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Naim R, Dombek K, German RE, Haller SP, Kircanski K, Brotman MA. An Exposure-Based Cognitive-Behavioral Therapy for Youth with Severe Irritability: Feasibility and Preliminary Efficacy. J Clin Child Adolesc Psychol 2024; 53:260-276. [PMID: 37851393 PMCID: PMC11024061 DOI: 10.1080/15374416.2023.2264385] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Clinically impairing irritability and temper outbursts are among the most common psychiatric problems in youth and present transdiagnostically; however, few mechanistically informed treatments have been developed. Here, we test the acceptability, feasibility, and preliminary efficacy of a novel exposure-based treatment with integrated parent management skills for youth with severe irritability using a randomized between-subjects multiple baseline design. METHOD N = 41 patients (Age, Mean (SD) = 11.23 years (1.85), 62.5% male, 77.5% white) characterized by severe and impairing temper outbursts and irritability were randomized to different baseline observation durations (2, 4, or 6 weeks) prior to active treatment; 40 participants completed the 12 session treatment of exposure-based cognitive-behavioral therapy for irritability with integrated parent management skills. Masked clinician ratings were acquired throughout baseline and treatment phases, as well as 3- and 6-months post-treatment. To examine acceptability and feasibility, drop-out rates and adverse events were examined. Primary clinical outcome measures included clinician-administered measures of irritability severity and improvement. Secondary clinical outcome measures included multi-informant measures of irritability, depression, anxiety, and attention-deficit/hyperactivity disorder symptoms. RESULTS No patients dropped out once treatment began, and no adverse events were reported. Irritability symptoms improved during the active phase of treatment across all measurements (all βs > -0.04, ps < .011, Cohen's d range: -0.33 to -0.98). Treatment gains were maintained at follow-up (all βs(39) < -0.001, ps > .400). Sixty-five percent of patients were considered significantly improved or recovered post-treatment based on the primary clinician-rated outcome measure. CONCLUSIONS Results support acceptability, feasibility, and preliminary efficacy of this novel treatment for youth with severe irritability. Limitations and future directions are also discussed.
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Affiliation(s)
- Reut Naim
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Kelly Dombek
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Ramaris E. German
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Simone P. Haller
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of Mental Health, Bethesda, MD, USA
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Grasser LR, Erjo T, Goodwin MS, Naim R, German RE, White J, Cullins L, Tseng WL, Stoddard J, Brotman MA. Can peripheral psychophysiological markers predict response to exposure-based cognitive behavioral therapy in youth with severely impairing irritability? A study protocol. BMC Psychiatry 2023; 23:926. [PMID: 38082431 PMCID: PMC10712194 DOI: 10.1186/s12888-023-05421-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Irritability, an increased proneness to anger, is a primary reason youth present for psychiatric care. While initial evidence supports the efficacy of exposure-based cognitive behavioral therapy (CBT) for youth with clinically impairing irritability, treatment mechanisms remain unclear. Here, we propose to measure peripheral psychophysiological indicators of arousal-heart rate (HR)/electrodermal activity (EDA)-and regulation-heart rate variability (HRV)-during exposures to anger-inducing stimuli as potential predictors of treatment efficacy. The objective of this study is to evaluate whether in-situ biosensing data provides peripheral physiological indicators of in-session response to exposures. METHODS Blood volume pulse (BVP; from which HR and HRV canl be derived) and EDA will be collected ambulatorily using the Empatica EmbracePlus from 40 youth (all genders; ages 8-17) undergoing six in-person exposure treatment sessions, as part of a multiple-baseline trial of exposure-based CBT for clinically impairing irritability. Clinical ratings of irritability will be conducted at baseline, weekly throughout treatment, and at 3-month and 6-month follow-ups via the Clinical Global Impressions Scale (CGI) and the Affective Reactivity Index (ARI; clinician-, parent-, and child-report). Multilevel modeling will be used to assess within- and between-person changes in physiological arousal and regulation throughout exposure-based CBT and to determine whether individual differences are predictive of treatment response. DISCUSSION This study protocol leverages a wearable biosensor (Empatica) to continuously record HR/HRV (derived from BVP) and EDA during in-person exposure sessions for youth with clinically impairing irritability. Here, the goal is to identify changes in physiological arousal (EDA, HR) and regulation (HRV) over the course of treatment in tandem with changes in clinical symptoms. TRIAL REGISTRATION The participants in this study come from an overarching clinical trial (trial registration numbers: NCT02531893 first registered on 8/25/2015; last updated on 8/25/2023). The research project and all related materials were submitted and approved by the appropriate Institutional Review Board of the National Institute of Mental Health (NIMH).
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Affiliation(s)
- Lana Ruvolo Grasser
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Trinity Erjo
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Matthew S Goodwin
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Reut Naim
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ramaris E German
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Jamell White
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Cullins
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Joel Stoddard
- Department of Psychiatry and Biomedical Informatics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Melissa A Brotman
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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Naim R, Kircanski K, Gold A, German RE, Davis M, Perlstein S, Clayton M, Revzina O, Brotman MA. Across-subjects multiple baseline trial of exposure-based cognitive-behavioral therapy for severe irritability: a study protocol. BMJ Open 2021; 11:e039169. [PMID: 33692176 PMCID: PMC7949376 DOI: 10.1136/bmjopen-2020-039169] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 12/12/2020] [Accepted: 12/19/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Irritability is defined as a tendency towards anger in response to frustration. Clinically, impairing irritability is a significant public health problem. There is a need for mechanism-based psychotherapies targeting severe irritability as it manifests in the context of disruptive mood dysregulation disorder (DMDD). This study protocol describes a randomised multiple baseline design testing the preliminary efficacy of a new treatment, exposure-based cognitive-behavioral therapy for severe irritability in youth, which also integrates components of parent management training. We will investigate associations of this intervention with primary clinical measures, as well as ecological momentary assessment measures. METHODS AND ANALYSIS Forty youth will be enrolled. Participants, aged 8-17 years, must present at least one of two core symptoms of DMDD: abnormal mood or increased reactivity to negative emotional stimuli, with severe impairment in one domain (home, school, peers) and moderate in another, or moderate impairment in at least two domains. Each participant is randomised to a 2-week, 4-week or 6-week baseline observation period, followed by 12 active treatment sessions. Clinical ratings are conducted at baseline, biweekly (clinician), weekly (parent/child) throughout treatment, post-treatment, and 3-month and 6-month follow-up (clinician). Clinician ratings on the Affective Reactivity Index and Clinical Global Impressions-Improvement scale for DMDD are our primary outcome measures. Secondary outcome measures include parent and child reports of irritability. Post hoc additional symptom measures include clinician, parent and self-ratings of depression, anxiety and overall functional impairment. Prospective, digitally based event sampling of symptoms is acquired for a week pre-treatment, mid-treatment and post-treatment. Based on our pathophysiological model of irritability implicating frustrative non-reward, aberrant threat processing and instrumental learning, we probe these three brain-based targets using functional MRI paradigms to assess target engagement. ETHICS AND DISSEMINATION The research project and all related materials were submitted and approved by the appropriate Institutional Review Board (IRB) of the National Institute of Mental Health (NIMH). TRIAL REGISTRATION NUMBERS NCT02531893 and NCT00025935.
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Affiliation(s)
- Reut Naim
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Andrea Gold
- Pediatric Anxiety Research Center, Bradley Hospital, Riverside, Rhode Island, USA
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ramaris E German
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Mollie Davis
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Samantha Perlstein
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Michal Clayton
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Olga Revzina
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
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Zilcha-Mano S, Errázuriz P, Yaffe-Herbst L, German RE, DeRubeis RJ. Are there any robust predictors of “sudden gainers,” and how is sustained improvement in treatment outcome achieved following a gain? J Consult Clin Psychol 2019; 87:491-500. [DOI: 10.1037/ccp0000401] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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German RE, Adler A, Frankel SA, Stirman SW, Pinedo P, Evans AC, Beck AT, Creed TA. Testing a Web-Based, Trained-Peer Model to Build Capacity for Evidence-Based Practices in Community Mental Health Systems. Psychiatr Serv 2018; 69:286-292. [PMID: 29137558 DOI: 10.1176/appi.ps.201700029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Use of expert-led workshops plus consultation has been established as an effective strategy for training community mental health (CMH) clinicians in evidence-based practices (EBPs). Because of high rates of staff turnover, this strategy inadequately addresses the need to maintain capacity to deliver EBPs. This study examined knowledge, competency, and retention outcomes of a two-phase model developed to build capacity for an EBP in CMH programs. METHODS In the first phase, an initial training cohort in each CMH program participated in in-person workshops followed by expert-led consultation (in-person, expert-led [IPEL] phase) (N=214 clinicians). After this cohort completed training, new staff members participated in Web-based training (in place of in-person workshops), followed by peer-led consultation with the initial cohort (Web-based, trained-peer [WBTP] phase) (N=148). Tests of noninferiority assessed whether WBTP was not inferior to IPEL at increasing clinician cognitive-behavioral therapy (CBT) competency, as measured by the Cognitive Therapy Rating Scale. RESULTS WBTP was not inferior to IPEL at developing clinician competency. Hierarchical linear models showed no significant differences in CBT knowledge acquisition between the two phases. Survival analyses indicated that WBTP trainees were less likely than IPEL trainees to complete training. In terms of time required from experts, WBTP required 8% of the resources of IPEL. CONCLUSIONS After an initial investment to build in-house CBT expertise, CMH programs were able to use a WBTP model to broaden their own capacity for high-fidelity CBT. IPEL followed by WBTP offers an effective alternative to build EBP capacity in CMH programs, rather than reliance on external experts.
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Affiliation(s)
- Ramaris E German
- Dr. German, Dr. Adler, Ms. Pinedo, Dr. Beck, and Dr. Creed are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dr. Frankel is with the Columbia University Clinic for Anxiety and Related Disorders, Columbia University Medical Center, New York. Dr. Stirman is with the National Center for PTSD Dissemination and Training Division, U.S. Department of Veterans Affairs, Menlo Park, California, and with Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. Evans is with the American Psychological Association, Washington, D.C
| | - Abby Adler
- Dr. German, Dr. Adler, Ms. Pinedo, Dr. Beck, and Dr. Creed are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dr. Frankel is with the Columbia University Clinic for Anxiety and Related Disorders, Columbia University Medical Center, New York. Dr. Stirman is with the National Center for PTSD Dissemination and Training Division, U.S. Department of Veterans Affairs, Menlo Park, California, and with Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. Evans is with the American Psychological Association, Washington, D.C
| | - Sarah A Frankel
- Dr. German, Dr. Adler, Ms. Pinedo, Dr. Beck, and Dr. Creed are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dr. Frankel is with the Columbia University Clinic for Anxiety and Related Disorders, Columbia University Medical Center, New York. Dr. Stirman is with the National Center for PTSD Dissemination and Training Division, U.S. Department of Veterans Affairs, Menlo Park, California, and with Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. Evans is with the American Psychological Association, Washington, D.C
| | - Shannon Wiltsey Stirman
- Dr. German, Dr. Adler, Ms. Pinedo, Dr. Beck, and Dr. Creed are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dr. Frankel is with the Columbia University Clinic for Anxiety and Related Disorders, Columbia University Medical Center, New York. Dr. Stirman is with the National Center for PTSD Dissemination and Training Division, U.S. Department of Veterans Affairs, Menlo Park, California, and with Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. Evans is with the American Psychological Association, Washington, D.C
| | - Paola Pinedo
- Dr. German, Dr. Adler, Ms. Pinedo, Dr. Beck, and Dr. Creed are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dr. Frankel is with the Columbia University Clinic for Anxiety and Related Disorders, Columbia University Medical Center, New York. Dr. Stirman is with the National Center for PTSD Dissemination and Training Division, U.S. Department of Veterans Affairs, Menlo Park, California, and with Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. Evans is with the American Psychological Association, Washington, D.C
| | - Arthur C Evans
- Dr. German, Dr. Adler, Ms. Pinedo, Dr. Beck, and Dr. Creed are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dr. Frankel is with the Columbia University Clinic for Anxiety and Related Disorders, Columbia University Medical Center, New York. Dr. Stirman is with the National Center for PTSD Dissemination and Training Division, U.S. Department of Veterans Affairs, Menlo Park, California, and with Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. Evans is with the American Psychological Association, Washington, D.C
| | - Aaron T Beck
- Dr. German, Dr. Adler, Ms. Pinedo, Dr. Beck, and Dr. Creed are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dr. Frankel is with the Columbia University Clinic for Anxiety and Related Disorders, Columbia University Medical Center, New York. Dr. Stirman is with the National Center for PTSD Dissemination and Training Division, U.S. Department of Veterans Affairs, Menlo Park, California, and with Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. Evans is with the American Psychological Association, Washington, D.C
| | - Torrey A Creed
- Dr. German, Dr. Adler, Ms. Pinedo, Dr. Beck, and Dr. Creed are with the Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia. Dr. Frankel is with the Columbia University Clinic for Anxiety and Related Disorders, Columbia University Medical Center, New York. Dr. Stirman is with the National Center for PTSD Dissemination and Training Division, U.S. Department of Veterans Affairs, Menlo Park, California, and with Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California. Dr. Evans is with the American Psychological Association, Washington, D.C
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Creed TA, Frankel SA, German RE, Green KL, Jager-Hyman S, Taylor KP, Adler AD, Wolk CB, Stirman SW, Waltman SH, Williston MA, Sherrill R, Evans AC, Beck AT. Implementation of transdiagnostic cognitive therapy in community behavioral health: The Beck Community Initiative. J Consult Clin Psychol 2016; 84:1116-1126. [PMID: 27379492 PMCID: PMC5125881 DOI: 10.1037/ccp0000105] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Progress bringing evidence-based practice (EBP) to community behavioral health (CBH) has been slow. This study investigated feasibility, acceptability, and fidelity outcomes of a program to implement transdiagnostic cognitive therapy (CT) across diverse CBH settings, in response to a policy shift toward EBP. METHOD Clinicians (n = 348) from 30 CBH programs participated in workshops and 6 months of consultation. Clinician retention was examined to assess feasibility, and clinician feedback and attitudes were evaluated to assess implementation acceptability. Experts rated clinicians' work samples at baseline, mid-, and end-of-consultation with the Cognitive Therapy Rating Scale (CTRS) to assess fidelity. RESULTS Feasibility was demonstrated through high program retention (i.e., only 4.9% of clinicians withdrew). Turnover of clinicians who participated was low (13.5%) compared to typical CBH turnover rates, even during the high-demand training period. Clinicians reported high acceptability of EBP and CT, and self-reported comfort using CT improved significantly over time. Most clinicians (79.6%) reached established benchmarks of CT competency by the final assessment point. Mixed-effects hierarchical linear models indicated that CTRS scores increased significantly from baseline to the competency assessment (p < .001), on average by 18.65 points. Outcomes did not vary significantly between settings (i.e., outpatient vs. other). CONCLUSIONS Even clinicians motivated by policy-change rather than self-nomination may feasibly be trained to deliver a case-conceptualization driven EBP with high levels of competency and acceptability. (PsycINFO Database Record
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Affiliation(s)
- Torrey A. Creed
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Sarah A. Frankel
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Ramaris E. German
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Kelly L. Green
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Kristin P. Taylor
- Corporal Michael J. Crescenz Veteran's Administration Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104
| | - Abby D. Adler
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Courtney B. Wolk
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania. 3535 Market Street, Floor 3, Philadelphia, PA 19104
| | - Shannon W. Stirman
- Women's Health Sciences Division, National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, (116B-3), 150 South Huntington Avenue, Boston, 02130
| | - Scott H. Waltman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Michael A. Williston
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Rachel Sherrill
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
| | - Arthur C. Evans
- Philadelphia Department of Behavioral Health and Intellectual disAbility Services, 801 Market Street, Philadelphia, PA 19107
| | - Aaron T. Beck
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Floor 2, Philadelphia, PA 19104
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German RE, Lorenzo-Luaces L, DeRubeis RJ. Patient's Attributions about Symptom Improvement in CBT for Depression: Development of a Rating System and an Initial Test of Validity. Int J Cogn Ther 2014. [DOI: 10.1521/ijct.2014.7.3.272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Derubeis RJ, Gelfand LA, German RE, Fournier JC, Forand NR. Understanding processes of change: how some patients reveal more than others-and some groups of therapists less-about what matters in psychotherapy. Psychother Res 2013; 24:419-28. [PMID: 24219275 DOI: 10.1080/10503307.2013.838654] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE We identify difficulties researchers encounter in psychotherapy process-outcome investigations, and we describe several limitations of the popular "variance accounted for" approach to understanding the effects of psychotherapy. METHODS & RESULTS Using data simulations, we show how the expected correlation between an excellent measure of therapy quality and outcome would be surprisingly small (approximately .25) under conditions likely to be common in psychotherapy research. Even when we modeled conditions designed to increase the likelihood that strong process-outcome relationships would be observed, we found that the expected correlations were still only in the modest range (.38-.51). CONCLUSIONS We discuss the implications of our analysis for the interpretation of process-outcome findings as well as for design considerations in future investigations.
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Affiliation(s)
- Robert J Derubeis
- a Department of Psychology , University of Pennsylvania , Philadelphia , PA , USA
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Wenze SJ, Gunthert KC, German RE. Biases in Affective Forecasting and Recall in Individuals With Depression and Anxiety Symptoms. Pers Soc Psychol Bull 2012; 38:895-906. [DOI: 10.1177/0146167212447242] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors used experience sampling to investigate biases in affective forecasting and recall in individuals with varying levels of depression and anxiety symptoms. Participants who were higher in depression symptoms demonstrated stronger (more pessimistic) negative mood prediction biases, marginally stronger negative mood recall biases, and weaker (less optimistic) positive mood prediction and recall biases. Participants who were higher in anxiety symptoms demonstrated stronger negative mood prediction biases, but positive mood prediction biases that were on par with those who were lower in anxiety. Anxiety symptoms were not associated with mood recall biases. Neither depression symptoms nor anxiety symptoms were associated with bias in event prediction. Their findings fit well with the tripartite model of depression and anxiety. Results are also consistent with the conceptualization of anxiety as a “forward-looking” disorder, and with theories that emphasize the importance of pessimism and general negative information processing in depressive functioning.
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Loughead JW, Luborsky L, Weingarten CP, Krause ED, German RE, Kirk D, Gur RC. Brain activation during autobiographical relationship episode narratives: a core conflictual relationship theme approach. Psychother Res 2010; 20:321-36. [PMID: 20099204 DOI: 10.1080/10503300903470735] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The authors combined the core conflictual relationship theme (CCRT) method and functional magnetic resonance imaging (fMRI) to identify brain regions involved in recall of autobiographical relationship episodes, a key process in psychotherapy. Relationship narratives were obtained from healthy subjects and scored for CCRT relationship themes and emotion. Autobiographical personal and nonautobiographical control narratives were presented in a block-design fMRI experiment. Personal versus control narratives showed activations in anterior cingulate, precuneus, inferior and middle frontal gyri, and inferior parietal lobule. These are regions involved in autobiographical memory, theory of mind, self-referential processing, and emotion. In an exploratory analysis, higher CCRT scores correlated with increased brain activation in the left hippocampus, parahippocampal gyrus, and middle occipital gyrus. This suggests that brain systems subserving memory processes are more active when recalling relationship episodes with greater CCRT content.
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Affiliation(s)
- James W Loughead
- Department of Psychiatry, University of Pennsylvania, Gates Building, 10th floor, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Abstract
Several studies have shown that body satisfaction affects interpersonal functioning. However, few have studied the specific interpersonal correlates of another important body image dimension, appearance investment—that is, the importance a woman places on appearance. We used an experience sampling design with PDA (personal digital assistant) devices to assess how 92 college women's appearance investment is related to perceptions of everyday social interactions and to investigate the association of these perceptions with mood and self-esteem. For 1 week, participants completed electronic diaries of their mood, self-esteem, and perceptions of one-on-one interactions. High appearance investment was associated with a stronger relationship between perceived communion of the interaction and negative mood and self-esteem. Notably, highly appearance-invested women did not report differences in average momentary levels of perceived communion or agency in interactions, negative mood, or self-esteem when compared to women with lower appearance investment. In contrast, women with low body satisfaction reported lower average perceptions of communion and self-esteem as well as higher average negative mood compared to women with higher body satisfaction, but no relationships among perceptions and self-esteem and mood were found. Thus, self-esteem and negative mood in women high in appearance investment might be contingent on perceptions of communion in interactions, even though they appear to have average levels of mood and self-esteem in general. This mood and self-esteem contingency could predispose appearance-invested women to psychological distress or eating pathology.
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Affiliation(s)
- Nicholas R. Forand
- Nicholas R. Forand, Kathleen C. Gunthert, Ramaris E. German, and Susan J. Wenze, Department of Psychology, American University
| | - Kathleen C. Gunthert
- Nicholas R. Forand, Kathleen C. Gunthert, Ramaris E. German, and Susan J. Wenze, Department of Psychology, American University
| | - Ramaris E. German
- Nicholas R. Forand, Kathleen C. Gunthert, Ramaris E. German, and Susan J. Wenze, Department of Psychology, American University
| | - Susan J. Wenze
- Nicholas R. Forand, Kathleen C. Gunthert, Ramaris E. German, and Susan J. Wenze, Department of Psychology, American University
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Abstract
This is a dedicated review of the evidence for the relation of having a period of psychotherapy and then comparing it with a measure of improved physical health. We aimed to make it the first intended-to-be-complete review of this type. Three inter-related types of studies were examined: Type 1: reduction in physical illnesses through psychotherapy, especially for the patient's survival time during the interval between diagnosis and an end point, Type 2: reduction in pain in relation to receiving psychotherapy, and Type 3: reduction in costs of treatment in relation to receiving psychotherapy. To find the relevant studies on these topics, we performed a literature search using both Psychinfo and Medline databases. An average of the effect sizes under each type was taken to calculate the mean effect size along with its confidence interval. Our results (1) on survival time for the combined severe patients, did not reach even the lowest significant level of effect size, although the low severity patients seemed to fit the hypothesis better, but the other two reduction topics, (2) and (3), clearly did achieve it.
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Affiliation(s)
- Lester Luborsky
- Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 6thh Floor, Philadelphia, PA 19104, USA.
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