{"title":"Psychotherapy, Politics, and the Limits of Professionalism.","authors":"Jordan A Conrad","doi":"10.1176/appi.psychotherapy.20240066","DOIUrl":"https://doi.org/10.1176/appi.psychotherapy.20240066","url":null,"abstract":"","PeriodicalId":46822,"journal":{"name":"AMERICAN JOURNAL OF PSYCHOTHERAPY","volume":" ","pages":"appipsychotherapy20240066"},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Cost-Effectiveness of Intensive Short-Term Dynamic Psychotherapy in Public Health Care Settings.","authors":"Leo Russell","doi":"10.1176/appi.psychotherapy.20240041","DOIUrl":"https://doi.org/10.1176/appi.psychotherapy.20240041","url":null,"abstract":"<p><p>Public health care systems are tasked with meeting the wide-ranging needs of large patient populations. Interventions that are broadly applicable, clinically effective, and cost-efficient are essential. Intensive short-term dynamic psychotherapy (ISTDP) is an evidence-based psychodynamic therapy that has been successfully applied in the treatment of many mental health conditions and functional somatic disorders. The aim of this scoping review was to describe the health economic data of ISTDP in health care settings. Substantial financial savings and reductions were identified from hospital, physician, medication, disability, and welfare costs following treatment. ISTDP has the potential to deliver significant cost reductions for state funders, health commissioners, and care providers. Additional research is required to confirm the full extent of cost savings that can be achieved with ISTDP.</p>","PeriodicalId":46822,"journal":{"name":"AMERICAN JOURNAL OF PSYCHOTHERAPY","volume":" ","pages":"appipsychotherapy20240041"},"PeriodicalIF":2.3,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David A Bender, Sandeep M Nayak, Joshua S Siegel, David J Hellerstein, Baris C Ercal, Eric J Lenze
{"title":"The Role of Touch in Psychedelic Therapy: Perspectives From a Survey of Practitioners in Research Settings.","authors":"David A Bender, Sandeep M Nayak, Joshua S Siegel, David J Hellerstein, Baris C Ercal, Eric J Lenze","doi":"10.1176/appi.psychotherapy.20240025","DOIUrl":"https://doi.org/10.1176/appi.psychotherapy.20240025","url":null,"abstract":"<p><strong>Objective: </strong>Psychedelic therapies are promising new treatment options in psychiatry. Including the use of physical touch as part of treatment is an area of debate. This study aimed to characterize the viewpoints of practitioners on the use of touch in psychedelic therapy.</p><p><strong>Methods: </strong>An anonymous survey was distributed via e-mail to the contacts listed on ClinicalTrials.gov for trials of psilocybin and lysergic acid diethylamide, via e-mail to personal contacts of the current authors, and through snowball sampling. Survey items focused on topics related to the facilitation of psychedelic treatments. The survey included Likert-scale, free-response, and demographic items.</p><p><strong>Results: </strong>Forty respondents completed the survey. The respondents had overseen an average of 41.4 psychedelic sessions (range 2-200 sessions), had varying educational backgrounds (doctorate in medicine or osteopathic medicine, 43%; other degree, 58%), and were affiliated with ≥16 institutions worldwide. Seventy percent of the respondents agreed that therapeutic touch was a crucial component of psychedelic therapy, although a majority felt that specific forms of touch (bodywork, 63%; full-body contact, 98%) were inappropriate. Free-response analysis indicated that 96% of the respondents supported touch of the patient's hand and 58% supported touching of the shoulder. Unprompted, 63% of respondents emphasized the importance of consent.</p><p><strong>Conclusions: </strong>Classical psychedelic practitioners in research settings believed that physical touch is an important part of psychedelic therapy. However, they also emphasized the importance of professional boundaries. These findings may inform the future practice of psychedelic therapy.</p>","PeriodicalId":46822,"journal":{"name":"AMERICAN JOURNAL OF PSYCHOTHERAPY","volume":" ","pages":"appipsychotherapy20240025"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Seeing Signal Anxiety: Davanloo's Pathways of Anxiety Discharge.","authors":"Maurice L Joseph","doi":"10.1176/appi.psychotherapy.20240032","DOIUrl":"https://doi.org/10.1176/appi.psychotherapy.20240032","url":null,"abstract":"<p><p>Despite the efforts of Paul Gray and others, a \"developmental lag\" persists in the translation of Freud's structural theory into psychodynamic clinical technique, especially regarding the clinical manifestations and significance of signal anxiety. In this article, the author introduces Habib Davanloo's pathways of anxiety discharge as a conceptual tool that can be used for detecting Freud's signal anxiety and offers clinical hypotheses that can be extrapolated from a marriage of Freud's and Davanloo's ideas. The author demonstrates the clinical application of these ideas with a case example and discusses the virtues and limitations of incorporating Davanloo's ideas into psychodynamic clinical work in general, with the hope that therapists will further test these hypotheses as they listen to and intervene with their patients.</p>","PeriodicalId":46822,"journal":{"name":"AMERICAN JOURNAL OF PSYCHOTHERAPY","volume":" ","pages":"appipsychotherapy20240032"},"PeriodicalIF":2.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Role of Inpatient Psychotherapy in the Treatment of Depression.","authors":"Rachel Bigley","doi":"10.1176/appi.psychotherapy.20240048","DOIUrl":"https://doi.org/10.1176/appi.psychotherapy.20240048","url":null,"abstract":"","PeriodicalId":46822,"journal":{"name":"AMERICAN JOURNAL OF PSYCHOTHERAPY","volume":" ","pages":"appipsychotherapy20240048"},"PeriodicalIF":2.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jordan L Thomas, Julia S Yarrington, Tiffany Chen, Rosalita Benedicto, Jennifer A Sumner, Danielle Keenan-Miller
{"title":"Acceptance and Commitment Therapy for Posttraumatic Psychopathology: A Group-Based Telehealth Intervention.","authors":"Jordan L Thomas, Julia S Yarrington, Tiffany Chen, Rosalita Benedicto, Jennifer A Sumner, Danielle Keenan-Miller","doi":"10.1176/appi.psychotherapy.20240030","DOIUrl":"https://doi.org/10.1176/appi.psychotherapy.20240030","url":null,"abstract":"<p><strong>Objective: </strong>Transdiagnostic treatments are needed to address the diverse manifestations and effects of trauma-related psychopathology. Acceptance and commitment therapy (ACT) is a promising intervention, although little is known about its application among trauma-exposed civilians. A single-arm pilot study evaluated outcomes of a virtual, group-based ACT intervention for trauma delivered through a training clinic.</p><p><strong>Methods: </strong>Five female clients (mean age=42.6 years) with a history of criterion A trauma completed an 11-week skills group and repeated measures assessing posttraumatic and related psychopathology symptoms (e.g., depression, anxiety, posttraumatic stress disorder [PTSD]), emotion regulation, quality of life, posttraumatic growth, and experiential avoidance. Paired-samples t tests were used to assess pre- to postintervention effects.</p><p><strong>Results: </strong>All clients completed the intervention, suggesting high acceptability. Analyses of pre- to postintervention effects demonstrated significant reductions in depression (d<i>=</i>1.16, p=0.03) and anxiety (d=0.95, p=0.05) symptoms but not in PTSD symptoms; effect sizes for significant changes were large. Significant and large increases in effective use of emotion regulation strategies (d<i>=</i>1.02, p=0.04) and posttraumatic growth (d<i>=</i>1.18, p=0.03) were also observed. Experiential avoidance, a hypothesized treatment mechanism in ACT, decreased from pre- to postintervention (d<i>=</i>1.22, p=0.03).</p><p><strong>Conclusions: </strong>Findings provide initial evidence for acceptability and beneficial clinical outcomes of a virtual, group-based ACT intervention to address the transdiagnostic consequences of traumatic stress.</p>","PeriodicalId":46822,"journal":{"name":"AMERICAN JOURNAL OF PSYCHOTHERAPY","volume":" ","pages":"appipsychotherapy20240030"},"PeriodicalIF":2.3,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143812578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effectiveness of Intensive Short-Term Dynamic Psychotherapy for Suicidal Ideation and Anger in Suicidal Behavior.","authors":"Fateh Rahmani, Neda Kakaie, Habibolah Khazaie","doi":"10.1176/appi.psychotherapy.20240023","DOIUrl":"https://doi.org/10.1176/appi.psychotherapy.20240023","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the efficacy of intensive short-term dynamic psychotherapy (ISTDP) in reducing anger and suicidal ideation among individuals with suicidal behavior.</p><p><strong>Methods: </strong>A quasi-experimental design was used, with 30 participants randomly assigned to an experimental or a medication-only control group. Participants, recently hospitalized in Kermanshah, Iran, because of suicide attempt, were assessed via the State-Trait Anger Expression Inventory-2 and the Beck Scale for Suicidal Ideation at baseline and posttreatment. Treatment began after group assignment.</p><p><strong>Results: </strong>ISTDP significantly reduced anger (p<0.05) and suicidal ideation (p<0.05), significantly decreasing the likelihood of suicide reattempts.</p><p><strong>Conclusions: </strong>ISTDP offers promise in combating suicidal thoughts and behaviors, supporting the psychodynamic hypothesis of anger dynamics and inward anger.</p>","PeriodicalId":46822,"journal":{"name":"AMERICAN JOURNAL OF PSYCHOTHERAPY","volume":" ","pages":"appipsychotherapy20240023"},"PeriodicalIF":2.3,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jenna A Park, Daniel J Gottlieb, Bradley V Watts, Vincent Dufort, Jamie L Gradus, Brian Shiner
{"title":"Comparing Suicide Rates for Cognitive Processing Therapy Versus Prolonged Exposure Therapy for Posttraumatic Stress Disorder.","authors":"Jenna A Park, Daniel J Gottlieb, Bradley V Watts, Vincent Dufort, Jamie L Gradus, Brian Shiner","doi":"10.1176/appi.psychotherapy.20240035","DOIUrl":"10.1176/appi.psychotherapy.20240035","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare suicide mortality rates for patients receiving two evidence-based psychotherapy (EBP) protocols for posttraumatic stress disorder (PTSD): cognitive processing therapy (CPT) and prolonged exposure (PE).</p><p><strong>Methods: </strong>Suicide mortality was measured among U.S. Department of Veterans Affairs patients with PTSD who received EBP from 2009 through 2019. Regional variation in delivering CPT versus PE was leveraged as an instrumental variable (IV) to compare suicide mortality by using standard adjustment and IV-based analyses.</p><p><strong>Results: </strong>In total, 62,686 patients received EBP for PTSD; 82.4% were male, and the mean±SD age was 46.9±14.4. Patients were followed for a median of 6 years, and there were 136 deaths by suicide (38.3 and 32.4 per 100,000 person-years among the CPT and PE groups, respectively). The regional rate of CPT versus PE delivery was a strong IV that had greater explanatory power for the type of EBP received than all patient factors combined. The standard adjustment model for CPT produced a hazard ratio of 1.25, whereas the reduced-form IV produced a hazard ratio of 1.22. The probit IV, in which relevant covariates were updated annually, produced an odds ratio of 0.99. The time-to-event IV produced a hazard ratio of 1.20. The differences were not significant.</p><p><strong>Conclusions: </strong>No statistically significant difference was found between CPT and PE in the outcome of death by suicide. More effective interventions that result in higher remission rates would likely need to be developed to achieve a relative decrease in suicide risk through PTSD treatment.</p>","PeriodicalId":46822,"journal":{"name":"AMERICAN JOURNAL OF PSYCHOTHERAPY","volume":" ","pages":"appipsychotherapy20240035"},"PeriodicalIF":2.3,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Good Psychiatric Management of Borderline Personality Disorder and Co-Occurring Autism Spectrum Disorder.","authors":"Robert B Dudas, Lukas Cheney","doi":"10.1176/appi.psychotherapy.20230049","DOIUrl":"10.1176/appi.psychotherapy.20230049","url":null,"abstract":"<p><p>Borderline personality disorder has been estimated to occur among about 4% of those with autism spectrum disorder. This co-occurrence can escalate the challenges of treating either condition separately, and patients often face severe challenges in psychosocial and occupational functioning. Clinicians need guidance to manage a high degree of complexity, using standards of care and a synthesis of what is known so far, to navigate the currently limited armamentarium of clinical tools. This article reviews the available scientific research and clinical experience with respect to diagnosis, psychoeducation, treatment framework, safety management, other co-occurring disorders, and multimodal treatments. It also discusses future directions for generating new knowledge to improve the care of patients with this important co-occurrence. Although the discussion explores the unique complexity and relative lack of clinical guidelines at present, good psychiatric management serves as a clinical framework that anchors treatment approaches as the evidence base develops.</p>","PeriodicalId":46822,"journal":{"name":"AMERICAN JOURNAL OF PSYCHOTHERAPY","volume":" ","pages":"35-45"},"PeriodicalIF":2.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}