Muligheder og udfordringer i kognitiv adfærdsterapeutisk gruppesupervision

Kognitiv adfærdsterapeutisk gruppesupervision(KAT-GS) er et udbredt supervisionsformat, der anvendes i en række sammen­hænge, bl.a. i private kognitive klinikker, i behandlingspsyki­atrien, i manualbaserede forskningsprojekter og i formalisere­de uddannelser af kognitive adfærdsterapeuter. Sammenlignet med individuel kognitiv adfærdsterapeutisk supervision (KAT-S) er KAT-GS forbundet med en række muligheder og udfordringer. Den enkelte supervisionsgruppe rummer som udgangspunkt et væld af klientcases, terapeuterfaringer, teore­tiske og kliniske observationer samt interaktioner, ligesom gruppen er præget af den organisatoriske ramme, den er indle­jret i. Det illustreres, hvordan KAT-GS kan udøves på en måde, der afspejler virksomme læringsmetoder integreret med klas­siske principper og metoder i kognitiv adfærdsterapi som sokratisk dialog, caseformulering, hjemmearbejde m.m. Der præsenteres ideer til, hvordan supervisor kan organisere og strukturere supervisionsprocessen med henblik på at udnytte gruppens potentiale og sikre læring og erfaringsdannelse i gruppen og hos den enkelte supervisand. I artiklens sidste del sættes fokus på nogle af de særlige udfordringer, der kan blokere for at skabe et udviklende og kreativt læringsmiljø

Treatment of difficult-to-treat depression – clinical guideline for selected interventions

Difficult-to-treat-depression (DTD) is a clinical challenge. The interventions that are well-established for DTD are not suitable or effective for all the patients. Therefore, more treatment options are highly warranted. We formulated an evidence-based guideline concerning six interventions not well-established for DTD in Denmark. Selected review questions were formulated according to the PICO principle with specific definitions of the patient population (P), the intervention (I), the comparison (C), and the outcomes of interest (O), and systematic literature searches were performed stepwise for each review question to identify relevant systematic reviews/meta-analyses, and randomized controlled trials. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to assess the methodological quality of the included studies. Clinical recommendations were formulated based on the evidence, the risk-benefit ratio, and perceived patient preferences. We found sufficient evidence for a weak recommendation of repetitive transcranial magnetic stimulation (rTMS) and cognitive behavioural analysis system of psychotherapy (CBASP). The use of bright light therapy in DTD was not sufficiently supported by the evidence, but should be considered as good clinical practice. The interventions should be considered in addition to ongoing antidepressant treatment. We did not find sufficient evidence to recommend intravenous ketamine/esketamine, rumination-focused psychotherapy, or cognitive remediation to patients with DTD. The evidence supported two of the six reviewed interventions, however it was generally weak which emphasizes the need for more good quality studies. This guideline does not cover all treatment options and should be regarded as a supplement to relevant DTD-guidelines