Journal of consulting and clinical psychology最新文献

Objective: This article presents primary outcomes from the Community Study of Outcome Monitoring for Emotional Disorders in Teens, a two-site, randomized controlled trial comparing the effectiveness of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Adolescents plus measurement-based care (UP-A), measurement-based care alone (TAU+), and treatment as usual (TAU) in community mental health clinics. Method: A total of 174 clinicians were randomized to implement TAU (n = 49), TAU plus an MBC measure (TAU+; n = 63), or UP-A plus MBC (UP-A; n = 62). In addition, 196 adolescents were randomized to receive 16 weeks of either TAU (n = 68), TAU+ (n = 60), or UP-A (n = 68). Independent evaluator-, self-, and caregiver-reported adolescent anxiety and depression symptoms were measured at baseline and Weeks 8, 16, and 28 postenrollment. Results: Adolescents in all groups showed improvement over time, and compared with TAU, adolescents receiving TAU+ and UP-A conditions improved more quickly on adolescent-report measures only. There were no treatment group differences observed on independent evaluator (primary outcome) or caregiver-report measures. In post hoc analyses, moderators of treatment response included treatment duration and complexity of symptom presentation. Conclusions: In one of the largest adolescent-focused, community-located psychotherapy trials conducted in the United States, transdiagnostic treatment plus measurement-based care and measurement-based care alone conferred some adolescent-reported symptom benefits compared with treatment as usual, although adolescents in all conditions exhibited improvements in anxiety and depression. Future directions for subsequent adolescent psychotherapy effectiveness trials for anxiety and depression are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Cognitive control impairments are frequently observed after remission from depression. There is evidence to show that cognitive control training (CCT) can reduce such impairments and related risk for recurrent episodes. However, it is currently unclear how many CCT sessions are required for short- and long-term effects. Method: This randomized controlled trial investigates the dose-response relationship of CCT in a sample of individuals with remitted depression (n = 216). Participants were randomly assigned to one of six arms, each receiving a different amount of training sessions (zero, one, five, 10, 15, or 20 sessions) over the course of 4 weeks, with each session lasting 15 min. Depressive symptoms and other cognitive and emotional transfer effects were examined shortly after training, as well as at 3- and 6-month follow-up. Results: We found task-specific, but no near cognitive transfer. Mixed-effects models showed that a minimum of 10 training sessions was required for a significant decrease in depressive symptoms shortly after training with medium effect sizes, but this was not maintained at 3- or 6-month follow-up. We observed reductions in perseverative thinking in all groups receiving 10 or more CCT sessions, which remained present until 6-month follow-up. Conclusions: A minimum of 10 CCT sessions is required for beneficial effects on depressive symptoms and perseverative thinking. Where perseverative thinking remained decreased long-term, this was not the case for depressive symptoms, indicating the need for continued training or the use of booster sessions to maintain training-related improvement. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objectives: Evidence-based psychosocial treatments for the early stages of mood or psychotic spectrum disorders are difficult to find in public health settings, and the efficacy of these treatments is limited by inconsistent behavioral skill practice among youth between sessions. Treatments can be made more accessible and efficacious when delivered through a group format that makes use of mobile applications to remind users to practice skills. Method: We conducted a 9-week, randomized controlled trial of the unified protocol (UP) for cognitive behavioral therapy (CBT) delivered via telehealth in a group format, comparing an app-enhanced version of the treatment (AppUP) to standard UP for adolescents with mood and psychotic spectrum conditions. The app was designed to help participants review session content, practice treatment skills, and log their psychiatric symptoms. Study assessors evaluated adolescents for psychiatric symptom severity and psychosocial functioning prior to treatment, at posttreatment, and 3 months posttreatment. Results: Sixty adolescents (Mage = 15.0, SD = 1.3) initiated the trial (30 were randomly assigned to each condition) with 49 retained at posttreatment (9 weeks) and 48 retained at 3 months posttreatment. Adolescents in AppUP showed greater improvements in psychosocial functioning over the 5-month study compared with those in standard UP. AppUP was also associated with greater reductions in depression severity among youth with more self-reported skill practice compared to those in standard UP. Conclusions: This study supports the benefits of transdiagnostic CBT for youth with mood and psychotic symptoms. An adjunctive app appears to improve psychosocial functioning and mood among these youth, especially among those who practice behavioral skills regularly. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Despite decades of policy emphasizing the role of evidence in guiding services, few studies have sought to improve the degree to which evidence is used in supervision and treatment. This study reports supervisor and therapist outcomes from the Reaching Families multisite cluster-randomized controlled trial, which tested the effects of a coordinated knowledge system (CKS) against practice guidelines (PG) on the use of evidence in supervision and treatment targeting low treatment engagement in publicly funded youth community mental health organizations located in two geographically distinct, underresourced communities where service inequities are common.

Method: The sample included 121 mental health professionals (92.6% female; 81.0% Black, Indigenous, and people of color1) randomly assigned to a CKS or PG control condition. We recorded, transcribed, and coded 430 supervision and 208 treatment sessions involving 221 youth (Mage = 13.1 years, 46.2% female; 78.7% Black, Indigenous, and people of color) and/or their caregivers who reported engagement concerns during therapy.

Results: CKS dyads showed uniformly greater use of evidence focused on specific client needs relative to dyads in the PG condition, with large effect sizes and no differences in the effect of condition across the sites. Secondary analyses showed that tools in the CKS condition were perceived significantly more positively than those in the PG condition in terms of effort and effectiveness, and supervisory workload was the same across both conditions.

Conclusions: In routine clinical care delivered within highly representative community settings, a strategically designed knowledge resource can improve evidence-based reasoning and action and be perceived as easy to use and useful without negatively impacting workload. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Therapists report a lack of confidence and competence in teletherapy compared to in-person therapy. Training focusing on teletherapy skills is scarce. This study reports on (a) the development of a training workshop for facilitative interpersonal skills (FIS) in teletherapy (tele-FIRST) and (b) a randomized controlled trial assessing the efficacy of tele-FIRST. Tele-FIRST is a 2-hr online synchronous training workshop that incorporates didactics, deliberate practice, simulation of teletherapy challenges, modeling, and discussion.

Method: A set of tele-FIS stimulus clips that depict four types of teletherapy challenges (e.g., emotional disconnection, distraction) was used to evaluate and train therapists' teletherapy skills. A total of 182 licensed therapists and trainees were randomized into either the tele-FIRST or a waitlist group. Of these, 153 participants completed baseline assessment and were included in the final analyses (tele-FIRST: n = 82; waitlist: n = 71). At baseline, posttraining, and follow-up, participants were assessed on their observer-rated FIS for teletherapy, self-reported FIS, teletherapy skills, acceptance of teletherapy, and self-efficacy.

Results: Therapists demonstrated increased teletherapy skills following the tele-FIRST workshop. After controlling for baseline scores, the tele-FIRST group demonstrated significantly higher observer-rated tele-FIS (η_p² = .134), self-reported FIS (η_p² = .106), teletherapy skills (η_p² = .037), acceptance of teletherapy technology (η_p² = .082), and self-efficacy (η_p² = .036) compared to the waitlist group at posttraining.

Conclusion: The tele-FIRST demonstrated significant short-term effects on enhancing therapists' teletherapy skills as rated by both independent observers and therapists themselves. Tele-FIRST may improve the quality of teletherapy, though more research is needed to investigate its long-term effects. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Sudden gains in psychotherapy have been found to predict outcome, but the conditions under which this occurs remain understudied. In the present study, we experimentally examined the effects of processing sudden gains on treatment outcome.

Method: As part of a large randomized controlled trial of internet-delivered cognitive behavior therapy for social anxiety disorder (n = 182), we experimentally manipulated therapists' responses to sudden gains. Specifically, we randomized individuals who experienced a sudden gain (n = 52) to either receive (n = 26) or not receive (n = 26) processing of the gain.

Results: We found that processed sudden gains were significantly less likely to be reversed compared to unprocessed sudden gains. We also found that individuals with processed sudden gains had lower symptom levels at posttreatment/follow-up compared to individuals with unprocessed sudden gains (M_difference = 15.65, SE = 5.87, p = .023, Cohen's d = 0.84; M_difference = 16.68, SE = 6.36, p = .026, Cohen's d = 1.05; respectively). In addition, individuals with unprocessed sudden gains did not have significantly different symptom levels at posttreatment/follow-up compared to individuals who did not experience a sudden gain during treatment.

Conclusions: Our findings suggest that in internet-delivered cognitive behavior therapy for social anxiety disorder, the processing of sudden gains (rather than the gains themselves) leads to upward spirals of improvement that affect long-term outcomes. Replication of these findings in additional studies is needed, and, if replicated, such findings could provide the basis for adding processing of sudden gains to existing therapeutic protocols. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Veterans returning from deployment have high rates of posttraumatic stress disorder (PTSD) and co-occurring alcohol use disorder (AUD). Current treatments for PTSD and AUD report high dropout rates, and many veterans report alcohol misuse to cope with symptoms of PTSD. The present study is a pilot randomized controlled trial in which veterans (N = 201) were randomized to receive a mobile mindfulness-based intervention enhanced with brief alcohol intervention content (Mind Guide) or an active stress management program.

Method: To be eligible for the study, veterans had to have served after September 11, 2001 (post-9/11 veteran) and screen positive for PTSD and AUD. All participants were asked to complete a baseline and four monthly follow-up assessments (two during treatment phase and two posttreatment phase). Primary outcomes were PTSD symptoms, frequency of alcohol use, and alcohol use consequences.

Results: Engagement with Mind Guide was excellent (averages of over 31 logins and 5 hr of app usage). Those assigned to Mind Guide showed significant reductions in PTSD symptoms (d = -0.36; 16-week follow-up). No differences emerged for frequency of alcohol use (d = -0.12; 16-week follow-up) or consequences (d = -0.12; 16-week follow-up).

Conclusions: Mind Guide may be a valuable adjunct to more intensive in-person PTSD treatment by facilitating interest in services, integration into care, and/or sustainment of posttreatment improvements. Further development of Mind Guide may enhance efficacy at reducing alcohol use and consequences. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: This study applied a machine-learning-based skill assessment system to investigate the association between supportive counseling skills (empathy, open questions, and reflections) and treatment outcomes. We hypothesized that higher empathy and higher use of open questions and reflections would be associated with greater symptom reduction.

Method: We used a data set with 2,974 sessions, 610 clients, and 48 therapists collected from a university counseling center, which included 845,953 rated therapist statements. Client outcome was routinely monitored by the Counseling Center Assessment of Psychological Symptoms Instruments. Therapists' skills were measured via computer by a bidirectional-long-short-term-memory-based system that rated use of supportive counseling skills. We used multilevel modeling to separate the between-therapist and the within-therapist associations of the skills and outcome.

Results: Use of open questions and reflections was associated with client symptom reduction between therapists but not within therapists. We did not find significant associations between therapist empathy and client symptom reduction but found that empathy was negatively associated with clients' baseline symptom level within therapists.

Conclusions: Therapist exploration of clients' experience and expression of understanding may be important skills that are associated with clients' better outcomes. This study highlights the importance of support counseling skills, as well as the potential of machine-learning-based measures in psychotherapy research. We discuss the limitations of the study, including the limitations related to the speaker recognition system and potential reasons for the lack of association between empathy and client outcome. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: The therapeutic alliance is one of the most stable predictors of symptom burden over the course of therapy. So far, this effect has only been examined on the basis of sessions. Continuous-time models (CTM) allow this relationship to be modeled as a continuous process in which the actual time interval between measurements is considered. The aim of the present study was to compare the fit of discrete-time models (DTM) of the alliance-symptom relationship with CTM using different time variables (sessions vs. actual time interval).

Method: Data from 1,413 patients at a university psychotherapy outpatient clinic were analyzed. The alliance and symptom burden were assessed each session with the Bernese Session Report and the Hopkins Symptom Checklist-Short-Form, respectively. Different DTM and CTM were estimated using the R-package ctsem and compared in their fit via the Akaike information criterion.

Results: CTMs with session as the time unit fitted the data best. Significant negative within-person effects of alliance and symptom burden were found. These effects showed a significant positive correlation, implying that individuals with a stronger effect of the alliance on symptom severity also showed a stronger effect of symptom severity on the alliance.

Conclusions: When modeling the relationship of symptom severity and alliance, it seems to be of more importance to capture the fact that a session occurred than to capture the exact time intervals between sessions. Future studies should examine this finding for other psychotherapeutic factors. Interpersonal factors might explain the positive association of the reciprocal alliance-symptom effects. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: The present study assessed two theory-driven mediators of the effects of a family group cognitive-behavioral (FGCB) preventive intervention for youth of parents with a history of major depressive disorder (MDD) or dysthymia on long-term youth psychopathology symptoms and diagnoses.

Method: Sample included 180 parents (M_age = 41.9, 89% female, 82% White, non-Hispanic) and one of their children/adolescents ages 9-15 years (M_age = 11.4, 49% female, 74% White, non-Hispanic). Changes in the hypothesized mediators, observations of positive parenting (Iowa Family Interaction Rating Scales) and youth secondary control coping (SCC) skills (Responses to Stress Questionnaire), were assessed at 6 months. Changes in youth psychopathology symptoms were assessed on the Child Behavior Checklist and Youth Self-Report at 18- and 24-month follow-ups and MDD diagnoses with the Kiddie Schedule for Affective Disorders and Schizophrenia at 12 and 24 months.

Results: Changes in youth SCC skills (e.g., acceptance, reappraisal) after the intervention mediated the effects of the FGCB program on changes in youth internalizing and externalizing symptoms at 18- and 24-month follow-ups. Effects for changes in positive parenting behaviors as a mediator were more limited. SCC skills were further shown to mediate the effects of the FGCB intervention on MDD diagnoses from 12 to 24 months.

Conclusions: This study provides clear and strong evidence that changes in youth SCC skills mediated the long-term effects of preventive intervention for families of depressed parents. (PsycInfo Database Record (c) 2025 APA, all rights reserved).