Clinical intervention and training

Online intervention for people who have difficulties overcoming the loss of a dear one

Losing a close person, either by death, divorce or separation, is inherent to the human condition, but is nevertheless a particularly stressful life event. It is associated with poor psychological, social and physical health outcomes. Some people show major difficulties in coping with this event that can lead to pathological symptoms.

Regarding the access to preventive treatment, innovative tools have been developed, such as Internet interventions. These are proved to be effective in a variety of disorders (e.g., anxiety and depressive disorders), including complicated grief. Aiming at preventing symptoms of complicated grief, Brodbeck, Berger and Znoj (2017) developed a German internet intervention based on cognitive-behavioural therapy elements (LIVIA) for bereaved and separated individuals. This program significantly diminished grief symptoms and improve well-being. However, to date, there is no empirically validated grief internet intervention in French. Thus, the first objective of this research is to test the French version of LIVIA (LIVIA-1). The second and main objective is to develop a new version, LIVIA-2, which introduces innovative elements designed to facilitate its use in an unguided format, that is, an internet intervention without external support by professionals (e.g. via email). LIVIA-2 is thus part of the current trend of digitalization of the prevention and care of mental disorders.

To foster adherence and efficiency of the program, we will bring about the following developments:

a) a greater inclusion of positive psychology aspects (more explicit assessment and mobilization of individual and social resources)

b) a reorganisation of the modules to better align with current bereavement models

c) the introduction of a novel specific module focused on the memory processes

d) the possibility of navigating between modules more autonomously and, if possible, better adapted to the needs and capacities of its users

We will compare the effects of LIVIA-1 and 2 at post-intervention and six-month follow-up. The main goal of this research is to offer an effective and handy preventive intervention, a fellow traveller accessible at all times to French-speaking people who have difficulties overcoming the loss of a loved one.

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The present project is funded by the Swiss National Science Foundation and is part of the NCCR LIVES.

CARLA collaborators:
Dr. Anik Debrot, PhD, Principal Investigator
Prof. Valentino Pomini
Dr. Laurent Berthoud, Senior researcher
Liliane Efinger, PhD student
Maya Kheyar, PhD student
Mihaela Moga, student assistant

Research partners:
Dr. Tanja Bellier-Teichmann, Haute Ecole de la Santé la Source- HES-SO, Lausanne
Prof. Thomas Berger, University of Bern
Prof. Jeannette Brodbeck, FHNW
Prof. Hansjörg Znoj, University of Bern

Alliance repair in psychotherapy

Research suggests that the best therapists are the ones that are better able to identify and repair alliance ruptures, which are common in therapy. Developing the capacity to manage these disruptions should be an important component of the therapist training curricula. However, this type of training is currently not widely available.

This study examines the effects of a two-day training workshop on the repair of alliance ruptures, based on the model developed by Safran & Muran (1996, 2000). This research involves 37 participants, who are therapists in their first or second year of postgraduate training in psychotherapy. They were randomized in two separate groups: 1) participants assigned to the experimental condition were trained in therapeutic alliance repair strategies and 2) control condition participants were placed on a waiting list and had the opportunity to participate in the training once the study was completed. The therapists' competence to manage the alliance was assessed before and after the training through a standardized role-playing setup realized with professional actors who simulated an episode of alliance rupture. Based on the video recordings of these role-playing games, coders used a hetero-evaluative instrument (the 3RS) to measure the frequency of use of resolution strategies, their clarity and their impact.

The results show that the evolution of competences is significantly different according to the experimental condition. While there is no change in control group participants, experimental group participants improve their ability to restore the alliance, use more resolution strategies and formulate them more clearly. The impact of the resolution strategies employed by participants who received training is also increased.

In general, these results support the benefit of the integration of alliance-centered training into the psychotherapy training curriculum.

CARLA collaborators:
Diana Ortega
Valentino Pomini

Supported employment for borderline personality disorders

Employment has shown highly positive effects on recovery from mental health problems, because of financial as well as interpersonal reasons. In that sense, several vocational rehabilitation programs have been developed to help people suffering from psychiatric disorders regain employment. The Individual Placement and Support (IPS) model has proved to be the most efficient program to help people with severe mental illness find an employment. Its main aim is to help people with psychiatric disorders to reintegrate competitive employment as quickly as possible, rather than going through long periods of training or sheltered jobs. However, no study has yet proved IPS efficiency with people suffering from borderline personality disorder. These patients show several serious functional deficits that negatively affect their employment trajectories. The goal of this research is to establish the picture of vocational rehabilitation programs for borderline personality disorder patients, and to test the IPS effectiveness with this population. The final aim is to improve the clinical practice of supported employment team when facing this category of patients.

CARLA Collaborators :
Noëllie Dunand
Valentino Pomini
Philippe Golay

External Collaborators :
Daniele Spagnoli
Charles Bonsack

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