ABSTRACT
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. (AU)
Subject(s)
Quality of Life , Mental Disorders , TherapeuticsABSTRACT
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.
