The role of cognitive biases in short‐term psychodynamic psychotherapy

Abstract

The concept of biased thinking – or cognitive biases – is relevant to psychotherapy research and clinical conceptualization, beyond cognitive theories. The present naturalistic study aimed to examine the changes in biased thinking over the course of a short‐term dynamic psychotherapy (STDP) and to discover potential links between these changes and symptomatic improvement. This study focuses on 32 self‐referred patients consulting for Adjustment Disorder according to DSM‐IV‐TR. The therapists were experienced psychodynamically oriented psychiatrists and psychotherapists. Coding of cognitive biases (using the Cognitive Errors Rating Scale; CERS) was made by external raters based on transcripts of interviews of psychotherapy; the reliability of these ratings on a randomly chosen 24% of all sessions was established. Based on the Symptom Check List SCL‐90‐R given before and after, the Reliable Change Index (RCI) was used. The assessment of cognitive errors was done at three time points: early (session 4–7), mid‐treatment (session 12–17), and close to the end (after session 20) of the treatment. The results showed that the total frequency of cognitive biases was stable over time (p = .20), which was true both for positive and for negative cognitive biases. In exploring the three main subscales of the CERS, we found a decrease in selective abstraction (p = .02) and an increase in personalization (p = .05). A significant link between RCI scores (outcome) and frequency of positive cognitive biases was found, suggesting that biases towards the positive might have a protective function in psychotherapy. Practitioner points Therapists may be attentive to changes in biased thinking across short‐term dynamic psychotherapy for adjustment disorder. Therapists may foster the emergence of positive cognitive biases at mid‐treatment for adjustment disorder.

Cognitive heuristics in borderline personality disorder across treatment: A longitudinal non‐parametric analysis

“…Biased thinking is amenable by psychotherapy, but the meaning of the change remains unclear. A recent study described in a sample of psychodynamic psychotherapy an increase in the in‐session frequency of positive cognitive biases (Kramer, Ortega, Ambresin, Despland, & de Roten, ), some of which were related with therapy outcome. These results may speak to the idea that higher frequencies of certain types of biased thinking may help the client to better adapt to reality.…”