1,721,049 research outputs found
Empirically supported treatments - Scientific theory and methodology in controlled versus naturalistic studies
No full textThe present article addresses the question which kind of evidence is required to demonstrate that a method of psychotherapy works. Referring to recent conceptualizations of the logical structure of scientific theories, that is the structuralistic view of theories, the author shows that randomized controlled studies (RCTs) and naturalistic studies refer to different domains of intended applications (laboratory vs. field). This view has several important implications: (L) RCTs and naturalistic studies are not in a competitive relationship, but refer to different questions of research. (2.) RCTs and naturalistic studies do not a priori differ concerning their internal and external validity. (3.) In principal, naturalistic studies do not provide lower level evidence than RCT's. (4.) Evidence from RCTs cannot be transferred to psychotherapeutic practice in the field. (5.) Naturalistic studies provide evidence for the question if a therapy works in the field. (6.) The proposed catalogues for levels of evidence focus on RCTs. Thus, they cannot be applied to hypotheses referring to the question if a therapy works in the filed (naturalistic studies). (7.) It is necessary to define separate criteria for levels of evidence of naturalistic studies. In this article, a proposal is made to define levels of evidence of naturalistic studies. (8.) A research agenda for naturalistic studies is derived
The effectiveness of psychodynamic therapy. A review using criteria of evidence-based medicine
No full textObjectives: The existing studies on the effectiveness of psychodynamic therapy are reviewed. Methods: All studies published between 1960 and 2001 were collected. In the first part of this survey, the focus is on short-term psychodynamic therapy, the second part focuses on longer-term psychoanalytic and psychodynamic therapy. The studies are reviewed with regard to forms of disorders. The methodological quality of the studies is judged according to criteria of evidence-based medicine. These criteria themselves are also critically discussed. Results: Although they vary concerning their methodological quality, the studies reveal evidence of the effectiveness of both short-term and long-term psychodynamic therapy. In a meta-analytic evaluation performed by the author, substantial effects were found for psychodynamic therapy of personality disorders, i.e. 1.13 (self-report measures) and 1.57 (observer-rated measures) for short-term psychodynamic therapy and 1.05 (self-report measures) and 2.11 (observer-rated measures) for longer term psychodynamic therapy. Conclusions: Although there is evidence of the effectiveness of psychodynamic therapy, further research of specific forms of psychodynamic therapy in specific disorders is necessary
Randomized controlled versus naturalistic studies: A new research agenda
No full textThe present article addresses the question of what kind of evidence is required to demonstrate that a method of psychotherapy works. Referring to recent conceptualizations of the logical structure of scientific theories, that is, the structuralistic view of theories, the author shows that randomized controlled studies (RCTs) and naturalistic studies (effectiveness studies) refer to different domains of intended applications (laboratory vs. field). This view has several important implications: (1) RCTs and naturalistic studies do not differ concerning their internal and external validity; (2) naturalistic studies do not necessarily provide lower-level evidence than RCTs; (3) evidence from RCTs cannot be transferred to psychotherapeutic practice in the field; (4) naturalistic studies are required to demonstrate that a form of therapy works in the field; (5) The proposed catalogues for levels of evidence focus on RCTs; thus, they cannot be applied to the question if a therapy works in the field; (6) It is necessary to define separate criteria for levels of evidence of naturalistic studies; and (7) a new research agenda for naturalistic studies can be derived, which is analogous to that of efficacy studies. In this article, a proposal is made to define levels of evidence of naturalistic studies. A gold standard for naturalistic studies is proposed
The effectiveness of psychodynamic therapy. A review using criteria of evidence-based medicine
No full textObjectives: The existing studies on the effectiveness of psychodynamic therapy are reviewed. Methods: All studies published between 1960 and 2001 were collected. In the first part of this survey, the focus is on short-term psychodynamic therapy, the second part focuses on longer-term psychoanalytic and psychodynamic therapy. The studies are reviewed with regard to forms of disorders. The methodological quality of the studies is judged according to criteria of evidence-based medicine. These criteria themselves are also critically discussed. Results: Although they vary concerning their methodological quality, the studies reveal evidence of the effectiveness of both short-term and long-term psychodynamic therapy. In a meta-analytic evaluation performed by the author, substantial effects were found for psychodynamic therapy of personality disorders, i.e. 1.13 (self-report measures) and 1.57 (observer-rated measures) for short-term psychodynamic therapy and 1.05 (self-report measures) and 2.11 (observer-rated measures) for longer term psychodynamic therapy. Conclusions: Although there is evidence of the effectiveness of psychodynamic therapy, further research of specific forms of psychodynamic therapy in specific disorders is necessary
Empirically supported treatments - Scientific theory and methodology in controlled versus naturalistic studies
No full textThe present article addresses the question which kind of evidence is required to demonstrate that a method of psychotherapy works. Referring to recent conceptualizations of the logical structure of scientific theories, that is the structuralistic view of theories, the author shows that randomized controlled studies (RCTs) and naturalistic studies refer to different domains of intended applications (laboratory vs. field). This view has several important implications: (L) RCTs and naturalistic studies are not in a competitive relationship, but refer to different questions of research. (2.) RCTs and naturalistic studies do not a priori differ concerning their internal and external validity. (3.) In principal, naturalistic studies do not provide lower level evidence than RCT's. (4.) Evidence from RCTs cannot be transferred to psychotherapeutic practice in the field. (5.) Naturalistic studies provide evidence for the question if a therapy works in the field. (6.) The proposed catalogues for levels of evidence focus on RCTs. Thus, they cannot be applied to hypotheses referring to the question if a therapy works in the filed (naturalistic studies). (7.) It is necessary to define separate criteria for levels of evidence of naturalistic studies. In this article, a proposal is made to define levels of evidence of naturalistic studies. (8.) A research agenda for naturalistic studies is derived
Are psychodynamic and psychoanalytic therapies effective? A review of empirical data
No full textThere is a need for empirical outcome research in psychodynamic and psychoanalytic therapy. However both the approach of empirically supported therapies (EST) and the procedures of evidence-based medicine (EBM) have severe limitations making randomised controlled trials (RCTs) an absolute standard. After a critical discussion of this approach, the author reviews the empirical evidence for the efficacy of psychodynamic psychotherapy in specific psychiatric disorders. The review aims to identify for which psychiatric disorders RCTs of specific models of psychodynamic psychotherapy are available and for which they are lacking, thus providing a basis for planning further research. In addition, results of process research of psychodynamic psychotherapy are presented. As the methodology of RCTs is not appropriate for psychoanalytic therapy, effectiveness studies ofpsychoanalytic therapy are reviewed as well. Studies of psychodynamic psychotherapy published between 1960 and 2004 were identified by a computerised search using Medline, PsycINFO and Current Contents. In addition, textbooks and journal articles were used. Twenty-two RCTs were identified of which 64% had not been included in the 1998 report by Chambless and Hollon. According to the results, for the following psychiatric disorders at least one RCT providing evidence for the efficacy of psychodynamic psychotherapy was identified: depressive disorders (4 RCTs), anxiety disorders (1 RCT), post-traumatic stress disorder (1 RCT), somatoform disorder (4 RCTs), bulimia nervosa (3 RCTs), anorexia nervosa (2 RCTs), borderline personality disorder (2 RCTs), Cluster C personality disorder (1 RCT), and substance-related disorders (4 WE). According to results of process research, outcome in psychodynamic psychotherapy is related to the competent delivery of therapeutic techniques and to the development of a therapeutic alliance. With regard to psychoanalytic therapy, controlled quasi-experimental effectiveness studies provide evidence that psychoanalytic therapy is (1) more effective than no treatment or treatment as usual, and (2) more effective than shorter forms of psychodynamic therapy. Conclusions are drawn for future research
The phenomenology and psychodynamics of affects in borderline patients
No full textThis paper presents a review of the phenomenology and psychodynamics of affects in borderline patients. The first part demonstrates that in most current conceptions of the borderline disorder affective disturbances are regarded as to be characteristic. In this context, the strong overlap between borderline disorders and affective disorders found in many empirical studies is described and different hypotheses are presented to explain this phenomenon. The second part of this review is concerned with the psychodynamics of affects in borderline patients. The role of affects in thinking, behaviour, self perception and the regulation of object relations is discussed. Borderline and other severe personality disorders are assessed from the perspective of affective disturbances. The psychodynamic functions of particularly characteristic affects such as anger, anxiety, depression and boredom are discussed. The close connection between affective and cognitive functioning in borderline patients is described and evaluated with regard to modern theories of affect and cognition. Finally, the role of affects in the treatment of borderline patients is discussed
The role of structure in the assessment of psychopathology
No full textThis study investigated the role that the structure of a diagnostic instrument plays in the assessment of personality functioning. Empirical studies have shown that the cards of the Rorschach and Holtzman Inkblot, Technique (HIT) vary significantly with regard to their structure. Thus, it was possible to investigate if cards of high vs. low structure tend to elicit specific diagnostically useful responses. For this purpose, samples of normals (n = 30), patients with neurotic disorders (n = 30), borderline patients (n = 30), acute schizophrenics (n = 25), and chronic schizophrenics (n = 25) were studied with the HIT. For each diagnostic group it was examined if cards of high vs low structure tended to elicit more thought disordered responses, hostility, and anxiety according to the HIT scoring system. With regard to structure, two aspects were differentiated, structural vs. interpretative ambiguity of the HIT cards. In all nonschizophrenic groups, cards of high structural ambiguity elicited significantly less thought disordered responses. By contrast, cards of high interpretative ambiguity elicited more thought disordered responses, anxiety, and hostility in all groups except the chronic schizophrenics. The measures of structural vs. interpretative ambiguity of the HIT cards showed a negative correlation in all diagnostic groups. According to these results, both aspects of ambiguity and their interplay play an important rolein the assessment of psychopathology, at least within the range of ambiguity represented by the inkblots of the HIT
Quality of depressive experiences in borderline personality disorders: Differences between patients with borderline personality disorder and patients with higher levels of personality organization
No full textClinical observations suggest that depressive experiences in patients with borderline personality disorder have a specific quality. These experiences are characterized by emptiness and anger ("angry depression") and are associated with primitive forms of object relations. In this study, this observation was tested empirically. A sample of borderline inpatients (N = 30) was compared with a sample of inpatients with higher levels of personality organization suffering from neurotic disorders (N = 30). Depression and other affects were assessed by the Affective Dictionary Ulm (Dahl, Holzer, & Berry, 1992). The quality of object relations was assessed by a scale developed by Urist (1977), which was applied to responses in the Holtzman Inkblot Technique (Holtzman, Thorpe, Swartz, & Herron, 1961). Correlations were assessed between depression, on the one band, and anger, anxiety, and the quality of object relations, on the other band. The clinical observations were confirmed: In the patients with borderline personality disorder, depression showed significant correlations with the affects of anger, anxiety, and fear, and with primitive forms of object relations. In the patients with higher levels of personality organization, no such correlations were found. The results are discussed with regard to the understanding of borderline disorders, diagnosis, and therapy
The phenomenology and psychodynamics of affects in borderline patients
No full textThis paper presents a review of the phenomenology and psychodynamics of affects in borderline patients. The first part demonstrates that in most current conceptions of the borderline disorder affective disturbances are regarded as to be characteristic. In this context, the strong overlap between borderline disorders and affective disorders found in many empirical studies is described and different hypotheses are presented to explain this phenomenon. The second part of this review is concerned with the psychodynamics of affects in borderline patients. The role of affects in thinking, behaviour, self perception and the regulation of object relations is discussed. Borderline and other severe personality disorders are assessed from the perspective of affective disturbances. The psychodynamic functions of particularly characteristic affects such as anger, anxiety, depression and boredom are discussed. The close connection between affective and cognitive functioning in borderline patients is described and evaluated with regard to modern theories of affect and cognition. Finally, the role of affects in the treatment of borderline patients is discussed
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