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Vroegindeweij A, Wulffraat NM, Van De Putte EM, De Jong HBT, Lucassen DA, Swart JF, Nijhof SL. Targeting persistent fatigue with tailored versus generic self-management strategies in adolescents and young adults with a fatigue syndrome or rheumatic condition: A randomized crossover trial. Br J Health Psychol 2024; 29:516-532. [PMID: 38072649 DOI: 10.1111/bjhp.12711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/02/2023] [Accepted: 11/27/2023] [Indexed: 08/10/2024]
Abstract
OBJECTIVES To evaluate the use of two self-management intervention strategies for persistent fatigue in adolescents and young adults with a fatigue syndrome or rheumatic condition. DESIGN A randomized crossover trial administering tailored lifestyle advice and generic dietary advice, each 12 weeks, with a four-week washout period between. METHODS Sixty participants (aged 12-29) were included. Tailoring was achieved through the PROfeel method. Dietary guidelines were conceptualized by the Netherlands Nutrition Centre. Questionnaires were used pre-post-interventions to measure primary outcome 'fatigue severity' (Checklist Individual Strength-8) and secondary outcomes 'self-efficacy' (Self-Efficacy Scale-28) and 'quality of life' (QoL) (Paediatric Quality of Life Inventory 4.0). Feasibility and adherence were self-rated on a scale of 1 to 10 (low to high). Linear mixed modelling was used to assess change over time, compare strategy effectiveness and study the impact of intervention order. RESULTS Fatigue severity, self-efficacy and QoL regarding 'physical' and 'emotional' functioning improved significantly over time (all p < .015). The average improvement of the two QoL subscales was clinically relevant, as was the fatigue improvement in 20 out of 46 participants who completed the trial and 5 dropouts. The interventions were equally effective, and intervention order did not impact the improvement level (prange = .242-.984). The self-management strategies received similar feasibility (M = 6.45, SD = 1.91) and adherence (M = 7.67, SD = 1.67) ratings. CONCLUSIONS As small to clinically relevant improvements were observed, self-management strategies might be particularly useful to bridge waiting time for guided treatments such as Cognitive Behavioural Therapy.
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Affiliation(s)
- Anouk Vroegindeweij
- Department of Paediatric Rheumatology/Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Rheumatology/Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Elise M Van De Putte
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hanne B T De Jong
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Desiree A Lucassen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Joost F Swart
- Department of Paediatric Rheumatology/Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sanne L Nijhof
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Vroegindeweij A, Houtveen J, Lucassen DA, Van De Putte EM, Wulffraat NM, Nijhof SL, Swart JF. Individual outcomes after tailored versus generic self-management strategies for persistent fatigue in youth with a fatigue syndrome or rheumatic condition: A multiple single-case study. Br J Health Psychol 2024; 29:712-730. [PMID: 38531612 DOI: 10.1111/bjhp.12722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE To examine individual outcomes after tailored lifestyle (PROfeel) or generic dietary advice as self-management intervention for persistent fatigue in adolescents and young adults with a chronic condition, to compare participants who did and did not benefit and to explore changes to factors in the biopsychosocial model of fatigue after PROfeel. METHOD A multiple single-case AB-phase design was embedded in a randomized crossover trial (N = 45). Intensive longitudinal data (ILD) on outcomes 'fatigue severity', 'self-efficacy' and 'quality of life' (QoL) were collected through weekly smartphone measurement for 20 weeks. ILD on biopsychosocial factors were collected through experience sampling methodology for 28 days pre-post first intervention. Baseline characteristics were compared with t-tests and chi-square tests. Permutation distancing tests were used to assess change over time in all ILD. RESULTS Regarding weekly measurements, nineteen participants (42.22%) showed small to large positive outcomes (drange = .05 to 2.59), mostly after PROfeel. Eleven participants (24.44%) showed small to moderate negative outcomes (drange = -.02 to -2.46), mostly after dietary advice. Fatigue severity improved most, followed by self-efficacy. Participants who benefitted showed higher QoL levels and lower fatigue and pain levels compared with others at baseline (all p < .02). When positive outcomes were observed after PROfeel, typically ≥1 biopsychosocial factor had been targeted successfully. CONCLUSION Self-management advice has more potential when tailored to individual characteristics, including the biopsychosocial model of fatigue. PROfeel appears particularly useful as fatigue intervention for individuals with relatively less severe symptoms.
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Affiliation(s)
- Anouk Vroegindeweij
- Department of Paediatric Rheumatology/Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jan Houtveen
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Desiree A Lucassen
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Elise M Van De Putte
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Rheumatology/Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sanne L Nijhof
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Joost F Swart
- Department of Paediatric Rheumatology/Immunology and Infectious Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
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Steinberg JS, Fitzpatrick OM, Khurana S, Kim MY, Mair P, Schleider JL, Hatzenbuehler ML, Weisz JR. Is There a Place for Cognitive Restructuring in Brief, Self-Guided Interventions? Randomized Controlled Trial of a Single-Session, Digital Program for Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-21. [PMID: 39120779 DOI: 10.1080/15374416.2024.2384026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
OBJECTIVE Self-guided digital mental health interventions (DMHIs) teaching empirically supported skills (e.g. behavioral activation) have demonstrated efficacy for improving youth mental health, but we lack evidence for the complex skill of cognitive restructuring (CR). METHOD We conducted the first-ever RCT testing a CR DMHI ("Project Think") against an active control (supportive therapy; "Project Share") in collaboration with public schools. Pre-registered outcomes were DMHI acceptability and helpfulness post-intervention, as well as internalizing symptoms and CR skills use from baseline to seven-month follow-up, in the full sample and the subsample with elevated symptoms. RESULTS Participants (N = 597; MAge = 11.99; 48% female; 68% White) rated both programs highly on acceptability and helpfulness. Both conditions were associated with significant internalizing symptom reductions across time in both samples, with no significant condition differences. CR skills use declined significantly across time for Project Share youths but held steady across time for Project Think youths in both samples; this pattern produced a significant condition difference favoring Project Think within the elevated sample at seven-month follow-up. CONCLUSION Internalizing symptoms declined comparably for Think and Share participants. Consequently, future research should examine whether encouraging youths to share their feelings produces symptom improvements, and whether a single-session, self-guided CR DMHI produces beneficial effects relative to more inert control conditions. Further, the decline in CR skills use for Project Share youths versus sustained CR use by Project Think youths raises questions about the natural time course of youths' CR use and the impact of these DMHIs on that course. ClinicalTrials.gov Registration: NCT04806321.
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McGovern R, Balogun-Katung A, Artis B, Bareham B, Spencer L, Alderson H, Brown E, Brown J, Lingam R, McArdle P, Newham JJ, Wojciechowska A, Rankin J, Redgate S, Thomason P, Kaner E. The Effectiveness of Preventative Interventions to Reduce Mental Health Problems in at-risk Children and Young People: A Systematic Review of Reviews. JOURNAL OF PREVENTION (2022) 2024; 45:651-684. [PMID: 38884876 PMCID: PMC11271346 DOI: 10.1007/s10935-024-00785-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/18/2024]
Abstract
Mental health problems are the leading cause of childhood disability worldwide, resulting in poor outcomes for children and young people that persist into adulthood. It is essential that those young people most at risk of developing mental health problems receive effective preventative interventions. Whilst there have been a number of systematic reviews which have examined the effectiveness of secondary prevention interventions for specific groups of children and young people, or to address identified mental health concerns, no review has engaged with the breadth of this literature. We conducted a systematic review of systematic reviews to map this complex field of secondary preventative interventions and identify effective interventions to prevent mental health problems in children and adolescents aged 3-17 years. The review protocol was registered on PROSPERO. We searched five electronic databases from inception to February 2023. The certainty of the evidence was appraised using the AMSTAR 2. We included 49 unique systematic reviews each including between 2 and 249 (mean 34) unique studies; the majority of which were reviews which included only or mostly randomised controlled trials (70%). The reviews examined selective interventions (defined as interventions which are delivered to sub-group populations of young people at increased risk of mental health problems) (n = 22), indicated interventions (defined as interventions which target young people who are found to have pre-clinical symptoms) (n = 15) or a synthesis of both (n = 12). The certainty of the evidence in the reviews was rated as high, (n = 12) moderate (n = 5), low (n = 9) and critically low (n = 23). We found evidence to support both selective and indicated interventions in a range of populations and settings, with most of this evidence available for children and young people in their mid-years (6-10 years) and early adolescence (11-13 years). There was a large body of evidence suggesting that resilience enhancing, cognitive behaviour therapy-based and psychoeducational interventions for children who experience adversity, or those with subclinical externalising problems may offer promise. Early selective interventions for a subpopulation of children and young people who have experienced adversity which combines risk reduction and resilience enhancing approaches directed at children and their families may be effective at reducing mental health problems.
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Affiliation(s)
- R McGovern
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
| | - A Balogun-Katung
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - B Artis
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - B Bareham
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - L Spencer
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - H Alderson
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - E Brown
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - J Brown
- Children's Social Care, Newcastle City Council, Newcastle upon Tyne, UK
| | - R Lingam
- Population Child Health Research Group, School of Women and Children's Health, University New South Wales, Sydney, Australia
| | - P McArdle
- Child and Adolescent Mental Health Services, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J J Newham
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - A Wojciechowska
- Disabilities Integrated Team at the Tees, Esk and Wear Valleys, NHS Foundation Trust, Newcastle upon Tyne, UK
| | - J Rankin
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - S Redgate
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - P Thomason
- Children's Social Care, Gateshead Council, Tyne and Wear, UK
| | - E Kaner
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
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Lorien LM, Arthur M, Keiler K, Lowry J, Ryan K. Recovery-oriented practice in a hospital mental health service. Int J Ment Health Nurs 2024; 33:1100-1109. [PMID: 38459635 DOI: 10.1111/inm.13316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
As part of mental health reform in Australia, new policies were introduced to support recovery-oriented practice; however, little has changed in hospital settings focused on managing risk and remediating acute symptoms. Previous studies have indicated that patients' experiences of personal recovery, during a hospital admission, may not mirror that of people living in the community, with patients being more likely to experience disconnection, hopelessness and disempowerment. Using a Participatory Health Research approach, eight mental health professionals, a patient advocate and an external researcher formed a research partnership to answer the question: How can staff enhance recovery-oriented practice in a hospital-based mental health service? The COREQ checklist was used for reporting the methods, analysis and findings. The methods comprised patient focus groups (n = 16 participants), interviews with managers (n = 7) and an online survey for staff (n = 17). Researchers analysed the feedback from the consultations using inductive thematic analysis, identifying two themes: relational recovery and recovery interventions. The findings indicate that relational recovery is key to recovery during a hospital admission and interventions that increase connectedness or reduce the impact of symptoms enhance personal recovery.
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Affiliation(s)
- Leonie M Lorien
- School of Health, Medical and Applied Sciences, CQUniversity, Rockhampton, Australia
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Holmes MB, Jackson G, George SZ. Clinimetric Properties of the Working Alliance Inventory and Credibility Expectancy Questionnaire: Screening Options for Musculoskeletal Pain. Arch Phys Med Rehabil 2024; 105:1471-1479. [PMID: 38432329 DOI: 10.1016/j.apmr.2024.02.724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE To investigate clinimetric properties of 2 surveys used to evaluate common factors in the patient-provider relation and present screener options for the assessment of common factors and report their correlation with pain and functional outcomes. DESIGN Observational cohort. SETTING Outpatient physical therapy. PARTICIPANTS 100 individuals (58% women, mean age=34, SD=15; N=100) presenting to physical therapy with musculoskeletal pain in the following regions: 44% lower extremity, 36% spine, 19% upper extremity, 1% undetermined. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Participants completed the Working Alliance Inventory (WAI) and the Credibility and Expectancy Questionnaire (CEQ). Exploratory factor analysis (EFA) explored factor structure of the WAI and CEQ. Internal consistency was evaluated for scales derived from items retained based on factor loadings. Finally, options for screener tools were proposed and assessed based on their correlation to original surveys as well as pain and functional outcomes. RESULTS The data supported a 4-factor structure for the surveys. Some WAI items were excluded due to cross-loading. The derived four-factor scales demonstrated strong correlations with the original surveys (r=.89-.99) and exhibited good internal consistency (α=.824-.875). Two screening options were suggested: 1 retaining 11 of the original 18 items and the other comprising just 3 items. Both screening tools correlated with the original surveys and showed associations with improvements in pain and functional outcomes (r=-.21-.34). CONCLUSION The proposed screeners provide concise measurement options to facilitate use in clinical practice. These tools can aid in facilitating patient communication specifically addressing patient expectation and understanding the tasks required to enact behavior change.
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Affiliation(s)
| | | | - Steven Z George
- Duke Clinical Research Institute, Durham, NC; Department of Orthopaedic Surgery, Duke University, Durham, NC
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Botvinik-Nezer R, Petre B, Ceko M, Lindquist MA, Friedman NP, Wager TD. Placebo treatment affects brain systems related to affective and cognitive processes, but not nociceptive pain. Nat Commun 2024; 15:6017. [PMID: 39019888 PMCID: PMC11255344 DOI: 10.1038/s41467-024-50103-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 06/28/2024] [Indexed: 07/19/2024] Open
Abstract
Drug treatments for pain often do not outperform placebo, and a better understanding of placebo mechanisms is needed to improve treatment development and clinical practice. In a large-scale fMRI study (N = 392) with pre-registered analyses, we tested whether placebo analgesic treatment modulates nociceptive processes, and whether its effects generalize from conditioned to unconditioned pain modalities. Placebo treatment caused robust analgesia in conditioned thermal pain that generalized to unconditioned mechanical pain. However, placebo did not decrease pain-related fMRI activity in brain measures linked to nociceptive pain, including the Neurologic Pain Signature (NPS) and spinothalamic pathway regions, with strong support for null effects in Bayes Factor analyses. In addition, surprisingly, placebo increased activity in some spinothalamic regions for unconditioned mechanical pain. In contrast, placebo reduced activity in a neuromarker associated with higher-level contributions to pain, the Stimulus Intensity Independent Pain Signature (SIIPS), and affected activity in brain regions related to motivation and value, in both pain modalities. Individual differences in behavioral analgesia were correlated with neural changes in both modalities. Our results indicate that cognitive and affective processes primarily drive placebo analgesia, and show the potential of neuromarkers for separating treatment influences on nociception from influences on evaluative processes.
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Affiliation(s)
- Rotem Botvinik-Nezer
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
| | - Bogdan Petre
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA
| | - Marta Ceko
- Institute of Cognitive Science, University of Colorado Boulder, Boulder, CO, USA
| | - Martin A Lindquist
- Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA
| | - Naomi P Friedman
- Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, USA.
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Pérez-Esteban A, Díez-Gómez A, Pérez-Albéniz A, Al-Halabí S, Lucas-Molina B, Debbané M, Fonseca-Pedrero E. The assessment of transdiagnostic dimensions of emotional disorders: Validation of the Multidimensional Emotional Disorders Inventory (MEDI) in adolescents with subthreshold anxiety and depression. J Affect Disord 2024; 357:138-147. [PMID: 38685278 DOI: 10.1016/j.jad.2024.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/27/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND The transdiagnostic approach to psychopathology has emerged as an alternative to traditional taxonomic approaches. The Multidimensional Emotional Disorders Inventory (MEDI) is a specifically designed self-report to measure the transdiagnostic dimensions proposed by Brown and Barlow (2009). This study aims to analyse the psychometric properties of the MEDI scores in adolescents with subthreshold anxiety and depression. METHOD The sample consisted of a total of 476 students. The mean age was 13.77 years (SD = 1.43) (range 10 to 18 years), 73.9 % were females. Several questionnaires assessing positive affect, negative affect, mental health difficulties, and quality of life were used. RESULTS The original 9-factor structure of the MEDI was confirmed with good fit indices. Satisfactory levels of internal consistency were observed in most of the MEDI scores using McDonald's Omega, ranging from 0.58 to 0.87. The MEDI dimensions were associated with psychopathology, positive affect, negative affect, and quality of life. LIMITATIONS Reliance on self-reported data, a cross-sectional design limiting temporal assessment, and a 73.9 % female gender imbalance. CONCLUSION The MEDI scores showed adequate psychometric properties among adolescents with subclinical emotional symptoms. The results found might have potential clinical implications for conceptualization, assessment, intervention, and prevention of emotional disorders at both clinical and research levels.
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Affiliation(s)
| | | | | | | | | | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
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Albano G, Teti A, Scrò A, Bonfanti RC, Fortunato L, Lo Coco G. A systematic review on the role of therapist characteristics in the treatment of eating disorders. RESEARCH IN PSYCHOTHERAPY (MILANO) 2024. [PMID: 38988291 DOI: 10.4081/ripppo.2024.750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/04/2024] [Indexed: 07/12/2024]
Abstract
Treating patients with eating disorders can be challenging for therapists, as it requires the establishment of a strong therapeutic relationship. According to the literature, therapist characteristics may influence intervention outcomes. The aim of this systematic review was to identify and synthesize existing literature on therapist interpersonal characteristics that could affect psychotherapy relationship or outcomes in the context of eating disorder treatment from both patients' and therapists' perspectives. We conducted a systematic search using electronic databases and included both qualitative and quantitative studies from 1980 until July 2023. Out of the 1230 studies screened, 38 papers met the inclusion criteria and were included in the systematic review. The results indicate that patients reported therapist's warmth, empathic understanding, a supportive attitude, expertise in eating disorders, and self-disclosure as positive characteristics. Conversely, a lack of empathy, a judgmental attitude, and insufficient expertise were reported as therapist negative characteristics, which could have a detrimental impact on treatment outcome. Few studies have reported therapist's perceptions of their own personal characteristics which could have an impact on treatment. Therapists reported that empathy and supportiveness, optimism, and previous eating disorder experience were positive characteristics. Conversely, clinician anxiety, a judgmental attitude, and a lack of objectivity were reported as negative characteristics that therapists felt could hinder treatment. This systematic review offers initial evidence on the personal characteristics of therapists that may affect the treatment process and outcomes when working with patients with eating disorders.
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Affiliation(s)
- Gaia Albano
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| | - Arianna Teti
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| | - Arianna Scrò
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| | | | - Lucia Fortunato
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
| | - Gianluca Lo Coco
- Department of Psychology, Educational Science and Human Movement, University of Palermo.
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López-Aybar L, Gonzales L, Dhillon A. Intimate partner violence survivors' reported experiences of discrimination in mental health treatment settings. JOURNAL OF COMMUNITY PSYCHOLOGY 2024. [PMID: 38976375 DOI: 10.1002/jcop.23132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 06/12/2024] [Accepted: 06/26/2024] [Indexed: 07/10/2024]
Abstract
Research indicates that survivors of intimate partner violence (IPV) face substantial stigma and discrimination, with varying impacts based on demographic factors such as race and income. This study explored perceived discrimination among 88 IPV survivors across different racial backgrounds and income levels in mental health settings. Participants completed a mixed-method electronic survey assessing discrimination experiences related to survivor status, income, and race within mental health treatment. Results revealed high levels of perceived discrimination based on survivor status among both racially minoritized and majoritized survivors. However, racially minoritized survivors reported greater racial discrimination and associated stress within mental healthcare settings. Regardless of income level, all survivors reported significant discrimination experiences. Qualitative analysis highlighted factors perceived as helpful or unhelpful within mental health settings. This study underscores the need for further research on socioeconomic influences on stigma experiences among IPV survivors and suggests implications for provider training to better support survivors, especially those from diverse racial backgrounds.
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Affiliation(s)
- Laura López-Aybar
- Derner School of Psychology, Adelphi University, Garden City, New York, USA
| | - Lauren Gonzales
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York-Presbyterian, New York, New York, USA
- New York State Office of Mental Health, New York, New York, USA
| | - Ashley Dhillon
- Derner School of Psychology, Adelphi University, Garden City, New York, USA
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Funk J, Takano K, Babl M, Goldstein R, Oberwestersberger R, Kopf-Beck J, Rohleder N, Ehring T. Can an intervention designed to reduce repetitive negative thinking alter the response to a psychosocial stressor? A randomized controlled study. Behav Res Ther 2024; 178:104547. [PMID: 38678755 DOI: 10.1016/j.brat.2024.104547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/07/2023] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Abstract
Prior research suggests that repetitive negative thinking (RNT) negatively impacts mental health by intensifying and prolonging emotional reactivity to stress. This study investigated whether an intervention designed to reduce RNT alters emotional reactivity. Young adults with high trait RNT (N = 79) were randomly allocated to an RNT-focused intervention (smartphone app-based, 10 days) or a waiting list before exposure to a standardized stressor. The pre-registered analysis did not reveal a significant condition * time interaction for negative affect. However, exploratory analyses showed that whilst initial increases in negative affect in response to the stressor did not differ between conditions, participants in the intervention condition reported less negative affect throughout the following recovery phase. Additionally, participants in the intervention condition appraised their ability to cope with the stressor as higher and reported less RNT in the recovery phase. In contrast, the intervention did not affect biological stress responses. The findings indicate that RNT-focused interventions might have positive effects on mental health by breaking the self-reinforcing cycle of RNT, negative affect and maladaptive appraisals in response to stress. However, as findings are partly based on exploratory analyses, further research is needed to confirm whether reduced subjective stress reactivity mediates the effects of RNT-focused interventions on psychopathological symptoms.
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Affiliation(s)
- Julia Funk
- Ludwig-Maximilians-Universität München, Germany, Department of Psychology, Clinical Psychology and Psychological Treatment.
| | - Keisuke Takano
- National Institute of Advanced Industrial Science and Technology, Japan, Human Informatics and Interaction Research Institute
| | - Marina Babl
- Ludwig-Maximilians-Universität München, Germany, Department of Psychology, Clinical Psychology and Psychological Treatment
| | - Rebecca Goldstein
- Ludwig-Maximilians-Universität München, Germany, Department of Psychology, Clinical Psychology and Psychological Treatment
| | - Regina Oberwestersberger
- Ludwig-Maximilians-Universität München, Germany, Department of Psychology, Clinical Psychology and Psychological Treatment
| | - Johannes Kopf-Beck
- Ludwig-Maximilians-Universität München, Germany, Department of Psychology, Clinical Psychology and Psychological Treatment
| | - Nicolas Rohleder
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany, Institute of Psychology, Health Psychology
| | - Thomas Ehring
- Ludwig-Maximilians-Universität München, Germany, Department of Psychology, Clinical Psychology and Psychological Treatment
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Lee GC, Platow MJ, Cruwys T. Listening quality leads to greater working alliance and well-being: Testing a social identity model of working alliance. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024. [PMID: 38946045 DOI: 10.1111/bjc.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 06/19/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Characterization of psychotherapy as the "talking cure" de-emphasizes the importance of an active listener on the curative effect of talking. We test whether the working alliance and its benefits emerge from expression of voice, per se, or whether active listening is needed. We examine the role of listening in a social identity model of working alliance. METHODS University student participants in a laboratory experiment spoke about stress management to another person (a confederate student) who either did or did not engage in active listening. Participants reported their perceptions of alliance, key social-psychological variables, and well-being. RESULTS Active listening led to significantly higher ratings of alliance, procedural justice, social identification, and identity leadership, compared to no active listening. Active listening also led to greater positive affect and satisfaction. Ultimately, an explanatory path model was supported in which active listening predicted working alliance through social identification, identity leadership, and procedural justice. CONCLUSIONS Listening quality enhances alliance and well-being in a manner consistent with a social identity model of working alliance, and is a strategy for facilitating alliance in therapy.
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Affiliation(s)
- Georgina C Lee
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michael J Platow
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Tegan Cruwys
- School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
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Clough BA, Alderson A, Savage S, Farrer L, Kebbell M. Can you tell me more about that? An examination of self-disclosure in videoconference and face-to-face psychological interviewing. Psychol Psychother 2024. [PMID: 38923149 DOI: 10.1111/papt.12539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/28/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES Videoconference psychotherapy (VCP) is a crucial component of many health care systems, allowing for remote delivery of services. However, little is known about the mechanisms of change within VCP. Previous research has suggested that self-disclosure may be greater in VCP than face-to-face modalities and was investigated in the current study. DESIGN Young adults aged 18-25 years (N = 57) were randomly allocated to face-to-face or VCP interview conditions, with measures completed pre- and post-interview. METHODS Participants completed an autobiographical memory task, requiring them to describe specific memories in response to positive and negative valence cue words. Measures included self-reported self-disclosure, blind observer-rated self-disclosure, memory specificity, and mean number of words per response. RESULTS No significant differences were found between conditions with regard to self-reported self-disclosure, capacity to recall specific memories, or words uttered per response. However, observer-rated depth of self-disclosure was significantly higher for participants in the face-to-face than VCP condition. Self-disclosure and memory specificity were also significantly greater for negative than positive valence cue words, regardless of condition. CONCLUSIONS The findings indicate that whilst participants may be able to draw on memories with equal ease regardless of interview modality, in VCP, emotional processing of these memories may require increased support and guidance from the therapist.
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Affiliation(s)
- Bonnie A Clough
- School of Applied Psychology, Griffith University, Mt Gravatt, Queensland, Australia
- Griffith Centre for Mental Health, Griffith University, Southport, Queensland, Australia
| | - Angie Alderson
- School of Applied Psychology, Griffith University, Mt Gravatt, Queensland, Australia
| | - Stacey Savage
- School of Applied Psychology, Griffith University, Mt Gravatt, Queensland, Australia
| | - Louise Farrer
- Centre for Mental Health Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mark Kebbell
- School of Applied Psychology, Griffith University, Mt Gravatt, Queensland, Australia
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Gupta V, Eames C, Bryant A, Greenhill B, Golding L, Day J, Fisher P. Identifying the priorities for supervision by lived experience researchers: a Q sort study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:66. [PMID: 38918822 PMCID: PMC11197215 DOI: 10.1186/s40900-024-00596-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Lived experience researchers draw on their lived and living experiences to either lead on or inform research. Their personal experiences are relevant to the research topic and so they must manage the interplay of their health and healthcare experiences with the research, population, and data they work with, as well as the more general challenges of being a researcher. Lived experience researchers must navigate these dilemmas in addition to queries over their competency, due to issues relating to intersectionality and epistemic injustice. This justifies a motivation to better understand the experiences of lived experience researchers and develop appropriate and personalised supervision based on their preferences and needs. METHODS Q methodology was used to identify a collection of identity-related issues that impact lived experience researchers during PhD research in the context of the UK. These issues were presented in the form of 54 statements to 18 lived experience researchers to prioritise as topics to explore in supervision. RESULT It was found that lived experiences researchers could be grouped into three distinct factors following an inverted factor analysis: Factor 1: Strengthening my identity, skills, growth, and empowerment; Factor 2: Exploring the emotional and relational link I have with the research and Factor 3: Navigating my lived and professional experiences practically and emotionally. The findings suggest that there may be three types of lived experience researchers, each with different needs from supervision, suggesting the population is heterogeneous. CONCLUSION The research identified a deeper understanding of the needs of lived experience researchers and highlights the importance of personalised supervision according to the individual needs of the researcher and their preferences for supervision. The findings reinforce the importance of integrating a clinical dimension into supervision to support the needs of all lived experience researchers.
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Affiliation(s)
- Veenu Gupta
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Department of Psychology, University of Durham, Durham, UK
| | - Catrin Eames
- School of Psychology, Liverpool John Moores University, Liverpool, UK
| | - Alison Bryant
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Beth Greenhill
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Laura Golding
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Jennifer Day
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Peter Fisher
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK.
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Headley E, Kellett S, Bee C, Lancashire J, Aadahl V, Bone C, Power N. Types and mechanisms of idiographic change during guided self-help for anxiety. Psychol Psychother 2024. [PMID: 38924285 DOI: 10.1111/papt.12536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 05/09/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To compare idiographic change during two formats of guided self-help (GSH); cognitive-behavioural therapy guided self-help (CBT-GSH) and cognitive analytic therapy guided self-help (CAT-GSH). DESIGN Qualitative inductive thematic analysis. METHODS Semi-structured interviews with N = 17 participants with a reliable change outcome on the GAD-7 after completing GSH for anxiety. Changes were categorised and themes extracted. RESULTS No differences between CAT-GSH and CBT-GSH were found regarding types of change reported. The five overarching themes found were personal qualities of success, enlightenment through understanding, specific tools and techniques, changes to relationships and tailoring support. Four themes maximally differentiated between the two different types of GSH; CAT-GSH enabled relational insight and change whilst CBT-GSH enabled better understanding of anxiety, new coping techniques and supportive relationships. CONCLUSIONS Both common and model-specific factors contribute to patient change during GSH. Whilst all forms of GSH are grounded in the psychoeducational approach, separate theoretical foundations and associated methods facilitate different types of ideographic change.
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Affiliation(s)
- Emma Headley
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Stephen Kellett
- Rotherham Doncaster and South Humber NHS Foundation Trust, UK and Clinical and Applied Psychology Unit, University of Sheffield, Rotherham, UK
| | - Charlotte Bee
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | | | - Vikki Aadahl
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - Claire Bone
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Niall Power
- Derbyshire Community Health Services NHS Foundation Trust, Derbyshire, UK
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Boecking B, Brueggemann P, Mazurek B. "I feel [so alone] nothing" - emotional vulnerability and detachment as transdiagnostic key characteristics of patients with chronic tinnitus: a schema mode model approach. Front Psychiatry 2024; 15:1375813. [PMID: 38979500 PMCID: PMC11229517 DOI: 10.3389/fpsyt.2024.1375813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/26/2024] [Indexed: 07/10/2024] Open
Abstract
Background Gold-standard approaches for chronic tinnitus involve hearing amplification measures and psychological therapy, where applicable. Whilst schema therapy is accumulating evidence as a transdiagnostically useful treatment framework, its applicability for patients with chronic tinnitus has not yet been examined. The present study (a) explores latent dimensions of psychological distress in a sample of chronic tinnitus patients, and (b) examines whether the schema mode model might explain these dimensions - thus constituting a potentially helpful conceptualization and treatment framework. Methods N = 696 patients with chronic tinnitus completed the Tinnitus Questionnaire, Tinnitus Handicap Inventory, Hospital Anxiety and Depression Scale, Perceived Stress Questionnaire and ICD-10 Symptom Rating. As criterion, patients further completed the Schema Mode Inventory (SMI-r) - which assesses psychological constructs linked to negative self-beliefs ("parent modes"), primary emotions resulting from unmet psychological needs ("child modes"), and secondary emotional or behavioral attempts to reinstate or maintain psychological equilibrium ("coping modes"). A varimax-rotated principal axis factor analysis grouped the primary item pool. Factor scale scores were then correlated with the SMI-r. Results A three-factor solution explained 37.4% of variance and represented 78% of the included items. Following item content examination, the factors represented (1) General emotional distress, (2) Tinnitus-attributed emotional distress, and (3) Socio-audiological impairment. Factors 1|2 correlated highly (r = 0.70), Factors 2|3 moderately (r = 0.62). Linked to the schema mode model, Factor 1 correlated highly with the "vulnerable child" (r = 0.78), and moderately with the "parent", "angry child", and "detached protector" modes (0.53 < r < 0.65). Factor 2 correlated moderately with the "vulnerable child" (r = 0.53). Factor 3 was largely uncorrelated with SMI-r scores - although a low correlation with the "detached protector" warrants further examination. Conclusion "General" and "tinnitus-attributed" emotional distress correlate highly - warranting holistic (not symptom-specific) psychological case conceptualization and treatment planning. Viewed from a schema mode perspective, the "vulnerable child" explains substantial variance across both dimensions. Consequently, autobiographically anchored, unmet emotional needs and emotional detachment constitute key treatment targets. Social-audiological impairment should be multimodally conceptualised and treated with hearing aids and psychological support measures, as applicable.
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Affiliation(s)
- Benjamin Boecking
- Charité - Universitatsmedizin-Berlin - Tinnitus Center, Berlin, Germany
| | - Petra Brueggemann
- Charité - Universitatsmedizin-Berlin - Tinnitus Center, Berlin, Germany
| | - Birgit Mazurek
- Charité - Universitatsmedizin-Berlin - Tinnitus Center, Berlin, Germany
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Jaffe CM, Bucci W, Maskit B, Murphy S. Clinical and Research Perspectives on the Therapeutic Conversation: The Case of MS. M. J Am Psychoanal Assoc 2024:30651241256650. [PMID: 38864203 DOI: 10.1177/00030651241256650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
This paper presents a collaboration between a clinician (C.M.J.) and a research team (W.B., B.M., and S.M.) to address the question: At an operational level, what happens in the special form of conversation that is psychotherapy? How can we study, beyond a priori lenses of psychoanalytic models, what we are actually doing when we engage in this process? How can we capture from the linear flow of conversation, the simultaneous, complex, active, interwoven, dimensional emotion schemas that words can only point toward? To address the question, we first present the need for new approaches in the current climate within the clinical and research communities. Next, we address the challenges for clinicians and researchers by using multiple code theory and derived linguistic measures that offer an objective view of the processes of subjectivity. We then apply the research methods to the clinical data to illustrate the yield of the collaborative effort-a yield that captures the connection between the linear flow of words and the arousal, verbal expression, and reflection/integration of emotion schemas without the usual filters of psychoanalytic models of process and change. The project illustrates the critical value of clinicians' perspectives to guide researchers and encourages clinicians to participate in research to advance our field. For researchers, this project represents a "fourth generation" of process research that includes the criteria of video-recorded, transcribed data; the clinician's report of their experience; a theory of how emotion-laden meaning and motivations (emotion schemas) are expressed in the therapeutic conversation; and reliable, valid measures to capture and represent those processes; and that encourages researchers to access the rich contributions of clinicians' understanding. The implication for clinical practice is a new way to look beyond the lens of psychoanalytic models into what is actually unfolding in real time.
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Namiba A, Nyirenda C, Sachikonye M, Mbewe R, Sseruma WS, Santos M, Croston M. Telling our stories: describing the experiences and contributions of African migrants living with HIV. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S4-S10. [PMID: 38850138 DOI: 10.12968/bjon.2024.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Abstract
HIV in the UK is concentrated in a few key populations, and African migrants are among them. To date, there has been no documented record of the personal experiences of this group to accompany the significant amount of epidemiological data on these communities. There is no record celebrating the contribution, resilience and lived experience of Africans living with HIV in the UK, their allies and their response to the epidemic. A group of African women who are long-standing HIV activists and advocates, much respected for their leadership within the HIV community, considered that it was important to capture and tell these stories to ensure they were accurately recorded in the history of HIV. Their experience spans the story of the African community's experience of HIV in the UK. They formed a steering group and the project aimed to showcase 40 stories to coincide with the 40th anniversary of HIV in 2021.
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Friedlander A, Sinai D, Zilcha-Mano S, Weiser M, Caspi A, Lichtenberg P, Amitai Z, Tzur Bitan D. Development of the Therapeutic Alliance in Alternative Settings to Psychiatric Hospitalization: An Open Comparative Study. Psychiatr Serv 2024; 75:549-555. [PMID: 38500450 DOI: 10.1176/appi.ps.20230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Patient-therapist alliance in two alternative treatment settings developed similarly to that in traditional psychiatric hospitalization.
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Affiliation(s)
- Avraham Friedlander
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Dana Sinai
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Sigal Zilcha-Mano
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Mark Weiser
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Asaf Caspi
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Pesach Lichtenberg
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Ziv Amitai
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
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Sun Q, Zhang C, Zhu X, Wu C, Ren Z, Falkenström F. Outcome expectations and working alliance may be more important for patients from rural areas during the transition to college life: An exploratory within-patient analysis. Psychother Res 2024; 34:679-693. [PMID: 37708452 DOI: 10.1080/10503307.2023.2256461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
ABSTRACTObjective Research has given limited attention to the distinction between patients from rural and urban areas, especially concerning the frequent overlap between rural living and low socio-economic status (SES). To shed more light on this, we explored the differential treatment processes between patients from rural and urban areas.Method Seven hundred and fourteen patients recruited from a university counseling center in China filled out the questionnaires for Outcome Expectation (OE), Session Alliance Inventory (SAI) and Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) each session. Data was analyzed using the disaggregated cross-lagged panel model and the asymmetric fixed-effect model.Results The findings indicated a reciprocal within-patient relation between OE and SAI for the whole sample. SAI mediated the effect of OE on next-session CORE-OM for patients from rural areas, with a significantly greater indirect effect than for patients from the urban areas. Asymmetric effects were found for OE among patients from urban areas, for whom drops in OE predicted worse next-session CORE-OM more strongly than improvements in OE predicted improved CORE-OM.Conclusion This study provided preliminary evidence for differential OE-alliance-outcome predictions between patients with different SES and affirmed a reciprocal OE-alliance relation in a Chinese sample during the transition period of college.
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Affiliation(s)
- Qiwu Sun
- Key Laboratory of Adolescent Cyberpsychology and Behavior (Central China Normal University), Ministry of Education, Wuhan, People's Republic of China
- School of Psychology, Central China Normal University, Wuhan, People's Republic of China
- Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, People's Republic of China
| | - Chaoli Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behavior (Central China Normal University), Ministry of Education, Wuhan, People's Republic of China
- School of Psychology, Central China Normal University, Wuhan, People's Republic of China
- Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, People's Republic of China
| | - Xu Zhu
- Key Laboratory of Adolescent Cyberpsychology and Behavior (Central China Normal University), Ministry of Education, Wuhan, People's Republic of China
- School of Psychology, Central China Normal University, Wuhan, People's Republic of China
- Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, People's Republic of China
| | - Caizhi Wu
- Key Laboratory of Adolescent Cyberpsychology and Behavior (Central China Normal University), Ministry of Education, Wuhan, People's Republic of China
- School of Psychology, Central China Normal University, Wuhan, People's Republic of China
- Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, People's Republic of China
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behavior (Central China Normal University), Ministry of Education, Wuhan, People's Republic of China
- School of Psychology, Central China Normal University, Wuhan, People's Republic of China
- Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, People's Republic of China
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Cammalleri A, Perrault AA, Hillcoat A, Carrese-Chacra E, Tarelli L, Patel R, Baltzan M, Chouchou F, Dang-Vu TT, Gouin JP, Pepin V. A Pilot Randomized Trial of Combined Cognitive-Behavioral Therapy and Exercise Training Versus Exercise Training Alone for the Management of Chronic Insomnia in Obstructive Sleep Apnea. JOURNAL OF SPORT & EXERCISE PSYCHOLOGY 2024; 46:125-136. [PMID: 38663849 DOI: 10.1123/jsep.2023-0139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 05/24/2024]
Abstract
Insomnia treatment among individuals with comorbid insomnia and obstructive sleep apnea is suboptimal. In a pilot randomized controlled trial, 19 individuals with comorbid insomnia and obstructive sleep apnea were allocated to one of two arms: EX + EX, consisting of two 8-week phases of exercise training (EX), or RE + CBTiEX, encompassing 8 weeks of relaxation training (RE) followed by 8 weeks of combined cognitive-behavioral therapy and exercise (CBTiEX). Outcomes included Insomnia Severity Index (ISI), polysomnography, and cardiorespiratory fitness measures. A mixed-model analysis of variance revealed a Group × Time interaction on peak oxygen consumption change, F(1, 14) = 10.1, p = .007, and EX increased peak oxygen consumption (p = .03, g' = -0.41) and reduced ISI (p = .001, g' = 0.82) compared with RE (p = .49, g = 0.16) post-8 weeks. Post-16 weeks, there was a significant Group × Time interaction (p = .014) driven by RE + CBTiEX yielding a larger improvement in ISI (p = .023, g' = 1.48) than EX + EX (p = .88, g' < 0.1). Objective sleep was unchanged. This study showed promising effects of regular EX alone and combined with cognitive-behavioral therapy for insomnia on ISI in comorbid insomnia and obstructive sleep apnea.
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Affiliation(s)
- Amanda Cammalleri
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Aurore A Perrault
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Alexandra Hillcoat
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Emily Carrese-Chacra
- Department of Psychology, Center for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Lukia Tarelli
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
- Department of Psychology, Center for Clinical Research in Health, Concordia University, Montreal, QC, Canada
| | - Rahul Patel
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Marc Baltzan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Axe Maladies chroniques, Centre de Recherche du CIUSSS du Nord-de-l'Ⓘle-de-Montréal, Montreal, QC, Canada
| | - Florian Chouchou
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
- EA4075 IRISSE-Département STAPS, Université de La Réunion, Saint-Denis, France
| | - Thien Thanh Dang-Vu
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
- PERFORM Center, Concordia University, Montreal, QC, Canada
| | - Jean-Philippe Gouin
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
- Department of Psychology, Center for Clinical Research in Health, Concordia University, Montreal, QC, Canada
- PERFORM Center, Concordia University, Montreal, QC, Canada
| | - Veronique Pepin
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
- Axe Maladies chroniques, Centre de Recherche du CIUSSS du Nord-de-l'Ⓘle-de-Montréal, Montreal, QC, Canada
- PERFORM Center, Concordia University, Montreal, QC, Canada
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22
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Seewald A, Rief W. Therapist's warmth and competence increased positive outcome expectations and alliance in an analogue experiment. Psychother Res 2024; 34:663-678. [PMID: 37531315 DOI: 10.1080/10503307.2023.2241630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 08/04/2023] Open
Abstract
Objective: The quality of the therapeutic alliance, treatment motivation, outcome expectations (OE), and specific health behaviour predicts psychotherapy success. Therapists should be able to improve these factors to optimize outcomes. This study investigated the therapist's interpersonal behaviour to optimize alliance, motivation, OE, and health behaviour. Method: A stressed study sample (N = 465) completed an online analogue experiment. We gave participants positive information about psychotherapy effectiveness and varied the therapist's interpersonal behaviour along the dimensions of warmth and competence.Results: High (vs. low) competence and high (vs. low) warmth increased alliance, OE, and help-seeking scores, while high (vs. low) competence increased motivation to do psychotherapy. We found no effects on health behaviour.Conclusion: In contrast to previous correlational analyses, our experimental study supports the causal role of the therapist's warmth and competence and its impact on alliance, motivation, and OE. We discuss approaches for future studies and clinical implications.
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Affiliation(s)
- Anna Seewald
- Department of Psychology, Clinical Psychology & Psychotherapy, University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Psychology, Clinical Psychology & Psychotherapy, University of Marburg, Marburg, Germany
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23
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Faith LA, Hillis-Mascia JD, Wiesepape CN. How Does Individual Psychotherapy Promote Recovery for Persons with Psychosis? A Systematic Review of Qualitative Studies to Understand the Patient's Experience. Behav Sci (Basel) 2024; 14:460. [PMID: 38920792 PMCID: PMC11201174 DOI: 10.3390/bs14060460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Psychotherapy for individuals with psychosis is an effective treatment that promotes recovery in various ways. While there is strong quantitative evidence across modalities, less is known from the patient's perspective. There are many varied forms of psychotherapy, and gaining the patient's perspective can improve understanding of salient elements of psychotherapy and increase engagement, ultimately improving recovery rates. The purpose of this review is to identify and integrate data from published studies of patient perspectives of psychotherapy for psychosis to understand essential elements across approaches, differences between approaches, and how psychotherapy impacts recovery. We aimed to understand further: what are the perceptions about individual psychotherapy from the perspective of individuals with psychosis? The current study was a systematic review using PRISMA guidelines of studies that included qualitative interviews with persons with experiences of psychosis who participated in psychotherapy. All three authors participated in the literature search using Pubmed, APA PsycInfo, and Psychiatry Online. We identified N = 33 studies. Studies included cognitive therapies, acceptance and mindfulness approaches, trauma therapies, metacognitive therapy, and music therapy. All studies reported participants' perceived benefit with the therapeutic relationship as especially salient. Participants described diverse aspects of objective (e.g., symptoms, functioning) and subjective (e.g., self-experience or quality of life) recovery improvements, with perceived mechanisms of change, and with music therapy having some unique benefits. Participants also reported challenges and suggestions for improvement. Study findings highlight the salient aspects of psychotherapy identified by patients that may help therapists to individualize and improve approaches to psychotherapy when working with individuals experiencing psychosis. Overall, findings support the potential for integrative psychotherapy approaches for maximal treatment personalization.
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Affiliation(s)
- Laura A. Faith
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Jaclyn D. Hillis-Mascia
- Psychosocial Rehabilitation and Recovery Center, Chillicothe VA Medical Center, Chillicothe, OH 45601, USA;
| | - Courtney N. Wiesepape
- Psychosocial Rehabilitation and Recovery Center, Austin VA Clinic, Austin, TX 78744, USA;
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24
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Hutsebaut J. Scorn Not Its Simplicity: Examining the Effectiveness of Simple Generalist Treatment for Personality Disorders. Am J Psychother 2024:appipsychotherapy20230042. [PMID: 38812459 DOI: 10.1176/appi.psychotherapy.20230042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Treatment guidelines for personality disorders have typically recommended specialized psychotherapeutic interventions. In this review, the author suggests that an intervention's effectiveness may be determined less by the specific method than by therapist competence, team culture, clinical process structure, and institutional context. The author argues that these elements determine variance in effectiveness between and within methods. Whereas initial studies of a specialized treatment may reflect the exceptional competencies of the treatment's developers and early adopters, in daily clinical practice, therapists with an average level of skill may struggle with the theoretical and methodological complexities of these treatments, which can hinder genuine connection with patients. This interference may particularly affect treatment outcomes when therapists encounter the intense emotions and interpersonal hypersensitivity experienced by patients with personality disorders. Most therapists would benefit from a set of simple generalist principles that determine the context for their work and offer a framework for dealing with clinical challenges while enabling them to be true to themselves and use their previously learned competencies. The Guideline-Informed Treatment for Personality Disorders is an enhanced common-factors approach that summarizes the core principles of effective treatment and can be feasibly implemented by most therapists.
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Affiliation(s)
- Joost Hutsebaut
- Viersprong Institute for Studies on Personality Disorders, Bergen op Zoom, the Netherlands; Center of Research on Psychological Disorders and Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands
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25
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Gkintoni E, Kourkoutas E, Yotsidi V, Stavrou PD, Prinianaki D. Clinical Efficacy of Psychotherapeutic Interventions for Post-Traumatic Stress Disorder in Children and Adolescents: A Systematic Review and Analysis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:579. [PMID: 38790574 PMCID: PMC11119036 DOI: 10.3390/children11050579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 04/30/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Background: This systematic review aggregates research on psychotherapeutic interventions for Post-Traumatic Stress Disorder (PTSD) in children and adolescents. PTSD in this demographic presents differently from adults, necessitating tailored therapeutic approaches. In children and adolescents, PTSD arises from exposure to severe danger, interpersonal violence, or abuse, leading to significant behavioral and emotional disturbances that jeopardize long-term development. The review focuses on describing PTSD within two age groups, children (6 to 12 years) and adolescents (12 to 18 years), while evaluating the effectiveness of various clinical interventions aimed at this condition. Methods: Utilizing the PRISMA guidelines, this review systematically examines studies that assess clinical interventions for PTSD in the younger population. Results: Key symptoms of PTSD in children and adolescents include avoidance, overstimulation, flashbacks, depression, and anxiety. The review identifies several effective treatments, including Cognitive Behavioral Therapy (CBT), Trauma-Focused CBT (TF-CBT), Eye Movement Desensitization and Reprocessing (EMDR), Systemic Therapy, Play Therapy, Exposure Therapy, Relaxation Techniques, and Psychodynamic Psychotherapy. Particularly, TF-CBT is highlighted as the most effective and commonly used method in treating childhood and adolescent PTSD, as supported by most of the studies reviewed. Conclusions: A significant outcome of this study is the short-term effectiveness of CBT in reducing PTSD symptoms in children and adolescents. The findings underline the importance of psychotherapeutic interventions and mark a substantial advancement in understanding PTSD in young populations. It is crucial for practitioners to integrate various psychotherapeutic strategies into their practice to improve patient outcomes and treatment efficacy.
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Affiliation(s)
- Evgenia Gkintoni
- Department of Psychiatry, University General Hospital of Patras, 26504 Patras, Greece
| | - Elias Kourkoutas
- Department of Primary Education, Research Center for the Humanities, Social and Education Sciences, University of Crete, 74100 Rethymno, Greece;
| | - Vasiliki Yotsidi
- Department of Psychology, Panteion University, 17671 Athens, Greece;
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26
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Hyatt CS, Sleep CE, Asamsama OH, Reger MA. Surveying veterans affairs mental health care providers on experiences working with veteran patients with antagonistic clinical presentations. Psychol Serv 2024; 21:379-387. [PMID: 37358554 PMCID: PMC10749978 DOI: 10.1037/ser0000782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
We surveyed N = 84 mental health care providers (i.e., psychiatrists, psychologists, social workers) working across two Veterans Affairs health care sites about their experiences working with Veteran patients with antagonism-based clinical presentations (e.g., callous, aggressive, grandiose features), as well as negative affect-based clinical presentations (e.g., depressive, anxious, self-conscious features). Providers reported on aspects of these clinical interactions, including assessments and interventions used, treatment outcomes, interpersonal experiences, and training and preparedness to treat this type of presentation in the future. Compared to treatment experiences with patients with predominant negative affect, providers reported that treatment experiences with antagonistic (ANT) patients tended to be shorter (d = -.60), less effective at improving psychological functioning (d = -.61), more emotionally draining (d = 1.03), and more often marked by relationship ruptures (instance of ≥1 rupture = 72.6% vs. 15.5%). Providers also reported less professional training to treat antagonism (d = -1.56) and less preparedness to treat ANT patients in the future (d = -1.81). These results highlight the important role of patient characteristics in providers' experiences and underscore the need for more training and resources to support mental health providers working with ANT patients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Courtland S. Hyatt
- VA Puget Sound Health Care System, Seattle Division 1660 S Columbian Way, Seattle, WA 98108
- University of Washington, Department of Psychiatry and Behavioral Sciences 1959 NE Pacific St., Seattle, WA 98195
- Emory University, Department of Psychiatry and Behavioral Sciences 12 Executive Park Dr., 3 Floor, Atlanta, GA 30329
| | - Chelsea E. Sleep
- Cincinnati VA Medical Center 3200 Vine St., Cincinnati, OH 45220
- University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience 2600 Clifton Ave, Cincinnati, OH 45221
| | - Octaviana Hemmy Asamsama
- VA San Diego Health Care System 3350 La Jolla Village Dr, San Diego, CA 92161
- University of California, San Diego Health Department of Psychiatry 9500 Gilman Dr, La Jolla, CA 923093
| | - Mark A. Reger
- VA Puget Sound Health Care System, Seattle Division 1660 S Columbian Way, Seattle, WA 98108
- University of Washington, Department of Psychiatry and Behavioral Sciences 1959 NE Pacific St., Seattle, WA 98195
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27
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Lachance V, Laverdière O, Kealy D, Ogrodniczuk JS. Dispositional Empathy Among Psychotherapists: A Latent Profile Analysis. Clin Psychol Psychother 2024; 31:e3016. [PMID: 38859691 DOI: 10.1002/cpp.3016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/16/2024] [Accepted: 05/17/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE This study examined therapists' dispositional empathy profiles and how they differ based on professional and personal characteristics. METHOD A total of 376 clinicians was recruited for this study. Dispositional empathy was assessed with the Interpersonal Reactivity Index (IRI). Profiles were generated using latent profile analysis. Predictors of profiles were assessed with multiple self-report questionnaires measuring demographic and professional characteristics, romantic attachment styles, five-factor personality traits and vulnerable narcissism. RESULTS A four-profile solution was retained with the following proportions: rational empathic (20%), disengaged/detached (10%), empathic immersion (35%) and insecure/self-absorbed (35%). Overall, few relationships were found regarding demographic and professional characteristics. In contrast, significant relationships were found between profile membership and personal characteristics, including avoidant and anxious attachment, agreeableness, conscientiousness, neuroticism, intellect/imagination and vulnerable narcissism. CONCLUSION The findings show that differences in therapists' empathic dispositions are linked to personality dimensions. Implications for psychotherapy research, practice and training are discussed.
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Affiliation(s)
- Valerie Lachance
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Olivier Laverdière
- Department of Psychology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
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28
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Marchi M, Venturi G, Visentini C, Pinelli M, Priebe S, Galeazzi GM. The therapeutic relationship in community mental health services: a systematic review of the literature. Soc Psychiatry Psychiatr Epidemiol 2024; 59:731-743. [PMID: 37875610 DOI: 10.1007/s00127-023-02581-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE This systematic review aimed to investigate the therapeutic relationship (TR) between mental health professionals (MHPs) and their patients in community mental health services (CMHS). METHODS PubMed (Medline), PsycINFO, CINAHL, CENTRAL, and Web of Science were searched for studies that assessed TR in CMHS using quantitative measures developed specifically for this setting (i.e., Helping Alliance Scale [HAS] and the Scale to Assess the Therapeutic Relationship [STAR]). Studies were included if they considered adult patients with a psychiatric disorder and/or any MHP working in CMHS. Meta-analysis and narrative synthesis assessed the association between patients' and MHPs' ratings and identified predictors of TR. RESULTS Of 1934 studies, 15 were included in the review, including 3004 patients. A total of 1127 patients and 963 MHPs were considered in the meta-analysis. The heterogeneity of the studies was high, and there was no significant difference between the patients' and MHPs' TR ratings in the random-effects model (standardized mean difference [SMD]: - 0.39 [95% CI: - 1.03; 0.24]). In the multivariable meta-regression, only duration of illness was significantly associated with TR ratings (unstandardized regression coefficient [B]: 0.388 [95% CI: 0.217; 0.558]). A recovery-oriented service, shared decision-making, and the recognition of patient needs contributed to more positive TR ratings. CONCLUSION Patients and MHPs converged in their TR ratings, although patients gave lower ratings. Routine assessment of TR in CMHS can inform reflective practice and service development, as TR can be assessed easily and early in the treatment process. Future research should focus on developing and testing interventions to improve TR in CMHS.
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Affiliation(s)
- Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy
| | - Giulia Venturi
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy
| | - Chiara Visentini
- Department of Mental Health and Drug Abuse, AUSL Modena, Modena, Italy
| | - Margherita Pinelli
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy
| | | | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola 2, 42122, Reggio Emilia, Italy.
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29
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Smith MM, Hewitt PL. The equivalence of psychodynamic therapy and cognitive behavioral therapy for depressive disorders in adults: A meta-analytic review. J Clin Psychol 2024; 80:945-967. [PMID: 38324666 DOI: 10.1002/jclp.23649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/07/2024] [Accepted: 01/14/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Meta-analyses on the relative efficacy of psychodynamic psychotherapy (PDT) and cognitive behavioral therapy (CBT) for depressive disorders are limited by heterogeneity in diagnostic samples and comparators and a lack of equivalence testing. OBJECTIVE We addressed this through a meta-analytic test of the equivalence of manualized PDT and CBT in treating adults with depressive disorders as determined by diagnostic interviews. Sensitivity analyses evaluated the impact of pretreatment differences, mixed diagnostic samples, author allegiance, study quality, year of publication and outliers on findings. METHOD A comprehensive literature search across multiple databases using reliable screening methods identified nine randomized controlled trials directly comparing manualized PDT and CBT for diagnosed depressive disorders in adults. Following pre-registration, we employed random effect models for our meta-analyses and two one-sided test procedures for equivalence testing. RESULTS Independent raters determined that all studies were of adequate quality. Immediately posttreatment, depressive symptoms were statistically equivalent across PDT and CBT (k = 9; g = -0.11, 90% confidence interval [90% CI]: -0.24 to 0.02, pequivalence = .048, pNHST = .212, I2 = 32.7). At follow-up, the longest time point within a year, depressive symptoms were neither statistically equivalent nor statistically different (k = 6; g = -0.16, 90% CI: -0.31 to -0.02, pequivalence = .184, pNHST = .126, I2 = 0.00). CONCLUSION The efficacy of manualized PDT is equal to manualized CBT immediately at posttreatment for depressive disorders in the adult general population. Nevertheless, insufficient data exists to reach a conclusion regarding equivalence at follow-up.
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Affiliation(s)
- Martin M Smith
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Paul L Hewitt
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
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30
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Tasca GA. The Promise and Challenges of Practice-Oriented Research: A Commentary on the Special Issue. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:380-383. [PMID: 38598077 DOI: 10.1007/s10488-024-01370-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/11/2024]
Abstract
At the centre of POR is the concept of collaboration between patients, therapists, agencies, and third-party payers. For this commentary, I review the articles of the special issue with attention to both the opportunities and challenges offered by practice-oriented research (POR). I also reviewed some previous research on practice-research networks and how that research might inform POR. The use of routine outcome monitoring (ROM), artificial intelligence (AI), and program evaluation (PE) models show promise for advancing POR. However, each comes with its challenges. The use of ROM to improve patient outcomes has research support. However, researchers have identified problems with implementing ROM because of low uptake by clinicians and because clinicians may see ROM as a potential intrusion. AI shows promise to improve patient outcomes by potentially providing therapists with immediate and nuanced data to inform interventions and interpersonal stances specific to each patient. However, the scaling up of AI runs the risk of dehumanizing psychological interventions. PE may provide a context for allowing therapists to engage in POR to address real-world processes and outcomes of mental health interventions. However, like ROM PE faces the challenge of trust among clinicians and patients who may be reluctant to participate. Despite these challenges, and because of efforts to nurture and maintain respectful collaborations, articles in this special issue highlight how POR can play a pivotal role in bridging the gap between theory and practice.
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Affiliation(s)
- Giorgio A Tasca
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier, Ottawa, ON, K1N6N5, Canada.
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31
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Dandy S, Wittkowski A, Murray CD. Parents' experiences of receiving their child's diagnosis of congenital heart disease: A systematic review and meta-synthesis of the qualitative literature. Br J Health Psychol 2024; 29:351-378. [PMID: 37968248 DOI: 10.1111/bjhp.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/31/2023] [Accepted: 10/18/2023] [Indexed: 11/17/2023]
Abstract
PURPOSE This systematic review aimed to synthesize qualitative research on parents' psychological experiences following their child's diagnosis of congenital heart disease (CHD). METHODS A systematic search of six electronic databases (CINAHL, Embase, MEDLINE, PsycINFO, PubMed and Web of Science) was completed, inclusive of all years up to May 2022. Any included articles were synthesized using thematic synthesis and appraised using the Critical Appraisal Skills Programme Qualitative Checklist. RESULTS Twenty-six articles were included. Four main themes, and 11 subthemes, emerged from the synthesis. Theme 1 (unpreparedness for the diagnosis) concerned parents' shock, guilt and anger regarding the diagnosis. Theme 2 (the overwhelming reality of CHD) described parental fear about decision-making and the child's prognosis, and the influence of professionals on parents' well-being. Theme 3 (mourning multiple losses) detailed parents' sadness at losing their envisioned pregnancy, birth and parenthood experiences. Theme 4 (redefining hopes to reach an acceptance of CHD) described parents' adjustment to the diagnosis. CONCLUSIONS Receiving a child's CHD diagnosis was a uniquely challenging situation for parents. The findings provided insight into the emotions parents experienced and how they adjusted to the diagnosis psychologically. As parents' experiences were significantly influenced by their interactions with professionals, clinicians should offer compassion, validation and clear information throughout the diagnosis process.
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Ruiz-Yu B, Le TP, Weintraub MJ, Zinberg J, Addington J, O'Brien MP, Walsh BC, Friedman-Yakoobian M, Auther A, Cornblatt, Domingues I, Cannon TD, Miklowitz DJ, Bearden CE. Race/ethnicity and socioeconomic status as predictors of outcome following family therapy in youth at clinical high risk for psychosis. Early Interv Psychiatry 2024. [PMID: 38676463 DOI: 10.1111/eip.13541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 03/21/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
AIM There is limited research on the effects of sociodemographic and socioeconomic factors on treatment outcomes in youth at clinical high risk for psychosis (CHRp). This study examined sociodemographic factors that may affect functional outcomes within this population. Specifically, we investigated the influence of race/ethnicity (dichotomized as non-Hispanic whites [NHW] vs. people of colour [POC]), socioeconomic status (SES; operationalized as parental years of education), and their interaction on change in psychosocial functioning and symptoms over 6 months in a randomized trial of family-focused therapy. METHODS CHRp youth (N = 128) participated in a randomized trial of family therapy (18 sessions of family therapy vs. 3 sessions of family psychoeducation). Sixty-four participants who self-identified as POC and 64 self-identified NHW participants completed baseline and 6-month follow-up measures of positive and negative symptoms and psychosocial (global, role, and social) functioning. Multiple regression models were conducted to test the main effect of race/ethnicity on changes in positive and negative symptoms and functioning, and whether this effect was moderated by parental education. RESULTS There was a significant interaction between race/ethnicity and parental education, such that higher parental education was associated with greater improvement in global functioning in NHW participants, but there was no relationship between parental education and global functioning in POC. Additionally, higher parental education was associated with a decrease in negative symptoms in NHW participants but not in POC. There were no significant effects of race/ethnicity or parental education on positive symptoms, nor on social or role functioning. CONCLUSIONS Clinicians may consider tailoring psychosocial treatments according to the needs of diverse families who vary in sociodemographic factors such as educational attainment and race/ethnicity.
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Affiliation(s)
- Bernalyn Ruiz-Yu
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Thanh P Le
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Marc J Weintraub
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Jamie Zinberg
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Jean Addington
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mary P O'Brien
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Barbara C Walsh
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Andrea Auther
- Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
- Department of Psychiatry, The Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Garden City, New York, USA
| | - Cornblatt
- Department of Psychiatry Research, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York, USA
- Department of Psychiatry, The Barbara and Donald Zucker School of Medicine at Hofstra/Northwell, Garden City, New York, USA
- Institute of Behavioral Science, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Isabel Domingues
- Department of Psychiatry, University of California, San Diego, California, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - David J Miklowitz
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
| | - Carrie E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California, USA
- Department of Psychology, University of California, Los Angeles, California, USA
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33
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Holmes J. Friston, Free Energy, and Psychoanalytic Psychotherapy. ENTROPY (BASEL, SWITZERLAND) 2024; 26:343. [PMID: 38667897 PMCID: PMC11049609 DOI: 10.3390/e26040343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/26/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024]
Abstract
This paper outlines the ways in which Karl Friston's work illuminates the everyday practice of psychotherapists. These include (a) how the strategic ambiguity of the therapist's stance brings, via 'transference', clients' priors to light; (b) how the unstructured and negative capability of the therapy session reduces the salience of priors, enabling new top-down models to be forged; (c) how fostering self-reflection provides an additional step in the free energy minimization hierarchy; and (d) how Friston and Frith's 'duets for one' can be conceptualized as a relational zone in which collaborative free energy minimization takes place without sacrificing complexity.
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Affiliation(s)
- Jeremy Holmes
- Department of Psychology, University of Exeter, Exeter EX4 4QG, UK
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Stefana A, Vieta E, Fusar-Poli P, Youngstrom EA. Enhancing Psychotherapy Outcomes by Encouraging Patients to Regularly Self-Monitor, Reflect on, and Share Their Affective Responses Toward Their Therapist: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2024; 13:e55369. [PMID: 38587881 PMCID: PMC11036184 DOI: 10.2196/55369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The quality of the therapeutic relationship is pivotal in determining psychotherapy outcomes. However, facilitating patients' self-awareness, reflection on, and sharing of their affective responses toward their therapist remains underexplored as a potential tool for enhancing this relationship and subsequent treatment outcomes. OBJECTIVE The primary objective of this study is to examine whether and how the patients' regular self-monitoring and self-reflection (fostered by the systematic compilation of a brief postsession battery) on their affective reactions toward the psychotherapist impact the quality of the therapeutic relationship and treatment outcomes in individual psychotherapy. Secondary objectives are to (1) explore whether and how the characteristics of the patient, the therapist, and the process moderate the effect of regular self-monitoring on the therapeutic relationship and outcomes; (2) examine the relationships between the affective response of the patient, the alliance, and the result of the therapy session outcome; and (3) explore how the affective responses of the patient unfold or change throughout the course of the therapy. METHODS We conducted a 1:1 randomized controlled trial of adults in individual psychotherapy versus individual psychotherapy plus self-monitoring. Participants will be enrolled through the web-based recruitment platforms "ResearchMatch" and "Research for Me," and data will be collected through web-based surveys. Participants in the control group will receive only their regular individual psychotherapy (treatment as usual) and will not complete postsession questionnaires. Participants in the intervention group will continue their regular individual psychotherapy sessions and complete the "in-Session Patient Affective Reactions Questionnaire" and the "Rift In-Session Questionnaire" following each therapy session in the 10 weeks of the trial. Additionally, after completion of the postsession battery, they will receive general written feedback encouraging them to discuss their feelings and reflections with their therapist. Participants in both groups will complete a comprehensive psychological assessment at baseline, midtrial (week 5), and end-of-trial (week 10). The primary outcome measure of the trial is the "Clinical Outcomes in Routine Evaluation-Outcome Measure," while the secondary outcomes are the "Real Relationship Inventory-Client-Short Form," the "Working Alliance Inventory-Short Revised," and the number of scheduled therapy sessions that the patient has missed or canceled. RESULTS The trial was approved by the institutional review board of the University of North Carolina at Chapel Hill. Recruitment started in September 2023. A total of 475 individuals completed the baseline assessment. Data collection was completed in February 2024. The results are expected to be published in the autumn of 2024. CONCLUSIONS This study could reveal key information on how regular self-monitoring and introspection can influence both the therapeutic relationship and treatment outcomes. Findings have the potential to shape interventions, enhance the efficacy of psychotherapeutic sessions, and possibly offer a cost-effective strategy for improving patients' well-being. TRIAL REGISTRATION ClinicalTrials.gov NCT06038747; https://classic.clinicaltrials.gov/ct2/show/NCT06038747. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55369.
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Affiliation(s)
- Alberto Stefana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona,, Barcelona, Spain
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Early Psychosis: Interventions and Clinical-detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Institute for Mental and Behavioral Health Research, Nationwide Children's Hospital, Division of Child and Family Psychiatry, The Ohio State University, Columbus, OH, United States
- Helping Give Away Psychological Science, Chapel Hill, NC, United States
- Department of Psychiatry, The Ohio State University, Columbus, OH, United States
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Taubner S, Sharp C. Mental Flexibility and Epistemic Trust Through Implicit Social Learning - A Meta-Model of Change Processes in Psychotherapy With Personality Disorders. CLINICAL PSYCHOLOGY IN EUROPE 2024; 6:e12433. [PMID: 39118648 PMCID: PMC11303934 DOI: 10.32872/cpe.12433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/03/2024] [Indexed: 08/10/2024] Open
Abstract
This position paper follows the call for transtheoretical meta-models of general clinical change by concentrating on severe mental illness such as Personality Disorders (PDs). We have identified a core process of change related to mental flexibility through implicit learning and propose recommendations for stance and technique that are informed by research on Mentalization-Based-Treatment (MBT) and the learning components as represented in the Mediational Intervention for Sensitizing Caregivers (MISC). While the idea of corrective emotional experience as a general change mechanism involves discriminating between an old and new relationship to update relationship knowledge, the capacity to understand and process corrective emotional experiences may be limited and even iatrogenic in patients with PDs. By integrating MBT and MISC, a meta-model of change is created that allows training in and observation of the granular-level, behaviorally anchored, actions taken by the therapist to open up social learning. Here, social learning is conceptualized as epistemic trust, increasing the client's reflective functioning during sessions to ultimately enhance cognitive flexibility outside the therapy room. This opens the possibility to implement and observe micro changes in what should be termed now implicit cognitive and emotional corrective experiences. Thus, we propose to shift towards implicit learning within professional relationships; that is, internalizing a new way of thinking about any life-event that requires adaption thereby creating adaptive capacities via mental flexibility as the general change mechanism of Personality Disorder (PD) treatment.
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Affiliation(s)
- Svenja Taubner
- Institut für Psychosoziale Prävention, Universitätsklinikum Heidelberg, Heidelberg, Gemany
| | - Carla Sharp
- University of Houston, Houston, TX, USA
- University of the Free State, Bloemfontein, South Africa
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Leung KCY, Lele K. A hospital-wide group approach to promote open dialogues of workplace issues and staff wellbeing with Schwartz Rounds. Australas Psychiatry 2024; 32:151-156. [PMID: 38288725 PMCID: PMC10913322 DOI: 10.1177/10398562241229887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
OBJECTIVES This study aims to explore the feasibility and impact of Schwartz Rounds® led by psychiatrists/mental health professionals in an urban Australian public hospital setting and to develop strategies for optimising participants' experiences. METHODS Being a mixed-methods study collecting qualitative and quantitative data through post-Rounds evaluation surveys, this study thematically analysed responses from 105 participants attending four consecutive monthly Rounds between February and May 2023 to assess the perceived benefits and challenges of Schwartz Rounds. RESULTS Respondents highly valued the Rounds and felt cared for by the healthcare organisation. Themes related to perceived benefits included (i) Connectedness and shared experience; (ii) Understanding other professionals; (iii) Normalisation of emotional distress, validation and a safe space for vulnerability; and (iv) Fostering authenticity and humanitarian aspects of healthcare. Challenges included (i) Fear of exposure and judgment; (ii) Emotional discomfort; (iii) Unfamiliarity with reflection; and (iv) Safety concerns. CONCLUSIONS This study suggests acceptability and feasibility of implementing Schwartz Rounds within an Australian public health setting, particularly when facilitated by skilled mental health professionals. The outcomes provide preliminary support for the use of group interventions to enhance staff collegiality and culture in healthcare settings, thereby addressing critical needs for health professional wellbeing.
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Affiliation(s)
| | - Kiran Lele
- University of Sydney, Camperdown, NSW, Australia
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Day MA, Ehde DM, Bindicsova I, Jensen MP. Understanding the Role of Therapist Quality in Accounting for Heterogeneity of Patient Outcomes in Psychosocial Chronic Pain Treatments. THE JOURNAL OF PAIN 2024; 25:843-856. [PMID: 37832902 DOI: 10.1016/j.jpain.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/24/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023]
Abstract
A variety of evidence-based psychosocial treatments now exist for chronic pain. However, on average, effect sizes have tended to be modest and there is a high degree of heterogeneity in treatment response. In this focus article, we explore the potential role that therapist quality in delivering treatment may have in accounting for a degree of this variability in outcome. Therapist quality refers to the skillful delivery of treatment, harnessing both specific and common therapeutic factors during sessions. While recognized as important to assess and report in clinical trials by some reporting guidelines, few randomized controlled trials evaluating psychosocial treatments for chronic pain have reported on therapist factors. We reviewed the clinical trials included in three systematic reviews and meta-analyses of trials of cognitive-behavioral therapy (mainly), mindfulness-based interventions, and acceptance and commitment therapy. We found that of the 134 trials included, only nine assessed and reported therapist quality indicators, with a variety of procedures used. This is concerning as without knowledge of the quality in which treatments are delivered, the estimates of effect sizes reported may be misrepresented. We contextualize this finding by drawing on the broader psychotherapy literature which has shown that more skillful, effective therapists demonstrated ten times better patient response rates. Examination of the characteristics associated with these more effective therapists tends to indicate that skillful engagement of common factors in therapy sessions represents a distinguishing feature. We conclude by providing recommendations for assessing and reporting on therapist quality within clinical trials evaluating psychosocial treatments for chronic pain. PERSPECTIVE: Therapist quality in the delivery of psychosocial treatments for chronic pain has rarely been assessed in clinical trials. We propose that therapist quality indicators are an under-studied mechanism that potentially contributes to the heterogeneity of treatment outcomes. We provide recommendations for assessing and reporting on therapist quality in future trials.
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Affiliation(s)
- Melissa A Day
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia; Department of Rehabilitation Medicine, The University of Washington, Seattle, Washington
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, The University of Washington, Seattle, Washington
| | - Ingrid Bindicsova
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Mark P Jensen
- Department of Rehabilitation Medicine, The University of Washington, Seattle, Washington
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Howe E. Psychotherapeutic approaches: hopefully, globally effective. Front Psychiatry 2024; 15:1322184. [PMID: 38606404 PMCID: PMC11007125 DOI: 10.3389/fpsyt.2024.1322184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/23/2024] [Indexed: 04/13/2024] Open
Abstract
Many patients have lasting disorders due, for example, to excessive and chronic childhood stress. For these patients, certain psychotherapeutic approaches may be maximally effective, and this may be universally the case. This piece is intended to give providers optimal tools for reaching and helping these patients who, otherwise, may remain among those worst off. These interventions should enhance patients' trust, the quintessential precondition for enabling these patients to change. Specific interventions discussed include anticipating ambiguity and clarifying this before ambiguity occurs, therapists indicating that they will support patients' and families' wants over their own views, feeling and disclosing their emotions, validating patients' anger, laughing, going beyond usual limits, explaining why, asking before doing, discussing religion and ethics, and informing whenever this could be beneficial.
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Affiliation(s)
- Edmund Howe
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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Gumz A, Daubmann A, Erices R, Berger J, Reuter L, Kästner D. Associations between therapists' verbal techniques and patient-rated therapeutic alliance, insight, and problem solving. Psychother Res 2024:1-12. [PMID: 38527181 DOI: 10.1080/10503307.2024.2327443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/04/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To investigate associations between common factors (alliance, insight, problem solving) and therapists' techniques. We expected a positive association between (1) supportive techniques and the alliance, (2) interpretative techniques and insight, and (3) a stronger association between interpretative techniques and insight for patients with more severe baseline symptoms. Other associations were analyzed in an exploratory way. METHOD Sixty sessions from 15 adult female patients diagnosed with personality disorder were analyzed using the Psychodynamic Interventions List (verbal techniques, observer-rated transcripts), and the Session Questionnaire for General and Differential Individual Psychotherapy (common factors, patient-rated after each session). Multilevel modeling was applied. RESULTS A greater use of supportive techniques was related to a higher therapeutic alliance (b = .28, 95% CI: .01-.55, p = .042). Neither the positive association between interpretative techniques and insight nor the moderating effect of baseline symptom severity could be confirmed. Exploratory analyses revealed associations between problem-solving and different verbal techniques. CONCLUSION Therapists' use of supportive techniques seems to influence the therapeutic alliance positively in patients with personality disorders. The effect of interpretative techniques might depend on other factors like patient characteristics. In general, there seem to be differential and specific associations between different therapists' verbal techniques and common factors.
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Affiliation(s)
- Antje Gumz
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Erices
- Institute for History of Medicine and Medical Ethics, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen, Germany
| | - Jelka Berger
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Laurence Reuter
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Denise Kästner
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
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Stefana A, Fusar-Poli P, Langfus J, Vieta E, Youngstrom E. Development and preliminary validation of the Clinician Affective REsponse (CARE) scale. RESEARCH IN PSYCHOTHERAPY (MILANO) 2024; 27:736. [PMID: 38551502 PMCID: PMC11064772 DOI: 10.4081/ripppo.2024.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/19/2024] [Indexed: 05/03/2024]
Abstract
The present study reports on the development and validation of the clinician affective response (CARE) scale. The CARE scale was designed as a self-report measure of therapists' patterns of thoughts, feelings, and behaviors toward the patient during an individual psychotherapy session. An initial pool of 116 items was generated, and its quality was evaluated by subject matter experts. Validation data were gathered from licensed psychotherapists (n=554). We used exploratory factor analysis and item response theory-graded response modeling to select items, confirmatory factor analysis to test how well the factor structure fit the data, and k-fold cross-validation to ascertain the robustness of the model. Criterion validity was evaluated by correlating the scores of the scale with the characteristics of therapists, patients, and treatment. The selected model consists of 15 items and a 3-factor structure, which showed excellent model fit, good internal consistency, and evidence of criterion validity. The CARE scale, short and quick to complete, enables therapists to reflect on and recognize their inner experiences and quantify these experiences in ways conducive to statistical analysis and research. Furthermore, the monitoring of these affective reactions toward their patients can guide therapeutic interventions and inform clinical supervisors.
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Affiliation(s)
- Alberto Stefana
- Department of Brain and Behavioral Sciences, University of Pavia.
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Italy; OASIS Service, South London and Maudsley NHS Foundation Trust, London; Early Psychosis: Interventions and Clinical-detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London.
| | - Joshua Langfus
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC.
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona.
| | - Eric Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC; Helping Give Away Psychological Science, Chapel Hill, NC; Division of Child and Family Psychiatry, Institute for Mental and Behavioral Health Research, Ohio State University, Nationwide Children's Hospital, Columbus, OH.
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Feingold D, Tzur Bitan D, Ferri M, Hoch E. Predictors of effective therapy among individuals with Cannabis Use Disorder: a review of the literature. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01781-4. [PMID: 38493284 DOI: 10.1007/s00406-024-01781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Abstract
Treatment demand for Cannabis Use Disorder (CUD) has increased in the past decade in almost all European countries, and CUD is currently the most common reason for first-time drug-related treatment admission in the European Union. Even though several therapeutic approaches have been shown to benefit individuals with CUD, there is a lack of knowledge regarding factors associated with effective therapy and the underlying mechanisms of change among individuals with CUD presenting for treatment. The aim of the present paper was to review current knowledge on factors that have been shown to contribute to positive outcomes in CUD treatment. A scoping methodology was used, focusing on empirically evaluated studies that used defined, cannabis-related outcome measures. In eligible studies, factors of investigation were categorized as either 'mediators', i.e., treatment-related factors associated with the processes or mechanisms through which patients benefit from therapy, or 'moderators' which are patient-related characteristics that predict his/her odds to benefit from treatment or patient-related (i.e., moderators). Factors categorized as mediators were then classified 'specific factors' if they were related to a certain technique or treatment modality or 'common factors' if they were assessed beyond treatment modalities. Findings suggest that in CUD treatment, specific mediators include treatment duration, addressing motivation to change, acquiring coping skills, enhancing self-efficacy, and integrating several therapeutic components. Common mediators include therapeutic alliance, empathy, expectations and cultural adaptation. Moderators in CUD treatment include sex, ethnicity, age-related factors and comorbid disorders.
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Affiliation(s)
- Daniel Feingold
- Psychology Department, Achva Academic College, Achva, Israel.
| | - Dana Tzur Bitan
- Department of Community Mental Health, University of Haifa, Haifa, Israel
- Shalvata Mental Health Center, Hod Hasharon, Israel
| | | | - Eva Hoch
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
- IFT Institut für Therapieforschung, Centre of Health and Addiction Research, Munich, Germany
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Echterhoff J, Kriston L, Klein JP, Härter M, Schramm E, Schumacher L. Symptom-specific improvement across therapies and their putative mediators: A mediation network intervention analysis. Psychother Res 2024:1-12. [PMID: 38431848 DOI: 10.1080/10503307.2024.2320349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE We evaluated differential treatment effects on specific symptoms and their mediators for Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy (SP) in persistently depressed patients. METHOD We conducted a Bayesian mediation network intervention analysis with data from a randomized controlled trial comparing CBASP and SP. Three networks were calculated to investigate (1) differential treatment effects on specific symptoms, (2) differential treatment effects on the potential mediators interpersonal problems and social functioning, and (3) associations between change in symptoms and change in the potential mediators. RESULTS First, we found no evidence that CBASP more strongly improves most depressive symptoms specifically, except minimal evidence of symptom-specific effects on sleeping problems and self-esteem. Second, no and minimal evidence for differential treatment effects on interpersonal problems and social functioning was shown, respectively. Third, interpersonal problems and social functioning were strongly related to depressive symptoms. CONCLUSION While CBASP showed superior treatment effects for overall symptom severity, this treatment might not be superior in improving specific symptoms and the potential mediators interpersonal problems and social functioning. Still, interpersonal problems and social functioning seem to play an important role for depression symptoms. Future research needs to further investigate potential working mechanisms of CBASP.Trial registration: ClinicalTrials.gov identifier: NCT00970437.
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Affiliation(s)
- Jette Echterhoff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Philipp Klein
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lea Schumacher
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Levenson JS, Grady MD, Lasoski H, Collins KT. Learning From Consumers of Mandated Sex-Offending Programs: "It's Not Treatment, I Wish It Was.". SEXUAL ABUSE : A JOURNAL OF RESEARCH AND TREATMENT 2024; 36:203-232. [PMID: 37078579 DOI: 10.1177/10790632231172158] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The purpose of this qualitative study was to explore clients' perceptions of sex-offending treatment. The sample included 291 people required to register as sex offenders in the U.S. who answered an open-ended question in an online survey asking them to describe their positive and negative experiences in mandated treatment. Using qualitative analysis, three overarching themes (with several subthemes) were identified: (1) positive and (2) negative treatment experiences and (3) the affiliation between the criminal justice system and clinical services. Experiences in sex offending treatment were viewed as positive when clients had opportunities to learn about themselves, experience group cohesion, build a positive alliance with a caring therapist, learn tools and skills for emotional health, explore the roots of offense behavior, and create healthy life plans to reduce risk for re-offending. Negative themes emerged when treatments were viewed as coercive, confrontational, or demeaning; when therapists seemed inexperienced or unqualified; and when seemingly outdated or unscientific methods were emphasized without explanation or dialogue. The entanglement between court-mandated treatment providers and the criminal justice system led to concerns about confidentiality, conflicts of interest, and role ambiguity. Drawing upon literature related to therapeutic alliance, trauma-informed care, and Risk-Need-Responsivity models, we offer suggestions for integrating client feedback to improve treatment responsivity and prevent re-offending.
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Affiliation(s)
| | - Melissa D Grady
- National School of Social Service, The Catholic University of America, Washington, DC, USA
| | - Heike Lasoski
- National School of Social Service, The Catholic University of America, Washington, DC, USA
| | - Kyle T Collins
- National School of Social Service, The Catholic University of America, Washington, DC, USA
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Smith R, Persich MR, Chuning AE, Cloonan S, Woods-Lubert R, Skalamera J, Berryhill SM, Weihs KL, Lane RD, Allen JJB, Dailey NS, Alkozei A, Vanuk JR, Killgore WDS. Improvements in mindfulness, interoceptive and emotional awareness, emotion regulation, and interpersonal emotion management following completion of an online emotional skills training program. Emotion 2024; 24:431-450. [PMID: 37535567 PMCID: PMC10837318 DOI: 10.1037/emo0001237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Socioemotional skills, such as the ability to recognize, understand, and regulate the emotions of self and others, are associated with both physical and emotional health. The present study tested the effectiveness of a recently validated online training program for increasing these emotional skills in adults. In this study, 448 participants (323 female) were randomly assigned to complete this training program or a placebo control program. Among those who completed the training program or placebo (N = 326), the training program led to improved scores post-training on measures of interoceptive and emotional awareness, mindfulness, emotion recognition, and emotion regulation strategies (e.g., reduced emotion suppression and greater impulse control) relative to placebo. In a smaller group of participants who also completed a 6-month follow-up visit (N = 94), sustained improvements were observed on several measures in those who completed the training program, while the placebo group instead showed decreased performance. This suggested a potentially protective effect against emotional challenges associated with the COVID-19 pandemic occurring during this time. These results suggest that this online training program shows promise in improving emotional skills relevant to adaptive social and emotional functioning, and that it might be useful as an intervention within at-risk populations and those with emotional disorders associated with reduced application of these skills. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Ryan Smith
- University of Arizona
- Laureate Institute for Brain Research
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Shi C, Zhang T, Du X, Lu S, Witthöft M. Efficacy of internet-based psychological interventions for pathological health anxiety: A three-level meta-analysis of randomized controlled trials. Gen Hosp Psychiatry 2024; 87:77-82. [PMID: 38335917 DOI: 10.1016/j.genhosppsych.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE This study aimed to provide a comprehensive summary and synthesis of available evidence on the efficacy of internet-based psychological interventions for pathological health anxiety, as well as to examine the variables that possibly moderate intervention effects. METHOD Four databases were searched for the literature up to October 2023. A three-level random-effects model was used to estimate the pooled effect size, with Hedge's g as the measure. RESULTS We extracted 28 effect sizes from nine eligible randomized controlled trials with 1079 participants. The results showed that internet-based psychological interventions had a moderate to large between-group effect on health anxiety (g = 0.70) that was significant both at post-intervention (g = 0.74) and follow-up (g = 0.64). Furthermore, these interventions were significantly more effective than passive control conditions including waitlist, usual care, and placebo at post-treatment (g = 1.07), but had effects comparable to active control groups at both post-intervention and follow-up. CONCLUSIONS Internet-based psychological interventions are an effective way to alleviate pathological health anxiety. We recommend that these interventions be more widely implemented in routine care settings to ensure easy accessibility for patients with health anxiety.
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Affiliation(s)
- Congrong Shi
- School of Educational Science, Anhui Normal University, Wuhu, China.
| | - Tao Zhang
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiayu Du
- School of Psychology, Central China Normal University, Wuhan, China
| | - Shan Lu
- Nanning Fifth People's Hospital, Nanning, China
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
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Hartstein GL, Peck P, Yellowlees P, Torous J. Psychotherapy in the Digital Era: A Case for Hybrid Care and Remote Therapeutic Monitoring. Harv Rev Psychiatry 2024; 32:63-69. [PMID: 38452286 DOI: 10.1097/hrp.0000000000000393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- George Luke Hartstein
- From Harvard Medical School (Drs. Hartstein, Peck, and Torous); Department of Psychiatry and Behavioral Sciences, University of California, Davis (Dr. Yellowlees)
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Litt MD. Do you need a therapist to have a therapeutic alliance? Comment on Benitez et al., "The connection still matters: Therapeutic alliance with digital treatment for alcohol use disorder". ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:459-461. [PMID: 38195112 DOI: 10.1111/acer.15260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Affiliation(s)
- Mark D Litt
- Division of Behavioral Sciences and Community Health - MC3910, UConn Health, Farmington, Connecticut, USA
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Wucherpfennig F, Schwartz B, Rubel J. Towards a taxonomy of mechanisms of change? Findings from an expert survey on the association between common factors and specific techniques in psychotherapy. Psychother Res 2024; 34:398-411. [PMID: 37127943 DOI: 10.1080/10503307.2023.2206051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE In the present study, we used structural equation modeling (SEM) to investigate the complex relationship between common factors, i.e., mechanisms of change, and specific factors, i.e., therapeutic techniques. METHOD N = 256 psychotherapy experts were asked to rate the appropriateness of 14 techniques commonly used in psychotherapy to facilitate five different common factors - resource activation, motivational clarification, self-management & emotion regulation, social competence, and therapeutic relationship. Using SEM, we defined techniques as indicators and common factors as latent variables. Data were split randomly into two subsets. Indicators were selected if three a priori defined criteria were met based on training data (n = 128). Subsequently, the goodness of model fit was assessed in the test data (n = 128). RESULTS The proposed model revealed adequate fit. All factor loadings were theoretically sound and significant in magnitude. Findings suggest that psychotherapy experts discriminate between common factors by their various associations with therapeutic techniques. CONCLUSION Suggestions are made, how therapeutic techniques are to be used to facilitate desirable change in the patient. Our model is a step towards a taxonomy of mechanisms of change that may help to improve research-informed decision-making.
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Affiliation(s)
| | - Brian Schwartz
- Department of Psychology, University of Trier, Trier, Germany
| | - Julian Rubel
- Department of Psychology, University of Giessen, Giessen, Germany
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Feng G, Posa S, Sureshkumar A, Simpson S, Bruno T, Morrow SA, Donkers S, Knox K, Feinstein A, Bayley M, Munce S, Simpson R. Experiences of people with multiple sclerosis and clinicians in using cognitive behavioural therapies for hidden symptoms: a systematic review and meta-aggregation. J Neurol 2024; 271:1084-1107. [PMID: 38219252 DOI: 10.1007/s00415-023-12116-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/31/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE Cognitive behavioural therapies (CBTs) are a standard of care for treatment of many 'hidden symptoms' in people with MS (PwMS), such as stress, depression, and fatigue. However, these interventions can vary widely in formatting and may not be tailored for PwMS. To optimize CBTs for MS, understanding the experiences of PwMS and clinicians is essential. This systematic review and meta-aggregation synthesizes existing qualitative data on stakeholder perspectives of CBTs for PwMS. METHODS Systematic searches across five major electronic databases were conducted. Studies reporting qualitative data were identified. Two reviewers performed screening, quality assessment, data extraction, and certainty of evidence assessments. Meta-aggregation was performed as per the Joanna Briggs Institute approach, entailing qualitative data extraction, developing categories, and synthesizing overall findings. RESULTS Twenty-eight studies were included in this review, comprising data from 653 PwMS and 47 clinicians. In the meta-aggregation, 122 qualitative results were extracted and grouped into nine categories. Categories were then combined into six synthesized findings: (1) setting the context-life with MS, (2) reasons for participating in CBTs, (3) acceptability of and experiences with participating in CBTs, (4) perceived benefits of CBTs, (5) perceived challenges with CBTs, and (6) suggestions to improve CBTs for PwMS. CONCLUSIONS A range of benefits including psychological, social, and lifestyle improvements were reported, but varied based on the design of the CBT intervention. Future CBT interventions should be tailored to participant needs, delivered in group settings, offer online options, and be delivered by a trained facilitator familiar with MS. Further exploration of the ideal CBT design for PwMS, as well as engagement with caregivers and clinicians treating MS, is warranted.
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Affiliation(s)
- Gregory Feng
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Stephanie Posa
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | | | - Sharon Simpson
- Forest Hill Centre for Cognitive Behavioural Therapy, Toronto, Canada
| | - Tania Bruno
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Sarah A Morrow
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- London Health Sciences Centre, University of Western Ontario, London, Canada
| | - Sarah Donkers
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Katherine Knox
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Robert Simpson
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
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Drake G, Drewek K. "I Hate Sim!"-Using Psychotherapeutic Concepts to Help Educators Attend to Challenging States of Mind During Simulation Prebriefs. Simul Healthc 2024:01266021-990000000-00110. [PMID: 38421370 DOI: 10.1097/sih.0000000000000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
SUMMARY STATEMENT This article outlines the theoretical development of an approach to simulation prebriefing that we have adopted at Great Ormond Street Children's Hospital. Many educators struggle with anxious or reticent learners during simulation. This reticence often becomes apparent first during the simulation prebrief. Previous work highlights key points to cover in a prebrief. Less work has been done on the dilemma of how to engage such learners while also attempting to maintain a pedagogically effective stance for the entire group. This article pulls together current best practice guidance on prebriefing before exploring pertinent concepts from psychotherapeutic and pedagogical domains-the therapeutic setting, the therapeutic stance, and epistemic trust-which we believe can usefully and practically be applied to simulation practice in the service of engaging reticent learners while enhancing the psychological safety of both learners and educators.
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Affiliation(s)
- Gareth Drake
- From the DClinPsy (G.D.), Great Ormond Street Children's Hospital, London, UK; and BMBS BMedSci (K.D.), St George's Hospital, London, UK
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