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FUNDACION CASTILLA DEL PINO ABORDAJES PSICOTERAPEUTICO DE LOS TRASTORNOS PSIQUIATRICOS

FUNDACION CASTILLA DEL PINO ABORDAJES PSICOTERAPEUTICO DE LOS TRASTORNOS PSIQUIATRICOS Cordoba, Marzo 2009. INVESTIGACION EN PSICOTERAPIA DINAMICA BREVE Manuel Trujillo, M.D. Professor of Psychiatry New York University.

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FUNDACION CASTILLA DEL PINO ABORDAJES PSICOTERAPEUTICO DE LOS TRASTORNOS PSIQUIATRICOS

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  1. FUNDACION CASTILLA DEL PINO ABORDAJES PSICOTERAPEUTICO DE LOS TRASTORNOS PSIQUIATRICOS Cordoba, Marzo 2009

  2. INVESTIGACION EN PSICOTERAPIADINAMICA BREVE Manuel Trujillo, M.D. Professor of Psychiatry New York University

  3. BIOLOGICAL CORRELATES OF PSYCHOTHERAPYFIGURE I -3 -2 -1 0 2 3 1 Average (no treatment) control effect size Average psychotherapy effect size (.82) Average Minimal Treatment (placebo) effect size (.42) Adapted from Lambert, et al. 1993

  4. TABLE IMETA-ANALYTIC REVIEWS OF OUTCOME WITH DEPRESSION * Adapted from Lambert, et al. (1994)

  5. TABLE IIMETA-ANALYTIC REVIEWS OF OUTCOME WITH ANXIETY DISORDERS * Percent improved , ** Pretest/Posttest measure Modified from Lambert (1994)

  6. TABLE IIIMETA-ANALYTIC REVIEWS OF OUTCOME WITH ANXIETY DISORDERS * Percent improved , ** Pretest/Posttest measure Modified from Lambert (1994)

  7. Leichsenring F ( 2004)

  8. Criteria for Admission to the StudyInclusion Criteria • Age between 18 and 60 • Evidence of at least one close personal relationship • No evidence of psychosis, organic brain syndrome or mental retardation • Absence of active Axis III medical diagnosis • No evidence of substance abuse • Not actively suicidal • No history of violence or destructive impulse control problem • No recent psychotropic medication such as neuroleptics, antidepressants, Lithium, etc.

  9. Patient Demographics By Group

  10. Assessment Instruments • Social History • Target Complaints • Symptom Checklist (SCL-90) • Social Adjustment Scale - SR • Personality Diagnostic Questionnaire (PDQ)

  11. Therapist Characteristics

  12. Reliability of Six Combination VariablesProcess Coding of Videotaped Psychotherapy Sessions VariableThree Judges Pooled Transference Interpretation .93 followed by affect Transference Interpretation .75 followed by defense Non-transference Interpretation .84 followed by affect Non-transference Interpretation .67 followed by defense Clarification Interpretation .62 followed by affect Clarification Interpretation .63 followed by defense

  13. Admission & Termination Means and Effect Sizes* for Significant Findings on the SCL-90 and SAS Subscales Across Groups

  14. Admission & Termination Means and Effect Sizes for Global Outcomes Across Groups

  15. Subscales with STDP showing significant differences over BAP and controls

  16. Average Frequencies of Occurrence and Comparative Percentages Per Session of Therapist Behaviors in the Two Treatment Groups

  17. Stepwise Regression For Affect and Defense Variables On Composite Outcome Score Multiple R Squared = .66 (F Value=7.71; df=3 and 12)

  18. Partial Correlations of Affect Variables & Outcome(with Defensive Responding Partialed Out Composite Outcome Clarification followed by Affect .09 Nontransference Interpretation followed by Affect .44 Transference Interpretation followed by Affect .73 All Interventions followed by Affect .58

  19. BEST/WORST OUTCOMES BEST OUTCOME WORST OUTCOME STDP 2-Obsessional 1- Histrionic 1 - Mixed BAP 1- Histrionic 2- Obsessional 1- Mixed

  20. BIOLOGICAL CORRELATES OF PSYCHOTERAPY PSYCHOTHERAPY CHANGE AGENTS • Affective experiencing • Cognitive mastery • Behavioral regulation

  21. BIOLOGICAL CORRELATES OF PSYCHOTHERAPY AFFECTIVE EXPERIENCE • Implosion therapy Flooding • Gestalt therapy Emotional Experience • Psychodrama Role playing • STDP Impulse/Feelings Experiencing

  22. BIOLOGICAL CORRELATES OF PSYCHOTHERAPY COGNITIVE MASTERY • Psychoan. therapy Interpretation • Supportive Clarification, support • Cognitive Modification of beliefs

  23. BIOLOGICAL CORRELATES OF PSYCHOTHERAPY BEHAVIORAL REGULATION • Behavior therapy Conditioning • Assertiveness Skills develop. therapy • Token economy Modification of rewards system

  24. PSYCHOTHERAPY AND NEUROBIOLOGY Cortex Pre Frontal Cortex - + Stimulus Amygdala Hippocampus Thalamus

  25. PSYCHOTHERAPY AND NEUROBIOLOGY Stress Glucocorticoids Glutamate Moderate duration stress Severe and prolonged stress CA3 Reversible atrophy and loss of dendritic spines Neuronal death * Adapted from Kandel, 1999

  26. THE MIRROR NEURON SYSTEMRizzollati 1995 • Subset of multimodal neurons (Simultaneous activation by different sensory modalities) • F5 in monkeys • Broca 44, 45 in humans (Prefrontal Cortex)

  27. THE MIRROR NEURON SYSTEM Activated by: • Observing a meaningful action • Performing the same action • Basis for primitive learning/communicating with others

  28. THE MIRROR NEURON SYSTEM Plays a role in: • Affect resonance • Empathy • Group behaviors: hunting, dancing • Language development

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