Do personality problems improve during psychodynamic supportive–expressive psychotherapy? Secondary outcome results from a randomized controlled trial for psychiatric outpatients with personality disorders.

Abstract

Studies involving patients with personality disorders (PD) have not focused on improvement of core aspects of the PD. This paper examines changes in quality of object relations, interpersonal problems, psychological mindedness, and personality traits in a sample of 156 patients with DSM-IV PD diagnoses being randomized to either manualized or non manualized dynamic psychotherapy. Effect sizes adjusted for symptomatic change and reliable change indices were calculated. We found that both treatments were equally effective at reducing personality pathology. Only in neuroticism did the non manualized group do better during the follow-up period. The largest improvement was found in quality of object relations. For the remaining variables only small and clinically insignificant magnitudes of change were found.The prevalence of personality disorders (PD) among psychiatric patients ranges between 31 -45 % (Samuels et al., 2002). Psychotherapeutic treatment in general and dynamic therapy in particular has increasingly shifted from a long term to briefer time formats. As a result, the focus of brief dynamic psychotherapies has shifted from restructuring personality Publisher's Disclaimer:The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/journals/pst. NIH Public AccessAuthor Manuscript Psychotherapy (Chic). Author manuscript; available in PMC 2010 September 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript pathology to a focus on symptom reduction. For these briefer treatments, however, there is so far no substantial evidence for their capacity to reduce character pathology.A comprehensive meta-analysis of 25 clinical trials with patients with PD (Leichsenring & Leibing, 2003) indicated that most studies had focused on symptomatic measures such as the Symptom Check List-90 (SCL-90, Derogatis, 1997), Beck Depression Inventory (BDI, Beck & Steer, 1988), and Global Adjustment Scale (GAS, First, Spitzer, & Gibbon, 1997). Few of these studies included measures assessing core PD pathology. For example, interpersonal problems, often considered a major aspect of PD pathology, were assessed in only two psychodynamic studies (Bateman & Fonagy, 2001Muran, Safran, Samstag, & Winston, 2005). Furthermore, measures theoretically relevant to the goals of psychodynamic psychotherapy (e.g., reflective functioning and levels or forms of attachment) have surprisingly rarely been used (for an exception see Levy et al., 2006).Improving maladaptive personality functioning is of considerable importance for patients with PD. Crits-Christoph and Barbe...

Estudos clínicos em psicoterapia psicodinâmica: uma revisão do follow-up das intervenções

“…As modalidades de psicoterapia avaliadas foram: psicoterapia psicodinâmica -PP (Lilliengren et al, 2015;Berghout e Zevalkink, 2009); psicoterapia psicodinâmica de curto prazo -PPCP (Leichsenring et al, 2014;Amianto et al, 2011); psicoterapia psicodinâ-mica de longo prazo -PPLP (Leichsenring et al, 2014;Arvidsson et al, 2011); psicoterapia psicodinâmica intensiva e curto prazo -PPI-CP (Solbakken e Abbass, 2015); psicoterapia psicodinâmica intensiva -PPI (Abass et al, 2015); psicoterapia psicodinâmica de apoio -PPA (Driessen et al, 2013); psicoterapia psicodinâmica breve -PPB (Amianto et al, 2011); psicoterapia psicodinâmica focal -PPF (Zipfel et al, 2014); tratamento comunitário de foco psicodinâmico -TCFP (Vinnars et al, 2009); psicoterapia psicodinâmica interpessoal -PIT (Sattel et al, 2012); psicoterapia psicodinâmica pela internet -PPIN (Johansson et al, 2013); psicanálise -PA (Grande et al, 2009); psicaná-lise com predomínio de interpretações transferências -PAT e sem interpretações transferenciais -PAST (Høglend et al, 2008) e terapia cognitivo comportamental -TCC; (Levi et al, 2015;Zipfel et al, 2014); terapia cognitivo comportamental pela internet -TCCI (Johansson et al, 2013); terapia do esquema -TE (Gude e Hoffart., 2008); terapia de apoio -TA (Vinnars et al, 2009); e, terapia focal -TF (Heinonen et al, 2012). Foram encontradas também intervenções com medicamentos como a fluoxetina (Sørensen et al, 2011), sozinhos ou combinados com psicoterapia psicodinâmica (Koppers et al, 2011); e também intervenções combinadas com outros tratamentos multidisciplinares, tais como dieta alimentar e acompanhamento familiar (Abba-te Daga et al, 2015).…”

“…Outro método utilizado para complementar os questionários foram entrevistas presenciais semiestruturadas desenvolvidas para o próprio estudo, ou entrevistas estruturadas, por exemplo: Operationalized Psychodynamic Diagnosis -OPD Task Force (Levi et al,2015;Vinnars et al, 2009;Marttunen et al, 2008;Johansson et al, 2013;Kronström et al, 2009;Koppers et al, 2011;Høglend et al, 2008;Gude e Hoffart, 2008;Abbate-Daga et al, 2015;Berghout e Zevalkink, 2009;Lilliengren et al, 2015;Grande et al, 2009;Arvidson et al, 2011;Leichsenring et al, 2014). O estudo que avaliou custo-efetividade dos serviços de saúde também utilizou, além dos questionários, os registros nacionais de verificação para compor as medidas de follow-up (Abass et al, 2015).…”

“…Em oito deles, foram comparadas intervenções psicanalíticas com tratamentos "as usual" (TAU), ou com grupo controle (GC). Em cinco estudos, a PP foi superior (Sattel et al, 2012;Amianto et al, 2011;Hasse et al, 2008;Zipfel et al, 2014;Lilliengren et al, 2015), e em dois, pacientes de ambos os estudos melhoraram e os resultados se mantiveram no follow-up (Scheidt et al, 2013;Vinnars et al, 2009).…”

Psychodynamic profile and reflective functioning in patients with bulimia nervosa

“…Previously, the KAPP has been used in psychosomatic research (ulcerative colitis, [11]; adult atopic dermatitis [12]), in personality disorder research (personality change after brain injury [13]); in borderline and organic personality disorder [14], in psychotherapy research [15][16][17][18]; and in substance abuse research [19,20]. Only one previous study has, however, examined the KAPP profile of patients with eating disorders [21], and the sample size in that study was quite small (n = 16) and consisted of both patients with AN (n = 7) and BN (n = 9).…”

The effectiveness of short- and long-term psychotherapy on personality functioning during a 5-year follow-up

“…They have shown that improvements extending beyond the end of treatment can be attained in many aspects of personality functioning, e.g. quality of object relations and interpersonal problems, reflecting quality and extent of characteristic behavior patterns (Vinnars et al, 2009), and defense mechanisms (Bond and Perry, 2004;Perry and Bond, 2012). Instead, comparisons between various short-term therapies have mostly found no significant differences across different outcome domains for patients with depressive and anxiety disorder (Abbass et al, 2011;Cuijpers et al, 2010;Driessen et al, 2013;Salzer et al, 2011;Slavin-Mulford and Hilsenroth, 2011), albeit some studies have shown lesser (Leichsenring et al, 2013b;Watzke et al, 2012) and some greater (Kallestad et al, 2010) effects in different aspects of personality functioning after short-term psychodynamic therapy in comparison to other therapies.…”