Multi-Level Outcome Study of Psychoanalyses of Chronically Depressed Patients with Early Trauma (MODE)

MODE thus investigates the outcomes of psychoanalytic long-term treatment with different intensities (frequent versus less frequent weekly sessions) for this specific patient population. Patients are randomly assigned to one of the two treatment conditions. The patient population consists of chronically depressed individuals who have experienced severe childhood trauma. The major hypothesis is that for this group of patients, intensive frequent treatment produces demonstrably better outcomes, achieved more rapidly, in comparison to less frequent psychoanalytic treatment. Treatment outcomes will include depressive symptom severity and MRI-based brain measures. Treatment progress will be followed in relation to symptom reduction (using standard psychological measures), structural change (defined by psychoanalytic methods), and neurobiological change (assessed using MRI). Centers for the initial phase of the study are in Los Angeles, Frankfurt, Cologne/Bochum and Leipzig, Germany and Lausanne, Switzerland.

Prof. Dr. Leuzinger-Bohleber will give an overview of the historical, institutional and conceptual background of the study, the design, the problematic nature of psychoanalytic manuals and the state of the study. We have screened more than 90 patients as of November 2021. More than 50 patients are now in psychoanalyses. A detailed case study will be used to illustrate, among other things, why the MODE design has been shown to be particularly suitable for chronically ill patients between the ages of 20 and 30 who suffer from characteristic conflicts of so called “emergent adulthood.” Dreams illustrate that psychoanalysis offers a unique opportunity to therapeutically process a developmental stand-still in this age group.

High frequency psychoanalysis may be more effective in this clinical context because it may be better able to promote reconsolidation of early life trauma memories. As reconsolidation of emotional memories occurs during REM sleep when most dreaming occurs, dream reports will be used as an outcome measure. Dr. Lane, a consultant to the MODE study, will focus his remarks on the phenomenon of memory reconsolidation as it applies to psychotherapy and psychoanalysis and will discuss the opportunities and challenges in testing the memory reconsolidation hypothesis as a mechanism of enduring change.

Suggested Readings:
Leuzinger-Bohleber, M., Hautzinger, M., Fiedler, G., Keller, W., Bahrke, U., Kallenbach, L., … & Küchenhoff, H. (2019a). Outcome of psychoanalytic and cognitive-behavioural long-term therapy with chronically depressed patients: a controlled trial with preferential and randomized allocation. The Canadian Journal of Psychiatry, 64(1), 47-58.

Leuzinger-Bohleber, M., Kaufhold, J., Kallenbach, L., Negele, A., Ernst, M., Keller, W., … & Beutel, M. (2019b). How to measure sustained psychic transformations in long-term treatments of chronically depressed patients: Symptomatic and structural changes in the LAC Depression Study of the outcome of cognitive-behavioural and psychoanalytic long-term treatments. The International Journal of Psychoanalysis, 100(1), 99-127.

Neuroscience of Enduring Change: Implications for Psychotherapy. Edited by Lane R & Nadel L. New York, Oxford University Press, 2020.

About the Presenters:
Marianne Leuzinger-Bohleber, Prof. Dr. Phil, Director in charge of the Sigmund-Freud-Institut in Frankfurt am Main, Germany (2001-2016), Professor emerita for psychoanalysis at the University of Kassel, senior professor at the IDeA Excellency Center in Frankfurt am Main. and the University Medicine in Mainz. She is training analyst of the German Psychoanalytical Association (DPV) and the International Psychoanalytical Association (IPA). Chair of the Research Subcommittees for Clinical, Conceptual, Epistemological and Historical Research of the IPA (2001-2009), Vice Chair for Europe of the Research Board of the IPA 2010- 2021; IPA Subcommittee for Migration and Refugees (Chair: 2018/19). She received the Mary Sigourney Award 2016 and the Haskell Norman Prize for Excellence in Psychoanalysis 2017. Her research fields are clinical and extra-clinical research in psychoanalysis, psychoanalytical developmental research, prevention studies, interdisciplinary dialogue between psychoanalysis and literature, educational sciences and the neurosciences.

Richard D. Lane, M.D., Ph.D. is Professor of Psychiatry, Psychology and Neuroscience at the University of Arizona. A clinical psychiatrist and psychodynamic psychotherapist with a Ph.D. in Experimental Psychology (systems neuroscience and emotion research), he is the author of 190 papers and book chapters and is senior editor of two books. He was President of the American Psychosomatic Society in 2005-6, elected member of the American College of Neuropsychopharmacology, Distinguished Life Fellow of the American Psychiatric Association and elected Honorary Fellow of the American College of Psychoanalysts. Guiding themes in his research and scholarship have been the importance of integrating systems neuroscience with psychological conceptualizations and the need to bridge basic science and clinical application. These themes have driven his work on emotional awareness, the role of emotion in mind-brain-body interactions and the mechanisms by which memory and emotion interact to make enduring change in psychotherapy possible.