John S. Ogrodniczuk

Comparative efficacy, speed, and adverse effects of three PTSD treatments: Exposure therapy, EMDR, and relaxation training

The authors examined the efficacy, speed, and incidence of symptom worsening for 3 treatments of posttraumatic stress disorder (PTSD): prolonged exposure, relaxation training, or eye movement desensitization and reprocessing (EMDR; N = 60). Treaments did not differ in attrition, in the incidence of symptom worsening, or in their effects on numbing and hyperarousal symptoms. Compared with EMDR and relaxation training, exposure therapy (a) produced significantly larger reductions in avoidance and reexperiencing symptoms, (b) tended to be faster at reducing avoidance, and (c) tended to yield a greater proportion of participants who no longer met criteria for PTSD after treatment. EMDR and relaxation did not differ from one another in speed or efficacy.

Patient Personality and Time-limited Group Psychotherapy for Complicated Grief

Abstract We used a randomized clinical trial to investigate the interaction of two patient personality characteristics (quality of object relations [QOR] and psychological mindedness [PM]) with two forms of time-limited, short-term group therapy (interpretive and supportive) for 139 psychiatric outpatients with complicated grief. Findings differed depending on the outcome variable (e.g., grief symptoms, general symptoms) and the statistical criterion (e.g., statistical significance, clinical significance, magnitude of effect). Patients in both therapies improved. For grief symptoms, a significant interaction effect was found for QOR. High-QOR patients improved more in interpretive therapy and low-QOR patients improved more in supportive therapy. A main effect was found for PM. High-PM patients improved more in both therapies. For general symptoms, clinical significance favored interpretive therapy over supportive therapy. Clinical implications concerning patient-treatment matching are discussed.

Relationships among psychological mindedness, alexithymia and outcome in four forms of short‐term psychotherapy

This study explored the relative strength of two patient characteristics, psychological mindedness (PM) and alexithymia, as predictors of psychotherapy outcome. Data were provided by two comparative trials of interpretive versus supportive therapy. One involved short-term group therapy for 107 outpatients with complicated grief. The other involved short-term individual therapy for 144 outpatients of mixed diagnoses. Prior to beginning therapy, patients were assessed for PM using the Psychological Mindedness Assessment Procedure and for alexithymia using the 20-item Toronto Alexithymia Scale. For both trials, the association between PM and alexithymia was small and non-significant. The therapy approach (interpretive vs. supportive) did not differentially affect the relationship between either predictor variable and outcome. There were significant direct relationships between PM and favourable outcome, and between alexithymia and favourable outcome in both trials. There was an additive relationship between PM and alexithymia in predicting outcome. Implications of these results are discussed.

Transference interpretations in short-term dynamic psychotherapy.

Transference interpretations are one of the distinguishing features of dynamically oriented psychotherapy. Previous studies have suggested that too many transference interpretations may be detrimental, in particular for certain kinds of patients. Given the potential for negative effects, attempts to validate (replicate) the previous findings are worthwhile. The relationships between the frequency and proportion of transference interpretations and both the therapeutic alliance and treatment outcome were examined in a sample of 40 patients who received time-limited, 20-session, individual psychotherapy. Inverse relationships were found between the frequency of transference interpretations and both patient-rated therapeutic alliance and favorable outcome. The relationships differed as a function of the patient personality characteristic known as quality of object relations (QOR). These results extend previous findings regarding transference technique in short-term dynamic therapy with low-QOR and high-QOR patients.

Interpretive and supportive psychotherapies : matching therapy and patient personality

What is Short-Term, Interpretive Therapy, and Who is a Good Candidate? What is Short-Term Supportive Therapy, and Who is a Good Candidate? Interpretive and Supportive Dimensions of Psychotherapy Optimal Matching of Parents and Short-Term Psychotherapies Quality of Objective Relations and Psychological Mindedness - Predictive Patient Characteristics Interaction of Interpretive and Supportive Forms of Psychotherapy and Patient Personality Variables What Role Does Gender Play as a Patient Aptitude for Therapy? Relationships Among Therapy Process, Outcome, and Dropping Out Clinical Illustrations of Dropping Out From Interpretive Therapy - Importance of Flexibility Relationships Between Patient Personality (QOR, PM) and the Process of Psychotherapy - Clinical Illustrations of Successful and Unsuccessful Cases Therapy Manuals for Interpretive and Supportive Forms of Psychotherapy Themes and Future Directions.

Quality of Object Relations as a Moderator of the Relationship Between Pattern of Alliance and Outcome in Short-Term Individual Psychotherapy

In this study, we investigated the personality variable quality of object relations (QOR) as a moderator of the relationship between the pattern of the therapeutic alliance and treatment outcome in two forms (interpretive, supportive) of short-term individual psychotherapy. In a sample of 72 psychiatric outpatients who completed interpretive therapy, QOR emerged as a moderator for the outcome factor general symptomatology and dysfunction. For high-QOR patients, an increasing level of alliance was directly related to benefit, whereas for low-QOR patients, a decreasing level of alliance was directly related to benefit. An explanation for these findings emphasized the importance of patients repeating their typical pattern of maladaptive interpersonal behavior in the therapy sessions in the context of the therapist working with the transference. In a sample of 72 psychiatric outpatients who completed supportive therapy, QOR did not emerge as a moderator. These findings in combination with evidence from previous studies suggest that QOR should be investigated as a moderator variable in future studies of short-term psychotherapy.

Day Treatment for Personality Disorders: A Review of Research Findings

Day treatment, a form of partial hospitalization, may have unique advantages in the care of patients with personality disorders. It appears to offer a favorable level of intensiveness and containment, thus facilitating treatment of the chronic emotional and behavioral difficulties experienced by these individuals. Although several authors have written about the appropriateness of day treatment for personality disorder patients, empirical support has been slow to accumulate. More recently, greater research attention has been focused on this question. This review examines the current research. The findings suggest that day treatment is effective for this difficult patient population and that it is more effective than standard treatment (i.e., medication and support). Preliminary evidence indicates that day treatment may lead to a reduction in future health-services costs. Some findings also show that day treatment may be particularly beneficial for certain patients-for example, those who are more psychologically minded. Implications of these findings for clinical practice are considered. Limitations in our current approach to research in this area are highlighted, and recommendations for future study are provided.

NEO-five factor personality traits as predictors of response to two forms of group psychotherapy.

Abstract The relationships between patient personality variables and outcome for 107 psychiatric outpatients with complicated grief who completed either interpretive or supportive short-term group therapy were investigated. The personality variables were assessed prior to treatment with the NEO-Five Factor Inventory (NEO-FFI). For patients in both forms of therapy, extraversion, conscientiousness, and openness were directly associated with favorable treatment outcome. In contrast, neuroticism was inversely related to favorable outcome for patients in both forms of therapy. Agreeableness was directly related to favorable improvement in grief symptomatology for patients in interpretive therapy, but not for those in supportive therapy. The results highlight the importance of assessing patient personality in order to predict response to short-term group therapy. Possible explanations and clinical implications of these findings are discussed.

Three-level multilevel growth models for nested change data: A guide for group treatment researchers

Abstract Researchers have known for years about the negative impact on Type I error rates caused by dependencies in hierarchically nested and longitudinal data. Despite this, group treatment researchers do not consistently use methods such as multilevel models (MLMs) to assess dependence and appropriately analyse their nested data. The goals of this study are to review some of the study design issues with regard to hierarchically nested and longitudinal data, discuss MLMs for assessing and handling dependence in data, and present a guide for developing a three-level growth MLM that is appropriate for group treatment data, design, and research questions. The authors present an example from group treatment research to illustrate these issues and methods.

Preventing postnatal depression: a review of research findings.

Postnatal depression is a major source of morbidity among women who have recently delivered a child. Considering its high prevalence and serious negative consequences, prevention should be a high priority. A comprehensive synthesis of current knowledge of prevention strategies is important for clinical practice and future research. Searches of MEDLINE and PsychINFO were performed to identify English‐language articles of randomized, controlled trials published from 1990 to 2003 focusing on primary prevention of postnatal depression in both the general and high‐risk populations. Nineteen studies meeting these criteria were identified. The main findings and limitations of each study are documented. While the results are mixed, several of the studies provide support for the role of midwife intervention for pregnant and postnatal women. There are also some data that support the efficacy of brief psychotherapy in primary prevention. Unfortunately, many of the studies suffer from shortcomings that may limit their generalizability. Data is also lacking on biological interventions. Directions for future research are discussed, and general recommendations for prevention of postnatal depression in clinical practice are made. The findings of this review indicate that despite the relatively brief history of work in this area, progress is being made in identifying possible prevention interventions.