Psychotherapy最新文献

The facilitative interpersonal skills (FIS) task is a performance-based task designed to assess clinicians' capacity for facilitating a collaborative relationship. Performance on FIS is a robust clinician-level predictor of treatment outcomes. However, the FIS task has limited scalability because human rating of FIS requires specialized training and is time-intensive. We aimed to catalyze a "big needle jump" by developing an artificial intelligence- (AI-) based automated FIS measurement that captures all behavioral audiovisual markers available to human FIS raters. A total of 956 response clips were collected from 78 mental health clinicians. Three human raters rated the eight FIS subscales and reached sufficient interrater reliability (intraclass correlation based on three raters [ICC3k] for overall FIS = 0.85). We extracted text-, audio-, and video-based features and applied multimodal modeling (multilayer perceptron with a single hidden layer) to predict overall FIS and eight FIS subscales rated along a 1-5 scale continuum. We conducted 10-fold cross-validation analyses. For overall FIS, we reached moderate size relationships with the human-based ratings (Spearman's ρ = .50). Performance for subscales was variable (Spearman's ρ from .30 to .61). Inclusion of audio and video modalities improved the accuracy of the model, especially for the Emotional Expression and Verbal Fluency subscales. All three modalities contributed to the prediction performance, with text-based features contributing relatively most. Our multimodal model performed better than previously published unimodal models on the overall FIS and some FIS subscales. If confirmed in external validation studies, this AI-based FIS measurement may be used for the development of feedback tools for more targeted training, supervision, and deliberate practice. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Group therapy has evolved as a powerful therapeutic approach, facilitating mutual support, interpersonal learning, and personal growth among members. However, the complexity of studying communication dynamics, emotional expressions, and group interactions between multiple members and often coleaders is a frequent barrier to advancing group therapy research and practice. Fortunately, advances in machine learning technologies, for example, natural language processing (NLP), make it possible to study these complex verbal and behavioral interactions within a small group. Additionally, these technologies may serve to provide leaders and members with important and actionable feedback about group therapy sessions, possibly enhancing the utility of feedback-informed care in group therapy. As such, this study sought to provide a proof of concept for applying NLP technologies to automatically assess alliance ratings from participant utterances in two community-based online support groups for weight stigma. We compared traditional machine learning approaches with advanced transformer-based language models, including variants pretrained on mental health and psychotherapy data. Results indicated that several models detected relationships between participant utterances and alliance, with the best performing model achieving an area under the receiver operating characteristic curve of 0.654. Logistic regression analysis identified specific utterances associated with high and low alliance ratings, providing interpretable insights into group dynamics. While acknowledging limitations such as small sample size and the specific context of weight stigma groups, this study provides insights into the potential of NLP in augmenting feedback-informed group therapy. Implications for real-time process monitoring and future directions for enhancing model performance in diverse group therapy settings are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In this preregistered Prospero (CRD42022334071) review, the authors updated a meta-analysis review that examined the relation between therapist facilitation of patient emotional experience/expression and outcome in psychodynamic psychotherapy. Computer, manual, and backwards searches were conducted for relevant publications, and 14 independent samples of short-term dynamic psychotherapy were included in the meta-analysis. Data analysis included calculation of an overall effect size of the relationship between therapist affect focus and outcome, statistical significance, and test for homogeneity. In addition, moderator analyses were conducted to examine the potential impact of the methodological quality of individual studies. The overall weighted average r was .265, which was statistically significant, p < .001 (k = 14; 95% confidence interval [.130, .392]), indicating that therapist affect focus was associated with greater degree of patient change over the course of psychodynamic therapy. The results were not demonstrably heterogeneous, Q(13) = 14.787, p = .321, I² = 12.085, and publication bias analyses did not indicate cause for concerns regarding the results (all ps > .05). Trim-and-fill results indicated an adjusted weighted average r of .250 (decrease of 5.660%). None of the moderator analyses examining study methodology quality were statistically significant (all ps > .10). These data indicate that therapist facilitation of patient affective experience/expression is associated with patient improvement over the course of psychodynamic psychotherapy. The size of this relation was not significantly related to methodological quality. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

We developed an asynchronous online cognitive behavioral therapy (CBT) training tool that provides artificial intelligence- (AI-) enabled feedback to learners across eight CBT skills. We sought to evaluate the technical reliability and to ascertain how practitioners would use the tool to inform product iteration and future deployment. We conducted a single-arm 2-week field trial among behavioral health practitioners who treat outpatients with psychosis. Practitioners (N = 21) were invited to use the AI-enabled CBT training tool over a 2-week (15 days, inclusive) period. To enable naturalistic observation, no adjustments were made to their workloads nor were prescriptions on use provided. We conducted daily assessments and collected backend analytics for all users. At end point, we assessed acceptability, appropriateness, feasibility of implementation, perceived usability, satisfaction, and perceived impact of training. We observed four types of technical issues: broken links, intermittent issues receiving AI-enabled feedback, video replay errors, and an HTML error. Participants averaged 6.57 logins over the 2 weeks, with more than half engaging daily. Most participants (44.7%) engaged for < 30-min increments. Usability scores exceeded industry standard and satisfaction scores indicated good promotion of the tool. All participants endorsed high feasibility, acceptability, and appropriateness. Twelve participants (57%) used the AI-enabled feedback feature; those who did tended to report improved satisfaction, feasibility, and perceived impact of the training. The training tool was used by practitioners in a routine care setting, met or exceeded conventional implementation benchmarks, and may support skill improvement; however, data suggest that practitioners may need support or accountability to fully leverage the training tool. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Complementing the oft-studied construct of interpersonal isolation, research has increasingly focused on existential isolation (EI), or the subjective feeling of separateness in one's experience. In the clinical realm, several studies have demonstrated that higher EI is associated with more severe mental health problems at a single cross-section of time. Moreover, one study showed that higher pretreatment EI predicted worse psychotherapy outcomes. However, it remains unknown whether an average level of EI across all of psychotherapy (a type of during-treatment "trait") and/or fluctuations in EI during psychotherapy (a type of during-treatment "state") relate to broader treatment outcomes. Addressing EI in this more nuanced and complex manner, the present study parsed the EI-outcome association in its between- (trait) and within-patient (state) components in the context of naturalistic outpatient psychotherapy (Constantino et al., 2021). Participants were 46 therapists treating 144 patients who provided enough EI and outcome data to establish average, longitudinal, and temporal associations across treatment. Using a random intercept cross-lagged panel model, the between-patient results showed that higher average EI was associated with worse average outcomes (standardized association = .60, p < .001). However, although within-patient EI demonstrated significant variability over time, such fluctuations were unexpectedly unrelated to subsequent changes in outcome-when accounting for prior EI and outcome changes (p = .617). The findings suggest that although EI seems to possess both traitlike and statelike qualities, the former component may have the greatest influence on treatment outcomes, whereas the latter may be more of an outcome in itself. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

A key mechanism of psychopathology and change proposed by the theory of interpersonal reconstructive therapy (IRT; Benjamin, 2003, 2018) is termed the "gift of love" (GOL). The GOL hypothesis is that wishes to receive love and acceptance from specific internalized attachment figures shape and maintain problem patterns and their associated symptoms for many patients across a wide range of psychopathology. According to IRT theory, optimal intervention is defined by therapist alignment, or "adherence," to a core algorithm of principles that are tailored individually and bring awareness to (a) attachment-based yearnings for love and acceptance from internalized figures and (b) how those yearnings shape and motivate current problems and symptoms. The method then seeks to enhance choice about those relationships and their attendant feelings, hopes, and fears. The study sample includes 30 patients, referred while receiving inpatient treatment and followed on an outpatient basis, with complex, high-acuity clinical needs (i.e., histories of multiple psychiatric hospitalizations, recurrent suicidality, ineffectiveness of prior treatment, and significant personality pathology). Reliable measures were developed to track therapist adherence to IRT principles, as well as patient stages of change coming to terms with the GOL. IRT adherence was associated with retention, reduced depression and anxiety, and improved self-treatment. Mediation analyses support the proposition that change in IRT is contingent upon patient progress at grieving the losses and associated wishes linked to attachment figures. Implications for theory-guided research and practice at the level of underlying principles are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Between the racial reckoning of 2020 and wider spread policy development that is explicitly homophobic and transphobic, there have been consistent and resurgent calls for clinicians to address aspects of power and privilege in psychotherapy. This is especially important in a field that continues to be largely White, cisgender, and heterosexual (not to mention abled, socioeconomically privileged, and privileged in many other aspects of human diversity). However, too few models for how to accomplish this in actual practice are offered in the literature. Further, while there is little guidance for clinicians on how to address power, privilege, and intersectionality in the therapy room, there is even less direction for how to train those learning to be clinicians to do this from the start. The purpose of this article is to translate existing knowledge into a framework for supervisors to guide trainees' application in psychotherapy. The article provides an overview of social location, including an analytic framework, as well as a set of practical steps for supervisors and trainees. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

There is a growing consensus that effective psychotherapists and counselors require antioppressive, social-justice-oriented, culturally and structurally responsive training (e.g., Neville et al., 2021; Singh, 2020; Vera & Speight, 2003). The field has a long way to go to answer this call (Wilcox et al., 2024), including with social class topics (Liu, 2012) and peer-to-peer initiatives (Stigmar, 2016). Thus, the current qualitative study examined five student facilitators' perspectives on a counseling psychology graduate program's antioppressive peer-to-peer social class workshop (SCW). The SCW was originally grounded in the Social Class Worldview Model-Revised (Liu, 2012) and the multicultural orientation (MCO) framework (Davis et al., 2018) and later incorporated ideas from liberation psychology (Comas-Díaz & Torres Rivera, 2020) and decolonial pedagogies (Goodman et al., 2015). To illuminate the factors that affect student facilitators' SCW experiences, and how this work can inform culturally and structurally responsive psychotherapy training more broadly, we collected student facilitators' collaborative autoethnographic reflections. Using reflexive thematic analysis, we constructed two core themes: (a) nurturing growth: ingredients and orientations and (b) navigating barriers: oppressive structures manifest at multiple levels. Even as student facilitators acknowledged ways that they and the SCW fell short, they remained optimistic about growth both achieved and hoped for. We discuss limitations and implications for the promotion of peer-to-peer and/or social class initiatives in psychotherapy training. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Psilocybin-assisted therapy (PAT) is an experimental treatment with transformative promise. Developing standards for PAT psychotherapy protocols is a priority, but psychotherapeutic protocol components of PAT have been subjected to little rigorous research. This study was designed to assess protocol components in a trial of PAT. The Enhanced Critical Incident Technique (E-CIT) was used to identify critical incidents in the treatment, wish list items comprising components or modifications that would have improved the treatment experience, and contributing factors that influenced the treatment. Participants included patients (n = 10), facilitators (n = 7 licensed mental health clinicians and certified spiritual health clinicians), and caregivers (n = 7) in an open-label trial investigating PAT for cancer-related demoralization and chronic pain. Patients and caregivers were interviewed after their last treatment session in the trial; facilitators were interviewed at the end of the entire trial. Rapid qualitative analysis identified specific domains for improvement in the treatment protocol based on the E-CIT. Critical incidents, wish list items, and contributing factors pertained to aspects of the therapy (e.g., importance of intention-setting) and the overall protocol (e.g., navigating transitions in the treatment). Findings indicate the importance of tailoring PAT to accommodate the medical history and needs of this population, support common factors, and ensure collaborative care. Recommendations across nine topic areas were derived from the data and presented in the Discussion. The E-CIT shows promise for advancing early stage research on PAT components. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Exposure and response prevention (ERP) is an effective treatment for obsessive-compulsive disorder. However, ERP's distressful nature may be too demanding for some patients, resulting in low engagement with treatment or even dropout. The current review aimed to summarize and categorize the components of ERP plus add-on protocols. Studies were deemed eligible when an ERP treatment was combined with a psychological add-on in the treatment of adult obsessive-compulsive disorder patients. Nineteen studies fulfilled the inclusion criteria. Add-ons were divided into eight categories: acceptance and commitment therapy, cognitive therapy-based interventions, family accommodation, inhibitory learning theory strategies, inhibitory training, mindfulness-based techniques, and motivational interviewing. Studies were divided into two methods of combining ERP with an add-on: the additive and the integrative format. These types of protocols may offer a feasible way for clinicians to personalize, according to the patient's needs, an otherwise structured treatment, increasing its responsiveness. Future studies, besides studying the efficacy of these adaptations, should also assess whether clinicians who are reluctant to use exposure therapy are more willing to employ the technique in an ERP plus add-on protocol. (PsycInfo Database Record (c) 2025 APA, all rights reserved).