Social Work News Headlines

Updated on: Wed, 21 Mar 2018 04:00:27 GMT

The importance of problem-focused treatments: A meta-analysis of anxiety treatments.
One explanation for differences in treatment effectiveness for targeted symptoms is that more-effective treatments are more focused on patients’ problems than are less-effective treatments. This conjecture was examined meta-analytically. Comparisons of two treatments of adults with anxiety disorders were included. Effect sizes for targeted symptoms, nontargeted symptoms, and global outcomes (e.g., quality of life and well-being) as well as the relative focus on patients’ problems and researcher allegiance were coded. Metaregressions were conducted to predict effect sizes from (a) variables related to the focus on patients’ problems and (b) researcher allegiance. For symptom measures, the relative focus on patients’ problems predicted the relative effectiveness of the treatments, with the expectations created by explanation appearing more predictive than specific therapeutic actions focused on patients’ problems, although conclusions about relative importance were difficult to determine given collinearity of predictors. Researcher allegiance also predicted the effects of the comparisons. For global outcomes, both the focus on patients’ problems and researcher allegiance seemed to have smaller roles. A focus on patients’ problems appears to be important for the reductions of symptoms. Clinical trials comparing treatments need to balance the focus on patients’ problems and reduce researcher allegiance. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Partner-related attachment as a moderator of outcome in patients with social anxiety disorder—a comparison between short-term cognitive–behavioral and psychodynamic therapy.
This study investigated whether partner-related attachment characteristics differentially predict premature treatment termination as well as posttreatment and 1-year follow-up outcome in patients with social anxiety disorder treated with a manualized cognitive–behavioral therapy (CBT) or short-term psychodynamic therapy (PDT) in the SOPHO-NET (Social Phobia Psychotherapy Network) trial. Participants were 412 patients with social anxiety disorder (57% female) with a mean age of 35.4 years (SD = 12.1) who were randomized to either CBT or PDT. Partner-related attachment characteristics were measured using the revised Experiences in Close Relationships Questionnaire (ECR-R) at pretreatment. The Liebowitz Social Anxiety Scale was administered at pretreatment, posttreatment, and a 1-year follow-up. To address our research questions, linear regression models were applied. Furthermore, we compared CBT versus PDT patients within ECR-R quartiles. Treatment dropout did not differ between CBT and PDT and was not predicted by pretreatment attachment. In both treatment conditions, there was a trend for higher attachment anxiety to be associated with a more limited reduction in symptoms if controlling for pretreatment Liebowitz Social Anxiety Scale scores. Exploratory analyses showed that patients assigned to the highest quartile of the ECR-R-Avoidance distribution showed more benefit within the CBT condition posttreatment and at follow-up than the PDT condition. Our findings suggest that it may be useful to assess attachment characteristics in patients with social anxiety disorder before psychotherapeutic treatment. Patients characterized by very high pretreatment attachment avoidance (ECR-R-Avoidance >3.87) may specifically benefit more from CBT than from PDT. However, replication studies are needed that also should investigate nonlinear effects of pretreatment attachment. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Internet-based affect-focused psychodynamic therapy for social anxiety disorder: A randomized controlled trial with 2-year follow-up.
Social anxiety disorder (SAD) is associated with considerable individual suffering and societal costs. Although there is ample evidence for the efficacy of cognitive behavior therapy, recent studies suggest psychodynamic therapy may also be effective in treating SAD. Furthermore, Internet-based psychodynamic therapy (IPDT) has shown promising results for addressing mixed depression and anxiety disorders. However, no study has yet investigated the effects of IPDT specifically for SAD. This paper describes a randomized controlled trial testing the efficacy of a 10-week, affect-focused IPDT protocol for SAD, compared with a wait-list control group. Long-term effects were also estimated by collecting follow-up data, 6, 12, and 24 months after the end of therapy. A total of 72 individuals meeting diagnostic criteria for DSM–IV social anxiety disorder were included. The primary outcome was the self-report version of Liebowitz Social Anxiety Scale. Mixed model analyses using the full intention-to-treat sample revealed a significant interaction effect of group and time, suggesting a larger effect in the treatment group than in the wait-list control. A between-group effect size Cohen’s d = 1.05 (95% [CI]: [0.62, 1.53]) was observed at termination. Treatment gains were maintained at the 2-year follow-up, as symptom levels in the treated group continued to decrease significantly. The findings suggest that Internet-based affect-focused psychodynamic therapy is a promising treatment for social anxiety disorder. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Emotion-focused therapy for generalized anxiety disorder: An exploratory study.
Among psychological therapies for generalized anxiety disorder (GAD), cognitive–behavioral therapy has a dominant position as the most studied therapy. However, some researchers have recommended that to increase treatment options and broaden choice for clients, non-cognitive–behavioral therapy models for GAD should be examined. The present study was an exploratory study, assessing pre–post outcomes and 6-month follow-up of emotion-focused therapy for GAD, supplemented by qualitative posttherapy client accounts of helpful and unhelpful aspects of therapy and changes reported since therapy started. Fourteen clients were assessed on several measures focusing on GAD symptoms, depressive symptoms, and general psychological functioning. Quantitative pre–post and 6-month follow-up data indicated large effect sizes. Qualitative data captured changes in emotional functioning, anxiety, self-acceptance, self-confidence, and self-understanding. Clients reported as helpful both relational aspects of the work and in-depth experiential tasks, although some found the experiential aspect of the work difficult. The findings suggest that there may be value in assessing emotion-focused therapy as a treatment for GAD in a randomized controlled trial. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

An introduction to the special section on psychotherapy for pregnancy loss: Review of issues, clinical applications, and future research direction.
This introduction article to the special section on psychotherapy for pregnancy loss reviews important societal and psychological issues, key clinical processes and recommendations, and future research directions. Differences and similarities among the articles in the special section are discussed along with each article’s contribution to the higher order goal of viewing pregnancy loss through a psychological rather than solely medical lens. Each article in this section reviews different therapeutic modalities, interventions, and key clinical process issues when working with patients who have suffered the loss of a pregnancy. The important role that psychotherapy can play in helping parents to mourn the loss of a pregnancy is explored in this introductory article and throughout the special section. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Parenthood after reproductive loss: How psychotherapy can help with postpartum adjustment and parent–infant attachment.
Parenting after pregnancy loss is often complicated for people who have not effectively grieved the loss and worked through the trauma. Reproductive losses can trigger shame and self-doubt, damage the sense of self-as-parent, and inflict narcissistic injuries, which, in turn, may impede the resolution of grief. If not addressed, these unresolved feelings may be projected onto subsequent children, potentially disrupting attachment relationships and the child’s sense of self. The reproductive story, a lifelong internal narrative that comprises the thoughts, feelings, and hopes about how parenting and adulthood will unfold, and forms the core of parental identity, can be used as a tool in helping parents understand the depth of their feelings, integrate current and past losses into the self, and resolve grief. The authors discuss 3 crucial aspects of intervention with parents who have had pregnancy losses, aimed both at healing the parents themselves and at protecting attachment relationships with subsequent children: (a) initially staying present-focused and engaging with the painful details of the loss experience, to normalize and validate the patient’s grief and trauma, counteract shame, and begin repairing narcissistic injuries; (b) eliciting the reproductive story to identify and integrate past losses, and in its revision, to allow for hope and repair; and (c) attending to both acknowledged and denied grief. The challenges and satisfactions of working with this population and potential countertransference reactions are also discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Reproductive trauma: Psychotherapy for pregnancy loss and infertility clients from a reproductive story perspective.
The reproductive story offers a unique way to conceptualize pregnancy loss and infertility. This article describes the development of the reproductive story from early childhood on, and focuses on the devastating losses when the story does not unfold as originally hoped. Regardless of the type of reproductive trauma that clients experience, the underlying psychological constructs of grief are the same. The goal is to help clients work through their grief and loss, accept that their story can be edited and rewritten, and come away with a positive new ending. This paper illustrates how to utilize the reproductive story with infertility and pregnancy loss clients in psychotherapy. Using clinical illustrations, interventions for the treatment of perinatal grief, particularly in the context of infertility, are discussed. Specific suggestions are offered to help clients rethink past ideals, cope with their current trauma, and make constructive decisions in their effort to build their future family. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Therapeutic educational support for families pregnant after loss (PAL): A continued bond/attachment perspective.
Pregnancy following the loss of a baby is a complex journey that often requires supportive intervention to support attachment to a baby that follows. This article offers guidance in supporting parents during their pregnancy that follows a perinatal loss. Content is based on using the continued bond/attachment theories in a therapeutic educational group setting and in individual therapy sessions in clinical practice. Practical guidelines in working with parents to support their parenting relationship with a deceased baby while risking attachment to a new unborn baby are offered. This educational intervention can be useful in both a psychotherapeutic group setting and with individual clients. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Empathic psychotherapy for pregnancy termination for fetal anomaly.
Pregnancy termination for fetal anomaly is a unique reproductive loss with many issues distinct from spontaneous pregnancy loss, as typically addressed in the current literature. After providing a brief overview of this loss and the impact of stigma, some of the therapeutic tasks particular to this loss will be identified, including absorbing the impact of learning about the anomaly, defining what or who has been lost, deciding whether to continue or terminate the pregnancy, and deciding who to tell what. These therapeutic tasks are discussed using the available research literature, but primarily illustrated through clinical vignettes and therapist–client dialogue. Therapeutic empathy will be demonstrated as both an instrument of healing in itself, as well as a means of realizing other therapeutic goals and interventions such as empowerment, normalization, validation and processing grief and trauma, all crucial elements of doing therapy with this population. Contrasting perspectives of this loss in therapy and the role of the therapist are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Cognitive behavioral therapy for pregnancy loss.
Cognitive–behavioral therapy (CBT) is a system of psychotherapy in which an individualized case formulation drives the strategic delivery of therapeutic interventions that target cognition, emotion, behavior, and the therapeutic relationship. It has the potential to be effective for women who have experienced pregnancy loss, as pregnancy loss often carries profound meaning that disrupts many layers of a woman’s belief system, and the associated emotional consequences cannot always be managed using their typical repertoire of coping skills. The distinctive features of CBT are described, as well as 3 typical intervention strategies (i.e., behavioral activation, cognitive restructuring, and mindfulness and acceptance) that are often delivered during the course of CBT with patients who have experienced pregnancy loss. Throughout the article, emphasis is placed on balancing attention to the therapeutic relationship and affective experiencing with the implementation of cognitive and behavioral change strategies. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

A theoretical framework for treating perinatal depression using couple-based interventions.
Between 10% and 20% of women will experience depression in the perinatal period, which begins during pregnancy and extends into the first year after delivery. Perinatal depression (PD) is associated with significant emotional and social impairments that impact women, their children, and their partners. Although the majority of women with PD do not seek treatment, a considerable proportion of those who engage in treatment do not achieve remission. The couples and depression literature suggests that interpersonal processes are central in the development and maintenance of depressive disorders and thus, as researchers seek safe and effective treatments for perinatal populations, there may be therapeutic benefit in examining the role that partners play in women’s recovery. The primary goal of this practice review is to highlight the utility of including partners in treatment for maternal PD and propose a model for practitioners to guide their work with couples within this domain. Specifically, this model involves three key components of treatment: psychoeducation, communication training, and behavioral activation. Each component addresses distinct risk factors for women and couples in the perinatal period in hopes of offering guidance to practitioners for how to address PD symptomology through a dyadic lens. (PsycINFO Database Record (c) 2017 APA, all rights reserved)