Journal of consulting and clinical psychology最新文献

Objective: To determine if adults with an alcohol use disorder (AUD), who had a preintervention urine ethyl glucuronide (uEtG) level predictive of nonresponse to contingency management (CM), would respond to two intervention modifications (https://clinicaltrials.gov/ ID: NCT03481049).

Method: One hundred fifty-eight adults (53.2% female) with AUD, serious mental illness, and a mean uEtG ≥ 350 ng/mL over a 4-week induction period were randomized to (a) usual CM (uEtG-negative [<150 ng/mL] samples reinforced with $1,686); (b) high magnitude CM (uEtG-negative samples reinforced with $2,983); or (c) shaping CM (reduced drinking [uEtG < 500 ng/mL] samples reinforced for 4 weeks, then uEtG-negative samples reinforced for 12 weeks with $1,686). The primary outcome was uEtG-negative samples during induction and Weeks 5-16 of CM. The relationship between outcomes and uEtG-defined heavy drinking (≥ 500 ng/mL) immediately prior to randomization was assessed.

Results: CM conditions did not differ in uEtG-negative samples during the intervention period, Wald, χ²(2) = 1.96, p = .46. Participants were 4.2 times (95% CI [3.02, 5.92], p < .01) more likely to submit a uEtG-negative sample during CM, relative to induction. Those with a heavy drinking uEtG result immediately before randomization were less likely to submit uEtG-negative samples during CM, Wald, χ²(1) = 15.33, p < .01.

Conclusions: CM modifications were not associated with lower levels of alcohol use. Participants engaged in less alcohol use during CM, relative to induction. Two patterns of response to CM were observed based on uEtG-defined heavy drinking immediately prior to CM. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: This meta-analysis and systematic review assessed whether personalization within psychological treatments for mental health problems or persistent somatic symptoms improves treatment outcomes, compared to non- or less personalized treatments.

Method: APA PsycInfo, Cochrane Library, MEDLINE, and EMBASE were searched up to January 14, 2024, for randomized controlled trials comparing within-treatment personalization against no or less personalization. Risk of bias was assessed with the Cochrane tool. A meta-analysis was performed using a random-effects model. Additionally, a three-level meta-analysis was conducted, and moderation analyses were performed. A narrative synthesis was included.

Results: Sixteen studies were included. Risk of bias was low for two studies and high for three studies, and 11 studies had some concerns. Effect sizes were calculated for the subgroups: symptoms, smoking cessation, and treatment process outcomes. For symptoms, the pooled standardized mean difference was 0.07 (95% CI [-0.06, 0.20], p = .28); for smoking cessation, the pooled odds ratio was 1.12 (95% CI [0.84, 1.51], p = .43); and for treatment process outcomes, the pooled standardized mean difference was 0.29 (95% CI [-0.27, 0.85], p = .31). Treatment format (in person/online), personalization factor (preference/individual profile), or personalized treatment aspect (content/modules) did not moderate the effect of personalization.

Conclusions: Evidence of moderate quality does not convincingly suggest that within-treatment personalization outperforms no or less personalization with respect to treatment outcome. Using evidence-based personalization strategies, future studies should clarify which degree of personalization yields clinically relevant effects for which populations, interventions, and outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: This article presents a randomized waitlist-controlled trial testing Couple HOPES, a coach-guided, online intervention for couples wherein one member had posttraumatic stress disorder (PTSD) symptoms. Aims involved examining whether Couple HOPES resulted in greater improvements in PTSD symptoms, relationship satisfaction, and secondary outcomes compared to a waitlist, whether outcomes were maintained over a 3-month follow-up, and whether outcomes differed if PTSD was COVID-19-related.

Method: Sixty-seven couples were recruited, where one partner met criteria for likely PTSD and was either a military member, veteran, first responder, health care worker, and/or whose PTSD symptoms were related to COVID. Couples were randomized to receive Couple HOPES immediately or after 8 weeks. Outcomes were measured at the beginning, middle, and end of Couple HOPES/the waiting period, and 1- and 3-months after Couple HOPES. Measures of PTSD and relationship satisfaction were also completed during each of seven modules.

Results: Intent-to-treat analyses showed greater improvements in self- and informant-reported PTSD in those receiving Couple HOPES relative to waiting, with large- and medium-effect sizes, respectively. Partners without PTSD symptoms reported greater improvements in relationship satisfaction in Couple HOPES compared to the waitlist with a small effect size, but people with PTSD symptoms did not. Uncontrolled follow-up showed reversion of gains in some outcomes. Whether PTSD was COVID-19-related did not significantly moderate outcomes.

Conclusions: Findings support the efficacy of this low-cost, scalable intervention for improving PTSD, regardless of the means through which it was acquired (COVID-19-related or not). Further testing with larger sample sizes is needed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Atrial fibrillation (AF) is associated with distressing symptoms and diminished quality-of-life (QoL). In a recent randomized controlled trial (RCT), online exposure-based cognitive behavioral therapy (AF-CBT) targeting symptoms preoccupation, i.e., cardiac-related fear, hypervigilance, and avoidance behavior, in patients with symptomatic paroxysmal (i.e., intermittent) AF significantly improved AF-specific QoL relative to a control group receiving standardized AF education. This study aims to investigate whether a reduction in symptom preoccupation can explain the treatment effect of AF-CBT on self-rated AF symptoms and AF disability.

Method: We used data from a recent RCT involving 127 patients diagnosed with paroxysmal AF, randomized to undergo AF-CBT over 10 weeks (n = 65) or to receive AF education (n = 62). Two putative mediators, cardiac-related fear/hypervigilance and avoidance behavior, along with a competing mediator, perceived stress, were measured weekly. Outcome variables included self-rated AF symptoms and AF-related disability.

Results: Results from parallel process growth models indicated that the reduction in symptom preoccupation-but not perceived stress-mediated the controlled effect of AF-CBT on both AF symptoms and disability. In cross-lagged panel models, of the within-individual week-by-week change, a reduction in cardiac-related fear predicted subsequent improvement in AF symptoms, while a decrease in avoidance behavior predicted subsequent improvement in AF-related disability.

Conclusions: Our findings suggest that symptom preoccupation plays a significant role in AF symptoms and disability and can be effectively targeted by online AF-CBT. Integrating this understanding into the clinical management of AF holds promise for improving patient outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: A "Goldilocks" effect is when "just right" conditions are present for a phenomenon to occur. In psychotherapy research, the Goldilocks effect is when moderate intervention levels (not very low or high) correlate with more improvement than very high or very low levels. Finding curvilinear relations requires the wider range of what a specific intervention can take, which can be seen when examining technique and outcome across different treatments rather than within a single therapy orientation.

Method: For 151 patients with panic disorder (66% female, 33% racial/ethnic minority) in a randomized comparative trial of panic-focused psychodynamic psychotherapy (B. L. Milrod et al., 1997), panic control therapy (Craske et al., 2000), and applied relaxation training (Schwalberg & Chambless, 2006), observers assessed insight-, cognition-, and skills-focused techniques using the multitheoretical list of therapeutic interventions (McCarthy & Barber, 2009) from Weeks 1, 5, and 9 session recordings. Outcome was assessed at Weeks 1, 5, 9, and termination by the Panic Disorder Severity Scale (Shear et al., 1997).

Results: When looking across treatments, very high or low (not moderate) insight-oriented interventions were associated with the most symptom improvement by the subsequent assessment point and at termination. Moderate (not very high or low) skills- and cognition-oriented interventions correlated with more improved outcome at the subsequent assessment and termination. These findings describe when interventions are used in general but not within a specific protocol treatment.

Conclusions: Curvilinear relations between technique and symptom change might more closely depict how interventions relate to outcome than might more conventional linear approaches. (PsycInfo Database Record (c) 2025 APA, all rights reserved).