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Scholten S, Schemer L, Herzog P, Haas JW, Heider J, Winter D, Reis D, Glombiewski JA. Leveraging Single-Case Experimental Designs to Promote Personalized Psychological Treatment: Step-by-Step Implementation Protocol with Stakeholder Involvement of an Outpatient Clinic for Personalized Psychotherapy. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:702-724. [PMID: 38467950 PMCID: PMC11379774 DOI: 10.1007/s10488-024-01363-5] [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] [Accepted: 02/27/2024] [Indexed: 03/13/2024]
Abstract
Our objective is to implement a single-case experimental design (SCED) infrastructure in combination with experience-sampling methods (ESM) into the standard diagnostic procedure of a German outpatient research and training clinic. Building on the idea of routine outcome monitoring, the SCED infrastructure introduces intensive longitudinal data collection, individual effectiveness measures, and the opportunity for systematic manipulation to push personalization efforts further. It aims to empower psychotherapists and patients to evaluate their own treatment (idiographic perspective) and to enable researchers to analyze open questions of personalized psychotherapy (nomothetic perspective). Organized around the principles of agile research, we plan to develop, implement, and evaluate the SCED infrastructure in six successive studies with continuous stakeholder involvement: In the project development phase, the business model for the SCED infrastructure is developed that describes its vision in consideration of the context (Study 1). Also, the infrastructure's prototype is specified, encompassing the SCED procedure, ESM protocol, and ESM survey (Study 2 and 3). During the optimization phase, feasibility and acceptability are tested and the infrastructure is adapted accordingly (Study 4). The evaluation phase includes a pilot implementation study to assess implementation outcomes (Study 5), followed by actual implementation using a within-institution A-B design (Study 6). The sustainability phase involves continuous monitoring and improvement. We discuss to what extent the generated data could be used to address current questions of personalized psychotherapy research. Anticipated barriers and limitations during the implementation processes are outlined.
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Affiliation(s)
- Saskia Scholten
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany.
| | - Lea Schemer
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Philipp Herzog
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
- Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
| | - Julia W Haas
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Jens Heider
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Dorina Winter
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
| | - Dorota Reis
- Applied Statistical Modeling, Universität des Saarlandes, Campus, 66123, Saarbrücken, Germany
| | - Julia Anna Glombiewski
- Department of Psychology, Pain and Psychotherapy Research Lab, RPTU Kaiserslautern-Landau, Ostbahnstr. 10, 76829, Landau, Germany
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Norman-Nott N, Hesam-Shariati N, Wewege MA, Rizzo RRN, Cashin AG, Wilks CR, Quidé Y, McAuley JH, Gustin SM. Emotion regulation skills-focused interventions for chronic pain: A systematic review and meta-analysis. Eur J Pain 2024. [PMID: 38558425 DOI: 10.1002/ejp.2268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/07/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES To investigate the effect of emotion regulation skills-focused (ERSF) interventions to reduce pain intensity and improve psychological outcomes for people with chronic pain and to narratively report on safety and intervention compliance. METHODS Six databases and four registries were searched for randomized controlled trials (RCTs) up to 29 April 2022. Risk of bias was evaluated using the Cochrane RoB 2.0 tool, and certainty of evidence was assessed according to the Grading, Assessment, Development and Evaluation (GRADE). Meta-analyses for eight studies (902 participants) assessed pain intensity (primary outcome), emotion regulation, affect, symptoms of depression and anxiety, and pain interference (secondary outcomes), at two time points when available, post-intervention (closest to intervention end) and follow-up (the first measurement after the post-intervention assessment). RESULTS Compared to TAU, pain intensity improved post-intervention (weighted mean difference [WMD] = -10.86; 95% confidence interval [CI] [-17.55, -2.56]) and at follow-up (WMD = -11.38; 95% CI [-13.55, -9.21]). Emotion regulation improved post-intervention (standard mean difference [SMD] = 0.57; 95% CI [0.14, 1.01]), and depressive symptoms improved at follow-up (SMD = -0.45; 95% CI [-0.66, -0.24]). Compared to active comparators, anxiety symptoms improved favouring the comparator post-intervention (SMD = 0.10; 95% CI [0.03, 0.18]), and compared to CBT, pain interference improved post-intervention (SMD = -0.37; 95% CI [-0.69, -0.04]). Certainty of evidence ranged from very low to moderate. SIGNIFICANCE The findings provide evidence that ERSF interventions reduce pain intensity for people with chronic pain compared to usual treatment. These interventions are at least as beneficial to reduce pain intensity as the current gold standard psychological intervention, CBT. However, the limited number of studies and certainty of evidence mean further high-quality RCTs are warranted. Additionally, further research is needed to identify whether ERSF interventions may be more beneficial for specific chronic pain conditions.
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Affiliation(s)
- Nell Norman-Nott
- NeuroRecovery Research Hub, School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Negin Hesam-Shariati
- NeuroRecovery Research Hub, School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Michael A Wewege
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rodrigo R N Rizzo
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Aidan G Cashin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Chelsey R Wilks
- Department of Psychological Science, University of Missouri-St Louis, St. Louis, Missouri, USA
| | - Yann Quidé
- NeuroRecovery Research Hub, School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - James H McAuley
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- School of Health Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sylvia M Gustin
- NeuroRecovery Research Hub, School of Psychology, Faculty of Science, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
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Podolan M, Gelo OCG. The Functions of Safety in Psychotherapy: An Integrative Theoretical Perspective Across Therapeutic Schools. CLINICAL NEUROPSYCHIATRY 2023; 20:193-204. [PMID: 37554697 PMCID: PMC10405669 DOI: 10.36131/cnfioritieditore20230304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Objective There is a certain consensus in the psychotherapeutic literature that safety plays a central role in human development and psychotherapy and that lack of safety undermines mental health. However, the role of safety in psychotherapy has not yet been thoroughly examined. In this article, we identify and integrate the diferent functions of safety in psychotherapy on a theoretical basis. Method We made a panoramic overview of the concept of safety across some of the main psychotherapeutic schools that represent major paradigms in contemporary psychotherapy (psychodynamic, cognitive-behavioral, humanistic). We then analyzed, compared, and synthetized the findings to identify the common functions that safety plays both in ontogenesis and in clinical practice across different therapeutic orientations. Results Our analysis showed that safety is indeed rightly prioritized across psychotherapy schools because of its developmental value in promoting change and adaptation both in ontogenesis and clinical settings. The findings suggest that the main functions of safety are to secure survival, facilitate restoration, promote exploration, sustain risk-taking, and enable integration, with these functions being complementary and dependent on the context. However, safety seems to be in a dialectical and paradoxical relationship to psychotherapy and human development. Adequate ontogenetic development and treatment progress do not appear to require continuous maintenance of maximum possible safety. Rather, they seem to require enough safety, adequately and timely modulated according to developmental needs and treatment phases. Conclusions Although safety provides the necessary basis that enables restoration, fuels exploration, and facilitates treatment progress, safety's misdosage (e.g., lack, excess), misconstruction (e.g., misattunement, misinterpretation), or misuse (exploitation, idealization) may hinder the healthy development of attachment, identity, autonomy, self/co-regulation as well as the ability to tolerate and cope with dangers, risks, insecurities, or frustrations. Future research is suggested to further explore the role of safety in psychotherapy.
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Affiliation(s)
- Martin Podolan
- Faculty of Psychotherapy Science, Sigmund Freud University, Freudplatz 1, 1020 Vienna (Austria)
| | - Omar C. G. Gelo
- Faculty of Psychotherapy Science, Sigmund Freud University, Freudplatz 1, 1020 Vienna (Austria)
- Department of History, Society and Human Studies, University of Salento, Via di Valesio SNC, 73100, Lecce (Italy)
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Mohorić T, Pokrajac-Bulian A, Anić P, Kukić M, Mohović P. Emotion regulation, perfectionism, and eating disorder symptoms in adolescents: the mediating role of cognitive eating patterns. CURRENT PSYCHOLOGY 2022; 42:1-12. [PMID: 36406848 PMCID: PMC9644388 DOI: 10.1007/s12144-022-03824-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/14/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022]
Abstract
Poor emotion regulation, along with elevated perfectionism, is recognised as a risk factor for the development of eating disorder (ED) symptoms. Therefore, the aim of our study was to examine the relationship between emotion regulation difficulties and perfectionism with ED symptoms, while controlling for emotional eating, uncontrolled eating, and cognitive restraint as mediators. In total, 482 adolescents (246 girls and 236 boys; M = 15.00, SD = 0.31) participated in this study. Based on the participants' body height and weight measured by the medical team during their regular preventive health examinations, the body mass index (BMI) was calculated. Participants also answered the Difficulties in Emotion Regulation Scale, Multidimensional Perfectionism Scale, Three-Factor Eating Questionnaire, and Eating Disorder Examination Questionnaire. According to the results obtained, adolescent girls in our sample reported more difficulties in emotion regulation, more uncontrolled and emotional eating, and more ED symptoms. A significant direct effect was found for difficulties in emotion regulation and ED symptoms but not for perfectionism. In addition, only emotional eating and cognitive restraint (not uncontrolled eating) mediated the relationship between difficulties in emotion regulation and perfectionism and ED symptoms. The results suggest that difficulties in emotion regulation may be more important than perfectionism in explaining ED symptoms in a sample of healthy adolescents. When adolescents experience problems in emotion regulation in combination with emotional or uncontrolled eating, they might be at a higher risk of experiencing concerns about weight and a variety of other ED symptoms, and this should be considered when planning preventive interventions for adolescents.
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Affiliation(s)
- Tamara Mohorić
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Sveučilišna avenija 4, 51 000 Rijeka, Croatia
| | - Alessandra Pokrajac-Bulian
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Sveučilišna avenija 4, 51 000 Rijeka, Croatia
| | - Petra Anić
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Sveučilišna avenija 4, 51 000 Rijeka, Croatia
| | - Miljana Kukić
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Sveučilišna avenija 4, 51 000 Rijeka, Croatia
| | - Patrizia Mohović
- Faculty of Humanities and Social Sciences, Department of Psychology, University of Rijeka, Sveučilišna avenija 4, 51 000 Rijeka, Croatia
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Russo A, Santoro G, Schimmenti A. Interpersonal Guilt and Problematic Online Behaviors: The Mediating Role of Emotion Dysregulation. CLINICAL NEUROPSYCHIATRY 2022; 19:236-247. [PMID: 36101646 PMCID: PMC9442854 DOI: 10.36131/cnfioritieditore20220406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The positive association between problematic Internet use (PIU) and emotion dysregulation (ED) is well documented. Research has also found that interpersonal guilt is positively associated with ED. Nevertheless, the influence of interpersonal guilt on PIU has been scarcely examined. In the current study, we investigated the relationships among the three constructs, and tested if emotion dysregulation mediates the association between interpersonal guilt and different types of PIU, namely problematic online gaming, problematic social media use, and problematic online pornography use. METHOD A sample of 434 adult participants (210 males, 48.4%) aged between 18 and 69 years old completed self-reported measures on interpersonal guilt, ED, and PIU. A structural equation modeling (SEM) framework was used to test the mediation models. RESULTS SEM analyses showed that ED mediates the relationship between interpersonal guilt as antecedent, and problematic online gaming, problematic social media use, and problematic online pornography use as outcomes. CONCLUSIONS Our findings suggest that emotion dysregulation deriving from experiences of interpersonal guilt can amplify the risk of using gaming, social media, and online pornography in a problematic way. Implications for prevention and treatment of PIU are discussed.
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Affiliation(s)
- Angela Russo
- Department of Educational Sciences, University of Catania, Catania, Italy,Corresponding author Dr. Angela Russo, Department of Educational Sciences, University of Catania, Catania, Italy.
| | - Gianluca Santoro
- Faculty of Human and Social Sciences, UKE – Kore University of Enna, Enna, Italy
| | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE – Kore University of Enna, Enna, Italy
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