Herziening Besluit Psychotherapeut: kans voor sprong voorwaarts.

Het Besluit Psychotherapeut (bp) 1998 regelt de toegang tot het beroep van psychotherapeut in het big-register. Er klinken geluiden om de definitie van het beroep psychotherapeut opnieuw onder de loep te nemen via een herziening van het bp. Een herziening van dit besluit binnen afzienbare tijd is nuttig en noodzakelijk. De bijdrage van psychotherapieonderzoekers aan de herziening is essentieel, omdat de kwaliteitseisen moeten stoelen op onderzoeksgegevens over de werkzaamheid en kosten)effectiviteit van therapieën in plaats van op theoretische stromingen. Van herziening van het besluit valt een belangrijk effect op de praktijk van de psychotherapeutische hulpverlening te verwachten

The exploratory value of cross-sectional partial correlation networks:Predicting relationships between change trajectories in borderline personality disorder

OBJECTIVE: Within the network approach to psychopathology, cross-sectional partial correlation networks have frequently been used to estimate relationships between symptoms. The resulting relationships have been used to generate hypotheses about causal links between symptoms. In order to justify such exploratory use of partial correlation networks, one needs to assume that the between-subjects relationships in the network approximate systematic within-subjects relationships, which are in turn the results of some within-subjects causal mechanism. If this assumption holds, relationships in the network should be mirrored by relationships between symptom changes; if links in networks approximate systematic within-subject relationships, change in a symptom should relate to change in connected symptoms. METHOD: To investigate this implication, we combined longitudinal data on the Borderline Personality Disorder Severity Index from four samples of borderline personality disorder patients (N = 683). We related parameters from baseline partial correlation networks of symptoms to relationships between change trajectories of these symptoms. RESULTS: Across multiple levels of analysis, our results showed that parameters from baseline partial correlation networks are strongly predictive of relationships between change trajectories. CONCLUSIONS: By confirming its implication, our results support the idea that cross-sectional partial correlation networks hold a relevant amount of information about systematic within-subjects relationships and thereby have exploratory value to generate hypotheses about the causal dynamics between symptoms

Imagery rescripting for the treatment of trauma in voice hearers: a case series

Background: High rates of trauma and post-traumatic stress disorder (PTSD) are reported in people who hear voices (auditory hallucinations). A recent metanalysis of trauma interventions in psychosis showed only small improvements in PSTD symptoms and voices. Imagery Rescripting (ImRs) may be a therapy that is more effective in this population because it generalizes over memories, which is ideal in this population with typically repeated traumas. The primary aims of this study were to investigate whether ImR reduces (1) PTSD symptoms and (2) voice frequency and distress in voice hearers. Methods: A single arm open trial study, case-series design. Twelve voice hearers with previous traumas that were thematically related to their voices participated. Brief weekly assessments (administered sessions 1-8, post-intervention, and 3-month follow-up) and longer measures (administered pre-, mid-, and post-intervention) were administered. Mixed regression analysis was used to analyze the results. Results: There was one treatment dropout. Results of the weekly measure showed significant linear reductions over time in all three primary variables - Voice Distress, Voice Frequency, and Trauma Intrusions - all with large effect sizes. These effects were maintained (and continued to improve for Trauma Intrusions) at 3-month follow-up. On the full assessment tools, all measures showed improvement over time, with five outcomes showing significant time effects: trauma, voice frequency, voice distress, voice malevolence and stress. Conclusion: The findings of the current study suggest that ImRs for PTSD symptoms is generally well tolerated and can be therapeutically beneficial among individuals who hear voices

Positive cognitive behavior therapy in the treatment of depression:A randomized order within-subject comparison with traditional cognitive behavior therapy

Previous research suggests that a stronger focus on positive emotions and positive mental health may improve efficacy of Cognitive Behavior Therapy (CBT). Objectives were to compare differential improvement of depressive symptoms (primary outcome), positive affect, and positive mental health indices during positive CBT (P-CBT; CBT in a solution-focused framework, amplified with optional positive psychology exercises) versus traditional, problem-focused CBT (T-CBT). Forty-nine patients with major depressive disorder (recruited in an outpatient mental health care facility specialized in mood disorders) received two treatment blocks of eight sessions each (cross-over design, order randomized). Intention-To-Treat mixed regression modelling indicated that depressive symptoms improved similarly during the first, but significantly more in P-CBT compared to T-CBT during the second treatment block. Rate of improvement on the less-frequently measured secondary outcomes was not significantly different. However, P-CBT was associated with significantly higher rates of clinically significant or reliable change for depression, negative affect, and happiness. Effect sizes for the combined treatment were large (pre-post Cohen's d = 2.71 for participants ending with P-CBT, and 1.85 for participants ending with T-CBT). Positive affect, optimism, subjective happiness and mental health reached normative population averages after treatment. Overall, findings suggest that explicitly focusing on positive emotions efficiently counters depressive symptoms

Schema therapy for Dissociative Identity Disorder:a case report

Treatment for Dissociative Identity Disorder (DID) often follows a practice-based psychodynamic psychotherapy approach that is conducted in three phases: symptom stabilization, trauma processing, and identity integration and rehabilitation. The percentage of patients that reach the third phase is relatively low, treatment duration is long, and the effects of this treatment on the core DID symptoms have been found to be small or absent, leaving room for improvement in the treatment of DID. Schema Therapy (ST) is an integrative psychotherapy that has been proposed as a treatment for DID. This approach is currently being investigated in several studies and has the potential to become an evidence-based treatment for DID. This case report presents an overview of the protocol adaptations for DID ST treatment. The presented case concerns a 43-year-old female patient with DID, depressive disorder (recurrent type), PTSD, cannabis use disorder, and BPD. Functioning was very low. She received 220 sessions of ST, which included direct trauma processing through Imagery Rescripting (ImRs). The patient improved in several domains: she experienced a reduction of PTSD symptoms, as well as dissociative symptoms, there were structural changes in the beliefs about the self, and loss of suicidal behaviors. After treatment she was able to stop her punitive mode, to express her feelings and needs to others, and to participate adequately in social interaction. This case report indicates that ST might be a viable treatment for DID, adding to a broader scope of treatment options for this patient group.</p

Schema modes and childhood abuse in borderline and antisocial personality disorders

Abstract Complex personality disorders (PDs) have been hypothesized to be characterized by alternating states of thinking, feeling and behavior, the so-called schema mode

Schema therapy for chronic depression: Results of a multiple single case series

Background and Objectives: The aim of this study was to test the effects of individual schema therapy (ST) for patients with chronic depression. Methods: Using a multiple-baseline single case series design, patients with chronic major depressive disorder (N = 25) first entered a 6 to 24 weeks baseline phase; this phase functioned as a no-treatment control condition. Then, patients started a 12 week exploration phase during which symptoms and underlying schemas were explored; this phase functioned as an attention control condition. Next, patients received up to 65 sessions of individual ST. The Beck Depression Inventory II (BDI-II) and the Quick Inventory of Depressive Symptomatology (QIDS) were the primary outcome measures. The BDI-II was assessed once a week during all phases of the study resulting in 100 repeated assessments per participant on average. Mixed regression analysis was used to contrast change in symptoms during the intervention with change in symptoms during the baseline and exploration control phases. Results: When compared to the no-treatment control period, the intervention had a significant, large effect on depressive symptoms (Cohen’s d BDI-II = 1.30; Cohen’s d QIDS = 1.22). Effects on secondary continuous outcomes were moderate to large. Limitations: The small sample size and lack of a control group. Conclusions: These findings provide evidence that ST might be an effective treatment for patients with chronic depression

Mechanisms of change in psychotherapy for depression:An empirical update and evaluation of research aimed at identifying psychological mediators

We present a systematic empirical update and critical evaluation of the current status of research aimed at identifying a variety of psychological mediators in various forms of psychotherapy for depression. We summarize study characteristics and results of 35 relevant studies, and discuss the extent to which these studies meet several important requirements for mechanism research. Our review indicates that in spite of increased attention for the topic, advances in theoretical consensus about necessities for mechanism research, and sophistication of study designs, research in this field is still heterogeneous and unsatisfactory in methodological respect. Probably the biggest challenge in the field is demonstrating the causal relation between change in the mediator and change in depressive symptoms. The field would benefit from a further refinement of research methods to identify processes of therapeutic change. Recommendations for future research are discussed. However, even in the most optimal research designs, explaining psychotherapeutic change remains a challenge. Psychotherapy is a multi-dimensional phenomenon that might work through interplay of multiple mechanisms at several levels. As a result, it might be too complex to be explained in relatively simple causal models of psychological change