Modern Possibilities

By Charity Shumway

How Effective is Psychodynamic Therapy for Depression?

New treatments for depression grab headlines on a regular basis, but how effective are they? How does one form of treatment compare to another? Psychodynamic therapy has been widely used to treat depression for decades, but few studies have empirically examined its effectiveness. In 2001, Jacques P. Barber, Ph.D., who joined the Gordon F. Derner Institute of Advanced Psychological Studies as dean in August 2011, and colleagues at the University of Pennsylvania set out to conduct just such a study.

With funding from the National Institute of Mental Health, they recruited a sample of 156 patients suffering from a major depressive disorder and randomly assigned each patient to one of three treatments for a 16-week period: psychodynamic therapy, antidepressant medication or a placebo.

What the researchers found surprised them. Dr. Barber and his colleagues expected results indicating that treatment with either psychodynamic therapy or medication would be more effective than treatment with a placebo. Disappointingly, no real differences emerged among the treatments.

But further analysis of the data yielded more surprises. “We looked at the impact of gender and minority status, and we found a significant interaction,” Dr. Barber says.

The study drew participants from urban Philadelphia and, as a result, the sample population was 52 percent minority and 41 percent male, much higher percentages of minorities and males than in the typical samples of patients in pharmacotherapy trials for depression.

When they looked at subgroups within the sample, Dr. Barber and his colleagues found real differences emerged among outcomes. For minority men, psychodynamic therapy proved most effective. For white men, the placebo emerged as the most effective treatment. For minority women, no significant difference was found among the treatments.

White women were the only group for whom the study’s original hypothesis proved true. For that subgroup, medication and psychodynamic therapy both proved more effective than a placebo treatment.

The study was published in The Journal of Clinical Psychiatry in December 2011, and Dr. Barber is hopeful that the publication will lead to further research. “Our results were interesting, but with only 156 patients, when you speak about three groups of patients, you don’t have that many patients per treatment cell,” he says.

Additionally, there is the concern that the original goal of the study was not to examine minority and gender-related outcomes, and post-hoc analysis means additional research is necessary to replicate the findings. With this in mind, Dr. Barber is optimistic about future research in this area. “Hopefully, people will see the research and decide to study these kinds of questions,” he says.

Can the Wii Get Preschoolers Up and Moving?

Most gaming systems involve minute hand motions with a controller, but the Nintendo Wii is different. Real-time physical movements translate directly to on-screen activity. And alongside this difference in playing technology comes a difference in audience. Instead of traditional gamers—typically older males—the audience for the Wii is much more likely to be a family, with players from very young children all the way up to grandparents, all playing along.

For Associate Professor of Communications Anna Akerman, Ph.D., this shift in players presented a new opportunity: if preschool-aged children were already playing with the Wii, why not create a game specifically geared for their physical and cognitive abilities?

In coordination with colleagues at Nickelodeon, where she also serves as an academic consultant, Dr. Akerman rose to the challenge. Rather than the traditional industry model of developing a game, then testing it with consumers, Dr. Akerman and her colleagues flipped the process, first conducting a study of preschoolers and their families’ interactions with video game systems, and then designing a game based on their findings.

Using data drawn from 26 in-home interviews, Dr. Akerman and her colleagues were able to identify a number of essential ingredients for a successful Wii game for preschoolers, all of which they then incorporated into a game called Go, Diego, Go! Safari Rescue.

“We had to avoid text,” Dr. Akerman says. “It’s obvious, but important.” Fine motor skills, such as angling the controller, and complex, multi-step controller actions were also consistently difficult for preschoolers, so the Safari Rescue game requires only simple, unrefined movements. Additionally, preschoolers’ movements in general are larger and more exaggerated than older players’ movements, so the hot spots in the game that recognize movement were designed to be both larger and less sensitive.

They also found that parents or older children were almost always playing Wii games alongside preschoolers, so their game was designed with ample opportunities for multiple players.

In addition to sharing their findings with colleagues through publication in the International Journal of Gaming and Computer-Mediated Simulations, Dr. Akerman and her collaborators had the reward of not just designing a new game, but also of seeing it successfully go to market. “There just wasn’t anything like it out there,” Dr. Akerman says.

What is more, Dr. Akerman points out, “There’s that hope in the back of everyone’s mind when we talk about the Wii: It’s a way to get kids moving.”

Embryo Adoption and the Future of In Vitro Fertility Treatment

Thanks to advances in reproductive technology, infertility treatments are more effective than ever, but advancements in one form of technology, in vitro fertilization (IVF), have led to a new area of concern and potential controversy. Physicians are now able to extract and successfully fertilize many eggs from women’s ovaries—sometimes far more than a dozen—which increases the likelihood of successful conception, but which also leads to multiple embryos in frozen storage that couples may not ultimately use. Worldwide, there are now more than half a million frozen embryos. What should be done with the excess embryos once couples decide their families are complete?

In 2008, Adelphi University School of Social Work Clinical Assistant Professor Marilyn Paul, Ph.D., and Professor Roni Berger, Ph.D., along with two collaborators from other universities, began a study of couples who, once their own families were complete, chose to donate their frozen embryos to other families through an embryo adoption agency—a practice that elicits controversy on many levels.

In many countries, options for embryo relinquishment are limited, but in the United States, couples have five choices. They may: 1) use all the embryos themselves; 2) dispose of them; 3) donate them to research; 4) donate them to other couples or individuals; or 5) leave them in storage indefinitely.

“There’s no regulation in the U.S. at all on assisted reproduction. There are guidelines from professional associations, but that’s all,” Dr. Paul explains.

For some study participants, the decision to donate their embryos to other families came easily. For others, it was more emotionally challenging. While the reasoning behind the decision varied, a clear finding emerged: every participant in the study reported satisfaction with the final decision.

Despite this ultimate satisfaction, another clear finding of the study was that for each couple, fully understanding the options available to them was a challenge. Among the 18 couples and seven women who comprised the sample, none of them had received counseling or advisement on the options for embryo disposition at any point during their infertility treatment. All of them had found the embryo adoption agency on their own, through online forums or through discussions with friends, without any professional advising.

In the results of their study, published in Family, Systems, & Health in 2010, Dr. Berger, Dr. Paul and their colleagues suggested several directions for the future, among them providing access to comprehensive information about frozen embryo disposition much earlier in the process.

“When people get to the point in infertility where they are utilizing in vitro fertilization, they are focused on having a baby. They do not think, ‘What will I do with the excess embryos?’” Dr. Berger says. “As practitioners and mental health professionals, we understand that,” Dr. Paul continues. “But the challenge is how to incorporate an appropriate level of future thinking into the fertility treatment process.”

“There must be a better way to learn about the options, and there must be a way to offer support throughout. That leaves us with a lot of things to do,” Dr. Berger says.