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Biomedical subjects

L Luborsky

Publications and source records attributed to L Luborsky.

At least 37 records · Page 2Linked to original sources
PubMed1996

Relation of stressors and depressive symptoms to clinical progression of viral illness.

OBJECTIVE: The aim of this research was to determine whether and in whom stressors and depressive symptoms facilitate clinical recurrence of herpes simplex virus (HSV) and progression of HIV. METHOD: Meta-analytic techniques were used to review the relations of stressors and depressive symptoms to clinical recurrence of HSV in 16 published studies and to indicators of HIV progression in 19 published studies. The authors calculated average effect sizes, performed fixed effect and random effect inferential analyses, tested for heterogeneous findings, and identified potential moderating variables. RESULTS: Depressive symptoms were associated with a slightly increased risk of HSV recurrence and increased reports of HIV-related symptoms, whereas stressors were not. However, depressive symptoms were not associated with objective indicators of accelerated HIV progression. Stressor studies, especially those that ascertained population-specific life events, found numerical and functional decrements in circulating natural killer cell populations. The candidate moderators identified include, for HSV recurrence, age, sex, and medication status, and for HIV-related symptoms, age, race, disease stage, and co-infection with HSV. CONCLUSIONS: Depressive symptoms, but not stressors, increase the risk of HSV recurrence generally. Depressive symptoms do not appear to accelerate HIV progression ubiquitously, although they are associated with increased reporting of HIV-related symptoms. Future studies that ascertain population-specific stressors should determine whether reductions in cytotoxic lymphocytes influence HIV disease progression. Moreover, researcher should investigate the role of the identified moderators and recognize psychoimmune moderators in existing and novel study groups. These analyses could confirm that certain individuals are especially susceptible to the effects on disease progression of stressors, depressive symptoms, or both.

Adult↗
PubMed1996

Onset conditions for psychological and psychosomatic symptoms during psychotherapy: a new theory based on a unique data set.

OBJECTIVE: The author's goal was to evaluate theories of the conditions that exist before onset of psychological and somatic symptoms by assessing these preconditions clinically and quantitatively. METHOD: He assembled a set of texts from the cases of seven patients who had recurrent psychological or somatic symptoms and examined the segments of texts that came before the symptoms occurred; he then compared these segments with segments of text that occurred before control points in the same case. The recurrent psychological symptoms were momentary forgetting, shifts in level of depression, and phobic behavior; the recurrent somatic symptoms were stomach ulcer pains, migraine headaches, absence epilepsy (petit mal) episodes, and premature ventricular contractions of the heart. RESULTS: 1)Independent ratings of presymptom segments compared with precontrol segments revealed some significant differences in all seven cases. 2) Some variables that distinguished the presymptom from the precontrol segments occurred in all of the cases. In rank order of their effect size across cases, these variables were hopelessness, lack of control, anxiety, feeling blocked, helplessness, concern about "supplies," depression, and hostility toward the therapist. For example, hopelessness was significant in seven of the seven cases. CONCLUSIONS: For the first time, segments of texts of psychotherapy sessions that occurred before recurrent symptoms have been assembled and analyzed. These brief segments before recurrent symptoms showed more of certain qualities than did segments before control points where no symptoms appeared. On the basis of these results the author constructed a new symptom-context theory of symptom formation and compared this new theory with five classical theories of symptom formation, drawing implications for research and for treatment techniques.

Depressive Disorder↗
PubMed1995

To use or to refuse cocaine--the deciding factors.

Two types of narratives were obtained from 35 cocaine-addicted patients: narratives about using cocaine and narratives about not using cocaine. The most prevalent factors in using cocaine were (a) having enough money, (b) wish to end physical/emotional pain, and (c) wish/decision to use. The factors in narratives about not using cocaine were (a) patient arranged conditions to be nonstimulating for using cocaine, (b) recognition of bad consequences, and (c) wish/decision not to use. It is clear in both the cocaine-using episodes and not-using episodes that the patient's wish/decision is important. The conditions for using cocaine tended to be more external, whereas those for not using tended to be more internal. Similar conditions were found by a questionnaire method. A major treatment implication of these findings is that the focus of therapy can be directed to planning strategies to minimize influence of the external factors and to rehearse strategies to prepare for situations involving cues that influence use of cocaine.

Adult↗
PubMed1995

A comparison of core conflictual relationship themes before psychotherapy and during early sessions.

This report shows (a) that the Core Conflictual Relationship Theme (CCRT) can be rated reliably either from therapy sessions or from a special pretreatment interview in a group of depressed patients, and (b) that the CCRTs obtained before treatment are similar to the CCRTs extracted from the early sessions of brief dynamic psychotherapy. The data suggest that, at least in the early sessions of treatment, the therapist's influence did not significantly alter the patients' CCRTs.

Adult↗
PubMed1995

Psychotherapy in community methadone programs: a validation study.

OBJECTIVE: The authors tested the efficacy of individual psychotherapy in the rehabilitation counseling of psychiatrically symptomatic opiate-dependent patients during methadone maintenance treatment in community programs. METHOD: Volunteers in three community programs were randomly assigned to 24 weeks of counseling plus supplemental drug counseling or to counseling plus supportive-expressive psychotherapy. Follow-ups were done 1 and 6 months after treatment ended. A total of 84 subjects were evaluated at both follow-up points. RESULTS: During the study the patients receiving supportive-expressive psychotherapy and those receiving drug counseling had similar proportions of opiate-positive urine samples, but the patients receiving supportive-expressive psychotherapy had fewer cocaine-positive urine samples and required lower doses of methadone. One month after the extra therapy ended both groups had made significant gains, but there were no significant differences between groups. By 6-month follow-up many of the gains made by the drug counseling patients had diminished, whereas most of the gains made by the patients who received supportive-expressive psychotherapy remained or were still evident; many significant differences emerged, all favoring supportive-expressive psychotherapy. CONCLUSIONS: Psychotherapy can be delivered to psychiatrically impaired patients in community methadone programs. Additional counseling is associated with early benefits comparable to those from psychotherapy, but these gains are not sustained. The gains associated with psychotherapy persist and in some cases strengthen for at least 6 months after the end of therapy.

Adult↗
PubMed1995

The first trial of the P technique in psychotherapy research--a still-lively legacy.

A 49-year-old study of P technique applied to a psychotherapy patient with a recurrent physical symptom is dusted off and re-presented, together with examples of other studies with similar methods conducted since then. The specific aims were to understand the main dimensions of psychotherapeutic change as well as the context for the recurrent symptom. The general aims were to illustrate the contributions from applying the P technique to psychotherapy research to psychosomatic medicine, and to personality research.

Adult↗
PubMed1994

Similarity of outcome predictors across opiate, cocaine, and alcohol treatments: role of treatment services.

This study examined the patient and treatment factors associated with 6-month outcome in 649 opiate-, alcohol-, and cocaine-dependent (male and female) adults, treated in inpatient and outpatient settings, in 22 publicly and privately funded programs. Outcomes were predicted by similar factors, regardless of the drug problem of the patient or the type of treatment setting or funding. Greater substance use at follow-up was predicted only by greater severity of alcohol and drug use at treatment admission, not by the number of services received during treatment. Better social adjustment at follow-up was negatively predicted by more severe psychiatric, employment, and family problems at admission and positively predicted by more psychiatric, family, employment, and medical services provided during treatment.

Adult↗
PubMed1994

A descriptive study of immune status in patients undergoing colorectal surgery: lymphocyte phenotypes.

PURPOSE/OBJECTIVES: To describe immune status in patients prior to colorectal surgery for cancer, to establish values to serve as a baseline for subsequent analyses, and to describe a procedure for studying phenotypes of the immune system, elucidating its advantages. DESIGN: One component of a larger longitudinal survey. SETTING: Two large, inner-city university hospitals and two of their affiliated hospitals in the northeastern United States. SAMPLE: Patients undergoing surgery for colorectal cancer (N = 94). Subjects were primarily male (n = 57) and Caucasian (n = 85) and ranged in age from 26-88 years (mean = 63). Seventy-seven percent (n = 73) had cancer, 23% (n = 21) had benign diseases or conditions. METHODS: Flow cytometry analysis of lymphocyte phenotypes was performed on blood samples drawn from patients before they underwent surgery for colorectal cancer. MAIN OUTCOME MEASURES: The average absolute lymphocyte subset levels and the average relative lymphocyte subset levels of blood samples taken from patients undergoing surgery for colorectal cancer were compared (using t-tests) with the subset levels of two normal reference samples. FINDINGS: The average absolute lymphocyte subset levels and average relative lymphocyte subset levels of patients undergoing surgery for colorectal cancer fell within normal ranges. CONCLUSIONS: These findings suggest that this sample of patients undergoing surgery has one essential element of an intact immune system--normal levels of lymphocyte subsets. IMPLICATIONS FOR NURSING PRACTICE: There is no indication preoperatively that this population is at a higher risk for infection or delayed wound healing. However, there may be other times in the illness trajectory when the immune system does become compromised, and these values prior to surgery will serve as a baseline to identify changes in patients' immune status over time. Further longitudinal studies are necessary.

Adult↗
PubMed1993

The role of the therapeutic alliance in psychotherapy.

The article traces the development of the concept of the therapeutic working alliance from its psychodynamic origins to current pantheoretical formulations. Research on the alliance is reviewed under four headings: the relation between a positive alliance and success in therapy, the path of the alliance over time, the examination of variables that predispose individuals to develop a strong alliance, and the exploration of the in-therapy factors that influence the development of a positive alliance. Important areas for further research are also noted.

Empathy↗
PubMed1993

Three concomitants: personality disorders, psychiatric severity, and outcome of dynamic psychotherapy of major depression.

In a group of 25 patients with major depression, the authors investigated the relationships among having a comorbid personality disorder, the severity of psychiatric disorder, and the outcome of dynamic psychotherapy. They found that 1) depressed patients with a comorbid diagnosis of personality disorder had more severe psychiatric disturbance at intake and at termination of therapy as well as at follow-up and 2) although all patients improved and maintained their gains at follow-up, those with a comorbid personality disorder diagnosis did not improve as much as those without a personality disorder.

Adult↗
PubMed1993

Psychological health-sickness (PHS) as a predictor of outcomes in dynamic and other psychotherapies.

This is the first dedicated review of quantitative studies on Sigmund Freud's proposition that the poorer the psychological health, the more limited are the benefits from treatment. Since observer-rated scales for psychological health-sickness were developed in 1949, many studies have applied them, and the majority show significant prediction of outcomes of psychotherapy, with correlations between .2 and .35. This article reviews (a) the main methods of measurement, (b) the record of predictive success, (c) validity studies, (d) the relation to psychiatric diagnosis, (e) prediction in forms of treatment other than psychotherapy, and (e) theories of why psychological health predicts outcomes of psychotherapy.

Humans↗
PubMed1992

The first empirical demonstration of transference in psychotherapy.

This study investigates the similarity between patients' relationships with their therapists and patients' relationships with others in their life. We examined the in-session narratives about the therapist and compared them with the patient's general relationship pattern as determined by a previously tested method, the Core Conflictual Relationship Theme (CCRT) method. The source for both narratives and CCRT patterns were transcripts of therapy sessions from 35 consenting outpatients in a university clinic. We found significant similarity between the patterns of relationship with the therapist and with others. One aspect of the relationship pattern, the patient's response to the therapist and to others, was consistently similar. We offer objective evidence in support of an age-old and central tenet of psychodynamic therapy, the transference concept.

Ambulatory Care↗
PubMed1991

What makes Susie cry? A symptom-context study of family therapy.

The aim of this investigation was to examine the context of recurrent crying episodes during family therapy sessions. We tested the relative contribution of social versus individual intrapsychic variables within a 10-session, videotaped, structural family therapy. Segments of therapy before crying episodes when compared with control (non-crying) segments were found to have higher levels of the following variables: involvement with others in the room, rejection, and concern about supplies. Two family variables were also higher before crying episodes: family discussion about patient, and patient receives hostility. A stepwise discriminant function analysis using these variables indicated that family discussion about the patient was most important in signaling onset of crying. The results are discussed in terms of individual and family theories of symptom formation as illuminated through this case study.

Adolescent↗
PubMed1991

Addressing psychiatric comorbidity.

Research studies indicate that addressing psychiatric comorbidity can improve treatment for selected groups of substance-abusing patients. However, the chances for implementing the necessary techniques on a large scale are compromised by the absence of professional input and guidance within programs. This is especially true in public programs, which treat some of the most disadvantaged, disturbed, and socially destructive individuals in the entire mental health system. One starting point for upgrading the level of knowledge and training of staff members who work in this large treatment system could be to develop a better and more authoritative information dissemination network. Such a system exists in medicine; physicians are expected to read appropriate journals and to guide their treatment decisions using the data contained in the journals. Standards of practice and methods for modifying current practice are within the tradition of reading new facts, studying old ones, and comparing treatment outcome under different conditions with what is actually being done. No such general system of information-gathering or -sharing exists, particularly in public treatment programs. One of the most flagrant examples of this "educational shortfall" can be found among those methadone programs that adamantly insist on prescribing no more than 30 to 35 mg/day for all patients, in spite of the overwhelming evidence that these dose levels generally are inadequate. In some cases, program directors are unaware of studies that have shown the relationship between dose and outcome. In other cases, they are aware of the studies but do not modify their practices accordingly. This example of inadequate dosing is offered as an example of one situation that could be improved by adherence to a system of authoritative and systematic information dissemination. Many issues in substance abuse treatment do not lend themselves to information dissemination as readily as that of methadone dosing. However, the existence of a general information/education system about substance abuse treatment, combined with adherence to it among care providers, not only would provide helpful data for treatment staff but also might stimulate their curiosity and initiative. These later qualities, along with additions to existing treatment resources, may in the long run serve as the best guarantee for improvement. and maintenance of quality care.

Humans↗
PubMed1990

Theory-based research for understanding the process of dynamic psychotherapy.

Research is reviewed on 6 theoretical propositions central to psychodynamic psychotherapy: (1) The establishment of an alliance is important to successful outcome; (2) the patient displays a central relationship theme (transference); (3) transference interpretations are helpful; (4) the therapist aims at accurate interpretations of the transference; (5) the patient gains understanding of self and the relationship pattern; and (6) the patient's improvement is reflected in changes in the relationship pattern, although the pattern is still evident. We suggest concepts that are in need of research development: internalization, resistance, working through, self-understanding and insight, and the therapist's adherence to recommended techniques.

Follow-Up Studies↗
PubMed1990

Theory and technique in dynamic psychotherapy--curative factors and training therapists to maximize them.

Three principles of curative factors in dynamic psychotherapy are reviewed: (1) Achieving a helping relationship; (2) achieving self-understanding, and (3) maintaining the gains. A new development in psychotherapy research is illustrated: the creation of operational measures that relate to the curative factors: the therapeutic alliance, the transference, accuracy of interpreting the transference, insight, change in transference and psychiatric severity. Such operational measures can be reliably estimated from psychotherapy sessions because they specify what each measure represents. A special format for training therapists to foster these curative factors is presented called 'group training in supervision of psychotherapy'.

Adaptation, Psychological↗