Browsing by Subject "psykoterapia"

Aims. Clinical errors cause a significant number of deaths both in the field of medicine and clinical psychology, hence being a major threat to patient safety. One explanation behind clinical errors is heuristic thinking which affects decision-making automatically and aims for a result that is sufficient enough. Heuristic thinking can also lead to cognitive biases which affect decision-making by distorting interpretations of observations. The clinical errors caused by physicians have been studied far more than those caused by psychologists and psychotherapists. However, research has shown that a clinical error, such as a diagnostic mistake or unsuitable therapy method, affects the treatment of every fifth psychiatric patient. Thus, the main aim of this literature review was to investigate which heuristics and biases affect therapists’ decision-making and through which mechanisms they affect. In addition, the review examined which characteristics related to the therapist, patient and situation predispose to the adverse effects and how these effects could be minimized. Methods. The literature for this review was retrieved from the databases of Helsinki University Library and Google Scholar with the search statement (heuristic* OR bias*) AND (clinical reasoning OR clinical decision* OR clinical judgement). The search was limited to articles published between 2015-2022, but some previously published articles found in the references and the older original editions of the most influential papers were also used. Results and conclusion. This review showed that spending an insufficient amount of time with the case evidence, being too inflexible, therapist’s emotional reactions and false beliefs of their competence are strongly related to the adverse effects of cognitive biases and heuristics. This review also identified that the characteristics of patients, like their ability to cooperate, and the complexity of situations also affect the quality of clinical decisions. In addition, this review showed that it is possible to minimize the adverse effects by participating in training that focuses on these effects, using a patient-therapist feedback system, and keeping the mechanisms through which biases and heuristics affect consciously in mind when making decisions. These strategies should be implemented as quickly as possible to ensure safety and health equality.

Depression is one of the most common psychological symptoms that often occurs with dementia. It can be a risk factor for dementia to develop, or it can also appear after dementia causes losses to a patient’s abilities. Depression has been shown to hinder the functional status of a patient with dementia even further. Using medication to treat depression in patients with dementia holds the risk of side effects. Instead, psychosocial treatments should be considered essential in the treatment of depression in dementia patients. The purpose of this review is to examine psychosocial treatments used for treating depression in patients with dementia. Of these treatments, psychotherapy, music therapy and reminiscence therapy are considered further. The evidence for psychotherapy, music therapy and reminiscence therapy is partly conflicting, but overall quite promising. In the future, more randomized controlled trials should be carried out, but there is also a need for qualitative studies to clarify which mechanisms enable treatments to affect depression in dementia patients.

MDMA (3,4-methylenedioxymethamphetamine) was used as an adjunct to psychotherapy before recreational use of MDMA in the form of “ecstasy” led to its criminalization in the U.S. in 1985. However, MDMA has still been thought to have psychotherapeutically beneficial effects on socioemotional processing. Research into MDMA-assisted psychotherapy (MDMA-AP) for chronic, treatment-resistant post-traumatic stress disorder (PTSD) is moving into Phase III clinical trials in the U.S., and the approval of European Medicines Agency will also be sought. The purpose of this thesis was to assess the efficacy and psychological safety of MDMA-AP. Source material included, and was limited to, placebo-controlled & double-blind clinical (and experimental) studies of pure MDMA’s effects in humans, as well as follow-up and analysis studies based on them, from the last decade. The efficacy of MDMA-AP was found promising at least for chronic, treatment-resistant PTSD. However, MDMA-AP meetings that last for many hours do require, both from the therapists and the patients, more commitment and stamina than meetings of traditional length, and more research is needed on the role of therapists in MDMA-AP’s efficacy. Pure MDMA in a controlled setting was not found to have severe nor non-transient adverse psychological effects in the single doses (≤ 125 mg) used in the studies. Physiological effects were also mostly mild, transient, and highly predictable. The most considerable risks in participating in MDMA-AP treatment might be cardiovascular. MDMA-AP was not found to predispose the participants to problem use of illegal substances outside the research setting; rather, successful treatment protects from it.

Tiivistelmä Psilosybiinin terapeuttisia vaikutuksia tutkittiin jo 1950- ja 1960-luvuilla, mutta tutkimus tyrehtyi, kun psilosybiini luokiteltiin laittomaksi huumausaineeksi 1970-luvulla. Kiinnostus psilosybiinin terapeuttiseen potentiaaliin on herännyt 2000-luvulla uudelleen. Yhdysvaltain elintarvike- ja lääkevirasto FDA on nimennyt psilosybiiniavusteisen psykoterapian läpimurtoterapiaksi masennuksen sekä hoitoresistentin masennuksen hoidossa vuonna 2018. Tässä katsauksessa tarkasteltiin, minkälaisia tuloksia psilosybiiniavusteisen psykoterapian vaikutuksesta masennukseen on saatu 2000-luvulla tehdyissä kliinisissä tutkimuksissa. Tutkimustulosten lisäksi tarkasteltiin tutkimusten puutteita ja hoidon turvallisuutta. Tutkimusaineisto kerättiin PubMed-tietokannasta syys- ja lokakuun 2021 aikana. Moderni tutkimus psilosybiiniavusteisen psykoterapian vaikutuksesta masennukseen on vasta hyvin alkuvaiheessa. Tulokset ovat positiivisia: potilaiden masennusoireet olivat kaikissa tutkimuksissa merkitsevästi vähentyneet heti hoidon jälkeen ja vaikutus kesti muutamasta viikosta muutamaan kuukauteen. Tutkimusten otoskoot ovat kuitenkin pieniä ja vain puolet tutkimuksista on plasebokontrolloituja. Plasebokontrolloiduissa tutkimuksissa on käytetty ristikkäisasetelmaa, sokkoutus on haastavaa ja sen onnistumisesta on raportoitu puutteellisesti. Nämä tekijät heikentävät efektikokojen luotettavuutta. Huolellisesti toteutettuna psilosybiiniavusteinen psykoterapia on turvallinen hoitomuoto. Psilosybiinin sivuvaikutukset olivat ohimeneviä, eikä vakavia sivuvaikutuksia havaittu lainkaan.

In today’s health-care, evidence-based medicine is practised, which means that treatment needs to be based on the latest research. Country-specific guidelines, that help to apply latest research into practise, are created to standardize treatment and to ease the work of clinicians. In my thesis I will compare Finnish (käypä hoito) and Canadian (CANMAT) recommendations for psychosocial treatment of depression. Various therapies can be used in the treatment of depression. Cognitive and interpersonal psychotherapies and behavioural activation have the strongest recommendation in the treatment of acute depression. The most clear difference between the recommendations is regarding psychodynamic therapies; In finnish recommendation psychodynamic therapies are seen as effective as other therapies, whereas in Canadian recommendation the grading for it is not as strong. The lack of research on psychodynamic therapies is most likely a major factor in it’s weaker position. The amount of research has increased in recent years and the grading of psychodynamic therapies has improved accordingly in both recommendations. The position of psychodynamic therapies in the treatment of depression is still controversial which can be seen in the difference between Finnish and Canadian recommendations.

Selective mutism is a children’s psychiatric disorder. Children with selective mutism won’t talk in certain situations, for example in school, despite talking at home with family members. Previously selective mutism was seen as an independent disorder. Research has shown that selective mutism has prominent comorbidity with anxiety disorder, therefore selective mutism is now seen as a specific children’s anxiety disorder or as a symptom of social phobia. Since anxiety plays a notable role in selective mutism, treatments to decrease anxiety have been used to treat selectively mute children. Selective mutism has been shown to be a resilient disorder. Longer duration of symptoms makes the treatment more challenging. Selective mutism is a rare disorder and because of that there is a limited amount of research of selective mutism and its treatment. Most of the research are case studies. Controlled experiments that includes control groups are rare. Clinicians may find it hard to propose a certain treatment for selectively mute patient since there is not unified treatment recommendations. Cognitive-behavioral interventions are primary when treating selective mutism. These interventions include for example self-modeling, stimulus fading and rewarding. Patient’s muteness creates extra challenge, and parents are usually essential help during the assessment and treatment. If therapeutic treatment doesn’t seem to be efficient, medical treatment can be considered. Selective serotonin reuptake inhibitor (SSRI), fluoxetine, is found to be effective when treating adults with social anxiety and some researchers have presented its applicability to treat children’s selective mutism. More research of the treatment of selective mutism is needed to be able to give the best evidence-based information for the clinicians who are dealing with selectively mute patients. Because selective mutism is such a rare disorder, it would be desirable to collect research data internationally and work together with researchers from different countries. Reliable estimations of treatment possibilities could be made if big enough data could be collected.

Tavoitteet: Vaikka psykoterapiat ovat tehokkaita hoitoja, niiden vaikuttavuudessa on parannettavaa. Yksi ratkaisukeino on potilaan rutiininomainen tulosten seuranta routine outcome monitoring eli ROM. ROM:n avulla mitataan hoidon kannalta asiaankuuluvia tulosmuuttujia kuten potilaan oireita ja tämän pohjalta hoitoa sopeutetaan vastaamaan paremmin potilaan tarpeisiin. Vaikka ROM:n hyödystä hoidon vaikuttavuuteen on empiiristä näyttöä, osa terapeuteista vastustaa menetelmää. Katsaukseni tavoite on tutkia terapeuttien kielteisiä asenteita ROM:ia kohtaan sekä pohtia mahdollisia tekijöitä asenteiden taustalla. Pohdin myös keinoja asenteiden muuttamiseksi. Menetelmät: Kirjallisuushaku tehtiin syksyllä 2023 Scopus ja Google Scholar tietokantoihin termein (ROM OR ”routine outcome monitoring”) AND (therapist OR clinician) sekä (ROM OR ”routine outcome monitoring”) AND (implementation). Katsaus rajattiin mielenterveystyön ammattilaisten asenteiden tarkasteluun. Tulokset ja pohdinta: Terapeuttien havaittiin olevan huolissaan erityisesti ROM:iin liittyvistä käytännönjärjestelyistä. Menetelmän mahdollinen vaikutus työnkuvaan, asemaan ja terapiasuhteeseen herättävät myös epäilyksiä. Asenteissa ROM:ia kohtaan löytyi eroja tutkimuksen toteutusmaasta, terapeutin teoreettisesta suuntauksesta ja käyttömäärästä riippuen. Katsauksessa keskustellaan ROM:n käyttöönottoa helpottavista tekijöistä.