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Schneider BC, Veckenstedt R, Karamatskos E, Scheunemann J, Moritz S, Jelinek L, Miegel F. Change in negative mental filter is associated with depression reduction in metacognitive training for depression in older adults (MCT-Silver). Sci Rep 2024; 14:17120. [PMID: 39054326 PMCID: PMC11272923 DOI: 10.1038/s41598-024-67063-0] [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: 02/07/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024] Open
Abstract
Identifying components of modularized psychological interventions that contribute to symptom reduction is essential to improving depression treatment. In a secondary analysis of a randomized controlled trial (RCT), session-specific effects of Metacognitive Training-Silver, a group intervention for older adults with depression, were investigated. Thirty-eight older adults with major depressive disorder or dysthymia participated in up to eight sessions of MCT-Silver. A clinical assessment of depressive symptoms (Hamilton Depression Rating Scale) as well as additional interviews and questionnaires administered as part of the RCT were completed at pre- and post-intervention. Depressive symptoms, negative (meta)cognitive beliefs, emotion regulation strategies and attitudes toward aging were assessed pre- and post-session. The rate of change in each variable per module, elevation following the module in which the variable was addressed, and the rate of change post module were examined via linear mixed models. Clinician-rated depressive symptoms were significantly reduced from pre- to post-intervention (Cohens d = 1.31). Self-reported depression and negative mental filter measured within sessions improved significantly over treatment, whereas black-and-white thinking improved after module #3 (Should Statements, All or Nothing Thinking and Acceptance). Module-specific within-session effects were found for overgeneralization (module #1: Mental Filter) and rumination (module #6: Rumination and Social Withdrawal). Improvement in mental filter in module #1 was significantly associated with depression reduction. This study provides initial evidence that MCT-Silver partially meets its aims of reducing depression and specific cognitive variables within and across sessions. Improvement of the instrument used to measure change may improve detection of module-specific effects.Trial registration: NCT03691402.
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Affiliation(s)
- Brooke C Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Evangelos Karamatskos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Ong CW, Sheehan KG, Xu J, Falkenstein MJ, Kuckertz JM. A network analysis of mechanisms of change during exposures over the course of intensive OCD treatment. J Affect Disord 2024; 354:385-396. [PMID: 38508457 DOI: 10.1016/j.jad.2024.03.089] [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: 09/27/2023] [Revised: 02/27/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
Exposure and response prevention (ERP) is an evidence-based treatment for obsessive-compulsive disorder (OCD). Theories for how it works vary in their emphasis on active mechanisms of change. The current study aimed to clarify mechanisms of change in ERP for OCD using network analysis, comparing ERP networks at the start and end of intensive treatment (partial hospital and residential). In our sample of 182 patients, the most central node in both networks was engagement with exposure, which was consistently related to greater understanding of ERP rationale, higher willingness, and less ritualization, accounting for all other variables in the network. There were no significant differences in networks between the start and end of treatment. These results suggest that nonspecific parameters like facilitating engagement in exposures without ritualizing and providing a clear rationale to clients may be key to effective treatment. As such, it may be useful for clinicians to spend adequate time underscoring the need to eliminate rituals to fully engage in exposure tasks and explaining the rationale for ERP prior to doing exposures, regardless of theoretical orientation. Nonetheless, findings represent group-level statistics and more fine-grained idiographic analyses may reveal individual-level differences with respect to central mechanisms of change. Other limitations include demographic homogeneity of our sample.
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Affiliation(s)
- Clarissa W Ong
- Department of Psychology, University of Toledo, United States.
| | - Kate G Sheehan
- Department of Psychology, University of Toledo, United States
| | - Junjia Xu
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States
| | - Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
| | - Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
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Baker C, Thomas S, Tjokrowijoto P, Ryan B, Kneebone I, Stolwyk R. Aphasia Depression and Psychological Therapy (ADaPT): Perspectives of People with Post-Stroke Aphasia on Participating in a Modified Cognitive Behavioral Therapy. Healthcare (Basel) 2024; 12:771. [PMID: 38610193 PMCID: PMC11012076 DOI: 10.3390/healthcare12070771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/21/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Aphasia, a communication disability commonly caused by stroke, can profoundly affect a person's mood and identity. We explored the experiences of stroke survivors with aphasia and depression who received a modified cognitive behavioral therapy (CBT)-based psychological intervention. The therapy is manualized with a flexible treatment protocol, including 10 individually based therapy sessions (+2 booster sessions) either via telehealth or in person. Six participants with chronic aphasia (60% of the total sample) participated in in-depth interviews that were analyzed using reflexive thematic analysis. Two core themes were derived from the data: the first theme, helpful elements of therapy-doing enjoyable activities, new ways of thinking, problem solving, working with the experienced therapist, and using telehealth; and the second theme, making progress-mood, communication, acceptance of the 'new me', and improving relationships. All participants found the therapy to be helpful in managing mood problems with various elements being beneficial depending on the individual, highlighting the importance of tailoring the intervention. Therefore, delivering modified CBT to individuals with aphasia is likely to be acceptable both in person and through telehealth. Further evaluation of the intervention and its impact on mood would be beneficial.
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Affiliation(s)
- Caroline Baker
- Speech Pathology Department, Monash Health, Melbourne, VIC 3192, Australia
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, VIC 3086, Australia; (P.T.); (B.R.); (I.K.); (R.S.)
| | - Sonia Thomas
- Thinking Matters, Melbourne, VIC 3184, Australia;
| | - Priscilla Tjokrowijoto
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, VIC 3086, Australia; (P.T.); (B.R.); (I.K.); (R.S.)
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC 3800, Australia
- Stroke and Telehealth Research, Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC 3121, Australia
| | - Brooke Ryan
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, VIC 3086, Australia; (P.T.); (B.R.); (I.K.); (R.S.)
- Speech Pathology, Curtin School of Allied Health, Curtin University, Perth, WA 6845, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Ian Kneebone
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, VIC 3086, Australia; (P.T.); (B.R.); (I.K.); (R.S.)
- Graduate School of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Renerus Stolwyk
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, VIC 3086, Australia; (P.T.); (B.R.); (I.K.); (R.S.)
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC 3800, Australia
- Stroke and Telehealth Research, Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC 3121, Australia
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Lorenzo-Luaces L. Commentary: Holy grails, personalized medicine, and the public health burden of psychopathology - a reflection on Ahuvia et al. (2023). J Child Psychol Psychiatry 2024; 65:248-250. [PMID: 37921986 DOI: 10.1111/jcpp.13914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/05/2023]
Abstract
Clinical psychology and psychiatry have many 'holy grails' or research findings that are widely sought after but remain elusive. The use of machine learning (ML) models for treatment selection is one of these holy grails. Ahuvia et al. (Journal of Child Psychology and Psychiatry, 2023) recently analyzed a large trial (n = 996) of two distinct single-session interventions (SSIs) for internalizing distress and found little evidence that an ML model could predict differential treatment response. I discuss potential avenues for advancing SSI research. One avenue is the dissemination and implementation of SSIs, including how they interact with other treatments in routine care. Quantifying and critically questioning the promises of holy grails like ML models is sorely needed. Using simulation modeling to evaluate the relative merits of using ML models for treatment selection or using SSIs versus other treatment strategies may be another path forward.
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Meisel SN, Boness CL, Miranda R, Witkiewitz K. Beyond mediators: A critical review and methodological path forward for studying mechanisms in alcohol use treatment research. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:215-229. [PMID: 38099412 PMCID: PMC10922633 DOI: 10.1111/acer.15242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
Understanding how treatments for alcohol use disorder (AUD) facilitate behavior change has long been recognized as an important area of research for advancing clinical care. However, despite decades of research, the specific mechanisms of change for most AUD treatments remain largely unknown because most prior work in the field has focused only on statistical mediation. Statistical mediation is a necessary but not sufficient condition to establish evidence for a mechanism of change. Mediators are intermediate variables that account statistically for the relationship between independent and dependent variables, whereas mechanisms provide more detailed explanations of how an intervention leads to a desired outcome. Thus, mediators and mechanisms are not equivalent. To advance mechanisms of behavior change research, in this critical review we provide an overview of methodological shortfalls of existing AUD treatment mechanism research and introduce an etiologically informed precision medicine approach that facilitates the testing of mechanisms of behavior change rather than treatment mediators. We propose a framework for studying mechanisms in alcohol treatment research that promises to facilitate our understanding of behavior change and precision medicine (i.e., for whom a given mechanism of behavior change operates and under what conditions). The framework presented in this review has several overarching goals, one of which is to provide a methodological roadmap for testing AUD recovery mechanisms. We provide two examples of our framework, one pharmacological and one behavioral, to facilitate future efforts to implement this methodological approach to mechanism research. The framework proposed in this critical review facilitates the alignment of AUD treatment mechanism research with current theories of etiologic mechanisms, precision medicine efforts, and cross-disciplinary approaches to testing mechanisms. Although no framework can address all the challenges related to mechanisms research, our goal is to help facilitate a shift toward more rigorous and falsifiable behavior change research.
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Affiliation(s)
| | | | - Robert Miranda
- E. P. Bradley Hospital, Riverside, RI USA
- Department of Psychiatry & Human Behavior, Brown University, Providence, RI USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
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Lorenzo-Luaces L. Does the unified protocol really change personality more than other interventions? Probably little if at all: a commentary on a recently-published study. Front Psychiatry 2023; 14:1280905. [PMID: 38025471 PMCID: PMC10666260 DOI: 10.3389/fpsyt.2023.1280905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Affiliation(s)
- Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IL, United States
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Salkovskis PM, Sighvatsson MB, Sigurdsson JF. How effective psychological treatments work: mechanisms of change in cognitive behavioural therapy and beyond. Behav Cogn Psychother 2023; 51:595-615. [PMID: 38180111 DOI: 10.1017/s1352465823000590] [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] [Indexed: 01/06/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) has, in the space of 50 years, evolved into the dominant modality in psychological therapy. Mechanism/s of change remain unclear, however. AIMS In this paper, we will describe key features of CBT that account for the pace of past and future developments, with a view to identifying candidates for mechanism of change. We also highlight the distinction between 'common elements' and 'mechanisms of change' in psychological treatment. METHOD The history of how behaviour therapy and cognitive therapy developed are considered, culminating in the wide range of strategies which now fall under the heading of cognitive behavioural therapy (CBT). We consider how the empirical grounding of CBT has led to the massive proliferation of effective treatment strategies. We then consider the relationship between 'common factors' and 'mechanisms of change', and propose that a particular type of psychological flexibility is the mechanism of change not only in CBT but also effective psychological therapies in general. CONCLUSION Good psychological therapies should ultimately involve supporting people experiencing psychological difficulties to understand where and how they have become 'stuck' in terms of factors involved in maintaining distress and impairment. A shared understanding is then evaluated and tested with the intention of empowering and enabling them to respond more flexibly and thereby reclaim their life.
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Affiliation(s)
- Paul M Salkovskis
- University of Oxford Department of Experimental Psychology and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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Zieve GG, Sarfan LD, Dong L, Tiab SS, Tran M, Harvey AG. Cognitive Therapy-as-Usual versus Cognitive Therapy plus the Memory Support Intervention for adults with depression: 12-month outcomes and opportunities for improved efficacy in a secondary analysis of a randomized controlled trial. Behav Res Ther 2023; 170:104419. [PMID: 37879246 PMCID: PMC11025560 DOI: 10.1016/j.brat.2023.104419] [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: 05/04/2023] [Revised: 08/31/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Patient memory for treatment is emerging as an important transdiagnostic mechanism of treatment outcomes. However, patient memory for treatment is limited. The Memory Support Intervention was developed to improve patient memory for treatment and thereby strengthen treatment outcomes. In this secondary analysis, the primary, preregistered aim was to test the 12-month follow-up outcomes of the Memory Support Intervention when used with cognitive therapy (CT + MS) for major depressive disorder, relative to CT-as-usual. The secondary, exploratory aim was to investigate opportunities to improve efficacy of the Memory Support Intervention. METHOD Adults (N = 178) with major depressive disorder were randomized to CT-as-usual or CT + MS. Therapist use of memory support and patient memory for treatment, depression symptoms, and overall functioning were measured in blind assessments. RESULTS Findings did not support differences between treatment conditions at 12-month follow-up. Therapists used memory support strategies with a narrow subset of treatment contents, and similarly, patients recalled a narrow subset of treatment contents. CONCLUSIONS The findings highlight ways to strengthen the efficacy of the Memory Support Intervention, such as applying memory support strategies across a wider variety of treatment contents, which in turn, may boost patient recall and outcomes.
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Affiliation(s)
- Garret G Zieve
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Laurel D Sarfan
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Lu Dong
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Sondra S Tiab
- University of California, 2121 Berkeley Way, Berkeley, CA, 94720, USA.
| | - Melanie Tran
- University of Illinois at Chicago, 1747 W. Roosevelt Road, Chicago, IL, 60612, USA.
| | - Allison G Harvey
- University of California, Department of Psychology, 2121 Berkeley Way, Berkeley, CA, 94720-1650, USA.
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