Associação entre aliança terapêutica e qualidade de vida em psicoterapia psicodinâmica, terapia cognitivo comportamental e terapia interpessoal : a perspectiva do paciente

Introdução: A aliança terapêutica, originalmente um conceito psicanalítico, tem sido um fator associado a resultados positivos em todas as modalidades psicoterápicas, e essa associação vem sendo estudada de forma maciça nas últimas décadas. A evidência de sua capacidade preditiva de melhora dos sintomas específicos dos transtornos mentais é robusta, porém, na literatura revisada até o momento, não existem estudos relacionando a aliança terapêutica com medidas de qualidade de vida. Objetivos: Nosso objetivo é avaliar se existe associação entre aliança terapêutica e qualidade de vida em pacientes adultos em três diferentes psicoterapias. Métodos: Foi realizado um estudo transversal que incluiu pacientes ambulatoriais submetidos a tratamento psicoterapêutico individual em algumas modalidades: psicoterapia psicanalítica (PP), terapia cognitivo-comportamental (TCC) e terapia interpessoal (TIP). Foram avaliadas tanto as Escalas de Psicoterapia Aliança da Califórnia - versão Paciente (CALPAS -P), quanto a escala de Qualidade de Vida da Organização Mundial da Saúde - versão curta (WHOQOL-BREF) em 71 pacientes ambulatoriais. Para avaliar a associação do escore nos domínios da qualidade de vida, aplicou-se o modelo linear generalizado. Para avaliar a correlação entre essas variáveis, foi obtido o coeficiente de correlação de Pearson. Resultados: Ao incluir a amostra total na análise, a associação entre a escala CALPAS -P com os domínios do WHOQOL-BREF não apresentou significância estatística (p <0,05). Ao considerar apenas a amostra de pacientes que estavam em tratamento em PP, houve significância estatística na associação entre o escore total da CALPAS -P apenas com o domínio psicológico da WHOQOL-BREF b = 7.943 (0,14 a 15,74) (p = 0,046), e correlação de Pearson r = 0,287. Quando da regressão para os fatores de confusão (idade, número de sessões, sintomas depressivos, sexo e uso de medicação psiquiátrica), a correlação do domínio psicológico com o CALPAS -P nos pacientes com PP perde a significância (p = 0,221). Conclusão: Esses achados corroboram a hipótese de que, embora seja considerado um fator inespecífico de qualquer tipo de psicoterapia, parece estar mais fortemente relacionado a melhores resultados em psicoterapias psicanalíticas.Introduction: The therapeutic alliance, firstly a psychoanalytical concept, has been a factor associated with positive results in all psychotherapy modalities, and this association has been studied massively in the last decades. The evidence of its predictive capacity for improvement in specific symptoms of mental disorders is robust, however, in literature review so far, there are no studies relating the therapeutic alliance with quality of life measures. Objectives: Our objective is to evaluate if there is an association between therapeutic alliance and quality of life in adult patients in three different psychotherapies. Methods: It was conducted a cross-sectional study which included outpatients who were undergoing individual psychotherapeutic treatment in some of the modalities: psychoanalytic psychotherapy (PP), cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). We evaluated both the California Psycotherapy Alliance Scales – Patient version (CALPAS -P), and the World Healt Organization Quality of Life scale - short version (WHOQOL-BREF) in 71 outpatients. To evaluate the association of the -score on quality of life domains, the generalized linear model was applied. To evaluate the correlation between these variables the Pearson correlation coefficient was obtained. Results: When including total sample in the analysis, the correlation of the CALPAS -P) scale with the WHOQOL-BREF domains did not present statistical significance (p <0.05). When considering only the sample of patients who were undergoing treatment in PP, there was a statistical significance in the association between the CALPAS -P only on the psychological domain of the WHOQOL-BREF: b = 7,943 (.14 to 15.74) (p = 0.046), and Pearson's correlation r = 0.287. When the regression for the confounding factors (age, number of sessions, depressive symptoms, sex and use of psychiatric medication), the correlation of the psychic domain with the CALPAS-P in the PP patients loses the significance (p = 0.221). Conclusion: These findings corroborate the hypothesis that although it is considered a nonspecific factor of any kind of psychotherapy, it seems to be more strongly related to better results in psychoanalytic psychotherapies

Longitudinal investigation of psychotherapy outcomes (LIPO) : description of the study protocol

Background: Despite extensive research in the field of psychotherapies, few studies have compared the primary psychotherapies of naturalistic design, which represents real-life situations. Objective: The objectives of this study were to evaluate three modalities of evidence-based psychotherapy for clinical, psychosocial, and biological outcomes and to identify the mediators and confounders of this process. Our primary hypothesis is that all psychotherapies will improve clinical and psychosocial outcomes and will increase BDNF levels. Methods: Design: longitudinal, naturalistic. Participants: One hundred twenty-six patients who underwent one of three evidence-based modalities of individual psychotherapy [psychodynamic psychotherapy (PDT), interpersonal psychotherapy (IPT), and cognitive–behavioral psychotherapy (CBT)] were included. Measure: Primary outcomes are divided into three domains of variables: clinical (general psychiatric symptoms), biological (serum BDNF levels), and psychosocial (resilience, quality of life, coping strategies, social support, and quality of life-adjusted years of life). Confounding/mediator variables included clinical (personality traits, type of psychotherapy, number of sessions, concomitant use of pharmacological treatment, history of previous psychotherapeutic treatment, medical and psychiatric comorbidities, and psychiatric diagnosis), psychosocial (psychosocial stressors, therapeutic alliance, and defense mechanism style), and other (religiosity) factors. Procedure: The follow-up period will be baseline and 6 months and 1 year after entering the study. The study will include 42 controls for biological variables only. Sample size calculation considered a significance level of 5% and a power of 80% to detect a difference of 0.22 with a standard deviation of 0.43, assuming losses of 20–30% of patients. The comparison between the modalities of psychotherapy will be by generalized estimating equations (GEE) model, the analysis of mediators by the Hayes method, and confounders by multivariate logistic regression. Discussion: The findings of this study are intended to demonstrate the outcomes of evidence-based psychotherapies for clinical, psychosocial, and biological parameters and to understand the mediators and confounders of this process in a real-life setting for patients with severe mental illness, thus contributing to the establishment of evidence-based public health policies in the field of psychological interventions

Positive association between therapeutic alliance and quality of life in psychodynamic psychotherapy, cognitive behavior therapy, and interpersonal therapy : the patient’s perspective

Background: The therapeutic alliance (TA) is considered a common psychotherapeutic factor associated with positive results in psychotherapies. There are no studies relating the TA with quality of life (Qol). Objectives: Our objective was to evaluate whether there is an association between the TA and Qol across three different psychotherapies. Methods: A cross-sectional study, which included outpatients undergoing individual psychotherapeutic treatment was conducted. When analyzing the total sample, the correlation of the TA with Qol domains did not present statistical significance. When considering only the sample of patients who were undergoing treatment in psychodynamic psychotherapy (PP), there was a statistically significant association between the TA and the psychological domain of Qol (p < 0.05). When using a regression model for adjusting for confounding factors, the association between psychological domain with the TA on the PP patients sample lost significance (p = 0.221). Discussion: These findings suggest that the TA seems to be more strongly related to better QoL in PP

Propriedades psicométricas do protocolo de sistema diagnóstico Operationalization of Psychodynamic Diagnosis 2 (OPD-2) em pacientes com transtorno mental grave em psicoterapia

Introduction: In order to expand the descriptive classification of symptoms in mental disorders, and to bring empirical consistency to psychodynamic/psychoanalytic models, a multiaxial instrument called Operationalized Psychodynamic Diagnosis (OPD-2) has been developed, allowing psychotherapy research to encompass the complexity of the relationships between conditions and factors that determine the phenomena of mental pathologies, from a psychodynamic point of view. Methodology: Longitudinal naturalistic study with 80 outpatients with severe mental disorders, who were treated with a) psychodynamic psychotherapy, b) interpersonal psychotherapy and c) cognitive behavioral psychotherapy. All patients were interviewed at baseline and after six months, according to OPD-2’s criteria. They all also completed two self-report measures (WHOQOL-BREF and SCL-90R) to evaluate symptoms and quality of life at each assessment point. Results: According to OPD-2’s axis I, better personal resources, psychosocial support, and introspective capacity significantly correlated with fewer symptoms in the BDI’s and SCL-90’s measures. Also, symptoms’ reduction and quality of life’s domains significantly correlated with items that assessed OPD-2’s “desire for care versus autarchy” and “identity” conflicts. There was also a significant correlation between all items that evaluate structural functioning according to OPD-2 and the SCL-90R’s psychotic index. Regarding predictive validity analysis, we observed mean differences in the structural functioning of patients with a history of suicide attempt and previous history of hospitalization. Discussion: results support that OPD-2’s criteria significantly correlates with data from validated self-report measures. When administered by trained raters, OPD-2 displayed good quality in assessing patients’ conflicts and structural issues. This evidence suggests that the Brazilian version of OPD-2 is a valid and reliable instrument in evaluating psychodynamic properties and can be a useful tool within the clinical and research contexts

Longitudinal investigation of psychotherapy outcomes (LIPO) : description of the study protocol

Background: Despite extensive research in the field of psychotherapies, few studies have compared the primary psychotherapies of naturalistic design, which represents real-life situations. Objective: The objectives of this study were to evaluate three modalities of evidence-based psychotherapy for clinical, psychosocial, and biological outcomes and to identify the mediators and confounders of this process. Our primary hypothesis is that all psychotherapies will improve clinical and psychosocial outcomes and will increase BDNF levels. Methods: Design: longitudinal, naturalistic. Participants: One hundred twenty-six patients who underwent one of three evidence-based modalities of individual psychotherapy [psychodynamic psychotherapy (PDT), interpersonal psychotherapy (IPT), and cognitive–behavioral psychotherapy (CBT)] were included. Measure: Primary outcomes are divided into three domains of variables: clinical (general psychiatric symptoms), biological (serum BDNF levels), and psychosocial (resilience, quality of life, coping strategies, social support, and quality of life-adjusted years of life). Confounding/mediator variables included clinical (personality traits, type of psychotherapy, number of sessions, concomitant use of pharmacological treatment, history of previous psychotherapeutic treatment, medical and psychiatric comorbidities, and psychiatric diagnosis), psychosocial (psychosocial stressors, therapeutic alliance, and defense mechanism style), and other (religiosity) factors. Procedure: The follow-up period will be baseline and 6 months and 1 year after entering the study. The study will include 42 controls for biological variables only. Sample size calculation considered a significance level of 5% and a power of 80% to detect a difference of 0.22 with a standard deviation of 0.43, assuming losses of 20–30% of patients. The comparison between the modalities of psychotherapy will be by generalized estimating equations (GEE) model, the analysis of mediators by the Hayes method, and confounders by multivariate logistic regression. Discussion: The findings of this study are intended to demonstrate the outcomes of evidence-based psychotherapies for clinical, psychosocial, and biological parameters and to understand the mediators and confounders of this process in a real-life setting for patients with severe mental illness, thus contributing to the establishment of evidence-based public health policies in the field of psychological interventions