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Improving Access to Psychological Therapies (IAPT) services treat most patients in England who present to primary care with major depression. Psychodynamic psychotherapy is one of the psychotherapies offered. Dynamic Interpersonal Therapy (DIT) is a psychodynamic and mentalization-based treatment for depression. 16 sessions are delivered over approximately 5 months. Neither DIT's effectiveness relative to low-intensity treatment (LIT), nor the feasibility of randomizing patients to psychodynamic or cognitive-behavioural treatments (CBT) in an IAPT setting has been demonstrated.
147 patients were randomized in a 3:2:1 ratio to DIT (n = 73), LIT (control intervention; n = 54) or CBT (n = 20) in four IAPT treatment services in a combined superiority and feasibility design. Patients meeting criteria for major depressive disorder were assessed at baseline, mid-treatment (3 months) and post-treatment (6 months) using the Hamilton Rating Scale for Depression (HRSD-17), Beck Depression Inventory-II (BDI-II) and other self-rated questionnaire measures. Patients receiving DIT were also followed up 6 months post-completion.
The DIT arm showed significantly lower HRSD-17 scores at the 6-month primary end-point compared with LIT (d = 0.70). Significantly more DIT patients (51%) showed clinically significant change on the HRSD-17 compared with LIT (9%). The DIT and CBT arms showed equivalence on most outcomes. Results were similar with the BDI-II. DIT showed benefit across a range of secondary outcomes.
DIT delivered in a primary care setting is superior to LIT and can be appropriately compared with CBT in future RCTs.
Two types of mentalisation-based treatment (MBT) have been developed and empirically evaluated for borderline personality disorder (BPD): day hospital MBT (MBT-DH) and intensive out-patient MBT (MBT-IOP). No trial has yet compared their efficacy.
To compare the efficacy of MBT-DH and MBT-IOP 18 months after start of treatment. MBT-DH was hypothesised to be superior to MBT-IOP because of its higher treatment intensity.
In a multicentre randomised controlled trial (Nederlands Trial Register: NTR2292) conducted at three sites in the Netherlands, patients with BPD were randomly assigned to MBT-DH (n = 70) or MBT-IOP (n = 44). The primary outcome was symptom severity (Brief Symptom Inventory). Secondary outcome measures included borderline symptomatology, personality functioning, interpersonal functioning, quality of life and self-harm. Patients were assessed every 6 months from baseline to 18 months after start of treatment. Data were analysed using multilevel modelling based on intention-to-treat principles.
Significant improvements were found on all outcome measures, with moderate to very large effect sizes for both groups. MBT-DH was not superior to MBT-IOP on the primary outcome measure, but MBT-DH showed a clear tendency towards superiority on secondary outcomes.
Although MBT-DH was not superior to MBT-IOP on the primary outcome measure despite its greater treatment intensity, MBT-DH showed a tendency to be more effective on secondary outcomes, particularly in terms of relational functioning. Patients receiving MBT-DH and MBT-IOP, thus, seem to follow different trajectories of change, which may have important implications for clinical decision-making. Longer-term follow-up and cost-effectiveness considerations may ultimately determine the optimal intensity of specialised treatments such as MBT for patients with BPD.
Declaration of interest
P.L. and D.L.B. have been involved in the training and dissemination of MBT.
The aim of this study was to reanalyse the data from Cuijpers et al.'s (2018) meta-analysis, to examine Eysenck's claim that psychotherapy is not effective. Cuijpers et al., after correcting for bias, concluded that the effect of psychotherapy for depression was small (standardised mean difference, SMD, between 0.20 and 0.30), providing evidence that psychotherapy is not as effective as generally accepted.
The data for this study were the effect sizes included in Cuijpers et al. (2018). We removed outliers from the data set of effects, corrected for publication bias and segregated psychotherapy from other interventions. In our study, we considered wait-list (WL) controls as the most appropriate estimate of the natural history of depression without intervention.
The SMD for all interventions and for psychotherapy compared to WL controls was approximately 0.70, a value consistent with past estimates of the effectiveness of psychotherapy. Psychotherapy was also more effective than care-as-usual (SMD = 0.31) and other control groups (SMD = 0.43).
The re-analysis reveals that psychotherapy for adult patients diagnosed with depression is effective.
Day hospital mentalization-based treatment (MBT-DH) is a promising treatment for borderline personality disorder (BPD) but its evidence base is still limited. This multi-site randomized trial compared the efficacy of MBT-DH delivered by a newly set-up service v. specialist treatment as usual (S-TAU) tailored to the individual needs of patients, and offered by a well-established treatment service.
Two mental healthcare institutes in The Netherlands participated in the study. Patients who met DSM-IV criteria for BPD and had a score of ⩾20 on the borderline personality disorder severity index (BPDSI) were randomly allocated to MBT-DH (N = 54) or S-TAU (N = 41). The primary outcome variable was the total score on the BPDSI. Secondary outcome variables included symptom severity, quality of life, and interpersonal functioning. Data were collected at baseline and every 6 months until 18-month follow-up, and were analyzed using multilevel analyses based on intention-to-treat principles.
Both treatments were associated with significant improvements in all outcome variables. MBT-DH was not superior to S-TAU on any outcome variable. MBT-DH was associated with higher acceptability in BPD patients compared v. S-TAU, reflected in significantly higher early drop-out rates in S-TAU (34%) v. MBT-DH (9%).
MBT-DH delivered by a newly set-up service is as effective as specialist TAU in The Netherlands in the treatment of BPD at 18-month follow-up. Further research is needed to investigate treatment outcomes in the longer term and the cost-effectiveness of these treatments.
The existing data on proper motions from meridian catalogues and proper motion surveys appear to be reasonably complete for motions larger than 0.24 arc seconds per year and down to the 19th magnitude visual but for motions between 0.24 and 0.18 there exists a lacuna for stars between 8.5 and 11.5 visual which could easily be observed by repeating Carte du Ciel plates.
A brief review is given of the several ways in which stellar motions may be used statistically. In the case where the motions of all stars shown on plates of certain regions are measured these are generally used to determine kinematical relations in the Galaxy and only secondarily for the estimation of luminosities; when motions are measured for special groups of stars the solar motion is first determined and then used for the calculation of distances and luminosities.
Mather and colleagues postulate that norepinephrine promotes selective processing of emotionally salient information through local “hotspots” where norepinephrine release interacts with glutamatergic activity. However, findings in rodents and humans indicate that norepinephrine is ineffective in modulating mnemonic processes in the absence of a functional amygdala. We therefore argue that emphasis should shift toward modulatory effects of amygdala-driven changes at the network level.
Replicability of findings is an essential prerequisite of research. For both basic and clinical research, however, low replicability of findings has recently been reported. Replicability may be affected by research biases not sufficiently controlled for by the existing research standards. Several biases such as researcher allegiance or selective reporting are well-known for affecting results. For psychotherapy and pharmacotherapy research, specific additional biases may affect outcome (e.g. therapist allegiance, therapist effects or impairments in treatment implementation). For meta-analyses further specific biases are relevant. In psychotherapy and pharmacotherapy research these biases have not yet been systematically discussed in the context of replicability. Using a list of 13 biases as a starting point, we discuss each bias's impact on replicability. We illustrate each bias by selective findings of recent research, showing that (1) several biases are not yet sufficiently controlled for by the presently applied research standards, (2) these biases have a pernicious effect on replicability of findings. For the sake of research credibility, it is critical to avoid these biases in future research. To control for biases and to improve replicability, we propose to systematically implement several measures in psychotherapy and pharmacotherapy research, such as adversarial collaboration (inviting academic rivals to collaborate), reviewing study design prior to knowing the results, triple-blind data analysis (including subjects, investigators and data managers/statisticians), data analysis by other research teams (crowdsourcing), and, last not least, updating reporting standards such as CONSORT or the Template for Intervention Description and Replication (TIDieR).
In November 1934 the President circulated a letter to the members of the Commission as follows:
Since the 1932 meeting the following projects have been completed, or are nearing completion:
(1)The publication of many lists of trigonometric parallaxes.
(2)The determination of the spectroscopic parallaxes of 4179 stars at Mt Wilson Observatory by Adams, Joy and Humason.
(3)A discussion of systematic errors of trigonometric parallaxes by van Maanen and a re-discussion in the Astrophysical Journal of the same material by Mitchell and by Sterne.
(4)The compilation of a second Yale Catalogue to include parallaxes completed before the end of 1934.
(5)Substantial progress on the proper motions of 32,000 stars by Boss and his associates at the Dudley Observatory.
(6)The publication at the Radcliffe Observatory of the proper motions of 32,000 stars from photographs on 115 Selected Areas.
(7)The completion of the dynamical parallaxes of 2000 stars.
(8)The completion of the proper motions of 18,000 stars derived from parallax plates at the Leander McCormick Observatory.
(9)The publication at the Yale Observatory of the proper motions of 40,000 stars with a probable error less than 0”.010 determined from photographs by re-observing in zones the Astronomische Gesellschaft stars.
(10)The determination of the proper motions of 50,000 stars in the Southern Hemisphere by Luyten from Harvard photographs.
In the wide field of research covered by the Commission considerable progress has been made in recent years, and it is only possible here to touch briefly on the results of a few lines of investigation, without any attempt to completeness.
Stellar luminosities. On the basis of the new list of Mount Wilson spectroscopic parallaxes and a compilation of the long series of modern trigonometric parallaxes A. van Maanen finds 617 objects within a distance of 20 parsecs from the sun. It is very doubtful, however, if we know all the stars even in the region of 5 parsecs radius. Almost all the known stars within 20 parsecs belong to the main sequence, the faintest star being of absolute magnitude +16.6. The most interesting deviations from the main sequence are the three “white dwarfs”, Сотр. of Sirius, Comp. o2 Eridani, and van Maanen’s F type star. G. P. Kuiper lists 3 additional white dwarfs at larger distances which were estimated to be of types Bo, B7 and A2. For the first two stars, A.C. 70°8247 and Wolf 1346, a revision of the spectral types by Adams and Humason gives A2 and A5, respectively, although the spectra differ considerably from normal ones. The A2 star in Kuiper’s list is the one discovered by Oosterhoff in the region of the cluster h, X Persei; its spectral characteristics have been examined by Öhman and by Humason. The absence of the high-numbered members of the Bahner series and of the continuous absorption at the Balmer limit seems to be an important criterion of such stars. A white dwarf of quite peculiar spectrum (type probably about B8) is the companion of o Ceti discovered spectro-graphically by Joy in 1922. There appear several additional deviations towards faint magnitudes from the main sequence which may be classed more or less safely among the white dwarfs. A few such cases have been discussed at Lund by J. Tuominen.
There seems to be a consensus of opinion that the useful life of the commission has come to an end with the achievement of the principal aim of the historical task of the Carte du Ciel, presenting an overall picture of the Heavens as to positions of the fixed stars up to a definite limiting magnitude. The French presidents in succession with great energy, supported by the IAU, succeeded in overcoming all obstacles and in finishing the printed Astrographic Catalogue. Remaining tasks of deriving definitive plate constants, eventually deriving reliable proper motions of all stars in the programme evidently rests with individual observatories or at other commissions of the Union within their proper frame of activities.
Following a suggestion presented at the meeting of the Executive Committee in September 1969 a decision was reached to abolish the Commission 23 proper by merging it with Commission 24 (Stellar parallax and proper motion), and a working group in the latter commission would become a suitable means to continue work on data furnished by the Astrographic Catalogue.
Several of those observatories still in possession of Carte du Ciel-astrographs are going on with proper motion (p.m.) work in their zones or are preparing to do so. The application of the astrographs to the programme of attachment of stars to galaxies according to A. N. Dejč’s method is in progress.
In November 1931 the President circulated a letter to the members of the Commission which in part was as follows:
In view of the fact that it is now over a quarter of a century since Schlesinger by photography began to determine trigonometric parallaxes by a long focus telescope, and fifteen years since Adams and Kohlschütter derived the first spectroscopic parallaxes, it would seem appropriate to take stock of our present position and to make plans for future development.
Will you be good enough, therefore, to furnish such statements concerning the following topics as are appropriate to the work of your observatory?
At the Pulkovo Observatory a parallax programme has been started by Kanayev for 120 stars chosen mainly from Vyssotsky’s lists and the Leningrad list of multiple systems. Proper Motions relative to galaxies have been determined by Fatchikhin for 14669 stars in 85 different fields; the magnitude equation is being investigated and secular parallaxes as well as the solar apex and the constants of galactic rotation are being calculated. The general programme on absolute proper motions is being carried out by Dejč at Pulkovo, and at Cerro Calan in Chile, by Panteleyeva at Sternberg, and by Rahimov at Tashkent.
The following report, which has been drawn up partly on the basis of the reports of the members of the Commission, touches briefly and without any attempt at completeness a few points of the recent developments in certain important fields falling within the domain of the Commission.
The discovery of southern double stars carried out at Bloemfontein by Dr R. A. Rossiter and his collaborators with the 27-inch Lamont refractor has recently been brought to a close. The total number of new pairs found in this way and published now amounts to 5252. It is a great satisfaction to know that Dr Rossiter has been enabled to complete his work by micrometrical measures of these objects. Only in this way can full value be given to our knowledge of these new pairs.