Metaphor and the politics and poetics of youth distress in an evidence-based psychotherapy

This article explores the relationship between metaphors and emotion in the context of adolescent distress and psychotherapeutic treatment. Drawing on data from an ethnographic study of Mexican American adolescents receiving outpatient treatment for a variety of emotional and behavioral problems, the article examines what I call “prescribed” metaphors deployed in mainstream, manualized child and adolescent Cognitive Behavioral Therapies commonly used in mainstream clinical contexts. I explore the models of emotion communicated to youth by one such metaphor, youth responses to this metaphor, and the potential implications for young people as they take up the underlying models and affective practices embedded in the metaphor. Specifically, I examine how youth respond to messages about emotion metacognition and emotion regulation embedded in a metaphor that equates feelings with temperatures that can be monitored and objectively measured. I find that youth are at once convinced that abstract knowledge about internal states is inherently valuable because it is linked to desired forms of personhood, but also concerned about the limits of technical metaphors to capture aspects of lived experience and the flattening and homogenization of affect that might accompany the practices such metaphors help to enact. I analyze alternative interpretations of prescribed metaphors as well as the spontaneous metaphors used by youth to talk about their emotions and experiences of distress, in an effort to think through the politics and poetics of emotion metaphors in the context of an evidence-based psychotherapy for young people.

Medication-enhanced psychotherapy for posttraumatic stress disorder: Recent findings on oxytocin’s involvement in the neurobiology and treatment of posttraumatic stress disorder

Background Traumatic experiences may result in Posttraumatic Stress Disorder (PTSD), which is characterized as an exaggerated fear response that cannot be extinguished over time or in safe environments. What are beneficial psychotherapeutic treatment options for PTSD patients? Can oxytocin (OXT), which is involved in the stress response, and safety learning, ameliorate PTSD symptomatology and enhance psychotherapeutic effects? Here, we will review recent studies regarding OXT’s potential to enhance psychotherapeutic therapies for PTSD treatment. Method We conducted a literature review on the neurobiological underpinnings of PTSD especially focusing on OXT’s involvement in the biology and memory formation of PTSD. Furthermore, we researched successful psychotherapeutic treatments for PTSD patients and discuss how OXT may facilitate observed psychotherapeutic effects. Results For a relevant proportion of PTSD patients, existing psychotherapies are not beneficial. OXT may be a promising candidate to enhance psychotherapeutic effects, because it dampens responses to stressful events and allows for a faster recovery after stress. On a neural basis, OXT modulates processes that are involved in stress, arousal and memory. OXT effectively counteracts memory impairments caused by stress and facilitates social support seeking which is a key resilience factor for PTSD and which is beneficial in psychotherapeutic settings. Conclusion OXT has many characteristics that are promising to positively influence psychotherapy for PTSD patients. It potentially reduces intrusions, but preserves memory of the event itself. Introducing OXT into psychotherapeutic settings may result in better treatment outcomes for PTSD patients. Future research should directly investigate OXT’s effects on PTSD, especially in psychotherapeutic settings.

An Innovative Project of a Bionic Robot for Social Applications in Felinotherapy

The paper describes an innovative design of a bionic robot for applications in felinotherapy supporting hospital and home psychotherapeutic treatment of bedridden children and adults. The project was engineered by biomimicrating a biological cat, reaching its robotic model. Particular attention in this process was devoted to capturing the essence of feline motorics behavior and the possibility of mapping them in a mechatronic model. The geometry, kinematics and kinetics of this model were analyzed, creating assumptions for its practical implementation in the real mechanism of cat skeleton movement. The used software used the topology of elements in Autodesk Fusion 360 Simulation workspace by performing the critical elements of the mechatronic model in print using SLS technology. The work was also supported by a graphical simulation in the PyBullet environment.

A Research Paradigm to Investigate Event-Related Shame and Guilt: Preliminary Findings

Our aim was to study effects of different psychotherapeutic treatment components on event-related emotions and psychological symptoms. In this pilot study, we wanted to evaluate if our audiotaped memory retrieval task (MRT) is able to elicit event-related emotions. Also, we made a first attempt to compare the effects of two standardized mini-interventions based on IRRT and PE on event-related shame and guilt, general distress and affective state.

Prevalence of multimodal treatment in children and adolescents with ADHD in Germany: a nationwide study based on health insurance data

Background Attention-deficit hyperactivity disorder (ADHD) ranks top among neurodevelopmental disorders in children and adolescents. Due to a large number of unfavorable outcomes including psychiatric comorbidities, school problems, and lower socioeconomic status, early and effective treatment of ADHD is essential. Multimodal treatment has become the gold standard in ADHD management, comprising pharmacotherapy and psychosocial interventions, e.g., psychotherapy. Yet, little is known about the prevalence of multimodal treatment in routine care. Methods Based on German health claims data for the years 2009–2017, we identified children and adolescents aged 3–17 years diagnosed with ADHD and characterized them cross-sectionally (per calendar year) in terms of treatment status and psychiatric comorbidities. The detection of pharmacotherapy was based on dispensations of drugs to treat ADHD (e.g., methylphenidate); psychotherapeutic treatment was based on corresponding billing codes. Multimodal treatment was assumed if ADHD medication and psychotherapeutic treatment were coded within the same calendar year. Psychiatric comorbidities were based on outpatient and inpatient diagnoses. Prevalences of ADHD and proportions of different treatment options were calculated and standardized by age and sex. Results In 2017, 91,118 children met the study criteria for ADHD (prevalence: 42.8/1000). Of these, 25.2% had no psychiatric comorbidity, 28.8% had one, 21.6% had two, and 24.5% had three or more. Regarding overall treatment status, 36.2% were treated only pharmacologically, 6.5% received multimodal treatment, and 6.8% were treated with psychotherapy only (neither treatment: 50.2%). With increasing numbers of psychiatric comorbidities, the proportions of patients with multimodal treatment increased from 2.2% (no psychiatric comorbidities) to 11.1% (three or more psychiatric comorbidities) while the proportions of untreated (from 56.8% to 42.7%) or only pharmacologically treated patients (38.4% to 35.0%) decreased. From 2009 to 2017, prevalences were stable and the proportion of patients with only pharmacotherapy decreased from 48% to 36.5%. Concurrently, the proportion of patients with neither pharmacotherapy nor psychotherapy increased from 40.5% to 50.2%. The fraction of patients with multimodal treatment ranged between 6.5% (2017) and 7.4% (2013). Conclusions Multimodal treatment, although recommended as the standard of treatment, is rather the exception than the rule. It is, however, increasingly common in ADHD patients with psychiatric comorbidities.

OXTR-Related Markers in Clinical Depression: a Longitudinal Case–Control Psychotherapy Study

We investigated stability and change of plasma and urinary oxytocin as well as OXTR DNA methylation patterns through psychotherapy. Furthermore, we explore the potential impact of inpatient psychotherapy on oxytocin-related biomarkers and vice versa by differentiating patients who remitted from depression versus non-remitters. Blood and urine samples were taken from 85 premenopausal women (aged 19–52), 43 clinically depressed patients from a psychosomatic inpatient unit, and 42 healthy control subjects matched for age and education at two points of time. Serum and urine oxytocin was measured using standard ELISA, and DNA methylation of the OXTR gene was assessed using bisulfite sequencing at the time of admission (baseline) and at discharge and from controls at matched time points. Oxytocin plasma levels were not associated with depression and were influenced by neither time in healthy controls nor psychotherapy in patients. Non-remitting depressed patients had significantly lower oxytocin urine levels before and after psychotherapy treatment. We found significantly lower exon 1 OTXR methylation in depressed patients over time and these differences were driven by patients remitting due to psychotherapy. A reverse pattern — higher levels of methylation in remitters — was found for exon 2 OXTR DNA methylation. Plasma oxytocin, urinary oxytocin, and OXTR DNA methylation patterns were intrapersonally relatively stable. OXTR-related factors were seemingly unaffected by inpatient psychotherapeutic treatment, but we found significant differences between remitting and non-remitting patients in urinary oxytocin and OXTR DNA methylation. If replicated, this suggests that OXTR-related markers may predict inpatient treatment outcomes of clinically depressed patients.

Evaluating the structural reform of outpatient psychotherapy in Germany (ES-RiP trial) - a qualitative study of provider perspectives

Background Access to outpatient mental healthcare can be challenging for patients. In Germany, a national structural reform was implemented in 2017 to accelerate and enhance access to outpatient psychotherapy and reduce waiting times. During the first phase of the study ‘Evaluation of a structural reform of the outpatient psychotherapy guideline (ES-RiP)’ and embedded into a process evaluation, the implementation was to be evaluated through assessing general practitioners’ (GPs) and psychotherapists’ (PTs) perspectives regarding utilization of provided new measures, and perceived potential for optimization. Particular focus was on patients with a comorbidity of mental disorders and chronic physical conditions (cMPs). Methods This exploratory cross-sectional qualitative study used on-site and online focus group discussions and semi-structured telephone interviews with GPs and outpatient PTs. Generated data were analyzed using thematic framework analysis. Descriptive statistics were used to analyze participant characteristics collected via a socio-demographic questionnaire. Results Perspectives on the structural reform were heterogenous. GPs and PTs considered the component of timely initial psychotherapeutic assessment consultations beneficial. GPs disapproved of their deficits in detailed information about the structural reform and exchange with outpatient PTs. Improvement suggestions included structured short information exchange and joint quality circles. The overall number of available outpatient PTs in rural areas was perceived as insufficient. For patients with cMPs, GPs saw patient barriers for therapy access and continuity in low intrinsic motivation, physical impediments and older age. PTs also saw patient challenges regarding low intrinsic motivation and keeping scheduled appointments. They considered post-reform administrative efforts to be high and reported that the regulations (conformity) lead to planning difficulties and financial losses. Reform elements were tailored to fit in with PTs key therapy areas. Stronger networking and joint lectures were suggested as remedy for the currently still limited exchange with GPs. Unlike the GPs, PTs emphasized that accepting patients into psychotherapeutic treatment was independent of a possibly present chronic physical disease. Conclusions The findings contribute to understanding the integration of the delivered structural reform into daily care processes and provide an indication about reached targets and potential improvements. Further phases of the ES-RiP study can build on the findings and broaden insights. Trial registration Registration-ID DRKS00020344 (DRKS German Register of Clinical Trials.

ON PSYCHOTHERAPEUTIC TREATMENT OF PHYSICAL TRAUMA CONSEQUENCES IN GESTALT APPROACH PERSPECTIVE. AUTHOR'S METHOD OF MICRO-MOTION REACTIONS RESTORATION (MRR)

Физическая травма и лечение ее последствий в основном находится в сфере задач специалистов-медиков. Но вряд ли мы можем себе представить, что какое-либо физическое воздействие может привести только к телесному повреждению. Фактически, человек сталкивается с рядом психологических последствий, начиная ограничениями, вызванными болью, заканчивая тонкими изменениями в жизненной ситуации и отношениях. Таким образом, можно считать, что пациенты с последствиями физических травм могут успешно получать помощь и у психологов. В статье предлагается и описывается метод восстановления микродвигательных реакций (ВМР). Этот метод основан на принципе дифференциации микродвигательных реакций. В нашем подходе мы используем концепцию «незавершенных дел», происходящую из гештальт-терапии. Метод ВМР позволяет развивать различные разнонаправленные и противоречивые импульсы и реакции, которые были временно остановлены в эпизоде перенесенной физической травмы. Такой вид работы дает каждому незавершенному двигательному импульсу, рожденному во время травмы, полностью развиться. В результате восстанавливается вера в спонтанность движений и увеличивается резилентность пациента. Также в статье представлены три клинических случая, демонстрирующих возможности использования метода ВМР в психотерапевтической работе. Physical trauma and treatment of its consequences basically lies in the domain of medical specialists. But we would hardly imagine that some physical injury may result in bodily impairment only. As a matter of fact, one encounters with a number of psychological consequences from restriction caused by pain to subtle changes in life situation and relationships. Thus, we can consider that patients with physical trauma consequences may be also successfully treated by psychologists. Micro-motion reactions restoration method (MRR) is suggested and described in the article. This method is based on the principle of micro-motion reactions differentiation. In our approach we are using the concept of “unfinished tasks” which originates from Gestalt therapy. The MRR method enables development of various multidirectional and contradictory impulses and reactions that had been temporarily stalled in the episode of past physical trauma. That type of work permits each unfinished motion impulse born during trauma to develop completely. As a result, trust in spontaneity of movement is restored and one’s resilience grows. Also three clinical cases are presented in the article to demonstrate the possibilities of using the MRR method in psychotherapeutic work.

Attachment Orientations Mediate the Effect of World Assumptions on Posttraumatic Stress in Survivors of Childhood Sexual Abuse

Recent research indicates that world assumptions are broad cognitive-affective schemas that affect attachment orientations in close relationships which in turn affect psychological symptoms severity. The present study analyzed if adult attachment mediated the effect of world assumptions (worthiness of the self, benevolence and meaningfulness of the world) on PTSD symptoms (PTS), in survivors of childhood sexual abuse during treatment for PTSD. Sample included 327 individuals who were sexually abused in childhood. Variables were assessed using self-report measures. Structural equation modeling was conducted to examine if the effect of world assumptions at the beginning of psychotherapeutic treatment (T1) on PTS levels 12 months after the beginning of psychotherapeutic treatment (T3) was mediated by both attachment avoidance and attachment anxiety six months after the beginning of treatment (T2). Attachment avoidance fully mediated the effect of both worthiness of the self and benevolence of the world at T1 on PTS at T3 was mediated by both attachment anxiety and attachment avoidance at T2. Findings suggest that world assumptions are broad cognitive-affective schemas about the self and the world that have their actual expression in close relationships which mediate the effect of world assumptions on PTS levels.

Social Phobia and Evasiveness: Trial Protocol for a Feasibility, Superiority, Randomized Controlled Trial of the Effect of Modified Collaborative Assessment vs. Standard Assessment on Patients’ Readiness for Psychotherapy (CO-ASSM-RCT).

BackgroundEvasive personality disorder (EPD) and social phobia (SP) have substantial costs to the patients and their families, and great economic costs to the community. While psychotherapy can be an efficient treatment, a large percentage of patients drop-out during treatment. Little is known about what can be done in order to decrease dropout from psychotherapy in general, including how to increase a patient’s readiness for psychotherapy. MethodsWe describe a feasibility randomized controlled trial of 42 individuals with a clinical diagnosis of either SP or evasive personality disorder, who are to initiate psychotherapeutic treatment in Danish outpatient mental health services. They will be randomized in a 1:1 ratio to either assessment-as-usual and receive no further assessment, or to a Modified Collaborative Assessment (MCA) provided as a pre-treatment intervention before psychotherapy initiation. MCA will included a battery of psychological tests designed to thoroughly assess the patients’ psychopathology. The tests is administered in collaboration with the patient including a detailed oral and written feedback. We hypothesize that the patients randomized to MCA will reach higher levels of readiness for psychotherapy as assessed with the University of Rhode Island Change Assessment Scale (URICA) and have lower dropout-rates than assessment-as-usual. DiscussionThis protocol assess the feasibility, efficacy, acceptability, and safety of an intervention aimed at changing the readiness for participation in psychotherapy for patients with SP and EVP. Results from this feasibility study could guide the development of future large-scale trials of MCA and procedures for MCA treatment fidelity assessment.