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Del Giacco Luca - One of the best experts on this subject based on the ideXlab platform.
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Los Procesos de Regulación Mutua Durante la Psicoterapia Psicodinámica de la Depresión: Un Estudio Observacional de los Actos Comunicativos en la Construcción de la Alianza Terapéutica Temprana
'Edicions de la Universitat de Barcelona', 2021Co-Authors: Del Giacco LucaAbstract:[eng] Therapeutic conversation represents a continuous and dynamic activity of meaning construction turn by turn, based on a two-way interpretative process between therapist and Patient. In particular, verbal structures and intents, vocal characteristics, and speech interruptions are indivisible and fundamental elements of therapeutic discourse; they convey psychological and emotional processes that transform the internal organization of individuals into more complex structures, fostering change. During this activity, verbal and non-verbal components interact with each other, forming a non-linear communication field that expresses the therapeutic process and the clinical function of the therapeutic relationship and fosters the development and regulation of factors such as the therapeutic alliance. This relational dimension, influenced by communicative coordination processes underlying the mutual regulation between participants, is predictive of change, especially in the early stages of psychotherapy. During the therapeutic interaction, Patients experience alliance construction by manifesting different verbal and non-verbal behaviors whereby they express their psychological processes and symptoms. In particular, Depressed Patients present verbal, vocal, and interruption behaviors that are an expression of their symptomatology and impact on communicative exchanges with the therapist, hindering the development and maintenance of the therapeutic alliance and change. In literature, the predominance of verbal communication over the above-stated components resulted in a fragmented communicative field with distinct theories and measurement tools, which prevented the understanding of therapist-Patient dynamics and their role in the construction of the early therapeutic alliance at the process level. Studies analyzing the dynamics between communication (as a single and interacting communicative field) and relational aspects in the therapist-Patient interplay are absent, especially in the Italian context and in brief focal psychotherapy with Depressed Patients. Therefore, this doctoral thesis as a collection of two publications aims to identify the verbal, vocal, and interruption behaviors emerging turn by turn between the therapist and Depressed Patient within psychodynamic psychotherapy and investigate those communicative modes of each participant that foster the alliance construction by the other during mutual regulation processes. A particular case of indirect observational methodology was implemented; as a mixed method in itself, it was able to provide a fuller picture of the therapeutic interaction by supporting it with objective measures. Thirty audio recordings and transcripts of brief focal psychotherapy sessions with ten Depressed Patients treated by the same therapist (8,327 speaking turns) were considered. The observational design selected to guide and organize the investigation was nomothetic/follow-up/multidimensional, given its greater wealth of information and complexity among low-intensity evaluation designs. Study 1, focused on identifying communicative behaviors through a theory that unify the communicative field, resulted in the construction of an ad hoc indirect observation instrument of the therapeutic conversation based on the performative function of the Speech Act Theory. This classification system showed high intra-and inter-observer reliability and made it possible to describe the participants’ communicative modes trend. Study 2 aimed to investigate the communicative modes of the therapist and Depressed Patients that, according to the literature, foster the mutual construction of the early therapeutic alliance: asking, exploring, elaborating, and interrupting cooperatively for the former; affirming, exploring, expressing emotions, and interrupting cooperatively for the latter. The study showed the presence of sequential patterns and significant relationships between the selected communicative behaviors and this relational dimension during the mutual regulation processes. All this allows increasing knowledge about these dynamics, providing professionals with useful information to improve the treatment effectiveness and to advance in the application of the mixed-methods approach in the field of psychotherapy research.[spa] Durante la psicoterapia psicodinámica, los componentes verbales (estructuras e intenciones) y no verbales (voz e interrupciones) interactúan entre sí, transmitiendo procesos psicológicos y emocionales y formando un campo comunicativo no lineal en la base de la alianza terapéutica. Esta dimensión relacional predice el cambio, influenciada por los intercambios paciente-terapeuta desde las etapas iniciales del encuentro. Los pacientes deprimidos presentan comunicación verbal y no verbal específica y muestran dificultades para desarrollar y mantener la alianza terapéutica. Esta tesis doctoral tiene como objetivo identificar las conductas verbales, vocales y de interrupción que emergen turno tras turno entre el terapeuta y el paciente deprimido dentro de la psicoterapia psicodinámica e investigar aquellos modos comunicativos de cada participante que fomentan la construcción de la alianza durante la regulación mutua. Se aplicó un caso particular de metodología observacional indirecta como método mixto en sí mismo y se consideraron 30 grabaciones de audio y transcripciones de sesiones de psicoterapia con diez pacientes deprimidos tratados por la misma terapeuta (8,327 turnos de habla). El diseño observacional fue nomotético, de seguimiento y multidimensional. El estudio 1, centrado en la identificación de las conductas comunicativas a través de una teoría unificadora del campo comunicativo, produjo un instrumento de observación indirecta ad hoc de la conversación terapéutica basado en la función performativa de la Teoría de los Actos del Habla. Este sistema de clasificación mostró una alta fiabilidad intra e inter-observador y permitió describir la tendencia de los modos comunicativos de los participantes. El estudio 2 investigó los modos comunicativos del terapeuta y de los pacientes deprimidos que, según la literatura, fomentan la construcción mutua de la alianza terapéutica temprana: preguntar, explorar, elaborar e interrumpir cooperativamente para el primero; afirmar, explorar, expresar emociones e interrumpir cooperativamente para el segundo. Se detectaron patrones secuenciales y relaciones significativas entre las conductas comunicativas seleccionadas y la dimensión relacional durante los procesos de regulación mutua. Todo ello permite aumentar el conocimiento de estas dinámicas, proporcionando a los profesionales información útil para mejorar la eficacia del tratamiento y avanzar en la aplicación del enfoque de mixed methods en el campo de la investigación en psicoterapia
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The Mutual Regulation Processes During the Psychodynamic Psychotherapy of Depression: An Observational Study of Communicative Acts in the Construction of the Early Therapeutic Alliance = Los Procesos de Regulación Mutua Durante la Psicoterapia Psicodinámica de la Depresión: Un Estudio Observacional de los Actos Comunicativos en la Construcción de la Alianza Terapéutica Temprana
'Edicions de la Universitat de Barcelona', 2021Co-Authors: Del Giacco LucaAbstract:Therapeutic conversation represents a continuous and dynamic activity of meaning construction turn by turn, based on a two-way interpretative process between therapist and Patient. In particular, verbal structures and intents, vocal characteristics, and speech interruptions are indivisible and fundamental elements of therapeutic discourse; they convey psychological and emotional processes that transform the internal organization of individuals into more complex structures, fostering change. During this activity, verbal and non-verbal components interact with each other, forming a non-linear communication field that expresses the therapeutic process and the clinical function of the therapeutic relationship and fosters the development and regulation of factors such as the therapeutic alliance. This relational dimension, influenced by communicative coordination processes underlying the mutual regulation between participants, is predictive of change, especially in the early stages of psychotherapy. During the therapeutic interaction, Patients experience alliance construction by manifesting different verbal and non-verbal behaviors whereby they express their psychological processes and symptoms. In particular, Depressed Patients present verbal, vocal, and interruption behaviors that are an expression of their symptomatology and impact on communicative exchanges with the therapist, hindering the development and maintenance of the therapeutic alliance and change. In literature, the predominance of verbal communication over the above-stated components resulted in a fragmented communicative field with distinct theories and measurement tools, which prevented the understanding of therapist-Patient dynamics and their role in the construction of the early therapeutic alliance at the process level. Studies analyzing the dynamics between communication (as a single and interacting communicative field) and relational aspects in the therapist-Patient interplay are absent, especially in the Italian context and in brief focal psychotherapy with Depressed Patients. Therefore, this doctoral thesis as a collection of two publications aims to identify the verbal, vocal, and interruption behaviors emerging turn by turn between the therapist and Depressed Patient within psychodynamic psychotherapy and investigate those communicative modes of each participant that foster the alliance construction by the other during mutual regulation processes. A particular case of indirect observational methodology was implemented; as a mixed method in itself, it was able to provide a fuller picture of the therapeutic interaction by supporting it with objective measures. Thirty audio recordings and transcripts of brief focal psychotherapy sessions with ten Depressed Patients treated by the same therapist (8,327 speaking turns) were considered. The observational design selected to guide and organize the investigation was nomothetic/follow-up/multidimensional, given its greater wealth of information and complexity among low-intensity evaluation designs. Study 1, focused on identifying communicative behaviors through a theory that unify the communicative field, resulted in the construction of an ad hoc indirect observation instrument of the therapeutic conversation based on the performative function of the Speech Act Theory. This classification system showed high intra-and inter-observer reliability and made it possible to describe the participants’ communicative modes trend. Study 2 aimed to investigate the communicative modes of the therapist and Depressed Patients that, according to the literature, foster the mutual construction of the early therapeutic alliance: asking, exploring, elaborating, and interrupting cooperatively for the former; affirming, exploring, expressing emotions, and interrupting cooperatively for the latter. The study showed the presence of sequential patterns and significant relationships between the selected communicative behaviors and this relational dimension during the mutual regulation processes. All this allows increasing knowledge about these dynamics, providing professionals with useful information to improve the treatment effectiveness and to advance in the application of the mixed-methods approach in the field of psychotherapy research.Durante la psicoterapia psicodinámica, los componentes verbales (estructuras e intenciones) y no verbales (voz e interrupciones) interactúan entre sí, transmitiendo procesos psicológicos y emocionales y formando un campo comunicativo no lineal en la base de la alianza terapéutica. Esta dimensión relacional predice el cambio, influenciada por los intercambios paciente-terapeuta desde las etapas iniciales del encuentro. Los pacientes deprimidos presentan comunicación verbal y no verbal específica y muestran dificultades para desarrollar y mantener la alianza terapéutica. Esta tesis doctoral tiene como objetivo identificar las conductas verbales, vocales y de interrupción que emergen turno tras turno entre el terapeuta y el paciente deprimido dentro de la psicoterapia psicodinámica e investigar aquellos modos comunicativos de cada participante que fomentan la construcción de la alianza durante la regulación mutua. Se aplicó un caso particular de metodología observacional indirecta como método mixto en sí mismo y se consideraron 30 grabaciones de audio y transcripciones de sesiones de psicoterapia con diez pacientes deprimidos tratados por la misma terapeuta (8,327 turnos de habla). El diseño observacional fue nomotético, de seguimiento y multidimensional. El estudio 1, centrado en la identificación de las conductas comunicativas a través de una teoría unificadora del campo comunicativo, produjo un instrumento de observación indirecta ad hoc de la conversación terapéutica basado en la función performativa de la Teoría de los Actos del Habla. Este sistema de clasificación mostró una alta fiabilidad intra e inter-observador y permitió describir la tendencia de los modos comunicativos de los participantes. El estudio 2 investigó los modos comunicativos del terapeuta y de los pacientes deprimidos que, según la literatura, fomentan la construcción mutua de la alianza terapéutica temprana: preguntar, explorar, elaborar e interrumpir cooperativamente para el primero; afirmar, explorar, expresar emociones e interrumpir cooperativamente para el segundo. Se detectaron patrones secuenciales y relaciones significativas entre las conductas comunicativas seleccionadas y la dimensión relacional durante los procesos de regulación mutua. Todo ello permite aumentar el conocimiento de estas dinámicas, proporcionando a los profesionales información útil para mejorar la eficacia del tratamiento y avanzar en la aplicación del enfoque de mixed methods en el campo de la investigación en psicoterapia
Koichi Otani - One of the best experts on this subject based on the ideXlab platform.
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case report changes in regional cerebral blood flow in chronic akathisia of a Depressed Patient before and after electroconvulsive therapy treatment
Frontiers in Psychiatry, 2021Co-Authors: Akihito Suzuki, Ryota Kobayashi, Toshinori Shirata, Hitomi Komoriya, Masafumi Kanoto, Koichi OtaniAbstract:Akathisia, which characterized by subjective restlessness and objective hyperactivity, is induced mostly by antipsychotics and antidepressants. Chronic akathisia is defined as persistence of symptoms for more than 3 months. The pathophysiology of chronic akathisia remains unclear. This report describes a Depressed Patient, a 66-year-old woman with a diagnosis of major depressive disorder, with chronic akathisia. Her regional cerebral blood flow (rCBF) was measured using single photon emission computed tomography (SPECT) before and after the treatment with electroconvulsive therapy (ECT). She had experienced akathisia three times prior because of risperidone, escitalopram, and clomipramine administration. After levomepromazine was added to quetiapine to treat insomnia, she developed akathisia symptoms such as a sense of restlessness and inability to sit in one place for a few minutes. These antipsychotics were withdrawn. Propranolol was administered, leading to no apparent improvement for eight months. After she was diagnosed as having major depressive disorder and chronic akathisia, she received 10 sessions of bilateral ECT. Her depressive symptoms improved greatly. Akathisia disappeared completely after ECT. SPECT revealed that rCBF was decreased in the middle frontal gyrus and parietal lobe, that it was increased in the thalamus, fusiform gyrus, and cerebellum before ECT, and that these abnormalities in rCBF were approaching normal levels after ECT. Findings presented in this report suggest ECT as a beneficial treatment for chronic akathisia. Altered rCBF in the middle frontal gyrus, parietal lobe, thalamus, fusiform gyrus, and cerebellum, and especially decreased rCBF in the parietal lobe, may be related to the pathophysiology of chronic akathisia.
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Case Report: Changes in Regional Cerebral Blood Flow in Chronic Akathisia of a Depressed Patient Before and After Electroconvulsive Therapy Treatment
'Frontiers Media SA', 2021Co-Authors: Akihito Suzuki, Ryota Kobayashi, Toshinori Shirata, Hitomi Komoriya, Masafumi Kanoto, Koichi OtaniAbstract:Akathisia, which characterized by subjective restlessness and objective hyperactivity, is induced mostly by antipsychotics and antidepressants. Chronic akathisia is defined as persistence of symptoms for more than 3 months. The pathophysiology of chronic akathisia remains unclear. This report describes a Depressed Patient, a 66-year-old woman with a diagnosis of major depressive disorder, with chronic akathisia. Her regional cerebral blood flow (rCBF) was measured using single photon emission computed tomography (SPECT) before and after the treatment with electroconvulsive therapy (ECT). She had experienced akathisia-like symptoms three times prior because of risperidone, escitalopram, and clomipramine administration, accompanied by major depression. After levomepromazine was added to quetiapine to treat insomnia, she developed akathisia symptoms such as a sense of restlessness and inability to sit in one place for a few minutes. These antipsychotics were withdrawn. Propranolol was administered, leading to no apparent improvement for 8 months. After she was diagnosed as having major depressive disorder and chronic akathisia, she received 10 sessions of bilateral ECT. Her depressive symptoms improved greatly. Akathisia disappeared completely after ECT. SPECT revealed that rCBF was decreased in the middle frontal gyrus and parietal lobe, that it was increased in the thalamus, fusiform gyrus, and cerebellum before ECT, and that these abnormalities in rCBF were approaching normal levels after ECT. Findings presented in this report suggest ECT as a beneficial treatment for chronic akathisia. Altered rCBF in the middle frontal gyrus, parietal lobe, thalamus, fusiform gyrus, and cerebellum, and especially decreased rCBF in the parietal lobe, may be related to the pathophysiology of chronic akathisia
Akihito Suzuki - One of the best experts on this subject based on the ideXlab platform.
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case report changes in regional cerebral blood flow in chronic akathisia of a Depressed Patient before and after electroconvulsive therapy treatment
Frontiers in Psychiatry, 2021Co-Authors: Akihito Suzuki, Ryota Kobayashi, Toshinori Shirata, Hitomi Komoriya, Masafumi Kanoto, Koichi OtaniAbstract:Akathisia, which characterized by subjective restlessness and objective hyperactivity, is induced mostly by antipsychotics and antidepressants. Chronic akathisia is defined as persistence of symptoms for more than 3 months. The pathophysiology of chronic akathisia remains unclear. This report describes a Depressed Patient, a 66-year-old woman with a diagnosis of major depressive disorder, with chronic akathisia. Her regional cerebral blood flow (rCBF) was measured using single photon emission computed tomography (SPECT) before and after the treatment with electroconvulsive therapy (ECT). She had experienced akathisia three times prior because of risperidone, escitalopram, and clomipramine administration. After levomepromazine was added to quetiapine to treat insomnia, she developed akathisia symptoms such as a sense of restlessness and inability to sit in one place for a few minutes. These antipsychotics were withdrawn. Propranolol was administered, leading to no apparent improvement for eight months. After she was diagnosed as having major depressive disorder and chronic akathisia, she received 10 sessions of bilateral ECT. Her depressive symptoms improved greatly. Akathisia disappeared completely after ECT. SPECT revealed that rCBF was decreased in the middle frontal gyrus and parietal lobe, that it was increased in the thalamus, fusiform gyrus, and cerebellum before ECT, and that these abnormalities in rCBF were approaching normal levels after ECT. Findings presented in this report suggest ECT as a beneficial treatment for chronic akathisia. Altered rCBF in the middle frontal gyrus, parietal lobe, thalamus, fusiform gyrus, and cerebellum, and especially decreased rCBF in the parietal lobe, may be related to the pathophysiology of chronic akathisia.
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Case Report: Changes in Regional Cerebral Blood Flow in Chronic Akathisia of a Depressed Patient Before and After Electroconvulsive Therapy Treatment
'Frontiers Media SA', 2021Co-Authors: Akihito Suzuki, Ryota Kobayashi, Toshinori Shirata, Hitomi Komoriya, Masafumi Kanoto, Koichi OtaniAbstract:Akathisia, which characterized by subjective restlessness and objective hyperactivity, is induced mostly by antipsychotics and antidepressants. Chronic akathisia is defined as persistence of symptoms for more than 3 months. The pathophysiology of chronic akathisia remains unclear. This report describes a Depressed Patient, a 66-year-old woman with a diagnosis of major depressive disorder, with chronic akathisia. Her regional cerebral blood flow (rCBF) was measured using single photon emission computed tomography (SPECT) before and after the treatment with electroconvulsive therapy (ECT). She had experienced akathisia-like symptoms three times prior because of risperidone, escitalopram, and clomipramine administration, accompanied by major depression. After levomepromazine was added to quetiapine to treat insomnia, she developed akathisia symptoms such as a sense of restlessness and inability to sit in one place for a few minutes. These antipsychotics were withdrawn. Propranolol was administered, leading to no apparent improvement for 8 months. After she was diagnosed as having major depressive disorder and chronic akathisia, she received 10 sessions of bilateral ECT. Her depressive symptoms improved greatly. Akathisia disappeared completely after ECT. SPECT revealed that rCBF was decreased in the middle frontal gyrus and parietal lobe, that it was increased in the thalamus, fusiform gyrus, and cerebellum before ECT, and that these abnormalities in rCBF were approaching normal levels after ECT. Findings presented in this report suggest ECT as a beneficial treatment for chronic akathisia. Altered rCBF in the middle frontal gyrus, parietal lobe, thalamus, fusiform gyrus, and cerebellum, and especially decreased rCBF in the parietal lobe, may be related to the pathophysiology of chronic akathisia
X Zendjidjian - One of the best experts on this subject based on the ideXlab platform.
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Emotional intelligence and coping strategies as determinants of quality of life in Depressed Patient-caregiver dyads: An actor-partner interdependence analysis
Comprehensive Psychiatry, 2017Co-Authors: Laurent Boyer, K Baumstarck, M Alessandrini, Z Hamidou, T Testart, P Serres, P Arquillière, P Auquier, T Leroy, X ZendjidjianAbstract:Objective: Patients with major depressive disorder (MDD) and their natural caregivers experience major lifestyle difficulties. Little is known concerning dyadic (i.e., Patient and natural caregiver) characteristics' impact on quality of life. In a sample of Depressed Patient–caregiver dyads, we examined quality of life (QoL) levels compared with the general population and whether QoL is influenced by emotional intelligence (EI) and coping strategies using the actor–partner interdependence model (APIM). Methods: This cross-sectional study involved 79 Patient–caregiver dyads. The self-reported data, completed by Patients and their primary caregivers, included QoL (SF-36), EI (TEIQue-SF) and coping strategies (BriefCope). The QoL of Patients and caregivers was compared with 158 French age-sex-matched healthy controls. The dyadic interactions were analyzed using structural equation modeling. Results: Patients and their caregivers experienced lower QoL levels than French age–sex-matched controls. The EI findings showed actor (degree to which the person's EI was associated with his/her own QoL) and partner (degree to which the person's EI was associated with QoL of the other member of the dyad) effects for Patients and caregivers. The coping strategies (i.e., problem solving, positive thinking, avoidance and social support) revealed only actor effects. Conclusion: QoL is seriously impaired in Depressed Patients and their primary caregivers and is associated with EI and coping strategies. Targeted interventions focusing on EI and coping strategies could be offered to improve QoL in dyads.
Zendjidjian Xavier - One of the best experts on this subject based on the ideXlab platform.
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actor partner interdependence analysis in Depressed Patient caregiver dyads influence of emotional intelligence and coping strategies on anxiety and depression
Psychiatry Research-neuroimaging, 2017Co-Authors: Serres Marguerite, Boyer Laurent, Alessandrini Marine, Leroy Tanguy, Baumstarck Karine, Auquier Pascal, Zendjidjian XavierAbstract:Abstract Objective Major depressive disorder (MDD) is a leading cause of suffering for both Patients and their natural caregivers. A preliminary study highlights the association of emotional intelligence (EI) and coping strategies with quality of life. However, there is a lack of studies concerning dyadic (i.e., Patient and natural caregiver) characteristics’ impact on anxious and depressive symptoms. In a sample of MDD Patients-caregivers dyads, we explored the influence of EI and coping strategies on anxious and depressive symptoms using the actor-partner interdependence model (APIM). Methods The cross-sectional study included 79 MDD Patient-caregiver dyads. Self-reported data, completed by Patients and their primary caregivers, were collected including socio-demographic, EI using TEIQue-SF, coping strategies using BriefCope, depressive symptoms using Beck Depression Inventory, anxious symptoms using STAI. The APIM was used to test the dyadic effects of EI and coping strategies on anxious and depressive symptoms, using structural equation modelling. Results Patients and caregivers reported both anxious and depressive symptoms. Coping strategies, such as problem solving, positive thinking and avoidance, exhibited evidence of actor (degree to which the individual's coping strategies are associated with their own anxiety or depression level) and partner effect (degree to which the individual's coping strategies are associated with the anxiety or depression level of the other member of the dyad). The caregivers’ EI was associated with a decrease of their own depression level contrary to Patients for which the results were not significant. The Patients’ and caregivers’ EI was associated with a decrease of their own level of anxiety. Conclusion EI and coping strategies were moderately associated with anxious and depressive symptomatology among MDD Patient-caregiver dyads. These results suggest that targeted interventions could be proposed to both Patients and caregivers.