Demoralization and Response to Psychotherapy: A Pilot Study Comparing the Sequential Combination of Cognitive-Behavioral Therapy and Well-Being Therapy with Clinical Management in Cyclothymic Disorder

Tomba, Elena; Tecuta, Lucia; Guidi, Jenny; Grandi, Silvana; Rafanelli, Chiara

doi:10.1159/000438674

Cited by 15 publications

(11 citation statements)

References 9 publications

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“…Promising results in this regard have been shown in a study addressing depressive symptoms and demoralization after myocardial infarction. 63 The evidence that DCPR-R allowed to formulate a higher rate of diagnoses than DSM-5 also suggest that psychiatric disorders are less represented in migraine patients than psychosomatic syndromes, thus pharmacological interventions having an indication for psychiatric disorders but not having indications for psychosomatic syndromes should be used with caution in migraine patients. Antidepressants, which are largely prescribed in this population, should be used only based on clear indications.…”

Section: Resultsmentioning

confidence: 99%

Criterion-related validity in a sample of migraine outpatients: the diagnostic criteria for psychosomatic research

et al. 2019

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Objective.The Diagnostic Criteria for Psychosomatic Research (DCPR) are those of psychosomatic syndromes that did not find room in the classical taxonomy. More recently, the DCPR were updated, called DCPR-revised (DCPR-R). The present study was conducted to test the criterion-related validity of the DCPR-R.Methods.Two hundred consecutive subjects were enrolled at the Headache Center of Careggi University Hospital (Italy): 100 subjects had a diagnosis of chronic migraine (CM) and 100 had a diagnosis of episodic migraine (EM). Participants received a clinical assessment, which included the DCPR-revised Semi-Structured Interview (DCPR-R SSI), the Structured Clinical Interview for DSM-5 (SCID-5), and the psychosocial index (PSI).Results.Forty-seven subjects (23.5%) had at least one DSM-5 diagnosis: major depressive disorder (8.5%; n = 17) and agoraphobia (7.5%; n = 15) were the most frequent. One hundred and ten subjects (55%) reported a DCPR-R diagnosis: allostatic overload (29%; n = 58) and type A behavior (10.5%; n = 21) were the most frequent. When the incremental validity of the DCPR system over the DSM system was tested using PSI subscales as the criterion variable, the DCPR-R increased up to 0.11–0.24 the amount of explained variance. Subjects with at least one DCPR-R diagnosis showed lower PSI well-being scores (p = .001), higher PSI stress scores (p < .001), and higher PSI psychological distress scores (p = .008) than subjects without a DCPR-R diagnosis.Conclusion.The DCPR-R showed a good criterion-related validity in migraine outpatients. Thus, they might be implemented, together with the DSM-5, in the assessment of migraine subjects.

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Section: Resultsmentioning

confidence: 99%

Criterion-related validity in a sample of migraine outpatients: the diagnostic criteria for psychosomatic research

et al. 2019

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“…65 Indeed, demoralization has been found to affect response to psychotherapy. 66,67 Moreover, the clinical utility of depression diagnoses in ED populations is called into question by treatment trials. Depression comorbidity in EDs has an unclear role in treatment response with inconsistent results across ED categories.…”

Section: Resultsmentioning

confidence: 99%

An innovative approach for the assessment of mood disturbances in patients with eating disorders

2019

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Objective.Assessment of mood in eating disorders (EDs) has important clinical implications, but the current standard psychiatric classification (DSM-5) has limitations. The aim of the current study is to broaden the evaluation of depressive symptomatology by providing a comprehensive and innovative assessment approach in EDs through instruments that capture clinical phenomena of demoralization, subclinical distress, and psychological well-being.Methods.Seventy-nine patients who met diagnostic criteria for EDs of the Diagnostic and Statistical Manual of Mental Disorders – Fifth edition (DSM-5) were evaluated for depressive symptoms through Paykel’s Clinical Interview for Depression, the Structured Clinical Interview for DSM-5 for major depressive episode and persistent depressive disorder, and the Diagnostic Criteria for Psychosomatic Research (DCPR) interview for demoralization. Further, self-report inventories encompassing psychological well-being and distress were used.Results.Guilt, abnormal reactivity to social environment, and depressed mood were the most common depressive symptoms in the sample. DSM-defined depressive disorders were found in 55.7% of patients. The DCPR-demoralization criteria identified an additional 20.3% of the sample that would have been undetected with DSM criteria. Both DSM and DCPR diagnostic categories were associated with compromised psychological well-being and distress. Demoralization, unlike depression, was not associated with the severity of ED symptomatology.Conclusion.The findings indicate that a standard psychiatric approach, DSM-5-based, captures only a narrow part of the spectrum of mood disturbances affecting patients with EDs. A broadened clinimetric assessment unravels the presence of demoralization and yields clinical distinctions that may entail prognostic and therapeutic differences among patients who would be otherwise simply labeled as depressed.

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“…It applies psychological understanding to the management of an individual patient, identifying current problems and providing opportunities for disclosure. It may be associated with medication monitoring [37,38], but its primary focus may also be unrelated to pharmacological treatment [39][40][41][42]. Since CM provides the nonspecific ingredients of the psychotherapeutic approach, significant differences between an experimental treatment and CM are likely to reflect specific ingredients entailed by the experimental approach, unlike what takes place with TAU or WLC.…”

Section: Comparison Between Experimental Psychotherapy and Nonspecifimentioning

confidence: 99%

Methodological Recommendations for Trials of Psychological Interventions

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Brakemeier

Bockting

et al. 2018

Psychother Psychosom

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Recent years have seen major developments in psychotherapy research that suggest the need to address critical methodological issues. These recommendations, developed by an international group of researchers, do not replace those for randomized controlled trials, but rather supplement strategies that need to be taken into account when considering psychological treatments. The limitations of traditional taxonomy and assessment methods are outlined, with suggestions for consideration of staging methods. Active psychotherapy control groups are recommended, and adaptive and dismantling study designs offer important opportunities. The treatments that are used, and particularly their specific ingredients, need to be described in detail for both the experimental and the control groups. Assessment should be performed blind before and after treatment and at long-term follow-up. A combination of observer- and self-rated measures is recommended. Side effects of psychotherapy should be evaluated using appropriate methods. Finally, the number of participants who deteriorate after treatment should be noted according to the methods that were used to define response or remission.

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Demoralization and Response to Psychotherapy: A Pilot Study Comparing the Sequential Combination of Cognitive-Behavioral Therapy and Well-Being Therapy with Clinical Management in Cyclothymic Disorder

Cited by 15 publications

References 9 publications

Criterion-related validity in a sample of migraine outpatients: the diagnostic criteria for psychosomatic research

Criterion-related validity in a sample of migraine outpatients: the diagnostic criteria for psychosomatic research

An innovative approach for the assessment of mood disturbances in patients with eating disorders

Methodological Recommendations for Trials of Psychological Interventions

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