Thirty Years of the DCPR with Jenny Guidi, PsyD, PhD

Journal of Clinical Psychiatry

Publisher of peer-reviewed research discussed in this episode.

Thirty Years of the Diagnostic Criteria for Psychosomatic Research (DCPR): A Systematic Review and Discussion of Clinical Implications

https://www.psychiatrist.com/jcp/Thirty-years-Diagnostic-Criteria-Psychosomatic-Research-systematic-review

Dr. Guidi’s systematic review of all 14 DCPR syndromes across 96 studies, the focus of this episode.

The Demoralization Construct in Clinical Practice and Research (de Figueiredo)

https://www.psychiatrist.com/jcp/demoralization-construct-clinical-practice-research/

Companion commentary on distinguishing demoralization from depression, discussed in the episode.

Biography Inscribed in Biology (Horwitz)

https://www.psychiatrist.com/jcp/biography-biology-diagnostic-criteria-psychosomatic-research-embodiment-lived-experience/

Companion commentary on allostatic overload and the embodiment of lived experience.

Dr. Jenny Guidi – LinkedIn

https://www.linkedin.com/in/jenny-guidi-psyd-phd/

Jenny Guidi, PsyD, PhD, is an associate professor of clinical psychology at the University of Bologna and director of psychometric and clinimetric studies at CTNI, Massachusetts General Hospital. A clinical psychologist and researcher, she focuses on psychosomatic medicine, psychological assessment, and clinimetrics. She trained under Professor Giovanni Fava at the University of Bologna and as a research associate in the Department of Psychiatry at Mass General. She is first author of a systematic review spanning 30 years of DCPR research.

Ben Everett, PhD, is the creator and host of The JCP Podcast, a series that brings together leading voices in psychiatry to explore the latest research and its clinical implications. Everett earned his PhD in Biochemistry with an emphasis in Neuroscience from the University of Tennessee Health Science Center. Over a two-decade career spanning academia, publishing, and the pharmaceutical industry, he has helped launch more than a dozen new treatments across psychiatry, neurology, and cardiometabolic medicine. His current work focuses on translating complex scientific advances into accessible, evidence-based insights that inform clinical practice and foster meaningful dialogue among mental health professionals.

This transcript has been auto-generated and may contain errors. Please refer to the original audio recording for full accuracy.

00:00 – Introduction and Dr. Guidi’s Path to the DCPR Review

Dr. Ben Everett: Hello, and welcome to the “JCP Podcast.” I’m your host, Dr. Ben Everett. On the podcast, we sit down with leading clinicians, researchers, and educators to explore the science shaping mental health care today with a focus on the insights that matter most in clinical practice.

Dr. Ben Everett: Today on the JCP podcast, we’re talking about something that sits right at the intersection of psychiatry and medicine, how we understand the psychological and behavioral dimensions of patients who are medically ill. My guest today is Dr. Jenny Guidi, a clinical psychologist and researcher whose work is focused extensively on psychosomatic medicine, psychological assessment, and clinimetrics.

She’s currently an associate professor of clinical psychology at the University of Bologna and directs the psychometric and clinimetric studies at Massachusetts General. Dr. Guidi is first author of a new systematic review looking at over thirty years of research on the diagnostic criteria for psychosomatic research or DCPR.

It’s currently in press in JCP. This new assessment includes all 14 DCPR syndromes across 96 separate studies. It was quite an undertaking. What I found particularly interesting about this conversation is that we really moved beyond the question of what are the DCPR and into the bigger question, what might we be missing when we look at a medically ill patient primarily through the lens of traditional psychiatric diagnosis?

We spend quite a lot of time on demoralization and how it differs from depression, and Dr. Guidi gives a great way of thinking about that distinction. We also talk about allostatic overload and her description of it as a bridge between a person’s biography and biology, and I love that phrase, biography and biology. The idea that our lived experiences can become embedded in the biology of health and illness.

Ultimately, we come back to the practical question, how do we take these concepts and make them useful to clinicians? It’s a fascinating conversation about the way psychological experience, medical illness, and the biology of stress intersect and what that means for how we assess and care for patients. So let’s get into it. Dr. Guidi, welcome to the podcast.

Dr. Jenny Guidi: Thank you very much indeed for inviting me. It’s a great pleasure to be here.

Dr. Ben Everett: Thank you. I think we’re gonna have a lot of fun today. So I want to start, go back in time a little bit to your very first research project. Back in two thousand and two, you worked with Dr. Fava on a citation study looking at the impact of Italian research in psychology and psychiatry. So your very first project was really about understanding how research get used and how it spreads.

Now, more than twenty years later, you’ve led a review looking back over thirty years of diagnostic criteria for psychosomatic research or DCPR. Did you think about that connection while you were actually working on this new analysis, or am I making this connection for you?

Dr. Jenny Guidi: It was quite a long time ago. My master’s dissertation focused on citation analysis to monitor the impact of Italian academic research in psychology and psychiatry. Then received further training at University of Bologna, under Professor Giovanni Fava’s supervision, I conducted several systematic reviews and meta-analysis on different topics, the efficacy and tolerability of antidepressants, withdrawal symptoms following their discontinuation, efficacy of the sequential treatment model in major depressive disorder, and allostatic load and its impact on health. But given the extensive clinical research over the past three decades of the DCPR across different medical settings, Professor Giovanni Fava, Nicoletta Sonino, and I felt that the systematic review was long overdue.

Dr. Ben Everett: Yeah. I certainly enjoyed reading it. It’s in press right now in JCP. And you’ve– you told me you’ve just come back from a sabbatical where you went back to Massachusetts General Hospital and you did your early research training there, you mentioned, and now you’re actually directing work in psychometrics and clinimetrics at at Massachusetts General.

What is it like to come back and continue that research tradition there?

Dr. Jenny Guidi: Well, during my post-graduate training and later during my PhD, I spent some times in the US and worked as a research associate in the Department of Psychiatry, Mass General, where under Pr- Dr. George Papakostas’ supervision, I became familiar with the theoretical principles and the practical applications of systematic reviews and meta-analysis. Have continued my collaboration with Mass General over the years as a consultant, and I was recently appointed director in psychometric and clinimetric studies at CTNI. This long-standing collaboration has been a tremendous source of research opportunities, fostering new scientific partnerships, generating innovative research ideas, and leading to exciting developments, I have to say.

05:00 – What the DCPR Detect Beyond DSM and the 2017 Revision

Dr. Ben Everett: Congratulations on your appointment to the directorship there and that sounds wonderful. All right let’s get into it. And really, let’s start with the basic question. The DCPR were first proposed over thirty years ago, around thirty years ago, and then there was a revision in 2017.

So in simple terms, what can the DCPR pick up in a medically ill patient that say DSM or maybe an ICD code can’t pick up or might miss?

Dr. Jenny Guidi: The DCPR framework expand the traditional domains of clinical evaluation by translating psychosocial factors that affect the development course and outcome of medical diseases into clinimetric diagnostic criteria. Flaws and clinical inadequacies in traditional psychiatric diagnostic system, especially when applied to medically ill patients, paved the way for their development. An extensive body of literature has shown that key psychosocial factors, distinct from psychiatric comorbidities and encompassing the patient’s subjective experience of illness, likely to affect the course and outcome of medical disorders, but cannot be detected using the assigned criteria alone.

Dr. Ben Everett: Your paper points to an important gap in the DSM, especially after the removal of the old Axis IV system. Why do you think the category of, and this is in quotes, “psychological factors affecting other medical conditions,” end quote, has been enough?

Dr. Jenny Guidi: Traditional psychiatric taxonomy, particularly after the removal of the DSM axis IV on psychosocial and environmental problems, does not fully address the complexity of psychosocial aspects of medical illness. DSM relies on the poorly ill-defined category of psychosocial factors affecting other medical conditions, making an artificial mind-body distinction, on the diagnosis, of of adjustment disorder, which is essentially an exclusion diagnosis. The DCPR provide an essential integration to the customary psychiatric taxonomy in the context of medical illness. Also provide clinically meaningful specifiers that could serve as subclassification headings within the this otherwise inadequately defined DSM category.

Dr. Ben Everett: Yeah. And then in 2017, there was this revision. Can you give us a sense of what led to these changes, especially adding allostatic overload and hypochondriasis and allowing demoralization to be diagnosed along with major depression.

Dr. Jenny Guidi: Yes. The revised version of the DCPR was based on insights derived from their extensive use across different medical settings and included diagnostic criteria for two additional syndromes. Concept of allostatic overload derives from Bruce McEwen’s seminal work on allostasis and allostatic load. And allostatic overload reflects a breakdown of adaptive capacity under sustained environmental demands, resulting in measurable changes across multiple biological systems. It can be assessed using specific clinical metric criteria that were originally developed in subsequently validated, and then included in the revised version of the DCPR. Retaining hypochondriasis, which was omitted from the DSM-5 classification, was also important because specific psychotherapeutic strategies have been developed and validated in randomized controlled trials to address patients’ resistance to reassurance, which is the key characteristic of hypochondriasis and can be effectively modified. As for demoralization, it can be differentiated from major depressive disorder on clinical grounds. Research showed that the two conditions may occur together or independently, even though a diagnosis of major depressive disorder does not necessarily imply the presence of demoralization and vice versa.

09:16 – DCPR Syndromes Across Cardiology, CL Psychiatry, and Primary Care

Dr. Ben Everett: Yeah, I think that’s an important distinction. So in your recent paper a-and analysis, one of the biggest findings was that DCPR syndromes were found more often than formal psychiatric diagnosis in many of the settings you reviewed. In some studies, they were about twice as common. What should that mean to a clinician sitting with a patient?

Dr. Jenny Guidi: Our results suggested that the DCPR captured distinct clinical phenomena rather than merely symptomatic manifestations or attenuated forms of psychiatric disorders. In most studies, the number of DCPR diagnosis was higher than the number of psychiatric diagnosis, even double. Furthermore, while patient who received a psychiatric diagnosis frequently presented with at least one comorbid DCPR syndrome, proportion of patient with DCPR diagnosis did not meet the criteria for any psychiatric diagnostic category, suggesting that standard psychiatric assessment may have missed an important part of their distress. The detection of DCPR syndrome is important also when they occur in the context of psychiatric diagnosis, since they can provide clinically meaningful information. For example, irritable mood may characterize the clinical presentation of major depressive disorder, while demoralization may represent an additional distinct feature of an anxiety disorder. So the DCPR may help identify specific clinical profile and distinguish prognostic and therapeutic differences among patient who might otherwise appear deceptively similar because they share the same psychiatric or medical diagnosis.

Dr. Ben Everett: That’s really good. Twice as many diagnoses, some clinicians might hear that and worry that we’re simply labeling normal distress as an illness. How do you respond to that concern?

Dr. Jenny Guidi: Exclusive reliance on psychiatric diagnostic criteria has restricted clinical assessment to a limited number of symptoms, neglecting the role of psychosocial factors. DCPR syndromes are clinically important when patients do not fulfill the diagnostic criteria for psychiatric disorders and yet present with significant psychological distress, maladaptive illness behavior, or psychosocial impairment. They also provide meaningful characterization and additional clinical information when they co-occur with psychiatric diagnosis. The DCPR disclosed their clinical utility in subtyping medical patients characterized by distinct psychological profiles, identifying subthreshold syndrome not detected otherwise by traditional psychiatric nosography, evaluating the burden of medical disorders, and predicting treatment outcomes.

Dr. Ben Everett: Yeah, it’s very interesting. Another thing y’all found that I found interesting was that these DCPR syndromes occur especially often in certain medical clinics, for example, cardiology, psychiatry, psychosomatic medicine, as well as consultation liaison settings. Why do you think they show up so often in those particular settings?

Dr. Jenny Guidi: We should say that about a quarter of the included studies, 23 in total, were conducted in cardiology, while 21 carried out in psychiatry or psychosomatic settings. 13 studies involved patients recruited from different medical settings, including cardiology and CL psychiatry, studies conducted in other medical specialties were less frequent. Nonetheless, research findings showed that DCPR may help identify allostatic overload, demoralization, irritable mood, illness behavior, and various manifestation of somatization across different medical settings, identify syndrome worthy of clinical attention that are transdiagnostic and may be formulated regardless of medical or psychiatric diagnosis, offering a comprehensive view of key psychosocial factors.

Dr. Ben Everett: That’s very interesting. Is there anything in particular that you think clinicians in primary care can take away from these findings?

Dr. Jenny Guidi: The DCPR can provide clinical meaningful information for the substantial number of primary care patient who do not meet the ASCEND diagnostic criteria and yet present with psychosocial problems. In a large study that we conducted in primary care settings, patient with DCPR syndromes report significantly higher level of stress, psychological distress, and maladaptive illness behaviors, as well as significantly lower quality of life and wellbeing compared to those who had no diagnosis. Such an assessment may be of value in a number of medical situation, such as a disproportionate level of disability compared to what is expected by disease status, or insufficient treatment response, delayed or partial recovery, inadequate self-management, unhealthy lifestyle, and excessive attendance of medical care services, as well as lack of therapeutic adherence.

14:32 – Distinguishing Demoralization From Major Depression

Dr. Ben Everett: Yeah. So I think this is actually really important for that general medicine or general practitioner who may be listening today. All right. You mentioned demoralization a minute ago. I wanna spend a little bit more time on that part of the paper and that syndrome that has really drawn the most attention so far.

You found that this demoralization was the most common DCPR syndrome with a median prevalence of about twenty-four percent. It was the focus of a commentary that was published concomitantly with the paper by an individual who’s done a lot of work on demoralization. I thought his perspective really raised an important question, and it’s how do we understand demoralization as something different from depression?

So let’s start there. How do you think DCPR criteria define demoralization? And when you’re sitting with a patient, what helps you recognize that it’s demoralization rather than major depression?

Dr. Jenny Guidi: The clinimetric formulation of demoralization aligns with Frank’s observation of patients seeking psychotherapy, as well as Schmale and Engel’s clinical descriptions. The unique clinical features of demoralization should be properly assessed through carefully interviewing and distinguished from those of major depression, though they may occur together. The two syndromes are not connected by a hierarchical relationship and call for a differential diagnosis, as pointed out by Professor John de Figueiredo. Unlike depression, demoralization seldom exists as a prolonged and uninterrupted condition. Individuals who are demoralized are willing to take action to improve their situation, but they are uncertain about how to proceed. They feel trapped and doubtful about the future. Are lost, not unmotivated. And drive may be fluctuating and inhibited by helplessness and lack of adequate support, and this uncertainty is called subjective incompetence. That is the clinical hallmark of demoralization. Demoralization occurs in the context of a stressful situation, a huge and pressing problem that disrupts assumptions and expectations. Further, anhedonia is absent in demoralization, as well as lack of energy, insomnia, decreased appetite, and lack of concentration. Suicidal ideation may occur in the presence of hopelessness, they lack the persistent features of depression. Is related to beliefs on one’s own personal failures or inadequacies for which nothing can be done.

Dr. Ben Everett: Yeah, I think that’s really important to, to understand the differences there. One distinction that Dr. de Figueiredo makes in his commentary is that a person who is demoralized may still want to act but doesn’t know how to move forward, whereas someone who is depressed may know what to do but no longer have the drive to do it.

Do you think that distinction holds up when you see patients in practice?

Dr. Jenny Guidi: One may think about it like this. With depression, you know the way out of the woods, but you have zero gas in your tank to get there. Demoralization, you have a full tank of gas, your map is completely blank. You are paralyzed because you have no idea which way to go, and you feel stuck there, inadequately supported by others and lost.

18:08 – Recognizing and Treating Demoralization

Dr. Ben Everett: Yeah interestingly also, demoralization is included in ICD-10 as well as ICD-11, but not in DSM-5. What does that mean for clinicians in the US, you think?

Dr. Jenny Guidi: It is important to acknowledge demoralization as a separate diagnosis because it may occur in the absence of any other syndrome, disorder, or illness. In the US, clinicians are expected to use DSM-5 diagnostic criteria for psychiatric diagnosis, particularly for clinical documentation, communication, and reimbursement. So the fact that demoralization are recognized in the ICD 10 and the ICD 11, but is not included in the DSM-5 means that clinicians cannot simply use as a formally coded psychiatric diagnosis. However, clinician can still recognize and assess demoralization as a clinically meaningful psychological phenomenon, even when the patient does not meet the criteria for a DSM psychiatric disorder. In practice will distinguish between what is formally coded as a psychiatric diagnosis and what is clinically relevant and documented as an important aspect of the patient’s presentation. In this regard, we are conducting a multicenter study at different hospitals in Boston that integrates demoralization into standard psychiatric assessment in CL psychiatry.

Dr. Ben Everett: It’ll be really interesting to, to follow that research as it comes out. I also think the distinction that you just made really does matter clinically. For instance, if you look at some studies in patients with cancer, demoralization without depression was actually linked with higher suicidal ideation.

So what do you think clinicians should do differently when they do recognize demoralization?

Dr. Jenny Guidi: If demoralization goes unrecognized and untreated, patients’ subjective incompetence and helplessness may escalate into hopelessness, a sense of failure, loss of meaning or purpose in life, and may eventually result in suicidal ideation. Clinical differentiation of demoralization is fundamental because it completely changes the treatment plan. It should not be ascribed to a normal reaction to stress or the presence of mood disorders in an attenuated form. On the other hand, if you misdiagnose demoralization as major depression, you are likely to prescribe unnecessary pharmacological treatment for what is essentially a psychological problem. There is no evidence that antidepressant medications are effective. Demoralization is not a diagnostic label that lends itself to the automatic application of a specific therapy, but a clinical syndrome that mandates case formulation according to specific clinical priorities.

Dr. Ben Everett: Yeah, I think that’s a really important distinction to make, is that even what I think as a clinician it’s one of these things where if you can make a diagnosis, does it help you treat the patient? And knowing that there’s no pharmacological, thing that can help this, it’s very important to understand there’s no sense in prescribing a medication unnecessarily.

But psychotherapy, on the other hand, especially well-being therapy, may actually help. So if a clinician’s first response to stress is typically, “I’m gonna prescribe an SSRI,” what should they be doing instead?

Dr. Jenny Guidi: Demoralization is treatable, and psychotherapeutic intervention can reduce demoralization by modifying the perception of stress, restoring hope, and replacing negative cognitive distortions with more positive and realistic appraisal. Well-being therapy in particular is a manualized short-term psychotherapeutic strategy aimed at modulating psychological well-being and may be particularly suitable for counteracting demoralization, particularly when arising from dysfunctional cognitive schemas, since it addresses low levels of psychological dimensions such as environmental mastery, self-acceptance, and purpose in life that may lead to subjective incompetence, feeling that performance do not fulfill the patient’s expectations, and diminished hope and confidence in the future. Further, well-being therapy may also modulate excessive levels of positive relationships that causes selfless devotion to others and a chronic sense of being unfulfilled. Meaning-centered psychotherapy, as well as supportive psychotherapy, can also be applied, and preliminary evidence has suggested the potential role of psilocybin-assisted psychotherapy too.

23:03 – Allostatic Overload: Where Biography Meets Biology

Dr. Ben Everett: Interesting. We’ve been talking a good bit about psychedelics on the podcast, and just really excited to see real research with these agents move forward. All right. Now I want to turn to the other syndrome that generated a lot of discussion, and that is allostatic overload. In your review, allostatic overload was one of the newer DCPR syndromes, and you found it in a substantial proportion of patients as high as 57% in some clinical settings.

The idea is that repeated or ongoing stress can eventually affect the body in ways that you can see and actually will actually manifest clinically. In another commentary, again, several commentaries published concomitantly with this by Dr. Ralph Horwitz, he explained this idea further.

He actually describes the DCPR approach as a way of connecting a person’s lived experience with what we see happening in the body. I thought that was a really interesting way to think about allostatic overload. So really, I’d like to start by asking how you see this concept.

Dr. Jenny Guidi: The concept of allostatic overload provides a theoretical bridge between biography and biology. It derives from Bruce McEwen’s seminal work on allostasis and allostatic load, and the concept of allostatic load reflects the cumulative burden of both chronic stress and life events that exceed an individual resources and ability to cope. It also includes the physiological consequences of the resulting health-damaging behaviors. Our systematic review pointed to the critical role of environmental factors in modulating an individual’s health status, explaining symptom production and illness configuration in functional medical disorders, and post-acute vulnerabilities in medical patients. So allostatic overload reflects a breakdown of adaptive capacity under sustained environmental demands, resulting in measurable changes across multiple biological systems that represent the biological embedding of experience. Biography and life experiences are literally written into their biology.

Dr. Ben Everett: I love that biography and biology and the connection right there is very clever. But it’s so true, and I think we see it in so many different parts of medicine. But sometimes just having the right wording or semantics really makes it click. I love that. Dr. Horwitz also suggests that this idea can help us move beyond the old separation between mind and body, and that chronic stress and its effects on the body are really a part of the same process.

Do you think that’s a fair way to understand allostatic overload, or you think maybe that’s going a little too far?

Dr. Jenny Guidi: Well, while the DSM-5 category of psychological factors affecting other medical condition implicitly maintains the separation between the mind, psychological factors, and the body, medical conditions, the allostatic load framework moves beyond this artificial distinction. There is no mind acting on the body. Environmental factors and biographical experiences are not merely the context for disease, but are constitutive of the disease and treatment response. When we diagnose allostatic overload and demoralization, we are identifying the clinical manifestation of biography inscribed in biology as a dynamic system continuously shaped by the lived experience of the perspective, and that’s fascinating, isn’t it?

Dr. Ben Everett: Yeah, absolutely. All right, so if a clinician recognizes allostatic overload, how do you think that should change in terms of the patient’s treatment? Is it therapeutic lifestyle changes? Is it a reason to think about psychotherapy? Or can it also change medical care in terms of other types of maybe rehabilitation programs or prescription medicines?

Dr. Jenny Guidi: Medical care should always be guided by clinical judgment, which provides a global assessment that takes into account the specific characteristics and attitudes of the patient, their biography and environmental circumstances, the patient-doctor interaction, and the clinician personal attention, reflections, and experience. The presence of allostatic overload may act as a countertherapeutic factor in both medical and psychiatric patients, affecting treatment response and increasing vulnerability to relapse. Psychological management, not necessarily psychotherapy, and lifestyle modifications should be first considered. Environmental circumstances are often neglected despite their role in explaining partial re- treatment response, treatment resistance, clinical deterioration, and other unfavorable clinical outcomes.

Dr. Ben Everett: Yeah, that’s really interesting. Your review also suggests that allostatic overload may help explain why some patients may be more vulnerable after leaving the hospital than their medical illness alone would suggest. How strong is the evidence for that right now?

Dr. Jenny Guidi: After discharge from the hospital, patient may face a transient period of general vulnerability to disease and an elevated risk of adverse event, including hospital readmission and mortality, is referred to as post-hospital syndrome. It could be viewed as a result of hospitalization-induced allostatic overload, including sleep disruptions mobility restrictions, pain, fears, and psychological distress.

29:02 – Bringing the DCPR Into Routine Clinical Practice

Dr. Ben Everett: All right. So far, a fascinating discussion. We’re getting close to the end of our time together. So I always try to end with, how does this impact people in clinic sitting with patients right now? So I think that’s really the practical question is how do we move from a useful research tool that something that clinicians can actually use?

And I did note that there’s a semi-structured interview, the SSI-DCPR, and it’s actually shown good reliability, but it seems to be underutilized in practice, which is unfortunately something common that we see. There’s a good tool, it’s been published, validated and whatnot, but the clinical uptick is just a little slow.

What do you think the biggest barrier to bringing that DCPR into routine clinical practice is?

Dr. Jenny Guidi: A semi-structured interview based on the DCPR is being developed and must be used only after adequate training. So that would be probably one of the major barrier. But the interviewer should be familiar with the literature on the DCPR. Constraints represent another important factor to bring the DCPR into routine practice. The interview requires prior knowledge of any patient’s medical and or psychiatric diagnosis, disease course over time, and treatment history, and joint psychiatric assessment is recommended. Semi-structured interview is administered in the context of a clinical interview and encompasses 14 diagnostic rubrics, but as a modular structure. It can be used as a full clinical interview or for assessing specific psychosomatic syndromes using individual diagnostic modules. In some collaborative research and clinical project at Mass General, we chose to administer selected individual diagnostic modules according to our research or clinical purposes.

Dr. Ben Everett: Yeah, I think that’s really interesting. All right in closing, one last question for you. So after thirty years in research in this field, if you could leave a clinician who treats, ill patients with just one idea from the DCPR, what would you want that to be?

Dr. Jenny Guidi: The DCPR can help identify transdiagnostic syndrome that may be established regardless of medical or psychiatric diagnosis, offering a comprehensive view of key psychosocial factors. These syndromes are particularly important when medically ill patients do not fulfill the diagnostic criteria for psychiatric disorders and yet present with significant psychological distress. They also provide clinically meaningful information when they co-occur with psychiatric diagnosis.

Dr. Ben Everett: Excellent. Dr. Guidi, this has been a real pleasure. We’ve covered a good bit today why the DCPR were originally developed things that led to the revision in twenty seventeen, what they can tell us about demoralization and allostatic overload, and what it may take to bring these ideas into everyday care.

So I wanna thank you for having this conversation and bringing it to our listeners today.

Dr. Jenny Guidi: Thank you so much for this opportunity. It was such a meaningful conversation.

Dr. Ben Everett: Absolutely. For our listeners, we’ll have all our citations, research references, everything else will be in our show notes at psychiatrist.com. With that, this has been the JCP podcast, insightful, evidence-based, human centered.