Journal of consulting and clinical psychology最新文献

Objective: Several clinical studies have found that therapists differ in their client outcomes, supporting the notion of "therapist effects" in psychotherapy. However, only a handful of studies have investigated therapist effects in internet-delivered cognitive behavior therapy. This study aimed to examine therapist effects in internet-delivered cognitive behavior therapy treatment of anxiety and depression in routine care.

Method: Data of 8,145 clients who were treated by 44 therapists were examined. Generalized linear mixed models were performed to identify the presence of therapist effects and the amount of variance attributable to therapists across several outcomes: (a) change in symptoms over time, (b) the occurrence of clinically significant change, (c) treatment completion, and (d) client satisfaction.

Results: Significant therapist effects were observed across all outcomes, indicating that there were differences between therapists in each outcome domain. However, the therapist effects appear relatively modest overall, with therapists explaining 1.5% and 1.4% of variance in change over time in anxiety and depression, respectively, 0.6% and 0.7% of the variance in the occurrence of clinical change in anxiety and depression, respectively, 2.3% of treatment completion, and 1.4% of client satisfaction.

Conclusions: The findings suggest that there are differences among therapists across a range of outcomes. However, these differences account for a modest proportion of the overall variation in client outcomes. Future research is needed to replicate these findings across different contexts before firm conclusions are drawn. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Objective/s: Transdiagnostic cognitive behavioral therapy has proven to be an effective treatment for emotional disorders. However, the cost-effectiveness of group Transdiagnostic cognitive behavioral therapy remains unknown. Given the growing demand for psychological care in primary care in the context of limited resources, an economic evaluation of transdiagnostic group cognitive behavioral therapy (TD-GCBT) would provide valuable data for treatment decision making.

Aims: To conduct an economic evaluation of the PsicAP treatment protocol.

Method: The PsicAP-Costs was a multicenter, randomized controlled trial of 429 patients with a suspected diagnosis of anxiety, depression, and/or somatoform disorders. Participants were randomized to treatment as usual (TAU [control group] or TD-GCBT plus TAU [experimental group]). Treatment consisted of seven sessions of TD-GCBT delivered over a 12-14 week period.

Results: The primary efficacy outcomes were significantly better in the TD-GCBT + TAU group, with small to large effect sizes for the reduction of depression, anxiety, and somatization symptoms. The economic evaluation yielded a mean incremental effectiveness of .06 quality-adjusted life years with a mean incremental cost of 263€. This resulted in an incremental cost-effectiveness ratio of 4,759€ per quality-adjusted life year.

Conclusions: The integration of TD-GCBT into TAU represents a cost-effective therapeutic approach. The incremental cost-effectiveness ratio of 4,759€ per quality-adjusted life years is well below the willingness-to-pay threshold accepted in Spain, which ranges from 20,000€ to 25,000€. At this threshold, the probability that the intervention is cost-effective is high, ranging from 86% to 89%. Therefore, the implementation of TD-GCBT in PC may represent a cost-effective option for improving the quality of care for emotional disorders. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Objective: Personalized normative feedback interventions targeting perceived descriptive norms (perceptions of how much or how often other people drink) have repeatedly been shown to reduce problem drinking among young adults. Less work has targeted perceived injunctive norms (perceptions of others' approval of drinking), possibly due to the potential for reactance to feedback, which communicates that others disapprove of intervention recipients' drinking. Motivational interviewing (MI) is a nonjudgmental clinical approach that diffuses reactance by emphasizing empathy and autonomy. This study evaluated the efficacy of in-person computer-delivered injunctive personalized normative feedback (IPNF) and facilitator-delivered IPNF with MI (IPNF + MI) in reducing alcohol consumption (past month drinking, typical weekly drinking, and maximum drinks consumed on one occasion) and two indices of alcohol-related consequences.

Method: Participants included 605 heavy-drinking college students from two large universities who were randomized to receive either IPNF, IPNF + MI, or attention control feedback. Participants completed 3- and 6-month follow-up surveys.

Results: Findings revealed no significant reductions in alcohol outcomes for IPNF relative to control. Results showed significant reductions for IPNF + MI relative to control in drinks per week and both indices of alcohol-related consequences. The effect of IPNF + MI was significantly stronger than IPNF for one index of consequences. There were no between-condition effects for peak drinks consumed or past month drinking after correcting for multiple comparisons. Mediation results revealed indirect effects of both IPNF conditions versus control through reductions in injunctive norms on all outcomes.

Conclusions: Results provide modest evidence for injunctive norms-based feedback as an intervention strategy for heavy-drinking students only when MI-delivered. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Objective: Emerging research suggests that mental health interventions led by community health workers (CHW) are effective and increase access to services for minoritized groups. However, the question of how these interventions work has rarely been tested. In this secondary analysis of data from a randomized clinical trial of a CHW-led intervention that included training in mindfulness and encouraged active engagement and self-efficacy in managing mental health care, we aimed to examine several mediators of change based on theoretical mechanisms of action.

Method: A sample of 1,044 racially and ethnically diverse adults (mean age 42.6; 83.8% female-identifying) with moderate to severe depression or anxiety symptoms were randomly assigned to the Strong Minds, Strong Communities psychoeducational intervention or an enhanced control condition. Models tested the direct effects of the intervention on outcomes (depression, anxiety, and functional impairment) as well as the indirect effects of proposed mediators (mindfulness, patient activation, self-efficacy, and working alliance).

Results: Multiple mediator models showed consistent, significant indirect effects of mindfulness across all outcomes, suggesting partial mediation. Patient activation was a significant partial mediator for depression only. Results for the working alliance were consistently nonsignificant. Exploratory analyses examined moderation by racial/ethnic group (Latinx, Asian, non-Latinx Black, and non-Latinx White), finding no significant effects.

Conclusion: These findings suggest that structured, short-term CHW-led interventions are operating through similar therapeutic processes as those observed in studies using licensed professionals. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Objective: The effectiveness of psychotherapy for suicidal youth remains a public health priority. Dialectical behavior therapy (DBT; Linehan, 1993) has been recognized as a well-established treatment for suicidal youth (Witt et al., 2021). Although promising, little work has explored mechanisms of change in DBT for suicidal youth (Asarnow et al., 2021). This study aimed to examine covariation in rates of change between symptoms and theorized mechanistic variables during a randomized controlled trial of DBT for suicidal youth.

Method: The present study was a secondary data analysis of a randomized controlled trial of DBT for 173 suicidal youth (ages 12-18; McCauley et al., 2018). Multilevel modeling was used to examine the association between person-level rates of change for self-harm (suicide attempts and nonsuicidal self-injury), suicidal ideation, DBT skills, emotion dysregulation, and reasons for living.

Results: Both treatment groups showed statistically significant covariation between reductions in self-harm and suicidal ideation. Rates of change in self-harm and suicidal ideation decreased with improvement in emotion regulation for both treatments. An increase in endorsed reasons for living significantly covaried with reductions in self-harm and suicidal ideation within the DBT condition only.

Conclusions: Study results support the potential value of efforts to reduce suicidal ideation and self-harm through improving emotion regulation and demonstrate common and unique mechanisms of change across treatments for youths at elevated suicide/self-harm risk. (PsycInfo Database Record (c) 2026 APA, all rights reserved).