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Biomedical subjects

P Crits-Christoph

Publications and source records attributed to P Crits-Christoph.

At least 19 recordsLinked to original sources
PubMed1996

The role of psychotherapy in the treatment of depression: review of two practice guidelines.

We review two recent practice guidelines' assessments of the role of psychotherapy in the treatment of major depression in adults. We examine the practice guideline published by the American Psychiatric Association (APA) and that published by the Depression Guideline Panel of the Agency for Health Care Policy and Research. We focus on the guidelines' evaluations of psychotherapies, their statements about the role of psychotherapy in first-line treatment of depression, and the procedures they recommend for choosing among psychotherapies. We argue that the APA guideline understates the value of cognitive, behavioral, brief psychodynamic, and group therapies. Both guidelines understate the value of psychotherapy alone in the treatment of more severely depressed outpatients. The APA guideline overvalues the role of combined psychotherapy-pharmacotherapy regimens, particularly in view of the greater cost of this strategy. The APA guideline also makes recommendations about choosing among psychotherapies that are not well supported by empirical evidence. We conclude with some guidelines for guideline development.

Adult↗
PubMed1996

Psychosocial treatment for drug abuse. Selected review and recommendations for national health care.

Substance abuse and dependence remains an important public health concern because of health-related and other costs to our society. We review selected articles that address questions about the psychosocial treatment of substance abuse disorders; these articles could aid in setting the parameters of a national health care insurance. Data from major program evaluation studies of existing substance abuse treatment programs are presented, followed by reviews of controlled studies of opiate, cocaine, and marijuana abuse and dependence; particular attention is given to studies that have standardized treatment through the use of treatment manuals. Articles about the treatment of substance abuse in adolescents are also reviewed. The existing data suggest that substance abuse treatment should be intensive and should probably involve multiple modalities targeted to various problems encountered in patients with substance use disorders, including comorbid psychiatric problems. However, only a few well-controlled studies have been performed to date; therefore, substantial research is needed before a system truly informed by research can be designed. Suggestions for future research directions are provided.

Adolescent↗
PubMed1996

Effects of therapist adherence and competence on patient outcome in brief dynamic therapy.

The authors examined the relation between therapist process variables (adherence and competence) and subsequent symptomatic change in patients. Twenty-nine depressed patients were seen in 16 sessions of weekly supportive expressive (SE) dynamic psychotherapy. Change in depression from intake to Session 3 predicted higher ratings of adherence to expressive (interpretative) techniques during Session 3 but not their competent delivery. Partialling pretreatment psychiatric severity, therapists' adherence to use of expressive techniques, and previous symptomatic improvement, relatively competent delivery of SE-specific expressive techniques predicted subsequent improvement in depression. Secondary analyses addressing alternative explanations (such as the role of either therapeutic alliance or general therapeutic skills) did not change the results.

Depressive Disorder↗
PubMed1995

A comparison of core conflictual relationship themes before psychotherapy and during early sessions.

This report shows (a) that the Core Conflictual Relationship Theme (CCRT) can be rated reliably either from therapy sessions or from a special pretreatment interview in a group of depressed patients, and (b) that the CCRTs obtained before treatment are similar to the CCRTs extracted from the early sessions of brief dynamic psychotherapy. The data suggest that, at least in the early sessions of treatment, the therapist's influence did not significantly alter the patients' CCRTs.

Adult↗
PubMed1994

Consistency of interpersonal themes for patients in psychotherapy.

In this study the extent to which patients in psychotherapy display similar interpersonal themes across multiple narratives of their interactions with others was investigated. Interpersonal themes were measured using a new instrument entitled the Quantitative Assessment of Interpersonal Themes (QUAINT) method, which assesses the wishes, responses from others, and responses of self that occur in narratives about interactions with others. For 60 patients in psychotherapy, evidence for repetitiveness of themes was found; the effect was relatively small but was highly statistically significant. Individual differences in the degree of repetitiveness of themes were not related to type of treatment (dynamic vs. cognitive), but they were related to length of time in treatment. The limitations of the study are reviewed and future research directions are outlined.

Adolescent↗
PubMed1993

Advances in measures of psychodynamic formulations.

Recently published methods are reviewed to assess dynamic formulations derived from psychodynamic case material, especially those methods that emphasize central maladaptive interpersonal patterns. These methods are divided into those that yield psychometric data based on samples that are at least of moderate size and those in which the measures are derived from case studies. The psychometric properties of the first group of measures are reviewed, including interjudge reliability, internal consistency, and content, predictive, and concurrent validity. This article then examines how the measures have addressed and could address the question of construct validity. Also discussed are issues involving the comparison of the methods, particularly their importance for examining specific hypotheses in psychodynamic psychotherapy. Concrete suggestions are made for future research.

Conflict, Psychological↗
PubMed1992

Therapist techniques used during the cognitive therapy of opiate-dependent patients.

A review of current substance abuse literature indicates that although clinicians espouse cognitive and behavioral methods in the treatment of drug-dependent patients, little is known about the process of cognitive-behavioral therapy with these individuals. Our objective is to examine the specific techniques used by manual-guided cognitive-behavioral therapists during the treatment of opiate-dependent patients. Ratings of audiotaped sessions using the Collaborative Study Psychotherapy Rating Scale indicate that the cognitive-behavioral therapists did not rely on behavioral methods early in treatment as predicted by both theory and the clinical literature. Cognitive techniques and techniques oriented toward establishing a collaborative structure predominated and increased from early- to late-in-treatment sessions. We discuss the implications of the results in terms of treatment manual revisions and directions for future research.

Adolescent↗
PubMed1992

The first empirical demonstration of transference in psychotherapy.

This study investigates the similarity between patients' relationships with their therapists and patients' relationships with others in their life. We examined the in-session narratives about the therapist and compared them with the patient's general relationship pattern as determined by a previously tested method, the Core Conflictual Relationship Theme (CCRT) method. The source for both narratives and CCRT patterns were transcripts of therapy sessions from 35 consenting outpatients in a university clinic. We found significant similarity between the patterns of relationship with the therapist and with others. One aspect of the relationship pattern, the patient's response to the therapist and to others, was consistently similar. We offer objective evidence in support of an age-old and central tenet of psychodynamic therapy, the transference concept.

Ambulatory Care↗
PubMed1992

The efficacy of brief dynamic psychotherapy: a meta-analysis.

OBJECTIVE: Insurance companies, legislators, and funding agencies have become increasingly concerned with efficacy and accountability in regard to psychotherapy, and psychodynamic therapy is a primary target of concern because it is widely practiced in outpatient settings. This paper is a meta-analytic review of recent well-controlled studies of the efficacy of brief dynamic therapy. METHOD: The meta-analysis included both published studies, located through an extensive computerized search of psychiatry and psychology journals, and studies reported at conferences. Eleven studies met the inclusion criteria: use of a specific form of short-term dynamic psychotherapy as represented in a treatment manual or manual-like guide; comparison of brief dynamic therapy and a waiting list control condition, nonpsychiatric treatment, alternative psychotherapy, pharmacotherapy, or other form of dynamic therapy; provision of the information necessary for calculation of effect sizes; at least 12 therapy sessions; and therapists who were trained and experienced in brief dynamic therapy. The outcome measures compared were target symptoms, psychiatric symptoms generally, and social functioning. RESULTS: Brief dynamic therapy demonstrated large effects relative to waiting list conditions but only slight superiority to nonpsychiatric treatments. Its effects were about equal to those of other psychotherapies and medication. CONCLUSIONS: These data confirm previous indications that various psychotherapies do not differ in effectiveness, although this finding should not be generalized to all patient populations, outcome measures, and treatment types. Also, the highly controlled conditions of these studies limit conclusions about actual practice. Future studies should address various treatment lengths, follow-up assessments, and specific treatments, patient groups, and outcome measures.

Humans↗
PubMed1991

Independent assessment of manic and depressive symptoms by self-rating. Scale characteristics and implications for the study of mania.

We report the reliability and validity of the Internal State Scale, a self-report instrument for the simultaneous assessment of severity of manic and depressive symptoms. The Internal State Scale consists of four empirically derived subscales: Activation, Well-Being, Perceived Conflict, and the Depression Index. All subscales had good internal consistency reliability. Activation subscale scores were significantly higher in manic patients than in depressed patients or control subjects, while Well-Being subscale scores were significantly lower and the Depression Index subscale scores were significantly higher in depressed patients than in the other two groups. Activation subscale scores were correlated specifically with clinician ratings of mania. Depression Index subscale scores were correlated specifically with clinician ratings of depression. Further evidence for the validity of the subscales of the Internal State Scale in reflecting manic or depressive symptoms came from discriminant function analysis in which these subscales assigned 88% of subjects to the correct diagnostic groups. In affectively ill patients who were studied in two or more mood states, Activation, Depression Index, and Well-Being subscale scores changed significantly in the predicted directions, while the same discriminant algorithm assigned 79% of mood states to the correct diagnostic category. Bimodal distribution of scores of manic patients on the Well-Being and Depression Index subscales substantiated earlier findings that euphoric mood is not an essential feature of mania. Based on findings from this and previous studies, the hypothesis is proposed that variables related to activation level, and not to mood state, constitute the core characteristics of the manic syndrome.

Bipolar Disorder↗
PubMed1991

Implications of therapist effects for the design and analysis of comparative studies of psychotherapies.

Technical reasons are presented as to why therapist should be included as a random design factor in the nested analysis of (co)variance (AN[C]OVA) design commonly used in psychotherapy research. Incorrect specification of the ANOVA design can, under some circumstances, result in incorrect estimation of the error term, overly liberal F ratios, and an unacceptably high risk of Type I errors. Review of studies indicates that the great majority of investigators continue to ignore this issue. Computer simulation studies revealed that considerable bias can be introduced by not specifying therapist as a random term. Finally, a reanalysis is presented of data from 10 psychotherapy outcome studies that indicated that therapist effects vary considerably and at times can be large. More recent studies that implement better quality controls appear to demonstrate less variance due to therapist. The implications of these results for the design of future studies are discussed.

Analysis of Variance↗
PubMed1991

What makes Susie cry? A symptom-context study of family therapy.

The aim of this investigation was to examine the context of recurrent crying episodes during family therapy sessions. We tested the relative contribution of social versus individual intrapsychic variables within a 10-session, videotaped, structural family therapy. Segments of therapy before crying episodes when compared with control (non-crying) segments were found to have higher levels of the following variables: involvement with others in the room, rejection, and concern about supplies. Two family variables were also higher before crying episodes: family discussion about patient, and patient receives hostility. A stepwise discriminant function analysis using these variables indicated that family discussion about the patient was most important in signaling onset of crying. The results are discussed in terms of individual and family theories of symptom formation as illuminated through this case study.

Adolescent↗
PubMed1990

Theory-based research for understanding the process of dynamic psychotherapy.

Research is reviewed on 6 theoretical propositions central to psychodynamic psychotherapy: (1) The establishment of an alliance is important to successful outcome; (2) the patient displays a central relationship theme (transference); (3) transference interpretations are helpful; (4) the therapist aims at accurate interpretations of the transference; (5) the patient gains understanding of self and the relationship pattern; and (6) the patient's improvement is reflected in changes in the relationship pattern, although the pattern is still evident. We suggest concepts that are in need of research development: internalization, resistance, working through, self-understanding and insight, and the therapist's adherence to recommended techniques.

Follow-Up Studies↗
PubMed1989

A relationship pattern measure: the core conflictual relationship theme.

Relationship pattern measures are recently developed systems for measuring the main relationship patterns expressed in psychotherapy sessions or in other interviews. They are precise measures of the kind of pattern that dynamic psychotherapists have estimated clinically ever since the start of such therapies. Leading off the comparisons of such measures that are presented in this issue, this paper will (a) describe a relationship pattern measure, (b) illustrate it, and then (c) compare it with one or more other relationship pattern measures. Beyond these purposes our aim is to indicate the values of these new methods for personality and psychotherapy research.

Adult↗
PubMed1988

Clinicians can agree in assessing relationship patterns in psychotherapy. The Core Conflictual Relationship Theme method.

This study examines interjudge agreement on formulations of dynamic themes in psychotherapy, using a session-based method, namely, the Core Conflictual Relationship Theme. Agreement was assessed by two methods: one was based on themes that were tailor-made for each case, while the other was based on coding themes into a standard set of categories. To assess agreement on the tailor-made formulations, a paired-comparisons procedure was used. For a sample of 35 patients, the similarity ratings for matched cases were significantly higher than for purposely mismatched cases. Using the standard set of categories, agreement was also good; weighted kappa values ranged from .61 to .70. The results also demonstrate reliability for the location of the relationship episodes, which form the database for the Core Conflictual Relationship Theme. Our positive results suggest that this guided clinical method can be used reliably as a measure of relationship patterns in psychotherapy; our results provide the first moderate-sized sample demonstration of clinicians' agreement in formulating this complex concept.

Attitude of Health Personnel↗