Psychotherapy最新文献

Reports an error in "Defining and assessing adverse events and harmful effects in psychotherapy study protocols: A systematic review" by Rahel Klatte, Bernhard Strauss, Christoph Flückiger, Francesca Färber and Jenny Rosendahl (Psychotherapy, 2023[Mar], Vol 60[1], 130-148). Psychotherapy Study Protocols: A Systematic Review" by Klatte et al. (2022) In the article "Defining and Assessing Adverse Events and Harmful Effects in Psychotherapy Study Protocols: A Systematic Review" by Rahel Klatte, Bernhard Strauss, Christoph Flückiger, Francesca Färber, and Jenny Rosendahl (Psychotherapy, 2022, Vol. 60, No. 1, pp. 130-148, https://doi.org/10 .1037/pst0000359), author contributions were corrected in the author note: Rahel Klatte served as support for methodology and project administration, and served as lead for data curation, formal analysis, and investigation, original draft, and writing, review, and editing. Bernhard Strauss served as lead for resources, contributed equally to conceptualization, funding acquisition and supervision, and served as support for methodology, validation, and writing, review, and editing. Christoph Flückiger contributed equally to supervision and served as support for methodology, validation, original draft, and writing, review, and editing. Francesca Färber served as support for data curation and writing, review, and editing. Jenny Rosendahl served as lead for methodology and project administration, contributed equally to conceptualization, funding acquisition, and supervision, and served as support for data curation, formal analysis, and investigation. (The following abstract of the original article appeared in record 2022-23289-001.) The assessment of safety data has become a standard across many clinical interventions. The aim of this systematic review is to investigate the extent to which harm is addressed within psychotherapy study protocols. The review includes study protocols of randomized controlled trials published between 2004 and 2017 investigating the effects of psychotherapy in adult patients with affective disorders, phobia, anxiety, obsessive-compulsive disorder, posttraumatic stress disorder, and/or personality disorders. We conducted a systematic search in the CENTRAL, Medline, PsycINFO, and Web of Science databases as well as in relevant journals. In total, 115 study protocols were included, examining 168 psychotherapy and 85 control conditions. These protocols differed considerably in the way they conceptualized harm: 77 explicitly addressed harm, 62 considered serious adverse events, and 39 considered adverse events. Although serious adverse events were defined somewhat consistently, adverse events were not. Our results imply that clinical researchers do not apply standardized approaches with regard to harm concepts, assessment, and management. To gather data on frequencies of harmful effects, we argue a higher degree of standardization would be useful. Feasible recommendations are provided

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).

To investigate the perceptions of ex-romantic partners regarding the extent to which and ways in which psychotherapy facilitates coping with the consequences of the dissolution of past relationships, a multipart survey (Representations of Past Significant Others) that included Likert-type, multiple-choice, and open-ended questions about the ways in which individuals remember a past significant relationship and the ways in which they have moved toward closure from that relationship was disseminated via social media and networking. An attachment status measure (Experience in Close Relationship Scale-Short Form) was also administered. A total of 1,846 respondents, mean age 30.6 and predominantly White, heterosexual, female, and from the United States, completed the survey, 74.6% of whom attended psychotherapy post breakup. On average, respondents who engaged in therapy following their breakup found it to be moderately to very helpful; younger respondents, those in longer term relationships, and those with higher scores on the Experience in Close Relationship Scale-Short Form Anxiety subscale evaluated the helpfulness of therapy more highly. Multiple clinical interventions were perceived as helpful in coping with romantic breakups, including normalizing respondents' feelings about their experience, encouraging them to be more aware of their feelings, encouraging them to move forward with their lives, reminding them of their strengths, exploring the story of the relationship and the breakup, and challenging their self-critical thoughts or feelings. Understanding who is best served by postbreakup therapy and the specific interventions, psychotherapeutic and otherwise, that move individuals toward closure may facilitate therapists' efforts to help with this common source of client distress. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychotherapy outcome research mainly focuses on scale-level changes and constructs that were developed using cross-sectional statistical analysis, possibly concealing important findings on the level of single items, and limiting the clinical utility of outcome scales. Our goal was to explore changes in symptoms, interpersonal problems, and level of functioning in everyday life and to establish groups of items with similar rates of change that could be used to form more coherent targets for measuring different therapeutic outcomes. Triangulated maximally filtered graphs were used to model the network structure of the Outcome Questionnaire-45 in a data set of N = 12,075 university counseling center patients. Dynamic exploratory graph analysis was used to establish communities of items with similar rates of change. Five item communities (anxiety, hopelessness, interpersonal problems, well-being, and work impairment) were found. Compared to the original Outcome Questionnaire-45 subscales, they showed better fit to the data. The "hopelessness" community, which describes the extent of a patient's demoralization before the start of therapy, had a significantly higher rate of change compared to other communities. The discerned item communities provide clinicians with theoretically grounded, precise targets for outcome tracking, thereby enhancing the responsiveness and adaptability of treatment interventions to individual client trajectories. Such granularity enriches our understanding of therapeutic change, with direct implications for tailoring intervention strategies to maximize early therapeutic gains and sustain long-term recovery. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Researchers have historically focused on understanding therapist multicultural competency and orientation through client self-report measures and behavioral coding. While client perceptions of therapist cultural competency and multicultural orientation and behavioral coding are important, reliance on these methods limits therapists receiving systematic, scalable feedback on cultural opportunities within sessions. Prior research demonstrating the feasibility of automatically identifying topics of conversation in psychotherapy suggests that natural language processing (NLP) models could be trained to automatically identify when clients and therapists are talking about cultural concerns and could inform training and provision of rapid feedback to therapists. Utilizing 103,170 labeled talk turns from 188 psychotherapy sessions, we developed NLP models that recognized the discussion of cultural topics in psychotherapy (F-1 = 70.0; Spearman's ρ = 0.78, p < .001). We discuss implications for research and practice and applications for future NLP-based feedback tools. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The empirical and clinical literature emphasizes the importance of alliance ruptures, signaling therapeutic processes occurring within and between the partners of the therapeutic dyad. However, knowledge about the underlying regulatory processes that occur amid ruptures is scarce. Identifying the underlying physiological markers may shed light on these regulatory processes. The overarching goal of the present study was to explore physiological markers of withdrawal and confrontation ruptures, within the patient and the therapist. Given the little known on the subject, we used a single-case design (94 episodic segments) to explore biologically based regulatory processes in the face of a rupture, contrasting confrontation ruptures versus withdrawal ruptures versus control episodes (emotional and neutral episodes). Findings showed that the patient and the therapist had contrasting physiological responses to the ruptures, depending on the type. During withdrawal ruptures, the patient exhibited high regulation, while the therapist did not show a clear physiological reaction. During confrontation ruptures, the patient exhibited low regulation, while the therapist exhibited high regulation. The different physiological regulation processes at times of ruptures suggest that, in withdrawal, the patient relied on intrapersonal regulation, contrasting with the interpersonal regulation observed in confrontation ruptures. Findings remained robust after controlling for speech turns and 10,000 Monte Carlo permutations to assess chance-level results. These findings provide initial evidence for the link between arousal and behavior in ruptures, offering valuable psychoeducational material for therapists to improve their handling of these challenging moments. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Chronic pain and depression are highly prevalent and correlated in older adults. Acceptance and commitment therapy (ACT) and exercise have been shown to be effective for both conditions, mostly in Western literature. Little is known about integrating two approaches, particularly in Asian cultures and among less well-educated people. This article describes the iterative process of developing a culturally adapted ACT with exercise intervention for older Chinese with chronic pain and depressive symptoms. A multidisciplinary expert panel codesigned a culturally adapted ACT with exercise intervention, comprising a weekly 2-hr ACT and a 1½-hr exercise program for 8 weeks, focusing on six ACT core components and low-to-moderate intensity circuit-based resistance exercise. Its feasibility was tested through a mixed-methods, pretest-posttest design with 22 older Chinese experiencing chronic pain and depressive symptoms (M_age = 71.5 years, SD = 7.5, 86% female). Participants showed significant improvements in pain intensity, pain interference, pain self-efficacy, physical performance, pain acceptance, and committed action (all p < .05). We identified five themes to inform protocol revision: (1) contextualizing values, (2) utilizing experiential learning, (3) using culturally appropriate metaphors, (4) establishing linkage between ACT concepts and pain, and (5) promoting application through repetition and prompts. Incorporating these findings, the final protocol emphasized three core ACT components and one set of physical exercises. This is the first study demonstrating the feasibility of a culturally adapted, person-centered tailoring ACT with exercise intervention for improving pain-related outcomes and mental wellness among older Chinese. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The collaborative relationship between a client and therapist, known as the therapeutic alliance, plays an important part in promoting engagement and symptom improvement in adolescent psychotherapy. However, research indicates that alliance strains, called ruptures, are common among this age group, emphasizing the importance of addressing and resolving them for enhanced engagement and better outcomes. Despite this, there is a dearth of age-specific guidelines for effectively fostering a positive alliance and repairing these ruptures. This review examines existing literature to (a) summarize the current understanding of alliance formation in youth psychotherapy, particularly considering the distinct characteristics of working with adolescents, and (b) provide evidence-based recommendations to assist youth therapists in building strong alliances and effectively addressing alliance ruptures with this age group. Existing evidence indicates that while guidance designed for adult therapy can be beneficial, working with adolescents poses unique challenges. These include resistance to treatment, engagement in risky behaviors, confidentiality issues, and parental involvement, which can strain the therapeutic relationship. This emphasizes the importance for youth therapists to understand the unique challenges and developmental stages adolescents face and to adapt their approach accordingly. By doing so, therapists can effectively address the needs of adolescents, fostering a strong alliance and handling any ruptures that may arise. Despite being a relatively new area of study with its inherent limitations, this review underscores the critical role of alliance research in improving therapy for adolescents and guiding the training of therapists who work with this age group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

As the popularity of dialectical behavior therapy (DBT) grows, so does its use with increasingly diverse groups of clients. In this article, we demonstrate that DBT in its standard form can incorporate the sequelae of oppression as a target of treatment by providing clients with skills to identify oppression and its impact while responding effectively. To support the use of DBT with individuals experiencing emotion/behavior dysregulation and oppression, we review how each of the primary strategies of DBT can be used within the context of oppression. Specifically, we discuss how dialectical philosophy, the acceptance/change dialectic, communication strategies, and case management strategies can be viewed through an oppression lens. A brief review of DBT research with historically oppressed populations and common pitfalls in treating oppressed individuals is presented. As research in examining and adapting DBT for minoritized groups continues to catch up to clinical need, guidance is presented here for researchers and clinicians interested in using this empirically supported treatment in communities that experience oppression. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Attachment has mostly been investigated as a stable characteristic of individuals, although theoretical considerations and recent empirical findings suggest that attachment styles are also subject to change. When attachment is investigated as a treatment factor in psychotherapy, state and trait characteristics need to be differentiated, as they warrant different conclusions. This study examined the trait- and statelike characteristics of attachment styles over the course of inpatient psychotherapy as predictors of treatment outcome. A total of N = 419 patients provided weekly measurements of attachment styles and symptoms for up to 8 weeks of inpatient psychotherapy. Data were analyzed in multilevel longitudinal models controlling for rolling admissions and weekly changes in group membership. Over the course of treatment, patients' attachment styles became more secure and less fearful-avoidant. Trait attachment security as well as gains in attachment security predicted better outcomes, while trait preoccupied and fearful-avoidant attachment as well as increases in attachment preoccupation and anxiety predicted worse outcomes. Findings imply that attachment security may grow during a relatively short inpatient treatment period and both trait attachment styles as well as changes in attachment styles predict outcome. (PsycInfo Database Record (c) 2024 APA, all rights reserved).