Sigal Zilcha-Mano1, Harold Chui2, Tohar Dolev3, Kevin S McCarthy4, Ulrike Dinger5, Jacques P Barber2. 1. The Department of Psychology, University of Haifa, Israel. Electronic address: sigalzil@gmail.com. 2. The Derner Institute of Advanced Psychological Studies, Adelphi University, United States. 3. The Department of Psychology, University of Haifa, Israel. 4. Department of Psychology, Chestnut Hill College, United States. 5. Clinic for General Internal Medicine and Psychosomatics, University of Heidelberg, Germany.
Abstract
BACKGROUND: The goal of the study was to examine two central theory-driven mechanisms of change, causal attributions and relational representations, to account for symptomatic improvement in psychodynamic treatment and supportive clinical management, combined with either pharmacotherapy or placebo, in a randomized control trial (RCT) for depression. METHOD: We used data from an RCT for depression, which reported non-significant differences in outcome among patients (N=149) who receivedsupportive-expressive psychotherapy (SET), clinical management combined with pharmacotherapy (CM+MED), or clinical management with placebo pill (CM+PBO) (Barber et al., 2012). Mechanism and outcome measures were administered at intake, mid-treatment, end of treatment, and at a 4-month follow-up. RESULTS: Improvements in causal attributions and in relational representations were found across treatments. Changes in causal attributions did not predict subsequent symptomatic level when controlling for prior symptomatic level. In contrast, decrease in negative relational representations predicted subsequent symptom reduction across all treatments, and increase in positive relational representations predicted subsequent symptom reduction only in SET. LIMITATIONS: The study is limited by its moderate sample size. Additional studies are needed to examine the same questions using additional treatment orientations, such as cognitive treatments. CONCLUSIONS: Findings demonstrate that changes in negative relational representations may act as a common mechanism of change and precede symptom reduction across psychodynamic therapy and supportive case management combined with either pharmacotherapy or placebo, whereas an increase in positive relational representation may be a mechanism of change specific to psychodynamic therapy.
RCT Entities:
BACKGROUND: The goal of the study was to examine two central theory-driven mechanisms of change, causal attributions and relational representations, to account for symptomatic improvement in psychodynamic treatment and supportive clinical management, combined with either pharmacotherapy or placebo, in a randomized control trial (RCT) for depression. METHOD: We used data from an RCT for depression, which reported non-significant differences in outcome among patients (N=149) who received supportive-expressive psychotherapy (SET), clinical management combined with pharmacotherapy (CM+MED), or clinical management with placebo pill (CM+PBO) (Barber et al., 2012). Mechanism and outcome measures were administered at intake, mid-treatment, end of treatment, and at a 4-month follow-up. RESULTS: Improvements in causal attributions and in relational representations were found across treatments. Changes in causal attributions did not predict subsequent symptomatic level when controlling for prior symptomatic level. In contrast, decrease in negative relational representations predicted subsequent symptom reduction across all treatments, and increase in positive relational representations predicted subsequent symptom reduction only in SET. LIMITATIONS: The study is limited by its moderate sample size. Additional studies are needed to examine the same questions using additional treatment orientations, such as cognitive treatments. CONCLUSIONS: Findings demonstrate that changes in negative relational representations may act as a common mechanism of change and precede symptom reduction across psychodynamic therapy and supportive case management combined with either pharmacotherapy or placebo, whereas an increase in positive relational representation may be a mechanism of change specific to psychodynamic therapy.
Authors: Ellen Frank; David J Kupfer; Daniel J Buysse; Holly A Swartz; Paul A Pilkonis; Patricia R Houck; Paola Rucci; Danielle M Novick; Victoria J Grochocinski; Deborah M Stapf Journal: Am J Psychiatry Date: 2007-05 Impact factor: 18.112
Authors: Anna Buchheim; Roberto Viviani; Henrik Kessler; Horst Kächele; Manfred Cierpka; Gerhard Roth; Carol George; Otto F Kernberg; Georg Bruns; Svenja Taubner Journal: PLoS One Date: 2012-03-28 Impact factor: 3.240
Authors: Sheila A M Rauch; H Myra Kim; Margaret R Venners; Katherine E Porter; Sonya B Norman; Naomi M Simon; Barbara O Rothbaum; Peter W Tuerk; Ronald E Acierno; Eric Bui; Corey Powell; Erin R Smith; Elizabeth Goetter; Lauren B McSweeney Journal: J Trauma Stress Date: 2021-12-31