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Porreca A, De Carli P, Filippi B, Bakermans-Kranenburg MJ, van IJzendoorn MH, Simonelli A. Maternal cognitive functioning and psychopathology predict quality of parent-child relationship in the context of substance use disorder: A 15-month longitudinal study. Dev Psychopathol 2024:1-12. [PMID: 38282537 DOI: 10.1017/s0954579424000026] [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: 01/30/2024]
Abstract
This longitudinal study aimed to investigate the role of maternal cognitive functioning and psychopathology in parent-child relationship quality during residential treatment for mothers with Substance Use Disorder (SUD), in order to identify factors that may enhance or limit intervention effects.We assessed cognitive functioning (Esame Neuropsicologico Breve-2 [ENB-2]) and psychopathology (Symptom Checklist-90 Revised [SCL-90-R]) in 60 mothers diagnosed with SUD (Mage = 30.13 yrs; SD = 6.79) at treatment admission. Parent-child relationship quality was measured during free-play interactions using the Emotional Availability Scales every three months from admission (Child Mage = 17.17m; SD = 23.60) to the 15th month of the residential treatment.A main effect of maternal psychopathology and an interaction effect of time and cognitive functioning were found. More maternal psychopathology predicted lower mother-child relationship quality. Mothers with higher cognitive functioning presented a better treatment trajectory, with an increase in mother-child relationship quality, whereas mothers with lower cognitive functioning showed a decrease in relationship quality after initial improvement.These findings suggest that maternal psychopathology and cognitive functioning may influence the treatment of parent-child relationships in the context of SUD, although causality is not yet established. Implications for assessment and intervention are discussed.
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Affiliation(s)
- Alessio Porreca
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, PD, Italy
| | - Pietro De Carli
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, PD, Italy
- Department of Psychology, University of Milano-Bicocca, Milan, MI, Italy
| | - Bianca Filippi
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, PD, Italy
| | | | - Marinus H van IJzendoorn
- Research Department of Clinical, Education and Health Psychology, Faculty of Brain Sciences, UCL, London, UK
| | - Alessandra Simonelli
- Department of Developmental and Social Psychology, University of Padua, Via Venezia, PD, Italy
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2
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Shayani DR, Canale CA, Sloan DM, Hayes AM. Predictors of dropout in cognitive processing therapy for PTSD: An examination of in-session treatment processes. Behav Res Ther 2023; 171:104428. [PMID: 37952284 PMCID: PMC10826797 DOI: 10.1016/j.brat.2023.104428] [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: 06/16/2023] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
Dropout rates for treatments for adult posttraumatic stress disorder (PTSD) are high. Process research can reveal client factors during treatment that predict dropout. An observational coding system was used to code client processes in audio-recorded early sessions of cognitive processing therapy (CPT), a gold-standard treatment for PTSD. Data are from a randomized controlled noninferiority trial of CPT and written exposure therapy (WET), with higher rates of dropout in CPT than WET (39.7% vs. 6.4%). Participants in this study were 53 treatment-seeking adults with PTSD who were in the CPT arm of the trial and completed the CAPS-5 at pretreatment and at least one session. Of these, 15 (28.3%) dropped out of CPT early (completing ≤9 sessions) and 38 (71.7%) completed treatment. Sessions were coded with an observational coding system on a four-point scale (0 = absent to 3 = high) for maladaptive trauma-related responses (overgeneralized beliefs, ruminative processing, avoidance), affective engagement (negative emotions, physiological distress), and adaptive processing (cognitive emotional processing). Binary logistic regressions showed that more physiological distress and cognitive emotional processing predicted lower dropout, whereas more avoidance predicted higher dropout. Negative emotion, ruminative processing, and overgeneralization were not significant predictors. These findings highlight potential early indicators of treatment engagement that could be targeted to reduce dropout and perhaps facilitate further therapeutic change.
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Affiliation(s)
- Danielle R Shayani
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA.
| | - Caroline A Canale
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Denise M Sloan
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA; Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Adele M Hayes
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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3
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Everett RA, Lewis AL, Kuerbis A, Peace A, Li J, Morgenstern J. Data driven mixed effects modeling of the dual process framework of addiction among individuals with alcohol use disorder. PLoS One 2023; 18:e0265168. [PMID: 37549160 PMCID: PMC10406226 DOI: 10.1371/journal.pone.0265168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 02/27/2022] [Indexed: 08/09/2023] Open
Abstract
Alcohol use disorder (AUD) comprises a continuum of symptoms and associated problems that has led AUD to be a leading cause of morbidity and mortality across the globe. Given the heterogeneity of AUD from mild to severe, consideration is being given to providing a spectrum of interventions that offer goal choice to match this heterogeneity, including helping individuals with AUD to moderate or control their drinking at low-risk levels. Because so much remains unknown about the factors that contribute to successful moderated drinking, we use dynamical systems modeling to identify mechanisms of behavior change. Daily alcohol consumption and daily desire (i.e., craving) are modeled using a system of delayed difference equations. Employing a mixed effects implementation of this system allows us to garner information about these mechanisms at both the population and individual levels. Use of this mixed effects framework first requires a parameter set reduction via identifiability analysis. The model calibration is then performed using Bayesian parameter estimation techniques. Finally, we demonstrate how conducting a parameter sensitivity analysis can assist in identifying optimal targets of intervention at the patient-specific level. This proof-of-concept analysis provides a foundation for future modeling to describe mechanisms of behavior change and determine potential treatment strategies in patients with AUD.
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Affiliation(s)
- Rebecca A. Everett
- Department of Mathematics and Statistics, Haverford College, Haverford, PA, United States of America
| | - Allison L. Lewis
- Department of Mathematics, Lafayette College, Easton, PA, United States of America
| | - Alexis Kuerbis
- Silberman School of Social Work, Hunter College, CUNY, New York, NY, United States of America
| | - Angela Peace
- Department of Mathematics and Statistics, Texas Tech University, Lubbock, TX, United States of America
| | - Jing Li
- Department of Mathematics, California State University, Northridge, CA, United States of America
| | - Jon Morgenstern
- Center for Addiction Services and Psychotherapy Research, Northwell Health, Great Neck, NY, United States of America
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4
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Alpert E, Hayes AM, Foa EB. Examining emotional processing theory and predictors of outcome in prolonged exposure for PTSD. Behav Res Ther 2023; 167:104341. [PMID: 37307658 DOI: 10.1016/j.brat.2023.104341] [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: 03/27/2022] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
Prolonged exposure (PE) is an empirically supported treatment for posttraumatic stress disorder (PTSD). The current study examined multiple facilitators and indicators of emotional processing to identify key predictors of outcome in PE using observational coding methods. Participants were 42 adults with PTSD who received PE. Video recordings of sessions were coded to capture negative emotion activation, negative and positive trauma-related cognitions, and cognitive rigidity. Two variables emerged as predictors of PTSD symptom improvement assessed via self-report, but not clinical interview: a greater decrease in negative trauma-related cognitions and lower average cognitive rigidity. Peak emotion activation, reductions in negative emotions, and increases in positive cognitions did not predict PTSD improvement (self-report or clinical interview). Findings contribute to growing evidence highlighting the importance of cognitive change as part of emotional processing and as a key ingredient of PE, beyond activation and reduction in negative emotions. Implications for evaluating emotional processing theory and for clinical practice are discussed.
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Affiliation(s)
- Elizabeth Alpert
- Department of Psychological and Brain Sciences, University of Delaware, United States.
| | - Adele M Hayes
- Department of Psychological and Brain Sciences, University of Delaware, United States.
| | - Edna B Foa
- Department of Psychiatry, University of Pennsylvania, United States
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Persons JB, Marker CD, Bailey EN. Changes in affective and cognitive distortion symptoms of depression are reciprocally related during cognitive behavior therapy. Behav Res Ther 2023; 166:104338. [PMID: 37270956 DOI: 10.1016/j.brat.2023.104338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 05/11/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
We tested the predictions from Beck's cognitive theory that change in cognitive distortions precedes and predicts change in affective symptoms of depression, and his secondary prediction that change in affective symptoms precedes and predicts change in cognitive distortions during the course of cognitive behavior therapy (CBT; Beck, 1963). We used bivariate latent difference score modeling to examine change in affective and cognitive distortion symptoms of depression over time in a sample of 1402 outpatients who received naturalistic CBT in a private practice setting. Patients completed the Beck Depression Inventory (BDI) at each therapy session to monitor their progress in treatment. We selected items from the BDI to create measures of affective and cognitive distortion symptoms that allowed us to assess change in those phenomena over the course of treatment. We examined BDI data from up to 12 sessions of treatment for each patient. As predicted by Beck's theory, we found that change in cognitive distortion symptoms preceded and predicted change in affective symptoms of depression, and that change in affective symptoms preceded and predicted change in cognitive distortion symptoms. Both effects were small in size. These findings support the notion that change in affective and cognitive distortion symptoms of depression each precedes and predicts the other - that is, they are reciprocal in nature during cognitive behavior therapy. We discuss implications of our findings for the nature of the change process in CBT.
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Affiliation(s)
- Jacqueline B Persons
- Oakland Cognitive Behavior Therapy Center, USA; University of California, Berkeley, USA.
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6
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Brockmeyer T, Titzmann M, Zipfel S, Wild B, Resmark G, Teufel M, Giel K, de Zwaan M, Dinkel A, Herpertz S, Burgmer M, Löwe B, Tagay S, Rothermund E, Zeeck A, Herzog W, Friederich HC. The role of general change mechanisms in sudden gains in the treatment of anorexia nervosa. Behav Res Ther 2023; 163:104285. [PMID: 36913844 DOI: 10.1016/j.brat.2023.104285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
Previous research has shown a robust association between sudden gains (SGs) and treatment outcome in psychotherapy for various mental disorders including anorexia nervosa (AN). However, little is known about factors contributing to SGs. This study investigated the role of general change mechanisms in body-weight related SGs in AN. Data were drawn from a randomized-controlled trial on cognitive-behavioral therapy (CBT) and focal psychodynamic therapy (FPT) for adult outpatients with AN. Session-level data on the general change mechanisms 'clarification' (insight), 'mastery' (coping), and 'therapeutic relationship' were analyzed. Pre-gain sessions were compared with control (pre-pre-gain) sessions in 99 patients with a SG in body weight. Additionally, propensity score matching was used to compare data from pre-gain sessions from 44 patients with SG and data from the corresponding session from 44 patients without SG. In the pre-gain session, patients experienced higher levels of clarification and mastery but not therapeutic relationship. Compared to patients without a SG, patients with a SG likewise experienced more clarification and mastery but not a better therapeutic relationship in the pre-gain/corresponding session. CBT and FPT did not differ regarding these effects. The findings suggest that general change mechanisms contribute to SGs in CBT and FPT for AN.
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Affiliation(s)
- Timo Brockmeyer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany; Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.
| | - Marieke Titzmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Beate Wild
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR University Hospital, Essen, Germany
| | - Katrin Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stephan Herpertz
- Department for Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-University of Bochum, Bochum, Germany
| | - Markus Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-Hospital and University Hospital Muenster, Muenster, Germany
| | - Bernd Löwe
- Institute and Outpatients Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Tagay
- Faculty of Social Sciences, TH Köln-University of Applied Sciences, Köln, Germany
| | - Eva Rothermund
- Ulm University Medical Center, Department of Psychosomatic Medicine and Psychotherapy, Ulm, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Herzog
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
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7
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Crits-Christoph P, Gallop R, Duong L, Zoupou E, Gibbons MBC. Repeated assessments of depressive symptoms in randomized psychosocial intervention trials: best practice for analyzing symptom change over time. Psychother Res 2023; 33:158-172. [PMID: 35544540 PMCID: PMC9649835 DOI: 10.1080/10503307.2022.2073289] [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: 02/03/2022] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Psychotherapy randomized trials rarely have tested for the best fitting model for time effects. We examined the fit of different statistical models for examining time when repeated assessments of depressive symptoms are the primary outcome. METHOD We used data from three studies comparing psychotherapy treatments for major depressive disorder. Outcome measures were self-report ratings for Study 1 (N = 237) and Study 2 (N = 100) and clinician ratings for Study 3 (N = 120) of depressive symptoms measured at every session (Studies 1 and 2) or monthly (Study 3). We examined the fit of the following time patterns: linear, quadratic, cubic, log transformation of time, piece-wise linear, and unstructured. RESULTS In Study 1, a log-linear model had the best fit (Δ Akaike information criterion [AICc] = 7.5). In Study 2, all models had essentially no support (Δ AICcs > 10) in comparison to the best fitting model, which was the unstructured model. In Study 3, the cubic model had the best fit, but it was not significantly better than a log-linear (Δ AICc = 3.5) or unstructured model (Δ AICc = 2.5). CONCLUSIONS Trials should routinely compare different time models, including an unstructured model, when repeated measures of depressive symptoms are the primary outcome.
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Affiliation(s)
| | | | - Lang Duong
- Department of Psychiatry, University of Pennsylvania
| | - Eirini Zoupou
- Department of Psychiatry, University of Pennsylvania
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8
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Gori A, Topino E, Svicher A, Schuldberg D, Di Fabio A. Insight orientation scale: A promising tool for organizational outcomes-A psychometric analysis using item response theory. Front Psychol 2022; 13:987931. [PMID: 36118493 PMCID: PMC9479453 DOI: 10.3389/fpsyg.2022.987931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 12/04/2022] Open
Abstract
Insight is a construct carried out into different theoretical orientations with increasing application out of the boundaries of clinical psychology. Recent studies have investigated insight also as a promising variable for organizational outcomes. Given the relevance of Insight in promoting change, this paper aimed at describing the psychometric analysis of one of the shortest, most agile, and most versatile tool for measuring some of the characteristics of insight, the Insight Orientation Scale (IOS), using Item Response Theory. To achieve this goal, we applied a Mixed Rash Model to the IOS. Data from 1,445 individuals were analyzed by the means of WIN-MIRA and Multilog. Based on the likelihood statistics (CAIC) we assumed a three-class solution for the IOS. Results also indicated that the greater part of items had good discrimination and threshold parameters. These findings confirmed psychometric stability of the IOS highlighting its measurement precision, supporting its utility in both research and practice.
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Affiliation(s)
- Alessio Gori
- Department of Health Sciences, University of Florence, Firenze, Italy
| | - Eleonora Topino
- Department of Human Sciences, LUMSA University of Rome, Rome, Italy
| | - Andrea Svicher
- Department of Education, Languages, Intercultures, Literatures and Psychology (Psychology Section), University of Florence, Firenze, Italy
| | - David Schuldberg
- Department of Psychology, The University of Montana, Missoula, MT, United States
| | - Annamaria Di Fabio
- Department of Education, Languages, Intercultures, Literatures and Psychology (Psychology Section), University of Florence, Firenze, Italy
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9
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Sudden Gains in Two Trauma-Focused Treatments for Posttraumatic Stress Disorder. Behav Ther 2022; 53:255-266. [PMID: 35227402 PMCID: PMC8896295 DOI: 10.1016/j.beth.2021.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022]
Abstract
In the current study, we examined the degree to which sudden gains (large, rapid, and stable symptom reduction in a one-session interval) predicted treatment outcome in adults randomized to two different trauma-focused treatments. Adults diagnosed with PTSD were randomized to either written exposure therapy (WET; n = 63), a brief, exposure-based treatment for posttraumatic stress disorder (PTSD), or the more time-intensive Cognitive Processing Therapy (CPT; n = 63). Findings showed that 20.6% of participants who received WET and 17.5% of participants who received CPT experienced sudden gains. Sudden gains occurred earlier in WET (M session = 2.69, SD = 0.75) than in CPT (M session = 5.64, SD = 3.01). However, there were no treatment condition differences in the magnitude of the sudden gains. Treatment outcomes were significantly better for those who experienced sudden gains compared with those who did not, regardless of treatment assignment. Exploratory analyses of participants' trauma narratives revealed that expressing more negative emotion predicted the occurrence of sudden gains in both treatment conditions. Negative beliefs about the self and others did not predict sudden gains. The findings are discussed in terms of how they may help identify individual early response patterns that predict outcomes in trauma-focused treatments.
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10
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Trajectories of Symptom Change in School-Based Prevention Programs for Adolescent Girls with Subclinical Depression. J Youth Adolesc 2022; 51:659-672. [PMID: 35113294 PMCID: PMC8924105 DOI: 10.1007/s10964-022-01578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/19/2022] [Indexed: 11/21/2022]
Abstract
Effectiveness research on depression prevention usually compares pre- to post-intervention outcomes across groups, but this aggregation across individuals may mask heterogeneity in symptom change trajectories. Hence, this study aimed to identify subgroups of adolescents with unique trajectories of change in a school-based depression prevention trial. It was also examined how trajectory membership was associated with the intervention conditions, depressive symptoms at 12-month follow-up, and baseline predictors. Hundred-ninety adolescent girls (Mage = 13.34; range = 11–16 years) with subclinical depression at screening (M = 57 days before pre-test) were allocated to four conditions: a face-to-face, group-based program (OVK), a computerized, individual program (SPARX), OVK and SPARX combined, and a monitoring control condition. Growth Mixture Modeling was used to identify the distinct trajectories during the intervention period using weekly depressive symptom assessments from pre-test to post-test. Analyses revealed three trajectories of change in the full sample: Moderate-Declining (62.1% of the sample), High-Persistent (31.1%), and Deteriorating-Declining (6.8%) trajectories. Trajectories were unrelated to the intervention conditions and the High-Persistent trajectory had worse outcomes at follow-up. Several baseline factors (depression severity, age, acceptance, rumination, catastrophizing, and self-efficacy) enabled discrimination between trajectories. It is concluded that information about likely trajectory membership may enable (school) clinicians to predict an individual’s intervention response and timely adjust and tailor intervention strategies as needed.
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11
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Insight and Outcome in Long-Term Psychotherapies of Depression. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2021; 68:54-73. [PMID: 34309499 DOI: 10.13109/zptm.2021.67.oa10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: In different therapeutic approaches, insight is acknowledged as an important part of patient's therapeutic change process. We examined whether the level of insight (1) differs between psychoanalytic (PA), psychodynamic (PD) and cognitive-behavioral therapy (CBT), and (2) predicts long-term symptomatic outcome. Methods: A completer sample of 67 depressed patients from the Munich Psychotherapy Study was analyzed. Symptoms were assessed with Beck Depression Inventory (BDI) and Symptom Checklist-Revised (SCL-90-R) at pre-treatment and three-year follow-up. Insight was assessed from 242 sessions of mid-therapy phase with the Experiencing Scale. Results: The general level of insight was higher in PA as compared to CBT, and associated with lower depressive symptoms (BDI) across all three therapeutic modalities at three-year follow-up. Insight was unrelated to general distress (SCL-90-R). Exploratory analyses suggested that patients treated with PA showed higher levels of insight especially in high quality sessions (assessed by therapist). Patients for whom the extent of insight was positively linked to session quality, suffered from more depressive symptoms at three-year follow-up than patients gaining insight when session quality was low. Conclusion: Insight differs between PA and CBT and may be a common change mechanism in long-term psychotherapies.
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12
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Dominguez SK, Matthijssen SJMA, Lee CW. Trauma-focused treatments for depression. A systematic review and meta-analysis. PLoS One 2021; 16:e0254778. [PMID: 34292978 PMCID: PMC8297785 DOI: 10.1371/journal.pone.0254778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 07/04/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Trauma-focused treatments (TFTs) have demonstrated efficacy at decreasing depressive symptoms in individuals with PTSD. This systematic review and meta-analysis evaluated the effectiveness of TFTs for individuals with depression as their primary concern. METHODS A systematic search was conducted for RCTs published before October 2019 in Cochrane CENTRAL, Pubmed, EMBASE, PsycInfo, and additional sources. Trials examining the impact of TFTs on participants with depression were included. Trials focusing on individuals with PTSD or another mental health condition were excluded. The primary outcome was the effect size for depression diagnosis or depressive symptoms. Heterogeneity, study quality, and publication bias were also explored. RESULTS Eleven RCTs were included (n = 567) with ten of these using EMDR as the TFT and one using imagery rescripting. Analysis suggested these TFTs were effective in reducing depressive symptoms post-treatment with a large effect size [d = 1.17 (95% CI: 0.58~ 1.75)]. Removal of an outlier saw the effect size remain large [d = 0.83 (95% CI: 0.48~ 1.17)], while the heterogeneity decreased (I2 = 66%). Analysis of the 10 studies that used EMDR also showed a large effect [d = 1.30 (95% CI: 0.67~1.91)]. EMDR was superior to non trauma-focused CBT [d = 0.66 (95% CI: 0.31~1.02)] and analysis of EMDR and imagery rescripting studies suggest superiority over inactive control conditions [d = 1.19 (95% CI: 0.53~ 1.86)]. Analysis of follow-up data also supported the use of EMDR with this population [d = 0.71 (95% CI: 1.04~0.38)]. No publication bias was identified. CONCLUSIONS Current evidence suggests that EMDR can be an effective treatment for depression. There were insufficient RCTs on other trauma-focused interventions to conclude whether TFTs in general were effective for treating depression. Larger studies with robust methodology using EMDR and other trauma-focused interventions are needed to build on these findings.
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Affiliation(s)
- Sarah K. Dominguez
- School of Psychology and Exercise Science, Murdoch University, Murdoch, WA, Australia
| | - Suzy J. M. A. Matthijssen
- Altrecht Academic Anxiety Centre, Utrecht, The Netherlands
- Faculty of Social Sciences, Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Christopher William Lee
- School of Psychology and Exercise Science, Murdoch University, Murdoch, WA, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, WA, Australia
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13
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Scott WD, Paup S, Kirchhoff C. Clinical Application of Social Cognitive Theory: A Novel Personality Assessment Procedure and a Case Study of Personality Coherence. EUROPEAN JOURNAL OF PERSONALITY 2021. [DOI: 10.1177/08902070211028362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We present a novel personality assessment method that applies social cognitive personality theory, and more specifically, the Knowledge and Appraisal Personality Architecture model (KAPA; Cervone, 2004 ; 2021 ; see Scott & Cervone, 2016 ). Our assessment method generates descriptions of how personality structures, including temperament, beliefs, goals, and evaluative standards, are activated in “functionally equivalent” situations to generate if–then personality signatures ( Mischel, 2004 ). These descriptions represent models of personality coherence, which we characterize as strong attractor states. We define personality incoherence as nonexistent or perturbed attractor states, in which the situational “if” does not consistently produce a coherent “then” pattern of thinking, feeling, and behaving. We provide a step-by-step description of our personality assessment method, and include lists of measures that can be used to assess temperament, beliefs, goals, and standards. To illustrate our personality assessment method, we present a case study of a man in his forties who met criteria for persistent depressive disorder, with intermittent major depressive episodes, with current episode and generalized anxiety disorder. For this client, we describe two “attractor states,” one maladaptive and one adaptive, each providing an example of personality coherence. We conclude by discussing potential future directions and limitations of our personality assessment method.
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Affiliation(s)
| | - Stephen Paup
- Washington State University, Washington, United States
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14
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Lam CY, Chiu CP, Lui KY. Hope as a Mediator of Spirituality and Subjective Happiness among Chinese Christians in Hong Kong Before and During the Civil Unrest: Implications for Counselling Practices. ASIA PACIFIC JOURNAL OF COUNSELLING AND PSYCHOTHERAPY 2021. [DOI: 10.1080/21507686.2021.1876115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Chi-Yeung Lam
- Divinity School of Chung Chi College, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Connie P.Y. Chiu
- Department of Marketing, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Karen Y.M. Lui
- Mong Man Wai College, The Church of Christ in China, Kowloon, Hong Kong
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15
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Du Y, Yang Y, Wang X, Xie C, Liu C, Hu W, Li Y. A Positive Role of Negative Mood on Creativity: The Opportunity in the Crisis of the COVID-19 Epidemic. Front Psychol 2021; 11:600837. [PMID: 33551914 PMCID: PMC7854895 DOI: 10.3389/fpsyg.2020.600837] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 12/11/2020] [Indexed: 12/21/2022] Open
Abstract
The COVID-19 epidemic is associated with negative mood, which has the potential to be a powerful driver of creativity. However, the influence of negative mood on cognitive creativity and emotional creativity remains elusive. Previous research has indicated that self-focused attention is likely to be related to both negative mood and creativity. The current study introduced two self-focused attention variables (i.e., rumination, reflection) to explore how negative mood might contribute to cognitive creativity and emotional creativity. Based on a sample of 351 participants, our study found that (1) negative mood during the outbreak of COVID-19 was associated with cognitive creativity and emotional creativity. Meanwhile, there were significant serial mediation effects of rumination and reflection in the relationship between negative mood and creativity and (2) the psychological impact after exposure to the COVID-19 epidemic was positively correlated with emotional creativity but not with cognitive creativity. These results suggested that individuals, in real life and work, could achieve better creative performance through moderate self-focus. Moreover, individuals with different mood states can be induced to enhance their creativity in times of crisis through intervention training to promote reflection.
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Affiliation(s)
- Ying Du
- Ministry of Education Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi’an, China
| | - Yilong Yang
- Research Center for Linguistics and Applied Linguistics, Xi’an International Studies University, Xi’an, China
- School of English Studies, Xi’an International Studies University, Xi’an, China
| | - Xuewei Wang
- Ministry of Education Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi’an, China
| | - Cong Xie
- Ministry of Education Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi’an, China
| | - Chunyu Liu
- Ministry of Education Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi’an, China
| | - Weiping Hu
- Ministry of Education Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi’an, China
- Shaanxi Normal University Branch, Collaborative Innovation Center of Assessment Toward Basic Education Quality at Beijing Normal University, Xi’an, China
| | - Yadan Li
- Ministry of Education Key Laboratory of Modern Teaching Technology, Shaanxi Normal University, Xi’an, China
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16
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Schiepek G, Schöller H, de Felice G, Steffensen SV, Bloch MS, Fartacek C, Aichhorn W, Viol K. Convergent Validation of Methods for the Identification of Psychotherapeutic Phase Transitions in Time Series of Empirical and Model Systems. Front Psychol 2020; 11:1970. [PMID: 32982834 PMCID: PMC7479190 DOI: 10.3389/fpsyg.2020.01970] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/16/2020] [Indexed: 12/20/2022] Open
Abstract
Aim In many cases, the dynamics of psychotherapeutic change processes is characterized by sudden and critical transitions. In theoretical terms, these transitions may be “phase transitions” of self-organizing nonlinear systems. Meanwhile, a variety of methods is available to identify phase transitions even in short time series. However, it is still an open question if different methods for timeseries analysis reveal convergent results indicating the moments of critical transitions and related precursors. Methods and Procedures Seven concepts which are commonly used in nonlinear time series analysis were investigated in terms of their ability to identify changes in psychological time series: Recurrence Plots, Change Point Analysis, Dynamic Complexity, Permutation Entropy, Time Frequency Distributions, Instantaneous Frequency, and Synchronization Pattern Analysis, i.e., the dynamic inter-correlation of the system’s variables. Phase transitions were simulated by shifting control parameters in the Hénon map dynamics, in a simulation model of psychotherapy processes (one by an external shift of the control parameter and one created by a simulated control parameter shift), and three sets of empirical time series generated by daily self-ratings of patients during the treatment. Results The applied methods showed converging results indicating the moments of dynamic transitions within an acceptable tolerance. The convergence of change points was confirmed statistically by a comparison to random surrogates. In the three simulated dynamics with known phase transitions, these could be identified, and in the empirical cases, the methods converged indicating one and the same transition (possibly the phase transitions of the cases). Moreover, changes that did not manifest in a shift of mean or variance could be detected. Conclusion Changes can occur in many different ways in the psychotherapeutic process. For instance, there can be very slow and small transitions or very high and sudden ones. The results show the validity and stability of different measures indicating pattern transitions and/or early warning signals of those transitions. This has profound implications for real-time monitoring in psychotherapy, especially in cases where a transition is not obvious to the eye. Reliably identifying points of change is mandatory also for research on precursors, which in turn can help improving treatment.
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Affiliation(s)
- Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, University Hospital of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria.,Department of Psychology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Helmut Schöller
- Institute of Synergetics and Psychotherapy Research, University Hospital of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Giulio de Felice
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy.,Faculty of Psychology, NCIUL University, London, United Kingdom
| | - Sune Vork Steffensen
- Centre for Human Interactivity, Department of Language and Communication, University of Southern Denmark, Odense, Denmark.,Center for Ecolinguistics, South China Agricultural University, Guangzhou, China
| | - Marie Skaalum Bloch
- Outpatient Clinic of Anxiety Disorders and Personality Disorders, Brønderslev Psychiatric Hospital, Brønderslev, Denmark
| | - Clemens Fartacek
- Institute of Synergetics and Psychotherapy Research, University Hospital of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Wolfgang Aichhorn
- Institute of Synergetics and Psychotherapy Research, University Hospital of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Kathrin Viol
- Institute of Synergetics and Psychotherapy Research, University Hospital of Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
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17
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Abstract
BACKGROUND A growing body of research highlights the limitations of traditional methods for studying the process of change in psychotherapy. The science of complex systems offers a useful paradigm for studying patterns of psychopathology and the development of more functional patterns in psychotherapy. Some basic principles of change are presented from subdisciplines of complexity science that are particularly relevant to psychotherapy: dynamical systems theory, synergetics, and network theory. Two early warning signs of system transition that have been identified across sciences (critical fluctuations and critical slowing) are also described. The network destabilization and transition (NDT) model of therapeutic change is presented as a conceptual framework to import these principles to psychotherapy research and to suggest future research directions. DISCUSSION A complex systems approach has a number of implications for psychotherapy research. We describe important design considerations, targets for research, and analytic tools that can be used to conduct this type of research. CONCLUSIONS A complex systems approach to psychotherapy research is both viable and necessary to more fully capture the dynamics of human change processes. Research to date suggests that the process of change in psychotherapy can be nonlinear and that periods of increased variability and critical slowing might be early warning signals of transition in psychotherapy, as they are in other systems in nature. Psychotherapy research has been limited by small samples and infrequent assessment, but ambulatory and electronic methods now allow researchers to more fully realize the potential of concepts and methods from complexity science.
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Affiliation(s)
- Adele M Hayes
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA.
| | - Leigh A Andrews
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA
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18
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Carey TA, Griffiths R, Dixon JE, Hines S. Identifying Functional Mechanisms in Psychotherapy: A Scoping Systematic Review. Front Psychiatry 2020; 11:291. [PMID: 32362848 PMCID: PMC7180170 DOI: 10.3389/fpsyt.2020.00291] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/24/2020] [Indexed: 11/13/2022] Open
Abstract
The identification of fundamental mechanisms is an important scientific pursuit in many fields of enquiry. With regard to the development of psychological treatments, understanding the mechanisms through which change occurs such that psychological distress resolves, can enable us to develop more effective and efficient interventions. In the field of psychotherapy, mechanisms are often identified either statistically or conceptually. The most powerful and useful mechanisms, however, are functional rather than statistical or conceptual. More specifically, with regard to mechanisms relevant to psychotherapy, it is difficult to identify what any of these mechanisms actually do in a mechanistic sense. That is, the mechanics of putative mechanisms are generally unspecified. In order to obtain a rigorous and comprehensive account of the current mechanisms in psychotherapy, as well as to evaluate their usefulness, a systematic scoping review was conducted. The systematic scoping review did not yield any mechanisms that were expressed in functional terms. We argue that, in order for psychotherapy to improve its effectiveness and efficiency, the standard for what is accepted as a useful mechanism needs to be substantially raised. Only functional mechanisms that express plausible actions consistent with known biological processes should be used to inform therapeutic interventions.
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Affiliation(s)
- Timothy A. Carey
- Institute of Global Health Equity Research, University of Global Health Equity, Kigali, Rwanda
| | - Robert Griffiths
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - James E. Dixon
- North West Boroughs Healthcare NHS Foundation Trust, Warrington, United Kingdom
| | - Sonia Hines
- Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
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19
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Schiepek G, Gelo O, Viol K, Kratzer L, Orsucci F, Felice G, Stöger‐Schmidinger B, Sammet I, Aichhorn W, Schöller H. Complex individual pathways or standard tracks? A data‐based discussion on the trajectories of change in psychotherapy. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12300] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical Private University Salzburg Austria
- University Hospital of Psychiatry, Psychotherapy Salzburg Austria
- Ludwig-Maximilian University Munich Munich Germany
| | - Omar Gelo
- Università del Salento, Dipartimento di Storia, Società e Studi sull'uomo Lecce Italy
- Faculty of Psychotherapy Science Sigmund Freud University Vienna Austria
| | - Kathrin Viol
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical Private University Salzburg Austria
- University Hospital of Psychiatry, Psychotherapy Salzburg Austria
| | - Leonhard Kratzer
- Clinic St. Irmingard, Department of Psychotraumatology, Prien am Chiemsee Prien am Chiemsee Germany
| | - Franco Orsucci
- University College London London UK
- Mind Force Institute Siena Italy
| | - Giulio Felice
- Sapienza University of Rome Rome Italy
- NCIUL University London UK
| | | | - Isa Sammet
- Christophsbad Medical Center Göppingen Germany
| | - Wolfgang Aichhorn
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical Private University Salzburg Austria
- University Hospital of Psychiatry, Psychotherapy Salzburg Austria
| | - Helmut Schöller
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical Private University Salzburg Austria
- University Hospital of Psychiatry, Psychotherapy Salzburg Austria
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20
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Beyond linear mediation: Toward a dynamic network approach to study treatment processes. Clin Psychol Rev 2020; 76:101824. [PMID: 32035297 DOI: 10.1016/j.cpr.2020.101824] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 01/06/2023]
Abstract
Few clinical scientists would disagree that more research is needed on the underlying mechanisms and processes of change in psychological therapies. In the dominant current approach, processes of change are studied through mediation. The study of mediation has been largely structured around a distinction between moderation and mediation first popularized by Baron and Kenny's (1986) seminal article, which is based on a nomothetic and cross-sectional framework. In this article, we argue that this approach is unable to adequately address change processes in psychological therapies, because it falsely assumes that treatment change is a linear, unidirectional, pauci-variate process and that the statistical assumptions are met to study processes of change in an individual using a nomothetic approach. In contrast, we propose that treatment is a dynamic process involving numerous variables that may form bi-directional and complex relationships that differ between individuals. Such relationships can best be studied using an individual dynamic network approach connected to nomothetic generalization methods that are based on a firm idiographic foundation. We argue that our proposal is available, viable, and can readily be integrated into existing research strategies. We further argue that adopting an individual dynamic network approach combined with experimental analyses will accelerate the study of treatment change processes, which is necessary as the field of evidence-based care moves toward a process-based model. We encourage future research to gather empirical evidence to examine this approach.
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21
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Gallagher MW, Long LJ, Richardson A, D’Souza J, Boswell JF, Farchione TJ, Barlow DH. Examining Hope as a Transdiagnostic Mechanism of Change Across Anxiety Disorders and CBT Treatment Protocols. Behav Ther 2020; 51:190-202. [PMID: 32005336 PMCID: PMC7000132 DOI: 10.1016/j.beth.2019.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 05/31/2019] [Accepted: 06/03/2019] [Indexed: 01/13/2023]
Abstract
Hope is a trait that represents the capacity to identify strategies or pathways to achieve goals and the motivation or agency to effectively pursue those pathways. Hope has been demonstrated to be a robust source of resilience to anxiety and stress and there is limited evidence that, as has been suggested for decades, hope may function as a core process or transdiagnostic mechanism of change in psychotherapy. The current study examined the role of hope in predicting recovery in a clinical trial in which 223 individuals with 1 of 4 anxiety disorders were randomized to transdiagnostic cognitive behavior therapy (CBT), disorder-specific CBT, or a waitlist controlled condition. Effect size results indicated moderate to large intraindividual increases in hope, that changes in hope were consistent across the five CBT treatment protocols, that changes in hope were significantly greater in CBT relative to waitlist, and that changes in hope began early in treatment. Results of growth curve analyses indicated that CBT was a robust predictor of trajectories of change in hope compared to waitlist, and that changes in hope predicted changes in both self-reported and clinician-rated anxiety. Finally, a statistically significant indirect effect was found indicating that the effects of treatment on changes in anxiety were mediated by treatment effects on hope. Together, these results suggest that hope may be a promising transdiagnostic mechanism of change that is relevant across anxiety disorders and treatment protocols.
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22
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Yasinski C, Hayes AM, Ready CB, Abel A, Görg N, Kuyken W. Processes of change in cognitive behavioral therapy for treatment-resistant depression: psychological flexibility, rumination, avoidance, and emotional processing. Psychother Res 2019; 30:983-997. [PMID: 31822203 DOI: 10.1080/10503307.2019.1699972] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Recent clinical research suggests that facilitating psychological flexibility and emotional processing and decreasing rumination and avoidance are important tasks of treatment for disorders characterized by entrenched patterns of psychopathology, such as major depressive disorder. The current study examined these processes as predictors of treatment outcomes in a subsample of depressed adult patients (n = 49) who had not fully responded to antidepressant medication and were randomized to receive cognitive-behavioral therapy (CBT). Target variables were coded from session recordings at baseline and in the vicinity of two therapeutic transition points: a sudden gain (improvement) and a transient spike in depression symptoms, or at similar periods for those without such transitions. Results indicated that psychological flexibility during the pre-sudden gain period predicted less depression at 12-month follow-up, beyond baseline symptoms and other co-occurring processes. Interaction analyses revealed that when flexibility was low during the post-spike period, avoidance and rumination predicted higher depressive symptoms, whereas emotional processing predicted lower symptoms at the 12-month follow-up. When flexibility was high, none of these variables were associated with outcome. Together, these findings highlight psychological flexibility as a key therapeutic target in CBT for treatment-resistant depression and might have implications for relapse prevention.
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Affiliation(s)
- Carly Yasinski
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Adele M Hayes
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - C Beth Ready
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Anna Abel
- Mood Disorders Centre, University of Exeter, Exeter, UK
| | - Nora Görg
- Mood Disorders Centre, University of Exeter, Exeter, UK
| | - Willem Kuyken
- Mood Disorders Centre, University of Exeter, Exeter, UK
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23
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Napoleone E, Evans C, Patalay P, Edbrooke-Childs J, Wolpert M. Trajectories of change of youth depressive symptoms in routine care: shape, predictors, and service-use implications. Eur Child Adolesc Psychiatry 2019; 28:1527-1536. [PMID: 30919053 DOI: 10.1007/s00787-019-01317-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
Depression is one of the main reasons for youth accessing mental health services, yet we know little about how symptoms change once youth are in routine care. This study used multilevel modeling to examine the average trajectory of change and the factors associated with change in depressive symptoms in a large sample of youth seen in routine mental health care services in England. Participants were 2336 youth aged 8-18 (mean age 14.52; 77% females; 88% white ethnic background) who tracked depressive symptoms over a period of up to 32 weeks while in contact with mental health services. Explanatory variables were age, gender, whether the case was closed, total length of contact with services, and baseline severity in depression scores. Faster rates of improvement were found in older adolescents, males, those with shorter time in contact with services, closed cases, and those with more severe symptoms at baseline. This study demonstrates that when youth self-report their depressive symptoms during psychotherapy, symptoms decrease in a linear trajectory. Attention should be paid to younger people, females, and those with lower than average baseline scores, as their symptoms decrease at a slower pace compared to others.
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Affiliation(s)
- Elisa Napoleone
- Anna Freud National Centre for Children and Families and University College London, 4-8 Rodney Street, London, N1 9JH, UK.
| | - Chris Evans
- University of Sheffield, Western Bank, Sheffield, S10 2TN, UK
| | - Praveetha Patalay
- University of Liverpool, Foundation Building, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Julian Edbrooke-Childs
- Anna Freud National Centre for Children and Families and University College London, 4-8 Rodney Street, London, N1 9JH, UK
| | - Miranda Wolpert
- Anna Freud National Centre for Children and Families and University College London, 4-8 Rodney Street, London, N1 9JH, UK
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24
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Olthof M, Hasselman F, Strunk G, Aas B, Schiepek G, Lichtwarck-Aschoff A. Destabilization in self-ratings of the psychotherapeutic process is associated with better treatment outcome in patients with mood disorders. Psychother Res 2019; 30:520-531. [DOI: 10.1080/10503307.2019.1633484] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Affiliation(s)
- Merlijn Olthof
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Fred Hasselman
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Guido Strunk
- Complexity Research, Vienna, Austria
- FH Campus Vienna, Vienna, Austria
- Technical University Dortmund, Dortmund, Germany
| | - Benjamin Aas
- Institute for Synergetics and Psychotherapy Research, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
- Faculty of Psychology and Educational Sciences, Ludwig Maximilians University, Munich, Bavaria, Germany
- Present address: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Günter Schiepek
- Institute for Synergetics and Psychotherapy Research, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
- Faculty of Psychology and Educational Sciences, Ludwig Maximilians University, Munich, Bavaria, Germany
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25
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Gmeinwieser S, Hagmayer Y, Pieh C, Probst T. General change mechanisms in the early treatment phase and their associations with the outcome of cognitive behavioural therapy in patients with different levels of motivational incongruence. Clin Psychol Psychother 2019; 26:550-561. [DOI: 10.1002/cpp.2381] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Sebastian Gmeinwieser
- Department for Clinical Psychology and Psychotherapy, Therapy and Counseling CenterUniversity of Göttingen Göttingen Germany
| | - York Hagmayer
- Department for Cognitive and Decision SciencesUniversity of Göttingen Göttingen Germany
| | - Christoph Pieh
- Department for Psychotherapy and Biopsychosocial HealthDanube University Krems Austria
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial HealthDanube University Krems Austria
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26
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Trajectories of Change in a Group Behavioral Activation Treatment for Severe, Recurrent Depression. Behav Ther 2019; 50:504-514. [PMID: 31030869 DOI: 10.1016/j.beth.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 11/20/2022]
Abstract
Depression is a common and costly problem. Behavioral Activation (BA) is an effective treatment for depression when delivered 1:1, but group treatments often do not perform as well as 1:1 treatments. One way to begin to understand how group treatments perform is to assess the process of change during treatment. This study examined trajectories of change across 10-session group BA for individuals with severe, chronic, or recurrent forms of depression. We also tested whether individuals who had associated sudden gains or depression spikes had better outcomes than those who did not have these change patterns. We examined psychological and sociodemographic predictors of the patterns of change. Participants were 104 individuals who met diagnostic criteria for major depressive disorder and participated in one of 10 BA groups, provided over a 2-year period. A linear, but not quadratic or cubic, rate of change fit the data and the effect size for the change in mood symptoms from baseline to posttreatment was large, Cohen's d = 1.25. Although 34% (26 of the 77 who provided outcome data) of individuals had a sudden gain and 10% (7/77) had a depression spike, neither sudden gains nor depression spikes predicted posttreatment outcomes. None of the demographic or psychological factors (rumination, behavioral activation) predicted the pattern of change. These results suggest that although group BA may help to reduce depressive symptoms in individuals with severe, recurrent, and/or chronic forms of depression, the overall linear pattern of change is different from quadratic patterns of change reported for 1:1 BA.
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27
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Hegarty BD, Marceau EM, Gusset M, Grenyer BFS. Early treatment response in psychotherapy for depression and personality disorder: links with core conflictual relationship themes. Psychother Res 2019; 30:112-123. [PMID: 31018824 DOI: 10.1080/10503307.2019.1609114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: Depressed personality disorder patients showing an early rapid response (or sudden gain) in psychotherapy have better outcomes. Early responders are five times more likely to recover, despite equivalent ratings of working alliance. We explored core conflictual relationship themes (CCRTs) of early responders compared to others to further elucidate process-outcome links. Method: Patients (N = 20) with diagnosed major depression and personality disorder received 16 weeks of psychodynamic therapy. Early response was defined as a 50% reduction in Beck Depression Inventory symptoms during the first six sessions. Transcripts of therapy session three for early responders (n = 10) and others (n = 10) were analyzed using the CCRT Leipzig/Ulm method, identifying 728 components scored by two independent judges. Results: Relationship narratives showed CCRT-wish satisfaction was lower for those not having an early response, for both CCRT "Response of Other" and "Response of Self" components. These patients told narratives of others as more unreliable, aggressive, and less supportive, with less feelings of being loved and a lower experience of being self-determined. Conclusions: Specific negative relationship patterns may inhibit the ability to benefit from both therapy and extra-therapy relationships, contributing to a slower treatment response.
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Affiliation(s)
- Bronwyn D Hegarty
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong NSW, Australia
| | - Ely M Marceau
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong NSW, Australia
| | - Monique Gusset
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong NSW, Australia
| | - Brin F S Grenyer
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong NSW, Australia
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28
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Panaite V, Bowersox NW, Zivin K, Ganoczy D, Kim HM, Pfeiffer PN. Individual and neighborhood characteristics as predictors of depression symptom response. Health Serv Res 2019; 54:586-591. [PMID: 30829408 DOI: 10.1111/1475-6773.13127] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Assess whether neighborhood characteristics predict patient-reported outcomes for depression. DATA SOURCES VA electronic medical record data and U.S. census data. STUDY DESIGN Retrospective longitudinal cohort. DATA EXTRACTION METHODS Neighborhood and individual characteristics of patients (N = 4,269) with a unipolar depressive disorder diagnosis and an initial Patient Health Questionnaire (PHQ-9) score ≥10 were used to predict 50 percent improvement in 4-8-month PHQ-9 scores. PRINCIPAL FINDINGS The proportion of a patient's neighborhood living in poverty (OR = 0.98; 95% CI: 0.97-.1.00; P = 0.03) was associated with lower likelihood of depression symptom improvement in addition to whether the patient was black (OR = 0.76; 95% CI:0.61-0.96; P = 0.02) had PTSD (OR = 0.59; 95% CI:0.50-0.69; P < 0.001) or had any service-connected disability (OR = 0.73; 95% CI:0.61-0.87; P < 0.001). CONCLUSIONS Neighborhood poverty should be considered along with patient characteristics when determining likelihood of depression improvement.
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Affiliation(s)
- Vanessa Panaite
- James A. Haley Veterans' Hospital, Tampa, Florida.,University of South Florida, Tampa, Florida
| | - Nicholas W Bowersox
- VA QUERI Center for Evaluation and Implementation Resources (CEIR), Ann Arbor, Michigan.,VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC), Ann Arbor, Michigan.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.,School of Public Health, Health Management and Policy, University of Michigan, Ann Arbor, Michigan.,Survey Research Center, Institute for Social Research, Ann Arbor, Michigan.,VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan
| | - Dara Ganoczy
- VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan.,Consulting for Statistics, Computing & Analytics Research, University of Michigan, Ann Arbor, Michigan
| | - Paul N Pfeiffer
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.,VA Center for Clinical Management Research (CCMR), Ann Arbor, Michigan
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Graham B, Garcia NM, Burton MS, Cooper AA, Roy-Byrne PP, Mavissakalian MR, Feeny NC, Zoellner LA. High expectancy and early response produce optimal effects in sertraline treatment for post-traumatic stress disorder. Br J Psychiatry 2018; 213:704-708. [PMID: 30355364 PMCID: PMC6263783 DOI: 10.1192/bjp.2018.211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Better indicators of prognosis are needed to personalise post-traumatic stress disorder (PTSD) treatments.AimsWe aimed to evaluate early symptom reduction as a predictor of better outcome and examine predictors of early response. METHOD Patients with PTSD (N = 134) received sertraline or prolonged exposure in a randomised trial. Early response was defined as 20% PTSD symptom reduction by session two and good end-state functioning defined as non-clinical levels of PTSD, depression and anxiety. RESULTS Early response rates were similar in prolonged exposure and sertraline (40 and 42%), but in sertraline only, early responders were four times more likely to achieve good end-state functioning at post-treatment (Number Needed to Treat = 1.8, 95% CI 1.28-3.00) and final follow-up (Number Needed to Treat = 3.1, 95% CI 1.68-16.71). Better outcome expectations of sertraline also predicted higher likelihood of early response. CONCLUSIONS Higher expectancy of sertraline coupled with early response may produce a cascade-like effect for optimal conditions for long-term symptom reduction. Therefore, assessing expectations and providing clear treatment rationales may optimise sertraline effects. DECLARATION OF INTEREST None.
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Affiliation(s)
- Belinda Graham
- Department of Psychology, University of Washington, Seattle, WA,Corresponding author’s current contact details: Belinda Graham, Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford OX1 1TW, U.K.,
| | | | - Mark S. Burton
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Andrew A. Cooper
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
| | - Peter P. Roy-Byrne
- Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, Seattle, WA
| | - Matig R. Mavissakalian
- Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland OH
| | - Norah C. Feeny
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH
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Basto I, Stiles WB, Bento T, Pinheiro P, Mendes I, Rijo D, Salgado J. Fluctuation in the Assimilation of Problematic Experiences: A Case Study of Dynamic Systems Analysis. Front Psychol 2018; 9:1119. [PMID: 30158881 PMCID: PMC6104492 DOI: 10.3389/fpsyg.2018.01119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 06/11/2018] [Indexed: 11/24/2022] Open
Abstract
Dynamic systems theory suggests that instability can be a key element in the promotion of human change processes. Several studies have confirmed an association between unstable patterns and successful psychotherapeutic outcome. Somewhat similarly, the assimilation model of psychotherapeutic change argues that clinical change occurs through the integration of problematic experiences that initially threaten the stability of the self. This study examined how instability in assimilation levels was related to assimilation progress and change in symptom intensity, within and across sessions, in a good-outcome case of Emotion Focused Therapy. We used the assimilation of problematic experiences scales (APES) to measure assimilation and the outcome-questionnaire (OQ-10) to measure clinical symptom intensity. To assess assimilation instability, we used a fluctuation measure that calculated the amplitude and the frequency of changes in assimilation levels. To analyze the structural relationships between variables we used a dynamic factor model. The results showed that APES level and APES fluctuation tended to increase across treatment, while OQ-10 scores tended to decrease. However, contrary to expectations, the dynamic factor model showed no significant associations between APES fluctuation and OQ-10 scores either within sessions or between adjacent sessions.
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Affiliation(s)
- Isabel Basto
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
- University Institute of Maia (ISMAI), Maia, Portugal
- Center of Psychology at University of Porto (CPUP), University of Porto, Porto, Portugal
| | - William B. Stiles
- Department of Psychology, Miami University, Oxford, OH, United States
- Department of Psychology, Appalachian State University, Boone, NC, United States
| | - Tiago Bento
- University Institute of Maia (ISMAI), Maia, Portugal
- Center of Psychology at University of Porto (CPUP), University of Porto, Porto, Portugal
| | - Patrícia Pinheiro
- Psychology Research Center (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Inês Mendes
- Royal Holloway, University of London, Egham, United Kingdom
| | - Daniel Rijo
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculty of Psychology and Education Sciences, University of Coimbra, Coimbra, Portugal
| | - João Salgado
- University Institute of Maia (ISMAI), Maia, Portugal
- Center of Psychology at University of Porto (CPUP), University of Porto, Porto, Portugal
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Bartoskova M, Sevcikova M, Durisko Z, Maslej MM, Barbic SP, Preiss M, Andrews PW. The form and function of depressive rumination. EVOL HUM BEHAV 2018. [DOI: 10.1016/j.evolhumbehav.2018.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Reinhold M, Bürkner PC, Holling H. Effects of expressive writing on depressive symptoms-A meta-analysis. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2018. [DOI: 10.1111/cpsp.12224] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Maren Reinhold
- Institute of Psychology; University of Münster; Münster Germany
| | | | - Heinz Holling
- Institute of Psychology; University of Münster; Münster Germany
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Kress VE, Haiyasoso M, Zoldan CA, Headley JA, Trepal H. The Use of Relational-Cultural Theory in Counseling Clients Who Have Traumatic Stress Disorders. JOURNAL OF COUNSELING AND DEVELOPMENT 2018. [DOI: 10.1002/jcad.12182] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Victoria E. Kress
- Department of Counseling, Special Education, and School Psychology; Youngstown State University
| | - Maria Haiyasoso
- Department of Counseling, Leadership, Adult Education, and School Psychology; Texas State University; San Marcos
| | | | | | - Heather Trepal
- Department of Counseling; University of Texas at San Antonio
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Grosse Holtforth M, Krieger T, Zimmermann J, Altenstein-Yamanaka D, Dörig N, Meisch L, Hayes AM. A randomized-controlled trial of cognitive–behavioral therapy for depression with integrated techniques from emotion-focused and exposure therapies. Psychother Res 2017; 29:30-44. [DOI: 10.1080/10503307.2017.1397796] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- 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
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
| | | | | | - Nadja Dörig
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Laurence Meisch
- Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Adele M. Hayes
- Department of Psychology and Brain Sciences, University of Delaware, Newark, DE, USA
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Lorenzo-Luaces L, Driessen E, DeRubeis RJ, Van HL, Keefe JR, Hendriksen M, Dekker J. Moderation of the Alliance-Outcome Association by Prior Depressive Episodes: Differential Effects in Cognitive-Behavioral Therapy and Short-Term Psychodynamic Supportive Psychotherapy. Behav Ther 2017; 48:581-595. [PMID: 28711109 DOI: 10.1016/j.beth.2016.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 11/05/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
Prior studies have suggested that the association between the alliance and depression improvement varies as a function of prior history of depression. We sought to replicate these findings and extend them to short-term psychodynamic supportive psychotherapy (SPSP) in a sample of patients who were randomized to one of these treatments and were administered the Helping Alliance Questionnaire (N=282) at Week 5 of treatment. Overall, the alliance was a predictor of symptom change (d=0.33). In SPSP, the alliance was a modest but robust predictor of change, irrespective of prior episodes (d=0.25-0.33). By contrast, in CBT, the effects of the alliance on symptom change were large for patients with 0 prior episodes (d=0.86), moderate for those with 1 prior episode (d=0.49), and small for those with 2+ prior episodes (d=0.12). These findings suggest a complex interaction between patient features and common vs. specific therapy processes. In CBT, the alliance relates to change for patients with less recurrent depression whereas other CBT-specific processes may account for change for patients with more recurrent depression.
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Affiliation(s)
| | | | | | | | | | | | - Jack Dekker
- VU University Amsterdam, Arkin Mental Health Care, Amsterdam
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36
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O'Mahen HA, Wilkinson E, Bagnall K, Richards DA, Swales A. Shape of change in internet based behavioral activation treatment for depression. Behav Res Ther 2017; 95:107-116. [PMID: 28618298 DOI: 10.1016/j.brat.2017.05.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/14/2017] [Accepted: 05/15/2017] [Indexed: 11/29/2022]
Abstract
Shape of change, sudden gains and depression spikes were examined in an online 12-session Behavioral Activation (BA) treatment for depression. Client and therapist factors related to sudden gains were examined to investigate processes associated with outcome. METHODS Participants were postpartum Women with Major Depressive Disorder (n=42) who received online BA supported in 30-minute telephone sessions by a mental health worker. Depression symptoms were assessed at each session and number of sessions completed were recorded by the online program. Therapist records were rated for client stressful life event and therapist concrete focus. A quadratic pattern provided the best fit with the data; a cubic pattern was a poor fit. Sudden gains, but not depression spikes, predicted lower depression scores at 17-week outcome. Women who had higher baseline social functioning, did not experience a stressful life event during therapy, and completed more online modules, but not more telephone sessions, were more likely to have a sudden gain. A concrete therapist focus was associated with sudden gains. These results extend research on trajectories of change and sudden gains to an online BA treatment and to postpartum depression, and suggest important client and therapist factors associated with sudden gains.
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Affiliation(s)
- Heather A O'Mahen
- Mood Disorders Centre, University of Exeter, Washington Singer Building, Exeter EX4 4QG, UK.
| | | | - Kara Bagnall
- Mood Disorders Centre, University of Exeter, Washington Singer Building, Exeter EX4 4QG, UK.
| | - David A Richards
- University of Exeter Medical School, St. Lukes Campus, South Cloisters, Exeter EX1 2LU, UK.
| | - Amanda Swales
- Mood Disorders Centre, University of Exeter, Washington Singer Building, Exeter EX4 4QG, UK.
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Feasibility of Training Frontline Therapists in Prolonged Exposure: A Randomized Controlled Pilot Study of Treatment of Complex Trauma in Diverse Victims of Crime and Violence. J Nerv Ment Dis 2017; 205:283-293. [PMID: 28157725 DOI: 10.1097/nmd.0000000000000659] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The study aims were to determine whether prolonged exposure (PE) improved mental health and was feasible to implement by frontline clinicians in a culturally diverse sample with complex trauma. Seventy-one individuals were randomly assigned to PE or person-centered therapy (PCT). Outcome measures were administered at baseline and sessions 3, 6, 9, and 12. Mixed modeling was used to regress outcome measures on time, treatment group, and number of visits. Individuals who received PE showed significant moderate association with decline in reported posttraumatic stress disorder (PTSD) symptoms as noted by the PTSD Checklist for DSM-5 (p = 0.05) compared with PCT. Results indicated improved scores on all measures at each follow-up time point compared with baseline (p ≤ 0.01). PE was feasible, shown by positive recruitment and ability of clinicians to effectively implement and maintain treatment fidelity. Findings suggest that PE can be effective for treating complex trauma when used by clinicians in community settings.
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Hayes AM, Yasinski C, Grasso D, Ready CB, Alpert E, McCauley T, Webb C, Deblinger E. Constructive and Unproductive Processing of Traumatic Experiences in Trauma-Focused Cognitive-Behavioral Therapy for Youth. Behav Ther 2017; 48:166-181. [PMID: 28270328 PMCID: PMC5344908 DOI: 10.1016/j.beth.2016.06.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 12/24/2022]
Abstract
Although there is substantial evidence to support the efficacy of cognitive-behavioral treatments (CBT) for posttraumatic stress disorder (PTSD), there is some debate about how these treatments have their effects. Modern learning theory and cognitive and emotional processing theories highlight the importance of reducing avoidance, facilitating the constructive processing of feared experiences, and strengthening new inhibitory learning. We examined variables thought to be associated with unproductive and constructive processing of traumatic experiences in a sample of 81 youth with elevated PTSD symptoms, who received Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for abuse or traumatic interpersonal loss. Sessions during the trauma narrative phase of TF-CBT were coded for indicators of unproductive processing (overgeneralization, rumination, avoidance) and constructive processing (decentering, accommodation of corrective information), as well as levels of negative emotion. In previous analyses of this trial (Ready et al., 2015), more overgeneralization during the narrative phase predicted less improvement in internalizing symptoms at posttreatment and a worsening of externalizing symptoms over the 12-month follow-up. In contrast, more accommodation predicted improvement in internalizing symptoms and also moderated the negative effects of overgeneralization on internalizing and externalizing symptoms. The current study examined correlates of overgeneralization and accommodation. Overgeneralization was associated with more rumination, less decentering, and more negative emotion, suggesting immersion in trauma-related material. Accommodation was associated with less avoidance and more decentering, suggesting a healthy distance from trauma-related material that might allow for processing and cognitive change. Decentering also predicted improvement in externalizing symptoms at posttreatment. Rumination and avoidance showed important associations with overgeneralization and accommodation, respectively, but did not predict treatment outcomes. This study identifies correlates of overgeneralization and accommodation that might shed light on how these variables relate to unproductive and constructive processing of traumatic experiences.
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Affiliation(s)
| | | | | | | | | | | | - Charles Webb
- Delaware Division of Prevention and Behavioral Health Services
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39
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Renna ME, Quintero JM, Fresco DM, Mennin DS. Emotion Regulation Therapy: A Mechanism-Targeted Treatment for Disorders of Distress. Front Psychol 2017; 8:98. [PMID: 28220089 PMCID: PMC5292405 DOI: 10.3389/fpsyg.2017.00098] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 01/16/2017] [Indexed: 11/13/2022] Open
Abstract
"Distress disorders," which include generalized anxiety disorder and major depression are often highly comorbid with each other and appear to be characterized by common temperamental features that reflect heightened sensitivity to underlying motivational systems related to threat/safety and reward/loss. Further, individuals with distress disorders tend to utilize self-referential processes (e.g., worry, rumination, self-criticism) in a maladaptive attempt to respond to motivationally relevant distress, often resulting in suboptimal contextual learning. Despite the success of cognitive behavioral therapies for emotional disorders, a sizable subgroup of patients with distress disorders fail to evidence adequate treatment response. Emotion Regulation Therapy (ERT) is a theoretically derived, evidence based, treatment that integrates principles (e.g., skills training, exposure) from traditional and contemporary therapies with findings from basic and translational affective science to offer a framework for improving intervention by focusing on the motivational responses and corresponding regulatory characteristics of individuals with high levels of chronic distress. Open and randomized controlled trials have demonstrated preliminary support for the utility of ERT as reflected by strong effect sizes comparable to and exceeding established intervention approaches. In addition, pilot findings support the role of underlying proposed mechanisms in this efficacious response. This article presents the functional model associated with ERT and describes the proposed mechanisms of the treatment. Additionally, a clinical case is presented, allowing the reader to gain a greater applied understanding of the different components of the ERT model and treatment.
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Affiliation(s)
- Megan E. Renna
- The Graduate Center, City University of New York, New YorkNY, USA
- Hunter College, City University of New York, New YorkNY, USA
| | - Jean M. Quintero
- The Graduate Center, City University of New York, New YorkNY, USA
- Hunter College, City University of New York, New YorkNY, USA
| | - David M. Fresco
- Psychology Department, Kent State University, KentOH, USA
- Case Western Reserve University School of Medicine, ClevelandOH, USA
| | - Douglas S. Mennin
- The Graduate Center, City University of New York, New YorkNY, USA
- Hunter College, City University of New York, New YorkNY, USA
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40
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Internalizing and Externalizing Symptoms Moderate Treatment Response to School-Based Trauma and Grief Component Therapy for Adolescents. SCHOOL MENTAL HEALTH 2016. [DOI: 10.1007/s12310-016-9204-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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41
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Lorenzo-Luaces L, Keefe JR, DeRubeis RJ. Cognitive-Behavioral Therapy: Nature and Relation to Non-Cognitive Behavioral Therapy. Behav Ther 2016; 47:785-803. [PMID: 27993333 DOI: 10.1016/j.beth.2016.02.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 02/24/2016] [Accepted: 02/25/2016] [Indexed: 11/19/2022]
Abstract
Since the introduction of Beck's cognitive theory of emotional disorders, and their treatment with psychotherapy, cognitive-behavioral approaches have become the most extensively researched psychological treatment for a wide variety of disorders. Despite this, the relative contribution of cognitive to behavioral approaches to treatment are poorly understood and the mechanistic role of cognitive change in therapy is widely debated. We critically review this literature, focusing on the mechanistic role of cognitive change across cognitive and behavioral therapies for depressive and anxiety disorders.
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42
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Does Feeling Bad, Lead to Feeling Good? Arousal Patterns during Expressive Writing. REVIEW OF GENERAL PSYCHOLOGY 2016. [DOI: 10.1037/gpr0000083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Different psychotherapy theories describe process patterns of emotional arousal in contradictory ways. To control both treatment and therapist responsivity, this study sought to test dynamic patterns in the arousal of negative affect using a controlled experimental study of expressive writing. There were 261 participants (78% women; M = 21 years old; 56% White) who suffered unresolved traumas who were randomly assigned to an expressive writing task and asked to write about their deepest thoughts and feelings, or to a writing control. Participants wrote for 15 min on three consecutive days, completing the Positive Affect and Negative Affect Scale before and after each visit. Data across 6 time points were subjected to hierarchical linear modeling (HLM) and pattern analyses. Session-by-session (24 hr periods), the expressive writing group showed an overall linear decrease in negative affect (β = −2.273, p < .001). However, in pre- to post-session ratings (15 min periods), the expressive writing group also demonstrated increases in negative affect (β = 6.467, p < .001). Neither of these patterns were observed in the control group. Pattern analysis demonstrated 69.8% of cases in the expressive writing group perfectly or almost perfectly followed a predicted zig-zag pattern ( p < .01). No control cases showed this pattern. Findings demonstrate how the habituation/inhibition hypothesis (“it gets easier as one gets over it”) and the meaning-making hypothesis (“it gets worse before it gets better”) can both be supported, each at different scopes of analysis. Implications clarify the role of emotional arousal in change.
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Clapp JD, Kemp JJ, Cox KS, Tuerk PW. PATTERNS OF CHANGE IN RESPONSE TO PROLONGED EXPOSURE: IMPLICATIONS FOR TREATMENT OUTCOME. Depress Anxiety 2016; 33:807-15. [PMID: 27321062 DOI: 10.1002/da.22534] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Assessment of response to Prolonged Exposure (PE) suggests some patients may experience discontinuous change involving sudden symptom reductions and/or temporary exacerbations. The current study looked to (1) isolate profiles of PE response among treatment-seeking veterans and (2) identify factors associated with unique patterns of change. METHODS Archival records were examined for veterans receiving PE through a specialty Veterans Affairs Medical Center (VAMC) clinic (N = 109). Latent profile analysis was used to extract response trajectories defined by change in weekly PTSD Checklist (PCL) scores. Associations with provider status (staff vs. intern), setting (in-person vs. telehealth), initial severity (PTSD; depression), and eventual treatment gains were examined. RESULTS Three profiles were observed. Rapid Responders (18.3%) evidenced sharp reductions at Week 2 and again between Weeks 5 and 6. Linear Responders (40.4%) demonstrated gradual reductions throughout the 10-week assessment window. Delayed Responder (41.3%) scores were relatively stable over the evaluation period although final session outcomes indicated reliable change (PCLΔ > 10) in 40% of patients. Profiles were similar with respect to provider status, treatment setting, and initial symptom severity. Rapid Responders evidenced lower final session scores relative to Linear (g = 1.13) and Delayed (g = 1.85) groups, with Linear Responders reporting lower end scores than Delayed Responders (g = 1.02). CONCLUSIONS Anticipating patterns of recovery and their association with therapeutic outcome is of immense clinical value. Sudden gains emerged as a strong predictor of enhanced response. Data also suggest potential benefits of extending standard intervention for patients who fail to demonstrate an immediate response to PE.
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Affiliation(s)
- Joshua D Clapp
- Department of Psychology, University of Wyoming, Laramie, Wyoming.
| | - Joshua J Kemp
- Department of Psychology, University of Wyoming, Laramie, Wyoming
| | - Keith S Cox
- Department of Psychology, University of North Carolina Asheville, Asheville, North Carolina
| | - Peter W Tuerk
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, 29401.,Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Yarger HA, Hoye JR, Dozier M. TRAJECTORIES OF CHANGE IN ATTACHMENT AND BIOBEHAVIORAL CATCH-UP AMONG HIGH-RISK MOTHERS: A RANDOMIZED CLINICAL TRIAL. Infant Ment Health J 2016; 37:525-36. [DOI: 10.1002/imhj.21585] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 02/18/2016] [Accepted: 05/16/2016] [Indexed: 11/12/2022]
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45
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Vittengl JR, Clark LA, Thase ME, Jarrett RB. Defined symptom-change trajectories during acute-phase cognitive therapy for depression predict better longitudinal outcomes. Behav Res Ther 2016; 87:48-57. [PMID: 27591917 DOI: 10.1016/j.brat.2016.08.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 08/08/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Acute-phase cognitive therapy (CT) is an efficacious treatment for major depressive disorder (MDD), but responders experience varying post-acute outcomes (e.g., relapse vs. recovery). Responders' symptom-change trajectories during response to acute-phase CT may predict longer term outcomes. METHOD We studied adult outpatients (N = 220) with recurrent MDD who responded to CT but had residual symptoms. Responders with linear (steady improvement), log-linear (quicker improvement earlier and slower later), one-step (a single, relatively large, stable improvement between adjacent assessments), or undefined (not linear, log-linear, or one-step) symptom trajectories were assessed every 4 months for 32 additional months. RESULTS Defined (linear, log-linear, one-step) versus undefined acute-phase trajectories predicted lower depressive symptoms (d = 0.36), lower weekly probability of being in a major depressive episode (OR = 0.46), higher weekly probabilities of remission (OR = 1.93) and recovery (OR = 2.35), less hopelessness (d = 0.41), fewer dysfunctional attitudes (d = 0.31), and better social adjustment (d = 0.32) for 32 months after acute-phase CT. Differences among defined trajectory groups were nonsignificant. CONCLUSIONS Responding to acute-phase CT with a defined trajectory (orderly pattern) of symptom reduction predicts better longer term outcomes, but which defined trajectory (linear, log-linear, or one-step) appears unimportant. Frequent measurement of depressive symptoms to identify un/defined CT response trajectories may clarify need for continued clinical monitoring and treatment.
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Affiliation(s)
- Jeffrey R Vittengl
- Department of Psychology, Truman State University, 100 East Normal Street, Kirksville, MO 63501-4221, USA.
| | | | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA
| | - Robin B Jarrett
- Department of Psychiatry, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9149, USA.
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O'Driscoll C, Mason O, Brady F, Smith B, Steel C. Process analysis of trauma-focused cognitive behavioural therapy for individuals with schizophrenia. Psychol Psychother 2016. [PMID: 26202461 DOI: 10.1111/papt.12072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Therapeutic alliance, modality, and ability to engage with the process of therapy have been the main focus of research into what makes psychotherapy successful. Individuals with complex trauma histories or schizophrenia are suggested to be more difficult to engage and may be less likely to benefit from therapy. This study aimed to track the in-session 'process' of working alliance and emotional processing of trauma memories for individuals with schizophrenia. DESIGN The study utilized session recordings from the treatment arm of an open randomized clinical trial investigating trauma-focused cognitive behavioural therapy (TF-CBT) for individuals with schizophrenia (N = 26). METHOD Observer measures of working alliance, emotional processing, and affect arousal were rated at early and late phases of therapy. Correlation analysis was undertaken for process measures. Temporal analysis of expressed emotions was also reported. RESULTS Working alliance was established and maintained throughout the therapy; however, agreement on goals reduced at the late phase. The participants appeared to be able to engage in emotional processing, but not to the required level for successful cognitive restructuring. CONCLUSION This study undertook novel exploration of process variables not usually explored in CBT. It is also the first study of process for TF-CBT with individuals with schizophrenia. This complex clinical sample showed no difficulty in engagement; however, they may not be able to fully undertake the cognitive-emotional demands of this type of therapy. Clinical and research implications and potential limitations of these methods are considered. PRACTITIONER POINTS This sample showed no difficulties engaging with TF-CBT and forming a working alliance. However, the participants may not have achieved a level of active involvement required for successful cognitive restructuring of trauma memories. This discrepancy may relate to the mediating role of both working alliance and cognitive-emotional processing. The results underscore the importance of therapists understanding the relationship between alliance and other process factors which may be implicit in facilitating change.
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Affiliation(s)
- Ciarán O'Driscoll
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Oliver Mason
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Francesca Brady
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Ben Smith
- North East London NHS Foundation Trust, London, UK
| | - Craig Steel
- Charlie Waller Institute, School of Psychology and Clinical Language Sciences, University of Reading, UK
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Schiepek G, Aichhorn W, Gruber M, Strunk G, Bachler E, Aas B. Real-Time Monitoring of Psychotherapeutic Processes: Concept and Compliance. Front Psychol 2016; 7:604. [PMID: 27199837 PMCID: PMC4853656 DOI: 10.3389/fpsyg.2016.00604] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 04/11/2016] [Indexed: 11/13/2022] Open
Abstract
Objective: The feasibility of a high-frequency real-time monitoring approach to psychotherapy is outlined and tested for patients' compliance to evaluate its integration to everyday practice. Criteria concern the ecological momentary assessment, the assessment of therapy-related cognitions and emotions, equidistant time sampling, real-time nonlinear time series analysis, continuous participative process control by client and therapist, and the application of idiographic (person-specific) surveys. Methods: The process-outcome monitoring is technically realized by an internet-based device for data collection and data analysis, the Synergetic Navigation System. Its feasibility is documented by a compliance study on 151 clients treated in an inpatient and a day-treatment clinic. Results: We found high compliance rates (mean: 78.3%, median: 89.4%) amongst the respondents, independent of the severity of symptoms or the degree of impairment. Compared to other diagnoses, the compliance rate was lower in the group diagnosed with personality disorders. Conclusion: The results support the feasibility of high-frequency monitoring in routine psychotherapy settings. Daily collection of psychological surveys allows for the assessment of highly resolved, equidistant time series data which gives insight into the nonlinear qualities of therapeutic change processes (e.g., pattern transitions, critical instabilities).
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Affiliation(s)
- Günter Schiepek
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical UniversitySalzburg, Austria; Department of Psychosomatics and Inpatient Psychotherapy, Christian Doppler University Hospital, Paracelsus Medical UniversitySalzburg, Austria; Faculty of Psychology and Educational Sciences, Ludwig Maximilians UniversityMunich, Germany
| | - Wolfgang Aichhorn
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical UniversitySalzburg, Austria; Department of Psychosomatics and Inpatient Psychotherapy, Christian Doppler University Hospital, Paracelsus Medical UniversitySalzburg, Austria
| | - Martin Gruber
- Department of Psychosomatics and Inpatient Psychotherapy, Christian Doppler University Hospital, Paracelsus Medical University Salzburg, Austria
| | | | - Egon Bachler
- Institute of Psychoanalysis and Family Therapy Salzburg, Austria
| | - Benjamin Aas
- Institute of Synergetics and Psychotherapy Research, Paracelsus Medical UniversitySalzburg, Austria; Faculty of Psychology and Educational Sciences, Ludwig Maximilians UniversityMunich, Germany
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Klug G, Zimmermann J, Huber D. Outcome trajectories and mediation in psychotherapeutic treatments of major depression. J Am Psychoanal Assoc 2016; 64:307-43. [PMID: 27151999 DOI: 10.1177/0003065116644742] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Indexed: 11/16/2022]
Abstract
Trajectories and mediators of change were investigated in a process-outcome study. Patients were allocated at random to psychoanalytic therapy (PA) or psychodynamic therapy (PD), and later to cognitive-behavioral therapy (CBT). Measurement points were at pre-treatment, during ongoing treatment, at post-treatment, and during a three-year follow-up. Outcome trajectories were assessed using the Beck Depression Inventory (BDI; Hautzinger et al. 1994), the Symptom Checklist 90 Revised Version (SCL-90-R; Franke 1995), and the Inventory of Interpersonal Problems (IIP; Horowitz, Strauss, and Kordy 2000). Therapeutic alliance and introject were tested as mediators, assessed using the Helping Alliance Questionnaire (HAQ; Bassler, Potratz, and Krauthauser 1995) and INTREX, introject surface (Tress 1993). Multilevel modeling was applied to estimate outcome trajectories and to test for mediation. Symptoms decreased in early and ongoing treatment in all treatment groups. After the end of treatment, depressive and general psychiatric symptoms continued to decrease in significantly greater degree in the PA group than in the PD and CBT cohorts. During early treatment, interpersonal problems decreased significantly more in those allocated to PD than in the PA and CBT groups. During ongoing treatment, improvement in interpersonal problems was significantly higher in the PA group than in the others and, compared to CBT, continued to increase significantly after termination. Mediational analyses revealed that neither introject affiliation nor therapeutic alliance mediated differential treatment effects.
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Beard C, Stein AT, Hearon BA, Lee J, Hsu KJ, Björgvinsson T. Predictors of Depression Treatment Response in an Intensive CBT Partial Hospital. J Clin Psychol 2016; 72:297-310. [DOI: 10.1002/jclp.22269] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 10/26/2015] [Accepted: 12/31/2015] [Indexed: 11/12/2022]
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Abstract
OBJECTIVE The purpose of this study is to shed light on therapy-relevant factors, such as self-esteem, self-efficacy, and resources in adults with ADHD in comparison with a healthy control group. METHOD A total of 43 adults who met Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria for ADHD in adulthood were matched with a nonclinical sample in terms of age and gender. All participants (N = 86) were assessed with self-ratings: Symptom Checklist-90-Revised (SCL-90-R), Rosenberg Self-Esteem Scale, General Perceived Self-Efficacy Scale, and Dick's Resources Checklist. RESULTS Adults with ADHD showed lower levels of self-esteem and self-efficacy when compared with the control group. The authors found some, but not all, of the resources of adults with ADHD to be reduced. In other words, people with ADHD seem to possess specific resources. CONCLUSION Our results have important implications for the treatment of adult ADHD and suggest that specific therapy programs should include resources-oriented modules for enhancing self-esteem, self-efficacy, and fostering strengths.
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