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Gonzalez AR, Strunk DR. Impact of messaging on views of depression treatment options: Examining credibility and expectations. J Clin Psychol 2023; 79:2288-2303. [PMID: 37259690 DOI: 10.1002/jclp.23548] [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: 07/26/2022] [Revised: 04/25/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Understanding how people respond to information about treatment options is important for informing efforts that promote treatment initiation and adherence. We examined the impact of informational treatment videos on treatment naive participants' views regarding the credibility of and their expectations for three treatment options. MATERIALS AND METHODS Adults (N = 300) who had experienced elevated depressive symptoms but had not participated in a treatment for depression were randomly assigned to one of four conditions. Three of the conditions were shown videos, providing information about (1) cognitive behavioral therapy (CBT), (2) antidepressant medication (ADM), or (3) the combination of CBT and ADM. The fourth condition was not shown a video. Participants' self-reported views of the credibility of and expectations for treatment served as primary outcome variables. RESULTS Compared with the control condition, videos about active treatments enhanced credibility and expectations for those treatments. When comparing CBT and ADM alone, messaging about either treatment enhanced credibility of and expectations for that treatment. The CBT only video produced the most positive expectations and highest credibility for CBT. Likewise, the ADM only video led to the most positive expectations and credibility for ADM. The video focused on combined treatment did not lead to particularly positive views of the combined treatment option. CONCLUSION These findings demonstrate the importance of providing focused messaging to enhance the credibility of and expectations for treatment. Future research is needed to examine the impact of messaging in different contexts, as well as the impact of such messaging on treatment seeking, adherence, and outcomes.
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Affiliation(s)
- August R Gonzalez
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Daniel R Strunk
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
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2
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Pagano N, Glasofer DR, Attia E, Ruggiero J, Eziri K, Goldstein CM, Steinglass JE. Perspectives on relapse prevention following intensive treatment of anorexia nervosa: A focus group study. Int J Eat Disord 2023; 56:1417-1431. [PMID: 37051854 PMCID: PMC10524497 DOI: 10.1002/eat.23952] [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: 12/23/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Including the perspectives of individuals with lived experience of mental health issues is a critical step in research and treatment development. Focus groups with patients with a history of treatment for anorexia nervosa (AN) were conducted in anticipation of a clinical trial of Relapse Prevention and Changing Habits (REACH+). METHODS Seven female adults (23-51 years) who had previously received inpatient treatment for AN, now in remission, participated in one of two semistructured focus groups. Rapid qualitative analysis was used to examine participants' contributions and identify common topics. RESULTS Transcript analysis yielded three topics related to relapse prevention: (1) recovery aids, including a sense of agency in treatment decisions and finding new interests/passions, (2) recovery hindrances, such as lack of access to care, and (3) identification of members of support system. Aspects of REACH+ received positive feedback, such as continuity of care from the inpatient setting and the use of telehealth. Viewpoints differed with respect to the helpfulness of obtaining patient weights in treatment. The REACH+ online platform received positive comments regarding content and usability, as well as suggestions for additional content. DISCUSSION Qualitative feedback from patients with a history of AN highlighted the value of engaging patients in their own treatment decisions, as well as in treatment design and innovation. Within this small group, there were differences of opinion about treatment components, specifically weight assessment, that suggest the need for further data. User-centered design provides opportunities to improve the acceptability and, therefore, dissemination of novel treatments. PUBLIC SIGNIFICANCE Relapse prevention is a critical treatment need for patients with anorexia nervosa, as this illness too often follows a protracted course. There are challenges in both obtaining specialized care and in retaining patients in treatment. Here, patient perspectives on these challenges offer input to allow for optimization of relapse prevention treatment. Shared decision-making may be particularly valuable to support an individual's sense of agency and engagement in care.
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Affiliation(s)
- Nikki Pagano
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Deborah R. Glasofer
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Evelyn Attia
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York,
USA
| | - Julia Ruggiero
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Kelechi Eziri
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Carly M. Goldstein
- Weight Control and Diabetes Research Center, The Miriam
Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode
Island, USA
| | - Joanna E. Steinglass
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
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Li X, Bao T, Garland SN, Li SQ, Yu J, Li Y, Mao JJ. Does expectancy affect insomnia treatment response in cancer survivors receiving acupuncture and cognitive behavioral therapy? J Cancer Surviv 2023; 17:826-835. [PMID: 36462115 PMCID: PMC11223715 DOI: 10.1007/s11764-022-01272-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/07/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE Insomnia negatively affects quality of life in cancer survivors. Expectations of insomnia treatment efficacy may influence response to intervention. We sought to determine whether pre-treatment outcome expectancy predicts response to two non-pharmacological interventions for insomnia among cancer survivors. METHODS We analyzed data from a randomized clinical trial that compared acupuncture versus cognitive behavioral therapy for insomnia (CBT-I) in cancer survivors. Patient expectancy was measured by the Mao Treatment Expectancy Scale (MTES) at baseline. Insomnia severity was assessed using the Insomnia Severity Index (ISI) at treatment completion (week 8). Multivariate linear regression was used to evaluate the associations between pre-treatment expectancy and ISI score at week, 8 adjusting for co-variates. RESULTS Expectancy for acupuncture and CBT-I were similar at baseline (acupuncture: 13.3 ± 4.0; CBT-I: 13.2 ± 2.9, p = 0.17). Greater baseline expectancy scores were associated with a greater and statistically significant insomnia severity reduction at week 8 in the acupuncture group (beta coefficients [Coef.] = - 0.35, 95% confidence interval [CI] = - 0.6 to - 0.1, p = 0.016) adjusted for co-variates. Baseline expectancy was not statistically associated with insomnia severity reduction in the CBT-I group (Coef. = - 0.2, 95% CI = - 0.7 to 0.2, p = 0.31). High expectancy was significantly associated with greater proportion of treatment responders at week 8 in the acupuncture group (76% vs. 38%, p = 0.001) but not in the CBT-I group (83% vs. 70%, p = 0.21). CONCLUSIONS Higher pre-treatment outcome expectancy predicted significantly greater insomnia improvement in patients receiving acupuncture but not in those receiving CBT-I. IMPLICATIONS FOR CANCER SURVIVORS Aligning treatment provision with expected outcomes may lead to personalized non-pharmacological insomnia management for cancer survivors.
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Affiliation(s)
- Xiaotong Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, 4th Floor, New York, NY 10065, USA
| | - Ting Bao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, 4th Floor, New York, NY 10065, USA
| | - Sheila N. Garland
- Departments of Psychology and Oncology, Memorial University of Newfoundland, 232 Elizabeth Avenue, St. John’s, St. John’s, Newfoundland and Labrador A1B 3X9, Canada
| | - Susan Q. Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, 4th Floor, New York, NY 10065, USA
| | - Jennifer Yu
- Clinical Tinking, Nucleus Global, 300 American Metro Boulevard, Suite 140, Hamilton, New Jersey, NY 08619, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jun J. Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, 321 East 61st Street, 4th Floor, New York, NY 10065, USA
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Bernstein EE, Weingarden H, Greenberg JL, Williams J, Hoeppner SS, Snorrason I, Phillips KA, Harrison O, Wilhelm S. Credibility and expectancy of smartphone-based cognitive behavioral therapy among adults with body dysmorphic disorder. J Obsessive Compuls Relat Disord 2023; 36:100781. [PMID: 38313683 PMCID: PMC10835574 DOI: 10.1016/j.jocrd.2023.100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Few patients receive cognitive behavioral therapy, the gold-standard for body dysmorphic disorder (CBT-BDD). Smartphones can make evidence-based interventions, like CBT-BDD, more accessible and scalable. A key question is: how do patients view it? Low credibility and expectancy would likely translate to low uptake and engagement outside of research settings, diminishing the impact. Thus, it is important to understand patients' beliefs about digital CBT-BDD. METHODS We compared credibility and expectancy in a coach-guided app-based CBT-BDD trial (N=75) to a previous in-person CBT-BDD trial (N = 55). We further examined the relationship of perceptions of digital CBT-BDD to baseline clinical and demographic factors and dropout. RESULTS Credibility did not differ between the in-person (M=19.3) and digital (M=18.3) trials, p=.24. Expectancy for improvement was moderately higher for in-person (M=58.4) than digital (M=48.3) treatment, p=.005. In the digital trial, no demographic variables were associated with credibility or expectancy. Better BDD-related insight and past non-CBT BDD therapy were associated with greater expectancy. Credibility was associated with lower likelihood of dropout. DISCUSSION Digital CBT-BDD was regarded as similarly credible to in-person CBT-BDD but with lower expectancy. Tailored expectancy-enhancing strategies could strengthen this novel approach, particularly among those with poorer insight and without prior BDD treatment.
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Affiliation(s)
| | | | | | | | | | | | - Katharine A. Phillips
- Rhode Island Hospital and Alpert Medical School of Brown University
- New York-Presbyterian Hospital and Weill Cornell Medical College
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Vîslă A, Allemand M, Flückiger C. Within- and between-patients associations between self-efficacy, outcome expectation, and symptom change in cognitive behavioral therapy for generalized anxiety disorder. J Clin Psychol 2023; 79:86-104. [PMID: 35781807 PMCID: PMC10084306 DOI: 10.1002/jclp.23407] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/05/2022] [Accepted: 06/23/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES There is limited information on how a change in patients' expectations over time results in symptom change in psychotherapy. This study aimed to investigate the changes in patients' expectations and symptoms during treatment and across follow-up as well as to determine the within- and between-patient relationships between two types of patient expectations, that is, self-efficacy and outcome expectation, and symptom change. METHODS Participants (80 participants × 6 repeated measures; 480 observations) with generalized anxiety disorder were treated using cognitive behavioral therapy and the within- and between-patient scores of self-efficacy and outcome expectation were evaluated in multilevel models as predictors of symptom change. RESULTS Patients' self-efficacy and outcome expectation increased, whereas severity of their symptoms reduced during and after treatment. At the within-patient (WP) level, an increase in self-efficacy was associated with a decrease in worry and depressive symptoms, and an increase in outcome expectation was associated with a decrease in depressive symptoms. The between-patient (BP) effect, however, was contrary to the WP effect, that is, self-efficacy was positively correlated with worry and outcome expectation was positively correlated with depressive symptoms CONCLUSION: These results highlight the importance of disaggregating the WP variability from BP variability in psychotherapy process-outcome research as they exhibit different associations at the within- and between-patient levels. Clinical Trial Registration: ClinicalTrial.gov (NCT03079336).
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Affiliation(s)
- Andreea Vîslă
- Department of Psychology, University of Zürich, Zürich, Switzerland
| | - Mathias Allemand
- Department of Psychology, University of Zürich, Zürich, Switzerland
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Ferkin AC, Tonkin SS, Maguin E, Mahoney MC, Colder CR, Tiffany ST, Hawk LW. A Psychometric Evaluation of the Stanford Expectations of Treatment Scale (SETS) in the Context of a Smoking Cessation Trial. Nicotine Tob Res 2022; 24:1914-1920. [PMID: 35906990 PMCID: PMC9653073 DOI: 10.1093/ntr/ntac187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Although treatment outcome expectancies (TOEs) may influence clinical outcomes, TOEs are rarely reported in the smoking cessation literature, in part because of the lack of validated measures. Therefore, we conducted a psychometric evaluation of TOEs scores with the Stanford Expectations of Treatment Scale (SETS) in the context of a smoking cessation clinical trial. METHODS Participants were 320 adults enrolled in a randomized controlled trial of extended versus standard pre-quit varenicline treatment for smoking cessation (clinicaltrials.gov ID: NCT03262662). Across an 8-week treatment period, we examined the nature and stability of the factor structure using confirmatory factor analysis (CFA), evaluated discriminant validity by examining correlations with abstinence self-efficacy and positive/negative affect (PA/NA), and assessed internal consistency and test-retest reliability of SETS scores. RESULTS CFAs supported a 2-factor structure that was stable (ie, invariant) across weeks. Positive and negative TOEs were each reflected in three-item subscales that exhibited acceptable to excellent internal consistency (Cronbach's alphas ≥ .77). Positive and negative TOEs were modestly correlated with PA and NA (all |rs| <.27, p < .05). Positive TOEs, but not negative TOEs, were moderately correlated with abstinence self-efficacy (rs = .45 to .61, p < .01). Both positive and negative TOEs scores demonstrated moderate test-retest reliability between assessments (rs = .54 to .72). CONCLUSIONS SETS scores generally reflect a valid and reliable assessment of positive and negative TOEs in a sample of adults enrolled in a smoking cessation trial. The SETS appears to be a reasonable option for assessing TOEs in future smoking treatment studies. IMPLICATIONS Assessments of treatment outcome expectancies are rarely reported in the smoking cessation literature. The present results support the validity and reliability of the SETS scores among adults seeking treatment for their smoking behavior.
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Affiliation(s)
- Adam C Ferkin
- Department of Psychology, University at Buffalo, Suny, Buffalo, NY, USA
| | - Sarah S Tonkin
- Department of Psychology, University at Buffalo, Suny, Buffalo, NY, USA
| | - Eugene Maguin
- Department of Psychology, University at Buffalo, Suny, Buffalo, NY, USA
| | - Martin C Mahoney
- Department of Internal Medicine and Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Craig R Colder
- Department of Psychology, University at Buffalo, Suny, Buffalo, NY, USA
| | - Stephen T Tiffany
- Department of Psychology, University at Buffalo, Suny, Buffalo, NY, USA
| | - Larry W Hawk
- Department of Psychology, University at Buffalo, Suny, Buffalo, NY, USA
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Scott J, Vedaa Ø, Sivertsen B, Langsrud K, Kallestad H. Using network intervention analysis to explore associations between participant expectations of and difficulties with cognitive behavioural therapy for insomnia and clinical outcome: A proof of principle study. J Psychiatr Res 2022; 148:73-83. [PMID: 35121271 DOI: 10.1016/j.jpsychires.2022.01.054] [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: 11/13/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Research about predictors of response to cognitive behaviour therapy for insomnia (CBT-I) is ongoing. We examined any whether pre-intervention expectations or post-intervention appraisals of difficulties in utilizing face to face (FtF) or digital (dCBT-I) versions of the therapy were associated with outcome. METHODS Self-rating data were extracted on 101 adult participants in a recent randomized controlled trial of FtF versus dCBT-I. Network intervention analyses were used to explore any associations between expectations of CBT-I at response at 9 weeks and between post-intervention ratings of difficulties, modality of therapy and response at 9-weeks and at 6-months. RESULTS Anticipated and actual difficulties in employing sleep restriction techniques predicted response in all network models. Modality of therapy played a more overt role in the 9-week outcome network, with FtF therapy more robustly associated with response. However, the direct association between FtF therapy and response was not found in the 6-month outcome network. Notable predictors of poor outcome at 9-weeks and 6-month follow-up were difficulties in accommodating CBT-I into work and daily routines and applying the rules of CBT-I. CONCLUSIONS This network intervention analysis highlights that self-confidence and ability in undertaking sleep restriction is a key active ingredient of CBT-I. Also, benefits and gains from access to the FtF version of this multi-component therapy were more apparent in the short than the longer term. However, it is important that findings from this proof of principle study are confirmed in further studies.
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Affiliation(s)
- Jan Scott
- Institute of Neuroscience, Newcastle University, UK; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Øystein Vedaa
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research & Innovation, Helse Fonna, HF, Haugesund, Norway; Haukeland University Hospital, Bjørgvin District Psychiatric Center, Bergen, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway; Department of Research & Innovation, Helse Fonna, HF, Haugesund, Norway
| | - Knut Langsrud
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | - Havard Kallestad
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
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Kuzminskaite E, Lemmens LHJM, van Bronswijk SC, Peeters F, Huibers MJH. Patient Choice in Depression Psychotherapy: Outcomes of Patient-Preferred Therapy Versus Randomly Allocated Therapy. Am J Psychother 2021; 74:103-111. [PMID: 34521212 DOI: 10.1176/appi.psychotherapy.20200042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patient choice is recognized as a factor that influences clinical outcomes and treatment evaluation in mental health care. However, research on how having a choice affects patients with depression has been rare. This Dutch study examined whether patients randomly selected to choose between two types of depression psychotherapy benefited more from treatment than patients randomly assigned to an intervention. METHODS Data were derived from a trial of outpatients with depression who were randomly assigned to cognitive therapy (CT), interpersonal psychotherapy (IPT), or a 2-month waitlist control condition followed by the patient's choice of CT or IPT. Treatment groups were combined into a no-choice condition (N=151), with the waitlist as the choice condition (N=31). Multilevel regression was used to compare depression severity (measured with the Beck Depression Inventory-II [BDI-II]) and general psychological distress (measured with the Brief Symptom Inventory [BSI]) posttreatment and at the 5-month follow-up. Differences in patients' pretreatment expectations, beliefs about treatment credibility, and posttreatment evaluation were examined. RESULTS No significant differences in clinical outcomes were found between the choice and no-choice conditions (mean difference: BDI-II posttreatment=-0.55, 95% confidence interval [CI]=-5.25 to 4.15; follow-up=2.10, 95% CI=-4.01 to 8.20; BSI posttreatment=-1.89, 95% CI=-15.35 to 11.58; follow-up=3.13, 95% CI=-12.32 to 18.57). Patients in both groups reported comparable scores on pretreatment expectations, credibility beliefs, and posttreatment evaluation. Neither expectations nor credibility beliefs were predictive of clinical outcomes. CONCLUSIONS Our findings did not support the value of patient choice. Considering the exploratory nature of the trial, future studies designed to examine the effects of choice in depression treatment are recommended.
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Affiliation(s)
- Erika Kuzminskaite
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Kuzminskaite, Huibers); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (Kuzminskaite); Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers)
| | - Lotte H J M Lemmens
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Kuzminskaite, Huibers); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (Kuzminskaite); Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers)
| | - Suzanne C van Bronswijk
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Kuzminskaite, Huibers); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (Kuzminskaite); Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers)
| | - Frenk Peeters
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Kuzminskaite, Huibers); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (Kuzminskaite); Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers)
| | - Marcus J H Huibers
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Kuzminskaite, Huibers); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (Kuzminskaite); Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers)
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Kuzminskaite E, Lemmens LHJM, van Bronswijk SC, Peeters F, Huibers MJH. Patient Choice in Depression Psychotherapy: Outcomes of Patient-Preferred Therapy Versus Randomly Allocated Therapy. Am J Psychother 2021:appiapt202020200042. [PMID: 34029118 DOI: 10.1176/appi.apt.2020.2020.0042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Patient choice is recognized as a factor that influences clinical outcomes and treatment evaluation in mental health care. However, research on how having a choice affects patients with depression has been rare. This Dutch study examined whether patients randomly selected to choose between two types of depression psychotherapy benefited more from treatment than patients randomly assigned to an intervention. METHODS Data were derived from a trial of outpatients with depression who were randomly assigned to cognitive therapy (CT), interpersonal psychotherapy (IPT), or a 2-month waitlist control condition followed by the patient's choice of CT or IPT. Treatment groups were combined into a no-choice condition (N=151), with the waitlist as the choice condition (N=31). Multilevel regression was used to compare depression severity (measured with the Beck Depression Inventory-II [BDI-II]) and general psychological distress (measured with the Brief Symptom Inventory [BSI]) posttreatment and at the 5-month follow-up. Differences in patients' pretreatment expectations, beliefs about treatment credibility, and posttreatment evaluation were examined. RESULTS No significant differences in clinical outcomes were found between the choice and no-choice conditions (mean difference: BDI-II posttreatment=-0.55, 95% confidence interval [CI]=-5.25 to 4.15; follow-up=2.10, 95% CI=-4.01 to 8.20; BSI posttreatment=-1.89, 95% CI=-15.35 to 11.58; follow-up=3.13, 95% CI=-12.32 to 18.57). Patients in both groups reported comparable scores on pretreatment expectations, credibility beliefs, and posttreatment evaluation. Neither expectations nor credibility beliefs were predictive of clinical outcomes. CONCLUSIONS Our findings did not support the value of patient choice. Considering the exploratory nature of the trial, future studies designed to examine the effects of choice in depression treatment are recommended.
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Affiliation(s)
- Erika Kuzminskaite
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Kuzminskaite, Huibers); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (Kuzminskaite); Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers)
| | - Lotte H J M Lemmens
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Kuzminskaite, Huibers); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (Kuzminskaite); Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers)
| | - Suzanne C van Bronswijk
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Kuzminskaite, Huibers); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (Kuzminskaite); Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers)
| | - Frenk Peeters
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Kuzminskaite, Huibers); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (Kuzminskaite); Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers)
| | - Marcus J H Huibers
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam (Kuzminskaite, Huibers); Department of Psychiatry, Amsterdam University Medical Center, Amsterdam (Kuzminskaite); Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands (Lemmens, van Bronswijk, Peeters); Department of Psychology, University of Pennsylvania, Philadelphia (Huibers)
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Shamai-Leshem D, Lazarov A, Pine DS, Bar-Haim Y. A randomized controlled trial of gaze-contingent music reward therapy for major depressive disorder. Depress Anxiety 2021; 38:134-145. [PMID: 32790036 DOI: 10.1002/da.23089] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/12/2020] [Accepted: 07/29/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Heightened attention allocation toward negative-valanced information and reduced attention allocation toward positive-valanced information represent viable targets for attention bias modification in major depressive disorder. Accordingly, we conducted a randomized controlled trial testing the efficacy of a novel gaze-contingent attention bias modification procedure for major depressive disorder. METHOD Sixty patients with major depressive disorder were randomly assigned to either eight training sessions of feedback-based gaze-contingent music reward therapy designed to divert patients' gaze toward positive over sad stimuli, or to a control condition which entailed eight sessions of gaze-noncontingent music. Clinician-rated and self-reported measures of depression, and proportion of dwell-time on sad faces, were assessed pretreatment, posttreatment, and at a 3-month follow-up. RESULTS Gaze-contingent music reward therapy produced a greater reduction in dwell-time on sad faces compared with the control condition, but it failed to generalize to novel faces. Both groups manifested similarly significant reductions in depression symptoms from pre- to posttreatment that were maintained at follow-up. Exploratory analyses suggest that first-episode patients may benefit more from this therapy than patients with a history of multiple episodes. CONCLUSIONS Gaze-contingent music reward therapy can modify attention biases in depression, but clear differential clinical effects did not emerge. Theoretical and practical implications are discussed.
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Affiliation(s)
- Dana Shamai-Leshem
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Daniel S Pine
- Section on Developmental Affective Neuroscience, National Institute of Mental Health, Bethesda, Maryland
| | - Yair Bar-Haim
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
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Constantino MJ, Coyne AE, Goodwin BJ, Vîslă A, Flückiger C, Muir HJ, Gaines AN. Indirect effect of patient outcome expectation on improvement through alliance quality: A meta-analysis. Psychother Res 2020; 31:711-725. [DOI: 10.1080/10503307.2020.1851058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Michael J. Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Alice E. Coyne
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Brien J. Goodwin
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Andreea Vîslă
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | - Heather J. Muir
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Averi N. Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
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12
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Hui VKY, Wong CYF, Ma EKY, Ho FYY, Chan CS. Treating depression with a smartphone-delivered self-help cognitive behavioral therapy for insomnia: study protocol for a parallel group randomized controlled trial. Trials 2020; 21:843. [PMID: 33036655 PMCID: PMC7545384 DOI: 10.1186/s13063-020-04778-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/29/2020] [Indexed: 11/25/2022] Open
Abstract
Background Depression is a major public health concern. Emerging research has shown that cognitive behavioral therapy for insomnia (CBT-I) is effective in treating individuals with comorbid insomnia and depression. Traditional face-to-face CBT-I encounters many obstacles related to feasibility, accessibility, and help-seeking stigma. CBT-I delivered via smartphone application could be a potential solution. This paper reports a protocol designed to evaluate the efficacy of a self-help smartphone-based CBT-I, using a waitlist group as control, for people with major depression and insomnia. Methods A two-arm parallel randomized controlled trial is conducted in a target sample of 285 non-suicidal Hong Kong Chinese older than 17 years of age with major depression and insomnia. Participants complete an online rapid screening, followed by a telephone diagnostic interview. Those who meet the eligibility criteria are randomized in a ratio of 1:1 to receive either CBT-I immediately or to a waitlist control condition. The CBT-I consists of six weekly modules and is delivered through a smartphone application proACT-S. This smartphone app has been pilot tested and revamped to improve user experience. An online randomized algorithm is used to perform randomization to ensure allocation concealment. The primary outcomes are changes over the measurement points in sleep quality, insomnia severity, and depression severity. The secondary outcomes include changes over the measurement points in anxiety, subjective health, treatment expectancy, and acceptability of treatment. Assessments are administered at baseline, post-intervention, and 6-week follow-up. The recruitment is completed. Important adverse events, if any, are documented. Multilevel linear mixed model based on intention-to-treat principle will be conducted to examine the efficacy of the CBT-I intervention. Discussion It is expected that proACT-S is an efficacious brief sleep-focused self-help treatment for people with major depression and insomnia. If proven efficacious, due to its self-help nature, proACT-S may be applicable as a community-based early intervention, thereby reducing the burden of the public healthcare system in Hong Kong. Trial registration ClinicalTrials.gov NCT04228146. Retrospectively registered on 14 January 2020.
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Affiliation(s)
- Victoria Ka-Ying Hui
- Department of Psychology, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, Hong Kong
| | - Christy Yim-Fan Wong
- Department of Psychology, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, Hong Kong
| | - Eric Ka-Yiu Ma
- Department of Psychology, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, Hong Kong
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Christian S Chan
- Department of Psychology, The University of Hong Kong, Pokfulam Road, Hong Kong SAR, Hong Kong.
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13
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Bell IH, Rossell SL, Farhall J, Hayward M, Lim MH, Fielding-Smith SF, Thomas N. Pilot randomised controlled trial of a brief coping-focused intervention for hearing voices blended with smartphone-based ecological momentary assessment and intervention (SAVVy): Feasibility, acceptability and preliminary clinical outcomes. Schizophr Res 2020; 216:479-487. [PMID: 31812327 DOI: 10.1016/j.schres.2019.10.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 06/25/2019] [Accepted: 10/10/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Voice-hearing experiences can be distressing and impairing, and existing psychological treatments show modest effectiveness. Ecological momentary assessment and intervention (EMA/I) are two promising approaches which may be used as digital tools to support and enhance existing psychological therapies. The aim of this study was to investigate the potential clinical utility of smartphone-based EMA/I in a blended, coping focused therapy for voice-hearing experiences. METHOD This pilot RCT focused on feasibility, acceptability and preliminary estimations of efficacy. Thirty-four participants with persisting and distressing voices were randomised to receive the four-session intervention along-side treatment-as-usual (TAU) or TAU-only. RESULTS Findings supported the feasibility and acceptability of the approach, with good engagement and satisfaction rates, and clinical outcomes showed the intervention holds promise for improving coping, overall severity of voices and to some degree their negative impact. CONCLUSION This is the first examination of the use of EMA/I in a blended therapy for psychotic experiences, with findings suggesting these technologies show promise as clinical tools.
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Affiliation(s)
- Imogen H Bell
- Centre for Mental Health, Swinburne University of Technology, Australia.
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Australia; Department of Psychiatry, St. Vincent's Hospital, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Australia; NorthWestern Mental Health, Melbourne Health, Australia
| | - Mark Hayward
- Sussex Partnership NHS Foundation Trust, UK; School of Psychology, University of Sussex, UK
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Australia
| | - Sarah F Fielding-Smith
- Sussex Partnership NHS Foundation Trust, UK; School of Psychology, University of Sussex, UK
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Australia.
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14
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Thiruchselvam T, Dozois DJA, Bagby RM, Lobo DSS, Ravindran LN, Quilty LC. The role of outcome expectancy in therapeutic change across psychotherapy versus pharmacotherapy for depression. J Affect Disord 2019; 251:121-129. [PMID: 30921595 DOI: 10.1016/j.jad.2019.01.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/24/2018] [Accepted: 01/22/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient outcome expectancy - the belief that treatment will lead to an improvement in symptoms - is linked to favourable therapeutic outcomes in major depressive disorder (MDD). The present study extends this literature by investigating the temporal dynamics of expectancy, and by exploring whether expectancy during treatment is linked to differential outcomes across treatment modalities, for both optimistic versus pessimistic expectancy. METHODS A total of 104 patients with MDD were randomized to receive either cognitive behavioral therapy (CBT) or pharmacotherapy for 16 weeks. Outcome expectancy was measured throughout treatment using the Depression Change Expectancy Scale (DCES). Depression severity was measured using both the Hamilton Depression Rating Scale and Beck Depression Inventory-II. RESULTS Latent growth curve models supported improvement in expectancy across both treatments. Cross-lagged panel models revealed that both higher optimistic and lower pessimistic expectancy at mid-treatment predicted greater treatment response in pharmacotherapy. For CBT, the associative patterns between expectancy and depression differed as a function of expectancy type; higher optimistic expectancy at pre-treatment and lower pessimistic expectancy at mid-treatment predicted greater treatment response. LIMITATIONS The sample size limited statistical power and the complexity of models that could be explored. CONCLUSIONS Results suggest that outcome expectancy improved during treatment for depression. Whether outcome expectancy represents a specific mechanism for the reduction of depression warrants further investigation.
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Affiliation(s)
- Thulasi Thiruchselvam
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, Ontario, Canada
| | - David J A Dozois
- Department of Psychology, University of Western Ontario, London, Ontario, Canada
| | - R Michael Bagby
- Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniela S S Lobo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lakshmi N Ravindran
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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15
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Smart E, Nalder E, Rigby P, King G. Generating Expectations: What Pediatric Rehabilitation Can Learn From Mental Health Literature. Phys Occup Ther Pediatr 2019; 39:217-235. [PMID: 29611777 DOI: 10.1080/01942638.2018.1432007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Family-Centered Care (FCC) represents the ideal service delivery approach in pediatric rehabilitation. Nonetheless, implementing FCC as intended in clinical settings continues to be hindered by knowledge gaps. One overlooked gap is our understanding of clients' therapy expectations. This perspective article synthesizes knowledge from the mental health services literature on strategies recommended to service providers for generating transparent and congruent therapy expectations with clients, and applies this knowledge to the pediatric rehabilitation literature, where this topic has been researched significantly less, for the purpose of improving FCC implementation. Dimensions of the Measure of Processes of Care, an assessment tool that measures clients' perceptions of the extent a service is family-centered, inform the organization of therapy expectation-generating strategies: (1) Providing Respectful and Supportive Care (assessing and validating clients' expectations); (2) General and Specific Information (foreshadowing therapy journeys, explaining treatment rationale, and conveying service provider qualifications); (3) Coordinated and Comprehensive Care (socializing clients to roles and reflecting on past socialization); and (4) Enabling and Partnership (applying a negotiation framework and fostering spaces safe to critique). Strategies can help pediatric rehabilitation service providers work with families to reframe unrealistic expectations, establish congruent beliefs supporting effective partnerships, and prevent possible disillusionment with therapy over time.
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Affiliation(s)
- Eric Smart
- a Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,b Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada
| | - Emily Nalder
- a Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,c Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada.,d March of Dimes Canada , Toronto , Ontario , Canada
| | - Patty Rigby
- a Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,c Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada
| | - Gillian King
- a Rehabilitation Sciences Institute, University of Toronto , Toronto , Ontario , Canada.,b Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital , Toronto , Ontario , Canada.,c Department of Occupational Science and Occupational Therapy , University of Toronto , Toronto , Ontario , Canada
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16
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The relationship between personal growth and psychological functioning in individuals treated in a partial hospital setting. J Clin Psychol 2018; 74:1759-1774. [DOI: 10.1002/jclp.22627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 01/26/2018] [Accepted: 02/17/2018] [Indexed: 11/07/2022]
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17
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Vîslă A, Flückiger C, Constantino MJ, Krieger T, Grosse Holtforth M. Patient characteristics and the therapist as predictors of depressed patients’ outcome expectation over time: A multilevel analysis. Psychother Res 2018; 29:709-722. [DOI: 10.1080/10503307.2018.1428379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Andreea Vîslă
- Department of Psychology, University of Zürich, Zürich, Switzerland
- Department of Educational Sciences, Stefan cel Mare University of Suceava, Suceava, Romania
| | | | - Michael J. Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Martin Grosse Holtforth
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
- Department of Psychosomatic Medicine, Inselspital, University of Bern, Bern, Switzerland
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18
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Patients' comprehension and skill usage as a putative mediator of change or an engaged target in cognitive therapy: Preliminary findings. J Affect Disord 2018; 226:163-168. [PMID: 28987648 DOI: 10.1016/j.jad.2017.09.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/02/2017] [Accepted: 09/24/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND The skills that patients learn in cognitive therapy (CT) and use thereafter may mediate improvement in depression during and after intervention. METHOD We used a sequential, three-stage design: acute phase (523 outpatients received 12-14 weeks of CT); 8-month experimental phase (responders at higher risk were randomized to continuation phases: C-CT, C-fluoxetine or C-pill placebo); and 24 months of longitudinal, post-treatment follow-up. Path analyses estimated mediation by skill measured by the Skills of Cognitive Therapy (SoCT: Patient and Observer [Therapist] versions). RESULTS Better SoCT scores predicted lower depressive symptoms both in CT and C-CT. In CT depressive symptoms did not predict subsequent changes in skills. During CT and C-CT, when averaged across patients and therapists, skills predicted subsequent decreases in depressive symptoms. LIMITATIONS Generalization of findings may be limited by the trial's methodology. CONCLUSION Further rigorous investigation of the role of patient CT skills stands to increase understanding of mediators of change or engaged targets in psychosocial intervention.
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19
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Terides MD, Dear BF, Fogliati VJ, Gandy M, Karin E, Jones MP, Titov N. Increased skills usage statistically mediates symptom reduction in self-guided internet-delivered cognitive–behavioural therapy for depression and anxiety: a randomised controlled trial. Cogn Behav Ther 2017; 47:43-61. [DOI: 10.1080/16506073.2017.1347195] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Matthew D. Terides
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Blake F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Vincent J. Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Milena Gandy
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Eyal Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Michael P. Jones
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
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20
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Levy HC, Worden BL, Gilliam CM, D'Urso C, Steketee G, Frost RO, Tolin DF. Changes in Saving Cognitions Mediate Hoarding Symptom Change in Cognitive-Behavioral Therapy for Hoarding Disorder. J Obsessive Compuls Relat Disord 2017; 14:112-118. [PMID: 29170732 PMCID: PMC5695719 DOI: 10.1016/j.jocrd.2017.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cognitive-behavioral therapy (CBT) is an empirically-supported treatment for hoarding disorder (HD). However, meta-analytic studies suggest that CBT is only modestly effective, and a significant number of individuals with HD remain symptomatic following treatment. To inform the development of more effective and targeted treatments, it will be important to clarify the mechanisms of treatment response in CBT for HD. To this end, the current study examined whether change in maladaptive saving beliefs mediated symptom change in CBT for HD. Sixty-two patients with primary HD completed measures of maladaptive saving cognitions and hoarding severity at pre-, mid-, and post-CBT. Results showed that change in saving cognitions mediated change in all three domains of HD symptoms (i.e., acquiring, difficulty discarding, and excessive clutter), suggesting that cognitive change may be a mechanism of treatment response in CBT. The findings indicate that cognitive change may have an impact on treatment outcomes, and are discussed in terms of cognitive-behavioral theory of HD and potential ways in which to enhance belief change in treatment.
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Affiliation(s)
- Hannah C Levy
- Anxiety Disorders Center, Institute of Living, Hartford Hospital 200 Retreat Avenue, Hartford, CT 06106 USA
| | - Blaise L Worden
- Anxiety Disorders Center, Institute of Living, Hartford Hospital 200 Retreat Avenue, Hartford, CT 06106 USA
| | - Christina M Gilliam
- Anxiety Disorders Center, Institute of Living, Hartford Hospital 200 Retreat Avenue, Hartford, CT 06106 USA
| | - Christine D'Urso
- Anxiety Disorders Center, Institute of Living, Hartford Hospital 200 Retreat Avenue, Hartford, CT 06106 USA
| | - Gail Steketee
- Boston University School of Social Work 264 Bay State Road, Boston, MA 02215 USA
| | - Randy O Frost
- Department of Psychology, Smith College 10 Elm Street, Northampton, MA 01063 USA
| | - David F Tolin
- Anxiety Disorders Center, Institute of Living, Hartford Hospital 200 Retreat Avenue, Hartford, CT 06106 USA
- Department of Psychiatry, Yale University School of Medicine 333 Cedar Street, New Haven, CT 06510 USA
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21
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Expectancies, working alliance, and outcome in transdiagnostic and single diagnosis treatment for anxiety disorders: An investigation of mediation. COGNITIVE THERAPY AND RESEARCH 2017; 42:135-145. [PMID: 29755154 DOI: 10.1007/s10608-017-9855-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Patients' outcome expectancies and the working alliance are two psychotherapy process variables that researchers have found to be associated with treatment outcome, irrespective of treatment approach and problem area. Despite this, little is known about the mechanisms accounting for this association, and whether contextual factors (e.g., psychotherapy type) impact the strength of these relationships. The primary aim of this study was to examine whether patient-rated working alliance quality mediates the relationship between outcome expectancies and pre- to post-treatment change in anxiety symptoms using data from a recent randomized clinical trial comparing a transdiagnostic treatment (the Unified Protocol [UP]; Barlow et al., 2011a; Barlow, Sauer-Zavala, et al., in press) to single diagnosis protocols (SDPs) for patients with a principal heterogeneous anxiety disorder (n = 179). The second aim was to explore whether cognitive-behavioral treatment condition (UP versus SDP) moderated this indirect relationship. Results from mediation and moderated mediation models indicated that, when collapsing across the two treatment conditions, the relationship between expectancies and outcome was partially mediated by the working alliance (B = .037, SE = .05, 95% CI [.005, .096]). Interestingly, within-condition analyses showed that this conditional indirect effect was only present for SDP patients, whereas in the UP condition, working alliance did not account for the association between expectancies and outcome. These findings suggest that outcome expectancies and working alliance quality may interact to influence treatment outcomes, and that the nature and strength of the relationships among these constructs may differ as a function of the specific cognitive-behavioral treatment approach utilized.
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22
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Oren-Yagoda R, Björgvinsson T, Aderka IM. The relationship between positive affect and negative affect during treatment for major depressive disorder. Psychother Res 2017; 28:958-968. [PMID: 28277040 DOI: 10.1080/10503307.2017.1292066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE The present study examined the relationship between positive affect (PA) and negative affect (NA) along the course of combined cognitive behavior therapy and pharmacological treatment for major depressive disorder (MDD). METHOD Participants were 165 individuals who sought treatment for MDD in a partial hospital setting. Participants' PA, NA, and depressive symptoms were measured at pre- and post-treatment and PA and NA were measured at up to 10 additional measurements along the course of treatment. RESULTS Results indicated that PA at pre-treatment predicted depressive symptoms at post-treatment above and beyond NA and the PA*NA interaction. However, an analysis of patterns of change during treatment using lower level mediational modeling in a multilevel framework indicated that NA predicted subsequent PA to a greater extent than vice versa. CONCLUSION Though many treatments for MDD predominantly focus on reducing NA, our findings suggest that PA may be an important predictor of outcome in treatment for MDD, and that the inclusion of interventions to increase the experience of PA may help improve the efficacy of treatment.
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Affiliation(s)
- Roni Oren-Yagoda
- a Department of Psychology, Faculty of Social Sciences , University of Haifa , Haifa , Israel
| | | | - Idan M Aderka
- a Department of Psychology, Faculty of Social Sciences , University of Haifa , Haifa , Israel
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Lemmens LHJM, Müller VNLS, Arntz A, Huibers MJH. Mechanisms of change in psychotherapy for depression: An empirical update and evaluation of research aimed at identifying psychological mediators. Clin Psychol Rev 2016; 50:95-107. [PMID: 27770716 DOI: 10.1016/j.cpr.2016.09.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/16/2016] [Accepted: 09/18/2016] [Indexed: 12/26/2022]
Abstract
We present a systematic empirical update and critical evaluation of the current status of research aimed at identifying a variety of psychological mediators in various forms of psychotherapy for depression. We summarize study characteristics and results of 35 relevant studies, and discuss the extent to which these studies meet several important requirements for mechanism research. Our review indicates that in spite of increased attention for the topic, advances in theoretical consensus about necessities for mechanism research, and sophistication of study designs, research in this field is still heterogeneous and unsatisfactory in methodological respect. Probably the biggest challenge in the field is demonstrating the causal relation between change in the mediator and change in depressive symptoms. The field would benefit from a further refinement of research methods to identify processes of therapeutic change. Recommendations for future research are discussed. However, even in the most optimal research designs, explaining psychotherapeutic change remains a challenge. Psychotherapy is a multi-dimensional phenomenon that might work through interplay of multiple mechanisms at several levels. As a result, it might be too complex to be explained in relatively simple causal models of psychological change.
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Affiliation(s)
- Lotte H J M Lemmens
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | - Viola N L S Müller
- Department of Psychology, University of Trier, Am Wissenschaftspark 25-27, 54286 Trier, Germany
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Psychology, University of Amsterdam, PO Box 19268, 1000 GG Amsterdam, The Netherlands
| | - Marcus J H Huibers
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraast 1, 1081 BT Amsterdam, The Netherlands
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Vîslă A, Constantino MJ, Newkirk K, Ogrodniczuk JS, Söchting I. The relation between outcome expectation, therapeutic alliance, and outcome among depressed patients in group cognitive-behavioral therapy. Psychother Res 2016; 28:446-456. [DOI: 10.1080/10503307.2016.1218089] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Andreea Vîslă
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Educational Sciences, Stefan cel Mare University of Suceava, Suceava, Romania
| | - Michael J. Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Katie Newkirk
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Ingrid Söchting
- Department of Psychology, University of British Columbia, Vancouver, Canada
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25
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Elchert DM, Gaasedelen OJ. Morality and Adult Attachment Style as Predictors of Psychotherapy Process and Outcome Expectations. COUNSELING AND VALUES 2016. [DOI: 10.1002/cvj.12027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Daniel M. Elchert
- Department of Psychological and Quantitative Foundations; University of Iowa
| | - Owen J. Gaasedelen
- Department of Psychological and Quantitative Foundations; University of Iowa
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26
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Webb CA, Beard C, Kertz SJ, Hsu KJ, Björgvinsson T. Differential role of CBT skills, DBT skills and psychological flexibility in predicting depressive versus anxiety symptom improvement. Behav Res Ther 2016; 81:12-20. [PMID: 27057997 DOI: 10.1016/j.brat.2016.03.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/24/2016] [Accepted: 03/27/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Studies have reported associations between cognitive behavioral therapy (CBT) skill use and symptom improvement in depressed outpatient samples. However, little is known regarding the temporal relationship between different subsets of therapeutic skills and symptom change among relatively severely depressed patients receiving treatment in psychiatric hospital settings. METHOD Adult patients with major depression (N = 173) receiving combined psychotherapeutic and pharmacological treatment at a psychiatric hospital completed repeated assessments of traditional CBT skills, DBT skills and psychological flexibility, as well as depressive and anxiety symptoms. RESULTS Results indicated that only use of behavioral activation (BA) strategies significantly predicted depressive symptom improvement in this sample; whereas DBT skills and psychological flexibility predicted anxiety symptom change. In addition, a baseline symptom severity X BA strategies interaction emerged indicating that those patients with higher pretreatment depression severity exhibited the strongest association between use of BA strategies and depressive symptom improvement. CONCLUSIONS Findings suggest the importance of emphasizing the acquisition and regular use of BA strategies with severely depressed patients in short-term psychiatric settings. In contrast, an emphasis on the development of DBT skills and the cultivation of psychological flexibility may prove beneficial for the amelioration of anxiety symptoms.
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Affiliation(s)
- Christian A Webb
- Department of Psychiatry, Harvard Medical School and Center for Depression, Anxiety and Stress Research, McLean Hospital.
| | - Courtney Beard
- Behavioral Health Partial Program, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA
| | - Sarah J Kertz
- Department of Psychology, Southern Illinois University, Carbondale, IL, USA
| | - Kean J Hsu
- Behavioral Health Partial Program, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA
| | - Thröstur Björgvinsson
- Behavioral Health Partial Program, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA
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Ito M, Okumura Y, Horikoshi M, Kato N, Oe Y, Miyamae M, Hirabayashi N, Kanie A, Nakagawa A, Ono Y. Japan Unified Protocol Clinical Trial for Depressive and Anxiety Disorders (JUNP study): study protocol for a randomized controlled trial. BMC Psychiatry 2016; 16:71. [PMID: 26987315 PMCID: PMC4797168 DOI: 10.1186/s12888-016-0779-8] [Citation(s) in RCA: 4] [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: 01/12/2016] [Accepted: 01/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The unified protocol for the transdiagnostic treatment of emotional disorders is a promising treatment approach that could be applicable to a broad range of mental disorders, including depressive, anxiety, trauma-related, and obsessive-compulsive disorders. However, no randomized controlled trial has been conducted to verify the efficacy of the unified protocol on the heterogeneous clinical population with depressive and anxiety disorders. METHODS/DESIGN The trial was designed as a single-center, assessor-blinded, randomized, 20-week, parallel-group superiority study in order to compare the efficacy of the combination of unified protocol and treatment-as-usual versus waiting-list with treatment-as-usual for patients with depressive and/or anxiety disorders. The primary outcome was depression at 21 weeks, assessed by the 17-item version of the GRID-Hamilton Rating Scale for Depression. Estimated minimum sample size was 27 participants in each group. We will also examine the treatment mechanisms, treatment processes, and neuropsychological correlates. DISCUSSION The results of this study will clarify the efficacy of the unified protocol for depressive and anxiety disorders, and the treatment mechanism, process, and neurological correlates for the effectiveness of the unified protocol. If its efficacy can be confirmed, the unified protocol may be of high clinical value for Japan, a country in which cognitive behavioral treatment has not yet been widely adopted. TRIAL REGISTRATION ClinicalTrials.gov NCT02003261 (registered on December 2, 2013).
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Affiliation(s)
- Masaya Ito
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo, 187-8511, Japan.
| | - Yasuyuki Okumura
- Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo, 187-8511, Japan
| | - Noriko Kato
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo, 187-8511, Japan
| | - Yuki Oe
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo, 187-8511, Japan
| | - Mitsuhiro Miyamae
- National Center for Cognitive Behavior Therapy and Research, National Center of Neurology and Psychiatry, Ogawa Higashi 4-1-1, Kodaira, Tokyo, 187-8511, Japan
| | | | - Ayako Kanie
- National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Atsuo Nakagawa
- Center for Clinical Research, Keio University School of Medicine, Tokyo, Japan
| | - Yutaka Ono
- Center for the Development of Cognitive Behavior Therapy Training, Tokyo, Japan
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Terides MD, Dear BF, Karin E, Jones MP, Gandy M, Fogliati VJ, Kayrouz R, Staples LG, Titov N. The frequency of actions and thoughts scale: development and psychometric validation of a measure of adaptive behaviours and cognitions. Cogn Behav Ther 2016; 45:196-216. [DOI: 10.1080/16506073.2016.1149876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Gaitan-Sierra C, Dempster M. Choosing to engage and choosing to persist: The role of non-specific factors in health-promoting activities. Br J Health Psychol 2016; 21:515-32. [DOI: 10.1111/bjhp.12183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 11/30/2015] [Indexed: 11/30/2022]
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Borderline Personality Traits Predict Poorer Functioning During Partial Hospitalization: The Mediating Role of Depressive Symptomatology. COGNITIVE THERAPY AND RESEARCH 2015. [DOI: 10.1007/s10608-015-9726-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Aderka IM, Beard C, Lee J, Weiss RB, Björgvinsson T. The relationship between depression and generalized anxiety during intensive psychological and pharmacological treatment. J Affect Disord 2015; 184:261-8. [PMID: 26118754 DOI: 10.1016/j.jad.2015.05.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 05/18/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the present study we examined the relationship between depressive symptoms and generalized anxiety symptoms during intensive cognitive-behavioral and pharmacological treatment. METHOD Individuals (n = 157) with major depressive disorder (MDD; n = 83), generalized anxiety disorder (GAD; n = 29) and their combination (n = 45) who attended an intensive partial hospital treatment program, completed daily self-report measures of depression and generalized anxiety. Treatment included empirically-based cognitive-behavioral interventions in both individual and group format, as well as pharmacotherapy. RESULTS Multilevel linear modeling indicated that for all diagnostic groups, changes in depressive symptoms led to changes in generalized anxiety symptoms to a greater extent than vice versa during treatment. Moreover, changes in depressive symptoms fully mediated changes in generalized anxiety symptoms, whereas changes in generalized anxiety symptoms only partially mediated the changes in depressive symptoms. LIMITATIONS Partial hospital setting. CONCLUSIONS Our results suggest that depressive symptoms may play a prominent role in the process of change in both MDD and GAD. This has implications for the classification of GAD as well as for choosing early treatment targets for individuals with comorbid MDD and GAD.
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Affiliation(s)
- Idan M Aderka
- McLean Hospital, Harvard Medical School, United States; Department of Psychology, University of Haifa, Mount Carmel, Haifa 31905, Israel.
| | | | - Josephine Lee
- McLean Hospital, Harvard Medical School, United States
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Riley BJ. The role of homework in exposure-based CBT outcome for problem gambling. INTERNATIONAL GAMBLING STUDIES 2015. [DOI: 10.1080/14459795.2015.1062532] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Patients' Outcome Expectations Matter in Psychological Interventions for Patients with Diabetes and Comorbid Depressive Symptoms. COGNITIVE THERAPY AND RESEARCH 2015; 39:307-317. [PMID: 25983355 PMCID: PMC4424270 DOI: 10.1007/s10608-014-9667-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examined whether patients’ expectations of treatment outcome predict treatment completion, homework compliance, and depressive symptom improvement in cognitive behavior therapy (CBT) and mindfulness-based cognitive therapy (MBCT). Study participants were patients with diabetes and comorbid depressive symptoms who were randomized to 8 sessions of either CBT (n = 45) or MBCT (n = 46), both individually delivered. The results showed that high outcome expectations were predictive of post-treatment depressive symptoms in CBT and MBCT, but not of early and mid-treatment symptoms. Patients’ outcome expectations predicted treatment completion in CBT and MBCT as well as homework compliance in MBCT. Homework compliance did not mediate the association between patients’ outcome expectations and post-treatment depressive symptom improvement. The findings do not support the hypothesis that patients’ expectations have an immediate impact on patients’ mental state and partially support the notion that patients are less involved in treatment when they hold low expectations for improvement.
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The therapeutic alliance in a naturalistic psychiatric setting: temporal relations with depressive symptom change. Behav Res Ther 2014; 61:70-7. [PMID: 25156322 DOI: 10.1016/j.brat.2014.07.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Numerous studies have reported associations between the therapeutic alliance and depressive symptom improvement in outpatient samples. However, little is known regarding the temporal relationship between the alliance and symptom change among relatively severely depressed patients receiving treatment in naturalistic, psychiatric hospital settings. METHOD Adult patients with major depression (n = 103) receiving combined cognitive behavioral therapy and pharmacological treatment at a psychiatric hospital completed repeated assessments of the therapeutic alliance and depressive symptoms, as well as a pretreatment assessment of their expectation of symptom improvement. RESULTS Results indicated that the alliance and treatment outcome expectancies significantly predicted subsequent depressive symptom change. However, in a model in which prior symptom change and treatment outcome expectancies were statistically controlled, the alliance-outcome association was rendered nonsignificant. The alliance was significantly associated with prior symptom improvement. CONCLUSIONS Findings highlight the importance of controlling for plausible third variable and temporal confounds to minimize biased estimates of alliance-outcome associations in future studies. Overall, results were more consistent with the alliance being a consequence, rather than a cause, of symptom change. Finally, findings contribute to a growing body of evidence supporting the role of treatment outcome expectancies in predicting symptom improvement, even within our relatively severely depressed sample.
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