The Importance of Psychotherapy for Treatment-Resistant Depression.

Many clinicians choose psychoanalytic psychotherapy or supportive psychotherapy as the primary method of treating depression with or without antidepressant medications. Despite new antidepressants, 20% or more patients showed inadequate responses to the medications, and remained in chronic courses, known as "treatment-resistant depression (TRD)."In this chapter, we described (1) the reasons for psychotherapy in treating TRD from the perspectives of the hazard of polypharmacy, resistance, and neural mechanisms. (2) Next, we focused on the importance of assessment with two clinical vignettes and the original modality of psychoanalysis, psychoanalytic psychotherapy, and supportive psychotherapy in brief. (3) Finally, we described specific considerations in undertaking psychotherapy for TRD patients in terms of transference, countertransference, and resistance. In addition, the efficacy of psychoanalytic psychotherapy in childhood, adolescent, and late-life depression has been depicted in this paper.

Biomarker-Guided Tailored Therapy in Major Depression.

This chapter provides a comprehensive examination of a broad range of biomarkers used for the diagnosis and prediction of treatment outcomes in major depressive disorder (MDD). Genetic, epigenetic, serum, cerebrospinal fluid (CSF), and neuroimaging biomarkers are analyzed in depth, as well as the integration of new technologies such as digital phenotyping and machine learning. The intricate interplay between biological and psychological elements is emphasized as essential for tailoring MDD management strategies. In addition, the evolving link between psychotherapy and biomarkers is explored to uncover potential associations that shed light on treatment response. This analysis underscores the importance of individualized approaches in the treatment of MDD that integrate advanced biological insights into clinical practice to improve patient outcomes.

Telepsychiatry in the Treatment of Major Depressive Disorders.

This chapter explores the transformative role of telepsychiatry in managing major depressive disorders (MDD). Traversing geographical barriers and reducing stigma, this innovative branch of telemedicine leverages digital platforms to deliver effective psychiatric care. We investigate the evolution of telepsychiatry, examining its diverse interventions such as videoconferencing-based psychotherapy, medication management, and mobile applications. While offering significant advantages like increased accessibility, cost-effectiveness, and improved patient engagement, challenges in telepsychiatry include technological barriers, privacy concerns, ethical and legal considerations, and digital literacy gaps. Looking forward, emerging technologies like virtual reality, artificial intelligence, and precision medicine hold immense potential to personalize and enhance treatment effectiveness. Recognizing its limitations and advocating for equitable access, this chapter underscores telepsychiatry's power to revolutionize MDD treatment, making quality mental healthcare a reality for all.

Digital Mental Health Interventions for Alleviating Depression and Anxiety During Psychotherapy Waiting Lists: Systematic Review.

BACKGROUND: Depression and anxiety have become increasingly prevalent across the globe. The rising need for treatment and the lack of clinicians has resulted in prolonged waiting times for patients to receive their first session. Responding to this gap, digital mental health interventions (DMHIs) have been found effective in treating depression and anxiety and are potentially promising pretreatments for patients who are awaiting face-to-face psychotherapy. Nevertheless, whether digital interventions effectively alleviate symptoms for patients on waiting lists for face-to-face psychotherapy remains unclear. OBJECTIVE: This review aimed to synthesize the effectiveness of DMHIs for relieving depression and anxiety symptoms of patients on waiting lists for face-to-face therapy. This review also investigated the features, perceived credibility, and usability of DMHIs during waiting times. METHODS: In this systematic review, we searched PubMed, PsycINFO, Cochrane, and Web of Science for research studies investigating the effectiveness of DMHIs in reducing either depression or anxiety symptoms among individuals waiting for face-to-face psychotherapy. The search was conducted in June 2024, and we have included the studies that met the inclusion criteria and were published before June 6, 2024. RESULTS: Of the 9267 unique records identified, 8 studies met the eligibility criteria and were included in the systematic review. Five studies were randomized controlled trials (RCTs), and 3 studies were not. Among the RCTs, we found that digital interventions reduced depression and anxiety symptoms, but the majority of interventions were not more effective compared to the control groups where participants simply waited or received a self-help book. For the non-RCTs, the interventions also reduced symptoms, but without control groups, the interpretation of the findings is limited. Finally, participants in the included studies perceived the digital interventions to be credible and useful, but high dropout rates raised concerns about treatment adherence. CONCLUSIONS: Due to the lack of effective interventions among the reviewed studies, especially among the RCTs, our results suggest that waiting list DMHIs are not more effective compared to simply waiting or using a self-help book. However, more high-quality RCTs with larger sample sizes are warranted in order to draw a more robust conclusion. Additionally, as this review revealed concerns regarding the high dropout rate in digital interventions, future studies could perhaps adopt more personalized and human-centered functions in interventions to increase user engagement, with the potential to increase treatment adherence and effectiveness.

Psychedelic research at a crossroads.

There is an urgent need to develop better treatments for mental health conditions that affect one in every eight people in the world. To combat this concern, psychedelic drugs have been combined with psychotherapy and studied in clinical trials in the United States and Europe. Psychedelics are hallucinogenic drugs that alter brain activity and facilitate altered states of consciousness. The proposed benefits of psychedelic-assisted therapy (PAT) include relatively short treatment times and stronger effects compared to other treatments. Although results of trials using MDMA for trauma or psilocybin for depression are promising, PAT is controversial because many questions about its safety and effectiveness are unanswered. This is evident in the recent ruling by the US Food and Drug Administration against the approval of MDMA therapy for post-traumatic stress disorder and the retraction of several papers about MDMA trials owing to unethical conduct by study therapists and data integrity, among other concerns. This field is at a crossroads, and the research community must address several obstacles to transition from exploratory trials to established, evidence-based treatments while avoiding pitfalls that can hinder advancement.

Aus Klinik und Praxis / From Clinic and Practice. Aktuelle Ansätze und Methoden Systemischer Therapie und Beratung: KIKOS® verbindet Techniken und Systeme / Current Approaches and Methods of Systemic Therapy and Counselling: KIKOS® Combines Techniques and Systems.

Current Approaches and Methods of Systemic Therapy and Counselling: KIKOSR Combines Techniques and Systems Therapy with children and teens could often be more effective and sustainable if the therapeutic process included not only the family environment, but also the more distant environment, such as teachers and pedagogues from school and leisure activities. It is important to take a look at the principles of hypnotherapeutic and systemic therapy approaches and perhaps even beyond. Whenever working according to guidelines or manuals no longer shows success, it can be extremely helpful to interrupt those patterns by making use of a combination of different therapeutic techniques, such as PEP®, impact and embodiment techniques, as well as resource and solution-oriented approaches. KIKOS® is an approach that promotes tolerance of ambiguity in all systems, regardless of the basic therapeutic orientation, by combining techniques and systems while taking into account the individuality of client and practitioner.

The allocation of patients with personality disorders to a suitable treatment approach: The development of a checklist based on patients' life stories.

Treatment assignment for patients with personality disorders (PDs) involves a complex process consisting of diagnostic assessment and deciding on the most appropriate psychotherapeutic treatment. This article describes the development of a checklist for systematic analysis of life stories to support reflective and transparent assignment of patients to either dialectical behavioral therapy (DBT) or schema-focused therapy (SFT). In a first study, an email survey, focus group, and member check were conducted among eight clinical experts to identify relevant dimensions in life stories in patients with PDs. In a second study, a checklist based on these dimensions was developed in three rounds of testing with nine clinical experts and nine psychology students. Checklist results were compared to actual assigned treatment for 20 patients. Systematic evaluation of life stories, is promising in supporting the allocation of patients with PDs to a suitable treatment approach by focusing on specific and consensual dimensions in patients' life stories.

A prospective non-randomized controlled trial testing the effectiveness of psychotherapeutic inpatient treatment of Post-COVID-19 syndrome - study protocol.

INTRODUCTION: In addition to physical symptoms such as dyspnea, fatigue, post-exertional malaise, and pain, a subgroup of patients with Post-COVID-19 syndrome (Post-Acute Sequelae of COVID-19, PASC) suffers from mental illnesses such as anxiety, depression, and neurocognitive impairments. To date, there are no causal treatments available for PASC. While initial studies show that psychotherapy improves psychological symptoms, PASC-related fatigue, and psychosocial functioning, further research is needed to evaluate the effectiveness of psychotherapeutic treatment for PASC. METHODS AND ANALYSIS: This study presents a non-randomized controlled trial aimed at evaluating the effectiveness of a five-week multimodal inpatient psychosomatic treatment program for individuals experiencing PASC symptoms and comorbid mental illness. A total of 118 patients presented at the Post-COVID Center at the Universitätsklinikum Erlangen will be assigned to the intervention group receiving inpatient psychosomatic treatment or the control group receiving treatment as usual. The inclusion criteria for the intervention group are a diagnosis of PASC and at least one condition of mental distress and problems with coping with illness. The primary objective of the intervention is to reduce mental ailments, including depression and anxiety, as well as neurocognitive deficits, and to address PASC symptoms such as fatigue and pain. The core elements of the treatment are psychotherapy in individual and group settings, medical treatment, neurocognitive training, and physical therapy, adapted to the individual's capacity and oriented towards the concept of pacing. After enrollment, participants will undergo a 6-month follow-up to assess long-term results and the sustainability of the intervention effects. DISCUSSION: This study examines the effectiveness of inpatient psychotherapeutic treatment in PASC patients with comorbid mental illness in comparison with a control group based on treatment as usual. The results of the study can contribute to the development of evidence-based interventions to address the complex needs of patients with PASC and comorbid mental illness. TRIAL REGISTRATION: German Clinical Trial Register (DRKS), retrospectively registered 15.02.2024 DRKSID DRKS00033562.

Longitudinal DNA methylation in parent-infant pairs impacted by intergenerational social adversity: An RCT of the Michigan Model of Infant Mental Health Home Visiting.

INTRODUCTION: Early childhood development is a strong predictor of long-term health outcomes, potentially mediated via epigenetics (DNA methylation). The aim of the current study was to examine how childhood experiences, punitive parenting, and an intergenerational psychotherapeutic intervention may impact DNA methylation in young children and their mothers. METHODS: Mothers and their infants/toddlers between 0 and 24 months were recruited at baseline (n = 146, 73 pairs) to participate in a randomized control trial evaluating the effectiveness of The Michigan Model of Infant Mental Health Home Visiting (IMH-HV) parent-infant psychotherapy compared to treatment as usual. Baseline and 12-month post-enrollment data were collected in the family's home and included self-report questionnaires, biological saliva samples, home environment observation, video-taped parent-child interaction, and audio-recorded interviews. Saliva DNA methylation was measured at the genes, nuclear receptor subfamily 3 group C member 1 (NR3C1), solute carrier family 6 member 4 (SLC6A4), brain-derived neurotrophic factor (BDNF), and the genetic element, long interspersed nuclear element-1 (LINE1). RESULTS: For mothers, baseline methylation of BDNF, SLC6A4, NR3C1, or LINE1 was largely not associated with baseline measures of their childhood adversity, adverse life experiences, demographic characteristics related to structurally driven inequities, or to IMH-HV treatment effect. In infants, there were suggestions that methylation in SLC6A4 and LINE1 was associated with parenting attitudes. Infant BDNF methylation suggested an overall decrease in response to IMH-HV psychotherapy over 12 months. CONCLUSIONS: Overall, our findings suggest that the epigenome in infants and young children may be sensitive to both early life experiences and parent-infant psychotherapy.

Psychokardiologie ­ aus praktischer und klinischer Sicht.

In order to treat and research the development, progression, therapy and prevention of cardiological and psychosomatic disorders and their interactions, the field of psychocardiology has been established in recent years and now offers several treatment options.The well-known somatic risk factors for cardiovascular diseases such as smoking, diabetes mellitus, arterial hypertension and acquired or congenital lipid metabolism disorders, lack of exercise, malnutrition and sleep-related disorders are often related to psychosocial risk factors. Conversely, mental illnesses such as depression and post-traumatic stress disorder can also be viewed as independent risk factors for cardiovascular diseases.Somatic illnesses can, in turn, result in significant psychological reactions that have a severely negative impact on the course of the disease, participation and quality of life.In addition to the scientific research into these connections, psychocardiology offers a clinical specialty that questions, diagnoses and provides treatment for psychosocial connections in cardiovascular patients.The aim of this article is primarily to convey clinical and practical aspects of psychocardiology and the most important psychological comorbidities in connection with heart disease. In addition, it should be shown which therapeutic offers are available in the medical care structures and how therapy can be carried out. Psychotherapy and exercise therapy are preferred for the treatment of these comorbid disorders. The possibility of psychopharmacological therapy for cardiovascular patients is also presented, especially because of possible problematic medication interactions.

Neurobiology and Treatment of Posttraumatic Stress Disorder.

The recent worldwide surge of warfare and hostilities exposes increasingly large numbers of individuals to traumatic events, placing them at risk of developing posttraumatic stress disorder (PTSD) and challenging both clinicians and service delivery systems. This overview summarizes and updates the core knowledge of the genetic, molecular, and neural circuit features of the neurobiology of PTSD and advances in evidence-based psychotherapy, pharmacotherapy, neuromodulation, and digital treatments. While the complexity of the neurobiology and the biological and clinical heterogeneity of PTSD have challenged clinicians and researchers, there is an emerging consensus concerning the underlying mechanisms and approaches to diagnosis, treatment, and prevention of PTSD. This update addresses PTSD diagnosis, prevalence, course, risk factors, neurobiological mechanisms, current standard of care, and innovations in next-generation treatment and prevention strategies. It provides a comprehensive summary and concludes with areas of research for integrating advances in the neurobiology of the disorder with novel treatment and prevention targets.

[The effects of changes in attitudes toward masculinity in the psychotherapy of depression].

INTRODUCTION: In recent decades, serious changes have been observed in social gender roles. More and more publications have been published regarding the connection between masculinity and mental disorders. Most of the professional guidelines related to major depression have not been adapted yet to social changes in gender roles, or only to a small extent. OBJECTIVE: The authors of the article present the possible influence of masculinity on psychotherapies, focusing on clients suffering from major depressive disorder. METHOD: In our manuscript, we first summarize the psychosocial changes that affect the male gender role in Western societies. After that, we review the possible impact of this transformation on psychotherapies. We mainly deal with the relationship between the onset of major depressive disorder and the male gender role. At the end of our publication, we make recommendations on how to integrate our knowledge of masculinity into the context of therapy. RESULTS: Individual socialization differences related to the male gender role and social expectations can greatly influence the appearance of mental illnesses. Internalized and externalized symptoms should also be taken into account in the recognition and treatment of major depressive disorder. Positive masculinity as a therapeutic framework can be successfully combined with specific psychotherapies in order to personalize the healing process. CONCLUSIONS: In recent years, mental health care sensitive to gender roles has gained more and more space. Although we already have more and more information about how masculinization affects the clinical picture of mental illness, such as major depressive disorder, further studies are needed for more effective diagnosis and therapy.

A Randomized Controlled Trial Comparing Mentalization-Based Therapy With the Unified Protocol in the Treatment of Psychopathy and Comorbid Borderline + Antisocial Personality Disorders.

BACKGROUND: Those with cooccurring antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are reported to be highly psychopathic and to represent a severe challenge to treatment efforts. In a sample of such individuals, the effects of two treatments, mentalization-based therapy (MBT) and the unified protocol (UP), were investigated on three outcomes: (i) the psychopathy trait domains of meanness, boldness and disinhibition proposed by the triarchic psychopathy model (TPM); (ii) antisocial and borderline symptom severity; and (iii) the severity of their common features including impulsivity, anger expression and self-harm. METHODS: Of 163 individuals with BPD + ASPD screened for eligibility, 55 were randomized to MBT treatment and 53 to UP treatment. Outcomes of treatment were assessed at 6-month intervals to 36 months. RESULTS: Short-term reductions were seen following both treatments in traits of psychopathy, antisocial and borderline personality symptom severity, anger dysregulation, impulsivity and self-harm, but both treatment groups showed almost complete relapse of symptoms at the 36-month follow-up. UP had more durable effects than MBT. CONCLUSIONS: Despite being a considerably shorter treatment, UP was at least as effective as MBT and in some respects superior. Remission of symptoms was not achieved by either treatment in the long term. Psychopathy and borderline/antisocial comorbidity with which it is associated are to some extent remediable through psychotherapy, but only in the short term. CLINICAL IMPLICATIONS: Patients with high levels of impulsivity and disinhibition are likely to relapse following psychotherapy and should be closely monitored after treatment.

Application of Psychotherapy Based on Five-Element Theory in Traditional Chinese Medicine in Improving the Mental States of Patients with Post-Stroke Depression.

BACKGROUND: This study aims to explore the clinical effect of psychotherapy based on five-element theory in traditional Chinese medicine (TCM) in improving the mental states of patients with post-stroke depression (PSD), to provide reference and guidance for clinical treatment. METHODS: A retrospective study was conducted on 163 PSD cases treated in The Second Affiliated Hospital, Hengyang Medical School, University of South China from January 2022 to January 2023. The patients treated with conventional treatment were included in the control group (n = 84), and patients receiving psychotherapy based on five-element theory in TCM and conventional treatment were classified as the observation group (n = 79). The anxiety levels, depression levels, TCM syndrome scores and sleep quality were compared in both groups. The enumeration data were tested by χ2 test. Kolmogorov-Smirnov method tested whether the measurement data met normal distribution, and those did not meet normal distribution were tested by Mann-Whitney method. The difference was statistically significant at p < 0.05. RESULTS: After 4-week and 8-week treatments, the observation group had significantly lower scores of Hamilton Anxiety Scale (z = -4.562, -6.765; p < 0.001), Hamilton Depression Scale (z = -7.588, -8.023; p < 0.001), TCM syndrome (z = -7.138, -10.946; p < 0.001), and Pittsburgh sleep quality index (z = -6.819, -8.240; p < 0.001) than the control group. CONCLUSION: Psychotherapy based on five-element theory in TCM is beneficial to patients with PSD and can bring a certain clinical reference value.

Childhood Trauma Questionnaire-based child maltreatment profiles to predict efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus non-specific psychotherapy in adults with early-onset chronic depression: cluster analysis of data from a randomised controlled trial.

BACKGROUND: Child maltreatment is a broadly confirmed risk factor for mental and physical illness. Some psychological treatments specifically target mental health conditions associated with child maltreatment. For example, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) focuses on maladaptive interpersonal behaviours in chronic depression. However, how the assessment of child maltreatment could inform personalised treatment is unclear. We used data from a previously published clinical trial to investigate whether a pre-established child maltreatment clustering approach predicts differential outcomes after CBASP versus non-specific supportive psychotherapy in patients with early-onset chronic depression. METHODS: We did a cluster analysis of data from a previous randomised controlled trial of unmedicated adult outpatients with early-onset chronic depression who were treated at eight university clinics and psychological institutes in Germany with 32 sessions of CBASP or non-specific supportive psychotherapy. Participants were eligible for the original trial if they were aged 18-65 years; had major depressive disorder (MDD) with an early onset and duration of at least 2 years, current MDD superimposed on a pre-existing dysthymic disorder, or recurrent MDD with incomplete remission between episodes as defined by DSM-IV; and had a score of at least 20 points on the 24-item Hamilton Rating Scale for Depression (HRSD-24). Participants were included in the current study if they had completed the short form of the Childhood Trauma Questionnaire (CTQ) at trial baseline. We used an agglomerative hierarchical clustering approach to derive child maltreatment clusters from individual patterns across the five domains of the CTQ. We used linear mixed models to investigate whether clustering could predict differential clinical outcomes (change in symptom severity on the HRSD-24) up to 2 years after treatment onset. People with lived experience were involved in the current study. FINDINGS: 253 patients (129 [51%] treated with CBASP and 124 [49%] with supportive psychotherapy) had complete CTQ records and were included in the analysis. 169 (67%) participants were women, 84 (33%) were men, and the mean age was 45·9 years (SD 11·7). We identified seven child maltreatment clusters and found significant differences in treatment effects of CBASP and supportive psychotherapy between the clusters (F(6,948·76)=2·47; p=0·023); differences were maintained over the 2-year follow-up. CBASP was superior in distinct clusters of co-occurring child maltreatment: predominant emotional neglect (change in ß -6·02 [95% CI -11·9 to -0·13]; Cohen's d=-0·98 [95% CI -1·94 to -0·02]; p=0·045), predominant emotional neglect and abuse (-6·39 [-10·22 to -2·56]; -1·04 [-1·67 to -0·42]; p=0·0011), and emotional neglect and emotional and physical abuse (-9·41 [-15·91 to -2·91]; -1·54 [-2·6 to -0·47]; p=0·0046). INTERPRETATION: CTQ-based cluster analysis can facilitate identification of patients with early-onset chronic depression who would specifically benefit from CBASP. Child maltreatment clusters could be implemented in clinical assessments and serve to develop and personalise trauma-informed care in mental health. FUNDING: The German Research Foundation and the German Federal Ministry of Education and Research.

Patient perspectives on systematic client feedback in Dutch outpatient mental healthcare, a qualitative case reports study.

OBJECTIVE: The added value of systematic client feedback (SCF) to psychotherapy can be affected by patient perspectives, both in a positive and negative way, and is influenced by cultural factors as well. Current study explores patients' perspectives on use and optimization of SCF in Dutch outpatient mental healthcare. Primary aim of present study is to generate implications for daily practice and optimize SCF implementation, particularly for the Netherlands. METHOD: Four patients suffering from mild to moderate psychological disorders were in-depth interviewed on their perspective on the use of SCF, when the Partners for Change Outcome Management System (PCOMS, high frequent), the Outcome Questionnaire (OQ-45, low frequent) and the Mental Health Continuum Short Form (MHC-SF, low frequent) was added to treatment as usual in two Dutch outpatient mental healthcare centers offering brief psychological treatment. Interview topics were (a) SCF in general; (b) type of questionnaires; (c) frequency of use; (d) effect of SCF on therapy; and (e) perceived added value of SCF. A SCF expert team analyzed the data through reflexive Thematic Analysis. RESULTS: We identified three themes, all of which have two sub-themes: (a) Requirements to use SCF, with sub-themes (a1) Balance between effort to complete SCF and perceived validity, and (a2) Balance between used frequency and perceived validity; (b) Modifiers for test-taking attitude, with subthemes (b1) SCF as an embedded part of therapy, and (b2) Quality of Therapist-Client alignment; and (c) Effects on therapeutic process, with subthemes (c1) Focus on task and goals, and shared responsibility, and (c2) Effects on outcome and satisfaction. CONCLUSIONS: Adding SCF to therapy can be perceived as helpful by patients in psychotherapy if two conditions are met: (1) Creating a right balance between effort and yield for SCF to be used at all; and (2) embedding SCF as an integral part of therapy, through therapist-client alignment. Throughout the progression of therapy, it might be useful to perceive SCF and therapy as communicating vessels; according to patients it is not only necessary to adjust therapy based on SCF, but also to adjust SCF based on the course of therapy. TRIAL REGISTRATION: This trial was registered on September 30, 2015 in the Dutch Trial Register NTR5466. The Medical Ethics Committee of the University of Twente (Enschede) approved this study (registration number: K15-11, METC Twente).

Psychological interventions for social anxiety disorder in children and adolescents: A systematic review and network meta-analysis.

BACKGROUND: Social anxiety disorder (SAD) is a high-prevalence mental disorder among children and adolescents. The aim of this study is to compare and rank the effectiveness of several psychotherapies for SAD among children and adolescents. METHODS: Only randomized controlled trials (RCTs) were utilized by searching PubMed, Embase, Cochrane Library, and Web of Science. We used network meta-analysis in the Bayesian framework to analyze the data. This study is registered with PROSPERO, number CRD42023476829. RESULTS: In total, 30 RCTs with 1547 individuals were included, and nine psychotherapies with three control conditions were compared and ranked in this study. The findings revealed that internet-delivered cognitive behavioural therapy (surface under the cumulative ranking curve [SUCRA: 71.2 %]), group cognitive behavioural therapy (SUCRA: 68.4 %), and individual cognitive behavioural therapy (SUCRA: 66.0 %) significantly reduced social anxiety symptoms; internet-delivered cognitive behavioural therapy also significantly decreased depression symptoms in these patients (SUCRA: 92.2 %). In addition, group cognitive behavioural therapy can enhance functioning in these patients (SUCRA: 89.6 %). CONCLUSION: These results suggest that internet-delivered cognitive behavioural therapy is the optimal type of psychotherapy for reducing social anxiety and depression symptoms in children and adolescents with SAD, internet-delivered parent-child interaction therapy and cognitive bias modification of interpretation have relatively poor treatment effects on social anxiety symptoms in children than other psychological interventions, and group cognitive behavioural therapy has better benefits in enhancing the functioning among children and adolescents with SAD. Further studies are needed to ascertain these results due to the limited number of included studies.

The relationship between attachment needs, earned secure therapeutic attachment and outcome in adult psychotherapy.

OBJECTIVE: The aim of this study was to investigate a sequence of associations between clients' pretreatment attachment style, the development of individuated-secure attachment to the therapist (i.e., therapeutic attachment), and the experience of increased comfort with emotional closeness (growing engagement) or independence (growing autonomy) in therapy. Moreover, the study explored whether clients' experience of growing engagement or growing autonomy was associated with a change in interpersonal problems at the end of therapy. METHOD: Three hundred thirty adult clients (mean age 40.2, 75% female) were seen by 44 therapists in individual psychotherapy. The associations between pretreatment attachment insecurity measured on the Experiences in Close Relationships scale, repeated measures of therapeutic attachment measured on the Client Attachment to Therapist Scale, repeated measures of a growing engagement or growing autonomy measured on the Therapeutic Distance Scale, and pre-post measures of interpersonal problems measured on the Inventory for Interpersonal Problems were analyzed using multilevel modeling. Two types of therapeutic attachment were estimated, one controlling for anxious attachment characteristics and one for avoidant. RESULTS: Significant associations between higher levels of therapeutic attachment controlled for avoidant attachment characteristics and lower levels of growing autonomy in therapy were found. Moreover, higher levels of growing engagement in therapy and higher levels of therapeutic attachment controlled for anxious attachment characteristics were associated with a decrease in interpersonal problems at the end of therapy. CONCLUSIONS: Distinct types of therapeutic attachment may exert different influences on the process and outcome of therapy. Furthermore, therapists' attunement to clients' specific attachment needs in therapy may enhance interpersonal outcomes of treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Injurious Fall Risk Differences Among Older Adults With First-Line Depression Treatments.

Importance: One-third of older adults in the US have depression, often treated with psychotherapy and antidepressants. Previous studies suggesting an increased risk of falls and related injuries (FRI) associated with antidepressant use may be affected by confounding by indication or immortal time bias. Objective: To evaluate the association between FRI risk and first-line treatments in older adults with depression. Design, Setting, and Participants: This cohort study used a target trial emulation framework with a cloning-censoring-weighting approach with Medicare claims data from 2016 to 2019. Participants included fee-for-service beneficiaries aged 65 years or older with newly diagnosed depression. Data were analyzed from October 1, 2023, to March 31, 2024. Exposures: First-line depression treatments including psychotherapy, sertraline, escitalopram, citalopram, mirtazapine, duloxetine, trazodone, fluoxetine, bupropion, paroxetine, and venlafaxine. Main Outcome and Measure: One-year FRI rate, restricted mean survival time (RMST), and adjusted hazard ratio (aHR) with 95% CI. Results: Among 101 953 eligible beneficiaries (mean [SD] age, 76 [8] years), 63 344 (62.1%) were female, 7404 (7.3%) were Black individuals, and 81 856 (80.3%) were White individuals. Compared with the untreated group, psychotherapy use was not associated with FRI risk (aHR, 0.94 [95% CI, 0.82-1.17]), while other first-line antidepressants were associated with a decreased FRI risk (aHR ranged from 0.74 [95% CI, 0.59-0.89] for bupropion to 0.83 [95% CI, 0.67-0.98] for escitalopram). The FRI incidence ranged from 63 (95% CI, 53-75) per 1000 person-year for those treated with bupropion to 87 (95% CI, 83-90) per 1000 person-year for those who were untreated. The RMST ranged from 349 (95% CI, 346-350) days for those who were untreated to 353 (95% CI, 350-356) days for those treated with bupropion. Conclusions and Relevance: In this cohort study of older Medicare beneficiaries with depression, first-line antidepressants were associated with a decreased FRI risk compared with untreated individuals. These findings provide valuable insights into their safety profiles, aiding clinicians in their consideration for treating depression in older adults.