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  • 1. Aafjes-van Doorn, Katie
    et al.
    Lilliengren, Peter
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Cooper, Angela
    McDonald, James
    Falkenström, Fredrik
    Patients’ Affective Processes Within Initial Experiential Dynamic Therapy Sessions2017Inngår i: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 54, nr 2, s. 175-183Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Research has indicated that patients’ in-session experience of previously avoided affects may be important for effective psychotherapy. The aim of this study was to investigate patients’ in-session levels of affect experiencing in relation to their corresponding levels of insight, motivation, and inhibitory affects in initial Experiential Dynamic Therapy (EDT) sessions. Four hundred sixty-six 10-min video segments from 31 initial sessions were rated using the Achievement of Therapeutic Objectives Scale. A series of multilevel growth models, controlling for between-therapist variability, were estimated to predict patients’ adaptive affect experiencing (Activating Affects) across session segments. In line with our expectations, higher within-person levels of Insight and Motivation related to higher levels of Activating Affects per segment. Contrary to expectations, however, lower levels of Inhibition were not associated with higher levels of Activating Affects. Further, using a time-lagged model, we did not find that the levels of Insight, Motivation, or Inhibition during one session segment predicted Activating Affects in the next, possibly indicating that 10-min segments may be suboptimal for testing temporal relationships in affective processes. Our results suggest that, to intensify patients’ immediate affect experiencing in initial EDT sessions, therapists should focus on increasing insight into defensive patterns and, in particular, motivation to give them up. Future research should examine the impact of specific inhibitory affects more closely, as well as between-therapist variability in patients’ in-session adaptive affect experiencing.

  • 2. Johansson, Robert
    et al.
    Hesslow, Thomas
    Ljótsson, Brjánn
    Jansson, Angelica
    Jonsson, Lina
    Färdig, Smilla
    Karlsson, Josefine
    Hesser, Hugo
    Frederick, Ronald J.
    Lilliengren, Peter
    Carlbring, Per
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Andersson, Gerhard
    Internet-based affect-focused psychodynamic therapy for social anxiety disorder: A randomized controlled trial with 2-year follow-up2017Inngår i: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 54, nr 4, s. 351-360Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Social anxiety disorder (SAD) is associated with considerable individual suffering and societal costs. Although there is ample evidence for the efficacy of cognitive behavior therapy, recent studies suggest psychodynamic therapy may also be effective in treating SAD. Furthermore, Internet-based psychodynamic therapy (IPDT) has shown promising results for addressing mixed depression and anxiety disorders. However, no study has yet investigated the effects of IPDT specifically for SAD. This paper describes a randomized controlled trial testing the efficacy of a 10-week, affect-focused IPDT protocol for SAD, compared with a wait-list control group. Long-term effects were also estimated by collecting follow-up data, 6, 12, and 24 months after the end of therapy. A total of 72 individuals meeting diagnostic criteria for DSM–IV social anxiety disorder were included. The primary outcome was the self-report version of Liebowitz Social Anxiety Scale. Mixed model analyses using the full intention-to-treat sample revealed a significant interaction effect of group and time, suggesting a larger effect in the treatment group than in the wait-list control. A between-group effect size Cohen’s d = 1.05 (95% [CI]: [0.62, 1.53]) was observed at termination. Treatment gains were maintained at the 2-year follow-up, as symptom levels in the treated group continued to decrease significantly. The findings suggest that Internet-based affect-focused psychodynamic therapy is a promising treatment for social anxiety disorder.

  • 3.
    Lilliengren, Peter
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Johansson, Robert
    Lindqvist, Karin
    Mechler, Jakob
    Andersson, Gerhard
    Efficacy of Experiential Dynamic Therapy for Psychiatric Conditions: a Meta-Analysis of Randomized Controlled Trials2016Inngår i: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 53, nr 1, s. 90-104Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Experiential dynamic therapy (EDT) is a subgroup of short-term psychodynamic psychotherapy (STPP) that emphasizes patients’ in-session affective processing. To evaluate the efficacy of EDT for psychiatric conditions, we conducted a meta-analysis of randomized controlled trials. Twenty-eight studies published between 1978 and 2014 were included, encompassing 1,782 adult patients with mood, anxiety, personality, or mixed disorders. Across targeted outcome domains, medium-size between-groups effects (Cohen’s ds ranging from 0.39 to 0.65) favored EDT over inactive controls at posttreatment and in symptom measures at follow-up. We found no differences between EDT and active treatments (e.g., medication, cognitive–behavioral therapy, manualized supportive therapy) at posttreatment, but EDT outperformed supportive therapy at follow-up (d = 0.75). In terms of within-group effect sizes, EDT was associated with large improvements in general psychiatric symptoms (d = 1.11), depression (d = 1.33), and anxiety (d = 1.09) and with small to moderate gains in the areas of interpersonal problems (d = 0.55) and global functioning (d = 0.86). Small but significant effects suggested continued improvement between posttreatment and follow-up. Heterogeneity in pre–post effects was explored in subgroup analyses, which indicated that EDT might be most effective in depressive disorders and that individual EDT had larger effects compared with group treatment. In addition, EDT performed better in higher quality studies. We conclude that EDT is a promising treatment for psychiatric conditions in adults. Further high-quality studies evaluating contemporary versions of EDT in specific psychiatric conditions are warranted.

  • 4. Lilliengren, Peter
    et al.
    Philips, Björn
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen, Klinisk psykologi.
    Falkenström, Fredrik
    Bergquist, Mia
    Ulvenes, Pål
    Wampold, Bruce
    Comparing the Treatment Process in Successful and Unsuccessful Cases in Two Forms of Psychotherapy for Cluster C Personality Disorders2019Inngår i: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 56, nr 2, s. 285-296Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Different forms of psychotherapy are effective for cluster C personality disorders, but we know less about what in-session processes promote change. Contrasting successful and unsuccessful cases may elucidate processes that facilitate or impede outcome and offer suggestions for clinical practice and future research. In this exploratory outcome-process study, 10 successful and 10 unsuccessful cases were selected from a randomized trial comparing cognitive therapy and short-term psychodynamic psychotherapy for cluster C personality disorders. Videotaped sessions were rated with the Psychotherapy Process Q-Set (PQS). The treatments were compared in terms of which PQS items differentiated successful and unsuccessful cases, as well as their resemblance with PQS prototypes of ideal treatments. Therapists' behavior in early sessions was also explored. Results indicate that successful cases in our sample were characterized by a more active and engaged patient. In contrast, unsuccessful cases were characterized by a more directive or controlling therapist stance. Correlations with PQS prototypes were moderate to strong in both successful and unsuccessful cases, suggesting that optimal and suboptimal interpersonal processes may be independent of adherence to particular treatments. Exploration of therapist behaviors in early sessions indicated that therapists were more likely to adjust their way of working in the successful cases. Our result suggests that patient engagement and therapists' early efforts to improve the therapy relationship may be pivotal for successful outcome, whereas therapist controlling behavior may obstruct the treatment process, regardless of therapy model used. The impact of these in-session processes should be examined more closely in larger samples in future studies.

  • 5.
    Lilliengren, Peter
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Werbart, Andrzej
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Therapists' view of therapeutic action in psychoanalytic psychotherapy with young adults2010Inngår i: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 47, nr 4, s. 570-585Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Studying experienced therapists' implicit theorizing may contribute to our understanding of what is helpful and what hinders treatment with particular patient populations. In this study, 16 therapists' views of curative factors, hindering factors, and outcome were explored in 22 interviews conducted at termination of individual psychoanalytic psychotherapy with young adults. Grounded theory methodology was used to construct a tentative model of therapeutic action based on the therapists' implicit knowledge. The results indicated that developing a close, safe and trusting relationship was viewed as the core curative factor in interaction with the patient making positive experiences outside the therapy setting and the therapist challenging and developing the patient's thinking about the self. The therapeutic process was experienced as a joint activity resulting in the patient becoming a subject and acquiring an increasing capacity to think and process problems. The patient's fear about close relationships was seen as hindering treatment and leading to core problems remaining. The model is discussed in relation to major theories of therapeutic action in the psychoanalytic discourse and previous research focusing on young adults' view of curative and hindering factors in psychotherapy. Implications for practice and further research are suggested.

  • 6.
    Lilliengren, Peter
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Werbart, Andzej
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    A model of therapeutic action grounded in the patients’ view of curative and hindering factors in psychoanalytic psychotherapy2005Inngår i: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 42, nr 3, s. 324-339Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The patients’ view of curative and hindering factors in psychoanalytic psychotherapy was explored, starting from conducting the Private Theories Interview with 22 young adult patients at termination of their therapies. A tentative theoretical model of therapeutic action was constructed using grounded theory methodology.Talking About Oneself, Having a Special Place and Relationship, and Exploring Together With the Therapist were perceived as curative factors by the patients, leading to therapeutic impacts such as New Relational Experiences and Expanding Self-Awareness. Hindering aspects included experiencing that Talking Is Difficult and that Something Was Missing in therapy, interacting with negative impacts such as Self-Knowledge Is Not Enough and Experiencing Mismatch. Methodological issues, the question of common versus specific factors, and implications for clinical practice are discussed.

  • 7. Philips, Björn
    et al.
    Wennberg, Peter
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för socialvetenskaplig alkohol- och drogforskning (SoRAD). Karolinska Institutet, Sweden.
    The Importance of Therapy Motivation for Patients With Substance Use Disorders2014Inngår i: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 51, nr 4, s. 555-562Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The present study aimed to examine whether patients' pretherapy motivation was related to other patient characteristics and whether it predicted retention in psychotherapy. Data were collected within a naturalistic outcome study of various forms of psychotherapy for patients (N = 172) with substance use disorders (SUD). Therapy motivation was measured using the Client Motivation for Therapy Scale (CMOTS), including the variables autonomous motivation, controlled motivation, and amotivation. Female patients had higher levels of autonomous motivation (d = .53), lower levels of controlled motivation (d = -.32), and lower levels of amotivation (d = -.62). Level of symptoms and impairment was significantly positively correlated with controlled motivation (r = .31). Autonomous motivation was positively correlated with four expectation subscales associated with constructive therapeutic work, whereas amotivation was negatively correlated with three of these subscales. Controlled motivation was positively correlated with the subscales external orientation, defensiveness, and support. In a logistic regression, amotivation stood out as a negative predictor of retention, in terms of starting in psychotherapy after assessment or not. Quite surprisingly, autonomous motivation was not a significant predictor of retention. The present study indicates that amotivation is a risk factor for early dropout among SUD patients. More efforts should be directed at preparing patients for psychotherapy through strengthening motivation.

  • 8.
    Werbart, Andrzej
    et al.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen. Stockholm Cty Council, Stockholm.
    Levin, Lars
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen. holm Cty Council, Outpatient Psychiat Clin West, Stockholm.
    Andersson, Håkan
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Psykologiska institutionen.
    Sandell, Rolf
    Everyday Evidence: Outcomes of Psychotherapies in Swedish Public Health Services2013Inngår i: Psychotherapy, ISSN 0033-3204, E-ISSN 1939-1536, Vol. 50, nr 1, s. 119-130Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This naturalistic study presents outcomes for three therapy types practiced in psychiatric public health care in Sweden. Data were collected over a 3-year period at 13 outpatient psychiatric care services participating in the online Quality Assurance of Psychotherapy in Sweden (OAPS) system. Of the 1,498 registered patients, 14% never started psychotherapy, 17% dropped out from treatment, and 36% dropped out from data collection. Outcome measures included symptom severity, quality of life, and self-rated health. Outcomes were studied for 180 patients who received cognitive behavioral, psychodynamic, or integrative/eclectic therapy after control for dropout representativity. Among treatment completers, patients with different pretreatment characteristics seem to have received different treatments. Patients showed significant improvements, and all therapy types had generally good outcomes in terms of symptom reduction and clinical recovery. Overall, the psychotherapy delivered by the Swedish public health services included in this study is beneficial for the majority of patients who complete treatment. Multilevel regression modeling revealed no significant effect for therapy type for three different outcome measures. Neither did treatment duration have any significant effect. The analysis did not demonstrate any significant therapist effects on the three outcome measures. The results must be interpreted with caution, as there was large attrition and incomplete data, nonrandom assignment to treatment, no treatment integrity control, and lack of long-term follow-up.

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