WHAT DO WOMEN NEED? INTEGRATING PSYCHODYNAMIC PSYCHOTHERAPY WITH COGNITIVE TECHNIQUES IN WORKING WITH PREGNANT WOMEN AND NEW MOTHERS

The transformation of women into mothers is both a psychic and a physical development. Although the focus of psychodynamic psychotherapy is on the internal, psychic world, a therapist working with pregnant women and new mothers may also need to deal with serious problems in the external, physical world. For instance, what approach is most helpful for a young woman who smacks her baby of 10 months, while also struggling with rage at her own mother's abandonment of her? This paper describes how psychodynamic and cognitive ideas and techniques have been combined to resolve this clinical dilemma. Lessons have been drawn from the integrated approach developed by psychodynamic practitioners working with a different patient group, that of borderline personality disorder, since such patients often present in crisis, as do pregnant women and new mothers. I worked with 76 patients in Maternity and Gynaecology in a London hospital over an 18‐month period and three cases are described in detail in this paper.     

抑郁青少年认知行为治疗前后脑电超慢涨落图

目的探索认知心理治疗缓解青少年抑郁症状的生物学原理。方法对73例患轻中度抑郁症的青少年进行8周的认知行为心理治疗。根据治疗末的疗效,将62例完成治疗的患者分为有效组和抵抗组;比较两组之间治疗后2、4、8周末,以及两组治疗前后的自身脑电超慢涨落图改变。结果对于有效组的青少年,EFG检测的r-氨基丁酸相对功率在治疗第2、4、8周末均高于治疗前(t=-2.58,P<0.05;t=-3.92,-4.14;P<0.01);五羟色胺相对功率在治疗第4、8周末均高于治疗前(t=-3.17,-2.07;P<0.05);在治疗第4周末高于抵抗组(t=-2.13,P<0.05);去甲肾上腺素相对功率在治疗第4周末高于治疗前(t=-2.08,P<0.05);谷氨酸相对功率在治疗第2、4、8周末均高于治疗前(t=-2.12,P<0.05;t=-3.00,P<0.01;t=-2.81,P<0.05);乙酰胆碱相对功率在治疗第2周末均高于治疗前(t=2.34,P<0.05);多巴胺相对功率在治疗第2、4、8周末均高于治疗前(t=-2.26,P<0.05;t=-5.83,-7.36;P<0.01);第4、8周末均高于抵抗组(t=2.47,3.36;P<0.01)。而抵抗组的EFG检测的多巴胺相对功率在治疗第4、8周末均高于治疗前(t=-2.89,-3.08;P<0.01)。结论认知行为心理治疗能改变脑内神经递质的活动。     

Brief intensive CBT for pediatric OCD with E-therapy maintenance

Cognitive behaviour therapy (CBT), incorporating exposure and response prevention (ERP), has received strong empirical support for the treatment of paediatric OCD, and moreover, is considered the first line treatment of choice (Geller & March, 2012). However, despite the availability of effective treatments for this chronic and debilitating disorder, only a small proportion of youth receive these evidence-based approaches. The present study aimed to examine the effectiveness of an intensive ERP-based treatment for youth OCD, using a multiple baseline controlled design. Children and youth (N = 10; aged 11–16 years) with a primary diagnosis of OCD were randomly assigned to a 1- or 2-week baseline monitoring condition followed by the intervention. The efficacy of the intensive treatment, involving 1 session psychoeducation, 2-sessions ERP plus e-therapy maintenance was examined across parent- child- and clinician-rated measures at post-treatment and 6-month follow-up. Overall, there were significant reductions across time on almost all measures (except self-report anxiety), and moreover, the majority of the sample (80%) were considered reliably improved, and meeting clinically significant change. At post-treatment, 60% were in remission of symptoms, and at 6-month follow-up this increased to 70%. These findings provide strong support for intensive, time-limited approaches to ERP-based CBT for children and youth with OCD.     

Understanding late life anxiety and cognitive processes – We are rapidly gaining momentum: Introduction to the special issue

The older adult population is growing at an accelerated pace, thus mental health professionals must become familiar with problems of aging. This special issue of Journal of Anxiety Disorders is the first to address the independent, interactive, and mutual effects of anxiety and cognitive processes in older adults. Although there are relatively longstanding traditions of study on cognitive aging and the effects of anxiety and cognition in younger adults, our understanding of anxiety and cognitive processes in the elderly lags far behind. The articles in this issue represent one of the first collective efforts to close this gap, addressing topics such as cognitive functioning in clinical and analog groups of anxious older adults, the relation of cognitive functions to indices of treatment outcome, and longitudinal models of increased anxiety in later life.