Manualized Supportive-Expressive Psychotherapy Versus Nonmanualized Community-Delivered Psychodynamic Therapy for Patients With Personality Disorders: Bridging Efficacy and Effectiveness

Vinnars, Bo; Barber, Jacques P.; Norén, Kristina; Gallop, Robert; Weinryb, Robert M.

doi:10.1176/appi.ajp.162.10.1933

Cited by 102 publications

(93 citation statements)

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“…42,43,44 O campo de pesquisa em TP tem evidenciado que tanto os tratamentos psicoterapêuticos quanto os farmacológicos são benéficos. 9,47,48 A psicoterapia é considerada o tratamento de primeira linha. 33,47,49,50 Não há medicamentos específicos recomendados para o tratamento dos TP, assim, são indicadas medicações para controle de sintomas nucleares e tratamento de comorbidades frequentemente presentes.…”

Section: Tratamentounclassified

“…9,47,48 A psicoterapia é considerada o tratamento de primeira linha. 33,47,49,50 Não há medicamentos específicos recomendados para o tratamento dos TP, assim, são indicadas medicações para controle de sintomas nucleares e tratamento de comorbidades frequentemente presentes. [51][52][53][54][55] Ambos os tratamentos devem ser considerados de longo prazo.…”

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Personality disorders

Mazer¹,

Macedo²,

Juruena³

2017

Medicina (Ribeirão Preto)

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RESUMOOs Transtornos da personalidade são padrões psicológicos de difícil diagnóstico que exigem uma avaliação criteriosa por parte do profissional da saúde mental. A relação médico-paciente também se configura como fator de extrema importância para o manejo destes quadros. Dentro deste contexto, é imprescindível orientar os alunos das áreas de graduação em saúde sobre a existência de tal categoria de transtornos. O presente artigo consiste em uma revisão descritiva, que busca elucidar a definição de transtornos da personalidade; além de discorrer sobre aspectos históricos, nosológicos e epidemiológi-cos. Nesta publicação ainda serão revisadas as particularidades referentes ao diagnóstico, as comorbidades, ao curso e tratamento destes transtornos. O enfoque maior será no manejo de indivíduos com transtorno da personalidade borderline, dada a maior procura destes por unidades de atendimento psiquiátrico. Palavras ABSTRACTPersonality disorders are psychological patterns of difficult diagnosis that require careful evaluations from mental health professionals. The physician-patient relationship is a crucial condition for the management of these disorders. On this view it must be important guide undergraduate students from health care areas through the existence of such a category of disorders. This article consists of a descriptive review aiming at clarifying the definition of personality disorders; furthermore discuss historical, physiological and epidemiological aspects. On this publication will be reviewed some particularities from diagnostic comorbidity, course and treatment of these disorders. The management of individuals with borderline personality disorder will be emphasized in this publication due to increased seek from this public for mental health care units.

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Section: Tratamentounclassified

Personality disorders

Mazer¹,

Macedo²,

Juruena³

2017

Medicina (Ribeirão Preto)

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“…Treatment attendance was classified into 1) regular once a week (SEP = 52, 65%, CDPT = 43, 56.6%), 2) irregular, i.e., less frequent than once a week, including an inability to keep regular appointments scheduled once a week (SEP = 16, 20%, CDPT = 17, 22.4%), or 3) no treatment, i.e., not attending more than two session after randomization (SEP = 12, 15%, CDPT = 16, 21.1%). No significant difference was found between the two treatments in terms of attendance (χ 2 (2) = 1.35, p = .51) (Vinnars et al, 2005). Outcome measures were collected at three time-points in both treatments: 1) pre-treatment, 2) post-treatment at termination of SEP (after one year), and 3) follow-up after one additional year.…”

Section: Treatment Attendancementioning

confidence: 99%

“…Patients were randomized using a computerized stratification randomization procedure (urn) (Vinnars et al, 2005), with DSM-Clusters (A, B or C), marital status, age, and sex being used as stratification variables. Stratification guarantees balance for a number of covariates.…”

Section: Data Analytic Strategymentioning

confidence: 99%

Do personality problems improve during psychodynamic supportive–expressive psychotherapy? Secondary outcome results from a randomized controlled trial for psychiatric outpatients with personality disorders.

Vinnars

Thormählen

Gallop

et al. 2009

Psychotherapy: Theory, Research, Practice, Training

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Studies involving patients with personality disorders (PD) have not focused on improvement of core aspects of the PD. This paper examines changes in quality of object relations, interpersonal problems, psychological mindedness, and personality traits in a sample of 156 patients with DSM-IV PD diagnoses being randomized to either manualized or non manualized dynamic psychotherapy. Effect sizes adjusted for symptomatic change and reliable change indices were calculated. We found that both treatments were equally effective at reducing personality pathology. Only in neuroticism did the non manualized group do better during the follow-up period. The largest improvement was found in quality of object relations. For the remaining variables only small and clinically insignificant magnitudes of change were found.The prevalence of personality disorders (PD) among psychiatric patients ranges between 31 -45 % (Samuels et al., 2002). Psychotherapeutic treatment in general and dynamic therapy in particular has increasingly shifted from a long term to briefer time formats. As a result, the focus of brief dynamic psychotherapies has shifted from restructuring personality Publisher's Disclaimer:The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/journals/pst. NIH Public AccessAuthor Manuscript Psychotherapy (Chic). Author manuscript; available in PMC 2010 September 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript pathology to a focus on symptom reduction. For these briefer treatments, however, there is so far no substantial evidence for their capacity to reduce character pathology.A comprehensive meta-analysis of 25 clinical trials with patients with PD (Leichsenring & Leibing, 2003) indicated that most studies had focused on symptomatic measures such as the Symptom Check List-90 (SCL-90, Derogatis, 1997), Beck Depression Inventory (BDI, Beck & Steer, 1988), and Global Adjustment Scale (GAS, First, Spitzer, & Gibbon, 1997). Few of these studies included measures assessing core PD pathology. For example, interpersonal problems, often considered a major aspect of PD pathology, were assessed in only two psychodynamic studies (Bateman & Fonagy, 2001Muran, Safran, Samstag, & Winston, 2005). Furthermore, measures theoretically relevant to the goals of psychodynamic psychotherapy (e.g., reflective functioning and levels or forms of attachment) have surprisingly rarely been used (for an exception see Levy et al., 2006).Improving maladaptive personality functioning is of considerable importance for patients with PD. Crits-Christoph and Barbe...

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“…an der Studie von Vinnars et al [2], ist nicht haltbar. Die dort angewandte supportiv-expressive Therapie ist als eine psychodynamische Behandlungsform bekannt und beschrieben [3].…”

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Die Psychoanalyse soll gerettet werden

Dümpelmann

2009

Nervenarzt

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Manualized Supportive-Expressive Psychotherapy Versus Nonmanualized Community-Delivered Psychodynamic Therapy for Patients With Personality Disorders: Bridging Efficacy and Effectiveness

Abstract: Manualized supportive-expressive psychotherapy was as effective as nonmanualized community-delivered psychodynamic therapy conducted by experienced dynamic clinicians.

Cited by 102 publications

References 36 publications

Personality disorders

Personality disorders

Do personality problems improve during psychodynamic supportive–expressive psychotherapy? Secondary outcome results from a randomized controlled trial for psychiatric outpatients with personality disorders.

Die Psychoanalyse soll gerettet werden

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