Journal of consulting and clinical psychology最新文献

Objective: To compare the course of change in individual posttraumatic stress disorder (PTSD) symptoms during prolonged exposure therapy (PE) and cognitive processing therapy (CPT).

Method: We analyzed data from a previously published randomized clinical trial comparing PE and CPT among male and female U.S. military veterans with PTSD (Schnurr et al., 2022). Using data from a self-rated PTSD symptom measure administered before each therapy session, we evaluated individual symptom change from pretreatment to final therapy session (N = 802). Then, using network intervention analysis, we modeled session-by-session PTSD symptom networks that included treatment allocation (CPT vs. PE) as a node in the networks, allowing us to compare individual symptom change following each session in each treatment.

Results: Relative to CPT, PE was associated with greater reduction in 10 PTSD symptoms from first to final session of therapy. Numerous treatment-specific effects on individual symptoms emerged during the treatment period; these session-level effects occurred only in symptoms relatively specific to the diagnosis of PTSD (e.g., avoidance, hypervigilance). PE was associated with greater reduction in avoidance following the introduction and early weeks of imaginal exposure. The treatments yielded comparable effects on trauma-related blame and negative beliefs from pretreatment to final therapy session. However, there were differences in session-level change in these symptoms that may reflect differential timing of interventions that reduce distorted cognitions within each treatment.

Conclusions: Findings may facilitate the shared decision-making process for patients choosing between CPT and PE. Session-level results provide direction for future research on the specific intervention components of CPT and PE. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objectives: Working alliance is considered an important determinant of outcome of psychotherapy. Patients with posttraumatic stress disorder (PTSD) following childhood abuse (CA-PTSD) may have challenges in building interpersonal relationships, including working alliance. Phase-based treatment provides an opportunity to strengthen alliance prior to trauma-focused treatment. This study aimed to compare the development of working alliance among patients with CA-PTSD in three variants of prolonged exposure (PE) therapy: standard PE, intensive PE (iPE), and skill training in affective and interpersonal regulation + prolonged exposure (STAIR + PE). We also examined the effect of alliance on treatment outcome and dropout.

Method: Self-reported PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (Blevins et al., 2015) and patient-rated Working Alliance Inventory (Tracey & Kokotovic, 1989) were assessed in a clinical trial. We analyzed data from 138 adult patients (76.1% female; 42% non-Western). Analyses were performed using mixed-effects models.

Results: Patients established a satisfactory alliance early in treatment, which increased over time. For PE and STAIR + PE, a larger decrease in PTSD symptom severity was related to a higher alliance in the subsequent session, but not the other way around. In STAIR + PE, a higher alliance in Phase 1 was related to lower PTSD symptoms in Phase 2. In all conditions, a higher initial working alliance was related to a lower chance of treatment dropout.

Conclusion: In the treatment of CA-PTSD, all three variants of prolonged exposure foster positive development of the working alliance. Across conditions, working alliance did not precede symptom decline. Therapists should strive for a strong alliance at the beginning of treatment as this reduces the likelihood of dropout. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The aim of this study was to investigate a sequence of associations between clients' pretreatment attachment style, the development of individuated-secure attachment to the therapist (i.e., therapeutic attachment), and the experience of increased comfort with emotional closeness (growing engagement) or independence (growing autonomy) in therapy. Moreover, the study explored whether clients' experience of growing engagement or growing autonomy was associated with a change in interpersonal problems at the end of therapy.

Method: Three hundred thirty adult clients (mean age 40.2, 75% female) were seen by 44 therapists in individual psychotherapy. The associations between pretreatment attachment insecurity measured on the Experiences in Close Relationships scale, repeated measures of therapeutic attachment measured on the Client Attachment to Therapist Scale, repeated measures of a growing engagement or growing autonomy measured on the Therapeutic Distance Scale, and pre-post measures of interpersonal problems measured on the Inventory for Interpersonal Problems were analyzed using multilevel modeling. Two types of therapeutic attachment were estimated, one controlling for anxious attachment characteristics and one for avoidant.

Results: Significant associations between higher levels of therapeutic attachment controlled for avoidant attachment characteristics and lower levels of growing autonomy in therapy were found. Moreover, higher levels of growing engagement in therapy and higher levels of therapeutic attachment controlled for anxious attachment characteristics were associated with a decrease in interpersonal problems at the end of therapy.

Conclusions: Distinct types of therapeutic attachment may exert different influences on the process and outcome of therapy. Furthermore, therapists' attunement to clients' specific attachment needs in therapy may enhance interpersonal outcomes of treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Current health care systems emphasize consensual collaboration between clinicians and patients to reduce symptoms and improve well-being (e.g., World Health Organization, 2023). The alliance is the internationally best-studied collaborative process characteristic in psychotherapy research. Recent empirical studies on the alliance have tripled in comparison to the entire 20th century. This increase in empirical data illustrates the cumulative outstanding scientific activities in this field (e.g., Wampold & Flückiger, 2023). The reasons for the international popularity of the pantheoretical alliance concept may lie in the practical experience of many practitioners that a balanced collaborative quality is a central ethical and conceptual premise for treatment progress (Horvath, 2018). The aim of a "Viewpoint" article is to provide thought-provoking notes on the current state of research, innovations, weaknesses in the field, and current debates. This article is limited to three aspects. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: This study examined variability in response to a couple and relationship education program for Black coparenting couples using group-based trajectory modeling. We identified groups of couples with different relationship satisfaction trajectories across a 2-year period following preintervention assessment.

Method: Black couples with a preadolescent child were randomized to the Protecting Strong African American Families intervention (N = 170) or a control condition (N = 174) and reported on their relationship satisfaction preintervention and approximately 9, 17, and 25 months later.

Results: Results indicated two trajectory groups among men and women receiving the intervention, comprising a large group consistently high in relationship satisfaction over time and a smaller group with moderate, stable satisfaction over time. In the control condition, there was also a large group of men and women who remained consistently high in satisfaction, but the smaller group with initially moderate satisfaction experienced decreased satisfaction over time. Trajectories among men and women in the moderate groups differed by treatment condition, reflecting nonsignificant change (i.e., stable satisfaction) for those receiving intervention and significant decline for controls. Trajectories among women in the high group also differed by treatment condition, reflecting better functioning among women receiving intervention.

Conclusions: Results indicated many benefits of intervention, most notably the stabilization of satisfaction among couples beginning with moderate satisfaction (who experienced declining satisfaction in the control condition). Similar examination of within-sample variability in response to other couple and relationship education programs may enhance understanding of specific treatment effects and guide identification of those most likely to benefit from relationship intervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Treatment personalization has evolved into an important zeitgeist in psychotherapy research. To date, such efforts have principally embodied a unidirectional focus on personalizing interventions to the patient. For example, earlier work in this area attempted to determine whether, on average, certain patients with certain characteristics or needs would respond better to one treatment package versus others. To the extent such aggregate "Aptitude × Treatment interactions" emerged, they could help guide overarching treatment selection. More recently, and drawing on technological and statistical advancements (e.g., machine learning, dynamic modeling), predictive algorithms can help determine for which individual patients certain treatment packages (DeRubeis et al., 2014) or specific during-session interventions within them (Fisher & Boswell, 2016) confer the most advantage for clinical improvement. Again, such work can help guide treatment decisions, though now at multiple care points. Although the aforementioned innovations in personalized psychotherapy have been leading-edge, precision care need not remain unidirectional. Rather, it can be complemented by efforts to personalize treatment decisions to the therapist. Namely, we can harness therapist effectiveness data to help ensure that therapists treat the patients they are empirically most equipped to help and use the interventions with which they have had the most empirical success. Such threads have been the focus of our team's novel, evolving, and multimethod work on improving psychotherapy by leveraging therapists' own practice-based evidence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Web-based cognitive bias modification for interpretation (CBM-I) can improve interpretation biases and anxiety symptoms but faces high rates of dropout. This study tested the effectiveness of web-based CBM-I relative to an active psychoeducation condition and the addition of low-intensity telecoaching for a subset of CBM-I participants.

Method: 1,234 anxious community adults (Mage = 35.09 years, 81.2% female, 72.1% white, 82.6% not Hispanic) were randomly assigned at Stage 1 of a sequential, multiple-assignment randomized trial to complete five weekly sessions of CBM-I or psychoeducation on our team's public research website. After the first session, for Stage 2, an algorithm attempted to classify CBM-I participants as higher (vs. lower) risk for dropping out; those classified as higher risk were then randomly assigned to complete four brief weekly telecoaching check-ins (vs. no coaching).

Results: As hypothesized (https://doi.org/j2xr; Daniel, Eberle, & Teachman, 2020), CBM-I significantly outperformed psychoeducation at improving positive and negative interpretation biases (Recognition Ratings, Brief Body Sensations Interpretation Questionnaire) and anxiety symptoms (Overall Anxiety Severity and Impairment Scale, Anxiety Scale from Depression Anxiety Stress Scales-Short Form), with smaller treatment gains remaining significant at 2-month follow-up. Unexpectedly, CBM-I had significantly worse treatment dropout outcomes than psychoeducation, and adding coaching (vs. no coaching) did not significantly improve efficacy or dropout outcomes (notably, many participants chose not to interact with their coach).

Conclusions: Web-based CBM-I appears effective, but supplemental coaching may not mitigate the challenge of dropout. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: To compare the effectiveness of an acceptance and commitment therapy (ACT)-based protocol and cognitive behavior therapy (CBT) for insomnia in adults.

Method: The participants comprised 227 adults with insomnia. They were randomized to six weekly group sessions consisting of acceptance and commitment therapy for insomnia (n = 76), cognitive behavioral therapy for insomnia (n = 76), or waitlist (WL; n = 75).

Results: Both treatment modalities significantly reduced insomnia severity with large effect sizes in the posttreatment phase. These results were maintained during the follow-up period with large effect sizes. CBT was superior to ACT in reducing the Insomnia Severity Index at posttreatment and follow-up, with a small effect size. ACT was superior to WL at posttreatment and at follow-up, with a moderate effect size. The treatment response and remission ratios were higher with CBT at posttreatment and similar at 6-month follow-up for both therapies, as ACT made further gains in response and remission. ACT had a significantly higher proportion of response and remission than WL in both periods (posttreatment and follow-up). Both therapies improved daytime functioning at both posttreatment and follow-up, with few differential changes across the groups.

Conclusions: Both cognitive behavior therapy and acceptance and commitment therapy are effective, with CBT showing superiority and ACT showing delayed improvement. ACT has proven to be an effective therapy, especially in the long term, even in the absence of behavioral techniques such as stimulus control and sleep restriction, and it is a viable option for those who have difficulties adhering to behavioral techniques. (PsycInfo Database Record (c) 2024 APA, all rights reserved).