Do psychologically-minded clients expect more from counselling?

Efficacy of Intellect's self-guided anxiety and worry mobile health programme: A randomized controlled trial with an active control and a 2-week follow-up

Digital self-guided mobile health [mHealth] applications are cost-effective, accessible, and well-suited to improve mental health at scale. This randomized controlled trial [RCT] evaluated the efficacy of a recently developed mHealth programme based on cognitive-behavioral therapy [CBT] principles in improving worry and anxiety. We also examined psychological mindedness [PM] as a mediator by which app engagement is thought to improve outcomes. The Intervention group completed a 2-week "Anxiety and Worry" programme with daily CBT-informed activities, while the active waitlist-control completed a matched 2-week mHealth programme on procrastination. Participants filled out the Generalized Anxiety Disorder [GAD-7], Patient Health Questionnaire [PHQ-9], and Psychological Mindedness Scale [PMS] at baseline, post-intervention, and 2-week follow-up. App engagement was measured at post-intervention only. Contrary to prediction, the Intervention group did not perform better than the Active Control group; both groups showed significant improvements on anxiety and depressive symptoms from baseline to follow-up. From post-intervention to follow-up, only the Intervention group showed further improvements for anxiety symptoms. Higher engagement with the mHealth app predicted lower anxiety and depressive symptoms at follow-up, and this relationship was fully mediated by psychological mindedness. This study provides evidence that [a] engaging in a CBT mHealth programme can reduce anxiety and worry, and [b] Psychological mindedness is a potential pathway by which engaging with a mHealth app improves anxiety and depressive symptoms. While overall effect sizes were small, at the population level, these can make significant contributions to public mental health.

Participant factors as correlates of patients' psychotherapy outcome expectation: A meta-analytic and box-count review

OBJECTIVE

More positive pre- or early therapy patient outcome expectation (OE) has consistently correlated with better treatment outcomes. Thus, it is important to identify factors that contribute to patients' OE, which can inform therapist responsivity to such risk or facilitative markers. With growing research on OE correlates-centered primarily on patient characteristics/treatment factors and, to a lesser extent, therapist factors-a comprehensive synthesis is warranted to elucidate replicated and mixed associations and stimulate further research. Accordingly, we set a pragmatic cutoff of k ≥ 5 for meaningful empirical aggregation of participant factor-OE associations; otherwise, we conducted box counts.

METHOD

We searched for articles published through March 2022 that included a clinical sample, a measure of patient's pre- or early treatment OE, and an explicit test of the factor-OE association.

RESULTS

Patient problem severity, problem chronicity, education, age, and quality of life were meta-analyzed. Greater severity correlated with lower/less optimistic OE (r = -0.13, p < .001) and higher QOL correlated with higher/more optimistic OE (r = 0.18, p < .001). Box counts revealed that few variables had consistent associations with OE.

CONCLUSIONS

Some factors can help forecast patient OE, though additional research is needed to enhance confidence and clinical meaning.

The impact of outcome expectancy on therapy outcome in adolescents with borderline personality disorder

BACKGROUND

Outcome expectancy has been found to be a significant predictor of psychotherapy outcome. However, given that severity, chronicity and comorbidity are moderators of outcome expectancy, it is important to provide evidence of whether the same holds true in clinical conditions marked by these attributes, such as in borderline personality disorder (BPD). The aim of the present study was to investigate the role of patients' outcome expectancy in adolescents undergoing early intervention for BPD using pre-post difference of psychosocial functioning as outcome.

METHODS

Forty-four adolescent BPD patients were treated with Dialectical Behavior Therapy for Adolescents (DBT-A) or Adolescent Identity Treatment (AIT). We investigated the effect of outcome expectancy on outcome with type of treatment as moderator. Based on the relevant literature, we assess the correlation between outcome expectancy and pretreatment symptomatology, namely BPD severity, personality functioning, childhood trauma and depression.

RESULTS

The results showed a significant effect of expectancy on outcome (stand. β = 0.30, p = 0.020) above autoregression. ANOVA analysis revealed no difference between the two treatments. Further, results indicate that pretreatment symptomatology, i.e., depression, childhood trauma and personality functioning dimensions self-direction and intimacy, are associated with early treatment expectancy.

CONCLUSION

Outcome expectancy as a common factor plays a key role in successful psychotherapy with adolescent BPD patients. Elevated pretreatment depression, childhood trauma and impairment in personality functioning dimensions self-direction and intimacy are risk factors associated with lower expectancy. Low outcome expectancy should be addressed in early psychotherapy to improve the therapeutical process.

The relative association between individual difference variables and general psychotherapy outcome expectation in socially anxious individuals

OBJECTIVE

Although patients' psychotherapy outcome expectation relates to their treatment outcome, little is known about correlates of this expectation. Moreover, the limited research has largely assessed convenience variables as correlates, with little replication and few examinations of the relative strength of associations between the correlates and outcome expectation. This clinical analogue study examined the relation between socially anxious undergraduates' (N = 178) characteristics and their general psychotherapy outcome expectation. We investigated characteristics supported as correlates in prior studies.

METHODS

Data derived from a baseline assessment prior to a larger experiment. Participants' mean level of social anxiety was within 1 standard deviation of the mean of clinical, treatment-seeking samples, and 65.2% of the sample either had therapy experience or were actively considering it.

RESULTS

Participants' general outcome expectation was significantly associated with positive beliefs about and intention to seek therapy. Multivariate regression models showed a positive association between psychological mindedness (B = .59, p < .001) and outcome expectation. Subgroup analyses indicated that for participants with prior therapy experience, greater satisfaction with that treatment (B = 5.26, p < .001) was associated with higher outcome expectation.

CONCLUSION

Results are discussed with regard to their implications for treatment-seeking intentions and treatment planning.

Psychotherapy role expectations and experiences - discrepancy and therapeutic alliance among patients with substance use disorders

OBJECTIVES

The main aim of the study was to examine how the discrepancy between role expectations prior to psychotherapy and experiences of ongoing psychotherapy related to therapeutic alliance. We hypothesized that a similarity between patient role expectations and experiences would be associated with a stronger alliance. The study also examined whether different dimensions of psychotherapy role expectations predicted retention in psychotherapy.

DESIGN

A naturalistic study design was used with data collected prior to therapy and during the first 6 months of therapy.

METHOD

Patients with substance use disorders completed the Psychotherapy Expectation Questionnaire-short version (PEX-S) at the time of therapy assessment. A subsample of these patients (n = 41; n = 24 in individual therapy and n = 17 in group therapy) provided data from therapy including psychotherapy experiences (also measured with PEX-S) and therapeutic alliance, measured with Working Alliance Questionnaire-short version.

RESULTS

For patients in group therapy, discrepancy between role expectations and experiences correlated negatively with alliance. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention.

CONCLUSION

The finding that disconfirmation of patients' role expectations in group therapy were associated with weaker therapeutic alliance highlights the importance of discussing psychotherapy expectations at an early stage in treatment. Expectations characterized by defensiveness predicted worse retention in psychotherapy, which indicates that the PEX-S can be helpful in detecting patients at risk for dropout.

PRACTITIONER POINTS

In targeting a patient's role expectancies prior to treatment, possible discrepancies between patient and therapist are made visible and possible to examine. Clarifying the patient's role expectations and the therapist's rationale might be a first step towards establishing a strong working alliance. Surveying the patient's defensiveness tendencies at the beginning of therapy offers a chance to discuss possible fears and other obstacles concerning therapy. Discrepancy between the patient's role expectations prior to treatment and their actual experiences of psychotherapy render valuable information that can be of use in the therapy process.