Key Features of Intensive Short-term Dynamic Psychotherapy
Intensive Short-term Dynamic Psychotherapy (ISTDP) by Dr. Allan Abbass focuses on breaking through resistance, using psychodiagnostic tools, and optimizing strategies for maximal exposure to complex feelings. The therapy model includes a trial therapy approach and emphasizes the unconscious therapeutic alliance for memory and healing. Explore the signaling system of unconscious anxiety, specificity of interventions, and the somatic experience of unprocessed complex feelings.
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Intensive Short-term Dynamic Psychotherapy: Key features and evidence base Allan Abbass, Professor & Program Director Centre for Emotions and Health Dalhousie University, Halifax, Canada allan.abbass@dal.ca www.allanabbass.com References: Reaching through Resistance Hidden from View: www.unlearnyourpain.com
Key features of ISTDP Evidence base Dr Allan Abbass 2018
Intensive Short-term Dynamic Psychotherapy: Key Features 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Breaking through Resistance and Capacity building formats Psychodiagnostic tool to determine treatment pathway Broadly applicable Signaling system of the unconscious anxiety Video for research and training Specificity of timing and type of interventions Trial Therapy Model The Unconscious Therapeutic Alliance: Memory and Healing Somatic experience of unprocessed complex feelings Optimization strategies: maximal exposure to complex feelings Dr Allan Abbass 2018
Metapsychology: psychodiagnosis After Davanloo, 1980, 1990, 2000, 2005 Dr Allan Abbass 2018
BOND With Parents Dr Allan Abbass 2018
BOND With Parents PAIN FEAR Dr Allan Abbass 2018
BOND With Parents PAIN FEAR Rage, Guilt about the Rage Dr Allan Abbass 2018
BOND With Parents PAIN FEAR Rage, Guilt about the Rage Character Disorder + Symptoms Dr Allan Abbass 2018
Transference (Therapist) Current person Past person Dr Allan Abbass 2018
Unconscious defense Unconscious anxiety Unconscious impulses and feelings Dr Allan Abbass 2018
Psychodiagnosis Therapist efforts to enhance self-caring, identify underlying feelings and interrupt defenses mobilize Complex Transference Feelings (CTF) These CTF activate the attachments, pain, rage and guilt about rage from attachment trauma unconscious anxiety unconscious defenses rise Diagnose patterns and treatment format needed
Psychodiagnosis 2. Monitor anxiety & defense responses Unconscious defense Unconscious anxiety 1. Pressure on feelings or defenses Unconscious impulses and feelings Dr Allan Abbass 2018
Broad Applicability: 86% of Psychiatry office referrals Spectrum of Spectrum of Patients with Fragile Character Structure Psychoneurotic Disorders Highly Resistant Severe/ Borderline Low Resistant Moderate Resistant Mild Moderate Striated Muscle + Isolation of affect Smooth Muscle/Conversion + Repression Cognitive-Perceptual Disruption + Primitive Defenses Dr Allan Abbass 2018
Unconscious Therapeutic Alliance: unlocking the unconscious Unlocking the Unconscious Clarify and challenge defenses turns patient against defenses When the complex feelings (positive feeling, rage, guilt and grief) are experienced, they cut through the unconscious anxiety defenses weaken or stop The Unconscious Therapeutic Alliance activates direct access to the unconscious unprocessed emotions There is a spectrum of Unconscious Therapeutic Alliance Dr Allan Abbass 2018
Spectrum of Unconscious Therapeutic Alliance R << UTA Rage & Guilt Images Transfer to past figure R < UTA Some Rage guilt & grief Clear Links R >> UTA Negation & vivid Dreams R >> UTA Whispers from the UTA = Deep understanding Abbass, 2015 Reaching through Resistance Dr Allan Abbass 2018
Discharge pathways of unconscious anxiety Striated Muscle Unconscious Anxiety Hands Clench Arms, Shoulders, Neck Intercostal: Sigh Abdomen, back Legs and Feet Hyperventilation, Fibromyalgia, headache, chest pain, tremor Dr Allan Abbass 2018
Discharge pathways of unconscious anxiety Smooth muscle anxiety: Repression and visceral symptoms Cognitive perceptual disruption: Neurological symptoms and primitive defenses Motor Conversion: Due to repression. No tone in striated muscle. Dr Allan Abbass 2018
Video for training, teaching and research since 1970s Dr Allan Abbass 2018
Spectrum of Mobilization Specific timing and types of interventions Low Rise Resistance Unlocked : Emotion and Memory Function Greater than inhibitory functions Complex Transference feelings Unconscious therapeutic alliance Dr Allan Abbass 2018
Spectrum of Mobilization High Rise Resistance Unlocked : Emotion and Memory Function Greater than inhibitory functions Complex Transference feelings Unconscious therapeutic alliance Dr Allan Abbass 2018
Spectrum of Mobilization Partial Unlocking Resistance Unlocked : Emotion and Memory Function Greater than inhibitory functions Complex Transference feelings Unconscious therapeutic alliance Dr Allan Abbass 2018
Trial Therapy Model Unlocking vs Symptom changes with Trial Therapy N=500 Abbass, Town, Ogrodniczuk, Joffres, 2017 1.7 1.6 ES= 0.28 1.5 1.4 ES= 0.91 BSI Unlocking 1.3 BSI No Unlocking 1.2 1.1 1 Pre Post Dr Allan Abbass 2018
Trial Therapy Model Unlocking vs Interpersonal problem changes with Trial Therapy N=500.Abbass, Town, Ogrodniczuk, Joffres, 2017 1.7 1.6 1.5 ES= 0.12 1.4 IIP Unlocking ES= 0.37 1.3 IIP No Unlocking 1.2 1.1 1 Pre Post Dr Allan Abbass 2018
Trial Therapy Model Trial Therapy Cost Effects n=344 Abbass et al, in press Psychotherapy and Psychosomatics Total Hospital and Doctor Costs 6000 5000 4000 3000 Normal population 2000 1000 0 1 year pre 1 year post 2 year post 3 year post Dr Allan Abbass 2018
Major Unlocking and Extended Unlocking: somatic pathway of rage experienced for some minutes anxiety and resistance are removed transfer of image to the past person with passage of rage and guilt and grief. Dr Allan Abbass 2018
Somatic pathways of feeling: rage, guilt, grief Love: rising warmth, urge to smile and embrace Rage: rising heat up chest to head then down arms: tension and anxiety stop Guilt about rage: Hard waves, pain in upper chest. Feel as if have just murdered loved one. Grief: tears, painful feeling in chest. Waves not as hard and distinct as guilt. Not as loud or painful. Dr Allan Abbass 2018
Optimization: Capacity Building Formats for Repression and Fragile Cases: maximizing exposure Conscious feelings 1. Pressure 2. Rise in CTF 3. Recap 23 3 2 1 Unconscious anxiety and defense Isolation of affect Striated muscle 1 Mild fragile Severe fragile, borderline Moderate fragile Dr Allan Abbass 2018
Optimization: Capacity Building Formats for Repression and Fragile Cases: maximizing exposure Conscious feelings 3 1 Unconscious anxiety and defense 2 Dr Allan Abbass 2018
Well Researched Evidence for Intensive Short-term Dynamic Psychotherapy Over 50 outcome studies 30 RCTs Meta-analyses of 28 RCTs (Lilliengren et al, 2016): Large persistent symptom effects d > 1.0 (symptoms), Medium d=.55 for Interpersonal problems Low drop out at 16% Effects increase significantly in follow-up Outperforms controls with moderate to large effects Outperforms other Bona Fide Treatments in follow up 15 studies support it as cost effective Dr Allan Abbass 2018
Cost Effective Total Doctor and Hospital Costs/ patient: N=890 Abbass, Kisely, Rasic, Town and Johansson 2015, J Psychiatric Research $14,000.00 $12,000.00 17X cost offset $10,000.00 $8,000.00 Case $6,000.00 Control $4,000.00 Normal Population Costs $2,000.00 $0.00 1 yr Pre 1 yr Post 2 yr Post 3 yr Post Dr Allan Abbass 2018
Broad Utility Efficacious with refractory patient groups: 11 studies. Halifax Treatment Resistant Depression Study: Town et al, 2017 3.7% Remission 36% Remission Dr Allan Abbass 2018
Process studies: several types. Town et al, 2012, Town and Abbass 2013 E.g. Therapist focus on defences results in affective responses and decreased defenses Unconscious anxiety in trial therapies Types and frequency of interventions Interpretation on the triangles led to benefits Dr Allan Abbass 2018
Impact of Major Unlocking during Treatment N=500. Johansson, et al 2014 Dr Allan Abbass 2018
Impact of Major Unlocking on Healthcare Costs Impact of Major Unlocking ** Town et al, 2013 Dr Allan Abbass 2018
Conclusion ISTDP is well studied with foundation of video case based research, RCTs, Case series and cost effect studies Broad application with effects that may exceed other bona fide treatments Tailored based on specific psychodiagnostic findings Centers on handling resistance and complexity to enable direct experience of unconscious feelings Dr Allan Abbass 2018
Spectrum of Mobilization of UTA Low rise: flat process little anxiety or defense Mid rise: Tension rise and defenses crystallize in the transference: UTA: Whispers of insight High Rise: High tension between resistance and UTA: Negation Partial unlocking: Feel the complex feelings, anxiety drops, resistance is cut down and UTA dominates with LINK to past attachment trauma Dr Allan Abbass 2018
