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

BIOLOGICAL CORRELATES OF PSYCHOTHERAPY FIGURE I Average (no treatment) control effect size Average psychotherapy effect size (.82) Average Minimal Treatment (placebo) effect size (.42) Adapted from Lambert, et al. 1993

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

TABLE II META-ANALYTIC REVIEWS OF OUTCOME WITH ANXIETY DISORDERS * Percent improved, ** Pretest/Posttest measureModified from Lambert (1994)

TABLE III META-ANALYTIC REVIEWS OF OUTCOME WITH ANXIETY DISORDERS * Percent improved, ** Pretest/Posttest measureModified from Lambert (1994)

SUMMARY OF EFFECT OF STDP EFFECT SIZES DomainSTDP Term/F-U USUAL TX Term/F-U WAIT-LIST Term/F-U Target Problems 1.39 – – – NA Symptoms0.90 – – – NA  Leichsenring F ( 2004)

Criteria for Admission to the Study Inclusion 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.

Patient Demographics By Group

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

Therapist Characteristics

Reliability of Six Combination Variables Process Coding of Videotaped Psychotherapy Sessions Variable Three 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

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

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

Subscales with STDP showing significant differences over BAP and controls

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

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

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

BEST/WORST OUTCOMES BEST OUTCOMEWORST OUTCOME STDP2-Obsessional1- Histrionic 1 - Mixed BAP1- Histrionic2- Obsessional 1- Mixed

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

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

COGNITIVE MASTERY Psychoan. therapyInterpretation Supportive Clarification, support Cognitive Modification of beliefs BIOLOGICAL CORRELATES OF PSYCHOTHERAPY

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

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

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

THE MIRROR NEURON SYSTEM Rizzollati 1995 Subset of multimodal neurons (Simultaneous activation by d ifferent sensory modalities ) F5 in monkeys Broca 44, 45 in humans (Prefrontal Cortex)

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

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