Suchergebnisse

Patients who engage in deliberate self-harm (DSH) form a heterogeneous population. There is a need for psychotherapeutic interventions that give therapists the flexibility to tailor the treatment plan to the needs of an individual patient. To detect essential ingredients for treatment, three different cognitive-behavioral theories of DSH will be reviewed: (1) the cognitive-behavioral theory of Linehan (1993a) , (2) the cognitive theory of Berk, Henriques, Warman, Brown, and Beck (2004) , and (3) the cognitive-behavioral theory of Rudd, Joiner, and Rajab (2001) . A review of these theories makes it possible to compare the different approaches to the essential aspects in the treatment of DSH: a trusting patient-therapist relationship, building emotion regulation skills, cognitive restructuring, and behavioral pattern breaking. An overview will be given of therapeutic techniques that can be used to address the cognitive, emotional, behavioral, and interpersonal problems associated with DSH.

This article presents the results of a large efficacy study comparing different forms of therapy for major depressive disorder (MDD), including interpersonal psychotherapy (IPT) and pharmacotherapy. Patients were randomized to either IPT, IPT in combination with anti-depressant medication, IPT in combination with pill-placebo or medication only. The primary outcome measure was the Hamilton Rating Scale for Depression (HAMD). Patients were treated for 12 to 16 weeks. Ratings were performed at baseline, after 6 weeks of treatment and at the end of treatment. Ethnic minority patients (EMP) had higher scores on the HAMD than non-EMP for every rating period. However, the rate of improvement was the same for EMP and non-EMP. The higher mean scores of EMP on the HAMD could not be explained as solely due to higher scores on somatic items of the rating scales. The attrition rate in EMP (45.9%) was significantly higher than in non-EMP (24.4%), even in the structured treatment format studied. The results suggest that standard antidepressant therapy, be it medication, psychotherapy or both, may be effective for depressed minority patients but therapists should focus on enhancing adherence to treatment.