Alexa Negele

Psychoanalytic and cognitive-behavior therapy of chronic depression: study protocol for a randomized controlled trial.

BackgroundDespite limited effectiveness of short-term psychotherapy for chronic depression, there is a lack of trials of long-term psychotherapy. Our study is the first to determine the effectiveness of controlled long-term psychodynamic and cognitive-behavioral (CBT) treatments and to assess the effects of preferential vs. randomized assessment.Methods/designPatients are assigned to treatment according to their preference or randomized (if they have no clear preference). Up to 80 sessions of psychodynamic or psychoanalytically oriented treatments (PAT) or up to 60 sessions of CBT are offered during the first year in the study. After the first year, PAT can be continued according to the ‘naturalistic’ usual method of treating such patients within the system of German health care (normally from 240 up to 300 sessions over two to three years). CBT therapists may extend their treatment up to 80 sessions, but focus mainly maintenance and relapse prevention. We plan to recruit a total of 240 patients (60 per arm). A total of 11 assessments are conducted throughout treatment and up to three years after initiation of treatment. The primary outcome measures are the Quick Inventory of Depressive Symptoms (QIDS, independent clinician rating) and the Beck Depression Inventory (BDI) after the first year.DiscussionWe combine a naturalistic approach with randomized controlled trials(RCTs)to investigate how effectively chronic depression can be treated on an outpatient basis by the two forms of treatment reimbursed in the German healthcare system and we will determine the effects of treatment preference vs. randomization.Trial registrationhttp://www.controlled-trials.com/ISRCTN91956346

Childhood Trauma and Its Relation to Chronic Depression in Adulthood

There is a large consensus indicating that childhood trauma is significantly involved in the development of depression. The aim of this study was to examine the prevalence of retrospectively recalled childhood trauma in chronically depressed patients and to investigate a more specific relationship between trauma type and depression. We further asked for the influence of multiple experiences of childhood trauma on the vulnerability to a chronic course of depression in adulthood. 349 chronically depressed patients of the German LAC Depression Study completed the Childhood Trauma Questionnaire, a self-report measure of traumatic experiences in childhood. 75.6% of the chronically depressed patients reported clinically significant histories of childhood trauma. 37% of the chronically depressed patients reported multiple childhood traumatization. Experiences of multiple trauma also led to significantly more severe depressive symptoms. Stepwise multiple regression analysis suggested that childhood emotional abuse and sexual abuse were significantly associated with a higher symptom severity in chronically depressed adults. Yet, expanding the regression model for multiple exposures showed that multiplicity was the only remaining significant predictor for symptom severity in chronically depressed patients. Clinical implications suggest a precise assessment of childhood trauma in chronically depressed patients with a focus on emotional abuse, sexual abuse, and multiple exposures to childhood trauma. This trial is registered with registration number ISRCTN91956346.

Self-Continuity Across Developmental Change in and of Repeated Life Narratives

LUCAS participated in our longitudinal study of 8-, 12-, 16-, and 20-year olds, who narrated and re-narrated 4 years later their life stories in a free-standing monologue. He initiates his second life narrative at time 2 by referring to his first life narrative at time 1 or at least to the stories he remembers having told then. He also lets us know that this time he will tell different stories about his life, providing a changed version of his life and providing continuity across developmental change. In this chapter we ask both how adolescents reflect on biographical change and continuity in repeated life narratives, and how stable life narratives are across time by comparing them in exploratory analyses of repeated life narratives of eight adolescents and young adults from a 4-year longitudinal study.

Childhood trauma from a patient and a psychoanalyst perspective: linking chronic depression to relational multiple trauma

The relationship between multiple childhood trauma, as well as adversity, and chronic depression has been reported repeatedly. However, there is a lack of clinical differentiations of these findings. We complemented patient self-ratings, using the Childhood Trauma Questionnaire (CTQ), with psychoanalysts’ perspectives in order to provide finer grained clinical differentiations of the trauma behind chronic depression. These differentiations connect the trauma scales with early relational experiences. We developed a bespoke instrument derived from psychoanalytic trauma concepts. A subsample of 52 cases of chronically depressed patients alongside their 24 psychoanalysts was taken from the LAC depression study, in order to complement patient and psychoanalyst ratings. Our results confirm the connection between multiple childhood trauma and chronic depression. Besides relational trauma, the psychoanalysts’ perspective found separation trauma and transgenerational transmission of trauma to be significant. These traumatic relationships seem to precede and accompany adverse life events and/or traumatic experiences. They may even prevent adequate coping and/or processing of such experiences. Patient interview material from study intake and five-year follow-up further provides an insight into the changes the trauma narratives undergo throughout time. These changes emerged due to a joint reconstruction of the meaning of traumatic experiences throughout the course of the psychoanalytic process.

Zur Konfliktdynamik bei chronischer Depression – Ergebnisse zur Konflikt- und Strukturachse der OPD in der LAC-Studie

Zusammenfassung Fragestellung: Ausgehend von psychoanalytischen Theorien zur Depression wird untersucht, ob bei chronisch depressiven Patienten in der Konfliktachse der Operationalisierten Psychodynamischen Diagnostik (OPD-2) Versorgungs- und Selbstwertkonflikte uberwiegen. In zwei erganzenden Fragestellungen wird erfasst, ob es eine Dominanz passiver Modi in der Konfliktverarbeitung gibt und welchen Einfluss das Strukturniveau auf Konflikt und Konfliktverarbeitung hat. Methode: Im Rahmen der LAC-Depressionsstudie zur Wirksamkeit psychoanalytischer und verhaltenstherapeutischer Langzeitbehandlungen bei chronisch depressiven Patienten wurden bei 217 Patienten vor Behandlungsbeginn die OPD-Achsen Konflikt und Struktur erhoben. Ergebnisse: Als Hauptkonflikt dominiert der Versorgung vs. Autarkiekonflikt, gefolgt von Individuation versus Abhangigkeit. Bei den zweitbedeutsamsten Konflikten tritt der Selbstwertkonflikt am haufigsten auf. Hinsichtlich der Konfliktverarbeitung uberwiegt ein passiver Modus. Bei hoh...