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.

RATING OF THE SCIENTIFIC INFLUENCE OF ST. PETERSBURG PSYCHOTHERAPISTS WITHIN THE FRAMEWORK OF EVIDENCE-BASED PSYCHOTHERAPY

За последние 30 лет произошла революция в психотерапии под влиянием методологии доказательного подхода. Во всем мире преимущество получили методы доказательной психотерапии. Скорость внедрения результатов исследований в практику предопределяется феноменом научной влиятельности. Для определения данного феномена автор предлагает использовать процентиль по ядру РИНЦ. Впервые был составлен рейтинг научной влиятельности психотерапевтов Санкт-Петербурга. Всего в рейтинге представлен 31 специалист (процентиль по ядру РИНЦ от 4 до 51) из 12 организаций, расположенных по средней величине процентиля по ядру РИНЦ следующим образом: 1) Научный медицинский исследовательский центр психиатрии и неврологии им. В. М. Бехтерева — 16,1; 2) Петербургская школа психотерапии и психологии отношений — 17,7; 3) Санкт-Петербургский государственный педиатрический медицинский университет — 31,0; 4) Северо-Западный государственный медицинский университет им. И. И. Мечникова — 39,5. Важно отметить, что в рейтинг попали негосударственные организации, которые в отличие от государственных не имеют доступа к прямому государственному финансированию научных исследований. Методы психотерапии в рейтинге представлены следующим образом: психоанализ — 8,7; позитивная динамическая психотерапия — 17,7; когнитивно-поведенческая психотерапия — 31,3 и личностно-ориентированная (реконструктивная) — 31,6. Полученные результаты могут учитываться руководителями коммерческих структур, учреждений здравоохранения и образования при составлении перспективных планов, а также врачами и психологами при выборе образовательных программ профессиональной переподготовки в области психотерапии. Over the past 30 years, there has been a revolution in psychotherapy under the influence of evidence-based methodology. The methods of evidence-based psychotherapy have gained preference all over the world. The rapidity of implementation of research results into practice is predetermined by the phenomenon of scientific influence. To determine this phenomenon, the author proposes to use the RSCI (Russian Science Citation Index) core percentile. The rating of the scientific influence of St. Petersburg psychotherapists was compiled for the first time ever. In total, the rating includes 31 specialists (with the 133 RSCI core percentile from 4 to 51) representing 12 organizations, ranked in accordance with the average RSCI core percentile as follows: 1) Scientific Medical Research Center for Psychiatry and Neurology named after V. M. Bekhterev — 16.1; 2) St. Petersburg School of Psychotherapy and Psychology of attitudes — 17.7; 3) St. Petersburg State Pediatric Medical University — 31.0; 4) North-Western State Medical University named after I. I. Mechnikov — 39.5. It is important to note that the rating includes non-governmental organizations, which, unlike state-run ones, do not have access to direct state funding for scientific research. Methods of psychotherapy are presented in the rating as follows: psychoanalysis — 8.7; positive dynamic psychotherapy — 17.7; cognitive-behavioral psychotherapy — 31.3, and personality-oriented (person-centered) psychotherapy — 31.6. The results obtained can be taken into account by the heads of commercial structures, health care and educational institutions when drawing up long-term plans, as well as by doctors and psychologists when choosing educational programs for professional retraining in the field of psychotherapy.

Application of Near-Infrared Spectroscopy for Evidence-Based Psychotherapy

This perspective article discusses the importance of evidence-based psychotherapy and highlights the usefulness of near-infrared spectroscopy (NIRS) in assessing the effects of psychotherapeutic interventions as a future direction of clinical psychology. NIRS is a safe and non-invasive neuroimaging technique that can be implemented in a clinical setting to measure brain activity via a simple procedure. This article discusses the possible benefits and challenges of applying NIRS for this purpose, and the available methodology based on previous studies that used NIRS to evaluate psychotherapeutic effects. Furthermore, this perspective article suggests alternative methodologies that may be useful, namely, the single- and multi-session evaluations using immediate pre- and post-intervention measurements. These methods can be used to evaluate state changes in brain activity, which can be derived from a single session of psychotherapeutic interventions. This article provides a conceptual schema important in actualizing NIRS application for evidence-base psychotherapy.

Systematic review of the effects of evidence-based psychotherapies on neurocognitive functioning in mood disorders

Objective: Neurocognitive impairment is considered a core feature of mood disorders. Research has shown that neurocognitive impairment often persists beyond mood symptom resolution and can have significant deleterious effects on interpersonal relationships, academic achievement, occupational functioning and independent living. As such, neurocognitive impairment has become an important target for intervention. In this systematic review, we aimed to examine the extant literature to ascertain whether current standard evidence-based psychotherapies can improve neurocognitive functioning in mood disorders. Method: Studies examining changes in neurocognitive functioning following evidence-based psychotherapy were identified using MEDLINE, PsycINFO and Web of Science databases. Given the heterogeneity of study procedures, treatment protocols and patient samples, a narrative rather than meta-analytic review technique was employed. Results: Nineteen studies (21 articles) met inclusion criteria. There was preliminary evidence of improved executive functioning following evidence-based psychotherapy for Major Depressive Disorder and Bipolar Disorder. There was also some signal of reduced negative biases in emotional information processing following psychotherapy in depression. Due to methodological variability across studies however, it was difficult to draw clear conclusions. Conclusion: Findings from the current review suggest that evidence-based psychotherapies may influence some aspects of neurocognitive functioning in mood disorders. This continues to be an ongoing area of importance and warrants further research.

Determining prognostic variables of treatment outcome in obsessive–compulsive disorder: effectiveness and its predictors in routine clinical care

The objectives of this study were to investigate the naturalistic effectiveness of routine inpatient treatment for patients with obsessive–compulsive disorder (OCD) and to identify predictors of treatment outcome. A routinely collected data set of 1,596 OCD inpatients (M = 33.9 years, SD = 11.7; 60.4% female) having received evidence-based psychotherapy based on the cognitive–behavioral therapy (CBT) in five German psychotherapeutic clinics was analyzed. Effect sizes (Hedges' g) were calculated for several outcome variables to determine effectiveness. Predictor analyses were performed on a subsample (N = 514; M = 34.3 years, SD = 12.2; 60.3% female). For this purpose, the number of potential predictors was reduced using factor analysis, followed by multiple regression analysis to identify robust predictors. Effect sizes of various outcome variables could be classified as large (g = 1.34 of OCD–symptom change). Predictors of changes in OCD and depressive symptoms were symptom severity at admission and general psychopathological distress. In addition, patients with higher social support and more washing compulsions benefited more from treatment. Subgroup analyses showed a distinct predictor profile of changes in compulsions and obsessions. The results indicate that an evidence-based psychotherapy program for OCD can be effectively implemented in routine inpatient care. In addition to well-established predictors, social support, and washing compulsions in particular were identified as important positive predictors. Specific predictor profiles for changes in obsessions and compulsions are discussed.

A teenage girl with low body mass index due to restricting food intake

Anorexia nervosa (AN) is an eating disorder that is characterized by restriction of energy intake leading to significantly low body weight, an intense fear of gaining weight or persistent behavior that interferes with weight gain, and disturbance in the way one’s body weight or shape is experienced. Because many patients with AN attempt to conceal their efforts to lose weight and minimize their symptoms, obtaining information from a caregiver is an important part of the assessment. A medical history and physical examination must be completed to assess medical stability, including review of vital signs, electrocardiogram, and laboratory studies. Medically unstable patients require a medical admission for refeeding and stabilization, including monitoring for refeeding syndrome. Pharmacotherapy should not be used as the primary treatment for patients with AN. The most evidence-based psychotherapy approach for children and adolescents is family-based treatment (Maudsley family therapy).

A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for posttraumatic stress disorder

Background: Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies. Methods: The current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians’ adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings. Discussion: Findings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation. Trial registration: ClinicalTrials.gov: NCT01861769