Psychotherapy最新文献

Longitudinal evidence indicates struggles with spirituality/religion (S/R; e.g., feeling distant or abandoned by God, guilty for not attaining standards of moral perfection, judged by one's family or community) may cause distress and hinder recovery from mental health challenges. However, research has not examined temporal associations between spiritual struggles and psychological distress in spiritually integrated psychotherapies (SIPs). In total, 175 practitioners of SIPs from 38 clinics and other settings in a practice-research network assessed these outcomes with 1,404 clients over the first 6 weeks of treatment (Time 1 [Weeks 1-2], Time 2 [Weeks 3-4], and Time 3 [Weeks 5-6]). In keeping with findings from other samples (e.g., Cowden et al., 2022, 2024; Currier et al., 2015, 2018), cross-lagged panel analyses across the three time points revealed spiritual struggles predicted clients' psychological distress at the next interval rather than vice versa. Specifically, whereas psychological distress was not predictive of later spiritual struggles, clients who were struggling with their S/R at Time 2 were generally more psychologically distressed at Time 3. Further, the positive prospective association between spiritual struggles at Time 1 and psychological distress at Time 3 was mediated by the severity of spiritual struggles at Time 2. In combination, these findings affirm spiritual struggles drive many clients' depression, anxiety, and other symptoms over the course of SIPs. As such, clinicians will ideally cultivate foundational knowledge and skills about the darker side of S/R that might prepare them to address their clients' spiritual struggles throughout the treatment process when clinically indicated. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Process and outcome studies focusing on antisocial traits (ANT) are limited (Van den Bosch et al., 2018), especially in nonforensic/nonoffender outpatient settings (Thylstrup & Hesse, 2016). ANT can impact outcomes through several mechanisms, such as treatment rejection, premature dropout, or poor alliance formation (Van den Bosch et al., 2018; Messina et al., 2002). In a prior study (Cersosimo, Hilsenroth, Bornstein, & Gold, 2022), we found that patient-rated alliance early in outpatient psychotherapy was negatively related to pretreatment ratings on Personality Assessment Inventory scales assessing ANT. The present study extends this work by examining ANT, alliance, and treatment readiness with outcome. We found that ANT, treatment rejection, and patient-rated alliance were significantly related to patient-rated outcome (n = 65). Regression analysis indicated that both ANT (β = -.29, p = .014; f² = 0.09) and treatment rejection (β = -.28, p = .019; f² = 0.09) were unique, negative, predictors of outcome, explaining 18% of the variance. Adding the significant, positive, patient-rated alliance to the model (β = .34, p = .003; f² = 0.13) increased explained variance to 25%. Subsequent analyses revealed that the negative impacts of treatment rejection on outcome occur separate from both ANT and alliance, while the negative impact of ANT on outcome is partially mediated by the positive effects of alliance (indirect effect = -.10, lower level confidence interval = -.208; upper level confidence interval = -.003). We discuss how early assessment of ANT and treatment readiness informs treatment planning. Limitations of the study and next steps for research are noted. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Despite the availability of evidence-based psychosocial and pharmacologic interventions for mental health concerns, access to care remains suboptimal. We present a time-efficient mental health treatment program designed to improve overall community access to evidence-based care. Quality of care within the time-efficient model was prioritized by focusing on a multifaceted program of evidence-based interventions and facilitating connections to long-term care when needed. We present the results of a proof-of-concept open trial that indicates that access to care can be improved while maintaining quality mental health services. The Time-Efficient, Evidence-Based, Accessible, Multidisciplinary approach includes time-limited care provided by a team of psychotherapists, psychiatrists, nurse practitioners, and case managers working in pods, supported by measurement-based care, to develop individualized treatment plans. We used data from the electronic health record to evaluate (a) access to care, (b) engagement, and (c) treatment outcomes for an initial sample of 1,726 patients. Patients waited on average 17 days to see a therapist and 20 days to see a psychopharmacologist. Patients received on average 10 sessions of psychotherapy and four medication management sessions. Fifty-seven percent remained in treatment for at least 3 months. Patients demonstrated large improvements in depression (d = 1.18) and anxiety (d = 1.20) with small to moderate effects for improvements in functioning (d = 0.40). By capitalizing on a package of evidence-based interventions delivered with equitable time limits, the Time-Efficient, Evidence-Based, Accessible, Multidisciplinary clinic demonstrates initial access while yielding good engagement in services and moderate to large treatment effects. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

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).

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).

Operationalizing technical flexibility as session-to-session adjustments in therapist techniques, this study explored the context-dependent aspects of its effects on treatment outcomes. Specifically, we focused on how session-to-session adjustments in therapist techniques have different influences on subsequent client outcomes depending on the therapist-rated quality of the previous session. We used data collected from 3,970 sessions conducted by 17 doctoral student therapists in a university clinic, where 132 adult community clients received individual psychodynamic psychotherapy. The extents of session-to-session technique adjustment were measured by Euclidean distance scores representing the difference between techniques (i.e., explore, insight, and action skills) used in two adjacent sessions. Dynamic structural equation modeling was used to examine temporal relationships among client-rated therapist technical adjustments, therapist-rated previous session quality, and client functioning. When therapists evaluated their previous sessions as lower than usual in quality, moderate adjustments were associated with worse-than-usual client functioning in the current week, compared to sticking to previous techniques or making significant adjustments. When the therapist-rated previous session quality as higher than usual, more technical adjustments from the previous sessions were associated with better current week client functioning. The implications and limitations of the present study were discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Studies of psychotherapy efficacy have highlighted the importance of feedback-informed treatment (FIT), which involves the routine collection of client process and outcome data to inform intervention formulation and clinical decision making. Despite the relative ease with which FIT measures can be integrated into therapeutic practices, many providers do not use these information-gathering tools. The present study analyzed survey responses from therapists whose use of FIT was systemically incentivized and structurally supported. Within this sample, two groups of providers emerged: one (n = 30) that remained engaged in the use of FIT and another (n = 19) that discontinued its use despite its implementation being facilitated. There were some significant differences between the groups. Clinicians who persisted with FIT perceived it as more valid and reported more openness to information from an outside source, whereas clinicians who disengaged from FIT endorsed more antagonistic views about measurement. In addition, clinicians who discontinued FIT reported having a greater belief in the predictive validity of their own judgments without the use of FIT data than did current FIT users. There were statistically significant differences between the two groups in terms of their reliance on intuition, but not on their feedback propensities. These findings contribute to the growing literature regarding the effect of attitudes on the use of measurement in therapy when structural barriers to implementation are reduced. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Emotionally focused individual therapy (EFIT; Johnson, 2019) is a newly developed therapeutic modality. In this study, we used a randomized controlled trial (Clinical Trial Registration NCT04719780) intent-to-treat design to examine the effects of 15 sessions of EFIT in comparison with a 15-week wait-list control on general symptom distress and symptoms of depression and anxiety. Eighty-eight participants who met the diagnostic criteria for major depressive disorder and comorbid anxiety, as determined by the Anxiety and Related Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, were randomized to an EFIT treatment group (n = 44) or to a wait-list control group (n = 44). Average age was 35.73 years (SD = 12.28). Sixty-three percent identified as women, and 37% identified as male. In terms of ethnicity, 73% identified as White, 1.3% as Black, 7.7% as Southeast Asian, 7.7% as East Asian, 3.8% as Latinx, and 2.6% as First Nation. Participants completed the Outcome Questionnaire-30.2, the Patient-Reported Outcomes Measurement Information System (PROMIS)-Depression scale, and the PROMIS-Anxiety scale. Multilevel modeling results confirmed a significant difference in growth curves between the treatment group and controls on all measures. Follow-up analyses demonstrated significant reductions in symptom distress (Outcome Questionnaire-30.2) and symptoms of depression and anxiety (PROMIS-Depression and PROMIS-Anxiety) across 15 weeks. Overall, the results of this study suggest that EFIT leads to significant symptom reduction among people with depression and anxiety. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Recent scholarship has highlighted the value of therapists adopting a multicultural orientation (MCO) within psychotherapy. A newly developed performance-based measure of MCO capacities exists (MCO-performance task [MCO-PT]) in which therapists respond to video-based vignettes of clients sharing culturally relevant information in therapy. The MCO-PT provides scores related to the three aspects of MCO: cultural humility (i.e., adoption of a nonsuperior and other-oriented stance toward clients), cultural opportunities (i.e., seizing or making moments in session to ask about clients' cultural identities), and cultural comfort (i.e., therapists' comfort in cultural conversations). Although a promising measure, the MCO-PT relies on labor-intensive human coding. The present study evaluated the ability to automate the scoring of the MCO-PT transcripts using modern machine learning and natural language processing methods. We included a sample of 100 participants (n = 613 MCO-PT responses). Results indicated that machine learning models were able to achieve near-human reliability on the average across all domains (Spearman's ρ = .75, p < .0001) and opportunity (ρ = .81, p < .0001). Performance was less robust for cultural humility (ρ = .46, p < .001) and was poorest for cultural comfort (ρ = .41, p < .001). This suggests that we may be on the cusp of being able to develop machine learning-based training paradigms that could allow therapists opportunities for feedback and deliberate practice of some key therapist behaviors, including aspects of MCO. (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).