Journal of consulting and clinical psychology最新文献

Traditionally, psychotherapy distinguishes between "common factors" and "specific mechanisms." Common factors can be defined as "unrecognized factors in any therapeutic situation-factors that may be even more important than those being purposely employed." Specific mechanisms, by contrast, are deliberately targeted by given therapeutic approaches as the primary drivers of change. This distinction is based on the implicit assumption that each therapeutic ingredient fits exclusively into one of these categories. In this viewpoint, the author argues that the common versus specific dichotomy is both arbitrary and potentially detrimental. It risks preventing clinicians from using specific techniques to target some of the most effective therapeutic mechanisms identified in research. The trait-like and state-like theoretical framework has demonstrated that the term "common factor" is less useful as a fixed attribute and it is more productive to consider it as one potential role that mechanisms may play, alongside their ability to function as specific mechanisms targeted directly to drive state-like therapeutic change. This shift parallels the evolution from viewing individual characteristics as pure traits (e.g., personality traits) or states (e.g., emotional states) to recognizing them as coexisting dimensions of the same construct: Personality traits can display state-like fluctuations across time and contexts, while emotional states may follow stable trait-like patterns over time. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: To investigate if Sessions 1-4 Patient Health Questionnaire-9 (PHQ-9) scores are associated with treatment outcome and if there is a differential effect between person-centered experiential therapy (PCET) and cognitive behavioral therapy (CBT).

Method: A secondary data analysis of a prospectively registered and ethically approved pragmatic, noninferiority randomized controlled trial comparing PCET and CBT for the treatment of moderate or severe depression. Latent growth curve modeling was applied to data from 274 patients who received ≥ five sessions of therapy to investigate the association between change in Sessions 1-4 PHQ-9 scores on a binary end-of-treatment outcome (i.e., reliable and clinically significant improvement; RCSI) and on final-session PHQ-9 scores. Estimated power was 80%.

Results: Change in Sessions 1-4 PHQ-9 scores was significantly associated with the probability of RCSI in the PCET condition (p = .002) but not the CBT condition (p = .156). Specifically, greater early treatment improvement and higher PHQ-9 scores at Session 1 were significantly associated with obtaining RCSI in PCET, but not in CBT; this relationship differed significantly between conditions (p = .007). Greater early treatment improvement was also significantly associated with lower final-session PHQ-9 scores (p < .001), but this relationship did not significantly differ across conditions (p = .121).

Conclusions: Early session scores are associated with final-session depression scores, though PCET and CBT manifest distinctively different trajectories for patients achieving RCSI. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: In this commentary, we outline conceptual and methodological concerns we have with a recent randomized trial of two group-delivered transdiagnostic eating disorder treatments (Stice et al., 2023), particularly regarding the description, implementation, and labeling of the comparison condition.

Method: We discuss the selection of a control condition in comparative psychotherapy trials; the distinction between adaptations and other types of intervention modifications; the need for processes to ensure that an intervention is developmentally and diagnostically appropriate; and the provision of detailed descriptions of interventions in articles and supplementary materials, as well as making manuals publicly available, to ensure that reviewers and readers can understand the interventions delivered and can accurately interpret the results.

Results: We highlight the potential downstream implications of mislabeling an intervention and conclude that the comparison condition in Stice et al.'s (2023) article should be reclassified to avoid misinterpretation.

Conclusions: There are published frameworks and guidelines available that promote more detail, precision, and transparency about interventions being tested in clinical trials. We believe it is time for journals to implement these guidelines to ensure that reviewers and readers can fully understand what interventions were tested to draw informed conclusions from the study, replicate research findings, and reliably deliver these interventions in clinical practice. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Inhibitory learning models emphasize the central role of threat expectancy violation during exposure therapy. However, exposure is often implemented alongside cognitive restructuring, which reduces threat expectancies before exposure, reducing the potential for expectancy violation. This study examined whether the timing of expectancy violation (before/during exposure) and magnitude of expectancy change impact the efficacy of exposure therapy.

Method: A total of 249 adults (range 18-59 years old, M = 21.19, SD = 6.89) with elevated public speaking anxiety completed an intensive exposure session. Participants were randomly allocated to receive exposure based on (a) behavioral experiments (BE; i.e., maximizing expectancy violation and emphasizing prediction error following exposure); (b) cognitive restructuring before exposure (CR + EXP; i.e., threat expectancies reduced before exposure, thus reducing expectancy violation during exposure tasks); or (c) exposure without explicit processing of threat expectancies or expectancy violation. Change in symptoms was assessed pre-post exposure session and at 1-week follow-up.

Results: The BE and CR + EXP groups showed superior anxiety reduction (primary outcome) and threat expectancy change (secondary outcome) compared to exposure without explicit processing of threat expectancies or expectancy violation. There was a nonsignificant small effect size difference in anxiety reduction favoring BE over CR + EXP. There was greater expectancy change in the BE group compared to the CR + EXP group and shorter treatment duration. Greater threat expectancy change during exposure tasks was associated with greater anxiety reduction.

Conclusions: Threat expectancy change facilitates anxiety reduction during exposure therapy, and there may be modest advantages to challenging threat expectancies after exposure (BE) compared to before exposure (CR + EXP). (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Young adults in college engage in risky drinking that results in alcohol-related harms. Most evidence-based prevention interventions recommended for this population rely on correcting exaggerated drinking norms via personalized normative feedback (PNF). Informed by an extensive literature linking alcohol attitudes and drinking behavior, we adapted a brief counter-attitudinal advocacy (CAA) task to the alcohol prevention context. The goal of this study is to evaluate the ability of CAA in changing drinking and related consequences and to explore the comparative efficacy of CAA versus PNF.

Method: This two-site randomized controlled trial had two experimental conditions (CAA and PNF) and an assessment-only control condition. Participants were 585 students who reported heavy episodic drinking and ≥ 2 alcohol-related negative consequences. Alcohol outcomes were assessed at 1-, 3-, and 6-month follow-ups to test hypotheses that the CAA and PNF manipulations will decrease drinks per week, typical drinks per day, peak blood alcohol concentration, and alcohol consequences, relative to control.

Results: Participants reported reductions in drinks per week, typical drinks, and alcohol consequences. Those who received PNF reported significantly fewer drinks per week than controls, whereas those who received CAA reported significantly fewer consequences than controls. The CAA and PNF conditions did not differ from one another.

Conclusions: This study demonstrates an application of attitude change theory and CAA methods to the alcohol prevention context, across demographically different settings. The novel CAA task had a harm reduction effect on consequences but not consumption. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: To explore which cognitive behavioral therapy (CBT) self-help app usage predicted depression during a selective prevention trial.

Method: A recent controlled trial (ECoWeB-PREVENT) randomized young people aged 16-22, at increased risk for depression because of elevated worry/rumination, negative appraisals, and/or rejection sensitivity but without past or current history of major depression, to apps that provided self-monitoring, self-monitoring plus CBT self-help, or self-monitoring plus emotional competency self-help. Self-help included coping strategies for moment-by-moment use (Tools) and self-learning/planning exercises (Challenges). On the primary outcome (depression, Patient Health Questionnaire-9 [PHQ-9]) at 3-months follow-up (primary endpoint), only the CBT app outperformed self-monitoring. In this secondary analysis, only data from participants who used the CBT or self-monitoring apps at least once were analyzed to test what app use predicted change in depression from baseline to 3 months.

Results: Of the original 1,262 participants (79% female), 558 were included (CBT, baseline, n = 273, PHQ-9: M = 7.48, SD = 3.9; 3 months, N = 163, PHQ-9: M = 8.83, SD = 4.92; self-monitoring, baseline, n = 285, PHQ-9: M = 7.45, SD = 4.26; 3 months, N = 183, PHQ-9: M = 7.48, SD = 3.9). Neither total app use, self-monitoring, nor use of Tools predicted change in depression (all ps > .05). Frequency of use of Challenges predicted lower depression symptoms and caseness at 3 months (β = -0.28, 95% CI [-0.53, -0.03], p = .029). Specifically, the use of behavioral activation challenges mediated the effects of the CBT app on depression over 3 months (β = -0.59, 95% CI [-1.13, -0.05], p = .03).

Conclusions: Brief psychoeducation about behavioral activation principles in an app may protect young people from depression over 3 months, even when only used once. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: Despite the prevalence of depressive disorders among youth, there is no health system model to address the prevention of these disorders.

Method: With the goal of creating effective, tolerable, and scalable interventions for the prevention of adolescent depression, we have fielded three randomized clinical trials, centered in health care delivery organizations that use a whole-of-society approach: (a) Path 2 Purpose (N = 664), comparing the Competent Adulthood Transition with Cognitive Behavioral, Humanistic, and Interpersonal Training (CATCH-IT; B. W. Van Voorhees et al., 2015), guided digital health intervention to a synchronous mental health specialist-led group cognitive behavioral intervention, Coping with Depression Course-Adolescent; (b) PATHway (N = 400), examining the efficacy of the CATCH-IT components; and (c) Behavioral Health Stratified Treatment (N = 780), which examines the feasibility and potential benefit of a coordinated care, risk stratification, and intervention matching approach for adolescents with intellectual and developmental disabilities using both CATCH-IT (lower risk) and the Coping with Depression Course-Adolescent (higher risk).

Results: The study samples for all three trials include youth from traditionally underrepresented groups (71.8%) with some economic distress (47.6%). Intervention utilization was moderate across trials. Feedback from study teams reveals general barriers to implementation and challenges specific to the pandemic.

Conclusions: We review these trials, report preliminary data on demographics and intervention utilization, and provide feedback from study teams on implementation challenges encountered. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: The purpose of this randomized controlled trial was to test the effects of an online, coached mindfulness intervention on momentary negative affect (mNA) for youth with high levels of trait negative affectivity.

Method: Participants were 111 youth ages 12 to 17 years old (M = 14.17, SD = 1.60). Youth self-identified as 68% female, 29% male, and 4.5% gender diverse; 54.55% identified as White; 31.82 reported being Hispanic/Latinx. Participants were selected for having high levels of trait negative affect and were randomized to receive either the mindfulness program or no intervention. We used ecological momentary assessment to measure stress and emotions and to derive measures of mNA comprised of stressor-independent and stressor-reactive negative affect. The ecological momentary assessment protocol involved participants completing a short survey/diary entry on Qualtrics four times per day for 5 days. Internalizing symptoms were assessed with the Patient Health Questionnaire-8, Generalized Anxiety Disorder-7, and the Screen for Child Anxiety Related Disorders.

Results: The mindfulness intervention resulted in a significant reduction in stressor-reactive negative affect (t = 2.001, df = 96, p = .048; Cohen's d = .40), but not stressor-independent mNA or overall mNA. Additionally, reductions in stressor-reactive negative affect significantly correlated with changes in internalizing symptomatology (standardized β = .26, p = .032).

Conclusions: These results indicate that among youth with high levels of trait negative affectivity, a relatively affordable and accessible digital mindfulness program significantly reduced stressor-reactive negative affect. The absence of an effect on stressor-independent or overall average mNA suggests some specificity of the effects of mindfulness to stressor-reactive negative affect in an at-risk sample of adolescents. (PsycInfo Database Record (c) 2025 APA, all rights reserved).