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Babl A. [Explaining Transtheoretical Therapist Training using Alliance-Focused Training as an Example]. Psychother Psychosom Med Psychol 2024. [PMID: 39433272 DOI: 10.1055/a-2415-5871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2024]
Abstract
Although most psychotherapists adopt an integrative and process-oriented approach, transtheoretical approaches to psychotherapy training are rare. To better prepare future therapists for the complexities of clinical practice, such an approach is needed. A promising way forward is to consider principles of change that cut across different schools of therapy. The principle of the therapeutic alliance is where different therapy schools agree most. Therefore, an alliance-focused training is presented below, where therapists learn to recognize ruptures in the therapeutic alliance and respond to them with resolution strategies. Current teaching methods like role-playing and supervision have their limitations, as they can only be applied post hoc and to a small number of cases. A new approach could be an online training that integrates principles of change, such as the alliance and markers for interventions, utilizes proven methods of deliberate practice and expert training, and makes use of the potential of technology.
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Affiliation(s)
- Anna Babl
- Klinische Psychologie, Universität Leiden, Leiden, Niederlande
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2
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Sadeghi-Bahmani D, Rigotti V, Stanga Z, Lang UE, Blais RK, Kelley ML, Brand S. Sleep disturbances and psychological well-being among military medical doctors of the Swiss Armed Forces: study protocol, rationale and development of a cross-sectional and longitudinal interventional study. Front Public Health 2024; 12:1390636. [PMID: 39171319 PMCID: PMC11337202 DOI: 10.3389/fpubh.2024.1390636] [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: 02/23/2024] [Accepted: 07/15/2024] [Indexed: 08/23/2024] Open
Abstract
Background Compared to civilians and non-medical personnel, military medical doctors are at increased risk for sleep disturbances and impaired psychological well-being. Despite their responsibility and workload, no research has examined sleep disturbances and psychological well-being among the medical doctors (MDs) of the Swiss Armed Forces (SAF). Thus, the aims of the proposed study are (1) to conduct a cross-sectional study (labeled 'Survey-Study 1') of sleep disturbances and psychological well-being among MDs of the SAF; (2) to identify MDs who report sleep disturbances (insomnia severity index >8), along with low psychological well-being such as symptoms of depression, anxiety and stress, but also emotion regulation, concentration, social life, strengths and difficulties, and mental toughness both in the private/professional and military context and (3) to offer those MDs with sleep disturbances an evidence-based and standardized online interventional group program of cognitive behavioral therapy for insomnia (eCBTi) over a time lapse of 6 weeks (labeled 'Intervention-Study 2'). Method All MDs serving in the SAF (N = 480) will be contacted via the SAF-secured communication system to participate in a cross-sectional survey of sleep disturbances and psychological well-being ('Survey-Study 1'). Those who consent will be provided a link to a secure online survey that assesses sleep disturbances and psychological well-being (depression, anxiety, stress, coping), including current working conditions, job-related quality of life, mental toughness, social context, family/couple functioning, substance use, and physical activity patterns. Baseline data will be screened to identify those MDs who report sleep disturbances (insomnia severity index >8); they will be re-contacted, consented, and randomly assigned either to the eCBTi or the active control condition (ACC) ('Intervention-Study 2'). Individuals in the intervention condition will participate in an online standardized and evidence-based group intervention program of cognitive behavioral therapy for insomnia (eCBTi; once the week for six consecutive weeks; 60-70 min duration/session). Participants in the ACC will participate in an online group counseling (once the week for six consecutive weeks; 60-70 min duration/session), though, the ACC is not intended as a bona fide psychotherapeutic intervention. At the beginning of the intervention (baseline), at week 3, and at week 6 (post-intervention) participants complete a series of self-rating questionnaires as for the Survey-Study 1, though with additional questionnaires covering sleep-related cognitions, experiential avoidance, and dimensions of self-awareness. Expected outcomes Survey-Study 1: We expect to describe the prevalence rates of, and the associations between sleep disturbances (insomnia (sleep quality); sleep onset latency (SOL); awakenings after sleep onset (WASO)) and psychological well-being among MDs of the SAF; we further expect to identify specific dimensions of psychological well-being, which might be rather associated or non-associated with sleep disturbances.Intervention-Study 2: We expect several significant condition-by-time-interactions. Such that participants in the eCBTi will report significantly greater improvement in sleep disturbances, symptoms of depression, anxiety, stress reduction both at work and at home (family related stress), and an improvement in the overall quality of life as compared to the ACC over the period of the study. Conclusion The study offers the opportunity to understand the prevalence of sleep disturbances, including factors of psychological well-being among MDs of the SAF. Further, based on the results of the Intervention-Study 2, and if supported, eCBTi may be a promising method to address sleep disturbances and psychological well-being among the specific context of MDs in the SAF.
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Affiliation(s)
- Dena Sadeghi-Bahmani
- Department of Psychology, Stanford University, Stanford, CA, United States
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, United States
| | - Viola Rigotti
- University Hospital of Basel, Outpatient Medical Clinic, Basel, Switzerland
| | - Zeno Stanga
- Centre of Competence for Military and Disaster Medicine, Swiss Armed Forces, Bern, Switzerland
- Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital and University of Bern, Bern, Switzerland
| | - Undine E. Lang
- Psychiatric Hospital of the University of Basel, Basel, Switzerland
| | - Rebecca K. Blais
- Department of Psychology, Arizona State University, Tempe, AZ, United States
| | - Michelle L. Kelley
- Department of Psychology, Old Dominion University, Norfolk, VA, United States
| | - Serge Brand
- Psychiatric Hospital of the University of Basel, Center for Affective, Stress and Sleep Disorders, Basel, Switzerland
- Division of Sport Science and Psychosocial Health, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
- Center of Military Disaster Psychiatry and Disaster Psychology, Psychiatric Hospital of the University of Basel, Basel, Switzerland
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3
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Borgogna NC, Owen T, Aita SL. The absurdity of the latent disease model in mental health: 10,130,814 ways to have a DSM-5-TR psychological disorder. J Ment Health 2024; 33:451-459. [PMID: 37947129 DOI: 10.1080/09638237.2023.2278107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/21/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Latent disease classification is currently the accepted approach to mental illness diagnosis. In the United States, this takes the form of the Diagnostic and Statistical Manual of Mental Disorders-5-Text Revision (DSM-5-TR). Latent disease classification has been criticized for reliability and validity problems, particularly regarding diagnostic heterogeneity. No authors have calculated the scope of the heterogeneity problem of the entire DSM-5-TR. AIMS We addressed this issue by calculating the unique diagnostic profiles that exist for every DSM-5-TR diagnosis. METHODS We did this by applying formulas previously used in smaller heterogeneity analyses to all diagnoses within the DSM-5-TR. RESULTS We found that there are 10,130,814 ways to be diagnosed with a mental illness using DSM-5-TR criteria. When specifiers are considered, this number balloons to over 161 septillion unique diagnostic presentations (driven mainly by bipolar II disorder). Additionally, there are 1,951,065 ways to present with psychiatric symptoms, yet not meet diagnostic criteria. CONCLUSIONS Latent disease classification leads to considerable heterogeneity in possible presentations. We provide examples of how latent disease classification harms research and treatment programs. We echo recommendations for the dismissal of latent disease classification as a mental illness diagnostic program.
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Affiliation(s)
- Nicholas C Borgogna
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Tyler Owen
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Stephen L Aita
- Department of Psychology, University of Maine, Orono, ME, USA
- Department of Mental Health, VA Maine Healthcare System, Augusta, ME, USA
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4
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Wardle MC, Webber HE, Yoon JH, Heads AM, Stotts AL, Lane SD, Schmitz JM. Behavioral therapies targeting reward mechanisms in substance use disorders. Pharmacol Biochem Behav 2024; 240:173787. [PMID: 38705285 DOI: 10.1016/j.pbb.2024.173787] [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: 01/17/2024] [Revised: 04/04/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
Behavioral therapies are considered best practices in the treatment of substance use disorders (SUD) and used as first-line approaches for SUDs without FDA-approved pharmacotherapies. Decades of research on the neuroscience of drug reward and addiction have informed the development of current leading behavioral therapies that, while differing in focus and technique, have in common the overarching goal of shifting reward responding away from drug and toward natural non-drug rewards. This review begins by describing key neurobiological processes of reward in addiction, followed by a description of how various behavioral therapies address specific reward processes. Based on this review, a conceptual 'map' is crafted to pinpoint gaps and areas of overlap, serving as a guide for selecting and integrating behavioral therapies.
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Affiliation(s)
- Margaret C Wardle
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, United States of America
| | - Heather E Webber
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Jin H Yoon
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Angela M Heads
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Angela L Stotts
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, United States of America
| | - Scott D Lane
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States of America.
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5
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Exner C, Kleiman A, Haberkamp A, Hansmeier J, Milde C, Glombiewski JA. Metacognitive therapy versus exposure and response prevention for obsessive-compulsive disorder - A non-inferiority randomized controlled trial. J Anxiety Disord 2024; 104:102873. [PMID: 38729024 DOI: 10.1016/j.janxdis.2024.102873] [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: 10/12/2023] [Revised: 04/09/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Exposure with response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD). However, refusals, dropouts and the required high time and logistic effort constitute barriers to the use of ERP. In a non-inferiority randomized controlled trial, we compared metacognitive therapy (MCT) to exposure with response prevention (ERP) as treatments for OCD. METHOD 74 outpatients received 12 weekly sessions of either manualized MCT or ERP, with primary outcomes assessed by blinded assessors using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at pre-treatment, mid-treatment, post-treatment, and 6-month follow-up. Secondary outcomes included measures of depression and anxiety. Non-inferiority margin was specified at no less than d = 0.38 below the improvement reached by ERP, corresponding to a difference of about 3 points on the Y-BOCS. RESULTS Drop-out rates were low (<14%) and similar in both groups. Linear models indicated non-inferiority of MCT to ERP at post-treatment, but not at 6-month follow-up. While both groups showed comparable Y-BOCS improvements, the MCT group demonstrated a significantly greater reduction in state anxiety scores at post-treatment and follow-up. CONCLUSIONS Overall, MCT was not inferior to ERP, especially at post-treatment, suggesting it could be a treatment alternative. However, further research is needed to explore differential treatment indications.
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Affiliation(s)
- Cornelia Exner
- Wilhelm-Wundt Institute of Psychology, University of Leipzig, Neumarkt 9-19, D-04109 Leipzig, Germany.
| | - Alexandra Kleiman
- Leipzig Training Institute for Psychological Psychotherapy, Prager Straße 15, 04103 Leipzig, Germany.
| | - Anke Haberkamp
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstrasse 18, 35032 Marburg, Germany.
| | - Jana Hansmeier
- Wilhelm-Wundt Institute of Psychology, University of Leipzig, Neumarkt 9-19, D-04109 Leipzig, Germany.
| | - Christopher Milde
- Department for Clinical Psychology and Psychotherapy, Pain and Psychotherapy Research Lab, University of Kaiserslautern-Landau (RPTU), Ostbahnstraße 10, 76829 Landau, Germany.
| | - Julia Anna Glombiewski
- Department for Clinical Psychology and Psychotherapy, Pain and Psychotherapy Research Lab, University of Kaiserslautern-Landau (RPTU), Ostbahnstraße 10, 76829 Landau, Germany.
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6
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Babl A, Eubanks CF, Goldfried MR. A 21st Century Principle-Based Training Approach to Psychotherapy: A Contribution to the Momentum of Transtheoretical Work. CLINICAL PSYCHOLOGY IN EUROPE 2024; 6:e11925. [PMID: 39118649 PMCID: PMC11303931 DOI: 10.32872/cpe.11925] [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: 05/10/2023] [Accepted: 07/28/2023] [Indexed: 08/10/2024] Open
Abstract
Background Despite the finding that the majority of psychotherapists adopt a rather process-oriented and integrative stance, it is uncommon that psychotherapy trainings are transtheoretical and transdiagnostic. Considering principles of change that cut across different schools of therapy holds promise for developing truly research-informed psychotherapy trainings. Common principles of change may answer the question what should be trained. Another important question is how to train. In current psychotherapy training programs, transfer of theory into practice relies mainly on role-playing exercises and supervised practice, both of which have their limitations. Aims A fantasy for the future would be the development, implementation, and evaluation of a complementary 21st century online principle-based and marker-led psychotherapy training: incorporating the concepts of deliberate practice as well as expert training, the huge potential of technologies, and considering the importance of (context) responsiveness. Conclusion To illustrate this idea, we present a training that we are currently developing, an online Alliance-Focused Training.
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Affiliation(s)
- Anna Babl
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands
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7
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Zimmerman JA, Marcus DK. Does Researcher Allegiance Bias Outcomes in Psychotherapy Research? A Quasi-Experimental Secondary Analysis. Clin Psychol Psychother 2024; 31:e2974. [PMID: 38616708 DOI: 10.1002/cpp.2974] [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: 12/19/2023] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 04/16/2024]
Abstract
Researchers who conduct studies comparing the efficacy of two treatments often find that their preferred treatment outperforms the comparison treatment. This finding has been labelled the allegiance association. Although this association is robust, it is unclear whether it reflects an allegiance bias on the part of the researchers or whether it is noncausal, with researchers being allied to the more effective treatments. This study applied a quasi-experimental method proposed by a previous study to 19 pairs of treatment comparison studies. Each member of a pair had used the same two psychotherapies to treat clients with the same disorder, but the researchers in each of the two studies had opposing allegiances. If the authors of one study in the pair concluded that their preferred treatment was superior and the authors of the other study concluded that their preferred treatment was superior or that the two treatments were equivalent, these patterns would suggest allegiance bias. In 10 of the 19 pairs, the patterns were consistent with the operation of an allegiance bias, indicating that although allegiance biases are not inevitable, they are ubiquitous. Practitioners and other psychotherapy research consumers should use caution when interpreting the findings from treatment comparison studies.
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Affiliation(s)
- Jacob A Zimmerman
- Department of Psychology, Washington State University, Pullman, Washington, USA
| | - David K Marcus
- Department of Psychology, Washington State University, Pullman, Washington, USA
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8
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Morris EMJ, Johns LC, Gaudiano BA. Acceptance and commitment therapy for psychosis: Current status, lingering questions and future directions. Psychol Psychother 2024; 97:41-58. [PMID: 37357973 DOI: 10.1111/papt.12479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/23/2023] [Accepted: 06/05/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Acceptance and Commitment Therapy for psychosis (ACTp) is a contextual behavioural intervention that promotes psychological flexibility by fostering active acceptance, cognitive defusion, values construction and committed action to enhance well-being and recovery. Multiple studies have shown that ACTp is acceptable and efficacious, but questions remain as to its distinction from similar approaches and the conditions under which it would be implemented most effectively. METHODS We present the current evidence for processes and outcomes of ACTp and summarise the qualitative findings of experiences of service users in ACT programmes. We compare ACTp with other cognitive behavioural therapies and mindfulness-informed interventions for psychosis. RESULTS Acceptance and commitment therapy for psychosis is promising as a pragmatic, process-driven intervention model. Further efforts are needed to investigate psychological flexibility in the context of psychosis with observational, experimental and intervention studies that will inform model scope and treatment refinement. Additionally, implementation research is the necessary next step, including how support persons can be trained in ACTp. Lower intensity and technology-assisted approaches have the potential to reduce barriers to accessing ACTp and extend impact. CONCLUSIONS Over the last 20 years, ACTp has demonstrated meaningful effects in individual and group formats in a range of settings, targeting outcomes such as rehospitalisation, depression, psychotic symptom distress and impact. Future work should focus on how best to integrate ACTp with other current evidence-based interventions for psychosis.
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Affiliation(s)
- Eric M J Morris
- School of Psychology & Public Health, La Trobe University, Melbourne, Victoria, Australia
- Northern Health, Melbourne, Victoria, Australia
| | - Louise C Johns
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Brandon A Gaudiano
- Department of Psychiatry & Human Behavior, Brown University & Butler Hospital, Providence, Rhode Island, 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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10
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Tobiassen AH, Sundal T, Stänicke E, Folmo EJ. The cultural change narrative as a core component of therapeutic change. Front Psychiatry 2023; 14:1149984. [PMID: 37867772 PMCID: PMC10587421 DOI: 10.3389/fpsyt.2023.1149984] [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: 01/23/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction Research indicates a similar effect of Mentalization-based treatment (MBT) and Dialectical behavior therapy (DBT) for borderline personality disorder (BPD). However, there is a paucity in studies investigating the change narrative received from and developed in these treatments. The aim of the present study is to investigate similarities and differences in the change narratives provided by MBT and DBT, and how these narratives reflect the rationale, explanations, and procedures of the provided treatment. Methods The study is a qualitative analysis of seven interviews conducted by the authors. Three of the participants had received MBT, and four of the participants had received DBT. This study presents an Interpretative Phenomenological Analysis (IPA) of the change narratives received in two specialized treatments for BPD. Results The main findings from the IPA were that the change narratives described by the participants reflected the treatment they received. The DBT participants highlighted explicit learning of tools and techniques, with predictable and safe therapists. In contrast, the MBT participants emphasized a long-lasting process of exploring to create procedural learning with therapists who followed their lead. Discussion The participants' stories of change shed light on how a change narrative was developed, and therefore how the rationale, explanations and procedures were conveyed differently by MBT and DBT.
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Affiliation(s)
| | | | - Erik Stänicke
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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11
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Boselie JJLM, Vancleef LMG, van Hooren S, Peters ML. The effectiveness and equivalence of different versions of a brief online Best Possible Self (BPS) manipulation to temporary increase optimism and affect. J Behav Ther Exp Psychiatry 2023; 79:101837. [PMID: 36724699 DOI: 10.1016/j.jbtep.2023.101837] [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: 01/17/2022] [Revised: 12/23/2022] [Accepted: 01/21/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES The Best Possible Self (BPS) has been found to be an effective manipulation to temporarily improve optimism and affect. The BPS has been used in different formats. In some versions, participants just write about their best possible future, while in others this is combined with imagery. An imagery only version has not been tested yet. The aim of the current study was to examine the effectiveness of three different versions of the BPS and their equivalence in improving optimism and affect. METHODS In an online study format, participants (N = 141) were randomly assigned to one of four conditions: (1) writing and imagery BPS; (2) writing BPS; (3) imagery BPS; and (4) a typical day (TD) control condition. RESULTS Results showed that each BPS condition significantly improved optimism (i.e. increased positive future expectancies and decreased negative future expectancies) and affect (i.e. increased positive affect and decreased negative affect). Equivalence testing showed that all online BPS conditions were equivalent in increasing optimism and affect, thereby confirming that both the writing and imagery elements of the BPS can independently from each other increase optimism and positive affect in a healthy population. LIMITATIONS Only the immediate effects of the BPS formats on increasing optimism and affect were measured. CONCLUSIONS The BPS manipulation can be employed in different ways for potential future exploration, depending on the research question, design and context and/or E-mental health applications for the treatment of individuals suffering from psychological complaints.
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Affiliation(s)
| | - Linda M G Vancleef
- Clinical Psychological Science, Maastricht University, 6200 MD, Maastricht, the Netherlands.
| | - Susan van Hooren
- Clinical Psychology, Open University, 6401 DL, Heerlen, the Netherlands.
| | - Madelon L Peters
- Clinical Psychological Science, Maastricht University, 6200 MD, Maastricht, the Netherlands.
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12
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Nadkarni A, Massazza A, Guda R, Fernandes LT, Garg A, Jolly M, Andersen LS, Bhatia U, Bogdanov S, Roberts B, Tol WA, Velleman R, Moore Q, Fuhr D. Common strategies in empirically supported psychological interventions for alcohol use disorders: A meta-review. Drug Alcohol Rev 2023; 42:94-104. [PMID: 36134481 PMCID: PMC10087716 DOI: 10.1111/dar.13550] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 01/10/2023]
Abstract
ISSUES Despite the large number of effective psychological interventions for alcohol use disorders (AUD), there is still a lack of clarity concerning the strategies that make these interventions effective. APPROACH The overall goal of this review was to identify, examine and synthesise the information about common strategies from evidence-based psychological interventions for AUDs by conducting a review of systematic reviews, that is, a meta-review. We isolated the relevant primary studies from eligible systematic reviews and extracted information about the interventions from these studies to understand the strategies used. Analysis was restricted to narrative summaries. KEY FINDINGS Thirteen reviews were eligible for inclusion in our meta-review. Of these, eight demonstrated the effectiveness of a range of psychological interventions-behavioural couples therapy, cognitive behaviour therapy combined with motivational interviewing, brief interventions, contingency management, psychotherapy plus brief interventions, Alcoholics Anonymous and 12-step treatment programs, family-therapy or family-involved treatment, and community reinforcement approach. The most commonly used component strategies in effective interventions for AUDs included assessment, personalised feedback, motivational interviewing, goal setting, setting and review of homework, problem solving skills and relapse prevention/management. IMPLICATIONS Evidence about commonly used strategies in evidence-based psychological interventions for AUDs offer the possibility of creating menu-driven interventions that can be tailored to respond to individual client needs and preferences in different contexts.
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Affiliation(s)
- Abhijit Nadkarni
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Addictions Research Group, Sangath, Goa, India
| | - Alessandro Massazza
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rahul Guda
- Addictions Research Group, Sangath, Goa, India
| | | | - Ankur Garg
- Addictions Research Group, Sangath, Goa, India
| | - Mehak Jolly
- Addictions Research Group, Sangath, Goa, India
| | - Lena S Andersen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Sergiy Bogdanov
- Centre for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Wietse A Tol
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,HealthRight International, New York, New York, USA.,Athena Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Richard Velleman
- Addictions Research Group, Sangath, Goa, India.,Department of Psychology, University of Bath, Bath, UK
| | - Quincy Moore
- Centre for Mental Health and Psychosocial Support, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine
| | - Daniela Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany.,Health Sciences, University of Bremen, Bremen, Germany
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13
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Gaab J. The reasons for its effectiveness, however, remain in dispute—A tribute to Irving Kirsch. Front Psychol 2022; 13:1037678. [DOI: 10.3389/fpsyg.2022.1037678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022] Open
Abstract
Irving Kirsch’s work spans over four decades and provided science and clinical practice with as much invaluable insights in the inner workings of treatments as it provided us and patients with their rights and our duties. Here, two early publications of Irving Kirsch on the topic of psychotherapy and its relation to placebo are revised and put into both a historical and contemporary context to pay tribute to the work of Irving Kirsch.
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Goldberg SB. A common factors perspective on mindfulness-based interventions. NATURE REVIEWS PSYCHOLOGY 2022; 1:605-619. [PMID: 36339348 PMCID: PMC9635456 DOI: 10.1038/s44159-022-00090-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 05/25/2023]
Abstract
Mindfulness-based interventions (MBIs) have entered mainstream Western culture in the past four decades. There are now dozens of MBIs with varying degrees of empirical support and a variety of mindfulness-specific psychological mechanisms have been proposed to account for the beneficial effects of MBIs. Although it has long been acknowledged that non-specific or common factors might contribute to MBI efficacy, relatively little empirical work has directly investigated these aspects. In this Perspective, I suggest that situating MBIs within the broader psychotherapy research literature and emphasizing the commonalities rather than differences between MBIs and other treatments might help guide future MBI research. To that end, I summarize the evidence for MBI efficacy and several MBI-specific psychological mechanisms, contextualize MBI findings within the broader psychotherapy literature from a common factors perspective, and propose suggestions for future research based on innovations and challenges occurring within psychotherapy research.
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Affiliation(s)
- Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin, Madison, WI, USA
- Center for Healthy Minds, University of Wisconsin, Madison, WI, USA
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15
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Effects of two types of exercise training on psychological well-being, sleep and physical fitness in patients with high-grade glioma (WHO III and IV). J Psychiatr Res 2022; 151:354-364. [PMID: 35537372 DOI: 10.1016/j.jpsychires.2022.03.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/17/2022] [Accepted: 03/31/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is evidence that regular exercise training has the potential to improve psychological well-being among cancer survivors. However, limited findings are available for individuals with high-grade glioma (HGG; WHO grade III and IV) after neurosurgery and undergoing radiochemotherapy. Given this, endurance and strengths training were employed to investigate their impact on symptoms of depression, feelings of stress and anxiety, fatigue, insomnia, and physical fitness, compared to an active control condition. METHODS A total of 29 patients (M = 52.07, SD = 12.45, 55.2% women) participated in this randomized controlled trial (RCT). After neurosurgical treatment and during adjuvant radiotherapy and chemotherapy or combined radiochemotherapy, patients were randomly assigned to the following conditions: Endurance training (n = 10); strengths training (n = 11); active control condition (n = 8). At baseline, three weeks and six weeks later at the end of the study physical fitness was objectively measured with a 6-min walk test (6MWT) and a handgrip test. Participants completed a series of questionnaires covering sociodemographic information, symptoms of depression, stress, anxiety, fatigue, and insomnia. Further, experts rated participants' severity of symptoms of depression. RESULTS Over time and compared to the strengths and active control condition, self-rated symptoms of depression, state and trait anxiety, stress and insomnia decreased in the endurance condition. Over time and compared to the endurance and active control condition, no changes on symptoms of depression, anxiety, stress, or insomnia were observed in the strengths condition. Over time and compared to the endurance and strengths condition, symptoms of depression (self-ratings), stress, insomnia and fatigue decreased in the active control condition. Fatigue increased in both exercising conditions. Over time and irrespective from the study condition, physical fitness did neither improve nor decrease. CONCLUSIONS The pattern of results suggests that endurance training and an active control condition improved dimensions of depression, stress, and anxiety, while mere strengths training appeared to neither improve, nor decrease dimensions of psychological functioning. Further, exercise interventions did not change physical fitness, but increased fatigue. Overall, endurance training and an active control condition appeared to favorably impact on psychological well-being among patients with high-grade glioma after neurosurgery and undergoing radiochemotherapy.
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Maximizing the non-specific factors in brief cognitive behavioral therapy for panic disorder and agoraphobia: A multiple baseline case series documenting feasibility and initial efficacy. Asian J Psychiatr 2022; 72:103069. [PMID: 35339872 DOI: 10.1016/j.ajp.2022.103069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/09/2022] [Indexed: 11/21/2022]
Abstract
There is evidence for non-specific factors impacting treatment outcomes, with pragmatic concerns regarding the need to popularize briefer formats of cognitive behavioral therapy (CBT). The need to have more culturally suitable and acceptable forms of CBT is also indicated. We evaluated the feasibility and efficacy of a brief 5 session CBT (bCBT) in participants (N = 4) with panic disorder (PD) and agoraphobia, using a non-concurrent multiple baseline design. In this case series, efforts were made to maximize non-specific factors of psychotherapy in bringing about treatment outcomes. Reliable and significant treatment effects were observed at post-intervention and follow-up assessments. The present study offers preliminary evidence of a bCBT protocol that comprises the efforts to maximize the non-specific factors in psychotherapy such as credibility, expectancy, and the therapeutic alliance in bringing treatment outcomes; however, further controlled evaluation is warranted. We also discuss the mechanisms contributing to these treatment outcomes in the present protocol.
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Kunst LE, Maas J, van Balkom AJLM, van Assen MALM, Kouwenhoven B, Bekker MHJ. Group autonomy enhancing treatment versus cognitive behavioral therapy for anxiety disorders: A cluster-randomized clinical trial. Depress Anxiety 2022; 39:134-146. [PMID: 34951503 PMCID: PMC9303809 DOI: 10.1002/da.23231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 11/18/2021] [Accepted: 12/07/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Although cognitive behavioral therapy (CBT) is effective in the treatment of anxiety disorders, few evidence-based alternatives exist. Autonomy enhancing treatment (AET) aims to decrease the vulnerability for anxiety disorders by targeting underlying autonomy deficits and may therefore have similar effects on anxiety as CBT, but yield broader effects. METHODS A multicenter cluster-randomized clinical trial was conducted including 129 patients with DSM-5 anxiety disorders, on average 33.66 years of age (SD = 12.57), 91 (70.5%) female, and most (92.2%) born in the Netherlands. Participants were randomized over 15-week groupwise AET or groupwise CBT and completed questionnaires on anxiety, general psychopathology, depression, quality of life, autonomy-connectedness and self-esteem, pre-, mid-, and posttreatment, and after 3, 6, and 12 months (six measurements). RESULTS Contrary to the hypotheses, effects on the broader outcome measures did not differ between AET and CBT (d = .16 or smaller at post-test). Anxiety reduction was similar across conditions (d = .059 at post-test) and neither therapy was superior on long term. CONCLUSION This was the first clinical randomized trial comparing AET to CBT. The added value of AET does not seem to lie in enhanced effectiveness on broader outcome measures or on long term compared to CBT. However, the study supports the effectiveness of AET and thereby contributes to extended treatment options for anxiety disorders.
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Affiliation(s)
- Laura E. Kunst
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS)Tilburg UniversityTilburgThe Netherlands
- Mentaal Beter BredaMentaal BeterBredaThe Netherlands
| | - Joyce Maas
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS)Tilburg UniversityTilburgThe Netherlands
- Center for Eating Disorders HelmondMental Health Center Region Oost‐BrabantHelmondThe Netherlands
| | - Anton J. L. M. van Balkom
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
- Psychiatry, Research & InnovationGGZ inGeest Specialized Mental Health CareAmsterdamThe Netherlands
| | - Marcel A. L. M. van Assen
- Department of Methodology and StatisticsTilburg UniversityTilburgThe Netherlands
- Department of SociologyUtrecht UniversityUtrechtThe Netherlands
| | - Brenda Kouwenhoven
- PEP NoordwijkRegional Health Organization RijncoepelNoordwijkThe Netherlands
| | - Marrie H. J. Bekker
- Department of Medical and Clinical Psychology, Center of Research on Psychological disorders and Somatic diseases (CoRPS)Tilburg UniversityTilburgThe Netherlands
- Faculty of Behavioral and Movement Sciences, Faculty of Clinical, Neuro‐ and Developmental PsychologyVU UniversityAmsterdamThe Netherlands
- RINO AmsterdamRINOAmsterdamThe Netherlands
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Delboy S, Michaels L. Going Beneath the Surface: What People Want from Therapy. PSYCHOANALYTIC INQUIRY 2021. [DOI: 10.1080/07351690.2021.1992232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Daros AR, Haefner SA, Asadi S, Kazi S, Rodak T, Quilty LC. A meta-analysis of emotional regulation outcomes in psychological interventions for youth with depression and anxiety. Nat Hum Behav 2021; 5:1443-1457. [PMID: 34545236 PMCID: PMC7611874 DOI: 10.1038/s41562-021-01191-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 07/28/2021] [Indexed: 02/08/2023]
Abstract
Difficulties in applying emotional regulation (ER) skills are associated with depression and anxiety symptoms, and are common targets of treatment. This meta-analysis examined whether improvements in ER skills were associated with psychological treatment outcomes for depression and/or anxiety in youth. A multivariate, random-effects meta-analysis was run using metafor in R. Inclusion criteria included studies that were randomized controlled trials (RCTs) of a psychological intervention for depression and/or anxiety in patients aged 14-24, were peer reviewed, were written in English, measured depression and/or anxiety symptoms as an outcome and measured ER as an outcome. Medline, Embase, APA PsycInfo, CINAHL and The Cochrane Library were searched up to 26 June 2020. Risk of bias (ROB) was assessed using the Cochrane Collaboration Risk of Bias 2.0 tool. The meta-analysis includes 385 effect sizes from 90 RCTs with total N = 11,652. Psychological treatments significantly reduced depression, anxiety, emotion dysregulation (k = 13, Hedges' g = 0.54, P < 0.001, 95% confidence interval (CI) = 0.30-0.78) and disengagement ER (k = 83, g = 0.24, 95% CI = 0.15-0.32, P < 0.001); engagement ER also increased (k = 82, g = 0.26, 95% CI = 0.15-0.32, P < 0.001). Improvements in depression and anxiety were positively associated with improved engagement ER skills, reduced emotion dysregulation and reduced disengagement ER skills. Sensitivity considered study selection and publication bias. Longer treatments, group formats and cognitive-behavioural orientations produced larger positive associations between improved ER skills and reduced symptoms. ER skill improvement is linked to depression and anxiety across a broad range of interventions for youth. Limitations of the current study include reliance on self-report measures, content overlap between variables and inability to test the directionality of associations.
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Affiliation(s)
- Alexander R Daros
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Canada.
| | - Sasha A Haefner
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Shayan Asadi
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Sharifa Kazi
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Terri Rodak
- CAMH Library, Department of Education, Centre for Addiction and Mental Health, Toronto, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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Rabeyron T. L’évaluation et l’efficacité des psychothérapies psychanalytiques et de la psychanalyse. EVOLUTION PSYCHIATRIQUE 2021. [DOI: 10.1016/j.evopsy.2020.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Bourke E, Barker C, Fornells-Ambrojo M. Systematic review and meta-analysis of therapeutic alliance, engagement, and outcome in psychological therapies for psychosis. Psychol Psychother 2021; 94:822-853. [PMID: 33569885 DOI: 10.1111/papt.12330] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/16/2021] [Indexed: 01/07/2023]
Abstract
AIM The moderate association between therapeutic alliance (TA) and psychological therapy outcome is well established. Historically, the field has not focused on people with a severe mental illness. This is the first review to conduct a meta-analysis of associations between TA and therapeutic engagement as well as outcome in psychological therapy for psychosis. ELIGIBILITY CRITERIA Eligible studies conducted a quantitative investigation of the relationship between TA during a psychological therapy and outcome at a subsequent time-point. METHOD A systematic review examined the relationship between TA and engagement as well as outcome measures within psychological therapy for psychosis. Correlational meta-analyses using an aggregate random effects model were conducted. RESULTS Twenty-four studies were eligible for inclusion (n = 1,656) of which 13 were included in the meta-analyses. Client- and therapist-rated TA were associated with engagement in therapy (rclient (c) = 0.36, p = .003; rtherapist (t) = 0.40, p = .0053). TA was also associated with reduction in global (rc = 0.29, p = .0005; rt = 0.24, p = .0015) and psychotic symptoms (rc = 0.17, p = .0115; rt = 0.30, p = .0003). The systematic review identified no evidence or limited evidence for a relationship between TA during therapy and depression, substance use, physical health behaviours, global as well as social functioning, overall mental health recovery, and self-esteem at follow-up. Although number of studies was small, TA was related to a reduced risk of subsequent hospitalization in 40% of analyses (across two studies) and improved cognitive outcome in 50% of analyses (across three studies). CONCLUSIONS The observed TA-therapy engagement and TA-outcome associations were broadly consistent with those identified across non-psychotic diagnostic groups. Well-powered studies are needed to investigate the relationship between TA and process as well as outcome in psychological therapy for psychosis specifically. PRACTITIONER POINTS This is the first review to conduct a meta-analytic synthesis of the association between therapeutic alliance (TA) and both engagement and change in outcome in psychological therapies for psychosis. TA (as rated by therapist and client) was associated with the extent of therapeutic engagement as well as reduction in global mental health symptoms and psychotic symptoms. The significant associations between TA and engagement as well as change in outcome identified in the current review are broadly consistent with those observed across non-psychotic diagnostic groups. We consider factors that could impact upon the dynamic and potentially interdependent relationships between TA and therapeutic techniques, including attachment security and severity of paranoid ideation.
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Affiliation(s)
- Emilie Bourke
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Chris Barker
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Miriam Fornells-Ambrojo
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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22
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The effects of rational emotive behavior therapy for depressive symptoms in adults with congenital heart disease. Heart Lung 2021; 50:906-913. [PMID: 34411872 DOI: 10.1016/j.hrtlng.2021.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/06/2021] [Accepted: 07/28/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Over 30% of adults with congenital heart disease (CHD) experience depression. OBJECTIVES To evaluate the effectiveness of Rational Emotive Behavior Therapy (REBT) in reducing depressive symptoms in adults with CHD. METHODS Forty-two adults with CHD were recruited from an outpatient clinic and randomized to a study group (n = 21), which comprised 8-weekly group-based counseling sessions, or a control group (n = 21), which received usual care. REBT effectiveness was examined using the Hamilton Depression Rating Scale, Beck Depression Inventory, Shorten General Attitude and Belief Scale, and salivary cortisol levels before therapy, after the last session, and at follow-up 4 weeks later. RESULTS Average participant ages were 30.1 ± 7.58 and 33.3 ± 7.1 years in study and control groups, respectively; 52.4% of participants in each group were female. After REBT, depression (p < 0.001), irrational beliefs (p < 0.001), and salivary cortisol levels (p = 0.006) were significantly lower in the study group than in the control group. Effects of REBT in the study group remained consistent at the 4-week follow-up. CONCLUSION REBT may be effective in reducing depression in adults with CHD.
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Lazarus G, Fisher AJ. Negative Emotion Differentiation Predicts Psychotherapy Outcome: Preliminary Findings. Front Psychol 2021; 12:689407. [PMID: 34408708 PMCID: PMC8366397 DOI: 10.3389/fpsyg.2021.689407] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022] Open
Abstract
Emotion differentiation (ED), the extent to which same-valenced emotions are experienced as distinct, is considered a valuable ability in various contexts owing to the essential affect-related information it provides. This information can help individuals understand and regulate their emotional and motivational states. In this study, we sought to examine the extent to which ED can be beneficial in psychotherapy context and specifically for predicting treatment response. Thirty-two prospective patients with mood and anxiety disorders completed four daily assessments of negative and positive emotions for 30 days before receiving cognitive-behavioral treatment. Depression, stress, and anxiety symptoms severity were assessed pre- and post-treatment using self-reports and clinical interviews. We conducted a series of hierarchical regression models in which symptoms change scores were predicted by ED while adjusting for the mean and variability. We found that negative ED was associated with greater self-reported treatment response (except for anxiety) when negative emotional variability (EV) was included in the models. Probing negative ED and EV's interactive effects suggested that negative ED was associated with greater treatment response (except for anxiety) for individuals with lower EV levels. Results were obtained while controlling for mean negative affect. Our findings suggest that negative ED can benefit psychotherapy patients whose negative emotions are relatively less variable. We discuss the meaning of suppression and interactive effects between affect dynamics and consider possible clinical implications.
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Affiliation(s)
- Gal Lazarus
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
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24
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Thompson M, Parker H, Cave J. Exploring which aspects of a low‐intensity CBT intervention were found to contribute to a successful outcome from the service user point of view: A mixed methods study. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Miles Thompson
- Psychological Sciences Research Group (PSRG), Department of Social Sciences University of the West of England (UWE Bristol) Bristol UK
| | - Holly Parker
- Department of Social Sciences University of the West of England (UWE Bristol) Bristol UK
| | - Jodie Cave
- Department of Social Sciences University of the West of England (UWE Bristol) Bristol UK
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Uusitalo S, Tuominen J, Arstila V. Mapping out the philosophical questions of AI and clinical practice in diagnosing and treating mental disorders. J Eval Clin Pract 2021; 27:478-484. [PMID: 32996664 DOI: 10.1111/jep.13485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 11/26/2022]
Abstract
How to classify the human condition? This is one of the main problems psychiatry has struggled with since the first diagnostic systems. The furore over the recent editions of the diagnostic systems DSM-5 and ICD-11 has evidenced it to still pose a wicked problem. Recent advances in techniques and methods of artificial intelligence and computing power which allows for the analysis of large data sets have been proposed as a possible solution for this and other problems in classification, diagnosing, and treating mental disorders. However, mental disorders contain some specific inherent features, which require critical consideration and analysis. The promises of AI for mental disorders are threatened by the unmeasurable aspects of mental disorders, and for this reason the use of AI may lead to ethically and practically undesirable consequences in its effective processing. We consider such novel and unique questions AI presents for mental health disorders in detail and evaluate potential novel, AI-specific, ethical implications.
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Affiliation(s)
- Susanne Uusitalo
- Turku Institute for Advanced Studies, University of Turku, Turku, Finland.,Department of Philosophy, Contemporary History and Political Science/Philosophy, University of Turku, Turku, Finland
| | - Jarno Tuominen
- Department of Psychology and Speech-Language Pathology, University of Turku, Turku, Finland.,Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Valtteri Arstila
- Department of Philosophy, Contemporary History and Political Science/Philosophy, University of Turku, Turku, Finland.,Department of Philosophy, History, Art and Culture Studies, University of Helsinki, Helsinki, Finland
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A randomized experimental analysis of the attention training technique: Effects on worry and relevant processes in individuals with probable generalized anxiety disorder. Behav Res Ther 2021; 141:103863. [PMID: 33872957 DOI: 10.1016/j.brat.2021.103863] [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: 02/26/2020] [Revised: 03/31/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
Abstract
CONTEXT The Attention Training Technique (ATT, Wells, 1990) is an intervention guiding individuals to focus, shift, and divide their attention in response to sounds presented in an audiorecording. The ATT has long been recommended for generalized anxiety disorder (GAD); however, there is insufficient research on its effects on excessive worry and related processes. OBJECTIVES This experiment examined whether the ATT is more efficacious than a control intervention at reducing worry and modifying worry-related processes (e.g., attention control, negative metacognitive beliefs, attention bias, mindfulness). PARTICIPANTS 78 adults with probable GAD. DESIGN Participants completed measures of worry and worry-related processes at the lab. They then monitored worry and attention daily for a week. Following this baseline, participants recompleted the lab measures and were randomly assigned to ATT or control. Participants listened to their assigned recording once/day for a week while again monitoring worry and attention daily. Participants then recompleted the lab measures. RESULTS The ATT did not perform better than the control condition on any measure. A variety of improvements were seen over the intervention period in both conditions. CONCLUSIONS ATT may not have meaningful effects on excessive worry and worry-related processes. Explanations for null findings are offered. CLINICALTRIALS. GOV REGISTRATION NCT03216382.
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Acceptance and Commitment Therapy (ACT) Improves Sleep Quality, Experiential Avoidance, and Emotion Regulation in Individuals with Insomnia-Results from a Randomized Interventional Study. Life (Basel) 2021; 11:life11020133. [PMID: 33572330 PMCID: PMC7916154 DOI: 10.3390/life11020133] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 01/08/2023] Open
Abstract
Insomnia is a common problem in the general population. To treat insomnia, medication therapies and insomnia-related cognitive-behavioral interventions are often applied. The aim of the present study was to investigate the influence of acceptance and commitment therapy (ACT) on sleep quality, dysfunctional sleep beliefs and attitudes, experiential avoidance, and acceptance of sleep problems in individuals with insomnia, compared to a control condition. A total of 35 participants with diagnosed insomnia (mean age: 41.46 years old; 62.9% females) were randomly assigned to the ACT intervention (weekly group therapy for 60-70 min) or to the active control condition (weekly group meetings for 60-70 min without interventional and psychotherapeutic character). At baseline and after eight weeks (end of the study), and again 12 weeks later at follow-up, participants completed self-rating questionnaires on sleep quality, dysfunctional beliefs and attitudes about sleep, emotion regulation, and experiential avoidance. Furthermore, participants in the intervention condition kept a weekly sleep log for eight consecutive weeks (micro-analysis). Every morning, participants completed the daily sleep log, which consisted of items regarding subjective sleep duration, sleep quality, and the feeling of being restored. Sleep quality, dysfunctional beliefs and attitudes towards sleep, emotion regulation, and experiential avoidance improved over time, but only in the ACT condition compared to the control condition. Improvements remained stable until follow-up. Improvements in experiential avoidance were related to a favorable change in sleep and cognitive-emotional processing. Micro-analyses showed that improvements occurred within the first three weeks of treatment. The pattern of results suggests that ACT appeared to have improved experiential avoidance, which in turn improved both sleep quality and sleep-related cognitive-emotional processes at longer-term in adults with insomnia.
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Pittig A, Hoyer J, Noack R. Smart-Glass Guided Exposure for Anxiety Disorders: A Proof-of-Concept Study. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Blease CR, Walker J, Torous J, O'Neill S. Sharing Clinical Notes in Psychotherapy: A New Tool to Strengthen Patient Autonomy. Front Psychiatry 2020; 11:527872. [PMID: 33192647 PMCID: PMC7655789 DOI: 10.3389/fpsyt.2020.527872] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/22/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Charlotte R. Blease
- OpenNotes, General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Jan Walker
- OpenNotes, General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Stephen O'Neill
- OpenNotes, General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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Leder G. Psychotherapy, placebos, and informed consent. JOURNAL OF MEDICAL ETHICS 2020; 47:medethics-2020-106453. [PMID: 32820019 PMCID: PMC8257553 DOI: 10.1136/medethics-2020-106453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/19/2020] [Accepted: 06/26/2020] [Indexed: 05/29/2023]
Abstract
Several authors have recently argued that psychotherapy, as it is commonly practiced, is deceptive and undermines patients' ability to give informed consent to treatment. This 'deception' claim is based on the findings that some, and possibly most, of the ameliorative effects in psychotherapeutic interventions are mediated by therapeutic common factors shared by successful treatments (eg, expectancy effects and therapist effects), rather than because of theory-specific techniques. These findings have led to claims that psychotherapy is, at least partly, likely a placebo, and that practitioners of psychotherapy have a duty to 'go open' to patients about the role of common factors in therapy (even if this risks negatively affecting the efficacy of treatment); to not 'go open' is supposed to unjustly restrict patients' autonomy. This paper makes two related arguments against the 'go open' claim. (1) While therapies ought to provide patients with sufficient information to make informed treatment decisions, informed consent does not require that practitioners 'go open' about therapeutic common factors in psychotherapy, and (2) clarity about the mechanisms of change in psychotherapy shows us that the common-factors findings are consistent with, rather than undermining of, the truth of many theory-specific forms of psychotherapy; psychotherapy, as it is commonly practiced, is not deceptive and is not a placebo. The call to 'go open' should be resisted and may have serious detrimental effects on patients via the dissemination of a false view about how therapy works.
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Affiliation(s)
- Garson Leder
- Alden March Bioethics Institute, Albany Medical College, Albany, NY 12208, USA
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31
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Locher C, Mansour R, Koechlin H, Büchi S. Patient-appraised beneficial moments during inpatient psychiatric treatment. BMC Health Serv Res 2020; 20:734. [PMID: 32778097 PMCID: PMC7418414 DOI: 10.1186/s12913-020-05617-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychiatric inpatients receive a multidisciplinary treatment approach, covering psychiatry, nursing, occupational therapy, and psychology. Research findings reveal that the effectiveness of any treatment is associated with three types of factors: specific (e.g., treatment techniques), common (e.g., clinician-patient relationship, patients' expectations) and extra-therapeutic. However, there is little published research on the factors and events which inpatients themselves consider to be beneficial ('beneficial moments'). METHODS Inpatients (N = 107) of a psychiatric clinic completed a questionnaire to elicit their appraisal of beneficial moments. A qualitative content analysis was applied. The coding procedure was conducted independently by two authors. RESULTS Self-appraised beneficial moments were found in five areas: therapy-specific components (number of quotations, N = 204), positive relationships (N = 140), clinical setting and environment (N = 52), inpatients' new insights (N = 36), and factors unrelated to either therapy or the clinic (N = 30). In total, 44% of the quotations were related to specific factors, 49% to common factors, and 7% to extra-therapeutic factors. CONCLUSIONS Inpatients judge both specific and common factors as crucial for the therapeutic benefit they gain during their stay at the clinic. Our results differ from meta-analytical findings, where the impact of specific factors on symptom improvement has shown to be much smaller (i.e., 17%) than appraised by patients in our study (i.e., 44%). Our study underlines the importance of a patient-centred care approach as well as shared decision making and patient-clinician communication. For clinical practice, knowledge of inpatients' perspectives on beneficial moments is crucial in order to reinforce precisely these therapeutic components.
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Affiliation(s)
- Cosima Locher
- School of Psychology, Plymouth University, Plymouth, UK. .,Clinic for Psychotherapy and Psychosomatics "Hohenegg", Meilen, Switzerland. .,Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland. .,Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Ramin Mansour
- Clinic for Psychotherapy and Psychosomatics "Hohenegg", Meilen, Switzerland
| | - Helen Koechlin
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland.,Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan Büchi
- Clinic for Psychotherapy and Psychosomatics "Hohenegg", Meilen, Switzerland
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Moritz S, Klein JP, Lysaker PH, Mehl S. Metacognitive and cognitive-behavioral interventions for psychosis: new developments
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 21:309-317. [PMID: 31749655 PMCID: PMC6829173 DOI: 10.31887/dcns.2019.21.3/smoritz] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This review describes four cognitive approaches for the treatment of
schizophrenia: cognitive-behavioral therapy for psychosis (CBTp), metacognitive therapy,
metacognitive training, and metacognitive reflection insight therapy (MERIT). A central
reference point of our review is a seminal paper by James Flavell, who introduced the
term metacognition (“cognition about cognition”). In a way, every psychotherapeutic
approach adopts a metacognitive perspective when therapists reflect with clients about
their thoughts. Yet, the four approaches map onto different components of metacognition.
CBTp conveys some “metacognitive knowledge” (eg, thoughts are not facts) but is mainly
concerned with individual beliefs. Metacognitive therapy focuses on unhelpful
metacognitive beliefs about thinking styles (eg, thought suppression). Metacognitive
training brings distorted cognitive biases to the awareness of patients; a central goal
is the reduction of overconfidence. MERIT focuses on larger senses of identity and
highlights metacognitive knowledge about oneself and other persons. For CBTp and
metacognitive training, meta-analytic evidence supports their efficacy; single studies
speak for the effectiveness of MERIT and metacognitive therapy.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, US
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany;
Department of Health and Social Work, Frankfurt University of Applied Science Frankfurt, Germany
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Norouzi E, Gerber M, Masrour FF, Vaezmosavi M, Pühse U, Brand S. Implementation of a mindfulness-based stress reduction (MBSR) program to reduce stress, anxiety, and depression and to improve psychological well-being among retired Iranian football players. PSYCHOLOGY OF SPORT AND EXERCISE 2020; 47:101636. [DOI: 10.1016/j.psychsport.2019.101636] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
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Schiele MA, Gottschalk MG, Domschke K. The applied implications of epigenetics in anxiety, affective and stress-related disorders - A review and synthesis on psychosocial stress, psychotherapy and prevention. Clin Psychol Rev 2020; 77:101830. [PMID: 32163803 DOI: 10.1016/j.cpr.2020.101830] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 12/11/2022]
Abstract
Mental disorders are highly complex and multifactorial in origin, comprising an elaborate interplay of genetic and environmental factors. Epigenetic mechanisms such as DNA modifications (e.g. CpG methylation), histone modifications (e.g. acetylation) and microRNAs function as a translator between genes and the environment. Indeed, environmental influences such as exposure to stress shape epigenetic patterns, and lifetime experiences continue to alter the function of the genome throughout the lifespan. Here, we summarize the recently burgeoning body of research regarding the involvement of aberrant epigenetic signatures in mediating an increased vulnerability to a wide range of mental disorders. We review the current knowledge of epigenetic changes to constitute useful markers predicting the clinical response to psychotherapeutic interventions, and of psychotherapy to alter - and potentially reverse - epigenetic risk patterns. Given first evidence pointing to a transgenerational transmission of epigenetic information, epigenetic alterations arising from successful psychotherapy might be transferred to future generations and thus contribute to the prevention of mental disorders. Findings are integrated into a multi-level framework highlighting challenges pertaining to the mechanisms of action and clinical implications of epigenetic research. Promising future directions regarding the prediction, prevention, and personalized treatment of mental disorders in line with a 'precision medicine' approach are discussed.
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Affiliation(s)
- Miriam A Schiele
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104 Freiburg, Germany
| | - Michael G Gottschalk
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104 Freiburg, Germany
| | - Katharina Domschke
- Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 5, D-79104 Freiburg, Germany; Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Breisacher Straße 64, D-79106 Freiburg, Germany.
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Mullarkey MC, Stein AT, Pearson R, Beevers CG. Network analyses reveal which symptoms improve (or not) following an Internet intervention (Deprexis) for depression. Depress Anxiety 2020; 37:115-124. [PMID: 31710772 PMCID: PMC6992506 DOI: 10.1002/da.22972] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 09/15/2019] [Accepted: 10/31/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Depression is a heterogeneous collection of symptoms. Prior meta-analyses using symptom sum scores have shown the Internet intervention, Deprexis, to be an efficacious treatment for depression. However, no prior research has investigated how Deprexis (or any other Internet intervention for depression) impacts specific symptoms of depression. The current study utilizes symptom-level analyses to examine which symptoms are directly, indirectly, or minimally influenced by treatment. METHODS Network analysis and mean-level approaches examined which symptoms, assessed by the Quick Inventory of Depression Symptoms, were affected by an 8-week course of Deprexis compared with a waitlist in a nationally recruited sample from the United States (N = 295). RESULTS Deprexis directly improved the symptoms of sadness and indecision. Changes in these symptoms, in turn, was associated with a change in early insomnia, middle insomnia, self-dislike, fatigue, anhedonia, suicidality, slowness, and agitation. All of these symptoms (except for agitation and early insomnia) show decreases with Deprexis compared with a waitlist after correcting for multiple comparisons. Six additional symptoms, particularly the somatic symptoms, were not impacted by Deprexis compared with a waitlist. CONCLUSIONS In this sample, the efficacy of Deprexis was due to its direct impact on sadness and indecision. Examining the treatment-related change in specific symptoms may facilitate a more nuanced understanding of how a treatment works compared with examining symptom sum scores. Symptom-level approaches may also identify symptoms that do not improve and provide important direction for future treatment development.
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Affiliation(s)
- Michael C. Mullarkey
- Department of PsychologyInstitute for Mental Health ResearchUniversity of Texas at Austin Austin Texas
| | - Aliza T. Stein
- Department of PsychologyInstitute for Mental Health ResearchUniversity of Texas at Austin Austin Texas
| | - Rahel Pearson
- Department of PsychologyInstitute for Mental Health ResearchUniversity of Texas at Austin Austin Texas
| | - Christopher G. Beevers
- Department of PsychologyInstitute for Mental Health ResearchUniversity of Texas at Austin Austin Texas
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Rabeyron T. Processus transformationnels et champ analytique : un nouveau paradigme pour les modèles et les pratiques cliniques. EVOLUTION PSYCHIATRIQUE 2020. [DOI: 10.1016/j.evopsy.2019.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Watkins ER, Newbold A. Factorial Designs Help to Understand How Psychological Therapy Works. Front Psychiatry 2020; 11:429. [PMID: 32477195 PMCID: PMC7240021 DOI: 10.3389/fpsyt.2020.00429] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 04/27/2020] [Indexed: 11/13/2022] Open
Abstract
A large amount of research time and resources are spent trying to develop or improve psychological therapies. However, treatment development is challenging and time-consuming, and the typical research process followed-a series of standard randomized controlled trials-is inefficient and sub-optimal for answering many important clinical research questions. In other areas of health research, recognition of these challenges has led to the development of sophisticated designs tailored to increase research efficiency and answer more targeted research questions about treatment mechanisms or optimal delivery. However, these innovations have largely not permeated into psychological treatment development research. There is a recognition of the need to understand how treatments work and what their active ingredients might be, and a call for the use of innovative trial designs to support such discovery. One approach to unpack the active ingredients and mechanisms of therapy is the factorial design as exemplified in the Multiphase Optimization Strategy (MOST) approach. The MOST design allows identification of the active components of a complex multi-component intervention (such as CBT) using a sophisticated factorial design, allowing the development of more efficient interventions and elucidating their mechanisms of action. The rationale, design, and potential advantages of this approach will be illustrated with reference to the IMPROVE-2 study, which conducts a fractional factorial design to investigate which elements (e.g., thought challenging, activity scheduling, compassion, relaxation, concreteness, functional analysis) within therapist-supported internet-delivered CBT are most effective at reducing symptoms of depression in 767 adults with major depression. By using this innovative approach, we can first begin to work out what components within the overall treatment package are most efficacious on average allowing us to build an overall more streamlined and potent therapy. This approach also has potential to distinguish the role of specific versus non-specific common treatment components within treatment.
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Affiliation(s)
- Edward R Watkins
- College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
| | - Alexandra Newbold
- College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom
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Blease CR, Arnott T, Kelley JM, Proctor G, Kube T, Gaab J, Locher C. Attitudes About Informed Consent: An Exploratory Qualitative Analysis of UK Psychotherapy Trainees. Front Psychiatry 2020; 11:183. [PMID: 32231601 PMCID: PMC7083167 DOI: 10.3389/fpsyt.2020.00183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Ethical informed consent to psychotherapy has recently been the subject of in-depth analysis among healthcare ethicists. Objective: This study aimed to explore counseling and psychotherapy students' views and understanding about informed consent to psychological treatments. Methods: Two focus groups were conducted with a total of 10 students enrolled in a Masters course in counseling and psychotherapy at a British university. Questions concerned participants' understanding of informed consent including judgments about client capacity; the kinds of information that should be disclosed; how consent might be obtained; and their experiences of informed consent, both as a client and as a therapist. Focus groups were audio-recorded, transcribed, and analyzed using qualitative content analysis. Coding was conducted independently by three authors. Results: Comments were classified into three main themes: (1) the reasons and justifications for informed consent; (2) informed consent processes; and (3) the hidden ethics curriculum. Some trainees expressed significant doubts about the importance of informed consent. However, participants also identified the need to establish the clients' voluntariness and their right to be informed about confidentiality issues. In general, the format and processes pertaining to informed consent raised considerable questions and uncertainties. Participants were unsure about rules surrounding client capacity; expressed misgivings about describing treatment techniques; and strikingly, most trainees were skeptical about the clinical relevance of the evidence-base in psychotherapy. Finally, trainees' experiences as clients within obligatory psychotherapy sessions were suggestive of a "hidden ethics curriculum"-referring to the unintended transmission of norms and practices within training that undermine the explicit guidance expressed in formal professional ethics codes. Some students felt coerced into therapy, and some reported not undergoing informed consent processes. Reflecting on work placements, trainees expressed mixed views, with some unclear about who was responsible for informed consent. Conclusions: This qualitative study presents timely information on psychotherapy students' views about informed consent to psychotherapy. Major gaps in students' ethical, conceptual, and procedural knowledge were identified, and comments suggested the influence of a hidden curriculum in shaping norms of practice. Implications: This exploratory study raises important questions about the preparedness of psychotherapy students to fulfill their ethical obligations.
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Affiliation(s)
- Charlotte R Blease
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,School of Psychology, University College Dublin, Dublin, Ireland
| | - Tim Arnott
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - John M Kelley
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Department of Psychology, Endicott College, Beverly, MA, United States
| | - Gillian Proctor
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Tobias Kube
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Pain and Psychotherapy Lab, University of Koblenz and Landau, Landau, Germany
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,School of Psychology, University of Plymouth, Plymouth, United Kingdom
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Gerber M, Beck J, Brand S, Cody R, Donath L, Eckert A, Faude O, Fischer X, Hatzinger M, Holsboer-Trachsler E, Imboden C, Lang U, Mans S, Mikoteit T, Oswald A, Pühse U, Rey S, Schreiner AK, Schweinfurth N, Spitzer U, Zahner L. The impact of lifestyle Physical Activity Counselling in IN-PATients with major depressive disorders on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers: study protocol for a randomized controlled trial. Trials 2019; 20:367. [PMID: 31221205 PMCID: PMC6585067 DOI: 10.1186/s13063-019-3468-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/24/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a widespread and burdensome psychiatric issue. Physical activity counselling may increase lifestyle physical activity and cardiorespiratory fitness in this specific and particularly vulnerable population, which often suffers from both mental and physical health problems. Therefore, this study will examine the impact of a lifestyle physical activity counselling intervention on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers among in-patients diagnosed with MDD compared to controls. Secondary purposes are to examine the acceptability and perceived usefulness of the intervention among these patients, to find out whether the effectiveness of the intervention is moderated by genetic factors, and to compare baseline values with an age- and gender-matched group of healthy controls. METHODS The study is designed as a multi-centric two-arm randomized clinical trial including an intervention group and a placebo control group, allocation concealment, single-blinding, and intention-to-treat analysis. Participants (N = 334) will be continuously recruited from four clinics specialized in the treatment of MDD. The intervention builds on a standardized, theory-based, low-cost lifestyle physical activity counselling programme, which was specifically designed for an in-patient rehabilitation setting. The placebo control condition consists of general instructions about health-enhancing physical activity. Data assessments will take place 2-3 weeks after admission to in-patient treatment (baseline), and 6 weeks (post) and 12 months (follow-up) after discharge from in-patient treatment. The primary outcome is objectively assessed physical activity at follow-up. DISCUSSION Because regular physical activity has proven to be an important predictor of long-term response and remission in patients with major depression, we believe that our planned study may lay important groundwork by showing how individually tailored lifestyle physical activity counselling can be integrated into given clinical structures. Improving physical activity may have important implications for tackling metabolic and cardiovascular disease and increasing mood and cognitive functioning in this at-risk population, hence limiting the future burden of multiple chronic conditions. Increased physical activity may also reduce the likelihood of future depressive episodes. By moving towards the primary prevention of chronic physical conditions, much can be done to enhance the quality and quantity of life of people with MDD. TRIAL REGISTRATION ISRCTN, ISRCTN10469580 . Registered on 3 September 2018.
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Affiliation(s)
| | | | - Serge Brand
- University of Basel, Basel, Switzerland
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
- Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | | | - Lars Donath
- German Sport University Cologne, Cologne, Germany
| | - Anne Eckert
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
| | | | | | | | | | | | - Undine Lang
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
| | - Sarah Mans
- Private Clinic Wyss, Münchenbuchsee, Switzerland
| | | | - Anja Oswald
- Psychiatric Clinic Sonnenhalde, Riehen, Switzerland
| | - Uwe Pühse
- University of Basel, Basel, Switzerland
| | - Sofia Rey
- University of Basel, Basel, Switzerland
| | | | - Nina Schweinfurth
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
| | - Ursula Spitzer
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
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Abstract
Psychotherapies may work through techniques that are specific to each therapy or through factors that all therapies have in common. Proponents of the common factors model often point to meta-analyses of comparative outcome studies that show all therapies have comparable effects. However, not all meta-analyses support the common factors model; the included studies often have several methodological problems; and there are alternative explanations for finding comparable outcomes. To date, research on the working mechanisms and mediators of therapies has always been correlational, and in order to establish that a mediator is indeed a causal factor in the recovery process of a patient, studies must show a temporal relationship between the mediator and an outcome, a dose–response association, evidence that no third variable causes changes in the mediator and the outcome, supportive experimental research, and have a strong theoretical framework. Currently, no common or specific factor meets these criteria and can be considered an empirically validated working mechanism. Therefore, it is still unknown whether therapies work through common or specific factors, or both.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
| | - Mirjam Reijnders
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
| | - Marcus J.H. Huibers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
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41
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Locher C, Meier S, Gaab J. Psychotherapy: A World of Meanings. Front Psychol 2019; 10:460. [PMID: 30984050 PMCID: PMC6448000 DOI: 10.3389/fpsyg.2019.00460] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/15/2019] [Indexed: 11/18/2022] Open
Abstract
Despite a wealth of findings that psychotherapy is an effective psychological intervention, the principal mechanisms of psychotherapy change are still in debate. It has been suggested that all forms of psychotherapy provide a context which enables clients to transform the meaning of their experiences and symptoms in such a way as to help clients feel better, and function more adaptively. However, psychotherapy is not the only health care intervention that has been associated with "meaning": the reason why placebo has effects has also been proposed to be a "meaning response." Thus, it has been argued that the meaning of treatments has a central impact on beneficial (and by extension, negative) health-related responses. In light of the strong empirical support of a contextual understanding of psychotherapy and its effects, the aim of this conceptual analysis is to examine the role of meaning and its transformation in psychotherapy-in general-and within three different, commonly used psychotherapy modalities.
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Affiliation(s)
- Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
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42
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Blease CR, Kelley JM. Does Disclosure About the Common Factors Affect Laypersons' Opinions About How Cognitive Behavioral Psychotherapy Works? Front Psychol 2018; 9:2635. [PMID: 30622498 PMCID: PMC6308208 DOI: 10.3389/fpsyg.2018.02635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/07/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Written and online information about cognitive-behavioral therapy (CBT) prioritizes the role of specific techniques (e.g., cognitive restructuring) and typically omits discussion of “common factors” (e.g., the working alliance, or therapist empathy). However, according to extensive psychotherapy process research the common factors may be important mediators of client improvement. Objectives: This study aimed to assess lay opinions about the role of specific and common factors in CBT for depression. We also aimed to determine how different client disclosure processes might affect lay opinions about the relative importance of specific and common factors in CBT. Methods: We conducted a web-based experiment involving a sample of US participants who had never undergone psychotherapy. All participants were presented with similar vignettes describing an individual suffering from depression whose doctor recommends CBT. Participants were randomized to read one of six vignettes created in a 2 × 3 factorial design that crossed client gender with type of informed consent (Standard CBT Disclosure vs. Common Factors and CBT Disclosure vs. No Disclosure). Results: Disclosure type had a significant effect on participants' ratings of Common and Specific factors in psychotherapy. As compared to the CBT disclosure, participants allocated to the Common Factors disclosure rated Empathy and Positive Regard as significantly more important to treatment outcome, and rated the Specific factors of CBT as significantly less important to outcome. There were no significant differences between No Disclosure and Standard CBT Disclosure, and these participants rated Specific factors of CBT and the Working Alliance as more important components in treatment, and Empathy and Positive Regard as less important. Conclusions: The content of information disclosures influences lay opinions about the importance of specific and common factors in CBT. Further research should investigate ethically acceptable disclosures to CBT and other forms of psychotherapy, including whether disclosure practices affect treatment outcome.
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Affiliation(s)
- Charlotte R Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, MA, United States.,School of Psychology, University College Dublin, Dublin, Ireland
| | - John M Kelley
- School of Psychology, Endicott College, Beverly, MA, United States
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Midgley N, Reynolds S, Kelvin R, Loades M, Calderon A, Martin P, O'Keeffe S. Therapists' techniques in the treatment of adolescent depression. JOURNAL OF PSYCHOTHERAPY INTEGRATION 2018; 28:413-428. [PMID: 30518990 DOI: 10.1037/int0000119] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
When comparing the relative effectiveness of different psychological treatment approaches using clinical trials, it is essential to establish fidelity to each manualized therapy, and differentiation between the treatment arms. Yet few psychological therapy trials include details about the assessment of treatment integrity and little is known about the specific techniques used by therapists, or to what degree these techniques are shared or distinct across different therapeutic approaches. The aims of this study were: to establish the fidelity of two established psychological therapies - cognitive-behaviour therapy (CBT) and short-term psychoanalytic psychotherapy (STPP) - in the treatment of adolescent depression; and to examine whether they were delivered with adherence to their respective treatment modalities, and if they could be differentiated from each other and from a reference treatment (a brief psychosocial intervention; BPI). The study also aimed to identify shared and distinct techniques used within and across the three treatments. Audio-tapes (N=230) of therapy sessions, collected as part of a trial, were blind double-rated using the Comparative Psychotherapy Process Scale (CPPS), which includes subscales for cognitive-behavioural and psychodynamic-interpersonal techniques. The treatments were delivered with reasonable fidelity and there was clear differentiation in the use of cognitive-behavioural and psychodynamic-interpersonal techniques between CBT and STPP, and between these two established psychological therapies and BPI. An item-level analysis identified techniques used across all three treatments, techniques that were shared between BPI and CBT, and techniques that were unique to CBT and STPP.
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Affiliation(s)
- Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | - Raphael Kelvin
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Maria Loades
- Department of Psychology, University of Bath, Bath, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Ana Calderon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Martin
- Department of Applied Health Research, University College London, London, UK
| | - Sally O'Keeffe
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK
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Locher C, Gaab J, Blease C. When a Placebo Is Not a Placebo: Problems and Solutions to the Gold Standard in Psychotherapy Research. Front Psychol 2018; 9:2317. [PMID: 30542310 PMCID: PMC6277873 DOI: 10.3389/fpsyg.2018.02317] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/05/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Charlotte Blease
- Program in Placebo Studies, General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard, MA, United States.,School of Psychology, University College Dublin, Dublin, Ireland
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D’Errico L, Call M, Vogel E, Bents H, Mander J. Spezifische Techniken in kognitiv-verhaltenstherapeutischen Ausbildungstherapien. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2018. [DOI: 10.1026/1616-3443/a000489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Zur Frage, was Psychotherapie wirksam macht, wurde in den letzten Jahren viel hinsichtlich Wirkfaktoren und Techniken geforscht. Allerdings besteht weiterhin eine Forschungslücke in der Untersuchung konkreter kognitiv-verhaltenstherapeutischer Interventionen in der Psychotherapieausbildung. Fragestellung: Ziel war die Validierung des Heidelberger Inventars Kognitiv-Behavioraler Interventionen (HIKBI), welches diesbezüglich Facetten zentraler Interventionen aus Sicht von Ausbildungstherapeut_innen erfasst. Methode: In 589 ambulanten Ausbildungstherapien wurden das HIKBI und etablierte Prozess- und Outcome-Fragebögen ausgefüllt. Ergebnisse: Es ergab sich beim HIKBI eine eindeutige Faktorenstruktur, die Subskalen wiesen eingeschränkt akzeptable bis gute Reliabilitäten (.59 ≤ α ≤ .82) auf. Hinweise für die konvergente Validität lagen durch signifikante Zusammenhänge mit allgemeinen Wirkfaktoren vor. Jedoch zeigten sich keine statistisch signifikanten Zusammenhänge mit symptomatischen Outcomes. Schlussfolgerung: Mit dem HIKBI liegt ein psychometrisch akzeptables Messinstrument zur Erfassung spezifischer KVT-Techniken in der verhaltenstherapeutischen Ausbildung vor.
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Affiliation(s)
- Louisa D’Errico
- Zentrum für Psychologische Psychotherapie, Psychologisches Institut, Universität Heidelberg
| | - Manuela Call
- Zentrum für Psychologische Psychotherapie, Psychologisches Institut, Universität Heidelberg
| | - Eva Vogel
- Zentrum für Psychologische Psychotherapie, Psychologisches Institut, Universität Heidelberg
| | - Hinrich Bents
- Zentrum für Psychologische Psychotherapie, Psychologisches Institut, Universität Heidelberg
| | - Johannes Mander
- Zentrum für Psychologische Psychotherapie, Psychologisches Institut, Universität Heidelberg
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Prosser A, Friston KJ, Bakker N, Parr T. A Bayesian Account of Psychopathy: A Model of Lacks Remorse and Self-Aggrandizing. COMPUTATIONAL PSYCHIATRY (CAMBRIDGE, MASS.) 2018; 2:92-140. [PMID: 30381799 PMCID: PMC6184370 DOI: 10.1162/cpsy_a_00016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 04/27/2018] [Indexed: 12/28/2022]
Abstract
This article proposes a formal model that integrates cognitive and psychodynamic psychotherapeutic models of psychopathy to show how two major psychopathic traits called lacks remorse and self-aggrandizing can be understood as a form of abnormal Bayesian inference about the self. This model draws on the predictive coding (i.e., active inference) framework, a neurobiologically plausible explanatory framework for message passing in the brain that is formalized in terms of hierarchical Bayesian inference. In summary, this model proposes that these two cardinal psychopathic traits reflect entrenched maladaptive Bayesian inferences about the self, which defend against the experience of deep-seated, self-related negative emotions, specifically shame and worthlessness. Support for the model in extant research on the neurobiology of psychopathy and quantitative simulations are provided. Finally, we offer a preliminary overview of a novel treatment for psychopathy that rests on our Bayesian formulation.
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Affiliation(s)
- Aaron Prosser
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Karl J. Friston
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
| | - Nathan Bakker
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Thomas Parr
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, UK
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Blease CR. Psychotherapy and Placebos: Manifesto for Conceptual Clarity. Front Psychiatry 2018; 9:379. [PMID: 30177892 PMCID: PMC6109685 DOI: 10.3389/fpsyt.2018.00379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Charlotte R. Blease
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- School of Psychology, University College Dublin, Dublin, Ireland
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Wampold BE, Flückiger C, Del Re AC, Yulish NE, Frost ND, Pace BT, Goldberg SB, Miller SD, Baardseth TP, Laska KM, Hilsenroth MJ. In pursuit of truth: A critical examination of meta-analyses of cognitive behavior therapy. Psychother Res 2018; 27:14-32. [PMID: 27884095 DOI: 10.1080/10503307.2016.1249433] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Three recent meta-analyses have made the claim, albeit with some caveats, that cognitive-behavioral treatments (CBT) are superior to other psychotherapies, in general or for specific disorders (e.g., social phobia). METHOD The purpose of the present article was to examine four issues in meta-analysis that mitigate claims of CBT superiority: (a) effect size, power, and statistical significance, (b) focusing on disorder-specific symptom measures and ignoring other important indicators of psychological functioning, (c) problems inherent in classifying treatments provided in primary studies into classes of treatments, and (d) the inclusion of problematic trials, which biases the results, and the exclusion of trials that fail to find differences among treatments. RESULTS When these issues are examined, the effects demonstrating the superiority of CBT are small, nonsignificant for the most part, limited to targeted symptoms, or are due to flawed primary studies. CONCLUSION Meta-analytic evidence for the superiority of CBT in the three meta-analysis are nonexistent or weak.
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Affiliation(s)
- Bruce E Wampold
- a Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA.,b Research Institute, Modum Bad Psychiatric Center , Vikersund , Norway
| | | | - A C Del Re
- d VA Palo Alto Health Care System , Palo Alto , CA , USA
| | - Noah E Yulish
- a Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA
| | - Nickolas D Frost
- a Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA
| | - Brian T Pace
- e Department of Educational Psychology , University of Utah , Salt Lake City , UT , USA
| | - Simon B Goldberg
- a Department of Counseling Psychology , University of Wisconsin-Madison , Madison , WI , USA
| | | | | | - Kevin M Laska
- h VA Salt Lake City Health Care System , Salt Lake City , UT , USA
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49
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Kayrouz R, Dear BF, Kayrouz B, Karin E, Gandy M, Titov N. Meta-analysis of the efficacy and acceptability of cognitive-behavioural therapy for Arab adult populations experiencing anxiety, depression or post-traumatic stress disorder. Cogn Behav Ther 2018; 47:412-430. [PMID: 29714106 DOI: 10.1080/16506073.2018.1445124] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A meta-analysis of the literature of cognitive behaviour therapy (CBT) with Arab adult populations experiencing anxiety, depression or post-traumatic stress disorder (PTSD) was conducted. Nine studies (n = 536) met the eligibility criteria. Three of the nine studies (33%) were randomised control trials using waitlist control groups. All studies (100%) reported a statistically significant reduction in psychological symptoms at post-treatment with large effect sizes for anxiety (effect size, 95% confidence interval) (1.44 [1.29, 1.59]), depression (1.26 [1.16, 1.35]) and PTSD (2.08 [1.94, 2.23]). Six out of the nine studies (67%) collated follow-up data and reported that reductions of psychological symptoms were maintained at follow-up. An average dropout rate of 26% indicated good overall acceptability. Five out of nine (55%) of the trials reported diagnostic remission rates and of those trials the mean remission rate was 31%). Five of the nine eligible studies (55%) delivered remotely via Internet or telephone were found to have similar effect sizes as face-to-face CBT. The current meta-analysis indicates the potential of CBT, delivered either face-to-face or via internet, as efficacious and acceptable interventions for the treatment of anxiety, depression and PTSD for Arab adult populations.
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Affiliation(s)
- Rony Kayrouz
- a eCentreClinic, Department of Psychology , Macquarie University , Sydney , Australia
| | - Blake F Dear
- a eCentreClinic, Department of Psychology , Macquarie University , Sydney , Australia
| | - Bechara Kayrouz
- b Department of Psychology , Western Sydney University , Milperra , Australia
| | - Eyal Karin
- a eCentreClinic, Department of Psychology , Macquarie University , Sydney , Australia
| | - Milena Gandy
- a eCentreClinic, Department of Psychology , Macquarie University , Sydney , Australia
| | - Nickolai Titov
- a eCentreClinic, Department of Psychology , Macquarie University , Sydney , Australia
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Holmes EA, Ghaderi A, Harmer CJ, Ramchandani PG, Cuijpers P, Morrison AP, Roiser JP, Bockting CLH, O'Connor RC, Shafran R, Moulds ML, Craske MG. The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science. Lancet Psychiatry 2018; 5:237-286. [PMID: 29482764 DOI: 10.1016/s2215-0366(17)30513-8] [Citation(s) in RCA: 323] [Impact Index Per Article: 53.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/10/2017] [Accepted: 11/24/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Trust Foundation, Warneford Hospital, Oxford, UK
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Heath Trust, Manchester, UK; School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Claudi L H Bockting
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - Rory C O'Connor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Roz Shafran
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW, Sydney, NSW, Australia
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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