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- Frankl, My, et al.
(författare)
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Affect Phobia Therapy for Mild to Moderate Alcohol Use Disorder : The Cases of "Carey," "Michelle," and "Mary"
- 2019
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Ingår i: Pragmatic Case Studies in Psychotherapy. - : National Register of Health Service Psychologists. - 1553-0124. ; 15:3, s. 214-257
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Tidskriftsartikel (refereegranskat)abstract
- Affect Phobia Treatment (APT) is based on an integrative theory involving the use of psychodynamic principles for understanding a client’s psychological dynamics, experiential principles for engaging and working with the client’s affect, and behavioral principles of exposure and response prevention for desensitizing the client to the fear of affect. APT’s goal is "to help patients function better by resolving emotional conflict through reducing their avoidance of adaptive, activating emotions" (Osborn et al., 2014). APT has not yet been systematically employed and researched for patients with mild to moderate Alcohol Use Disorder (AUD) together with affect phobia. The present study was designed to begin this process by describing and comparing, both qualitatively and quantitatively, three illustrative, distinctive cases of APT in patients with AUD, assigned the names of "Carey," "Michelle," and "Mary." The focus was on exploring the process by which the different individual patients responded to the multifaceted APT therapy, and hence how the therapist had to adapt the therapy to each particular patient, as outlined in Stiles’ (2009) concept of "appropriate responsiveness." Following the manual for APT, therapy included 10 weekly sessions of individual psychotherapy. This short length for a therapy like APT, a treatment which usually has no determined session length (McCullough et al., 2003), was designed to make the therapy comparable in length to other therapies for AUD, like Motivational Interviewing. During the whole study period, patients gave weekly reports of their alcohol consumption and craving. In addition, at the beginning and at the end of the study, the patients answered questionnaires measuring affect phobia and psychiatric symptoms. Role expectations and experiences of psychotherapy were also measured. All three patients completed the treatment and the measurement period. No adverse events were reported. The patients had different trajectories of change regarding alcohol consumption, craving, and symptom change. The study showed that 10-session APT was a tolerable treatment for the patients with on-going mild-to-moderate alcohol dependence, who primarily used alcohol as a way of avoiding emotions, but that the therapy worked to different degrees and in different ways for the three patients due to their different presenting patterns of psychiatric symptoms and personality characteristics. Experience in the three cases suggests the advisability of (a) flexible treatment length in accordance to a patient's needs, and (b) complementary treatment strategies beyond APT focusing on reducing alcohol consumption per se for some patients.
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| 2. |
- Frankl, My, et al.
(författare)
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Psychometric properties of the Affect Phobia Test
- 2016
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Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 57:5, s. 482-488
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to make the first evaluation of the psychometric properties of the Affect Phobia Test, using the Swedish translation - a test developed to screen the ability to experience, express and regulate emotions. Data was collected from a clinical sample (N=82) of patients with depression and/or anxiety participating in randomized controlled trial of Internet-based affect-focused treatment, and a university student sample (N=197). The internal consistency for the total score was satisfactory (Clinical sample =0.88/Student sample =0.84) as well as for all the affective domains, except Anger/Assertion (=0.44/0.36), Sadness/Grief (=0.24/0.46) and Attachment/Closeness (=0.67/0.69). Test retest reliability was satisfactory (ICC>0.77) for the total score and for all the affective domains except for Sadness/Grief (ICC=0.04). The exploratory factor analysis resulted in a six-factor solution and did only moderately match the test's original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. As expected, the Affect Phobia test showed negative significant correlations in the clinical group with measures on depression (r(xy)=-0.229; p<0.01) and anxiety (r(xy)=-0.315; p<0.05). The conclusion is that the psychometric properties are satisfactory for the total score of the Affect Phobia Test but not for some of the test's affective domains. Consequently the domains should not be used as subscales. The test can discriminate between individuals who seek help for psychological problems and those who do not.
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| 3. |
- Frankl, My, 1968-
(författare)
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Psychotherapy for Substance Use Disorders – the importance of affects
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Substance use disorder (SUD) is a serious disorder with severe consequences for the individual, the family and for society. Comorbidity is common in the SUD population and the diversity of the disorder calls for a multiplicity of treatment options.The overall aim of this thesis was to explore the role of affects in psychotherapy for SUD. Further aims were to investigate affect-focused therapeutic orientations, demonstrate the importance of common factors and evaluate a measure of affect phobia.In Study I a naturalistic design was employed to examine how the discrepancy between patients' expectations and experience of psychotherapy related to alliance in 41 patients: 24 in individual therapy and 17 in group. An additional analysis concerned whether different dimensions of role expectations predicted retention in psychotherapy. Study II was the first psychometric evaluation of the Affect phobia test – a test developed to screen the ability to experience, express and regulate emotions. Data were collected from two samples: A clinical sample of 82 patients with depression and/or anxiety participating in a randomized controlled trial of Internet-based affect-focused treatment, and a university student sample of 197 students. Data analysed included internal consistency, test-retest reliability, factor analysis and calculation of an empirical cut-off. Study III focused on the feasibility of individual 10 week Affect Phobia Therapy (APT) for patients diagnosed with mild to moderate alcohol use disorder (AUD) and problematic affective avoidance in a nonconcurrent multiple baseline design. Study IV comprised an evaluation of the feasibility and preliminary effectiveness of APT adapted to a structured group format for patients (n=22) with comorbid substance use disorder and ADHD with core features of affective avoidance/emotion dysregulation in an open design.In Study I an overall discrepancy between role expectations and experiences was significantly related to a lower level of therapeutic alliance in group therapy. This relationship was not found in individual therapy. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention, even when controlling for waiting time for therapy. In Study II the internal consistency for the total score on the Affect phobia test was satisfactory but it was not for the affective domains, Anger/Assertion, Sadness/Grief, and Attachment/Closeness. Test retest reliability was satisfactory. The exploratory factor analysis resulted in a six-factor solution and only moderately matched the test´s original affective domains. An empirical cut-off between the clinical and the university student sample were calculated and yielded a cut-off of 72 points. In Study III patients reported no adverse events due to the treatment and finished the whole study period. The patients had different trajectories of alcohol consumption and craving and the hypothesis that heavy episodic drinking would subside during the time in therapy did not hold true. In Study IV patients reported significant pre-to post changes in increased self-compassion and decreased affect phobia but no change in psychological distress or emotion dysregulation. Craving fluctuated throughout the study period and patients’ drinking pattern changed in the direction of more social drinking.Main conclusions are the following: The Affect Phobia Test is a useful screening instrument for detecting emotional difficulties related to psychological malfunction. APT in both group and individual format are feasible treatments for the SUD population and has the potential to broaden the treatment options for some patients with SUD. Investigating expectations and fears prior to therapy may be means to prevent attrition.
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| 4. |
- Frankl, My, et al.
(författare)
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Psychotherapy role expectations and experiences Discrepancy and therapeutic alliance among patients with substance use disorders
- 2014
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Ingår i: Psychology and Psychotherapy. - : Wiley. - 1476-0835 .- 2044-8341. ; 87:4, s. 411-424
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesThe main aim of the study was to examine how the discrepancy between role expectations prior to psychotherapy and experiences of ongoing psychotherapy related to therapeutic alliance. We hypothesized that a similarity between patient role expectations and experiences would be associated with a stronger alliance. The study also examined whether different dimensions of psychotherapy role expectations predicted retention in psychotherapy. DesignA naturalistic study design was used with data collected prior to therapy and during the first 6months of therapy. MethodPatients with substance use disorders completed the Psychotherapy Expectation Questionnaire-short version (PEX-S) at the time of therapy assessment. A subsample of these patients (n=41; n=24 in individual therapy and n=17 in group therapy) provided data from therapy including psychotherapy experiences (also measured with PEX-S) and therapeutic alliance, measured with Working Alliance Questionnaire-short version. ResultsFor patients in group therapy, discrepancy between role expectations and experiences correlated negatively with alliance. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention. ConclusionThe finding that disconfirmation of patients' role expectations in group therapy were associated with weaker therapeutic alliance highlights the importance of discussing psychotherapy expectations at an early stage in treatment. Expectations characterized by defensiveness predicted worse retention in psychotherapy, which indicates that the PEX-S can be helpful in detecting patients at risk for dropout. Practitioner points In targeting a patient's role expectancies prior to treatment, possible discrepancies between patient and therapist are made visible and possible to examine. Clarifying the patient's role expectations and the therapist's rationale might be a first step towards establishing a strong working alliance. Surveying the patient's defensiveness tendencies at the beginning of therapy offers a chance to discuss possible fears and other obstacles concerning therapy. Discrepancy between the patient's role expectations prior to treatment and their actual experiences of psychotherapy render valuable information that can be of use in the therapy process. 10.1111/(ISSN)2044-8341
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