Psychotherapy最新文献

Research indicates an effect of nonverbal synchrony on the therapeutic relationship and patients' symptom severity within psychotherapy. However, vocal synchrony research is still rare and inconsistent. This study investigates the relationship between vocal synchrony and outcome/attachment dimensions, controlling for therapeutic alliance and movement synchrony. Our sample consisted of 64 patients with social anxiety disorder. Symptom severity was assessed with the Liebowitz Social Anxiety Scale and the Inventory of Interpersonal Problems, whereas attachment was assessed with the Experiences in Close Relationships Questionnaire at the beginning and end of therapy. Therapeutic alliance was measured with the Helping Alliance Questionnaire II. We determined vocal synchrony of the median and range of the fundamental frequency (f 0) by correlating f 0 values of manually segmented speaker turns. Movement synchrony was assessed via motion energy and time-series analyses. Patient- and therapist-led synchrony was differentiated. Statistical analyses were performed using mixed effects linear models. Vocal synchrony had a negative impact on outcome. Higher vocal synchrony led to higher symptom severity (if the patient led synchrony, at the end of therapy) as well as attachment anxiety, avoidance, and interpersonal problems at the end of therapy. Predicting attachment anxiety, the effect of therapist-led vocal synchrony went beyond the effect of therapeutic alliance and movement synchrony. High vocal synchrony may arise due to a lack of autonomy in social anxiety disorder patients or might reflect attempts to repair alliance ruptures. The results indicate that vocal synchrony and movement synchrony have different effects on treatment outcome. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Dialectical behavior therapy (DBT) is currently the most researched therapy method to treat borderline personality disorder (BPD). A major component of DBT is learning and practicing specific skills to regulate emotions. Qualitative studies found that patients perceived DBT skills as helpful in dealing with emotions. However, DBT consists of more than 60 different skills, and earlier qualitative studies had a broad focus. The present study explores patients' experience with a specific skill, opposite action (OA). The skill is one of the major DBT skills assumed to play an important role in symptom improvement. OA means deliberately performing a behavior that is opposite to the emotional urge to act and is intended to weaken the original emotion. Qualitative data from semistructured interviews with 23 patients diagnosed with BPD receiving DBT were analyzed following qualitative content analysis procedures. The participants generally had a good understanding of the skill, although it was often mixed with other skills of DBT. Performing OA was perceived as exhausting. Adverse effects of OA, intense emotions and high distress were reported as barriers to OA use. However, participants named several factors that helped them overcome these barriers, including their thoughts and actions, support from others, and treatment elements. Participants described positive effects of OA such as positive emotional changes and a decrease in problem behavior and more freedom in everyday life. The findings of the study provide valuable information to optimize the delivery of OA and DBT and can help to improve treatment outcome for patients with BPD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Although treatments for youth at risk for suicide have been successful, they are not similarly effective for everyone. Anxiety may interfere with adolescents' ability to engage with therapy and explain why some adolescents do not respond as well as others to treatment. The current study tested whether an anxiety diagnosis predicted treatment outcome among a sample of adolescents with suicidal ideation and depressive symptoms participating in either attachment-based family therapy or family-enhanced nondirective supportive therapy (N = 129; M age = 14.87, SD = 1.68; 81.9% female). The data set that the current study used had a high representation of Black/African American adolescents (48.8% of sample), which is valuable, as few studies have included adequate representation of this population. A significant indirect effect (.88; 95% confidence interval [.01, 2.64]) showed that across both treatment conditions, participants who met criteria for an anxiety disorder had greater difficulties engaging in goal-directed behavior midtreatment, and these difficulties, in turn, predicted more posttreatment suicidal ideation. The effect of anxiety on treatment outcome via difficulties with goal-directed behavior was nonspecific to the treatment condition. However, attachment-based family therapy was superior to family-enhanced nondirective supportive therapy in improving this aspect of emotion regulation among adolescents who did not have anxiety. In addition, difficulties with goal-directed behavior on treatment outcome were worse for adolescents' who reported greater attachment avoidance to their parents. Future research should test whether targeting goal-directed behavior and attachment avoidance would result in better treatment outcome for adolescents with suicidal ideation and anxiety. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Online guided self-help may be an effective and scalable intervention for symptoms of generalized anxiety disorder (GAD) among university students in India. Based on an online screen for GAD administered at 4 Indian universities, 222 students classified as having clinical (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria) or subthreshold (Generalized Anxiety Disorder Questionnaire, Fourth Edition, score ≥ 5.7) GAD were randomly assigned to receive either 3 months of guided self-help cognitive-behavioral therapy (n = 117) or a waitlist control condition (n = 105). Guided self-help participants recorded high program usage on average across all participants enrolled (M = 9.99 hr on the platform; SD = 20.87). Intent-to-treat analyses indicated that participants in the guided self-help condition experienced significantly greater reductions than participants in the waitlist condition on GAD symptom severity (d = -.40), worry (d = -.43), and depressive symptoms (d = -.53). No usage variables predicted symptom change in the guided self-help condition. Participants on average reported that the program was moderately helpful, and a majority (82.1%) said they would recommend the program to a friend. Guided self-help appears to be a feasible and efficacious intervention for university students in India who meet clinical or subthreshold GAD criteria. The trial is registered with ClinicalTrials.gov (NCT02410265). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Insight gained by patients during treatment has been theorized to be a central mechanism of change in psychotherapy, but empirical studies examining the association between patients' insight and psychopathological symptoms have produced mixed results. The present study addresses these inconsistencies by investigating convergence between the perspectives of patient and professional evaluator on insight and disentangling two potentially distinct components of insight: pretreatment individual differences and changes in insight during treatment. A sample of 393 patients receiving psychodynamic psychotherapy completed pre- and posttreatment measures on symptoms and insight. Professional evaluators evaluated patients' insight based on clinical interviews pre- and posttreatment. Polynomial regression and response surface analyses were used to examine congruence. The results indicate that when there was agreement between the patient and the evaluator on insight, both baseline level of insight and the changes in insight during treatment were found to be related to symptomatic change, although showing different patterns of association. Lower baseline levels of insight were significantly associated with greater symptomatic improvement than were higher levels of insight. At the same time, greater increase in insight during treatment was moderately significantly associated with greater reduction in symptoms, as long as the changes in insight were not minimal. The findings underscore the importance of assessing the congruence between patients' and professional observers' perspectives on patient insight and the potentially distinct roles of between-patients baseline differences and within-patient changes in insight during treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The study demonstrates how asymmetries in therapists' affiliations with spouses emerge and are addressed in couple therapy. A total of 4 video-recorded couple therapy first sessions were subjected to conversation analysis. The moment-by moment interactions that contribute to one sided affiliation, as well as the therapists' ways of managing such asymmetry, are described in detail. Asymmetries of affiliation regularly co-occur with the exclusion of 1 spouse from the interaction. Asymmetries of affiliation and participation can be addressed by 2 types of action by the therapist: (a) In counterbalancing moves, the therapist shifts their affiliation back to the spouse that was neglected. (b) In systemic couple-directed interventions, the therapist creates symmetry of affiliation and participation not only by attending to the individual spouses but also by addressing the couple as a single social unit. The observations are discussed in the light of the concept of split alliance and alliance ruptures, as well as in the context of research into affiliation as a generic property of social interaction. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Existing literature examining burnout in psychotherapists has not adequately considered the contributing role of emotional labor. Similarly, emotional labor research has not sufficiently explored how this construct operates in the context of psychologists who provide individual psychotherapy. To address these existing gaps in the literature, thematic analysis was conducted on interviews with 24 psychologists who provide individual psychotherapy to determine the perceived consequences of emotional labor identified by the participants. Participants discussed personal growth, feeling depleted and exhausted, and craving space free from people and work-related emotion as consequences of emotion management in the context of providing individual psychotherapy. The findings suggest that emotional labor can exert positive, negative, and neutral effects on psychologists providing psychotherapy and is worthy of attention as a variable in efforts to promote positive well-being. In the occupational group of psychologists providing individual psychotherapy, performing emotional labor can lead to personal growth, emotional exhaustion, and a need to distance oneself from work-related emotion. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The therapeutic alliance has gained status as a common factor in psychotherapy due to its robust predictive relationship with outcome. The current challenge in our field is to gain a more nuanced understanding of alliance's impact on the progress of treatment over the course of therapy. In the current study, alliance was measured on 3 dimensions: (a) the individual's as well as the couple's joint perception of alliance with the therapist ("self/group-therapist"), (b) each partner's perception of the alliance between the spouse and the therapist ("other-therapist"), and (c) the couple's assessment of alliance with each other ("within-system"). Based on self-reported data from 165 adult clients, we analyzed whether scores on these alliance dimensions at the beginning of therapy predicted the frequently measured outcomes on individual symptoms and relationship distress during treatment. We found that 2 of the alliance dimensions, the "self/group-therapist" and the "other-therapist," at the start of treatment predicted the slopes of the outcome measures. These findings add to established research suggesting that early establishment of alliance is an important predictor for progress during treatment. Variations in the results among the 3 alliance dimensions suggest the usefulness of the clinician assessing different aspects of alliance in couple therapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Individuals high in vindictive interpersonal problems tend to experience and express anger and irritability. In treatment, they have poor prognosis for alliance and outcome. We propose that positive expectation may serve as a moderating factor for these patients. In the current study, we examined the ability of expected alliance to act as a moderating factor in the early process and early progress of treatment for patients with vindictive interpersonal problems. A sample of 65 patients received short-term dynamic psychotherapy. At intake, before meeting the therapist, participants completed assessments for vindictive interpersonal problems and expected alliance. All therapy sessions were videotaped, and Session 2 was coded for confrontation ruptures. Early progress was assessed using the improvement from intake to Week 2 in the measure of distress from interpersonal relations. Our results show that, at high levels of vindictive interpersonal problems, higher expected alliance was associated with fewer confrontation ruptures. At high levels of vindictive interpersonal problems, higher expected alliance was associated with greater early improvement in distress from interpersonal relations. The findings demonstrate how positive expectations may function as a moderating factor that enables patients with vindictive tendencies to achieve a positive process and progress early in treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

In the present study, we examined whether clients' perceptions of similarity to their therapists in terms of the Big Five personality traits were associated with the real relationship and, indirectly through the real relationship, to treatment progress. Data collected through an online crowdsource platform from 212 adult clients in individual psychotherapy were analyzed using polynomial regression and response surface analysis. Results indicated that clients who perceived greater similarity to their therapists at higher (vs. lower) levels of Conscientiousness and Openness to Experience reported stronger real relationships, as did clients who perceived greater similarity at lower (vs. higher) levels of Neuroticism. Similarly, clients reported a stronger real relationship when they perceived their therapists as similarly high in Extraversion, but the real relationship decreased slightly when the similarity was perceived at higher (vs. moderate) levels of this trait. Perceived similarity at high and low levels of Agreeableness was also associated with stronger real relationships. There was no evidence of an indirect association between client-perceived similarity and treatment progress via the real relationship. However, clients who perceived greater similarity to their therapists at higher (vs. lower) levels of Openness to Experiences and Conscientiousness reported more progress in treatment. Implications for theory, research, and practice are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).