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From a mentalizing perspective, symptoms of depression arise from reactions to threats to attachment relationships—and thus threats to the self—and associated impairments in mentalizing problems. Mentalization-based treatment (MBT) for depression targets mentalizing impairments, dominant attachment styles, and problems with epistemic trust. Depression is not a homogeneous disorder, and mentalizing problems vary depending on whether the depressed mood is mild, moderate, or severe. Mentalizing interventions for the different severities of depression are summarized. A specific adaptation of MBT, namely dynamic interpersonal therapy (DIT), is also discussed.
This chapter pursues a historical, methodological and theoretical agenda to interrogate the validity and value of identifying proto-novelistic writing in medieval French literature. Informed by Terence Cave’s reflections on ‘pre-liminaries’, it counters conventional positionings of the medieval period in histories of the novel in French, ensuring that it is not unduly omitted or disparaged whilst opposing unhelpfully evolutionary approaches. It first considers methodological challenges to adopting a fruitful retrospective gaze on medieval textuality, specifically problems of teleology and etymology. Focusing on the Old French roman and Middle French nouvelle as the genres most targeted as precursors in histories of the novel, it uncovers unexpected aspects of such points of comparison, especially in light of the modern novel’s and medieval romance’s shifting generic and formal histories. Selected elements of form (language, prose/verse, narrative structure, paratext) are examined to promote modern-medieval literary dialogue. A concluding case study of the fourteenth- and fifteenth-century dit proposes a fresh approach to identifying what, in chronologically earlier texts, is beneficial to our thinking about the novel today, in terms of definitional boundaries, the literary representation of individual experience, and reflexivity – the ways storytelling reflects on its own modes and capacities of how to tell a tale.
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.
Methods
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.
Results
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.
Conclusions
DIT delivered in a primary care setting is superior to LIT and can be appropriately compared with CBT in future RCTs.
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