How to measure sustained psychic transformations in long-term treatments of chronically depressed patients: Symptomatic and structural changes in the LAC Depression Study of the outcome of cognitive-behavioural and psychoanalytic long-term treatments

Leuzinger‐Bohleber, Marianne; Kaufhold, Johannes; Kallenbach, Lisa; Negele, Alexa; Ernst, Mareike; Keller, Wolfram; Fiedler, Georg Martin; Hautzinger, Martin; Bahrke, Ulrich; Beutel, Manfred E.

doi:10.1080/00207578.2018.1533377

Cited by 47 publications

(18 citation statements)

References 38 publications

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“…Finally, considering metacognition and psychic structure as potential indicators of change during psychotherapy that can only be observed after an adequate amount of time (Leuzinger-Bohleber et al, 2019), longitudinal study designs are needed in addition to the cross-sectional analyses conducted here.…”

Section: Discussionmentioning

confidence: 99%

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

et al. 2020

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Synthetic metacognition is defined by integrative and contextualizing processes of discrete reflexive moments. These processes are supposed to be needed to meet intrapsychic as well as interpersonal challenges and to meaningfully include psychotic experience in a personal life narrative. A substantial body of evidence has linked this phenomenon to psychosocial functioning and treatment options were developed. The concept of synthetic metacognition, measured with the Metacognition Assessment Scale-Abbreviated (MAS-A), rises hope to bridge gaps between therapeutic orientations and shares valuable parallels to modern psychodynamic constructs, especially the 'levels of structural integration' of the Operationalized Psychodynamic Diagnosis (OPD-2). As theoretical distinctions remain, aim of this study was to compare the predictive value of both constructs with regard to psychosocial functioning of patients with non-affective psychoses, measured with the International Classification of Functioning, Disability and Health (MINI-ICF-APP). It was further explored if levels of structural integration (OPD-LSIA) would mediate the impact of metacognition (MAS-A) on function (MINI-ICF-APP). Expert ratings of synthetic metacognition (MAS-A), the OPD-2 'levels of structural integration' axis (OPD-LSIA), psychosocial functioning (MINI-ICF-APP) and assessments of general cognition and symptoms were applied to 100 individuals with non-affective psychoses. Whereas both, MAS-A and OPD-LSIA, significantly predicted MINI-ICF-APP beyond cognition and symptoms, OPD-LSIA explained a higher share of variance and mediated the impact of MAS-A on MINI-ICF-APP. Levels of structural integration, including the quality of internalized object representations and unconscious interpersonal schemas, might therefore be considered as valuable predictors of social functioning and as one therapeutic focus in patients with non-affective psychoses. Structural integration might go beyond and form the base of a person's actual reflexive and metacognitive capabilities. Psychotherapeutic procedures

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Section: Discussionmentioning

confidence: 99%

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

et al. 2020

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“…One particular difficulty in treating patients with severe chronic depression is approaching psychic pain and helping them face the unbearable thoughts that often underlie depression ( Leuzinger-Bohleber et al, 2019 ). Clinicians turning their attention to this psychological pain certainly help patients strengthen the self and regain a sense of self-agency.…”

Section: Discussionmentioning

confidence: 99%

Defense Mechanisms and Treatment Response in Depressed Inpatients

et al. 2021

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The study investigated the extent to which defensive functioning and defense mechanisms predict clinically meaningful symptomatic improvement within brief psychodynamic psychotherapy for recurrent and chronic depression in an inpatient setting. Treatment response was defined as a reduction in symptom severity of 46% or higher from the baseline score on the Montgomery–Asberg Depression Rating Scale (MADRS). A subsample of 41 patients (19 responders and 22 non-responders) from an RCT was included. For each case, two sessions (the second and the penultimate) of brief inpatient psychodynamic psychotherapy (a manualized 12-session therapy program developed in Lausanne) were transcribed and then coded using the Defense Mechanism Rating Scales (DMRS) and the Psychotic Defense Mechanism Rating Scales (P-DMRS), an additional scale developed to study psychotic defenses. Results showed that defensive functioning and mature and immature defense changed during psychotherapy and predicted treatment response. Patient’s defenses observed throughout therapy also predicted treatment response at 12-month follow-up. The addition of psychotic defenses allows a better prediction of the treatment response. Overall, these results are in line with previous research and provide further validation of defensive functioning as a predictor of outcomes and a mechanism of change in psychotherapy.

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“…(Huber, Zimmermann, & Klug, 2017). Die von in mehreren Artikeln (Kaufhold et al, 2019;Leuzinger-Bohleber, Kaufhold, et al, 2019) Unterschieden zwischen den Effekten von kognitiven und psychodynamischen Methoden (Luborsky et al, 2006), sodass bereits beim Studiendesign ein Equivalenz-oder "noninferiority"-Design hätte nahe liegen müssen. Fraglich ist daher zum Beispiel, warum nicht zumindest der sensitivere Grenzwert von d = 0,2 gewählt wurde, der mit plausibler Argumentation als Grenzwert für tatsächlich vernachlässigbare Behandlungsunterschiede angesehen werden sollte (Rief & Hofmann, 2019).…”

Section: Die Diversen Publikationen Zur Lac-studie Variieren Stark Inunclassified

Was sagt die LAC-Depressionsstudie wirklich aus? Eine methodenkritische Betrachtung.

Kaiser¹,

Kolar²,

Schuster³

et al. 2019

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Mit großem Interesse haben wir daher die erneute Publikation (Leuzinger-Bohleber, Hautzinger, Keller, et al., 2019) der Ergebnisse der Studie zu Langzeitbehandlungen bei chronisch depressiven Patienten (kurz: LAC-Studie) gelesen. Bislang haben die Autoren die regelmäßig veröffentlichten „Tranchen“ des sicherlich beträchtlichen Datensatzes dieses Forschungsprojektes lediglich im kleinen Kreis diskutiert. Da dieses Mal auch in Medien für interessierte Laien (Padberg, 2019) darüber berichtet wurde und die Studie als Beleg für eine vergleichbare Effektivität von Psychoanalyse und kognitiver Verhaltenstherapie verwendet wird, würden wir gerne die Gelegenheit wahrnehmen, diese zu kommentieren.

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How to measure sustained psychic transformations in long-term treatments of chronically depressed patients: Symptomatic and structural changes in the LAC Depression Study of the outcome of cognitive-behavioural and psychoanalytic long-term treatments

Cited by 47 publications

References 38 publications

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

Defense Mechanisms and Treatment Response in Depressed Inpatients

Was sagt die LAC-Depressionsstudie wirklich aus? Eine methodenkritische Betrachtung.

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