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Praxis Apr 2022
Topics: Humans; Psychiatry; Psychotherapy; Sports
PubMed: 35734970
DOI: 10.1024/1661-8157/a003864 -
Praxis 2022
Topics: Humans; Psychiatry; Psychotherapy; Sports
PubMed: 35291863
DOI: 10.1024/1661-8157/a003841 -
Psychotherapy and Psychosomatics 2022Evidence-based psychotherapies for borderline personality disorder (BPD) are lengthy, posing a barrier to their access. Brief psychotherapy may achieve comparable... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Evidence-based psychotherapies for borderline personality disorder (BPD) are lengthy, posing a barrier to their access. Brief psychotherapy may achieve comparable outcomes to long-term psychotherapy for BPD. Evidence is needed regarding the comparative effectiveness of short- versus long-term psychotherapy for BPD.
OBJECTIVE
The aim was to determine if 6 months of Dialectical Behavior Therapy (DBT) is noninferior to 12 months of DBT in terms of clinical effectiveness.
METHODS
This two-arm, single-blinded, randomized controlled noninferiority trial with suicidal or self-harming patients with BPD was conducted at two sites in Canada. Participants (N = 240, M (SD)age = 28.27 (8.62), 79% females) were randomized to receive either 6 (DBT-6) or 12 months (DBT-12) of comprehensive DBT. Masked assessors obtained measures of clinical effectiveness at baseline and every 3 months, ending at month 24. DBT-6 and DBT-12 were outpatient treatments consisting of weekly individual therapy sessions, weekly DBT skills training group sessions, telephone consultation as needed, and weekly therapist consultation team meetings.
RESULTS
The noninferiority hypothesis was supported for the primary outcome, total self-harm (6 months: margin = -1.94, Mdiff [95% CI] = 0.16 [-0.14, 0.46]; 12 months: margin = -1.47, Mdiff [95% CI] = 0.04 [-0.17, 0.23]; 24 months: margin = -1.25, Mdiff [95% CI] = 0.12 [-0.02, 0.36]). Results also supported noninferiority of DBT-6 for general psychopathology and coping skills at 24 months. Furthermore, DBT-6 participants showed more rapid reductions in BPD symptoms and general psychopathology. There were no between-group differences in dropout rates.
CONCLUSIONS
The noninferiority of a briefer yet comprehensive treatment for BPD has potential to reduce barriers to treatment access.
Topics: Female; Humans; Adult; Male; Dialectical Behavior Therapy; Borderline Personality Disorder; Referral and Consultation; Telephone; Psychotherapy; Self-Injurious Behavior; Treatment Outcome; Behavior Therapy
PubMed: 35738244
DOI: 10.1159/000525102 -
JAMA Psychiatry Mar 2024Generalized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatments for GAD, but which... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Generalized anxiety disorder (GAD) is one of the most common mental disorders in adults. Psychotherapies are among the most recommended treatments for GAD, but which should be considered as first-line treatment needs to be clarified.
OBJECTIVE
To use a network meta-analysis to examine the short- and long-term associations of different psychotherapies with outcomes of effectiveness and acceptability in adults with GAD.
DATA SOURCES
MEDLINE, Embase, PsycINFO, and the Cochrane Register of Controlled Trials were searched from database inception to January 1, 2023, to identify randomized clinical trials (RCTs) of psychotherapies for adults with GAD.
STUDY SELECTION
RCTs comparing any type of psychotherapy against another or with a control condition for the treatment of adults (≥18 years, both sexes) with a primary diagnosis of GAD were eligible for inclusion.
DATA EXTRACTION AND SYNTHESIS
This study followed Cochrane standards for extracting data and assessing data quality and used the PRISMA guideline for reporting. Risk of bias of individual studies was assessed using the second version of the Cochrane risk of bias tool, and the Confidence in Network Meta-Analysis was used to rate the certainty of evidence for meta-analytical results.
MAIN OUTCOMES AND MEASURES
Eight psychotherapies were compared against one another and with 2 control conditions. Primary outcomes were severity of GAD symptoms and acceptability of the psychotherapies. Random-effects model pairwise and network meta-analyses were conducted. For effectiveness, standardized mean differences (SMDs) were pooled, and for acceptability, relative risks with 95% CIs were calculated.
RESULTS
Data from 65 RCTs were included. Effect size estimates on data from 5048 participants (mean [SD], 70.9% [11.9%] women; mean [SD] age, 42.2 [12.5] years) suggested that third-wave cognitive behavior therapies (CBTs) (SMD, -0.76 [95% CI, -1.15 to -0.36]; certainty, moderate), CBT (SMD, -0.74 [95% CI, -1.09 to -0.38]; certainty, moderate), and relaxation therapy (SMD, -0.59 [95% CI, -1.07 to -0.11]; certainty, low) were associated with reduced GAD symptoms vs treatment as usual. Relative risks for all-cause discontinuation (indication of acceptability) signaled no differences compared with treatment as usual for all psychotherapies (eg, relative risk, 1.04 [95% CI, 0.64-1.67] for CBT vs treatment as usual). When excluding studies at high risk of bias, relaxation therapy lost its superiority over treatment as usual (SMD, -0.47; 95% CI, -1.18 to 0.23). When considering anxiety severity at 3 to 12 months after completion of the intervention, only CBT remained significantly associated with greater effectiveness than treatment as usual (SMD, -0.60; 95% CI, -0.99 to -0.21).
CONCLUSIONS AND RELEVANCE
Given the evidence in this systematic review and network meta-analysis for its associations with both acute and long-term effectiveness, CBT may represent the first-line therapy of GAD. Third-wave CBTs and relaxation therapy were associated with short-term effectiveness and may also be offered.
Topics: Humans; Anxiety Disorders; Cognitive Behavioral Therapy; Network Meta-Analysis; Psychotherapy; Randomized Controlled Trials as Topic
PubMed: 37851421
DOI: 10.1001/jamapsychiatry.2023.3971 -
Tidsskrift For Den Norske Laegeforening... Sep 2018
Topics: Cognitive Behavioral Therapy; Humans; Object Attachment; Psychotherapy, Psychodynamic; Therapeutic Alliance; Transference, Psychology
PubMed: 30180504
DOI: 10.4045/tidsskr.18.0331 -
Journal of Anxiety Disorders Jun 2024Given the growth in research examining the effects of psychotherapy on social anxiety disorder (SAD), an up-to-date comprehensive meta-analysis in this field is needed. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Given the growth in research examining the effects of psychotherapy on social anxiety disorder (SAD), an up-to-date comprehensive meta-analysis in this field is needed.
METHODS
We selected studies from a database of randomized trials (RCTs) on psychotherapies for anxiety disorders (last updated search of PubMed, PsycINFO, Embase, and Cochrane (CENTRAL): 1 January 2024) We included RCTs comparing psychotherapy to a control condition for adults with SAD and conducted random effects meta-analyses to examine the efficacy of psychotherapy compared to control conditions at post-treatment.
RESULTS
Sixty-six RCTs were included with 5560 participants and 98 comparisons between psychotherapy and control groups. Psychotherapy was effective in reducing SAD symptoms, with a large effect size (g = 0.88; 95 % CI: 0.76 to 1.0; I = 74 %; 95 % CI: 69 to 79, NNT = 3.8). Effects remained robust across sensitivity analyses. However, there was evidence for significant risk of bias in the included trials. The multivariable meta-regression indicated significant differences in treatment delivery formats, type of recruitment strategy, target group, and number of sessions.
CONCLUSION
Psychotherapy is an effective treatment for SAD, with moderate to large effect sizes across all treatment types and formats. Future research is needed to determine the long-term effects.
Topics: Humans; Phobia, Social; Psychotherapy; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 38815481
DOI: 10.1016/j.janxdis.2024.102881 -
Current Psychiatry Reports Sep 2017We review recent advances in psychotherapies for depressed older adults, in particular those developed for special populations characterized by chronic medical illness,... (Review)
Review
PURPOSE OF REVIEW
We review recent advances in psychotherapies for depressed older adults, in particular those developed for special populations characterized by chronic medical illness, acute medical illness, cognitive impairment, and suicide risk factors. We review adaptations for psychotherapy to overcome barriers to its accessibility in non-specialty settings such as primary care, homebound or hard-to-reach older adults, and social service settings.
RECENT FINDINGS
Recent evidence supports the effectiveness of psychotherapies that target late-life depression in the context of specific comorbid conditions including COPD, heart failure, Parkinson's disease, stroke and other acute conditions, cognitive impairment, and suicide risk. Growing evidence supports the feasibility, acceptability, and effectiveness of psychotherapy modified for a variety of health care and social service settings. Research supports the benefits of selecting the type of psychotherapy based on a comprehensive assessment of the older adult's psychiatric, medical, functional, and cognitive status, and tailoring psychotherapy to the settings in which older depressed adults are most likely to present.
Topics: Acute Disease; Aged; Aged, 80 and over; Chronic Disease; Cognitive Dysfunction; Depression; Health Services Accessibility; Health Services for the Aged; Humans; Primary Health Care; Psychotherapy; Suicide Prevention
PubMed: 28726061
DOI: 10.1007/s11920-017-0812-8 -
Clinical Psychology & Psychotherapy Jul 2022It is well established that there is a fundamental need to develop a robust therapeutic alliance to achieve positive outcomes in psychotherapy. However, little is known... (Review)
Review
It is well established that there is a fundamental need to develop a robust therapeutic alliance to achieve positive outcomes in psychotherapy. However, little is known as to how this applies to psychotherapies which reduce suicidal experiences. The current narrative review summarizes the literature which investigates the relationship between the therapeutic alliance in psychotherapy and a range of suicidal experiences prior to, during and following psychotherapy. Systematic searches of MEDLINE, PsycINFO, Web of Science, EMBASE and British Nursing Index were conducted. The search returned 6472 studies, of which 19 studies were eligible for the present review. Findings failed to demonstrate a clear link between suicidal experiences prior to or during psychotherapy and the subsequent development and maintenance of the therapeutic alliance during psychotherapy. However, a robust therapeutic alliance reported early on in psychotherapy was related to a subsequent reduction in suicidal ideation and attempts. Study heterogeneity, varied sample sizes and inconsistent reporting may limit the generalizability of review findings. Several recommendations are made for future psychotherapy research studies. Training and supervision of therapists should not only highlight the importance of developing and maintaining the therapeutic alliance in psychotherapy when working with people with suicidal experiences but also attune to client perceptions of relationships and concerns about discussing suicidal experiences during therapy.
Topics: Humans; Psychotherapy; Suicidal Ideation; Therapeutic Alliance
PubMed: 35168297
DOI: 10.1002/cpp.2726 -
Praxis Apr 2023Quality Standards in Old Age Psychiatry Quality standards and regulations are becoming increasingly important and are promoted in the context of the permission to...
Quality Standards in Old Age Psychiatry Quality standards and regulations are becoming increasingly important and are promoted in the context of the permission to treat, to bill and via financial incentives. In this context, the regulatory frameworks focus to varying degrees on structural, process or outcome criteria. On behalf of the Swiss Society for Old Age Psychiatry and Psychotherapy (SGAP), we summarize the quality elements in this document and group the requirements derived from them based on setting (outpatient, intermediate, inpatient) and structural quality criteria (staffing ratio, infrastructure). There is a very extensive requirements matrix, and its implementation requires considerable efforts, not least because of the shortage of specialists and limited financial resources of psychiatric institutions and medical practices. The criteria of the requirements matrix must be further developed and anchored in a "competence-based training in old age psychiatry".
Topics: Humans; Psychotherapy; Workforce
PubMed: 37042405
DOI: 10.1024/1661-8157/a004028 -
Current Opinion in Psychiatry Nov 2017This review discusses current concepts on the relationship between sleep, memory formation and underlying neural refinements, with a particular focus on possible ways to... (Review)
Review
PURPOSE OF REVIEW
This review discusses current concepts on the relationship between sleep, memory formation and underlying neural refinements, with a particular focus on possible ways to use or modulate sleep in a targeted manner to augment psychiatric and psychotherapeutic treatments.
RECENT FINDINGS
The most promising lines of research with regard to psychiatry and psychotherapy center on the targeted implementation or modulation of sleep to augment existing or create novel forms of treatment.
SUMMARY
The modulation of sleep and interconnected neural plasticity processes provides a window of opportunity for developing novel treatments in psychiatry and psychotherapy.
Topics: Humans; Memory; Neuronal Plasticity; Psychiatry; Psychotherapy; Sleep; Therapies, Investigational
PubMed: 28858009
DOI: 10.1097/YCO.0000000000000365