Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/2237-6089-2017-0144
Trends in Psychiatry and Psychotherapy
Original Article

The role of long-term psychodynamic psychotherapy in improving attachment patterns, defense styles, and alexithymia in patients with depressive/anxiety disorders

O papel da psicoterapia psicodinâmica de longo prazo na melhora de padrões de apego, estilos de defesa e alexitimia em pacientes com transtornos depressivos e de ansiedade

Mojgan Khademi; Mahmoud Hajiahmadi; Mahbobeh Faramarzi

http://dx.doi.org/10.1590/2237-6089-2017-0144 Trends Psychiatry Psychother, vol.41, n1, p.43-50, 2019
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Abstract

Abstract Introduction Long-term psychodynamic psychotherapy (LTPP) emphasizes the centrality of intrapsychic and unconscious conflicts and their relation to development. Although there is evidence supporting the efficacy of LTPP in mental disorders, little research has been published on the efficacy of LTPP for depressive and anxiety disorders. Objective To examine whether patients with anxiety and depressive disorders demonstrate improvement in their attachment styles, defense styles, psychiatric symptoms, anxiety/depressive symptoms, and alexithymia with LTPP. Methods In this retrospective, descriptive study, the psychological outcomes of patients who were treated at the psychoanalytic clinic of Babol University of Medical Sciences were assessed. Fourteen patients diagnosed with depressive or anxiety disorder participated in the study of LTPP using the self-psychology approach. The Beck Depression Inventory II, Beck Anxiety Inventory, Adult Attachment Scale, 40-item Defense Style Questionnaire, and the 20-item Toronto Alexithymia Scale were administered at pre-treatment, post-treatment, and 6-month follow-up. Generalized estimating equations were used to analyze changes in psychological outcomes after each of the three assessments. Results The mean scores of depression and anxiety and secure attachment improved significantly after LTPP with self-psychology approach from baseline to post-treatment and follow-up. Also, the mean scores of neurotic and immature defenses, difficulty in identifying feelings, difficulty in describing feelings, externally oriented thinking, and total alexithymia scores decreased significantly from baseline to post-treatment and follow-up. Conclusion Symptoms of anxiety disorders, depressive disorders, insecure attachment styles, alexithymia, and neurotic/immature defense styles improved after the LTPP with self-psychology approach. Moreover, the improvements persisted at the 6-month follow-up.

Keywords

Long-term psychodynamic psychotherapy, self-psychology, depression, anxiety, attachment, defense styles, alexithymia

Resumo

Resumo Introdução A psicoterapia psicodinâmica de longo prazo (PPLP) enfatiza a centralidade dos conflitos intrapsíquicos e inconscientes e sua relação com o desenvolvimento. Apesar da evidência em favor da eficácia da PPLP em transtornos mentais, há poucos dados sobre a eficácia da PPLP em transtornos de depressão/ansiedade. Objetivo Examinar se pacientes com transtornos de depressão/ansiedade demonstram melhora em seus estilos de apego, estilos defensivos, sintomas psiquiátricos, sintomas de ansiedade/depressão e alexitimia com PPLP. Métodos Neste estudo retrospectivo, descritivo, os desfechos psicológicos de pacientes tratados na clínica psicanalítica da Babol University of Medical Sciences foram avaliados. Quatorze pacientes com diagnóstico de transtorno de depressão ou ansiedade participaram do estudo sobre PPLP com abordagem de psicologia do self. O Inventário de Depressão de Beck II, o Inventário de Ansiedade de Beck, a Escala de Apego do Adulto, o Questionário de Estilo de Defesa-40 e a Escala de Alexitimia de Toronto-20 foram administrados antes e após o tratamento e no seguimento de 6 meses. Equações de estimação generalizadas foram usadas para analisar mudanças nos desfechos psicológicos após cada avaliação. Resultados Os escores médios de depressão/ansiedade e apego seguro melhoraram significativamente após PPLP com abordagem de psicologia do self do início do estudo ao pós-tratamento e seguimento. Além disso, os escores médios de defesas neuróticas e imaturas, dificuldade em identificar sentimentos, dificuldade em descrever sentimentos, pensamentos orientados externamente e escores totais de alexitimia diminuíram significativamente do início do estudo ao pós-tratamento e seguimento. Conclusão Sintomas de transtornos de ansiedade, transtornos depressivos, estilos de apego inseguro, alexitimia e estilos de defesa neuróticos/imaturos melhoraram após PPLP com abordagem de psicologia do self. Além disso, as melhoras persistiram no seguimento de 6 meses.

Palavras-chave

Psicoterapia psicodinâmica de longo prazo, psicologia do self, depressão, ansiedade, apego, estilos de defesa, alexitimia

References

Vittengl JR, Jarrett RB, Weitz E, Hollon SD, Twisk J, Cristea I. Divergent outcomes in cognitive-behavioral therapy and pharmacotherapy for adult depression. Am J Psychiatry. 2016;173:481-90.

Cuijprs P, Weitz E, Twisk J, Kuehner C, Cristea I, David D. Gender as predictor and moderator of outcome in cognitive behavior therapy and pharmacotherapy for adult depression: An individual patient data meta-analysis. Depress Anxiety. 2014;31:941-51.

Gunderson JG, Gabbard GO. Making the case for psychoanalytic therapies in the current psychiatric environment. J Am Psychoanal Assoc. 1999;47:679-704.

Faramarzi M, Azadfallah P, Book HE, Rasolzadeh Tabatabai K, Tahari H, Kashifard M. The effect of psychotherapy in improving physical and psychiatric symptoms in patients with functional dyspepsia. Iran J Psychiatry. 2015;10:43-9.

Leichsenring F, Rabung S. Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. JAMA Psychiatry. 2008;300:1551-65.

Maat S, Jonghe F, Schoevers R, Dekker J. The effectiveness of long-term psychoanalytic therapy: a systematic review of empirical studies. Harv Rev Psychiatry. 2009;17:1-23.

Smith JJ. Clients’ experience of effective psychoanalytic-psychodynamic psychotherapy for major depression. 2009.

Bowlby J. Attachment and loss. 1969.

Rholes WS, Simpson JA, Kohn JL, Wilson CL, Martin III AM, Tran S. Attachment orientations and depression: A longitudinal study of new parents. J Pers Soc Psychol. 2011;100:567-86.

Hazan C, Shaver PR. Romantic love conceptualized as an attachment process. J Pers Soc Psychol. 1987;52:511-24.

Bifulco A, Moran PM, Ball C, Bernazzani O. Adult attachment style I: Its relationship to clinical depression. Soc Psychiatry Psychiatr Epidemiol. 2002;37:50-9.

Conradi HJ, Jonge P. Recurrent depression and the role of adult attachment: A prospective and a retrospective study. J Affect Disord. 2009;116:93-9.

Abdul Kadir NB, Bifulco A. Insecure attachment style as a vulnerability factor for depression: Recent findings in a community-based study of Malay single and married mothers. Psychiatry Res. 2013;210:919-24.

Bartholomew K, Horowitz LM. Attachment styles among young adults: A test of a four-category model. J Pers Soc Psychol. 1991;61:226-44.

Mikulincer M, Orbach I. Attachment styles and repressive defensiveness: The accessibility and architecture of affective memories. J Pers Soc Psychol. 1995;68:917-25.

Shaver P, M ikulincer M. Attachment-related psychodynamics. Attach Hum Dev. 2002;4:133-61.

Mikulincer M, Nachshon O. Attachment styles and patterns of self-disclosure. J Pers Soc Psychol. 1991;61:321-31.

Besharat MA. Development and validation of Adult Attachment Inventory. Procedia Soc Behav Sci. 2011;30:475-9.

McMahon C, Barnett B, Kowalenko N, Tennant C. Psychological factors associated with persistent postnatal depression: past and current relationships, defense styles and the mediating role of insecure attachment style. J Affect Disord. 2005;84:15-24.

Vaillant GE. Natural history of male psychological health: the relation of choice of ego mechanisms of defense to adult adjustment. Arch Gen Psychiatry. 1976;33:535-45.

Kobak RR, Sceery A. Attachment in late adolescence: working models, after regulation and representations of self and others. Child Dev Res. 1988;59:135-46.

Vaillant GE. Adaptive mental mechanisms: Their role in a positive psychology. Am Psychol. 2000;55:89-98.

Besharat MA, Shahidi S. What is the relationship between alexithymia and ego defense styles? A correlational study with Iranian students. Asian J Psychiatr. 2011;4:145-9.

Liem JH, Boudewyn AC. Contextualizing the effects of childhood sexual abuse on adult self- and social functioning: an attachment theory perspective. Child Abuse Negl. 1999;23:1141-57.

Faramarzi M, Shokri-Shirvani J, Kheirkhah F. The role of psychiatric symptoms, alexithymia, and maladaptive defense in patients with functional dyspepsia. Indian J Med Sci. 2012;66:40-8.

Faramarzi M, Kheirkhah F, Shokri-Shirvani J, Sh Mosavi, Zarini S. Psychological factors in patients with peptic ulcer and functional dyspepsia. Caspian J Intern Med. 2014;5:71-6.

Besharat MA, Khajavi Z. The relationship between attachment styles and alexithymia: Mediating role of defense mechanisms. Asian J Psychiatr. 2013;6:571-6.

Bond M, Christopher PJ. Long-term changes in defense styles with psychodynamic psychotherapy for depressive, anxiety, and personality disorders. Am J Psychiatry. 2004;61:1665-71.

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). 1994.

Kohut H. The restoration of the self. 1977.

Goldberg A. The prisonhouse of psychoanalysis. 1990.

Beck AT, Steer RA, Ball R, Ranieri WF. Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. J Pers Assess. 1996;67:588-97.

Steer RA, Ball R, Ranieri WF. Further evidence for the construct validity of the Beck Depression Inventory-II with psychiatric outpatients. Psychol Rep. 1997;80:443-6.

Ghasemzadeh H, Mojtabai R, Khamghadiri N, Ebrahimkhani N. Psychometric properties of a Persian-language version of the Beck Depression Inventory Second edition: BDI-II-Persian. J Depress Anxiety. 2005;21:185-92.

Beck AT, Steer RA. Beck Anxiety Inventory manual. 1993.

Kabacoff RI, Segal DL, Hersen M, Van Hasselt VB. Psychometric properties and diagnostic utility of the Beck Anxiety Inventory and the State-Trait Anxiety Inventory with older adult psychiatric outpatients. J Affect Disord. 1997;11:33-47.

Hossein Kaviani H, Mousavi A S. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran Univ Med J. 2008;66:136-40.

Besharat MA, Irwani M, Sharifi M. An investigation of the relationship between attachment styles and defense mechanism. J Psychol. 2001;9:277-89.

Schauenburg H, Willenborg V, Sammet I, Ehrenthal JC. Self-reported defense mechanisms as an outcome measure in psychotherapy: a study on the German version of the Defence Style Questionnaire DSQ 40. J Psychol Psychother. 2007;80:355-66.

Besharat MA. Reliability and factorial validity of a Persian version of the Toronto Alexithymia Scale with a sample of Iranian students. Psychol Rep. 2007;101:209-20.

Shedler J. The efficacy of psychodynamic psychotherapy. J Am Psychoanal Assoc. 2010;65:98-109.

Knekt P, Lindfors O, Laaksonen MA, Renlund C, Haaramo P, Harkanen T. Quasi-experimental study on the effectiveness of psychoanalysis, long-term and short-term psychotherapy on psychiatric symptoms, work ability and functional capacity during a 5-year follow-up. J Affect Disord. 2011;132:37-47.

Jakobsen JC, Hansen JL, Simomsen E, Gluud C. The effect of adding psychodynamic therapy to antidepressants in patients with major depressive disorder. A systematic review of randomized clinical trials with meta-analyses and trial sequential analyses. J Affect Disord. 2012;137:4-14.

Stefini A, Horn H, Winkelmann K, Geiser-Elze A, Hartmann M, Kronmüller KT. Attachment styles and outcome of psychoanalytic psychotherapy for children and adolescents. Psychopathol Rev. 2013;46:192-200.

Kinley JL, Reyno SM. Attachment style changes following intensive short-term group psychotherapy. Int J Group Psychother. 2013;63:53-75.

Bond M, Perry JC. Long-term changes in defense styles with psychodynamic psychotherapy for depressive, anxiety, and personality disorders. Am J Psychiatry. 2004;61:1665-71.

Faramarzi M, Azadfallah P, Book HE, Rasolzadeh Tabatabai K, Tahari H. A randomized controlled trial of brief psychoanalytic psychotherapy in patients with functional dyspepsia. Asian J Psychiatr. 2013;6:228-34.

Stingl M, Bausch S, Walter B, Kagerer S, Leichsenring F, Leweke F. Effects of inpatient psychotherapy on the stability of alexithymia characteristics. J Psychosom Res. 2008;65:173-80.

Freud A. The ego and the mechanisms of defense. 1936.

Freud S. Inhibitions, symptoms, and anxiety. The standard edition of the complete psychological works of Sigmund Freud. 1959;20:77-172.

Weitz ES, Hollon SD, Twisk J, van Straten A, Huibers MJ, David D. Baseline depression severity as moderator of depression outcomes between cognitive behavioral therapy vs pharmacotherapy. JAMA Psychiatry. 2015;72:1102-9.

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