review)
Review
OBJECTIVE
The aim of this report is to describe how trainees and instructors skew their performance of psychotherapies when sessions are observed by third parties and to discuss approaches to mitigate potentially adverse consequences.
METHODS
To supplement clinical observations, a selective narrative literature review was conducted by searching PubMed and PsycInfo.
RESULTS
When third-party observers were involved, therapists were likely to skew how they conducted psychotherapy. Skewing occurred regardless of whether the third parties observed in vivo or remotely, observed synchronously or asynchronously, or were instructors or trainees. Such skewing may have resulted from conscious, preconscious, or unconscious decisions by therapists as well as by patients. Despite the benefits of observed psychotherapy for therapists and patients, deleterious consequences have sometimes emerged.
CONCLUSIONS
Benefits of third-party observation of psychotherapy are substantial. Nevertheless, therapists must recognize how being observed may adversely affect themselves and their patients. Mitigation strategies are available to address potential harms.
Topics: Humans; Psychotherapy; Allied Health Personnel
PubMed: 37203148
DOI: 10.1176/appi.psychotherapy.20230002 -
JAMA Aug 2015Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder common among military personnel and veterans. First-line psychotherapies most often recommended... (Review)
Review
IMPORTANCE
Posttraumatic stress disorder (PTSD) is a disabling psychiatric disorder common among military personnel and veterans. First-line psychotherapies most often recommended for PTSD consist mainly of "trauma-focused" psychotherapies that involve focusing on details of the trauma or associated cognitive and emotional effects.
OBJECTIVE
To examine the effectiveness of psychotherapies for PTSD in military and veteran populations.
EVIDENCE REVIEW
PubMed, PsycINFO, and PILOTS were searched for randomized clinical trials (RCTs) of individual and group psychotherapies for PTSD in military personnel and veterans, published from January 1980 to March 1, 2015. We also searched reference lists of articles, selected reviews, and meta-analyses. Of 891 publications initially identified, 36 were included.
FINDINGS
Two trauma-focused therapies, cognitive processing therapy (CPT) and prolonged exposure, have been the most frequently studied psychotherapies for military-related PTSD. Five RCTs of CPT (that included 481 patients) and 4 RCTs of prolonged exposure (that included 402 patients) met inclusion criteria. Focusing on intent-to-treat outcomes, within-group posttreatment effect sizes for CPT and prolonged exposure were large (Cohen d range, 0.78-1.10). CPT and prolonged exposure also outperformed waitlist and treatment-as-usual control conditions. Forty-nine percent to 70% of participants receiving CPT and prolonged exposure attained clinically meaningful symptom improvement (defined as a 10- to 12-point decrease in interviewer-assessed or self-reported symptoms). However, mean posttreatment scores for CPT and prolonged exposure remained at or above clinical criteria for PTSD, and approximately two-thirds of patients receiving CPT or prolonged exposure retained their PTSD diagnosis after treatment (range, 60%-72%). CPT and prolonged exposure were marginally superior compared with non-trauma-focused psychotherapy comparison conditions.
CONCLUSIONS AND RELEVANCE
In military and veteran populations, trials of the first-line trauma-focused interventions CPT and prolonged exposure have shown clinically meaningful improvements for many patients with PTSD. However, nonresponse rates have been high, many patients continue to have symptoms, and trauma-focused interventions show marginally superior results compared with active control conditions. There is a need for improvement in existing PTSD treatments and for development and testing of novel evidence-based treatments, both trauma-focused and non-trauma-focused.
Topics: Cognitive Behavioral Therapy; Humans; Implosive Therapy; Military Personnel; Psychotherapy; Randomized Controlled Trials as Topic; Stress Disorders, Post-Traumatic
PubMed: 26241600
DOI: 10.1001/jama.2015.8370 -
International Journal of Psychiatry in... 2012Because evidence-based psychotherapies of 12 to 20 sessions can be perceived as too lengthy and time intensive for the treatment of depression in primary care, a number... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Because evidence-based psychotherapies of 12 to 20 sessions can be perceived as too lengthy and time intensive for the treatment of depression in primary care, a number of studies have examined abbreviated psychotherapy protocols. The purpose of this study was to conduct a systematic review and meta-analysis to determine the efficacy of brief psychotherapy (i.e., < or =8 sessions) for depression.
METHODS
We used combined literature searches in PubMed, EMBASE, PsycINFO, and an Internet-accessible database of clinical trials of psychotherapy to conduct two systematic searches: one for existing systematic reviews and another for randomized controlled trials (RCTs). Included studies examined evidence-based psychotherapy(s) of eight or fewer sessions, focused on adults with depression, contained an acceptable control condition, were published in English, and used validated measures of depressive symptoms.
RESULTS
We retained 2 systematic reviews and 15 RCTs evaluating cognitive behavioral therapy, problem-solving therapy, and mindfulness-based cognitive therapy. The systematic reviews found brief psychotherapies to be more efficacious than control, with effect sizes ranging from -0.33 to -0.25. Our meta-analysis found six to eight sessions of cognitive behavioral therapy to be more efficacious than control (ES -0.42, 95% CI -0.74 to -0.10, 12 = 56%). A sensitivity analysis controlled for statistical heterogeneity but showed smaller treatment effects (ES -0.24, 95% CI -0.42 to -0.06, 12 = 0%).
CONCLUSIONS
Depression can be efficaciously treated with six to eight sessions of psychotherapy, particularly cognitive behavioral therapy and problem-solving therapy. Access to non-pharmacologic treatments for depression could be improved by training healthcare providers to deliver brief psychotherapies.
Topics: Adult; Depression; Depressive Disorder; Humans; Psychotherapy, Brief; Treatment Outcome
PubMed: 22849036
DOI: 10.2190/PM.43.2.c -
American Journal of Psychotherapy Jun 2021Group psychology and group psychotherapy (GPGP) are distinctive, effective practices that meet an important need. In 2018, the American Psychological Association...
Group psychology and group psychotherapy (GPGP) are distinctive, effective practices that meet an important need. In 2018, the American Psychological Association recognized GPGP as a specialty, thus setting standards for education and training in the field. Although there is a need for high-quality group psychotherapy, practitioners often lack standardized training, thus posing a risk to patients. Adoption of these standards by practice settings and training programs is essential for expanding the availability of quality group therapy. An understanding of how the specialty became recognized and of the specific criteria for its practice (i.e., public need, diversity, distinctiveness, advanced scientific and theoretical preparation, structures and models of education and training, effectiveness, quality improvement, guidelines for delivery, and provider identification and evaluation) are essential for expanding the availability of high-quality group psychotherapy. Such understanding also informs how training programs can align with standards. This article provides a foundation of understanding and details implications of group psychotherapy's establishment as a specialty. The benefits of high-quality group psychotherapy are far-reaching, whereas the risks of inadequate practice loom large.
Topics: Humans; Psychotherapy; Psychotherapy, Group; Societies, Scientific
PubMed: 34126749
DOI: 10.1176/appi.psychotherapy.20200037 -
Clinics in Geriatric Medicine May 1992Although psychotherapy outcome research is not without controversy, available evidence suggests that elderly patients benefit from an active, structured relationship... (Review)
Review
Although psychotherapy outcome research is not without controversy, available evidence suggests that elderly patients benefit from an active, structured relationship with a therapist who provides a helpful therapeutic setting for comprehending and mastering problems that contribute to depression. Until research can evaluate better the various types of therapies, it is reasonable to integrate aspects of different therapies in the clinician's approach to depressed elderly patients, depending on the clinician's understanding of the patient's diagnosis, ego strengths and weaknesses, and capacity to cope and change. The therapist can use psychodynamic, cognitive, behavioral, interpersonal, and supportive techniques in a flexible manner, individualizing therapy to meet the patient's specific needs. Antidepressants are helpful in conjunction with psychotherapy, particularly for patients with major depression and for patients with prominent neurovegetative signs of depression. A tailored, individualized approach that considers the patient's unique needs can strengthen the therapeutic relationship, which may be the primary "nonspecific factor" through which all psychotherapies appear to benefit patients.
Topics: Aged; Behavior Therapy; Cognitive Behavioral Therapy; Depressive Disorder; Female; Humans; Male; Prognosis; Psychotherapy
PubMed: 1600485
DOI: No ID Found -
Journal of Psychiatric Practice Jan 2017Regardless of their historical and theoretical roots, strategies, tactics, and techniques used in everyday psychotherapy across diverse theoretical schools contain... (Review)
Review
BACKGROUND AND OBJECTIVES
Regardless of their historical and theoretical roots, strategies, tactics, and techniques used in everyday psychotherapy across diverse theoretical schools contain common factors and methods from other specific psychotherapeutic modalities that contribute substantially to psychotherapy outcomes. Common factors include alliance, empathy, goal consensus/collaboration, positive regard/affirmation, and congruence/genuineness, among others. All therapies also recognize that factors specific to therapists impact treatment. Starting with these common factors, we add psychotherapeutic methods from many theoretical orientations to create a collection of clinical tools. We then provide concrete suggestions for enacting psychotherapy interventions, which constitute a transtheoretical collection.
METHODS
We begin with observations made by earlier scholars, our combined clinical and teaching experiences, and oral traditions and clinical pearls passed down from our own supervisors and mentors. We have compiled a list of tools for students with foundational knowledge in the basic forms of psychotherapy, which may expand their use of additional interventions for practicing effective psychotherapy.
RESULTS
Our toolbox is organized into 4 categories: Relating; Exploring; Explaining; and Intervening. We note how these tools correspond to items previously published in a list of core psychotherapy competencies.
CONCLUSIONS
In our view, the toolbox can be used most judiciously by students and practitioners schooled and grounded in frameworks for conducting established psychotherapies. Although they are still a work in progress, these tools can authorize and guide trainees and practitioners to enact specific approaches to psychotherapy utilizing other frameworks. We believe that psychotherapy education and training might benefit from explicitly focusing on the application of such interventions.
Topics: Humans; Psychotherapy
PubMed: 28072647
DOI: 10.1097/PRA.0000000000000208 -
The Cochrane Database of Systematic... Aug 2012Psychotherapy is regarded as the first-line treatment for people with borderline personality disorder. In recent years, several disorder-specific interventions have been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Psychotherapy is regarded as the first-line treatment for people with borderline personality disorder. In recent years, several disorder-specific interventions have been developed. This is an update of a review published in the Cochrane Database of Systematic Reviews in 2006.
OBJECTIVES
To assess the effects of psychological interventions for borderline personality disorder (BPD).
SEARCH METHODS
We searched the following databases: CENTRAL 2010(3), MEDLINE (1950 to October 2010), EMBASE (1980 to 2010, week 39), ASSIA (1987 to November 2010), BIOSIS (1985 to October 2010), CINAHL (1982 to October 2010), Dissertation Abstracts International (31 January 2011), National Criminal Justice Reference Service Abstracts (15 October 2010), PsycINFO (1872 to October Week 1 2010), Science Citation Index (1970 to 10 October 2010), Social Science Citation Index (1970 to 10 October 2010), Sociological Abstracts (1963 to October 2010), ZETOC (15 October 2010) and the metaRegister of Controlled Trials (15 October 2010). In addition, we searched Dissertation Abstracts International in January 2011 and ICTRP in August 2011.
SELECTION CRITERIA
Randomised studies with samples of patients with BPD comparing a specific psychotherapeutic intervention against a control intervention without any specific mode of action or against a comparative specific psychotherapeutic intervention. Outcomes included overall BPD severity, BPD symptoms (DSM-IV criteria), psychopathology associated with but not specific to BPD, attrition and adverse effects.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies, assessed the risk of bias in the studies and extracted data.
MAIN RESULTS
Twenty-eight studies involving a total of 1804 participants with BPD were included. Interventions were classified as comprehensive psychotherapies if they included individual psychotherapy as a substantial part of the treatment programme, or as non-comprehensive if they did not.Among comprehensive psychotherapies, dialectical behaviour therapy (DBT), mentalisation-based treatment in a partial hospitalisation setting (MBT-PH), outpatient MBT (MBT-out), transference-focused therapy (TFP), cognitive behavioural therapy (CBT), dynamic deconstructive psychotherapy (DDP), interpersonal psychotherapy (IPT) and interpersonal therapy for BPD (IPT-BPD) were tested against a control condition. Direct comparisons of comprehensive psychotherapies included DBT versus client-centered therapy (CCT); schema-focused therapy (SFT) versus TFP; SFT versus SFT plus telephone availability of therapist in case of crisis (SFT+TA); cognitive therapy (CT) versus CCT, and CT versus IPT.Non-comprehensive psychotherapeutic interventions comprised DBT-group skills training only (DBT-ST), emotion regulation group therapy (ERG), schema-focused group therapy (SFT-G), systems training for emotional predictability and problem solving for borderline personality disorder (STEPPS), STEPPS plus individual therapy (STEPPS+IT), manual-assisted cognitive treatment (MACT) and psychoeducation (PE). The only direct comparison of an non-comprehensive psychotherapeutic intervention against another was MACT versus MACT plus therapeutic assessment (MACT+). Inpatient treatment was examined in one study where DBT for PTSD (DBT-PTSD) was compared with a waiting list control. No trials were identified for cognitive analytical therapy (CAT).Data were sparse for individual interventions, and allowed for meta-analytic pooling only for DBT compared with treatment as usual (TAU) for four outcomes. There were moderate to large statistically significant effects indicating a beneficial effect of DBT over TAU for anger (n = 46, two RCTs; standardised mean difference (SMD) -0.83, 95% confidence interval (CI) -1.43 to -0.22; I(2) = 0%), parasuicidality (n = 110, three RCTs; SMD -0.54, 95% CI -0.92 to -0.16; I(2) = 0%) and mental health (n = 74, two RCTs; SMD 0.65, 95% CI 0.07 to 1.24 I(2) = 30%). There was no indication of statistical superiority of DBT over TAU in terms of keeping participants in treatment (n = 252, five RCTs; risk ratio 1.25, 95% CI 0.54 to 2.92).All remaining findings were based on single study estimates of effect. Statistically significant between-group differences for comparisons of psychotherapies against controls were observed for BPD core pathology and associated psychopathology for the following interventions: DBT, DBT-PTSD, MBT-PH, MBT-out, TFP and IPT-BPD. IPT was only indicated as being effective in the treatment of associated depression. No statistically significant effects were found for CBT and DDP interventions on either outcome, with the effect sizes moderate for DDP and small for CBT. For comparisons between different comprehensive psychotherapies, statistically significant superiority was demonstrated for DBT over CCT (core and associated pathology) and SFT over TFP (BPD severity and treatment retention). There were also encouraging results for each of the non-comprehensive psychotherapeutic interventions investigated in terms of both core and associated pathology.No data were available for adverse effects of any psychotherapy.
AUTHORS' CONCLUSIONS
There are indications of beneficial effects for both comprehensive psychotherapies as well as non-comprehensive psychotherapeutic interventions for BPD core pathology and associated general psychopathology. DBT has been studied most intensely, followed by MBT, TFP, SFT and STEPPS. However, none of the treatments has a very robust evidence base, and there are some concerns regarding the quality of individual studies. Overall, the findings support a substantial role for psychotherapy in the treatment of people with BPD but clearly indicate a need for replicatory studies.
Topics: Behavior Therapy; Borderline Personality Disorder; Humans; Psychoanalysis; Psychotherapy; Psychotherapy, Group; Randomized Controlled Trials as Topic
PubMed: 22895952
DOI: 10.1002/14651858.CD005652.pub2 -
The Lancet. Psychiatry Dec 2017Do psychotherapies work primarily through the specific factors described in treatment manuals, or do they work through common factors? In attempting to unpack this... (Review)
Review
Do psychotherapies work primarily through the specific factors described in treatment manuals, or do they work through common factors? In attempting to unpack this ongoing debate between specific and common factors, we highlight limitations in the existing evidence base and the power battles and competing paradigms that influence the literature. The dichotomy is much less than it might first appear. Most specific factor theorists now concede that common factors have importance, whereas the common factor theorists produce increasingly tight definitions of bona fide therapy. Although specific factors might have been overplayed in psychotherapy research, some are effective for particular conditions. We argue that continuing to espouse common factors with little evidence or endless head-to-head comparative studies of different psychotherapies will not move the field forward. Rather than continuing the debate, research needs to encompass new psychotherapies such as e-therapies, transdiagnostic treatments, psychotherapy component studies, and findings from neurobiology to elucidate the effective process components of psychotherapy.
Topics: Humans; Mental Disorders; Psychotherapeutic Processes; Psychotherapy
PubMed: 28689019
DOI: 10.1016/S2215-0366(17)30100-1 -
Tijdschrift Voor Psychiatrie 2008Psychotherapy is a popular treatment for many psychiatric symptoms and disorders. Finding evidence for the effectiveness of therapies and bridging the gap with daily... (Review)
Review
Psychotherapy is a popular treatment for many psychiatric symptoms and disorders. Finding evidence for the effectiveness of therapies and bridging the gap with daily practice are a challenge. The current state of psychotherapy is explored from the perspective of evidence-based medicine. Hundreds of meta-analyses, based on thousands of studies, showed an average effect size of 0.60. Discussion in this paper focuses on the achievements and limitations of research into methods and specific disorders. Much is known about the specificity of psychotherapies and about other issues relevant to service delivery. If patient-based indication is to be a goal for the future, we will need to have a differentiated spectrum of evidence-based psychotherapies. This approach will require the integration of effective elements taken from a variety of methods, the development of multi-dimensional indicators for patient-based indication, and research into cost-effectiveness to underpin the relevance of psychotherapy for the community at large.
Topics: Evidence-Based Medicine; Humans; Meta-Analysis as Topic; Netherlands; Psychiatry; Psychotherapy; Research; Treatment Outcome
PubMed: 18548415
DOI: No ID Found -
Canadian Journal of Psychiatry. Revue... Aug 1997To compile, review, and comment upon the application of psychotherapy to the treatment of psychiatric disorders first appearing in childhood and adolescence. (Comparative Study)
Comparative Study Review
OBJECTIVE
To compile, review, and comment upon the application of psychotherapy to the treatment of psychiatric disorders first appearing in childhood and adolescence.
METHOD
Representative research papers published over the past 4 decades on the subject of psychotherapy of children and adolescents were compiled. Selection for inclusion in this review was based upon salience to the subject of treatment of child psychiatric disorders. Special consideration was given to large-scale and metaanalytic studies, as well as to studies comparing psychotherapy with other forms of treatment.
RESULTS
There is mixed evidence for the efficacy of psychotherapy for child psychiatric disorders. There are few direct comparisons between treatment modalities in the child psychiatric literature. Methodological problems include a history of theoretical development of therapies without reference to current conceptions of mental illness, a paucity of direct comparisons among psychotherapies and between psychotherapy and other psychiatric treatments, inconsistent definition of psychotherapy from study to study, and inconsistency in stated outcome measures. In general, cognitive-behavioural therapies performed better in application to child psychiatric disorders than did insight-oriented therapies.
CONCLUSIONS
Outcome research in child-oriented psychotherapy is still in its infancy. There are simply too few studies of many therapies and many conditions to draw firm conclusions about efficacy. More work is needed in matching discrete, consistently applied therapies to selected psychiatric pathologies. Questions regarding psychotherapy's potential application to prevention of mental illness and to management of distress surrounding mental illness (as distinct from treatment of the illness itself) remain to be answered.
Topics: Adolescent; Child; Cognitive Behavioral Therapy; Humans; Mental Disorders; Outcome and Process Assessment, Health Care; Psychotherapy; Treatment Outcome
PubMed: 9288421
DOI: 10.1177/070674379704200605