Autonomous and controlled motivation and interpersonal therapy for depression: moderating role of recurrent depression

Optimizing outcomes in psilocybin therapy: Considerations in participant evaluation and preparation

Recent studies have demonstrated the promise of psilocybin therapies in creating positive changes for those with poor mental health across multiple diagnostic categories, including major depressive disorder (MDD), end-of-life anxiety, and obsessive-compulsive disorder (OCD). While there may be a large population that is eligible to participate in psilocybin therapy based on psychiatric diagnosis and medical clearance, little attention has been given to intrapersonal and interpersonal factors that might influence patient's readiness (i.e., eligibility and capacity) for psychedelic interventions. This paper proposes that readiness assessment includes both intrapersonal and interpersonal factors in order to improve safety, patient care, and treatment outcomes. While at the present time a reliable and valid instrument has not been developed, we propose that three specific areas of focus - patient presentation, therapeutic alliance, and patient safety - may be used to establish a patient's readiness for psilocybin therapy, thus increasing therapy optimization and personalization.

Associations Between Basic Psychological Need Satisfaction and Motivation Underpinning Daily Activity Participation Among Community-Dwelling Survivors of Stroke: An Ecological Momentary Assessment Study

OBJECTIVE

Grounded in the self-determination theory (SDT), this study aimed to examine the real-time associations between basic psychological need satisfaction and motivation underpinning daily activity participation among survivors of stroke.

DESIGN

Repeated-measures observational study involving 7 days of ambulatory monitoring; participants completed ecological momentary assessment (EMA) surveys via smartphones 8 times daily. Multilevel models were used to analyze EMA data for concurrent (same survey) and lagged (next survey) associations.

SETTING

General community.

PARTICIPANTS

Forty community-dwelling survivors of stroke (N=40).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

EMA measures of basic psychological needs (autonomy, competence, relatedness) and motivation (autonomous motivation, controlled motivation).

RESULTS

In concurrent analyses, increased autonomy (B=0.21; 95% confidence interval, 0.16-0.26; P<.001), competence (B=0.10; 95% confidence interval, 0.02-0.19; P=.021), and relatedness (B=0.10; 95% confidence interval, 0.06-0.13; P<.001) were momentarily associated with higher autonomous motivation. Conversely, increased autonomy (B=-0.19; 95% confidence interval, -0.27 to -0.10; P<.001) and competence (B=-0.09; 95% confidence interval, -0.17 to -0.01; P=.020) were momentarily associated with lower controlled motivation. Contrary to SDT, increased relatedness was momentarily associated with higher controlled motivation (B=0.10; 95% confidence interval, 0.05-0.14; P<.001). In lagged analyses, no momentary associations were detected between basic psychological needs and motivation (Ps>.05).

CONCLUSIONS

Findings suggest that basic psychological need satisfaction is momentarily associated with motivation for daily activity participation. Additional research is warranted to examine the associations of different orientations of relatedness with autonomous and controlled motivation. Supporting basic psychological needs may foster autonomous motivation of survivors of stroke to enhance daily activity participation after stroke.

Perceived stress linking psychosocial factors and depressive symptoms in low-income mothers

Background

Little is known about associations between perceived stress, psychosocial factors (social support, emotional coping, coping self-efficacy, and autonomous motivation), and depressive symptoms in low-income overweight or obese mothers of young children. Using baseline data of a lifestyle intervention study, this secondary analysis investigates whether perceived stress might mediate the associations between the psychosocial factors and depressive symptoms.

Methods

Convenience sampling was applied. Low-income overweight or obese mothers of young children were recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children in Michigan, US. Survey data were collected through phone interviews. Participants (N = 740) responded to valid surveys measuring perceived stress, social support, emotional coping, coping self-efficacy, autonomous motivation, and depressive symptoms. Composite indicator structural equation modeling was performed to test for potential mediation.

Results

When investigating the potential role of perceived stress as a mediator, the indirect effects of social support (b = − 2.10, p < 0.01), emotion coping (b = − 3.81, p < 0.05), and coping self-efficacy (b = − 7.53, p < 0.01) on depressive symptoms through perceived stress were significant, but the indirect effect of autonomous motivation was not.

Conclusion

Future intervention studies aiming to alleviate depressive symptoms in low-income overweight or obese mothers of young children might consider including practical strategies to promote social support, emotional coping, and coping self-efficacy to reduce perceived stress, which might potentially decrease depressive symptoms.

Trial registration

Clinical Trials NCT01839708; registered February 28, 2013.

Autonomous Motivation Moderates the Relation of Self-Criticism to Depressive Symptoms Over One Year: A Longitudinal Study of Cognitive-Behavioral Therapy Patients in a Naturalistic Setting

Introduction: This study examined whether motivation moderated the relation between self-criticism and depression over one year in a sample of adults receiving cognitive-behavior therapy (CBT).

Methods: Participants (N = 38) completed measures of pre-treatment self-criticism (Time 1), autonomous/controlled motivation for engaging in CBT at the beginning of treatment (Time 2), and interviewer-rated depression at Time 1, and one year after baseline (Time 3).

Results: Multiple regression analyses of moderator effects showed that patients higher in self-criticism with lower autonomous motivation for CBT had higher levels of depressive symptoms one year later. The effect of controlled motivation was nonsignificant.

Discussion: Our findings support the buffering hypothesis that engaging in CBT because it is personally meaningful may protect patients high in self-criticism from experiencing the poorer treatment outcomes associated with their specific vulnerability. However, given the small sample size, the results will need to be replicated within larger samples to ensure generalizability.

Interpersonal Psychotherapy: A Scoping Review and Historical Perspective (1974-2017)

BACKGROUND

Interpersonal Psychotherapy (IPT) is an affect- and relationally focused, time-limited treatment supported by research spanning >4 decades. IPT focuses on stressful interpersonal experiences of loss, life changes, disputes, and social isolation. It emphasizes the role of relationships in recovery. This scoping review describes, within a historical perspective, IPT's evolution as an evidence-supported treatment of psychiatric disorders.

METHODS

English-language publications (n = 1119) identified via EMBASE, MEDLINE, PsycINFO, and Web of Science databases (1974-2017), augmented with manual reference searches, were coded for clinical focus, population demographics, format, setting, publication type, and research type. Quantitative and qualitative analyses identified IPT publications' characteristics and trends over four epochs of psychotherapy research.

RESULTS

IPT literature primarily focused on depression (n = 772 articles; 69%), eating disorders (n = 135; 12%), anxiety disorders (n = 68; 6%), and bipolar disorder (n = 44; 4%), with rising publication rates and numbers of well-conducted randomized, controlled trials over time, justifying inclusion in consensus treatment guidelines. Research trends shifted from efficacy trials to effectiveness studies and population-based dissemination initiatives. Process research examined correlates of improvement and efficacy moderators. Innovations included global initiatives, prevention trials, and digital, web-based training and treatment.

CONCLUSION

Sparked by clinical innovations and scientific advances, IPT has evolved as an effective treatment of psychiatric disorders across the lifespan for diverse patients, including underserved clinical populations. Future research to elucidate mechanisms of change, improve access, and adapt to changing frameworks of psychopathology and treatment planning is needed. IPT addresses the universal centrality of relationships to mental health, which is as relevant today as it was over 40 years ago.

Dos and Don'ts in Treatments of Patients With Narcissistic Personality Disorder

This article identifies guiding principles in effective psychotherapies of patients with narcissistic personality disorder (NPD) and cautions against some common pitfalls. Individual psychotherapies of NPD patients were examined by both authors, who tested whether or not some principles, recommended in the literature, effectively promote these therapies and help these patients in moving forward with their lives and with effective therapy use. The authors identify a number of principles that were associated with more positive therapy development: helping patients identify goals and direction of their therapies, promoting a sense of agency, promoting a shift of focus to sense of vulnerability, and anticipating difficulty in developing and maintaining the treatment alliance. Common mistakes in these treatments are engaging in a power struggle with the patient, overindulging the grandiosity of the patient, directly challenging the grandiosity of the patient, and ignoring treatment-interfering behaviors. Identification of principles of effective therapies with NPD patients can help with the development of more effective treatment approaches for NPD.

Identifying pathways to quitting smoking via telemedicine-delivered care

OBJECTIVE

A randomized controlled trial of quitline-like phone counseling (QL) versus telemedicine integrated into primary care (ITM) compared the effectiveness of these modalities for smoking cessation. Study design and components were based on self-determination theory (SDT). The purpose of this study was to test our SDT-based model in which perceived health care provider autonomy support, working alliance, autonomous motivation, and perceived competence were hypothesized to mediate the effects of ITM on smoking cessation.

METHOD

Rural smokers (n = 560) were randomized to receive 4 sessions over a 3-month period of either QL or ITM. Follow-up assessments were conducted at Months 3, 6, and 12. The primary outcome was biochemically verified 7-day point prevalence at 12 -months. Structural equation modeling with latent change scores was used for the analysis.

RESULTS

Participants in the ITM condition reported greater increases in perceived health care provider autonomy support (PAS) at end of treatment, which in turn was associated with enhanced perceived competence to quit smoking (PC). Increased PC was associated with a higher likelihood of cessation at 12-months. Mediation analysis demonstrated significant indirect effects, including a path from ITM to increases in PAS to increases in PC to cessation at 12-months (indirect effect = 0.0183, 95% confidence interval [.003, .0434]).

CONCLUSIONS

When integrated into primary care, ITM may influence smoking cessation by enhancing the extent to which smokers feel supported by their providers and thereby increase their perceived ability to quit. Findings suggest that locating tobacco treatment services in health care provider offices imparts a motivational benefit for cessation. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Longitudinal Analysis of Factors Associated with Therapeutic Alliances

This study examined the impact, on therapeutic alliances, made by client motivation to change, insight, mistrust, and other factors; as well as therapist's clinical experience. This secondary data analysis used a sample of 212 client respondents extracted from the Treatment of Depression Collaborative Research Program's data set. Results of generalized least squares random-effects modeling showed a significant impact exerted by client social-adjustment difficulties, insight, alcohol use, and gender; and client-therapist matching gender. Also, four elements of therapeutic alliances-regard, empathic understanding, unconditionality, and congruence-had four unique patterns of significant factors. To foster therapeutic alliances, therapists need to help clients develop awareness of and insight into the clients' social-adjustment difficulties; therapists should also be particularly sensitive to expectations of clients of the opposite sex. Implications for future research are suggested.

Changes in Psychological Need Fulfillment Over the Course of Treatment for Major Depressive Disorder

Self-determination theory (Ryan & Deci, 2017) maintains that the psychological needs for autonomy, competence, and relatedness are essential qualities of experience that individuals require to thrive. The present research examined the role of psychological need fulfillment in a clinical sample undergoing treatment for major depressive disorder. Fifty-one patients with a SCID-IV diagnosis for major depressive disorder were randomly assigned to 16 weeks of cognitive behavioral therapy or antidepressant medication. Depressive symptoms, cognitive errors, dysfunctional attitudes, and psychological need fulfillment were assessed at four time points (pre-treatment, week 4, week 8, and week 16). Psychological need fulfillment increased over the course of treatment and did not differ significantly between treatment conditions. Furthermore, increases in psychological need fulfillment were associated with decreases in depression severity over and above the effects of time, cognitive errors, and dysfunctional attitudes. Given the incremental predictive validity of need fulfillment, a better understanding of its role in the treatment for depression may prove beneficial to mental health researchers and practitioners.

A self-determination approach to the understanding of the impact of physical activity on depressive symptoms

The purpose was to test a new motivational sequence. It was hypothesized that more autonomous forms of motivation would predict the intensity of physical activity (PA), which in turn, would predict depressive symptoms. In order to evaluate self-determined motivation, the Self-Determination Index (SDI) was used. Because the reasons that can lead a person to engage in walking, moderate PA, or vigorous PA may be different, 3 independent self-determination indexes were measured (SDIWalking, SDIModerate, and SDIVigorous). It was also measured the metabolic equivalent of task values (METs) for walking, moderate, and vigorous PA, as well as the depressive symptoms. The sample consisted of 357 college students whose ages ranged from 18 to 29 years. Structural equation modeling was used to test the hypothesized model. The indices of fit showed that the revised model fits the data reasonably well: S-Bχ²₍₁₁₎  = 14.83, p = .190; χ² /df = 1.35; *comparative fit index = .99; *root mean square error of approximation = .03, 90% CI [.000, .068]; standardised root mean square residual = .03. It was found that vigorous PA is the only intensity that predicts depressive symptoms. In other words, SDIV-predicted vigorous PA (measured as MET_S V), which subsequently predicted less depressive symptoms (SDIV → MET_S V → Depressive symptoms). Further research should investigate the effects of vigorous PA on depressive symptoms.

Assessing vocational outcome expectancy in individuals with serious mental illness: a factor-analytic approach

Background: Self-determination theory (SDT) and self-efficacy theory (SET) can be used to conceptualize self-determined motivation to engage in mental health and vocational rehabilitation (VR) services and to predict recovery. To incorporate SDT and SET as a framework for vocational recovery, developing and validating SDT/SET measures in vocational rehabilitation is warranted. Outcome expectancy is an important SDT/SET variable affecting rehabilitation engagement and recovery.Aims: The purpose of this study was to validate the Vocational Outcome Expectancy Scale (VOES) for use within the SDT/SET vocational recovery framework.Methods: One hundred and twenty-four individuals with serious mental illness (SMI) participated in this study. Measurement structure of the VOES was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).Results: Both EFA and CFA results supported a two-factor structure: (a) positive outcome expectancy, and (b) negative outcome expectancy. The internal consistency reliability coefficients for both factors were acceptable. In addition, positive outcome expectancy correlated stronger than negative outcome expectancy with other SDT/SET constructs in the expected directions.Conclusions: The VOES is a brief, reliable and valid instrument for assessing vocational outcome expectancy in individuals with SMI that can be integrated into SDT/SET as a vocational rehabilitation engagement and recovery model in psychiatric rehabilitation.

Exercise and Epstein's TARGET for treatment of depressive symptoms: A randomized study

This study was designed with a dual goal: (1) to compare the change in the scores of depressive symptoms by means of the implementation of three intervention programs in comparison to a control group: a) based on Epstein's TARGET (ET), b) without TARGET strategies (NET), and c) under conditions of active exercise (AE); and (2) to analyze whether the Self-determination Index (SDI) predicts the reduction of depressive symptoms. The participants (N = 106; 68 females and 38 males), aged between 18-30 years, were randomly assigned to one of the groups. Each treatment lasted 8 weeks (3 hours/week). Of the ET participants, 59.26% showed a therapeutic response, defined as a 50% reduction in the reference score, versus 25.93% for the NET, 19.23% for the AE, and 3.84% for the control group. After six months, the ET group increased their percentage of therapeutic response by slightly more than 10%, which did not occur in the other groups. SDI predicted lower levels of depressive symptoms, and our findings indicate that TARGET strategies can have a direct effect on depressive symptoms at the time of intervention and an indirect effect at a later stage due to their impact on future levels of physical activity.

The ability of early changes in motivation to predict later antidepressant treatment response

INTRODUCTION

Baseline values and early changes of emotional reactivity, cognitive speed, psychomotor function, motivation, and sensory perception have not been studied to any extent in unipolar depression, although they could help to characterize different dimensions of illness that are harder to capture by clinicians, give new insights on how patients improve, and offer new early clinical markers for later treatment response.

METHODS

About 1,565 adult outpatients with major depressive disorder receiving agomelatine completed the clinician-rated 16-item quick inventory of depressive symptoms, Clinical Global Impression, and Multidimensional Assessment of Thymic States (MAThyS) rating scales at inclusion, Week 2 and Week 6. The MAThyS includes a 20-item self-rated visual analog scale (from inhibition [0] to activation [10], with [5] representing the usual state) leading to five a priori dimensions (emotional reactivity, cognitive speed, psychomotor function, motivation, and sensory perception).

RESULTS

All MAThyS dimension scores increased from inclusion to Week 2 and from inclusion to Week 6 (P<0.001). Improvement was around 2 points (out of 10) for motivation, 1.5 points for psychomotor function, and 0.5 points for other dimensions. Motivation showed a trend to being more severely impaired at inclusion in future nonresponders (t=1.25, df=1,563, P=0.10). Its improvement at Week 2 was the most discriminating MAThyS dimension between future responders and nonresponders, and represents the best predictor of future response, with the highest area under the receptor operating characteristic curve (area under curve =0.616, 95% confidence interval [0.588-0.643], P<0.001). Finally, improvements in motivation correlated the most strongly with clinician-rated 16-item quick inventory of depressive symptoms improvement (r=-0.491, df=1,563, P<0.001).

CONCLUSION

Motivation had the most capacity for early improvement, the best predictive value for response, and the largest global margin of progress in depressed outpatients. Assessing the evolution of self-reported motivation over time in major depressive disorder could offer an interesting complementary approach to predict response.

The working alliance in group counseling: an exploratory study

The working alliance is a well-defined component of the therapeutic relationship. The present exploratory study examined the development of the working alliance within a group counseling context. The participants (N = 50) were students in a graduate program in mental health counseling taking an experiential training course in group dynamics. Participants rated their perceptions of the working alliance at the end of each session in a time-limited training group. Group members' perceptions of their alliance with the group leader and the group as a whole were positively correlated. Outcomes of the group experience were strongly related to the perceived strength of the working alliance as early as the fourth session. Outcomes were also positively correlated with the bonding and agreement-on-goals aspects of the working alliance, but not with the group tasks aspect. The more that group members reported strong working alliances, the more they tended to report that they had self-disclosed in the group.

Measures of motivation for psychiatric treatment based on self-determination theory: psychometric properties in Dutch psychiatric outpatients

Self-determination theory is potentially useful for understanding reasons why individuals with mental illness do or do not engage in psychiatric treatment. The current study examined the psychometric properties of three questionnaires based on self-determination theory-The Treatment Entry Questionnaire (TEQ), Health Care Climate Questionnaire (HCCQ), and the Short Motivation Feedback List (SMFL)-in a sample of 348 Dutch adult outpatients with primary diagnoses of mood, anxiety, psychotic, and personality disorders. Structural equation modeling showed that the empirical factor structures of the TEQ and SMFL were adequately represented by a model with three intercorrelated factors. These were interpreted as identified, introjected, and external motivation. The reliabilities of the Dutch TEQ, HCCQ, and SMFL were found to be acceptable but can be improved on; congeneric estimates ranged from 0.66 to 0.94 depending on the measure and patient subsample. Preliminary support for the construct validities of the questionnaires was found in the form of theoretically expected associations with other scales, including therapist-rated motivation and treatment engagement and with legally mandated treatment. Additionally, the study provides insights into the relations between measures of motivation based on self-determination theory, the transtheoretical model and the integral model of treatment motivation in psychiatric outpatients with severe mental illness.