Hans Henrik Jensen

Effectiveness of short-term psychodynamic group therapy in a public outpatient psychotherapy unit

Background: Short-term psychodynamic group therapy in heterogeneous patient groups is common in the public Danish psychiatric system but is in need of evaluation. Aim: To investigate improvement in 39-session psychodynamic group therapy using three criteria: 1) effect size (Cohens d), 2) statistically reliable improvement, and 3) clinical significant change (CSC). Methods: Pre–post treatment naturalistic design based on 236 outpatients with diagnoses of mood (9.7%), neurotic (50.8%), and personality disorders (39.4%). Symptom change was evaluated on the SCL-90-R Global Severity Index (GSI) and subscales. Analyses were conducted on the total sample and after exclusion of 32 GSI pre-treatment no-cases. Results: The total sample GSI effect size was 0.74 indicating a moderate to large effect size (ranging from 0.67 in depressed to 0.74 in neurotic and personality disorder patients), which increased to 1.02 after exclusion of pre-treatment no-cases (ranging from 0.98 to 1.11 in depressed and personality disorder patients, respectively). However, in the GSI pre-treatment case sample, 43.1% were unchanged or deteriorated, 27% reliably improved and 29.9% obtained CSC status (ranging from 23.8% of the neurotic to 42.9% of the depressed patients). Conclusion: Short-term psychodynamic group therapy is associated with medium to large or large effect sizes. However, even though many of the patients reliably improve, a substantial part of the patients are still, after therapy, within the pathological range compared with Danish norms. Clinical implications: Patients referred to public outpatient treatment settings may need alternative or longer treatment than 39 sessions of psychodynamic group therapy over 3 months.

Conditioned emotional responding under diazepam: a psychophysiological study of state dependent learning

An experimental study on 34 healthy male volunteers demonstrated that a therapeutic dose of diazepam (15 mg PO) influenced the reproduction of a conditioned emotional response (skin conductance activity) on subsequent test days. This effect depended upon the pharmacological state present at acquisition, and was in accordance with a drug-dissociation interpretation of diazepams amnesic effect. The results are interpreted as an example of diazepam state-dependency effects upon development of behavioral tolerance to stress. The clinical consequence of the results indicates that patients under diazepam medication will to a certain degree be deprived of the ability to develop appropriate coping strategies. It is concluded that combining psychotherapy with diazepam treatment may have the opposite effects to those intended.

Do changes on MCMI-II personality disorder scales in short-term psychotherapy reflect trait or state changes?

The Millon Clinical Multiaxial Inventory (MCMI) has become an important and commonly used instrument to assess personality functioning. Several studies report significant changes on MCMI personality disorder scales after psychological treatment. The aim of the study was to investigate whether pre–post-treatment changes in 39-session psychodynamic group psychotherapy as measured with the MCMI reflect real personality change or primarily reflect symptomatic state changes. Pre–post-treatment design included 236 psychotherapy outpatients. Personality changes were measured on the MCMI-II and symptomatic state changes on the Symptom Check List 90-R (SCL-90-R). The MCMI Schizoid, Avoidant, Self-defeating, and severe personality disorder scales revealed substantial changes, which could be predicted from changes on SCL-90-R global symptomatology (GSI) and on the SCL-90-R Depression scale. The MCMI Dependent personality score was the only MCMI personality scale showing significant change when the SCL-90-R Depression change score was included as a covariate. Splitting patients into those with and without personality disorders did not change the results. Observed changes on MCMI-II personality disorder scales in short-term psychotherapy reflect change in symptomatic state. The MCMI-II Base Rate cut-off points probably include too many patients, justifying the introduction of new scoring procedures in the MCMI-III.

Drop-out from a psychodynamic group psychotherapy outpatient unit.

Abstract Background. Drop-out from psychotherapy is common and represents a considerable problem in clinical practice and research. Aim. To explore pre-treatment predictors of early and late drop-out from psychodynamic group therapy in a public outpatient unit for non-psychotic disorders in Denmark. Methods. Naturalistic design including 329 patients, the majority with mood, neurotic and personality disorders referred to 39-session group therapy. Predictors were socio-demographic and clinical variables, self-reported symptoms (Symptom Check List-90-Revised) and personality style (Millon Clinical Multiaxial Inventory-II). Drop-out was classified into early and late premature termination excluding patients who dropped out for external reasons. Results. Drop-out comprised 20.6% (68 patients) of the sample. Logistic regression revealed social functioning, vocational training, alcohol problems and antisocial behavior to be related to drop-out. However, early drop-outs had prominent agoraphobic symptoms, lower interpersonal sensitivity and compulsive personality features, and late drop-outs cognitive and somatic anxiety symptoms and antisocial personality features. Clinical and psychological variables accounted for the major part of variance in predictions of drop-out, which ranged from 15.6% to 19.5% (Nagelkerke Pseudo R-Square). Conclusion. Social functioning was consistently associated with drop-out, but personality characteristics and anxiety symptoms differentiated between early and late drop-out. Failure to discriminate between stages of premature termination may explain some of the inconsistencies in the drop-out literature. Clinical implications. Before selection of patients to time-limited psychodynamic groups, self-reported symptoms should be thoroughly considered. Patients with agoraphobic symptoms should be offered alternative treatment. Awareness of and motivation to work with interpersonal issues may be essential for compliance with group therapy.

Focus in psychodynamic group therapy

The effect of psychodynamic focus allocated to two structural levels (high and low) is examined in 139 patients in 39-session psychoanalytic group psychotherapy. The influence of focusing upon pre-posttreatment symptomatic changes is weighted towards the influence of two distinct levels of pathology (high and low). Neurotic patients with high level focus were predicted to have the most favourable pre-posttreatment symptomatic improvement and end-state status according to the SCL-90-R subscales and Global Severity Index. However, neurotic patients with low level focus, and personality disorder patients with high level focus (44% of the patients) had the most favourable symptomatic improvement after controlling for pretreatment levels, and they obtained the overall most favourable effect-sizes. Depression and anxiety scales had the largest total sample effect-sizes, but improvement in “negative affect” was related to neither focus nor diagnoses. It is suggested that increased maladjustment according to the SCL-90-R and the MCMI-II personality disorder scales might have influenced the focus agreed upon prior to therapy, resulting in “asymmetry” between level of diagnosis and focus. This asymmetry, however, may be optimal for the patients in question.

The Dimensions of Personality: The Relationship Between the Models of Eysenck and Cloninger

In the clinical context and in research, there is a need to extend diagnostic personality disorder classification with dimensional models. Eysenck and Cloninger both proposed 3-dimensional models of personality with specific reference to psychopathology. In this study, we analyse the psychometric properties of the Danish version of Cloningers Tridimensional Personality Questionnaire (TPQ) and its correlations with Eysenck Personality Questionnaire (EPQ). The tests were administered to 191 male prisoners in a longitudinal medico-psychological study and the results compared with non-psychiatric control samples. There were significant, though small, group differences. Psychometric analyses of the 12 TPQ subscales indicate that TPQ Novelty Seeking and Reward Dependence and EPQ Psychoticism may not constitute coherent scales and constructs. The correlations between the TPQ and EPQ are discussed in relation to the suggestions by Gray concerning the location of anxiety and impulsivity in the Eysenckian personal...

SCL-90-R Symptom Profiles and Outcome of Short-Term Psychodynamic Group Therapy

Background. Psychodynamic group psychotherapy may not be an optimal treatment for anxiety and agoraphobic symptoms. We explore remission of SCL-90-R Global Severity Index (GSI) and target symptoms in 39 sessions of psychodynamic group therapy. Methods. SCL-90-R “target symptom” profile and GSI remission according to Danish norms were identified in 239 patients and evaluated according to reliable and clinical significant change. Results. Four major groups of target symptom cases (depression, interpersonal sensitivity, anxiety, and phobic anxiety) covered 95.7% of the sample. As opposite to phobic anxiety and anxiety patients, patients with interpersonal sensitivity obtained overall the most optimal outcome. The phobic anxiety scale, social network support, and years of school education were independent predictors of GSI remission, and a low anxiety score and absence of phobic anxiety target symptoms were independent predictors of remission of target symptom pathology. Conclusions. The negative results as associated with the SCL-90-R phobic anxiety scale and the phobic anxiety target symptom group are largely in agreement with recent studies. In contrast, whatever the diagnoses, patients with interpersonal sensitivity target symptom may be especially suited for psychodynamic group therapy. The SCL-90-R subscales may allow for a more complex symptom-related differentiation of patients compared with both diagnoses and GSI symptom load.

The welfare impact of a Free Trade Agreement: 'Cape to Cairo'

ABSTRACT The African market has become increasingly important to South Africas agricultural trade. Exports have been increasing rapidly, although imports have not kept pace. This pattern is also evident in the general trade in manufactured goods. The purpose of this article is to look at the best estimate conditiuons that will prevail with respect to trade in agricultural and manufactured goods between South Africa (SACU) and the member countries of SADC, the East African Comminuity and COMESA. The analysis is conducted using the GTAP database and its associated general equilibrium model. The results show that South Africa benefits from integration in SADC and from the integration of the entire region, but not from integration with the EAC and COMESA. However, the latter steps are necessary to reap the benefits of integration in the entire region.

Time limited psychodynamic group therapy

We explore predictors of participation in additional treatment within one year after termination of 39 sessions of psychodynamic group therapy (n=130). The sample was biased due to a 33% dropout at the one-year follow-up of symptomatic less improved treatment completers (N=194). Outcome predictors were the Symptom Check List 90 Revised (SCL-90-R), Millon Clinical Multiaxial Inventory II (MCMI-II), non-symptomatic Psychodynamic Focus, retrospective outcome evaluations, and socio-demographic and psychiatric variables.At follow-up, 57.6% of the patients had been seeking additional treatment for psychological or psychiatric problems; the percentage was 41.6%, when further treatment was defined as participating in more than 5 sessions. The majority (94.8%) was treated within the public health services.Participation in additional treatment was predicted by improvement on the MCMI Antisocial personality disorder scale and a higher SCL-90-R Somatization end-state score. When additional treatment was defined as receiving more than 5 sessions, lack of paid work before treatment (odds ratio 8.0), lack of social network support (odds ratio 2.9), and the Antisocial pre- post difference score (odds ratio 1.6) were significant predictors explaining a total of 26.4% variance. Neither SCL-90-R Global Severity Index (GSI) reliable and clinically significant improvement, therapist recommendations of further therapy, nor socio-demographic, psychiatric and treatment outcome variables were significantly associated with seeking additional treatment.Even though we identified only a small number of predictors for participation in further treatment, our study nevertheless points to the importance of employing reliable and validated methods in the evaluation of treatment outcome and further treatment planning.

Heterogeneity of treatment changes after psychodynamic therapy within a one year follow-up: a replication study.

Naturalistic psychotherapy effect studies commonly report effect sizes for the total sample. However, a previous study of SCL-90 Global Severity Index (GSI) improvement in a large outpatient sample used a cluster analytic strategy and reported clinical relevant outcome trajectories that could be grouped into early within-treatment improvement, late improvement in the follow-up period, and deteriorating patients with slight improvement that was lost at follow-up. We explore GSI outcome trajectories and clinical significant change in a sample of 320 patients at a public psychiatric outpatient psychodynamic group therapy unit, the majority with anxiety, personality, and mood disorders. The study revealed large discharge and follow-up effect sizes but more than one third of the patients were without measurable improvement. The major clusters described above were confirmed, and revealed unique clinical and socio-demographic characteristics. Late improvers, as compared with early improvers, were characterized by anxiety symptoms and lack of network support after controlling for GSI at admission. Similarly, deteriorating patients had longer duration of illness and less favourable social characteristics compared with the other two groups. Early improving patients were less likely to have participated in short-term groups, and only one third participated in additional treatment compared with more than 69% of the other patients. Severe and socially affected psychiatric patients, and patients with anxiety and agoraphobic symptoms may be less optimally treated in short-term time limited psychodynamic groups. There is an obvious need for diversity of treatment offers, better integration of psycho-social treatment components, and long-term open ended treatment.