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Espinosa V, Valiente RM, García-Escalera J, Chorot P, Arnáez S, Schmitt JC, Sandín B. Efficacy of a transdiagnostic internet-based program for adolescents with emotional disorders: A randomized controlled trial. Behav Res Ther 2024; 179:104560. [PMID: 38744141 DOI: 10.1016/j.brat.2024.104560] [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: 10/07/2023] [Revised: 04/23/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) is a well-established transdiagnostic cognitive-behavioral therapy (T-CBT) intervention. The aim of the present study was to examine the efficacy of the program Learn to Manage your Emotions [Aprende a Manejar tus Emociones] (AMtE), a self-applied transdiagnostic internet-delivered program based on the Spanish version of the UP-A. This is the first transdiagnostic internet-based program designed for the treatment of emotional disorders in adolescents. METHOD A sample of Spanish adolescents with a primary diagnosis of an anxiety and/or depressive disorder (n = 58; age range = 12-18 years; 78.3% girls; 90% Caucasian) were randomly allocated to receive AMtE (n = 28) or the UP-A via videocall (n = 30). Pre-treatment, post-treatment and 3-month follow-up data were collected using self-reports and clinician-rated measures of anxiety, depression, positive and negative affect, anxiety sensitivity and emotional avoidance. RESULTS Based on generalized estimating equations (GEE) models, both intervention programs were effective in significantly reducing self-reported anxiety and depressive disorder symptoms and clinician-rated severity of anxiety and depression, as well as self-reported transdiagnostic outcome variables. CONCLUSIONS Data provide empirical support for the efficacy of AMtE as a transdiagnostic online CBT treatment for anxiety and depressive disorders in adolescents. No marked nor consistent differences were observed between the UP-A and AMtE, highlighting the potential usefulness of the online self-administered AMtE program.
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Affiliation(s)
- Victoria Espinosa
- Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), 28040, Madrid, Spain
| | - Rosa M Valiente
- Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), 28040, Madrid, Spain
| | - Julia García-Escalera
- Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), 28040, Madrid, Spain
| | - Paloma Chorot
- Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), 28040, Madrid, Spain.
| | - Sandra Arnáez
- Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), 28040, Madrid, Spain
| | - Julia C Schmitt
- Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), 28040, Madrid, Spain
| | - Bonifacio Sandín
- Facultad de Psicología, Universidad Nacional de Educación a Distancia (UNED), 28040, Madrid, Spain
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Reilly EE, Wierenga CE, Grange DL. Testing the role of associative learning in evidence-based treatments for anorexia nervosa. Int J Eat Disord 2024; 57:1088-1095. [PMID: 38323377 PMCID: PMC11093706 DOI: 10.1002/eat.24161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024]
Abstract
Treatments for anorexia nervosa (AN) remain ineffective for many patients. Processes that can account for differential treatment outcomes remain mostly unknown. We propose that the field test the role of associative learning in current psychological treatments. We hold that this line of research could yield actionable information for understanding non-response and improving long-term outcomes. To make this argument, we define associative learning and outline its proposed role in understanding psychiatric disorders and their treatment. We then briefly review data exploring associative learning in AN. We argue that associative learning processes are implicitly implicated in existing treatments; by this rationale, baseline differences in learning may interfere with treatment response. Finally, we outline future research to test our hypotheses. Altogether, future research aimed at better understanding how associative learning may contribute to AN symptom persistence has the potential to inform novel directions in intervention research. PUBLIC SIGNIFICANCE: There is a pressing need to improve outcomes in treatments for anorexia nervosa (AN). We propose that individual differences in associative learning-the ability to form and update associations between cues, contexts, behaviors, and outcomes-may account for differential response to existing treatments. Undertaking this research could provide an understanding of how current treatments work and inform new approaches for those who may be at risk of poor outcomes.
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Affiliation(s)
- Erin E. Reilly
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | | | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
- Department of Psychiatry & Behavioral Neuroscience (Emeritus), The University of Chicago, Chicago, Illinois, USA
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Lutz W, Schwartz B, Deisenhofer AK, Schaffrath J, Eberhardt ST, Bommer J, Vehlen A, Moggia D, Poster K, Weinmann-Lutz B, Rubel JA, Hehlmann MI. From Theory to Practice: A Transtheoretical Treatment and Training Model (4TM). CLINICAL PSYCHOLOGY IN EUROPE 2024; 6:e12421. [PMID: 39118650 PMCID: PMC11303928 DOI: 10.32872/cpe.12421] [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: 07/17/2023] [Accepted: 09/14/2023] [Indexed: 08/10/2024] Open
Abstract
Background In this paper, we present the conceptual background and clinical implications of a research-based transtheoretical treatment and training model (4TM). Method The model implements findings from psychotherapy outcome, process, and feedback research into a clinical and training framework that is open to future research. Results The framework is based on interventions targeting patient processes on a behavioral, cognitive, emotional, motivational, interpersonal, and systemic/socio-cultural level. The 4TM also includes a data-based decision support and feedback system called the Trier Treatment Navigator (TTN). Conclusion We discuss important problems associated with clinical orientations solely based on one school of thought. We then contrast these concerns with a clinical and training framework that embraces ongoing research, serving as a guiding structure for process-based transtheoretical interventions. Such research-based psychological therapy can take both traditional and novel clinical developments as well as findings from psychotherapy research into account and be adaptively disseminated to a variety of patient populations.
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Affiliation(s)
- Wolfgang Lutz
- Department of Psychology, Trier University, Trier, Germany
| | - Brian Schwartz
- Department of Psychology, Trier University, Trier, Germany
| | | | | | | | - Jana Bommer
- Department of Psychology, Trier University, Trier, Germany
| | - Antonia Vehlen
- Department of Psychology, Trier University, Trier, Germany
| | - Danilo Moggia
- Department of Psychology, Trier University, Trier, Germany
| | - Kaitlyn Poster
- Department of Psychology, Trier University, Trier, Germany
| | | | - Julian A. Rubel
- Department of Psychology, Osnabrück University, Osnabrück, Germany
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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.
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Spinard A, Taylor CB, Ruzek JI, Jefroykin S, Friedlander T, Feleke I, Lev-Ari H, Szapiro N, Sadeh-Sharvit S. Action recommendations review in community-based therapy and depression and anxiety outcomes: a machine learning approach. BMC Psychiatry 2024; 24:133. [PMID: 38365635 PMCID: PMC10870574 DOI: 10.1186/s12888-024-05570-0] [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: 08/28/2023] [Accepted: 01/30/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND While the positive impact of homework completion on symptom alleviation is well-established, the pivotal role of therapists in reviewing these assignments has been under-investigated. This study examined therapists' practice of assigning and reviewing action recommendations in therapy sessions, and how it correlates with patients' depression and anxiety outcomes. METHODS We analyzed 2,444 therapy sessions from community-based behavioral health programs. Machine learning models and natural language processing techniques were deployed to discern action recommendations and their subsequent reviews. The extent of the review was quantified by measuring the proportion of session dialogues reviewing action recommendations, a metric we refer to as "review percentage". Using Generalized Estimating Equations modeling, we evaluated the correlation between this metric and changes in clients' depression and anxiety scores. RESULTS Our models achieved 76% precision in capturing action recommendations and 71.1% in reviewing them. Using these models, we found that therapists typically provided clients with one to eight action recommendations per session to engage in outside therapy. However, only half of the sessions included a review of previously assigned action recommendations. We identified a significant interaction between the initial depression score and the review percentage (p = 0.045). When adjusting for this relationship, the review percentage was positively and significantly associated with a reduction in depression score (p = 0.032). This suggests that more frequent review of action recommendations in therapy relates to greater improvement in depression symptoms. Further analyses highlighted this association for mild depression (p = 0.024), but not for anxiety or moderate to severe depression. CONCLUSIONS An observed positive association exists between therapists' review of previous sessions' action recommendations and improved treatment outcomes among clients with mild depression, highlighting the possible advantages of consistently revisiting therapeutic homework in real-world therapy settings. Results underscore the importance of developing effective strategies to help therapists maintain continuity between therapy sessions, potentially enhancing the impact of therapy.
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Affiliation(s)
- Amit Spinard
- Eleos Health, 117 Kendrick Street, Suite 300, Needham, MA, 02494, USA.
| | - C Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry, Stanford Medical Center, Stanford, CA, USA
| | - Josef I Ruzek
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA
- Department of Psychiatry, Stanford Medical Center, Stanford, CA, USA
| | - Samuel Jefroykin
- Eleos Health, 117 Kendrick Street, Suite 300, Needham, MA, 02494, USA
| | - Tamar Friedlander
- Eleos Health, 117 Kendrick Street, Suite 300, Needham, MA, 02494, USA
| | - Israela Feleke
- Eleos Health, 117 Kendrick Street, Suite 300, Needham, MA, 02494, USA
| | - Hila Lev-Ari
- Eleos Health, 117 Kendrick Street, Suite 300, Needham, MA, 02494, USA
| | - Natalia Szapiro
- Eleos Health, 117 Kendrick Street, Suite 300, Needham, MA, 02494, USA
| | - Shiri Sadeh-Sharvit
- Eleos Health, 117 Kendrick Street, Suite 300, Needham, MA, 02494, USA
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA
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Deisenhofer AK, Barkham M, Beierl ET, Schwartz B, Aafjes-van Doorn K, Beevers CG, Berwian IM, Blackwell SE, Bockting CL, Brakemeier EL, Brown G, Buckman JEJ, Castonguay LG, Cusack CE, Dalgleish T, de Jong K, Delgadillo J, DeRubeis RJ, Driessen E, Ehrenreich-May J, Fisher AJ, Fried EI, Fritz J, Furukawa TA, Gillan CM, Gómez Penedo JM, Hitchcock PF, Hofmann SG, Hollon SD, Jacobson NC, Karlin DR, Lee CT, Levinson CA, Lorenzo-Luaces L, McDanal R, Moggia D, Ng MY, Norris LA, Patel V, Piccirillo ML, Pilling S, Rubel JA, Salazar-de-Pablo G, Schleider JL, Schnurr PP, Schueller SM, Siegle GJ, Uher R, Watkins E, Webb CA, Wiltsey Stirman S, Wynants L, Youn SJ, Zilcha-Mano S, Lutz W, Cohen ZD. Implementing precision methods in personalizing psychological therapies: Barriers and possible ways forward. Behav Res Ther 2024; 172:104443. [PMID: 38086157 DOI: 10.1016/j.brat.2023.104443] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Claudi L Bockting
- AmsterdamUMC, Department of Psychiatry, Research Program Amsterdam Public Health and Centre for Urban Mental Health, University of Amsterdam, the Netherlands
| | | | | | | | | | | | | | - Kim de Jong
- Leiden University, Institute of Psychology, USA
| | | | | | | | | | | | | | - Jessica Fritz
- University of Cambridge, UK; Philipps University of Marburg, Germany
| | | | - Claire M Gillan
- School of Psychology, Trinity College Institute for Neuroscience, And Global Brain Health Institute, Trinity College Dublin, USA
| | | | | | | | | | | | | | | | | | | | | | | | - Mei Yi Ng
- Florida International University, USA
| | | | | | | | | | | | | | - Jessica L Schleider
- Stony Brook University and Feinberg School of Medicine Northwestern University, USA
| | - Paula P Schnurr
- National Center for PTSD and Geisel School of Medicine at Dartmouth, USA
| | | | | | | | | | | | | | | | - Soo Jeong Youn
- Reliant Medical Group, OptumCare and Harvard Medical School, USA
| | | | | | - Zachary D Cohen
- University of California, Los Angeles and University of Arizona, USA.
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Tolin DF, McKay D, Olatunji BO, Abramowitz JS, Otto MW. On the importance of identifying mechanisms and active ingredients of psychological treatments. Behav Res Ther 2023; 170:104425. [PMID: 37913558 PMCID: PMC11034847 DOI: 10.1016/j.brat.2023.104425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
This commentary addresses the thought-provoking article by Lorenzo-Luaces (in press). We review areas of both agreement and disagreement with the author's points, noting that readers should not infer that research into active ingredients and mechanisms is pointless. We conclude with a call for more research into the mechanisms of therapeutic change and the active ingredients of therapeutic interventions, with the aim of disseminating treatments that are both effective and efficient.
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Affiliation(s)
- David F Tolin
- The Institute of Living, Yale University School of Medicine, United States.
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