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Sidney J Blatt - One of the best experts on this subject based on the ideXlab platform.
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Psychodynamic Treatment of Depression
The Psychiatric clinics of North America, 2012Co-Authors: Patrick Luyten, Sidney J BlattAbstract:Findings reviewed in this article show that PT should be included in Treatment guidelines for Depression. BPT in particular has been found to be superior to control conditions, equally effective as other active psychological Treatments, with Treatment effects that are often maintained in the long run, conferring resistance to relapse. Moreover, BPT is as effective as pharmacotherapy in the acute Treatment of mild to moderate Depression, and, either as monotherapy or combined with medication, BPT is associated with better long-term outcome compared with pharmacotherapy alone. PT is accepted by many depressed patients as a viable and preferred Treatment. Furthermore, LTPT and PA have shown promise in treating patients with complex psychological disorders characterized by mood problems, often with comorbid personality problems. Finally, although studies suggest that effects of PT may be achieved somewhat slower compared with other forms of psychotherapy as well as medication in the acute Treatment of Depression, LTPT appears to be more clinically effective and perhaps more cost effective in the long run, particularly for chronically depressed patients. As noted, these conclusions need to be interpreted within the context of important limitations. Compared with other Treatments, the evidence base for PT in Depression remains relatively small, despite a respectable research tradition supporting psychodynamic assumptions with regard to the causation of Depression. Moreover, and perhaps most importantly, although more studies now include longer follow-up assessments, our knowledge about the long-term effects of so-called evidence-based Treatments of Depression remains sketchy at best. In this context, the growing evidence for the efficacy and effectiveness of LTPT is promising. Overall, it is clear that the future of the Treatment of Depression may lie in a combined disorder- and person-centered, tailored-made approach, which takes into account, particularly in chronic Depression, the broader interpersonal context and life history of the individual. It is clear that psychodynamic therapies have an important role to play in this respect.
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when and how perfectionism impedes the brief Treatment of Depression further analyses of the national institute of mental health Treatment of Depression collaborative research program
Journal of Consulting and Clinical Psychology, 1998Co-Authors: Sidney J Blatt, Charles A Sanislow, David C Zuroff, Paul A Pilkonis, Colin M BondiAbstract:: Perfectionism has previously been identified as having a significant negative impact on therapeutic outcome at termination in the brief (16-week) Treatment of Depression (S. J. Blatt, D. M. Quinlan, P. A. Pilkonis, & T. Shea, 1995) as measured by the 5 primary outcome measures used in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). The present analyses of other data from the TDCRP indicated that this impact of perfectionism on therapeutic outcome was also found in ratings by therapists, independent clinical evaluators, and the patients and that this effect persisted 18 months after termination. In addition, analyses of comprehensive, independent assessments made during the Treatment process indicated that perfectionism began to impede therapeutic gain in approximately 2/3 of the sample, in the latter half of Treatment, between the 9th and 12th sessions. Implications of these findings are discussed, including the possibility that more perfectionistic patients may be negatively impacted by anticipation of an arbitrary, externally imposed termination date.
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characteristics of effective therapists further analyses of data from the national institute of mental health Treatment of Depression collaborative research program
Journal of Consulting and Clinical Psychology, 1996Co-Authors: Sidney J Blatt, Charles A Sanislow, David C Zuroff, Paul A PilkonisAbstract:Analyses of the data of the National Institute of Mental Health-sponsored Treatment of Depression Collaborative Research Program have primarily examined the effects of types of Treatment and patient characteristics on outcome, but scant attention has been directed toward evaluating the contributions of the therapist. With an aggregate of residualized therapeutic change scores of the 5 primary outcome measures for each patient at termination as an overall measure of improvement, an average therapeutic effectiveness measure was derived for each of the 28 therapists based on the outcome of the patients they saw in active Treatment. The distribution of the therapists was divided into thirds, and comparisons indicate that more effective therapists are more psychological minded, eschew biological interventions (i.e., medication and electroconvulsive therapy) in their ordinary clinical practice, and expect outpatient Treatment of Depression to take longer than did moderately and less effective therapists. The National Institute of Mental Health (NIMH)-sponsored Treatment of Depression Collaborative Research Program (TDCRP), a comprehensive, well-designed, and carefully conducted multisite, randomized clinical trial, evaluated several forms of brief ( 16-20 session) outpatient Treatment for Depression. Prior analyses of these data compared the relative efficacy of four Treatment conditions and the effects of patient characteristics on outcome, but little attention has been directed to evaluating the therapists and their contributions to the therapeutic process. Therapists' contribution to Treatment outcome has long been of concern in psychotherapy research (e.g., Beutler, Crago, & Arizmendi, 1986; Gurman & Razin, 1977). However, as noted
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interpersonal factors in brief Treatment of Depression further analyses of the national institute of mental health Treatment of Depression collaborative research program
Journal of Consulting and Clinical Psychology, 1996Co-Authors: Sidney J Blatt, David C Zuroff, Donald M Quinlan, Paul A PilkonisAbstract:: Previous analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program indicate minimal differences in therapeutic outcome among 3 brief Treatments for Depression, but patients' preTreatment level of perfectionism had a significant negative relationship with residualized measures of clinical improvement. The present analyses indicate that the quality of the therapeutic relationship reported by patients early in Treatment contributed significantly to the prediction of therapeutic change. The quality of the therapeutic relationship was only marginally predictive of therapeutic gain at low and high levels of perfectionism, but significantly predicted therapeutic gain at moderate levels of perfectionism. These findings suggest that the extensive efforts to compare different manual-directed Treatments need to be balanced by commensurate attention to interpersonal dimensions of the therapeutic process.
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the destructiveness of perfectionism implications for the Treatment of Depression
American Psychologist, 1995Co-Authors: Sidney J BlattAbstract:Reports in the public media indicate that intense perfectionism and severe self-criticism played a role in the suicide of three remarkably talented individuals. The role of perfectionism in these suicides is consistent with recent extensive investigations of aspects of perfectionism as well as further analyses of the NIMH Treatment of Depression Collaborative Research Program (TDCRP), indicating that intense perfectionism interfered significantly with therapeutic response in the various brief Treatments for Depression. Self-critical individuals, however, made substantial improvement in long-term intensive Treatment. These findings suggest the value of considering psychopathology, especially Depression, from a psychological rather than a symptomatic perspective; that different patients may be differentially responsive to various types of therapy; and that more extensive therapy may be necessary for many highly perfectionistic, self-critical patients.
Paul A Pilkonis - One of the best experts on this subject based on the ideXlab platform.
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when and how perfectionism impedes the brief Treatment of Depression further analyses of the national institute of mental health Treatment of Depression collaborative research program
Journal of Consulting and Clinical Psychology, 1998Co-Authors: Sidney J Blatt, Charles A Sanislow, David C Zuroff, Paul A Pilkonis, Colin M BondiAbstract:: Perfectionism has previously been identified as having a significant negative impact on therapeutic outcome at termination in the brief (16-week) Treatment of Depression (S. J. Blatt, D. M. Quinlan, P. A. Pilkonis, & T. Shea, 1995) as measured by the 5 primary outcome measures used in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). The present analyses of other data from the TDCRP indicated that this impact of perfectionism on therapeutic outcome was also found in ratings by therapists, independent clinical evaluators, and the patients and that this effect persisted 18 months after termination. In addition, analyses of comprehensive, independent assessments made during the Treatment process indicated that perfectionism began to impede therapeutic gain in approximately 2/3 of the sample, in the latter half of Treatment, between the 9th and 12th sessions. Implications of these findings are discussed, including the possibility that more perfectionistic patients may be negatively impacted by anticipation of an arbitrary, externally imposed termination date.
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characteristics of effective therapists further analyses of data from the national institute of mental health Treatment of Depression collaborative research program
Journal of Consulting and Clinical Psychology, 1996Co-Authors: Sidney J Blatt, Charles A Sanislow, David C Zuroff, Paul A PilkonisAbstract:Analyses of the data of the National Institute of Mental Health-sponsored Treatment of Depression Collaborative Research Program have primarily examined the effects of types of Treatment and patient characteristics on outcome, but scant attention has been directed toward evaluating the contributions of the therapist. With an aggregate of residualized therapeutic change scores of the 5 primary outcome measures for each patient at termination as an overall measure of improvement, an average therapeutic effectiveness measure was derived for each of the 28 therapists based on the outcome of the patients they saw in active Treatment. The distribution of the therapists was divided into thirds, and comparisons indicate that more effective therapists are more psychological minded, eschew biological interventions (i.e., medication and electroconvulsive therapy) in their ordinary clinical practice, and expect outpatient Treatment of Depression to take longer than did moderately and less effective therapists. The National Institute of Mental Health (NIMH)-sponsored Treatment of Depression Collaborative Research Program (TDCRP), a comprehensive, well-designed, and carefully conducted multisite, randomized clinical trial, evaluated several forms of brief ( 16-20 session) outpatient Treatment for Depression. Prior analyses of these data compared the relative efficacy of four Treatment conditions and the effects of patient characteristics on outcome, but little attention has been directed to evaluating the therapists and their contributions to the therapeutic process. Therapists' contribution to Treatment outcome has long been of concern in psychotherapy research (e.g., Beutler, Crago, & Arizmendi, 1986; Gurman & Razin, 1977). However, as noted
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interpersonal factors in brief Treatment of Depression further analyses of the national institute of mental health Treatment of Depression collaborative research program
Journal of Consulting and Clinical Psychology, 1996Co-Authors: Sidney J Blatt, David C Zuroff, Donald M Quinlan, Paul A PilkonisAbstract:: Previous analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program indicate minimal differences in therapeutic outcome among 3 brief Treatments for Depression, but patients' preTreatment level of perfectionism had a significant negative relationship with residualized measures of clinical improvement. The present analyses indicate that the quality of the therapeutic relationship reported by patients early in Treatment contributed significantly to the prediction of therapeutic change. The quality of the therapeutic relationship was only marginally predictive of therapeutic gain at low and high levels of perfectionism, but significantly predicted therapeutic gain at moderate levels of perfectionism. These findings suggest that the extensive efforts to compare different manual-directed Treatments need to be balanced by commensurate attention to interpersonal dimensions of the therapeutic process.
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impact of perfectionism and need for approval on the brief Treatment of Depression the national institute of mental health Treatment of Depression collaborative research program revisited
Journal of Consulting and Clinical Psychology, 1995Co-Authors: Sidney J Blatt, Paul A Pilkonis, Donald M Quinlan, Tracie M SheaAbstract:: Patients in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP) were administered at intake with the Dysfunctional Attitude Scale (DAS; A. N. Weissman & A. T. Beck, 1978). Factor analyses of the DAS in the TDCRP data as well as in several independent samples reveal two primary factors: an interpersonal factor, Need for Approval, and a self-critical factor, Perfectionism. This study explored the hypotheses that these factors, assessed prior to Treatment, would have differential interactions with the two forms of psychotherapy evaluated in the TDCRP as well as differential relationships to various outcome measures (Depression, clinical functioning, and social adjustment). DAS Perfectionism had consistently significant negative relationships with all the outcome measures in all four Treatment conditions. Contrary to expectations, however, there were no significant interactions between the two DAS factors and the four types of brief Treatment (cognitive-behavioral therapy, interpersonal therapy, imipramine, and placebo).
David C Zuroff - One of the best experts on this subject based on the ideXlab platform.
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when and how perfectionism impedes the brief Treatment of Depression further analyses of the national institute of mental health Treatment of Depression collaborative research program
Journal of Consulting and Clinical Psychology, 1998Co-Authors: Sidney J Blatt, Charles A Sanislow, David C Zuroff, Paul A Pilkonis, Colin M BondiAbstract:: Perfectionism has previously been identified as having a significant negative impact on therapeutic outcome at termination in the brief (16-week) Treatment of Depression (S. J. Blatt, D. M. Quinlan, P. A. Pilkonis, & T. Shea, 1995) as measured by the 5 primary outcome measures used in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). The present analyses of other data from the TDCRP indicated that this impact of perfectionism on therapeutic outcome was also found in ratings by therapists, independent clinical evaluators, and the patients and that this effect persisted 18 months after termination. In addition, analyses of comprehensive, independent assessments made during the Treatment process indicated that perfectionism began to impede therapeutic gain in approximately 2/3 of the sample, in the latter half of Treatment, between the 9th and 12th sessions. Implications of these findings are discussed, including the possibility that more perfectionistic patients may be negatively impacted by anticipation of an arbitrary, externally imposed termination date.
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characteristics of effective therapists further analyses of data from the national institute of mental health Treatment of Depression collaborative research program
Journal of Consulting and Clinical Psychology, 1996Co-Authors: Sidney J Blatt, Charles A Sanislow, David C Zuroff, Paul A PilkonisAbstract:Analyses of the data of the National Institute of Mental Health-sponsored Treatment of Depression Collaborative Research Program have primarily examined the effects of types of Treatment and patient characteristics on outcome, but scant attention has been directed toward evaluating the contributions of the therapist. With an aggregate of residualized therapeutic change scores of the 5 primary outcome measures for each patient at termination as an overall measure of improvement, an average therapeutic effectiveness measure was derived for each of the 28 therapists based on the outcome of the patients they saw in active Treatment. The distribution of the therapists was divided into thirds, and comparisons indicate that more effective therapists are more psychological minded, eschew biological interventions (i.e., medication and electroconvulsive therapy) in their ordinary clinical practice, and expect outpatient Treatment of Depression to take longer than did moderately and less effective therapists. The National Institute of Mental Health (NIMH)-sponsored Treatment of Depression Collaborative Research Program (TDCRP), a comprehensive, well-designed, and carefully conducted multisite, randomized clinical trial, evaluated several forms of brief ( 16-20 session) outpatient Treatment for Depression. Prior analyses of these data compared the relative efficacy of four Treatment conditions and the effects of patient characteristics on outcome, but little attention has been directed to evaluating the therapists and their contributions to the therapeutic process. Therapists' contribution to Treatment outcome has long been of concern in psychotherapy research (e.g., Beutler, Crago, & Arizmendi, 1986; Gurman & Razin, 1977). However, as noted
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interpersonal factors in brief Treatment of Depression further analyses of the national institute of mental health Treatment of Depression collaborative research program
Journal of Consulting and Clinical Psychology, 1996Co-Authors: Sidney J Blatt, David C Zuroff, Donald M Quinlan, Paul A PilkonisAbstract:: Previous analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program indicate minimal differences in therapeutic outcome among 3 brief Treatments for Depression, but patients' preTreatment level of perfectionism had a significant negative relationship with residualized measures of clinical improvement. The present analyses indicate that the quality of the therapeutic relationship reported by patients early in Treatment contributed significantly to the prediction of therapeutic change. The quality of the therapeutic relationship was only marginally predictive of therapeutic gain at low and high levels of perfectionism, but significantly predicted therapeutic gain at moderate levels of perfectionism. These findings suggest that the extensive efforts to compare different manual-directed Treatments need to be balanced by commensurate attention to interpersonal dimensions of the therapeutic process.
Charles A Sanislow - One of the best experts on this subject based on the ideXlab platform.
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when and how perfectionism impedes the brief Treatment of Depression further analyses of the national institute of mental health Treatment of Depression collaborative research program
Journal of Consulting and Clinical Psychology, 1998Co-Authors: Sidney J Blatt, Charles A Sanislow, David C Zuroff, Paul A Pilkonis, Colin M BondiAbstract:: Perfectionism has previously been identified as having a significant negative impact on therapeutic outcome at termination in the brief (16-week) Treatment of Depression (S. J. Blatt, D. M. Quinlan, P. A. Pilkonis, & T. Shea, 1995) as measured by the 5 primary outcome measures used in the National Institute of Mental Health Treatment of Depression Collaborative Research Program (TDCRP). The present analyses of other data from the TDCRP indicated that this impact of perfectionism on therapeutic outcome was also found in ratings by therapists, independent clinical evaluators, and the patients and that this effect persisted 18 months after termination. In addition, analyses of comprehensive, independent assessments made during the Treatment process indicated that perfectionism began to impede therapeutic gain in approximately 2/3 of the sample, in the latter half of Treatment, between the 9th and 12th sessions. Implications of these findings are discussed, including the possibility that more perfectionistic patients may be negatively impacted by anticipation of an arbitrary, externally imposed termination date.
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characteristics of effective therapists further analyses of data from the national institute of mental health Treatment of Depression collaborative research program
Journal of Consulting and Clinical Psychology, 1996Co-Authors: Sidney J Blatt, Charles A Sanislow, David C Zuroff, Paul A PilkonisAbstract:Analyses of the data of the National Institute of Mental Health-sponsored Treatment of Depression Collaborative Research Program have primarily examined the effects of types of Treatment and patient characteristics on outcome, but scant attention has been directed toward evaluating the contributions of the therapist. With an aggregate of residualized therapeutic change scores of the 5 primary outcome measures for each patient at termination as an overall measure of improvement, an average therapeutic effectiveness measure was derived for each of the 28 therapists based on the outcome of the patients they saw in active Treatment. The distribution of the therapists was divided into thirds, and comparisons indicate that more effective therapists are more psychological minded, eschew biological interventions (i.e., medication and electroconvulsive therapy) in their ordinary clinical practice, and expect outpatient Treatment of Depression to take longer than did moderately and less effective therapists. The National Institute of Mental Health (NIMH)-sponsored Treatment of Depression Collaborative Research Program (TDCRP), a comprehensive, well-designed, and carefully conducted multisite, randomized clinical trial, evaluated several forms of brief ( 16-20 session) outpatient Treatment for Depression. Prior analyses of these data compared the relative efficacy of four Treatment conditions and the effects of patient characteristics on outcome, but little attention has been directed to evaluating the therapists and their contributions to the therapeutic process. Therapists' contribution to Treatment outcome has long been of concern in psychotherapy research (e.g., Beutler, Crago, & Arizmendi, 1986; Gurman & Razin, 1977). However, as noted
Steven P. Roose - One of the best experts on this subject based on the ideXlab platform.
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Pharmacologic Treatment of Depression in patients with heart disease.
Psychosomatic Medicine, 2005Co-Authors: Steven P. Roose, Marissa MiyazakiAbstract:The relationship between Depression and cardiovascular disease is complex and multifaceted. There is a growing body of evidence that Depression significantly and adversely affects cardiovascular health. Perhaps the most prominent finding is the documented increase in mortality rate in patients with Depression after myocardial infarction. The critical questions of interest to both the clinician and researcher are whether there are safe and effective Treatments for Depression in patients with heart disease and whether Treatment of Depression reduces the increased risk of cardiac morbidity and mortality. Although the data are limited and are primarily from open or comparator trials, the tricyclics (TCAs) and selective serotonin reuptake inhibitors (SSRI) are effective for Treatment of Depression in patients with ischemic heart disease (IHD), and response rates are comparable with those reported in depressed patients without heart disease. In terms of safety, the TCAs are associated with documented adverse cardiovascular effects, including increases in heart rate, orthostatic hypotension, and conduction delays. Use of TCAs in patients with IHD carries a proven increased risk of cardiac morbidity and perhaps of mortality as well. The SSRI appear to be relatively safe and effective in the Treatment for Depression in patients with comorbid IHD.
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Treatment of Depression in patients with heart disease
Biological psychiatry, 2003Co-Authors: Steven P. RooseAbstract:There is a growing body of evidence that Depression significantly and adversely affects cardiovascular health. Perhaps the most prominent finding is the documented increase in mortality rate in patients with Depression after myocardial infarction. The critical questions of interest to both the clinician and researcher are whether there are safe and effective Treatments for Depression in patients with heart disease and whether Treatment of Depression reduces the increased risk of cardiac morbidity and mortality. Though the data are limited and are primarily from open or comparator trials, the tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and specific psychotherapies appear to be effective for Treatment of Depression in patients with ischemic heart disease (IHD), and response rates are comparable to those reported in depressed patients without heart disease; however, there has been only one placebo-controlled trial to date, and therefore it is premature to come to definitive conclusions regarding the efficacy of antidepressant therapies in this patient population. With respect to safety, the TCAs are associated with documented adverse cardiovascular effects, including increases in heart rate, orthostatic hypotension, and conduction delays. Use of TCAs in patients with IHD carries a proven increased risk of cardiac morbidity and perhaps of mortality as well. The SSRIs appear to be relatively safe and effective Treatment for Depression in patients with comorbid IHD.
