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Reflective Functioning as Predictor of Working Alliance and Outcome in the Treatment of Depression
Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Sundsvall Hospital, Sweden.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Uppsala University, Sweden.
Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
2016 (English)In: Journal of Consulting and Clinical Psychology, ISSN 0022-006X, E-ISSN 1939-2117, Vol. 84, no 1, 67-78 p.Article in journal (Refereed) PublishedText
Abstract [en]

Aims: Although considerable attention has been paid to the concept of mentalization in psychotherapy, there is little research on mentalization as predictor of psychotherapy process and outcome. Using data from a randomized controlled trial of cognitive-behavioral therapy and interpersonal psychotherapy for depression, we studied mentalization in 85 outpatients with major depressive disorder (MDD) according to the Diagnostic and Statistical Manual of Mental Disorders. It was hypothesized that patients showing lower capacity for mentalization would experience poorer quality of alliance and worse outcome. Method: Depressive symptoms were measured each session using the Beck Depression Inventory-II. Mentalization was measured as reflective functioning (RF) on a slightly shortened version of the Adult Attachment Interview. A measure of depression-specific reflective functioning (DSRF), measuring mentalization about depressive symptoms, was also used. The Working Alliance Inventory-Short Form Revised was completed after each session by both therapist and patient. Longitudinal multilevel modeling was used to analyze data. Results: The patients had on average very low RF (M = 2.62, SD = 1.22). Lower pretreatment RF/DSRF predicted significantly lower therapist-rated working alliance during treatment. RF did not affect patient-rated alliance, but lower DSRF predicted lower patient-rated alliance across treatment. Patients with higher RF/DSRF had better outcomes on self-rated depression. Conclusions: The findings showed lower than normal capacity for mentalization in patients with MDD. Lower RF/DSRF predicted worse treatment outcome. More research is needed to understand how RF affects psychotherapy response and how RF is affected after recovery from depression.

Place, publisher, year, edition, pages
AMER PSYCHOLOGICAL ASSOC , 2016. Vol. 84, no 1, 67-78 p.
Keyword [en]
psychotherapy process; mentalization; reflective functioning; working alliance; major depression
National Category
Basic Medicine
Identifiers
URN: urn:nbn:se:liu:diva-124490DOI: 10.1037/ccp0000055ISI: 000367426900006PubMedID: 26594944OAI: oai:DiVA.org:liu-124490DiVA: diva2:899677
Note

Funding Agencies|Rehsam Fund [2010/013]; Swedish Research Council for Health, Working Life and Welfare [2013-0203]; L. J. Boethius Research Fund; Emil Andersson Research Fund

Available from: 2016-02-02 Created: 2016-02-01 Last updated: 2016-03-11
In thesis
1. A Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder: Predictors of process and outcome
Open this publication in new window or tab >>A Randomized Trial of Interpersonal Psychotherapy and Cognitive Behavioral Therapy for Major Depressive Disorder: Predictors of process and outcome
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Interpersonal Psychotherapy (IPT) and Cognitive Behavioral Therapy (CBT) are both evidence-based treatments for Major Depressive Disorder (MDD). Several head-to-head comparisons between these methods have been made, most of them in the US. There is a need for more trials in different treatment settings. This thesis is based on a randomized controlled trial of CBT and IPT for MDD in a community-based psychiatric outpatient clinic. In the trial, treatment outcome and mentalization change was compared between the methods. In addition, the significance of pre-treatment mentalization for subsequent alliance and outcome was analyzed. Ninety-six patients, about half of them with personality disorders, were randomized to 14 sessions of CBT or IPT. The hypothesis was that IPT would not be inferior to CBT which was confirmed. CBT had a significantly higher drop-out rate. Initial capacity for mentalization predicted alliance and outcome in both IPT and CBT. The level of mentalization was changed in IPT but not in CBT

Abstract [sv]

Interpersonell Psykoterapi (IPT) och Kognitiv Beteendeterapi (KBT) är båda evidensbaserade psykoterapier för egentlig depression. Flera direkta jämförelser mellan dessa terapimetoder har gjorts, de flesta i USA. Det finns dock ett behov av fler studier i olika socio-kulturella kontexter och behandlingsmiljöer. Denna avhandling är baserad på en randomiserad kontrollerad studie av KBT och IPT för egentlig depression på en psykiatrisk öppenvårdsmottagning. Behandlingsutfall och förändring i mentaliseringsförmåga jämfördes mellan metoderna. Dessutom studerades betydelsen av mentaliseringsförmågan före behandlingen som prediktor för allians och utfall. Nittiosex patienter, varav ca hälften med personlighetsstörning, randomiserades till 14 sessioner med IPT eller KBT. Hypotesen var att IPT inte skulle ha sämre utfall än KBT, vilket bekräftades. KBT hade signifikant högre grad av terapiavbrott. Initial mentaliseringsförmåga predicerade allians och utfall, både i IPT och KBT. Mentaliseringsförmågan ökade i IPT men inte i KBT.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 92 p.
Series
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 675Linköping Studies in Behavioural Science, ISSN 1654-2029 ; 196
Keyword
Clinical trail, Interpersonal psychotherapy, Cognitive behavioral therapy, major depressive disorder, drop-outs, mentalization, reflective functioning, working alliance, Randomiserad studie, egentlig depression, Interpersonell psykoterapi, kognitiv beteendeterapi, drop-out, utfall, mentaliseringsförmåga, arbetsallians
National Category
Psychiatry Applied Psychology
Identifiers
urn:nbn:se:liu:diva-125993 (URN)978-91-7685-803-5 (Print) (ISBN)
Public defence
2016-04-15, I:101, Hus I, Campus Valla, Linköping, 13:00 (Swedish)
Supervisors
Available from: 2016-03-11 Created: 2016-03-11 Last updated: 2016-03-11Bibliographically approved

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Ekeblad, AnnikaFalkenström, FredrikHolmqvist, Rolf
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