Psychotherapy Research最新文献

Objectives: This study aimed to investigate clients' perspectives on the integration of religion/spirituality (R/S) with psychotherapy in Singapore, a religiously diverse nation. It was hypothesized that clients would report R/S integration to have a positive impact (H1), initiate R/S discussions (H2), and their R/S and perception of the religious context would be associated with their attitudes towards R/S integrated psychotherapy (H3). A cross-sectional mixed-methods design was employed. Methods: Participants were 275 Singapore psychotherapy clients (52.3% male, 46.9% female, 8% non-binary/third gender). Mean age was 34.93 years (SD = 9.95). Participants completed a questionnaire comprised of demographical items, psychotherapy experiences, various R/S-related measures and qualitative questions on considerations and opinions on R/S integrated psychotherapy. Results: Clients reported that R/S integrated psychotherapy (RSIP) had a positive impact and that they were the main initiator. Considering R/S as supportive during adversity and perceptions of the religious context were associated with attitudes towards integration. Unexpectedly, R/S diversity appeared to have a facilitatory effect on RSIP. Qualitative findings revealed client's experiences and perspectives, including their expectations towards therapists. Conclusions: These findings highlight the importance of therapists' R/S competency. In R/S diverse contexts, therapists may require greater sensitivity, openness, and the ability to work with clients holding diverse R/S beliefs.

Objective: The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is a pantheoretical mental health assessment instrument that has been translated into over 50 languages. Despite its widespread international use in clinical practice and research, the psychometric properties of CORE-OM require further investigation.

Method: We explored and tested the factorial validity of the German version of CORE-OM in a large adult clinical outpatient sample (N = 4355) using exploratory and confirmatory factor analysis. Internal consistency and correlations of the four CORE-OM domains (Well-being, Problems, Functioning, and Risk) across gender identities are presented.

Results: While no model satisfied all fit criteria in confirmatory analyses, the three-factor structure derived from exploratory factor analysis outperformed the theoretically favored four-domain solution. Internal consistency was overall acceptable with Well-being scoring slightly lower than the other scales. Non-binary respondents had statistically significantly higher average Risk scores then men and women.

Conclusion: Our findings support the reliability of CORE-OM and lend limited support to its factorial structure in a large German-speaking sample, and emphasize the importance of considering diverse gender identities in mental health assessment. The analyses further indicate a need for refinement in the scoring of CORE-OM in various cultural contexts.

Objective: To develop and validate a video rating instrument designed to assess transtheoretical clinical micro-skills within deliberate practice (DP) exercises.

Method: The Clinical Micro-Skill Training (CMST) Scale was developed based on three established therapeutic competence measures and refined by expert clinician input. The instrument was then applied by trainee psychotherapists to rate N = 433 videos from N = 59 training candidates, who responded to simulated patient statements as if they were the therapist in that situation. Descriptive results, internal consistency, inter-rater reliability, item structure, convergent and discriminant validity were examined.

Results: The CMST demonstrated good reliability, with an internal consistency of ω = .82 and inter-rater reliability of ICC = .73 for the total score. Exploratory factor analysis revealed three factors-Interpersonal Competence, Communication Competence, and Process and Time Management. The CMST also exhibited satisfactory convergent and discriminant validity.

Conclusion: The CMST demonstrates feasibility, reliability, validity, and efficiency in the assessment of therapeutic micro-skills. Its multidimensional structure allows for a nuanced approach, moving beyond mean scores to evaluate and target specific competence facets for improvement. However, its predictive validity for treatment outcomes remains to be explored in future studies.

Background and objective: Cognitive-behavioral therapy (CBT) for somatoform disorders (SFDs) is understudied in China. Western findings may not be applicable to Chinese culture. This preliminary study evaluated the efficacy of CBT for patients in China, relative to treatment-as-usual (TAU). Methods: Seventy patients with SFDs randomly received either combined CBT and TAU (CBT + TAU), or TAU alone between January 2018 to May 2019. The CBT + TAU group received 12 weekly individual 50-minute CBT sessions. Participants were blindly assessed at 4 timepoints (baseline, week 6, end of treatment: week 12; 12 weeks post-treatment: week 24) using the following outcome measures: SQSS (Self-screening Questionnaire for Somatic Symptoms); PHQ-15 (Patient-Health-Questionnaire-15) and the WI (Whiteley Index); GAD-7 (General Anxiety Disorder-7); HAMD-17 (Hamilton Depression Rating Scale-17); Family Burden Interview Schedule (FBIS); Sheehan Disability Scale (SDS); and the Short Form of Quality-of-Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF). The primary endpoint was the difference between the SQSS total score at week 24 and the baseline. A mixed model for repeated measures was used to analyze inter- and intra-group changes from the baseline. Results: At week 24, The least-squares mean (LSM) change of the total score on the SQSS was -18.87 points and -9.69 points, respectively in the CBT + TAU group and in the TAU group (LSM difference, -9.18 points; 95% confidence interval, -15.72 to -2.64; P = 0.0068). At week 24, the LSM changes from baseline in the WI, HAMD, PHQ15, FBIS and SDS total scores were significantly different between the two groups, however, there was no significant difference in the Q-LES-Q-SF. The SQSS of group effect sizes were 0.63 at 24 weeks. The dropout rates of the CBT + TAU and TAU groups were comparable (22.9% and 19.3%). Conclusions: These preliminary findings suggest that CBT may be helpful for improving the symptoms of patients with SFDs in China.

Objective: We evaluated differential treatment effects on specific symptoms and their mediators for Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy (SP) in persistently depressed patients.

Method: We conducted a Bayesian mediation network intervention analysis with data from a randomized controlled trial comparing CBASP and SP. Three networks were calculated to investigate (1) differential treatment effects on specific symptoms, (2) differential treatment effects on the potential mediators interpersonal problems and social functioning, and (3) associations between change in symptoms and change in the potential mediators.

Results: First, we found no evidence that CBASP more strongly improves most depressive symptoms specifically, except minimal evidence of symptom-specific effects on sleeping problems and self-esteem. Second, no and minimal evidence for differential treatment effects on interpersonal problems and social functioning was shown, respectively. Third, interpersonal problems and social functioning were strongly related to depressive symptoms.

Conclusion: While CBASP showed superior treatment effects for overall symptom severity, this treatment might not be superior in improving specific symptoms and the potential mediators interpersonal problems and social functioning. Still, interpersonal problems and social functioning seem to play an important role for depression symptoms. Future research needs to further investigate potential working mechanisms of CBASP.Trial registration: ClinicalTrials.gov identifier: NCT00970437.

This study investigated if in-session reflective functioning (RF) of mothers improved between and within sessions of brief dyadic focused parent-infant psychotherapy (fPIP) for the treatment of regulatory disorders in infants.

In-session RF was coded for 44 therapy sessions from N = 11 mothers randomly selected from a RCT on the efficacy of fPIP as part of secondary analyses. A new rating system distinguished self-focused and child-focused in-session RF. Cumulative ordinal regression models were applied to analyze the dynamics of in-session RF within and across sessions, controlling for word count of each statement.

While in-session RF improved significantly within sessions, between-session RF improved significantly only in the second session compared to the first with a significant decrease observed in the last session. Child-focused in-session RF was significantly lower than self-focused in-session RF at the beginning of the sessions but improved significantly stronger than self-focused in-session RF during sessions.

In-session RF (particularly in child-focused statements) can be regarded as a dynamic change process relevant within each session of dyadic fPIP. Improvements made on a session-by-session basis may not be maintained until the next session. Implications for practitioners and in-session RF research are discussed.

Objective: Patients and therapists possess psychotherapy-related expectations, such as their forecast of what processes will promote improvement. Yet, there remains limited research on such change process expectations, including their independent and dyadic associations with psychotherapy outcome. In this study, we explored the predictive influence of participants' change process expectations, and their level of congruence, on therapeutic outcomes. Methods: Patients (N = 75) and therapists (N = 17) rated their change process expectations at baseline, and patients rated their psychological distress at baseline and three months into treatment. Results: Multilevel models indicated that patients' expectations for therapy to work through sharing sensitive contents openly and securely were positively related to subsequent improvement (B = -1.097; p = .007). On the other hand, patients' expectations for therapy to work through the exploration of unexpressed contents were negatively related to improvement (B = 1.388; p = .049). When patients rated the sharing of sensitive contents openly and securely higher than their therapists, they reported better outcomes (B = -16.528; p = .035). Conclusion: These findings suggest that patients' expectations produce diverse effects during early stages of treatment, and that patients' belief in their ability to share sensitive contents may constitute a potential target to improve therapy effectiveness.

Objective: The mental health benefits of physical activity are well-established. Integrating physical activity counseling into therapy would expand the reach of this evidence-based treatment for mental illness. This mixed methods study examined mental health clients' receptiveness and recommendations for effectively discussing physical activity in therapy.

Methods: A diverse sample of U.S. adults in therapy (N = 478) completed a survey that included the open-ended question: What specific recommendations would you have for your therapist to effectively discuss physical activity with you? We conducted a qualitative content analysis to identify their most common recommendations.

Results: Most participants indicated they would be comfortable discussing physical activity with their therapist. The content analysis resulted in 26 unique categories; most common recommendations included: provide information about what to do (n = 81), discuss physical activity benefits (n = 63), be understanding and nonjudgmental (n = 49), provide accountability (n = 41), and consider physical/mental health conditions (n = 35). Overarching themes emphasized making mental health central to discussions, tailoring discussions to each client, and reframing physical activity as a feasible, enjoyable activity.

Conclusions: Mental health clients are open to discussing physical activity during therapy if it is approached in a supportive, understanding, and personalized way. Clients' recommendations can inform future professional development for therapists.

Objective: An individual's attachment style may impact how they interact with their therapy group. This study examined the moderating role of a group member's attachment on the dynamic relationships between that group member's (actor) and other group members' (partner) therapeutic alliances and symptom outcomes. Method: This is a secondary analysis of data from a trial testing the outcome of emotionally-focused group therapy for binge-eating disorder. The sample consisted of 2,360 sessions nested within 118 group members who attended a 20-session treatment. Patients recorded binge eating episodes (BEE), their body weight and an alliance measure session-by-session.

Results: Dynamic structural equation modelling showed decreases in BEE and weight over the therapy. When attachment style was not included in the model, higher-than-average partner's alliance scores in the previous session were related to decreases in BEE in the current session. Attachment style moderated these actor and partner effects. For patients with preoccupied attachments, higher-than-average actor alliance in the previous session was related to subsequent decreases in BEE. For patients with dismissing or disorganized attachments, higher partner alliance in the previous session was related to subsequent decreases in BEE.

Conclusion: Group members' attachment characteristics can play a role in the development of alliance-outcome patterns in group therapy.

Objective: Despite effective treatment options for posttraumatic stress disorder (PTSD), many patients do not complete therapy. This includes U.S. active duty service members, yet factors linked to attendance in this population remain understudied and dropout remains difficult to predict. Additionally, most studies have not examined samples with PTSD and co-occurring major depressive disorder (MDD) despite high rates of comorbidity.

Method: The current study explored predictors of dropout among service members with comorbid PTSD and MDD (N = 94) randomized to cognitive processing therapy enhanced with behavioral activation (BA + CPT) or CPT as part of a clinical trial.

Results: Using the Fournier approach, only two predictors were associated with lower dropout risk among over 20 examined: shorter duration between pretreatment assessment and Session 1 (p = .041) and past 3-month PTSD treatment engagement (p = .036).

Conclusion: Results suggest the possible utility of early momentum in starting therapy and leveraging recent treatment to improve attendance. However, this study also highlights the possible limitations of commonly assessed pretreatment factors in predicting attendance and current challenges in measuring dropout risk. Strategies to improve prediction, such as shifting focus to assess modifiable factors and processes more proximal to dropout during treatment, may be needed.Trial registration: ClinicalTrials.gov identifier: NCT02874131.