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- Wienicke, Frederik J., et al.
(författare)
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Efficacy and moderators of short-term psychodynamic psychotherapy for depression : A systematic review and meta-analysis of individual participant data
- 2023
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Ingår i: Clinical Psychology Review. - : Elsevier. - 0272-7358 .- 1873-7811. ; 101
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Forskningsöversikt (refereegranskat)abstract
- Background: Short-term psychodynamic psychotherapy (STPP) is frequently used to treat depression, but it is unclear which patients might benefit specifically. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses and identify patient-level moderators. This IPD meta-analysis examined the efficacy and moderators of STPP for depression compared to control conditions.Methods: PubMed, PsycInfo, Embase, and Cochrane Library were searched September 1st, 2022, to identify randomized trials comparing STPP to control conditions for adults with depression. IPD were requested and analyzed using mixed-effects models.Results: IPD were obtained from 11 of the 13 (84.6%) studies identified (n = 771/837, 92.1%; mean age = 40.8, SD = 13.3; 79.3% female). STPP resulted in significantly lower depressive symptom levels than control conditions at post-treatment (d = −0.62, 95%CI [−0.76, −0.47], p < .001). At post-treatment, STPP was more efficacious for participants with longer rather than shorter current depressive episode durations.Conclusions: These results support the evidence base of STPP for depression and indicate episode duration as an effect modifier. This moderator finding, however, is observational and requires prospective validation in future large-scale trials.
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| 2. |
- Granqvist, Pehr, et al.
(författare)
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Disorganized attachment in infancy : a review of the phenomenon and its implications for clinicians and policy-makers
- 2017
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Ingår i: Attachment & Human Development. - : Informa UK Limited. - 1461-6734 .- 1469-2988. ; 19:6, s. 534-558
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Forskningsöversikt (refereegranskat)abstract
- Disorganized/Disoriented (D) attachment has seen widespread interest from policy makers, practitioners, and clinicians in recent years. However, some of this interest seems to have been based on some false assumptions that (1) attachment measures can be used as definitive assessments of the individual in forensic/child protection settings and that disorganized attachment (2) reliably indicates child maltreatment, (3) is a strong predictor of pathology, and (4) represents a fixed or static trait of the child, impervious to development or help. This paper summarizes the evidence showing that these four assumptions are false and misleading. The paper reviews what is known about disorganized infant attachment and clarifies the implications of the classification for clinical and welfare practice with children. In particular, the difference between disorganized attachment and attachment disorder is examined, and a strong case is made for the value of attachment theory for supportive work with families and for the development and evaluation of evidence-based caregiving interventions.
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| 3. |
- Künstlicher, Rolf, 1945-
(författare)
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The Psychoanalytic Situation as a Play Situation: Exploration of a multi-faceted clinical situation
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The research question was stirred by observations that the set-up of the clinical situation seems to contain elements that have a deep impact on the patient. I found that the clinical situation shows important similarities to the space for play that children negotiate when they want to immerse themselves in mutual phantasy play. Consequently, one overall purpose of the present study is to explore the psychoanalytic situation as a play situation with the help of two clinical vignettes.In the first part, I give a picture of my understanding of Freud’s reasons for shaping his clinical situation as he did. A critical scrutiny of Freud’s case of the Rat Man gave us keys to an understanding of the clinical method’s contradictoriness.A tentative hypothesis was framed that the set-up of psychoanalysis’s clinical situation induces an ambiguity about different levels of reality, the purpose being to create a space in the course of the analysis in which this confusion can be analyzed and comprehended. This work on the ambiguity of the reality links psychoanalysis with the intimate and spontaneous interaction that characterizes children’s social phantasy play. The investigation came to the conclusion that there exists a conspicuous equivalence between the two situations. The issue of what connects the universal play situation of children on the one hand, with the specific psychoanalytic situation on the other, makes a point of departure from which to approach and investigate the field of inquiry.The theory is that a ‘play’ with factual and illusory asymmetry generates a field of tension that serves as a sounding board from the moment of psychoanalysis's introductory negotiations until its ending. A third area is created that supports a mutual explorative space that in its turn makes a bridge between outer and inner reality and between now and the past. In such a context the phenomenon of play becomes a transformational concept.The conclusion is that psychoanalysis organizes a clinical situation that speaks to a profound and universal human need and that it is understood as an analogy of the play situation of children.
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| 4. |
- Moutoussis, Michael, et al.
(författare)
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Neural activity and fundamental learning, motivated by monetary loss and reward, are intact in mild to moderate major depressive disorder
- 2018
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 13:8
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Reduced motivation is an important symptom of major depression, thought to impair recovery by reducing opportunities for rewarding experiences. We characterized motivation for monetary outcomes in depressed outpatients (N = 39, 22 female) and controls (N = 22, 11 female) in terms of their effectiveness in seeking rewards and avoiding losses. We assessed motivational function during learning of associations between stimuli and actions, as well as when learning was complete. We compared the activity within neural circuits underpinning these behaviors between depressed patients and controls. Methods We used a Go/No-Go task that assessed subjects' abilities in learning to emit or withhold actions to obtain monetary rewards or avoid losses. We derived motivation-relevant parameters of behavior (learning rate, Pavlovian bias, and motivational influence of gains and losses). After learning, participants performed the task during functional magnetic resonance imaging (fMRI). We compared neural activation during anticipation of action emission vs. action inhibition, and for actions performed to obtain rewards compared to actions that avoid losses. Results Depressed patients showed a similar Pavlovian bias to controls and were equivalent in terms of withholding action to gain rewards and emitting action to avoid losses, behaviors that conflict with well-described Pavlovian tendencies to approach rewards and avoid losses. Patients were not impaired in overall performance or learning and showed no abnormal neural responses, for example in bilateral midbrain or striatum. We conclude that basic mechanisms subserving motivated learning are thus intact in moderate depression. Implications Therapeutically, the intact mechanisms identified here suggest that learning-based interventions may be particularly effective in encouraging recovery. Etiologically, our results suggest that the severe motivational deficits clinically observed in depression are likely to have complex origins, possibly related to an impairment in the representation of future states necessary for long-term planning.
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