1
|
Pedro LMR, de Oliveira MF, Pereira MD, da Fonseca AD, Canavarro MC. Factors Associated with Prospective Acceptability and Preferences for Unified Transdiagnostic Cognitive-Behavioral Treatments and Group Therapy in the Portuguese General Population. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01391-1. [PMID: 38839662 DOI: 10.1007/s10488-024-01391-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 06/07/2024]
Abstract
Group transdiagnostic cognitive-behavioral therapy (CBT) offers a promising solution for limited mental health access in Portugal. Understanding barriers to patient adherence is crucial for successful implementation. This study aimed to characterize the prospective acceptability and preferences for unified transdiagnostic CBT and group therapy in the Portuguese general population and explore their correlates. A sample of 243 participants (18-88 years old), recruited online, completed an online survey collecting information on sociodemographic and clinical characteristics, acceptability of transdiagnostic CBT treatments, specifically of Unified Protocol (UP), acceptability of group therapy, therapeutic format preferences, beliefs about group therapy and help-seeking attitudes. Most participants were receptive to and perceived as useful both unified transdiagnostic CBT and group therapy. Overall, participants presented significantly more favorable attitudes than unfavorable attitudes toward unified transdiagnostic CBT and group therapy (p < .001). Multivariate analyses revealed that (1) favorable attitudes toward transdiagnostic treatments were negatively associated with being employed and positively associated with living in an urban area, and higher efficacy scores; (2) unfavorable attitudes toward transdiagnostic treatments were positively associated with being married/cohabitating and negatively associated with vulnerability scores; (3) being female, living in an urban area, and higher efficacy and myth scores emerged as positive predictors of favorable attitudes toward group therapy; and (4) efficacy and vulnerability scores and help-seeking propensity emerged as negative predictors of unfavorable attitudes toward group therapy. These findings highlight the importance of delineating strategies to increase knowledge and acceptance of unified transdiagnostic CBT and group therapy in the Portuguese population, addressing specific individual characteristics.
Collapse
Affiliation(s)
- Liliana Maria Rodrigues Pedro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal.
| | | | - Marco Daniel Pereira
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
| | - Ana Dias da Fonseca
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
| | - Maria Cristina Canavarro
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, Coimbra, 3000-115, Portugal
| |
Collapse
|
2
|
Weinberg I. Building hope for treatment of narcissistic personality disorder. J Clin Psychol 2024; 80:721-732. [PMID: 37815416 DOI: 10.1002/jclp.23598] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Igor Weinberg
- Gunderson Personality Disorder Institute, McLean Hospital, Belmont, Massachusetts, USA
| |
Collapse
|
3
|
Fruhbauerova M, Terrill DR, Semcho SA, Stumpp NE, McCann JP, Sauer-Zavala S, Southward MW. Skill Use Mediates the Within-Person Effect of the Alliance on Session-to-Session Changes in Anxiety and Depression in the Unified Protocol. JOURNAL OF MOOD AND ANXIETY DISORDERS 2024; 5:100043. [PMID: 38523702 PMCID: PMC10959249 DOI: 10.1016/j.xjmad.2023.100043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Objective Both the therapeutic alliance and the specific skills taught in treatment are thought to contribute to change in cognitive-behavior therapy (CBT), but it is unclear if or how these processes influence each other and outcomes in treatment. We tested the hypothesis that the degree to which patients used CBT skills would mediate the relation between the alliance and session-to-session changes in anxiety and depression. Method Adult participants (N = 70; Mage = 33.74, 67% female, 70% White) with emotional disorders were randomized to receive 6 or 12 sessions of the Unified Protocol. Before each session, participants reported anxiety and depression severity and past-week skillfulness. After each session, participants rated the strength of the alliance. We tested whether greater within-person skillfulness mediated the relation between within-person alliance strength and session-to-session changes in anxiety and depression. Results Skillfulness significantly mediated the effect of the alliance on session-to-session changes in anxiety, ab = -.02, p = .04, and depression, ab = -.02, p = .02, such that a stronger alliance predicted greater next-session skillfulness, which predicted session-to-session decreases in anxiety and depression. When alliance subscales were examined separately, the strongest effect was observed for agreement on therapy tasks. Conclusions Improvements in the alliance may facilitate skill use and indirectly predict reductions in anxiety and depression through skill use in CBT. We encourage research on how to enhance both the alliance and skillfulness in CBT.
Collapse
|
4
|
Ito M, Horikoshi M, Kato N, Oe Y, Fujisato H, Yamaguchi K, Nakajima S, Miyamae M, Toyota A, Okumura Y, Takebayashi Y. Efficacy of the unified protocol for transdiagnostic cognitive-behavioral treatment for depressive and anxiety disorders: a randomized controlled trial. Psychol Med 2023; 53:3009-3020. [PMID: 37449485 PMCID: PMC10235654 DOI: 10.1017/s0033291721005067] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND The efficacy of the unified protocol of the transdiagnostic treatment for emotional disorders (UP) has been poorly studied in patients with depressive disorders. This study aimed to examine the efficacy of UP for improving depressive symptoms in patients with depressive and/or anxiety-related disorders. METHODS This assessor-blinded, randomized, 20-week, parallel-group, superiority study compared the efficacy of the UP with treatment-as-usual (UP-TAU) v. wait-list with treatment-as-usual (WL-TAU). Patients diagnosed with depressive and/or anxiety disorders and with depressive symptoms participated. The primary outcome was depressive symptoms assessed by GRID-Hamilton depression rating scale (GRID-HAMD) at 21 weeks. The secondary outcomes included assessor-rated anxiety symptoms, severity and improvement of clinical global impression, responder and remission status, and loss of principal diagnosis. RESULTS In total, 104 patients participated and were subjected to intention-to-treat analysis [mean age = 37.4, s.d. = 11.5, 63 female (61%), 54 (51.9%) with a principal diagnosis of depressive disorders]. The mean GRID-HAMD scores in the UP-TAU and WL-TAU groups were 16.15 (s.d. = 4.90) and 17.06 (s.d. = 6.46) at baseline and 12.14 (s.d. = 5.47) and 17.34 (s.d. = 5.78) at 21 weeks, with a significant adjusted mean change difference of -3.99 (95% CI -6.10 to -1.87). Patients in the UP-TAU group showed significant superiority in anxiety and clinical global impressions. The improvement in the UP-TAU group was maintained in all outcomes at 43 weeks. No serious adverse events were observed in the UP-TAU group. CONCLUSIONS The UP is an effective approach for patients with depressive and/or anxiety disorders.
Collapse
Affiliation(s)
- Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Kato
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Yuki Oe
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Hiroko Fujisato
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Keiko Yamaguchi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shun Nakajima
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Mitsuhiro Miyamae
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Functional Brain Imaging, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Ayaka Toyota
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | | | - Yoshitake Takebayashi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
- Department of Health Risk Communication, School of Medicine, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
5
|
Rodriguez-Moreno S, Guillén AI, Tirpak JW, Marín C, Cardona ND, Eustis EH, Farchione TJ, Barlow DH, Panadero S. Mediators and Moderators of Therapeutic Change in the Unified Protocol for Women Experiencing Homelessness. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
6
|
The Relational Fit in Organizational Interventions-What Can Organizational Research Learn from Research in Psychotherapy? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158104. [PMID: 34360396 PMCID: PMC8345511 DOI: 10.3390/ijerph18158104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022]
Abstract
There is a growing interest in organizational interventions (OI) aiming to increase employees' well-being. An OI involves changes in the way work is designed, organized, and managed. Studies have shown that an OI's positive results are increased if there is a good fit between context and intervention and between participant and intervention. In this article, we propose that a third fit-the Relational Fit (R-Fit)-also plays an important role in determining an intervention's outcome. The R-Fit consists of factors related to (1) the employees participating in the OI, (2) the intervention facilitator, and (3) the quality of the relation between participants and the intervention facilitator. The concept of the R-Fit is inspired by research in psychotherapy documenting that participant factors, therapist factors, and the quality of the relations explain 40% of the effect of an intervention. We call attention to the importance of systematically evaluating and improving the R-Fit in OIs. This is important to enhance the positive outcomes in OIs and thereby increase both the well-being and productivity of employees. We introduce concrete measures that can be used to study and evaluate the R-Fit. This article is the first to combine knowledge from research in psychotherapy with research on OIs.
Collapse
|
7
|
Carlucci L, Saggino A, Balsamo M. On the efficacy of the unified protocol for transdiagnostic treatment of emotional disorders: A systematic review and meta-analysis. Clin Psychol Rev 2021; 87:101999. [PMID: 34098412 DOI: 10.1016/j.cpr.2021.101999] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 01/19/2023]
Abstract
In recent years a large array of treatment protocols conceptualized as transdiagnostic have been developed with clinical and practical advantages compared to traditional single-disorder protocols. Within this panorama, the Transdiagnostic Unified Protocol (UP) of Emotional Disorders was developed aimed at treating the negative affective processes underlying several diagnostic categories, and accounting for the covariance of different emotional disorders. The UP has been found to efficiently target the roots of these disorders leading to a reduction in symptoms of co-occurring disorders. However, several questions have marginally addressed in the previous studies, and some UP features still remain unexplored. The present meta-analysis aims at evaluating whether the UP results to significant changes in anxiety and depression symptoms severity in children, adolescents, and adults. 19 RCTs and 13 uncontrolled pre-post trials comprising 2183 patients/clients met inclusion criteria for meta-analysis. Large to moderate combined overall effect size for both depression plus anxiety were detected in the uncontrolled pre-post studies (g = 0.756) and in RTCs studies (g = 0.452), respectively. Large effect size at pre-treatment to 3-6-month follow-up was observed for combined depression plus anxiety (g = 1.113). Subgroup analysis suggested that UP treatment does not differ across the anxiety and depression self-report measures. Moreover, UP intervention outperformed both passive and active control conditions to treat negative affective syndromes. Meta-regression confirmed the moderate effects of therapist level of experience, the sample characteristics, and the UP-protocol adaptations. The findings indicate that the manualized UP treatment has potential to contribute to improving mental health outcomes, particularly of anxiety and depression.
Collapse
Affiliation(s)
- Leonardo Carlucci
- School of Medicine and Health Sciences, G. d'Annunzio University of Chieti-Pescara, Italy.
| | - Aristide Saggino
- School of Medicine and Health Sciences, G. d'Annunzio University of Chieti-Pescara, Italy
| | - Michela Balsamo
- School of Medicine and Health Sciences, G. d'Annunzio University of Chieti-Pescara, Italy
| |
Collapse
|
8
|
Baier AL, Kline AC, Feeny NC. Therapeutic alliance as a mediator of change: A systematic review and evaluation of research. Clin Psychol Rev 2020; 82:101921. [DOI: 10.1016/j.cpr.2020.101921] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 08/06/2020] [Accepted: 09/14/2020] [Indexed: 02/07/2023]
|
9
|
Luong HK, Drummond SPA, Norton PJ. Elements of the therapeutic relationship in CBT for anxiety disorders: A systematic review. J Anxiety Disord 2020; 76:102322. [PMID: 33035773 DOI: 10.1016/j.janxdis.2020.102322] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/15/2020] [Accepted: 09/27/2020] [Indexed: 12/21/2022]
Abstract
To optimise the effects of cognitive behaviour therapy (CBT) for anxiety disorders, research has increasingly focussed on understanding mechanisms of change. Specifically, the therapeutic relationship has been identified as a potential "active ingredient" of therapy. The evidence for the effects of eleven elements of the therapeutic relationship (alliance, collaboration, goal consensus, group cohesion, empathy, positive regard, feedback, emotional expression, outcome expectations, treatment credibility, alliance rupture-repair) on treatment outcomes in CBT for anxiety disorders was systematically reviewed. Fifty unique studies were included, and findings were qualitatively reviewed and summarised. Results revealed consistent and sizeable evidence for the cohesion-outcome and expectation-outcome relationships. There was emerging evidence for the effects of collaboration, empathy, and alliance rupture-repair on outcomes. However, the evidence for goal consensus and credibility on outcomes was limited. Notably, review of the alliance literature revealed substantial inconsistencies across studies. No studies were identified for positive regard, feedback, and emotional expression. Overall, further research is needed to clarify the role of the therapeutic relationship in CBT for anxiety disorders. These findings will contribute to the conceptual integration of therapeutic relationship constructs in cognitive behavioural models, and help to improve treatments and outcomes for individuals.
Collapse
Affiliation(s)
- Hoang K Luong
- School of Psychological Sciences, Monash University, Victoria, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Monash University, Victoria, Australia
| | - Peter J Norton
- The Cairnmillar Institute, Hawthorn East, Victoria, Australia.
| |
Collapse
|
10
|
Constantino MJ, Coyne AE, Goodwin BJ, Vîslă A, Flückiger C, Muir HJ, Gaines AN. Indirect effect of patient outcome expectation on improvement through alliance quality: A meta-analysis. Psychother Res 2020; 31:711-725. [DOI: 10.1080/10503307.2020.1851058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Michael J. Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Alice E. Coyne
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Brien J. Goodwin
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Andreea Vîslă
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | - Heather J. Muir
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Averi N. Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| |
Collapse
|
11
|
Karam AM, Eichen DM, Fitzsimmons-Craft EE, Wilfley DE. An examination of the interpersonal model of binge eating over the course of treatment. EUROPEAN EATING DISORDERS REVIEW 2020; 28:66-78. [PMID: 31497914 PMCID: PMC7031004 DOI: 10.1002/erv.2700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/26/2019] [Accepted: 08/06/2019] [Indexed: 11/12/2022]
Abstract
The current study examined the interpersonal model of binge eating, which posits that interpersonal problems lead to negative affect, which results in binge eating, over the course of two psychotherapy treatments (interpersonal psychotherapy and cognitive behavioural therapy) in 162 adults with binge-eating disorder. A series of longitudinal simple mediation analyses preliminarily showed that treatment addresses the mechanisms of the interpersonal model of binge eating as theoretically proposed in predicting reductions in binge eating, the primary dependent variable, and the secondary dependent variables including global eating disorder psychopathology, shape concern, and weight concern, but not reductions in restraint or eating concern. Moderated mediation analyses did not fully support treatment differences, as changes in the mechanisms of the interpersonal model occurred in both treatments and suggest both treatments addressed negative affect and interpersonal precipitants of eating disorder symptomatology. Future research should replicate this study using variables that do not overlap in time to investigate causation of the model, and more generally, further examine theoretical treatment models and treatment mediators as this research could help improve efficacy of treatment for binge-eating disorder.
Collapse
Affiliation(s)
- Anna M Karam
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Dawn M Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | | | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| |
Collapse
|
12
|
Donahue JM, Hormes JM, Gordis EB, Anderson DA. Attending to the Alliance in the Application of the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: A Case Study. Clin Case Stud 2019. [DOI: 10.1177/1534650119845503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
As conceptualizations of mood and anxiety disorders shift toward a dimensional approach, transdiagnostic treatments have gained recognition and support. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is an evidence-based cognitive behavioral therapy that targets the core processes that underlie common and comorbid mental disorders. It is designed to help clients learn how to confront, experience, and respond to their emotions in adaptive ways through the modification of their emotion regulation strategies. The current case study describes the flexible application of the UP with a treatment-naïve 25-year-old female who presented to outpatient therapy with symptoms of anxiety and depression. Additions to the UP were made to address issues related to the therapeutic alliance and information discovered over the course of treatment. Outcome measures administered to the client reflect significant symptom improvement and add to a growing body of literature that supports the usefulness of transdiagnostic approaches to treating a range of disorders. Moreover, quantitative and qualitative data point to the necessity for clinicians to attend to the therapeutic alliance and consider cultural factors when delivering manualized treatment approaches to individuals from diverse backgrounds.
Collapse
|
13
|
Defining the Role and Function of the Therapeutic Relationship in Cognitive Behavioral Therapy: a Modified Delphi Panel. Int J Cogn Ther 2018. [DOI: 10.1007/s41811-018-0014-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
14
|
|
15
|
Miles to Go Before We Sleep: Advancing the Understanding of Psychotherapy by Modeling Complex Processes. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9893-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
16
|
Introduction to the Special Issue on Processes of Cognitive Behavioral Therapy: Does “Necessary, But Not Sufficient” Still Capture It? COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9891-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|