From infant attachment disorganization to adult dissociation: relational adaptations or traumatic experiences?
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Adaptation, Psychological↗
Biomedical subjects
Lissa Dutra
Publications and source records attributed to Lissa Dutra.
A multidimensional meta-analysis of psychotherapy for PTSD.
OBJECTIVE: The authors present a multidimensional meta-analysis of studies published between 1980 and 2003 on psychotherapy for PTSD. METHOD: Data on variables not previously meta-analyzed such as inclusion and exclusion criteria and rates, recovery and improvement rates, and follow-up data were examined. RESULTS: Results suggest that psychotherapy for PTSD leads to a large initial improvement from baseline. More than half of patients who complete treatment with various forms of cognitive behavior therapy or eye movement desensitization and reprocessing improve. Reporting of metrics other than effect size provides a somewhat more nuanced account of outcome and generalizability. CONCLUSIONS: The majority of patients treated with psychotherapy for PTSD in randomized trials recover or improve, rendering these approaches some of the most effective psychosocial treatments devised to date. Several caveats, however, are important in applying these findings to patients treated in the community. Exclusion criteria and failure to address polysymptomatic presentations render generalizability to the population of PTSD patients indeterminate. The majority of patients posttreatment continue to have substantial residual symptoms, and follow-up data beyond very brief intervals have been largely absent. Future research intended to generalize to patients in practice should avoid exclusion criteria other than those a sensible clinician would impose in practice (e.g., schizophrenia), should avoid wait-list and other relatively inert control conditions, and should follow patients through at least 2 years.
Behavior Therapy↗
Assessing adolescent personality pathology.
BACKGROUND: Personality pathology constitutes a major form of psychopathology in adolescents. AIMS: To examine the reliability and validity of a Q-sort instrument for assessing adolescent personality pathology designed for clinically experienced informants. METHOD: A sample of 294 randomly selected psychiatrists and psychologists each provided data on a current patient, aged 14-18 years. Clinicians completed several measures, including the Shedler-Westen Assessment Procedure for Adolescents (SWAP-200-A). RESULTS: Factor analysis identified II dimensions of adolescent personality: psychopathology/malignant narcissism, dysphoria/inhibition, psychological health, histrionic sexualisation, schizotypy, sexual conflict, emotional dysregulation, anxious obsessionality, peer rejection, delinquent behaviour and attentional dysregulation. These correlated in predicted ways with a range of criterion variables, including measures of adaptive functioning, Axis II pathology, the Five Factor Model and the Child Behavior Checklist. CONCLUSIONS: The SWAP-200-A shows promise as an instrument for assessing personality pathology in adolescents. Trait dimensions such as delinquent behaviour and emotional dysregulation may prove useful additions to a classification of personality.
Adolescent↗
Quantifying clinical judgment in the assessment of adolescent psychopathology: Reliability, validity, and factor structure of the Child Behavior Checklist for clinician report.
The aim of this study was to assess the reliability and validity of the Child Behavior Checklist (CBCL) as completed by doctoral-level clinicians in the treatment of adolescents. We asked 294 randomly selected, experienced psychiatrists and psychologists to describe a patient aged 14 to 18 in treatment for personality pathology. Clinicians completed the CBCL (parent-report version) and measures of adaptive functioning, personality pathology, and family and developmental history, which served as criterion variables to test the validity of the CBCL as completed by clinicians. Most CBCL scales demonstrated acceptable reliability. Validity estimates were impressive, and the data revealed clinically meaningful associations between specific CBCL scale scores and developmental and family history variables. Confirmatory factor analysis showed that the factorial structure of the clinician-report CBCL resembled that of the parent-report CBCL, with the exception of a substantially lower correlation between higher order internalizing and externalizing factors. The data suggest that clinical judgment can be both reliable and valid when quantified using psychometrically sound instruments.
Adolescent↗
A multidimensional meta-analysis of psychotherapy and pharmacotherapy for obsessive-compulsive disorder.
A number of qualitative and meta-analytic reviews point to the efficacy of psychotherapeutic and pharmacological interventions for obsessive-compulsive disorder (OCD). In this article, we report a multidimensional meta-analysis of psychological and pharmacological treatment studies for OCD published between 1980 and 2001, examining a range of variables not previously meta-analyzed, including exclusion rates and exclusion criteria, percent of patients improved or recovered post-treatment, mean post-treatment symptomatology, and long-term outcome. These additional metrics provide a more nuanced view of the strengths and limitations of the existing data and their implications for clinical practice. Behavioral and cognitive-behavioral therapy, and a range of pharmacological interventions, lead to substantial improvement for the average patient, with individual psychotherapies and clomipramine and other Serotonin reuptake inhibitors faring best across multiple metrics. However, OCD symptoms persist at moderate levels even following adequate treatment course, and no replicable data are available on maintenance of gains for either form of treatment at 1 year or beyond. Future research should track recruitment and exclusion of study participants, include more comorbid patients, and focus on longer-term follow-up using multiple indices of outcome. More research on combined pharmacological and psychotherapeutic interventions is also indicated.
Clinical Trials as Topic↗
Relationship between attachment patterns and personality pathology in adolescents.
OBJECTIVE: To explore the relationship between attachment status and personality pathology in a large clinical sample of adolescents. METHOD: Two hundred ninety-four randomly selected psychiatrists and psychologists were each asked to provide data on a patient (aged 14-18 years) in treatment for maladaptive personality patterns. Clinicians completed several measures including a clinician-report attachment questionnaire, several measures of personality pathology, and a clinician-report version of the Child Behavior Checklist. RESULTS: In both dimensional and categorical analyses, secure attachment was negatively correlated with personality pathology and positively correlated with healthy functioning, whereas disorganized/unresolved attachment was strongly associated with multiple forms of personality pathology. Anxious/ambivalent attachment tended to be associated with measures of withdrawal, internalization, and introversion. Avoidant attachment style was not associated with any single form of personality pathology. CONCLUSION: The marked association between unresolved attachment and more severe psychopathology in adolescents, the lack of construct validity of avoidant personality disorder in adolescents, and the broader relations among attachment, personality, and psychopathology are discussed.
Adolescent↗