eprintid: 1540251 rev_number: 29 eprint_status: archive userid: 608 dir: disk0/01/54/02/51 datestamp: 2017-03-16 12:22:52 lastmod: 2020-02-13 08:25:53 status_changed: 2017-03-16 12:22:52 type: thesis metadata_visibility: show creators_name: Rost, FM title: Treatment-resistant depression at different developmental levels - the anaclitic and introjective depression assessment ispublished: unpub divisions: UCL divisions: A01 divisions: B02 divisions: C07 divisions: D05 divisions: F66 abstract: Individuals with long-term and relapsing forms of depression are at a serious disadvantage due to the shortage of research evidence guiding their clinical management. Moreover, differences in responsiveness to treatment might result as a function of the interactions between patients’ pre-treatment personality characteristics and various aspects of the therapeutic process. This PhD takes the Two-Configurations model developed by Blatt and collaborators as its starting point. In order to circumvent well-known biases of self-report questionnaires as well as difficulties of available instruments to assess issues of dependency and self-criticism at different developmental levels reliably, the aim was to develop a viable alternative following a person-centred approach. After introducing the conceptualisation of treatment-resistant depression from four angles (the psychiatric, the psychoanalytic, the private, and Blatt’s integrative approach), the development and preliminary validation of the Anaclitic Introjective Depression Assessment (AIDA) is presented. This observer-rated measure was developed using expert consensus rating and Q-methodology. Psychometric properties, preliminary reliability, and validity were established using a sample of 128 patients diagnosed with treatment-resistant depression from a randomised controlled trial investigating the effectives of psychoanalytic psychotherapy (the TADS study). Using Q-Factor analysis, four naturally occurring clusters of patients representing concerns with relatedness and self-definition were identified. Anaclitic and introjective issues of severe depression appear to be expressed at different developmental levels. Whether and to what extent the four factors of depressed patients differed was investigated by testing their relations to expert anaclitic/introjective prototypes, developmental adversity, and various functioning indices. Finally, using multi-level modelling, their differential response to psychoanalytic treatment compared with treatment-as-usual was investigated. Overall, findings provide preliminary evidence for the reliability and validity of the new measure and evidence that anaclitic and introjective concerns are hierarchically organised among individuals with severe depression. Limitations, and implications for future research and clinical practice are discussed. date: 2017-02-28 date_type: published thesis_class: doctoral_md_only language: eng thesis_view: UCL_Thesis verified: verified_manual elements_id: 1207471 lyricists_name: Fonagy, Peter lyricists_name: Luyten, Patrick lyricists_name: Rost, Felicitas lyricists_id: PFONA04 lyricists_id: PLUYT39 lyricists_id: FMROS97 actors_name: Rost, Felicitas actors_id: FMROS97 actors_role: owner full_text_status: none pages: 331 event_title: UCL (University College London) institution: UCL (University College London) department: Clinical, Educational and Health Psychology thesis_type: Doctoral editors_name: Fonagy, P editors_name: Luyten, P citation: Rost, FM; (2017) Treatment-resistant depression at different developmental levels - the anaclitic and introjective depression assessment. Doctoral thesis , UCL (University College London).