Transdiagnostic Potential of Person-Centered (Reconstructive) Psychotherapy: Focus on Comorbid Depressive and Anxiety Disorders On the 95th Anniversary of Boris D. Karvasarsky

On the occasion of the 95th anniversary of the birth of the outstanding psychotherapist B.D. Karvasarsky, this article explores the transdiagnostic potential of person-oriented (reconstructive) psychotherapy (PORP) in treating comorbid depressive and anxiety disorders. Developed within the Leningrad–St. Petersburg school of psychotherapy, PORP is based on V.N. Myasishchev’s psychological theory of relationships and views the patient’s disrupted relational system as the primary pathogenetic factor in neurotic disorders. Unlike the mononozological approach focused on ICD-10 diagnoses, the transdiagnostic potential of PORP emphasizes deep personality mechanisms that underlie various clinical manifestations. PORP consists of several sequential stages: diagnosis and establishment of contact, insight and confrontation, reconstruction of the relational system, and consolidation of new attitudes in everyday practice. PORP demonstrates particular effectiveness in comorbid conditions, as it interprets depression and anxiety as complementary responses to disturbed relationships.

The advantages of PORP include a holistic approach to personality, work with deep structural layers, a high degree of individualization, and the ability to achieve not only symptomatic relief but also sustained changes in personality functioning, significantly reducing the risk of relapse. The article emphasizes the importance of developing transdiagnostic approaches in psychotherapy to overcome the limitations of current diagnostic practices and achieve stable remission in complex clinical cases.

1. Burlakova NS. Myasishchev’s Personality-Oriented Reconstructive Psychotherapy: Current State and Development Prospects. Konsul’tativnaya psikhologiya i psikhoterapiya. 2021;29(1):70–87. (In Russ.). ttps://doi.org/10.17759/cpp.2021290105

2. Vasileva AV, Karavaeva TA. Psychosocial factors of the neurotic disorders treatment and prevention in metropolis. Obozrenie psikhiatrii i meditsinskoi psikhologii imeni V.M. Bekhtereva. 2020;(2):95-104. (In Russ.). https://doi.org/10.31363/2313-7053-2020-2-95-104

3. Isurina GL, Karpova EB, Zhuravlev AL. Psychological concept of relations of v. N. Myasishchev: the doctrine of neuroses and psychotherapy. Psikhologicheskii zhurnal. 2021;42(2):36–44. (In Russ.). https://doi.org/10.31857/S020595920014238-7

4. Karavaeva TA, Vasileva AV, Radionov DS, et al. Clinical and etiopathogenetic aspects of depressive and anxiety disorders’ comorbidity: towards the problem of achieving stable remission. Obozrenie psikhiatrii i meditsinskoi psikhologii imeni V.M.Bekhtereva. 2024;58(4-1):23-33. (In Russ.) https://doi.org/10.31363/2313-7053-2024-975

5. Karavaeva TA, Mikhailov VA, Vasileva AV, et al.A comparative study of the efficacy of personality-oriented (reconstructive) and cognitive-behavioral psychotherapy in neurotic anxiety disorders with insomnia. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. Spetsvypuski. 2018;118(4 2):60-66. (In Russ.). https://doi.org/10.17116/jnevro20181184260

6. Karvasarsky B.D. Psikhoterapevticheskaya entsiklopediya — Sankt-Peterburg : Piter, 1998. (In Russ.).

7. Karvasarsky B.D. Aktual’nye zadachi razvitiya teorii i praktiki psikhoterapii na sovremennom etape. V kn.: 3 Mezhdunarodnyi simpozium sotsialisticheskikh stran po psikhoterapii. — L., 1979. (In Russ.).

8. Karvasarsky B.D., Murzenko V.A. Gruppovaya psikhoterapiya pri nevrozakh. Aktual’nye voprosy meditsinskoi psikhologii. — L., 1974. (In Russ.).

9. Lysenko IS, Karavaeva TA. Level and Structure of Personal and Interpersonal Conflict in Patients with Neurotic Disorders. Vestnik psikhoterapii. 2016;(58(63)):57–74. (In Russ.).

10. Myasishchev V.N. Psikhologiya otnoshenii: Izbrannye psikhologicheskie trudy. Pod red. A.A. Bodaleva. — Moskva : Izd-vo Mosk. psikhol.-sots. in-ta; Voronezh : MODEK, 2011. (In Russ.).

11. Pryanyk A.V. Gid po kognitivno-povedencheskoi terapii: istoriya, effektivnost’ i ogranicheniya KPT. [ippss.ru]. Ippss; 2025. [cited 5 March 2025] Available at: https://ippss.ru/blog/gid-po-kognitivno-povedencheskoj-terapii-istoriya-effektivnost-iogranicheniya-kpt (In Russ.).

12. Psikhoterapiya: natsional’noe rukovodstvo / Pod red. A.V. Vasil’evoi, T.A. Karavaevoi, N.G. Neznanova. [rosmedlib.ru]. Rosmedlib; 2023. Available at: https://www.rosmedlib.ru/doc/ISBN9785970485590-ISBN9785970485590-1/-esf2k2z11-tabrel-mode-pgs.html (In Russ.). https://doi.org/10.33029/9704-7567-6-PSY-2023-1

13. Savina MA, Petrova EA, Ponevezhskaya EV. Transdiagnostic approach in psychotherapy, psychiatry and neuropsychiatry. Psikhicheskoe zdorov’e. 2023;18(2):44-48. (In Russ.).

14. Barlow DH, Farchione TJ, Bullis JR, et al. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Compared With Diagnosis-Specific Protocols for Anxiety Disorders: A Randomized Clinical Trial. JAMA Psychiatry. 2017;74(9):875-884. https://doi.org/10.1001/jamapsychiatry.2017.2164

15. Barlow D.H., Farchione T.J., Sauer-Zavala S., et al. Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide. 2nd ed. Oxford University Press; 2017.

16. Bolton P, Lee C, Haroz EE, et al. A transdiagnostic community-based mental health treatment for comorbid disorders: development and outcomes of a randomized controlled trial among Burmese refugees in Thailand. PLoS Med. 2014;11(11):e1001757. https://doi.org/10.1371/journal.pmed.1001757

17. Brandl F, Weise B, Mulej Bratec S, et al. Common and specific large-scale brain changes in major depressive disorder, anxiety disorders, and chronic pain: a transdiagnostic multimodal meta-analysis of structural and functional MRI studies. Neuropsychopharmacology. 2022;47(5):1071-1080. https://doi.org/10.1038/s41386-022-01271-y

18. Bullis JR, Fortune MR, Farchione TJ, Barlow DH. A preliminary investigation of the long-term outcome of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Compr Psychiatry. 2014;55(8):1920-1927. https://doi.org/10.1016/j.comppsych.2014.07.016

19. Cuijpers P, Quero S, Noma H, et al. Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types. World Psychiatry. 2021;20(2):283-293. doi:10.1002/wps.20860

20. Cuijpers P, van Straten A, Warmerdam L, Smits N. Psychotherapy vs. other interventions as currently used in adult patients with major depressive disorder: A meta-analysis. J Affect Disord. 2009;114(1– 3):227–235. https://doi.org/10.1016/j.jad.2008.07.018

21. McWilliams N. Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process. Guilford Press; 2011:45-75.

22. Murray LK, Dorsey S, Haroz E, et al. A Common Elements Treatment Approach for Adult Mental Health Problems in Low- and Middle-Income Countries. Cogn Behav Pract. 2014;21(2):111-123. https://doi.org/10.1016/j.cbpra.2013.06.005

23. Norcross J.C., Goldfried M.R., eds. Handbook of Psychotherapy Integration. 3rd ed. Oxford University Press; 2019:3-27.

24. Norton PJ, Paulus DJ. Transdiagnostic models of anxiety disorder: Theoretical and empirical underpinnings. Clin Psychol Rev. 2017;56:122-137. doi:10.1016/j.cpr.2017.03.004

25. Ter Meulen WG, Draisma S, van Hemert AM, et al. Depressive and anxiety disorders in concert-A synthesis of findings on comorbidity in the NESDA study. J Affect Disord. 2021;284:85-97. doi:10.1016/j.jad.2021.02.004

26. Wittchen HU, Zhao S, Krause P, et al. Frequency, clinical relevance and comorbidity of subthreshold syndromes of depression and anxiety. Acta Psychiatr Scand. 1994;90(S386):1–8. https://doi.org/10.1111/j.1600-0447.1994.tb00325.x