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Emotional changes and outcomes in psychotherapy: A systematic review and meta-analysis. 心理治疗中的情绪变化与疗效:系统回顾和荟萃分析。
IF 4.5 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2024-09-01 Epub Date: 2023-05-11 DOI: 10.1037/ccp0000814
Nils M Sønderland, Ole A Solbakken, Dag E Eilertsen, Magnus Nordmo, Jon T Monsen

Objective: This systematic review and meta-analysis summarize current knowledge on emotional change processes and mechanisms and their relationship with outcomes in psychotherapy.

Method: We reviewed the main change processes and mechanisms in the literature and conducted meta-analyses of process/mechanism-outcome associations whenever methodologically feasible.

Results: A total of 121 studies, based on 92 unique samples, met criteria for inclusion. Of these, 85 studies could be subjected to meta-analysis. The emotional change processes and mechanisms most robustly related to improvement were fear habituation across sessions in exposure-based treatment of anxiety disorders (r = .38), experiencing in psychotherapy for depression (r = .44), and emotion regulation in psychotherapies for patients with various anxiety disorders (r = .37). Common methodological problems were that studies often did not ascertain representative estimates of the processes under investigation, determine if changes in processes and mechanisms temporally preceded outcomes, disentangle effects at the within- and between-client levels, or assess contributions of therapists and clients to a given process.

Conclusions: The present study has identified a number of emotional processes and mechanisms associated with outcome in psychotherapy, most notably fear habituation, emotion regulation, and experiencing. A common denominator between these appears to be the habitual reorganization of maladaptive emotional perception. We view this as a central pan-theoretical change mechanism, the essence of which appears to be increased differentiation between external triggers and one's own affective responses, which facilitates tolerance for affective arousals and leads to improved capacity for adaptive meaning-making in emotion-eliciting situations. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

目的这篇系统性综述和荟萃分析总结了当前关于情绪变化过程和机制及其与心理治疗结果之间关系的知识:我们回顾了文献中的主要改变过程和机制,并在方法可行的情况下对过程/机制与结果之间的关系进行了荟萃分析:共有 121 项研究(基于 92 个独特样本)符合纳入标准。其中 85 项研究可以进行元分析。与病情改善关系最密切的情绪变化过程和机制是:焦虑症暴露疗法中各疗程的恐惧习惯化(r = .38)、抑郁症心理疗法中的体验(r = .44)以及各种焦虑症患者心理疗法中的情绪调节(r = .37)。常见的方法学问题是,研究往往不能确定所调查过程的代表性估计值,不能确定过程和机制的变化是否在时间上先于结果,不能区分患者内部和患者之间的影响,也不能评估治疗师和患者对特定过程的贡献:本研究发现了一些与心理治疗结果相关的情绪过程和机制,其中最主要的是恐惧习惯化、情绪调节和体验。这些过程的共同点似乎是习惯性地重组适应不良的情绪感知。我们认为这是一种核心的泛理论改变机制,其本质似乎是提高外部触发因素与自身情绪反应之间的区分度,从而促进对情绪唤醒的容忍度,并提高在情绪诱发情境中进行适应性意义建构的能力。(PsycInfo Database Record (c) 2024 APA, 版权所有)。
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引用次数: 0
Dynamic processes in behavioral activation therapy for anhedonic adolescents: Modeling common and patient-specific relations. 青少年享乐缺乏症行为激活疗法的动态过程:共同关系和患者特定关系的建模。
IF 4.5 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2024-08-01 Epub Date: 2023-06-05 DOI: 10.1037/ccp0000830
Christian A Webb, Laura Murray, Anna O Tierney, Kathleen M Gates

Objective: Behavioral activation (BA) is a brief intervention for depression encouraging gradual and systematic re-engagement with rewarding activities and behaviors. Given this treatment focus, BA may be particularly beneficial for adolescents with prominent anhedonia, a predictor of poor treatment response and common residual symptom. We applied group iterative multiple model estimation (GIMME) to ecological momentary assessment (EMA) treatment data to investigate common and person-specific processes during BA for anhedonic adolescents.

Method: Thirty-nine adolescents (Mage = 15.7 years old, 67% female, 81% White) with elevated anhedonia (Snaith-Hamilton Pleasure Scale) were enrolled in a 12-week BA trial, with weekly anhedonia assessments. EMA surveys were triggered every other week (2-3 surveys per day) throughout treatment assessing current positive affect (PA) and negative affect (NA), engagement in pleasurable activities and social interactions, anticipatory pleasure, rumination, and recent pleasurable and stressful experiences.

Results: A multilevel model revealed significant decreases in anhedonia, t(25.5) = -4.76, p < .001, over the 12-week trial. GIMME results indicated substantial heterogeneity in variable networks across patients. PA was the variable with the greatest number (22% of all paths vs. 11% for NA) of predictive paths to other symptoms (i.e., highest out-degree). Higher PA (but not NA) out-degree was associated with greater anhedonia improvement, t(25.8) = -2.22, p = .035.

Conclusions: Results revealed substantial heterogeneity in variable relations across patients, which may obscure the search for common processes of change in BA. PA may be a particularly important treatment target for anhedonic adolescents in BA. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

目的:行为激活(Behavioral activation, BA)是一种针对抑郁症的短期干预方法,鼓励患者逐渐、系统地重新参与有益的活动和行为。鉴于这种治疗重点,BA可能对有明显快感缺乏症的青少年特别有益,这是治疗反应差和常见残留症状的预测因子。我们将群体迭代多模型估计(GIMME)应用于生态瞬间评估(EMA)治疗数据,以研究青少年快感缺乏症BA期间的共同和个人特异性过程。方法:39名青少年(年龄15.7岁,67%女性,81%白人)快感缺缺性升高(Snaith-Hamilton快乐量表),参加为期12周的BA试验,每周进行快感缺缺性评估。在整个治疗过程中,每隔一周触发一次EMA调查(每天2-3次调查),评估当前的积极影响(PA)和消极影响(NA),参与愉快活动和社会互动,预期愉悦,反刍以及最近的愉快和压力体验。结果:在12周的试验中,多水平模型显示快感缺乏症显著降低,t(25.5) = -4.76, p < 0.001。GIMME结果表明,患者之间的可变网络存在很大的异质性。PA是其他症状预测路径(即最高输出度)最多的变量(占所有路径的22%,NA为11%)。较高的PA(而非NA)输出度与快感缺乏症改善程度相关,t(25.8) = -2.22, p = 0.035。结论:结果显示患者之间的变量关系存在很大的异质性,这可能会模糊对BA共同变化过程的研究。PA可能是BA中快感缺乏症青少年的一个特别重要的治疗靶点。(PsycInfo数据库记录(c) 2023 APA,版权所有)。
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引用次数: 0
The prognostic role of emotion regulation dynamics in the treatment of major depressive disorder. 情绪调节动态在重度抑郁障碍治疗中的预后作用。
IF 5.9 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-12-01 Epub Date: 2023-08-24 DOI: 10.1037/ccp0000835
Avigail Bar-Sella, Aviv Nof, Brian R Baucom, Pavel Goldstein, Sergei Romanov, Iryna Shpakouskaya, Dmitrii Kaplun, Sigal Zilcha-Mano

Objective: The potential prognostic role of emotion regulation in the treatment of major depressive disorder (MDD) has been highlighted by transtheoretical literature and supported by promising empirical findings. The majority of the literature is based on self-report observations at a single snapshot, thus little is known about the prognostic value of moment-to-moment dynamic evolvement of emotion. The present study is the first to examine the prognostic value of both intra- and interpersonal, moment-to-moment emotion regulation dynamics, and the potential moderating effect of the type of treatment.

Method: To assess the prognostic value of emotion regulation dynamics, we focused on the first session, using 6,780 talk-turns within 52 patient-therapist dyads. Emotion regulation dynamics were measured using fundamental frequencies of the voice and were calculated using empirical Bayes residuals of the actor-partner interdependence model. Symptomatic change was measured using the Hamilton Rating Scale for Depression across 16 weeks of supportive treatment (ST) or supportive-expressive treatment (SET).

Results: Findings suggest that patients who show less regulated intrapersonal dynamics during the first session show less reduction of symptoms throughout treatment (β = .26, p = .019). Findings further suggest that this association is mitigated when these patients receive SET, as opposed to ST (β = .72, p = .020).

Conclusions: The findings demonstrate the ability of first-session emotion regulation dynamics to serve as a prognostic variable. The findings further suggest that the adverse effect of emotion regulation dynamics on the patient's prognosis can be mitigated by explicit work on changing maladaptive emotional patterns. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

目的:情绪调节在重度抑郁症(MDD)治疗中的潜在预后作用已被跨理论文献所强调,并得到了有希望的实证研究结果的支持。大多数文献都是基于单个快照的自我报告观察,因此对情绪瞬间动态演变的预测价值知之甚少。本研究首次探讨了内部和人际、即时情绪调节动态的预后价值,以及治疗类型的潜在调节作用。方法:为了评估情绪调节动力学的预后价值,我们集中在第一个阶段,在52对患者-治疗师中使用6780次谈话。情绪调节动态使用声音的基本频率进行测量,并使用演员-伴侣相互依赖模型的经验贝叶斯残差进行计算。在16周的支持性治疗(ST)或支持性表达治疗(SET)中,使用汉密尔顿抑郁评定量表测量症状变化。结果:研究结果表明,在第一次治疗期间表现出较少调节的患者在整个治疗过程中症状减轻较少(β = 0.26, p = 0.019)。研究结果进一步表明,当这些患者接受SET而不是ST时,这种关联会减轻(β = 0.72, p = 0.020)。结论:研究结果表明,第一阶段情绪调节动态可以作为预后变量。研究结果进一步表明,情绪调节动态对患者预后的不利影响可以通过改变不良情绪模式的明确工作来减轻。(PsycInfo数据库记录(c) 2023 APA,版权所有)。
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引用次数: 0
Ground-up approach to understanding the impacts of historical trauma in one reserve-dwelling first nations community. 了解历史创伤对一个居住在保留地的第一民族社区的影响的初步方法。
IF 5.9 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-12-01 Epub Date: 2023-08-31 DOI: 10.1037/ccp0000840
Nicole H Weiss, Nichea S Spillane, Silvi C Goldstein, Reina Kiefer, Alexa M Raudales, Tessa Nalven, Alana Egan, Catherine D Trinh, Roland S Moore, Joseph P Gone

Objective: First Nations peoples experience disproportionate health inequities compared to most non-Indigenous populations. Historical trauma is one factor that has received growing attention in relation to health inequities among First Nations populations. The goal of the present study was to improve understanding of the specific forms, impacts, and mechanisms of transmission of events that lead to historical trauma and the historical trauma response in First Nations peoples.

Method: Five focus groups were conducted among adult members of one First Nations community in Canada (N = 34; 70.4% female).

Results: Conventional content analysis revealed the numerous forms that historical trauma take in this First Nations community; individual-, familial-, community-, and societal-level impacts of historical trauma; and ways in which historical trauma has been transmitted in this community. Loss of culture, alcohol use, and parenting were major themes identified across these domains.

Conclusions: Findings provide important information on the experience of historical trauma in one First Nations community, highlighting the roles of loss of culture; alcohol use; and parenting in the forms, impacts, and transmission of historical trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

目标:与大多数非土著人口相比,原住民经历了不成比例的健康不平等。历史创伤是第一民族人口健康不平等问题日益受到关注的一个因素。本研究的目的是提高对导致历史创伤的事件的具体形式、影响和传播机制以及原住民对历史创伤的反应的理解。方法:对加拿大一个原住民社区的成年成员(N=34,女性70.4%)进行了五个焦点小组研究;历史创伤对个人、家庭、社区和社会层面的影响;以及历史创伤在这个社区传播的方式。文化丧失、酗酒和养育子女是这些领域确定的主要主题。结论:调查结果提供了关于一个第一民族社区历史创伤经历的重要信息,突出了文化丧失的作用;饮酒;以及以历史创伤的形式、影响和传播为人父母。(PsycInfo数据库记录(c)2023 APA,保留所有权利)。
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引用次数: 0
The role of therapy delivery and clinic organizational factors in explaining therapist effects for trauma-focused psychotherapies in the Veterans Health Administration. 治疗提供和临床组织因素在解释退伍军人健康管理局以创伤为重点的心理治疗师效果中的作用。
IF 4.5 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-11-01 Epub Date: 2023-09-04 DOI: 10.1037/ccp0000832
Nina A Sayer, Shannon Wiltsey Stirman, Craig S Rosen, Shannon Kehle-Forbes, Michele R Spoont, Afsoon Eftekhari, Kathleen M Chard, Adam Kaplan, David B Nelson

Objective: This study estimated the size of therapist effects (TEs) for dropout and clinical effectiveness of two trauma-focused psychotherapies (TFPs) and evaluated whether therapy delivery and clinic organizational factors explained observed TEs.

Method: Participants were 180 therapists (54.4% psychologists, 42.2% social workers) from 137 Veterans Health Administration facilities and 1,735 patients (24.7% women; 27.2% people of color) who completed at least two TFP sessions. Outcomes were dropout (< 8 TFP sessions) and for a subsample (n = 1,273), clinically meaningful improvement and recovery based on posttraumatic stress disorder checklist for DSM-5 (PCL-5) scores. Therapist-level predictors were ascertained through survey, manual chart review, and administrative data. Multilevel models estimated TEs.

Results: Over half (51.2%) of patients dropped out and those who dropped out were less likely to meet criteria for clinically meaningful improvement or recovery (ps < .001). Adjusting for case-mix and TFP type, therapists accounted for 5.812% (p < .001) of the unexplained variance in dropout. The average dropout rate for the 45 therapists in the top performing quartile was 27.0%, while the average dropout rate for the 45 therapists in the bottom performing quartile was 78.8%. Variation between therapists was reduced to 2.031% (p = .140) when therapists' mean of days between sessions, adherence, implementation climate, and caseload were added to multilevel models. TEs were nonsignificant for clinically meaningful improvement and recovery.

Conclusions: Interventions targeting therapy delivery and clinic organization have the potential to reduce variation between therapists in TFP dropout, so that more patients stay engaged long enough to experience clinical benefit. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

目的:本研究估计了两种以创伤为中心的心理治疗师治疗(TFP)的辍学和临床有效性的治疗师效应(TE)大小,并评估了治疗提供和临床组织因素是否解释了观察到的TE。方法:参与者包括来自137个退伍军人健康管理机构的180名治疗师(54.4%为心理学家,42.2%为社会工作者)和1735名至少完成两次TFP治疗的患者(24.7%为女性;27.2%为有色人种)。结果是辍学(<8次TFP治疗),对于一个子样本(n=1273),基于创伤后应激障碍DSM-5(PCL-5)评分检查表,有临床意义的改善和恢复。治疗师水平的预测因素是通过调查、手动图表审查和管理数据确定的。多层次模型估计TE。结果:超过一半(51.2%)的患者退出,退出的患者不太可能达到有临床意义的改善或恢复标准(p<0.001)。根据病例组合和TFP类型进行调整后,治疗师占退出的原因不明方差的5.812%(p<.001)。表现最好的四分位数中的45名治疗师的平均辍学率为27.0%,而表现最差的四分位中的45位治疗师的平均退学率为78.8%。当治疗师的平均疗程天数、依从性、实施氛围和工作量被添加到多水平模型中时,治疗师之间的差异减少到2.031%(p=.140)。TE对临床意义的改善和恢复无显著意义。结论:针对治疗提供和临床组织的干预措施有可能减少治疗师之间TFP脱落的差异,从而使更多的患者保持足够长的时间来体验临床益处。(PsycInfo数据库记录(c)2023 APA,保留所有权利)。
{"title":"The role of therapy delivery and clinic organizational factors in explaining therapist effects for trauma-focused psychotherapies in the Veterans Health Administration.","authors":"Nina A Sayer, Shannon Wiltsey Stirman, Craig S Rosen, Shannon Kehle-Forbes, Michele R Spoont, Afsoon Eftekhari, Kathleen M Chard, Adam Kaplan, David B Nelson","doi":"10.1037/ccp0000832","DOIUrl":"10.1037/ccp0000832","url":null,"abstract":"<p><strong>Objective: </strong>This study estimated the size of therapist effects (TEs) for dropout and clinical effectiveness of two trauma-focused psychotherapies (TFPs) and evaluated whether therapy delivery and clinic organizational factors explained observed TEs.</p><p><strong>Method: </strong>Participants were 180 therapists (54.4% psychologists, 42.2% social workers) from 137 Veterans Health Administration facilities and 1,735 patients (24.7% women; 27.2% people of color) who completed at least two TFP sessions. Outcomes were dropout (< 8 TFP sessions) and for a subsample (<i>n</i> = 1,273), clinically meaningful improvement and recovery based on posttraumatic stress disorder checklist for DSM-5 (PCL-5) scores. Therapist-level predictors were ascertained through survey, manual chart review, and administrative data. Multilevel models estimated TEs.</p><p><strong>Results: </strong>Over half (51.2%) of patients dropped out and those who dropped out were less likely to meet criteria for clinically meaningful improvement or recovery (<i>p</i>s < .001). Adjusting for case-mix and TFP type, therapists accounted for 5.812% (<i>p</i> < .001) of the unexplained variance in dropout. The average dropout rate for the 45 therapists in the top performing quartile was 27.0%, while the average dropout rate for the 45 therapists in the bottom performing quartile was 78.8%. Variation between therapists was reduced to 2.031% (<i>p</i> = .140) when therapists' mean of days between sessions, adherence, implementation climate, and caseload were added to multilevel models. TEs were nonsignificant for clinically meaningful improvement and recovery.</p><p><strong>Conclusions: </strong>Interventions targeting therapy delivery and clinic organization have the potential to reduce variation between therapists in TFP dropout, so that more patients stay engaged long enough to experience clinical benefit. (PsycInfo Database Record (c) 2023 APA, all rights reserved).</p>","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":" ","pages":"665-679"},"PeriodicalIF":4.5,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10592522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10152534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Examining engagement effects in an adaptive preventive intervention for college student drinking. 研究大学生饮酒适应性预防干预的参与效果。
IF 4.5 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-11-01 Epub Date: 2023-08-31 DOI: 10.1037/ccp0000845
Megan E Patrick, Aparajita Sur, Brooke Arterberry, Sarah Peterson, Nicole Morrell, David M Vock

Objective: This study determined the characteristics of engagement and whether engagement in an adaptive preventive intervention (API) was associated with reduced binge drinking and alcohol-related consequences.

Method: Incoming students were recruited for a sequential multiple assignment randomized trial (SMART; N = 891, 62.4% female, 76.8% non-Hispanic White) with an assessment-only control group. The API occurred during the first semester of college, with outcomes assessed at the end of the semester. The API involved two stages. Stage 1 included universal intervention components (personalized normative feedback [PNF] and self-monitoring). Stage 2 bridged heavy drinkers to access additional resources. We estimated the effect of engagement in Stage 1 only and in the whole API (Stages 1 and 2) among the intervention group, and the effect of the API versus control had all students assigned an API engaged, on alcohol-related outcomes.

Results: Precollege binge drinking, intention to pledge a fraternity/sorority, and higher conformity motives were most associated with lower odds of Stage 1 engagement. Action (readiness to change) and PNF engagement were associated with Stage 2 engagement. API engagement was associated with significant reductions in alcohol-related consequences among heavy drinkers. Compared to the control, we estimated the API would reduce the relative increase in alcohol-related consequences from baseline to follow-up by 25%, had all API students engaged.

Conclusions: Even partial engagement in each component of the "light-touch" API rendered benefits. Analyses suggested that had all students in the intervention group engaged, the API would significantly reduce the change in alcohol-related consequences over the first semester in college. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

目的:本研究确定了参与的特征,以及参与自适应预防干预(API)是否与酗酒和酒精相关后果的减少有关。方法:招募来校学生参加一项连续的多任务随机试验(SMART;N=891,62.4%为女性,76.8%为非西班牙裔白人),对照组仅进行评估。API发生在大学第一学期,在学期末评估结果。API涉及两个阶段。第1阶段包括普遍干预部分(个性化规范性反馈[PNF]和自我监测)。第二阶段为重度饮酒者提供额外资源。我们估计了干预组中仅参与第1阶段和整个API(第1和第2阶段)对酒精相关结果的影响,以及API与对照组的影响,即所有被分配API参与的学生对酒精相关结果的影响。结果:大学前酗酒、承诺加入兄弟会/女生联谊会的意图以及较高的从众动机与第一阶段参与的几率较低最相关。行动(准备改变)和PNF参与与第2阶段参与相关。在重度饮酒者中,API的参与与酒精相关后果的显著降低相关。与对照组相比,我们估计,如果所有API学生都参与,API将使从基线到随访的酒精相关后果的相对增加减少25%。结论:即使部分参与“轻接触”API的每个组成部分也会带来好处。分析表明,如果干预组的所有学生都参与,API将显著减少大学第一学期与酒精相关的后果的变化。(PsycInfo数据库记录(c)2023 APA,保留所有权利)。
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引用次数: 0
Treatment length and symptom improvement in prolonged exposure and present-centered therapy for posttraumatic stress disorder: Comparing dose-response and good-enough level models in two manualized interventions. 创伤后应激障碍长期暴露和以现状为中心的治疗的治疗时间和症状改善:比较两种手动干预的剂量反应和足够好的水平模型。
IF 4.5 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-10-01 Epub Date: 2023-07-20 DOI: 10.1037/ccp0000834
Johanna Thompson-Hollands, Carole A Lunney, Denise M Sloan, Shannon Wiltsey Stirman, Paula P Schnurr

Objective: The dose-response model of change in psychotherapy posits that each session of therapy is incrementally beneficial across patients. The contrasting good-enough level model suggests that patients improve at different rates in therapy and discontinue treatment when they are satisfied with their improvement. Support for each theory has been mixed, and many prior studies have relied on samples of patients receiving unstructured treatment approaches. We conducted this study to compare these two theories across two manualized treatments for posttraumatic stress disorder (PTSD).

Method: Two hundred eighty-four female veterans and military service members with PTSD (Mage = 44.79; 54.6% White non-Hispanic, 6.7% Black non-Hispanic, 37% other) were randomized to receive 10 sessions of prolonged exposure (PE), a trauma-focused therapy, or present-centered therapy (PCT), a non-trauma-focused therapy. Participants completed the PTSD Checklist (PCL) at even-numbered treatment sessions, and the timing of dropout/treatment completion was monitored.

Results: The point of highest risk for dropout differed between the treatments, with risk in PE corresponding to the beginning of imaginal exposures. In the PE condition, but not in PCT, a higher number of sessions completed increased the likelihood of achieving reliable clinically significant improvement. Across treatments, the rate of change in PTSD symptoms did not differ according to the number of sessions completed (b = 0.06, p = .687).

Conclusions: Findings support the dose-response model of change in psychotherapy. There were notable differences in dropout across the treatment conditions, including rates, timing, and implications for outcomes. These differences likely reflect differences in content between the protocols. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

目的:心理治疗变化的剂量反应模型认为,每一次治疗对患者都是递增的有益。对比良好水平模型表明,患者在治疗中的改善率不同,当他们对自己的改善感到满意时,停止治疗。对每种理论的支持都参差不齐,许多先前的研究都依赖于接受非结构化治疗方法的患者样本。我们进行了这项研究,以比较创伤后应激障碍(PTSD)的两种手动治疗方法中的这两种理论,或以当前为中心的治疗(PCT),一种非创伤为主的治疗。参与者在偶数次治疗中完成了创伤后应激障碍检查表(PCL),并监测了辍学/治疗完成的时间。结果:不同治疗的辍学最高风险点不同,PE的风险与想象暴露的开始相对应。在PE条件下,但在PCT条件下,完成的疗程数量越高,实现可靠的临床显著改善的可能性就越大。在不同的治疗中,创伤后应激障碍症状的变化率根据完成的疗程数没有差异(b=0.06,p=.687)。结论:研究结果支持心理治疗变化的剂量反应模型。不同治疗条件下的辍学率存在显著差异,包括发病率、时间和对结果的影响。这些差异可能反映了协议之间内容的差异。(PsycInfo数据库记录(c)2023 APA,保留所有权利)。
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引用次数: 0
Interpersonal problems as a predictor of outcome in psychotherapy for depressive and anxiety disorders: A multilevel meta-analysis. 人际问题作为抑郁症和焦虑症心理治疗结果的预测因素:一项多层次荟萃分析。
IF 5.9 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-10-01 Epub Date: 2023-06-01 DOI: 10.1037/ccp0000828
Juan Martín Gómez Penedo, Christoph Flückiger

Objective: Although interpersonal problems are assumed to play an important role in the treatment of depression and anxiety, meta-analytic attempts to explore the association between interpersonal problems and outcome in psychotherapy for these patients are missing. This study aims to conduct a systematic review and meta-analytic synthesis of the association between patients' baseline interpersonal problems and outcome in psychotherapy for depressive and anxiety disorders.

Method: We conducted a three-level meta-analysis (i.e., disaggregating sampling variance, within-study variance, and between-study variance) of the interpersonal problems-outcome prediction (IPOP; as measured by the total distress factor of Inventory of Interpersonal Problems).

Results: We found 40 effect sizes (ESs) nested within 21 primary studies. The three-level model showed a significant aggregated effect size of IPOP, r = -.13, SE = 0.02, 95% CI [-.18, -.09]; t(39) = -5.71, p < .001; d = -0.27, with greater interpersonal distress being associated with worse psychotherapy outcome. Results showed significant heterogeneity across effect sizes with considerable variability across studies (I² = .39) and to a lower extent across reported outcomes (I² = .19). Graphical measures did not show evidence of a substantial publication bias.

Conclusions: This meta-analysis showed that baseline overall interpersonal problems are a small but robust negative predictor of psychotherapy outcome. Therapists might benefit from exploring patients' interpersonal problems at the beginning of therapy to enhance their prognostic inferences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

目的:尽管人际关系问题被认为在抑郁症和焦虑症的治疗中发挥着重要作用,但在这些患者的心理治疗中,探索人际关系问题与结果之间关系的元分析尝试却很少。本研究旨在对抑郁症和焦虑症患者的基线人际问题与心理治疗结果之间的关系进行系统综述和元分析综合。方法:我们对人际问题结果预测(IPOP)进行了三级荟萃分析(即分解抽样方差、研究内方差和研究间方差)。结果:我们在21项主要研究中发现了40个效应大小。三级模型显示IPOP的聚集效应大小显著,r=-1.13,SE=0.02,95%CI[-.18,-.09];t(39)=-5.71,p<0.001;d=-0.27,人际关系痛苦越大,心理治疗结果越差。结果显示,效应大小之间存在显著的异质性,研究之间存在相当大的可变性(I²=0.39),报告结果之间的可变性较低(I²=1.19)。图形测量没有显示出实质性发表偏倚的证据。结论:这项荟萃分析表明,基线总体人际问题是心理治疗结果的一个小而有力的负面预测因素。治疗师可能受益于在治疗开始时探究患者的人际关系问题,以增强他们的预后推断。(PsycInfo数据库记录(c)2023 APA,保留所有权利)。
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引用次数: 1
The impact of multiple-behavior HIV interventions as a function of regional disadvantages: An analysis of syndemics. 多种行为HIV干预措施对地区劣势的影响:综合征分析。
IF 4.5 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-10-01 Epub Date: 2023-07-06 DOI: 10.1037/ccp0000827
Man-Pui Sally Chan, Sicong Liu, Benjamin White, Angela Zhang, Yubo Zhou, Melody Leung, Wenhao Dai, Xi Liu, Marta Durantini, Qijia Ye, Lidia Palmese, Devlin O'Keefe, Dolores Albarracín

Objective: Disadvantaged populations, including inhabitants of developing countries as well as racial/ethnic and sexual minorities in the United States, are disproportionally burdened by human immunodeficiency virus (HIV) infection, delayed HIV diagnosis, and unfavorable HIV-treatment outcomes. HIV interventions targeting single behaviors (e.g., testing) in these populations have shown to be efficacious at producing behavioral and clinical change but have been unable to eliminate the social health disparities associated with syndemics (i.e., a set of connected risks, interacting synergistically, and contributing to excess burden of disease in a population).

Method: This meta-analysis of 331 reports (clusters; number of effect sizes [k] = 1,364) assessed whether multiple-behavior interventions that target clusters of syndemic risks are more efficacious for those in disadvantaged regions and social groups.

Results: Across the board, multiple-behavior interventions were more efficacious than single-behavior ones as well as passive control groups among samples from countries with lower log gross domestic product (GDP), lower Human Development Index (HDI), and lower Healthcare Access and Quality (HAQ) Index.

Conclusions: Within the United States, the efficacy of multiple-behavior interventions was similar across different levels of representation of racial/ethnic and sexual minorities. The analyses used robust variance estimation with small-sample corrections to assess the differential effects of multiple-behavior interventions and Egger Sandwich test with the multilevel meta-analysis approach to detect selection biases. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

目标:弱势群体,包括发展中国家的居民以及美国的种族/族裔和性少数群体,因人类免疫缺陷病毒(HIV)感染、HIV诊断延迟和不利的HIV治疗结果而承受着不成比例的负担。针对这些人群的单一行为(如检测)的HIV干预措施已被证明在产生行为和临床变化方面是有效的,但无法消除与综合征相关的社会健康差异(即一组相互关联的风险,协同作用,并导致人群疾病负担过重)331份报告(集群;效应大小数[k]=1364)评估了针对综合征风险集群的多种行为干预措施是否对弱势地区和社会群体更有效。结果:在来自国内生产总值对数(GDP)较低、人类发展指数(HDI)较低和医疗保健可及性和质量指数(HAQ)较低的国家的样本中,综合而言,多重行为干预比单一行为干预以及被动对照组更有效。结论:在美国,在不同种族/民族和性少数群体的代表性水平上,多种行为干预的效果相似。分析使用了小样本校正的稳健方差估计来评估多种行为干预的差异效应,并使用多水平荟萃分析方法的Egger Sandwich检验来检测选择偏差。(PsycInfo数据库记录(c)2023 APA,保留所有权利)。
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引用次数: 0
Twelve-month follow-up: Comparative efficacy of cognitive therapy, behavior therapy, and cognitive behavior therapy for patients with insomnia. 12个月随访:认知疗法、行为疗法和认知行为疗法对失眠患者的疗效比较。
IF 4.5 1区 心理学 Q1 PSYCHOLOGY, CLINICAL Pub Date : 2023-10-01 Epub Date: 2023-02-23 DOI: 10.1037/ccp0000802
Laurel D Sarfan, Charles M Morin, Allison G Harvey

Objective: Treatments that alleviate insomnia over the long term are critical. We evaluated the relative long-term efficacy of cognitive therapy (CT), behavior therapy (BT), and cognitive behavior therapy (CBT) for insomnia.

Method: Patients (N = 188, 62.2% female, 81.1% White, 6.5% Hispanic or Latinx, Mage = 47.4 years) with insomnia were randomized to eight sessions of CT, BT, or CBT for insomnia. Assessments at pretreatment and 12-month follow-up measured insomnia severity, insomnia response/remission, sleep diary parameters, and daytime functioning.

Results: Patients in all three treatment groups improved on insomnia severity, sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, work and social adjustment, and mental health (ps < .05). Moreover, in each treatment group, a substantial proportion of patients achieved remission and response. CBT was associated with larger improvements in insomnia severity relative to CT as well as greater remission and improvements in physical health, relative to CT and BT (ps < .05). For patients with a psychiatric comorbidity, CBT was associated with greater improvements in work and social adjustment and mental health, relative to CT (ps < 0.05). CT was not associated with change in time in bed, and none of the treatment conditions were associated with change in daytime fatigue (ps > .05).

Conclusions: These encouraging results suggest that therapists may be able to offer CBT, BT, or CT to improve nighttime and daytime symptoms of insomnia over the long-term, with CBT offering a relative advantage for select outcomes and subgroups. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

目的:长期治疗失眠至关重要。我们评估了认知疗法(CT)、行为疗法(BT)和认知行为疗法(CBT)治疗失眠的相对长期疗效。方法:将患有失眠的患者(N=188,女性62.2%,白人81.1%,西班牙裔或拉丁裔6.5%,Mage=47.4岁)随机分为八组,分别接受CT、BT或CBT治疗。预处理和12个月随访的评估测量了失眠的严重程度、失眠反应/缓解、睡眠日记参数和日间功能。结果:三个治疗组的患者在失眠严重程度、睡眠开始潜伏期、睡眠开始后醒来、总睡眠时间、睡眠效率、工作和社会适应以及心理健康方面都有所改善(ps<.05)。此外,在每个治疗组中,相当大比例的患者都获得了缓解和缓解。与CT相比,CBT与失眠严重程度的更大改善以及与CT和BT相比,身体健康的更大缓解和改善相关(ps<.05)。对于患有精神病合并症的患者,与CT相比(ps<0.05),CBT在工作、社会适应和心理健康方面有更大改善。CT与卧床时间的变化无关,结论:这些令人鼓舞的结果表明,治疗师可能能够长期提供CBT、BT或CT来改善夜间和日间失眠症状,CBT在选择结果和亚组方面具有相对优势。(PsycInfo数据库记录(c)2023 APA,保留所有权利)。
{"title":"Twelve-month follow-up: Comparative efficacy of cognitive therapy, behavior therapy, and cognitive behavior therapy for patients with insomnia.","authors":"Laurel D Sarfan, Charles M Morin, Allison G Harvey","doi":"10.1037/ccp0000802","DOIUrl":"10.1037/ccp0000802","url":null,"abstract":"<p><strong>Objective: </strong>Treatments that alleviate insomnia over the long term are critical. We evaluated the relative long-term efficacy of cognitive therapy (CT), behavior therapy (BT), and cognitive behavior therapy (CBT) for insomnia.</p><p><strong>Method: </strong>Patients (<i>N</i> = 188, 62.2% female, 81.1% White, 6.5% Hispanic or Latinx, <i>M</i><sub>age</sub> = 47.4 years) with insomnia were randomized to eight sessions of CT, BT, or CBT for insomnia. Assessments at pretreatment and 12-month follow-up measured insomnia severity, insomnia response/remission, sleep diary parameters, and daytime functioning.</p><p><strong>Results: </strong>Patients in all three treatment groups improved on insomnia severity, sleep onset latency, wake after sleep onset, total sleep time, sleep efficiency, work and social adjustment, and mental health (<i>p</i>s < .05). Moreover, in each treatment group, a substantial proportion of patients achieved remission and response. CBT was associated with larger improvements in insomnia severity relative to CT as well as greater remission and improvements in physical health, relative to CT and BT (<i>p</i>s < .05). For patients with a psychiatric comorbidity, CBT was associated with greater improvements in work and social adjustment and mental health, relative to CT (<i>p</i>s < 0.05). CT was not associated with change in time in bed, and none of the treatment conditions were associated with change in daytime fatigue (<i>p</i>s > .05).</p><p><strong>Conclusions: </strong>These encouraging results suggest that therapists may be able to offer CBT, BT, or CT to improve nighttime and daytime symptoms of insomnia over the long-term, with CBT offering a relative advantage for select outcomes and subgroups. (PsycInfo Database Record (c) 2023 APA, all rights reserved).</p>","PeriodicalId":15447,"journal":{"name":"Journal of consulting and clinical psychology","volume":" ","pages":"606-613"},"PeriodicalIF":4.5,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10444907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10054112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Journal of consulting and clinical psychology
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