Journal of consulting and clinical psychology最新文献

Objective: A recent randomized controlled trial (RCT) indicated that individuals with higher levels of attachment anxiety exhibited better treatment outcomes in supportive-expressive therapy (SET) relative to supportive therapy (ST). But to gain insight into within-patient therapeutic changes, a within-individual design is required. The present study contrasts previous findings based on theory-driven between-patient moderators with data-driven moderators of within-patient processes to investigate whether findings converge or diverge across these two approaches.

Method: We used data of 118 patients from the pilot and active phases of a recent RCT for patients with major depressive disorder, comparing ST with SET, a time-limited psychodynamic therapy. The predefined primary outcome measure was the Hamilton Rating Scale for Depression. Supportive versus expressive techniques were rated based on patients' end-of-session perspective. We compared previous findings based on moderators of between-patient effects with a data-driven approach for identifying moderators of within-patient effects of techniques on subsequent outcome.

Results: After false discovery rate corrections, of 10 preselected moderators, patients' attachment anxiety and domineering style remained significant. Of these, bootstrap resampling revealed significant differences between ST and SET techniques for the attachment anxiety moderator: Those with higher attachment anxiety benefited more from greater use of ST than SET techniques in a particular session, as evidenced by lower levels of symptoms at the subsequent session.

Conclusions: Our within-individual findings diverge from previously published between-individual analyses. This proof-of-concept study demonstrates the importance of complementing between-individuals with within-individual analyses to achieve better understanding of who benefits most from specific treatment techniques. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: During treatment, the therapeutic alliance is characterized by rupture and repair episodes, which in turn are associated with psychotherapy outcome. It would be important to have a parsimonious tool to identify ruptures in psychotherapy sessions to provide therapists with meaningful feedback about when they occur. The present study thus aims to establish whether measuring self-reported alliance dynamics can function as a measure of alliance ruptures.

Method: The sample consisted of 58 depressed patients, who received 22 sessions of cognitive therapy for depression in an outpatient setting. The observer-rated Rupture Resolution Rating System (3RS) was applied to 58 sessions where the self-reported Working Alliance Inventory (WAI) completed by patients after each therapy session indicated that alliance ratings declined more than 2 SDs from that patient's individual mean. For comparison purposes, the 3RS was also applied to 58 randomly chosen sessions from the same treatment phase (early, middle, late).

Results: Results showed significant differences between sessions where the WAI indicated a drop in the alliance and randomly chosen sessions of the same treatment phase with regard to the frequency and impact of ruptures.

Conclusion: This speaks for the construct validity of the 3RS. Session-by-session alliance ruptures may reliably be measured using a case-sensitive approach to identify meaningful drops in alliance self-report (WAI). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: We conducted a large (N = 204) randomized, clinical trial to test the efficacy of parent-child interaction therapy (PCIT) on observed parenting, two key drivers of maladaptive parenting-self-regulation and social cognitions, and child behavior outcomes in a sample of child welfare-involved families.

Method: Participants were randomly assigned to standard PCIT (n = 120) or services-as-usual (SAU; n = 84). The sample was characterized by low household income, significant exposures to adverse childhood experiences, and substance abuse. Intention-to-treat analyses were conducted on multiply imputed data followed by secondary per-protocol analyses.

Results: Significant PCIT effects emerged on (a) increased positive parenting, reduced negative parenting and disruptive child behavior (small-to-medium intention-to-treat effects and medium-to-large per-protocol effects); (b) gains in parent inhibitory control on the stop-signal task (small-to-medium effects); (c) gains in parent-reported emotion regulation and (d) positive, affirming self-perceptions (small-to-medium effects), relative to the SAU control group. PCIT's effects on gains in parent emotion regulation were mediated by reductions in observed negative parenting. No differences in rates of parent commands or child compliance were observed across conditions. Harsh child attributions moderated treatment impact on parenting skills acquisition. PCIT parents who held harsher attributions displayed greater gains in use of labeled praises and declines in negative talk/criticism with their child, than control group parents.

Conclusions: This randomized trial presents the first evidence that PCIT improves inhibitory control and emotion regulation in a child welfare parents and replicates other published trials documenting intervention gains in positive parenting and child behavior in child welfare families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Suicide rates among African American adolescents have increased exponentially in recent years. The socioecological stressors that can increase suicide risk for African American adolescents, in conjunction with unique suicide risk manifestations within this group, require culturally sensitive preventive interventions. This study examines the efficacy of the Adapted-Coping With Stress course (A-CWS), a culturally tailored preventive intervention, to reduce suicidal ideation in African American adolescents, utilizing a randomized controlled design.

Method: Participants included 410 ninth-grade students in a large Midwestern city; most students identified as Black/African American. Participants were randomly assigned to either the A-CWS intervention or standard care control condition. All participants were assessed at baseline, immediately postintervention, and 6 and 12 months postintervention.

Results: Treatment effects were examined using latent growth models comparing suicidal ideation trajectories in control and intervention conditions. Analyses were conducted using both intention-to-treat and treatment-as-received samples (i.e., intervention condition participants who attended at least 80% of sessions). In both intention-to-treat and treatment-as-received analyses, there was a significant treatment effect: Individuals in the A-CWS intervention condition with higher baseline ideation evidenced a superior reduction in suicidal ideation over the course of the study, relative to their counterparts in the standard care control condition.

Conclusion: Findings indicate that the A-CWS preventive intervention is efficacious in reducing suicidal ideation among African American adolescents with higher levels of baseline suicidal ideation and that effects sustain over time, with the strongest effect evidenced 12 months postintervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: There is consistent evidence that cognitive behavioral therapies (CBTs) are effective interventions for adult depression. While some evidence has compared these effects in different countries, no prior systematic review and meta-analysis has compared the efficacy of CBTs between Chinese and people from the rest of the world. The current meta-analysis addressed this gap by a systematic review of eligible studies from Chinese and worldwide databases.

Method: Hedges' g was calculated using a random-effects model. Subgroup analyses and multilevel meta-analytic models were conducted to examine the relationship among effect sizes and the characteristics in Chinese studies. Metaregression analyses were conducted to explore the difference of the efficacy of CBTs between Chinese studies and non-Chinese studies after controlling for the moderators.

Results: A total of 34 (n = 3,710) studies in China and 307 (n = 30,333) studies from the rest of the world were included. The effect size of CBTs on depression for Chinese participants was 1.19 (95% CI [0.86, 1.52]), which was higher (Q = 4.63, p = .03) than the effect size of the rest of the world (0.82, 95% CI [0.74, 0.90]). After controlling for moderators, the effect size of Chinese studies was still higher than non-Chinese studies (β = 0.351, p = .011).

Conclusions: CBTs are effective interventions for adult depression and deserve more attention in China for depression management. Moderators related to study design, clinical features, and cultural factors need to be considered in the interpretation of the results. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: The objective of this research was to determine the efficacy and safety of an optimized informed consent (OIC) consultation for psychotherapy.

Method: We performed a randomized controlled superiority online trial involving 2 weeks of treatment and 3 months of follow-up. One hundred twenty-two adults with mental disorders confirmed by structured interview currently neither in out- nor inpatient psychotherapy (mean age: 32, gender identity: 51.6% female, 1.6% diverse), were randomized. Participants received an information brochure about psychotherapy for self-study (treatment as usual [TAU]; n = 61) or TAU plus a one-session OIC utilizing expectation management, contextualization, framing, and shared decision making (n = 61). The primary outcome was treatment expectations at 2-week follow-up.

Results: At 2-week follow-up, participants receiving OIC showed more positive treatment expectations compared to those receiving TAU only (mean difference: 0.70, 95% CI [0.36, 1.04]) with a medium effect size (d = 0.73). Likewise, OIC positively influenced motivation (d = 0.74) and adherence intention (d = 0.46). OIC entailed large effects on reduction of decisional conflict (d = 0.91) and increase of knowledge (d = 0.93). Participants receiving OIC showed higher capacity to consent to treatment (d = 0.63) and higher satisfaction with received information (d = 1.34) compared to TAU. No statistically significant group differences resulted for expected adverse effects of psychotherapy. Results were maintained at 3-month follow-up. Data sets for n = 10 cases (8.2%) were missing (postassessment n = 4, 2-week n = 6, 3-month follow-up n = 8).

Conclusions: Explaining to patients how psychotherapy works via a short consultation was effective in strengthening treatment expectations and decision making in a nonharmful way. Further trials clarifying whether this effectively translates to better treatment outcomes are required. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Few online interventions targeting anxiety and depression in university students are designed for universal delivery, and none for group-level delivery. This randomized controlled trial (NCT No. 04361045) examined the effectiveness of such a prevention program.

Method: StriveWeekly is a web-based intervention designed with weekly self-guided skill modules (e.g., behavioral activation) that are synchronously delivered to all users. Student participants (n = 1,607) were recruited from one large public university, and 65.4% had no prior mental health service use. Participants were randomly assigned to 8 weeks of StriveWeekly (n = 804) or a waitlist condition (n = 803). Participants completed web-based surveys at baseline, posttest, and 3-month follow-up. The primary outcome was the self-reported Depression Anxiety and Stress Scale-21.

Results: Piecewise linear mixed-effect models found significant group by time interactions for depression (t = -3.05, p = .002), anxiety (t = -3.01, p = .003), and total symptoms (t = -3.34, p < .001). Relative to the waitlist, students assigned to StriveWeekly improved more from baseline to posttest (between-group d = 0.18-0.21). These small effects were maintained through follow-up, and subsequently replicated by the original waitlist. The intervention was initiated by 73.0% of students in the StriveWeekly condition (modules completed: M = 3.72), and 71.6% of all posttest respondents rated the intervention highly.

Conclusion: Findings supported StriveWeekly's effectiveness for large scale indicated prevention of anxiety and depression symptoms in university students. However, further development and research are still needed, as not all students used the intervention, reported satisfaction, or experienced improvement. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Precision medicine is an area with great potential for mental health, but has made limited gains prognostically in predicting effective treatments. For refugees exposed to violence, culture may be a crucial factor in predicting treatment outcomes.

Method: For this study, 290 participants from three regions (Afghanistan, the Great Lakes region of Africa, and Iraq and Syria) participated in a randomized controlled trial of an advocacy-based intervention. Emotional distress symptoms were measured prior to intervention, midintervention (3 months), postintervention (6 months), and follow-up (6 months after the end of intervention). Number of traumatic events, resource access, social support, and English proficiency were tested for potential predictive effects on intervention outcome.

Results: Multilevel generalized linear models revealed that Afghans' (B = -0.259, SE = 0.108, p = .013), and Great Lakes Africans' (B = -0.116, SE = 0.057, p = .042) emotional distress symptoms improved as a function of the intervention, while Iraqis and Syrians showed no intervention effects. For Afghans, English proficiency (B = -0.453, SE = 0.157, p < .01) and social support (B = -0.179, SE = 0.086, p = .037) were most strongly correlated to emotional distress, while for Africans, resource access (B = -0.483, SE = 0.082, p < .001) and social support (B = -0.100, SE = 0.048, p = .040) were the strongest predictors of emotional distress.

Conclusions: Response to advocacy-based interventions and active ingredients may be influenced by culture; findings have implications for refugees and precision medicine. (PsycInfo Database Record (c) 2024 APA, all rights reserved).