Psychotherapy Research最新文献

Background: This study aims to evaluate the factor structure, reliability, and validity of the Clinician Affective REsponse (CARE) scales, a 15-item self-report measure designed for practical use in psychotherapy settings. Methods: Validation data were gathered from 151 mental health clinicians. These clinicians completed the CARE scales alongside measures capturing sociodemographic and professional details, patient demographics and clinical details, therapeutic intervention characteristics, therapeutic relationship elements, and session outcomes. Results: The CARE scales had a three-factor structure: positive engagement (k = 5, ω = .78), enmeshed (k = 5, ω = .72), and stuck (k = 5, ω = .71). Confirmatory factor analysis (CFA) yielded the following fit indices for the three-factor model: χ²₍₈₇₎= 120.41, CFI = .94; TLI = .93, RMSEA = .05, and SRMR = .08. Multigroup CFA (which pooled two samples for a total of 607 subjects) showed that the CARE scales were invariant across remote and in-person session formats. The scales showed meaningful correlations with concurrent measures of working alliance, real relationship, countertransference, patient's experience of the therapeutic relationship, and session outcome. Discussion: The CARE scales are a valuable instrument in clinical, training, and research contexts, adept at capturing clinicians' session-level affective responses and perceptions of the therapeutic relationship. Quantifying these reactions facilitates statistical analysis and empirical research, while their monitoring can guide therapeutic interventions and inform clinical supervision.

Objective: A parallel randomized clinical trial evaluated the efficacy of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) for victims of terrorist attacks with long-term psychopathology. Method: 120 adult Spanish victims, who met the criteria for current posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and/or anxiety disorders related to exposure to terrorist attacks that occurred 18 years ago, on average, were randomly assigned to 16 weekly sessions of TF-CBT (n = 60) or waiting list control conditions (n = 60). Results: Participants who completed TF-CBT (n = 25) experienced significant pre-post decreases in diagnostic rates and in posttraumatic stress, depression, and anxiety symptoms. Pre/post effect sizes for the TF-CBT-treated participants were large (g_PCL-S = 1.25; g_BDI-II = 1.03; g_BAI = 1.16), and between-groups effect sizes were medium-large (g_PCL-S=  0.94, g_BDI-II = 0.72, g_BAI = 0.95). Most TF-CBT completers (78.3% to 91.7%) achieved sub-syndromal symptom levels by post-treatment. The benefits persisted to the 6-month follow-up (n = 22). Modified intention-to-treat analyses (n = 35 vs. n = 50) confirmed the significance of the findings for PTSD and were significant but less robust for MDD and anxiety disorders. Conclusion: TF-CBT appears to be efficacious when applied to victims of terrorism with long-term psychopathology.Clinical or methodological significance of this articleTF-CBT was efficacious when applied to victims of terrorism with long-term PTSD. Results were significant but less robust for long-term MDD and anxiety disorders.

Objective: Internet-delivered cognitive behavior therapies (iCBT) are effective and scalable treatments for depression and anxiety. However, treatment adherence remains a major limitation that could be further understood by applying machine learning methods to during-treatment messages. We used machine learned topics to predict drop-out risk and symptom change in iCBT. Method: We applied topic modeling to naturalistic messages from 18,117 patients of nationwide iCBT programs for depression and generalized anxiety disorder (GAD). We used elastic net regression for outcome predictions and cross-validation to aid in model selection. We left 10% of the data as a held-out test set to assess predictive performance. Results: Compared to a set of reference covariates, inclusion of the topic variables resulted in significant decrease in drop-out risk prediction loss, both in between-patient and within-patient session-by-session models. Quantified as partial pseudo-R², the increase in variance explained was 2.1-6.8 percentage units. Topics did not improve symptom change predictions compared to the reference model. Conclusions: Message contents can be associated with both between-patients and session-by-session risk of drop-out. Our topic predictors were theoretically interpretable. Analysis of iCBT messages can have practical implications in improved drop-out risk assessment to aid in the allocation of additional supportive interventions.

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.

Objective: Patients with epistemic mistrust struggle to view others as trustworthy sources of knowledge and often default to negative appraisals in social communication. The three communication systems theory posits that resolving epistemic mistrust involves three systems: the epistemic match, improving mentalizing, and the re-emergence of social learning outside therapy. This study aimed to empirically examine the theory to understand how epistemic trust develops in psychotherapy.

Method: Using a theory-building case study approach, we analyzed therapeutic processes in six depressed adolescents (Mage = 16.58, SD = 1.17) with varying treatment outcomes. Sixty-six audiotaped psychotherapy sessions were reviewed to compare good- and poor-outcome cases, identifying patterns within therapeutic interactions.

Results: Findings provide the first empirical evaluation of the three communication systems theory, offering concrete examples of how it unfolds in clinical practice and suggesting refinements in therapist and patient processes to build epistemic trust. Additional insights into the theory highlight an early "window of opportunity" to foster epistemic openness, the influence of environmental factors outside therapy, and the interactive nature of therapist-patient dynamics.

Conclusion: This study refines the theoretical understanding of epistemic trust in psychotherapy, revealing specific therapist and patient behaviors that may facilitate its development. Implications for clinical practice and future research directions are discussed.

Objective: Several studies have identified therapist cultural humility as an important predictor of client psychotherapy outcomes, yet most have been conducted cross-sectionally, retrospectively, and/or with inconsistent assessment of other related therapy process constructs. Here, we bridge this gap by examining early treatment ratings of therapist cultural humility, multicultural competence, working alliance, and client-centered treatment approaches as prospective predictors of client functioning in an active community clinic.

Method: Fifty participants (56% women, 10% gender diverse; 44% ethnoracially diverse), aged 18-69, rated these factors within 12 weeks of intake in a community mental health clinic. Therapists assessed client functioning at pre-treatment screening, diagnostic feedback, and treatment termination.

Results: Multilevel modeling analyses indicated clients rating higher therapist cultural humility in early treatment had the largest improvements in therapist-rated functioning from pre-treatment to termination. Notably, the association between therapist cultural humility and client functioning at termination was moderated by ethnoracial status, with higher cultural humility ratings predicting better client functioning at termination solely for ethnoracially diverse clients.

Conclusion: These findings underscore the importance of integrating cultural humility instruction in training programs and therapeutic standards to promote mental health equity.

Objective: This study aims to review and synthesise qualitative studies of the subjective experiences of clinicians working with adolescents (11-18 years of age) who self-harm.

Method: We conducted a systematic literature search and included 14 studies in a meta-synthesis, applying Noblit and Hare's (1988) [Meta-ethnography - synthesizing qualitative studies. SAGE Publications] seven analytical steps for meta-ethnography.

Results: The meta-synthesis resulted in three meta-themes that narrate a process of the emotional experiences of being in a professional relationship with adolescents who self-harm: (1) "Sharing the pain - The relationship as a vehicle to help, understand, and protect"; (2) "Carrying the pain - Self-harm evokes strong feelings"; and (3) "Tolerating the pain - To show a way out".

Conclusion: Working with self-harm may represent a challenging balance for clinicians between exploring the pain in the therapeutic relationship, while also managing their own ability to tolerate the difficult emotions in this work.

Objective: Exposure to family violence in childhood significantly increases the risk of developing severe psychiatric and physiological illnesses. Trauma-focused cognitive behavioural therapy (TF-CBT) effectively addresses trauma-related symptoms and improves overall well-being. However, knowledge of the persistence of these positive effects over time, facilitating factors, and why some children are not benefited remains limited. Furthermore, little attention has been paid to exploring children's subjective experiences. This study aimed to investigate long-term changes in trauma-related symptoms among children and youths who underwent TF-CBT due to family violence. Nine participants (M age = 16,6 years, range = 14-23; 7 girls and 2 boys) were assessed and interviewed four to five years after TF-CBT treatment.

Methods: The study adopted a mixed-method approach, integrating quantitative and qualitative methods.

Results: While most participants still reported being affected by the violence, most had benefited from treatment, with improvements lasting over the years. However, for those who did not report decreased symptoms, trauma symptoms persisted, accompanied by additional severe mental health problems.

Conclusions: The findings underscore the importance of providing effective trauma-focused treatments such as TF-CBT and highlight the need for enhanced safety measures and parental interventions for children who do not benefit from treatment.

Objective: Emotion-focused skills training for parents (EFST) is a parental guidance intervention aimed at strengthening emotional bonds between parent and child and improve children's mental health. In this randomized controlled trial (RCT), EFST was compared to treatment as usual (TAU) in a Norwegian public outpatient clinic for child and adolescent mental health. The hypothesis was that EFST would be equal or superior to TAU in effectiveness on remission of diagnoses and symptomatic change for children.

Method: Seventy-two clients were randomly assigned to an EFST intervention or an integrative family-based intervention (TAU). The main outcome measure was the semi-structured diagnostic interview Schedule for Affective Disorders and Schizophrenia (K-SADS-PL), administered at pretreatment and after three months. The secondary outcome was the DSM-IV version of the Strengths and Difficulties Questionnaire (SDQ). Bayesian statistical methods, including clinically informed priors, were used to compare the effectiveness of the two interventions.

Results: Forty-four percent (15 of 34 clients) attained diagnostic remission in the EFST condition compared to 26 percent (10 of 38 clients) in TAU. The proportion of symptomatic decline was equivalent in both conditions.

Conclusion: The results support the hypothesis that EFST was equal or superior to TAU in effectiveness in a public outpatient setting.