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FUNDACION CASTILLA DEL PINO ABORDAJES PSICOTERAPEUTICO DE LOS TRASTORNOS PSIQUIATRICOS Cordoba, Marzo 2009. INVESTIGACION EN PSICOTERAPIA DINAMICA BREVE Manuel Trujillo, M.D. Professor of Psychiatry New York University.

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FUNDACION CASTILLA DEL PINO

ABORDAJES PSICOTERAPEUTICO

DE LOS

TRASTORNOS PSIQUIATRICOS

Cordoba, Marzo 2009


INVESTIGACION EN PSICOTERAPIADINAMICA BREVE

Manuel Trujillo, M.D.

Professor of Psychiatry

New York University


Biological correlates of psychotherapy figure i
BIOLOGICAL CORRELATES OF PSYCHOTHERAPYFIGURE I

-3

-2

-1

0

2

3

1

Average (no treatment)

control effect size

Average psychotherapy

effect size (.82)

Average Minimal Treatment

(placebo) effect size (.42)

Adapted from Lambert, et al. 1993


Table i meta analytic reviews of outcome with depression
TABLE IMETA-ANALYTIC REVIEWS OF OUTCOME WITH DEPRESSION

* Adapted from Lambert, et al. (1994)


Table ii meta analytic reviews of outcome with anxiety disorders
TABLE IIMETA-ANALYTIC REVIEWS OF OUTCOME WITH ANXIETY DISORDERS

* Percent improved , ** Pretest/Posttest measure Modified from Lambert (1994)


Table iii meta analytic reviews of outcome with anxiety disorders
TABLE IIIMETA-ANALYTIC REVIEWS OF OUTCOME WITH ANXIETY DISORDERS

* Percent improved , ** Pretest/Posttest measure Modified from Lambert (1994)



Criteria for admission to the study inclusion criteria
Criteria for Admission to the StudyInclusion Criteria

  • Age between 18 and 60

  • Evidence of at least one close personal relationship

  • No evidence of psychosis, organic brain syndrome or mental retardation

  • Absence of active Axis III medical diagnosis

  • No evidence of substance abuse

  • Not actively suicidal

  • No history of violence or destructive impulse control problem

  • No recent psychotropic medication such as neuroleptics, antidepressants, Lithium, etc.



Assessment instruments
Assessment Instruments

  • Social History

  • Target Complaints

  • Symptom Checklist (SCL-90)

  • Social Adjustment Scale - SR

  • Personality Diagnostic Questionnaire (PDQ)



Reliability of six combination variables process coding of videotaped psychotherapy sessions

Reliability of Six Combination VariablesProcess Coding of Videotaped Psychotherapy Sessions

VariableThree Judges Pooled

Transference Interpretation .93

followed by affect

Transference Interpretation .75

followed by defense

Non-transference Interpretation .84

followed by affect

Non-transference Interpretation .67

followed by defense

Clarification Interpretation .62

followed by affect

Clarification Interpretation .63

followed by defense


Admission & Termination Means and Effect Sizes* for Significant Findings on the SCL-90 and SAS Subscales Across Groups




Average Frequencies of Occurrence and Comparative Percentages Per Session of Therapist Behaviors in the Two Treatment Groups


Stepwise regression for affect and defense variables on composite outcome score
Stepwise Regression For Affect and Defense Variables On Composite Outcome Score

Multiple R Squared = .66 (F Value=7.71; df=3 and 12)


Partial correlations of affect variables outcome with defensive responding partialed out
Partial Correlations of Affect Variables & Outcome Composite Outcome Score(with Defensive Responding Partialed Out

Composite Outcome

Clarification followed by Affect .09

Nontransference Interpretation followed by Affect .44

Transference Interpretation followed by Affect .73

All Interventions followed by Affect .58


Best worst outcomes

BEST/WORST OUTCOMES Composite Outcome Score

BEST OUTCOME WORST OUTCOME

STDP 2-Obsessional 1- Histrionic

1 - Mixed

BAP 1- Histrionic 2- Obsessional

1- Mixed


Biological correlates of psychoterapy
BIOLOGICAL CORRELATES OF PSYCHOTERAPY Composite Outcome Score

PSYCHOTHERAPY CHANGE AGENTS

  • Affective experiencing

  • Cognitive mastery

  • Behavioral regulation


Biological correlates of psychotherapy
BIOLOGICAL CORRELATES OF PSYCHOTHERAPY Composite Outcome Score

AFFECTIVE EXPERIENCE

  • Implosion therapy Flooding

  • Gestalt therapy Emotional Experience

  • Psychodrama Role playing

  • STDP Impulse/Feelings

    Experiencing


Biological correlates of psychotherapy1
BIOLOGICAL CORRELATES OF PSYCHOTHERAPY Composite Outcome Score

COGNITIVE MASTERY

  • Psychoan. therapy Interpretation

  • Supportive Clarification, support

  • Cognitive Modification of beliefs


Biological correlates of psychotherapy2
BIOLOGICAL CORRELATES OF PSYCHOTHERAPY Composite Outcome Score

BEHAVIORAL REGULATION

  • Behavior therapy Conditioning

  • Assertiveness Skills develop. therapy

  • Token economy Modification of rewards system


PSYCHOTHERAPY AND NEUROBIOLOGY Composite Outcome Score

Cortex

Pre Frontal Cortex

-

+

Stimulus

Amygdala

Hippocampus

Thalamus


Psychotherapy and neurobiology

PSYCHOTHERAPY AND NEUROBIOLOGY Composite Outcome Score

Stress

Glucocorticoids

Glutamate

Moderate

duration

stress

Severe and

prolonged stress

CA3

Reversible atrophy

and loss of

dendritic spines

Neuronal

death

* Adapted from Kandel, 1999


The mirror neuron system rizzollati 1995
THE MIRROR NEURON SYSTEM Composite Outcome ScoreRizzollati 1995

  • Subset of multimodal neurons

    (Simultaneous activation by different sensory modalities)

    • F5 in monkeys

    • Broca 44, 45 in humans

      (Prefrontal Cortex)


The mirror neuron system
THE MIRROR NEURON SYSTEM Composite Outcome Score

Activated by:

  • Observing a meaningful action

  • Performing the same action

  • Basis for primitive learning/communicating with others


The mirror neuron system1
THE MIRROR NEURON SYSTEM Composite Outcome Score

Plays a role in:

  • Affect resonance

  • Empathy

  • Group behaviors: hunting, dancing

  • Language development


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