Faculty Bibliography

This article describes a new, structured short-term psychotherapy approach to working with IBD (inflammatory bowel disease) patients, based up on the integration of expressive writing therapy and narrative therapy. After reviewing the theoretical background and empirical literature on expressive writing and narrative therapy, a rationale for their integration, in particular with the IBD patient population, is made. A detailed description of the approach along with case materials follows.

Background: Hypnotherapy is a useful treatment for a variety of gastrointestinal conditions. While there is strong evidence for delivering other treatments virtually and in groups, there is no research thus far on delivering hypnotherapy in this format. Given the growth of both psychogastroenterology and telehealth, these methods should be explored as they have great potential for increasing access and cost-effectiveness of intervention. Aims: This qualitative study was developed to help understand patients experiences in virtual, group-based, gut-directed hypnotherapy (GDH) in two different institutions. Methods: Authors developed a qualitative interview with the assistance of two patient partners and then recruited patients from New York University and Dartmouth Health to participate. Interviews were completed one-on-one with patients who started and then completed GDH (≥5 visits) and who did not complete GDH (≤3 visits). Data were coded and then analyzed using thematic analysis. Results: Twenty-one patients from NYU and Dartmouth participated in qualitative interviews. Broadly, patients reported coming to GDH because they believed in the importance of the mind-body connection or were desperate for treatment. Regardless of why patients came to GDH, they generally reported positive outcomes for GI symptoms and for other physical and mental health conditions. Most patients appreciated the group and virtual formats, though some concerns about inflexible schedules and lack of anonymity were voiced. Despite these concerns, there was broad support for virtual, group-based GDH and general excitement for behavioral health programming. Conclusion: Virtual, group-based GDH is an acceptable treatment for patients from rural and urban settings. Given the possible improvements in access and cost-effectiveness that this treatment modality can provide, GI practices may want to consider it in lieu of or in addition to the traditional one-on-one treatment format. Barriers and facilitators and recommendations for practice are discussed.

Abstract This study tested whether group gut-focused hypnotherapy would improve irritable bowel syndrome (IBS). Several possible outcome predictors were also studied. Before treatment, 75 patients completed a Symptom Severity Scale, a Mind-Body attribution questionnaire, and a Quality of Relationship Inventory (QRI). The symptom scale was completed posttreatment, 3, 6, and 12 months later. There was significant symptom reduction at each data point (p < .001). Sixty percent had a reduction of more than 50 points, indicative of clinical improvement. Initial severity score (p = .0004) and QRI conflict (p = .057) were directly correlated with a response to hypnotherapy, while attribution of symptoms to mind (emotional) causation was inversely correlated (p = .0056). The authors conclude that group hypnotherapy is effective in patients with IBS.

We have utilized supportive therapy (ST) with an outpatient population with borderline personality disorder (BPD) who also engage in nonsuicidal self-injurious and suicidal behavior. In recent years, ST has been described as an active psychotherapeutic approach that may have efficacy comparable to other psychotherapies. ST emphasizes the mobilization of strengths to enhance self-esteem and utilize adaptive defenses and positive coping skills. Patients with BPD who self-injure and attempt suicide require integration of tangible solution-focused approaches with standard ST in order to address negative thinking patterns, impulsive behavior, and affective dysregulation, along with crisis intervention during periodic crisis states. ST appears to be well tolerated by patients with BPD who have self-injurious behavior and may be efficacious in engaging BPD patients in treatment and in minimizing the frequency and intensity of self-injurious and suicidal behavior.

Contrary to common clinical perceptions, individuals with personality disorders attempt and commit suicide at nearly the same rate as individuals with major depression. In particular, those with borderline personality disorder are at high risk for suicidal behavior and nonsuicidal self-injury. Yet there is significant controversy surrounding the diagnosis of borderline personality disorder in terms of its existence, its definition and symptom structure, its Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) axis location, and its importance as a contributing factor to suicidality and nonsuicidal self-injury. Furthermore, both suicidal and nonsuicidal self-harm is prominent in borderline personality disorder. There is often confusion between suicidal and nonsuicidal self-injury with one sometimes mistaken for the other. Nonsuicidal self-injury is sometimes met with hospitalization, because it is viewed as life threatening. Alternately, the potential lethality of suicidal behavior is underestimated, because it occurs in the context of multiple low lethality self-harm behaviors. It is possible to view these behaviors as distinct yet on a spectrum in borderline personality-disordered patients. With respect to treatment of self-injury in personality disorders, some recent pharmacotherapy trials have been conducted, though efficacy is often unclear. Findings with respect to psychotherapy, particularly dialectical behavior therapy, a form of cognitive behavioral treatment, are promising.

Examined the effects of religious and professional beliefs on clinical judgment. 87 psychotherapists (aged 24-77 yrs) completed a religious belief survey and a professional belief survey, as well as a questionnaire concerning internal conflict between professional and religious beliefs. The Ss then read two brief vignettes, describing a religious and a non-religious patient, and rated the patients with regard to optimism or pessimism concerning responsiveness to treatment. Results show that there was no significant relationship between religious and professional beliefs. However, the strength of religious beliefs predicted optimism for the religious patient. In addition, there was a significant interaction effect between strength of religious beliefs and strength of professional beliefs on clinical ratings.