Psychotherapy Research最新文献

ABSTRACTBackground: With the rising prevalence of major depressive disorder in the general population, understanding the mechanisms through which therapeutic interventions affect treatment outcomes is crucial. This study investigates the roles of mastery and motivational clarification as mediators of the treatment effectiveness of cognitive therapy for depression. Methods: This secondary analysis used data from a randomized controlled effectiveness trial involving 149 participants (M age = 40.7 years, SD = 11.6; 59.6% females, 40.4% males), who received a maximum of 22 sessions of either cognitive behavioral therapy (CBT) or exposure-based cognitive behavioral therapy (EBCT-R). Cross-lagged panel models were used to examine how mastery and motivational clarification mediated changes in depression severity over time. Results: The mediation paths showed a significant positive effect of therapy condition on mastery, with a larger increase for participants in the CBT condition. Mastery had a positive effect on WHO-5 well-being ratings and significantly mediated the treatment effect on well-being. Motivational clarification also had a significant positive effect on WHO-5 ratings, but did not mediate the overall treatment effect. Conclusion: Results suggest that fostering both mastery and motivational clarification within therapeutic interventions can enhance patients' well-being, with mastery specifically mediating the effects of CBT on treatment outcomes.

Objective: Young adult vulnerability is thought to elicit parental responsiveness, and parental responsiveness is thought to facilitate young adult vulnerability. These moment-by-moment in-session processes are purported core change mechanisms in attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents (ABFT-SGM). This study examined whether young adult vulnerability predicted immediately subsequent parental responsiveness, and parental responsiveness predicted immediately subsequent young adult vulnerability, and whether the frequency of such sequences predicted treatment outcome. Method: Analyses were conducted on all conjoint attachment sessions (N = 146) from 26 cases treated in an open trial of ABFT-SGM. Over 16,000 young adult speech-turns were coded for vulnerability and over 27,000 parental speech-turns were coded for responsiveness. Results: Hierarchical linear modeling revealed that young adult vulnerability predicted immediately subsequent parental responsiveness, and that parental responsiveness predicted immediately subsequent young adult vulnerability. Frequency of vulnerability-responsiveness sequences, for the most part, did not predict changes in young adults' perceived parental acceptance or rejection. Conclusions: Results support the bidirectional moment-by-moment effects of young adult vulnerability and parental responsiveness during conjoint ABFT-SGM sessions. The link between the simple frequency of vulnerability-responsiveness sequences and treatment outcome is tenuous.

This study examines fathers' experiences of participating in Emotion-Focused Skills Training (EFST). Method: The study is based on transcribed interviews with five men (M = 48 years) who participated in EFST. We analyzed the data using reflexive Thematic Analysis.

We identified five main themes: (1) Breach of expectations in the face of the program; (2) The group created a sense of community and normalization; (3) The program strengthened cohesion with partner; (4) Gaining better understanding of own emotional and behavioral patterns; and (5) Accessing concrete skills made it possible to be a father in new ways.

The findings show how the men experienced participation in EFST as both demanding and rewarding, with therapy-initiated processes expanding the perception of who they could be and what the role as a father and partner could entail.

Objective: The Working Alliance Inventory-Short Revised (WAI-SR) is a self-report measure of therapeutic alliance from the patient's perspective. This study aimed to examine the factor structure of the WAI-SR and evaluate its measurement invariance across in-person and videoconferencing psychotherapy sessions.

Method: The study sample consisted of 1043 adult patients. Exploratory and confirmatory factor analyses were conducted to evaluate the WAI-SR dimensions and structure. Measurement invariance was tested using multi-group confirmatory factor analysis, multiple indicator multiple causes model analysis, and item bias analysis.

Results: The findings supported a three-factor structure of the WAI-SR, encompassing goal, task, and bond dimensions. Results demonstrated configural, metric, scalar, and residual invariance across in-person and videoconferencing formats. The factor structure remained consistent after accounting for patient age and gender. Additionally, no differential item functioning or bias was observed between groups. The WAI-SR exhibited excellent internal consistency and composite reliability.

Conclusions: The WAI-SR is a reliable and valid tool for assessing therapeutic alliance across both in-person and videoconferencing sessions. The equivalence in measurement properties and mean scores across modalities highlights the adaptability of therapeutic alliance to virtual environments, supporting the broader use of telehealth in psychotherapy.

Objective: The therapeutic alliance is a strong predictor of treatment outcome. Recent research emphasizes distinguishing between trait-like and state-like alliance. This study used the Social Relations Model (SRM) to analyze the variance attributable to the different trait and state components. Specifically, we focused on the bond component of the alliance and examined the extent to which SRM elements - Perceiver effect (evaluating relationships consistently), Target effect (being consistently perceived by others), and Relationship effect (influences specific to the dyad) contribute to the bond variance, and their associations with treatment outcome.

Method: Bond ratings of 118 patients with major depressive disorder receiving psychodynamic psychotherapy, and three treatment-agents (therapists, case managers and interviewers) were analyzed, using the Working Alliance Inventory. Outcomes were assessed using the Hamilton Rating Scale for Depression.

Results: Variance partitioning of the elements showed that the perceiver effect accounted for the largest proportion of bond rating variance for patients and treatment-agents. The relationship effect (of patients and treatment-agents) emerged as a significant predictor of treatment outcome.

Conclusion: Applying SRM across psychotherapy advances understanding of trait/state-like bond contributions to outcomes. Our findings underscore the potential of the unique relationship to capture processes of change, beyond stable patients' and therapists' characteristics.

Objective: Written Exposure Therapy (WET) is a brief cognitive behavioral intervention that appears clinically useful for the individuals dually diagnosed with PTSD and substance use disorders. However, the factors that are associated with its effectiveness for this population are unclear. A promising direction for investigating correlates of WET treatment outcomes is to study the written narratives generated during exposure sessions.

Method: This study analyzed the WET narratives of dually diagnosed Veterans (n = 19) as part of a larger feasibility study implementing this intervention in a residential substance use disorder treatment setting. Participants' narratives were analyzed with a structural topic modeling approach to explore latent topics that characterize the writings and examine their associations with study outcomes.

Results: Latent topics were found to characterize WET narratives, with one appearing to comprise a dimension of negative cognitions. Change in negative cognitions in Veterans' writings over the course of treatment associated with change in PTSD symptom severity, as measured by the CAPS-5 (p = 0.045). Increasingly writing of the negative impact of the traumatic event was associated with reduced treatment response.

Conclusion: The results may indicate that negative cognitions common among dually diagnosed individuals may interfere with the effectiveness of WET.

Objective: Suicidal ideation is a central clinical risk in psychotherapy. Patients' engagement with therapy between sessions, captured by intersession processes (ISP), may be particularly informative for understanding risk and resilience. This study examined associations between ISP and suicidal ideation, distinguishing between-person vulnerabilities from within-person crisis dynamics.

Method: We analyzed routine outpatient data (N = 73, 2,586 total sessions), including an eight-item short version of the Intersession Experiences Questionnaire (IEQ-S) and the PHQ-9 suicidal ideation item. Multilevel logistic mixed-effects models treated suicidal ideation as a binary outcome, disaggregated between- and within-person effects, and included linear, quadratic, and cubic terms.

Results: At the between-person level, more frequent problem-focused application of therapeutic insights was associated with a lower likelihood, whereas higher levels of negative emotional ISP were linked to a higher likelihood of reporting suicidal ideation, following nonlinear trajectories. At the within-person level, increases in positive emotional engagement and problem-focused application co-occurred with a lower likelihood, whereas increases in imagining therapeutic dialogue and negative emotions were related to a higher likelihood of reporting suicidal ideation.

Conclusion: ISP reflect the internalized therapeutic alliance and clinically meaningful cognitive-affective processes, signaling crisis escalation, but also pointing to mechanisms of change. ISP may be valuable monitoring targets.

Objective: Enhancing affective regulation is a key focus in psychotherapy for depression, yet within-session markers that capture the dynamics of regulation remain limited. Respiratory Sinus Arrhythmia (RSA), a biomarker of vagal mediation of the parasympathetic nervous system, is well-known for its role in affective regulation. This nonrandomized observational psychotherapy process study examined (1) whether resting RSA can serve as a biomarker for depression severity, and (2) whether RSA reactivity and its interaction with resting RSA can serve as a within-session therapeutic biomarker linked to session quality. Method: Twenty-eight clients with MDD underwent Supportive-Expressive short-term psychodynamic therapy. Resting RSA and RSA reactivity were measured during five pre-scheduled sessions throughout treatment. Session quality was assessed using the self-report Session Evaluation Scale questionnaire. The data were analyzed using multi-level modeling. Results: Higher resting RSA was associated with lower pre-session depression and was only significant at the within-client level. The interaction between resting RSA and RSA reactivity was linked to session quality, with higher resting RSA predicting a positive association between RSA reactivity and session evaluation. Conclusion: The findings underscore the value of physiological measures such as RSA as a biomarker for assessing depression severity that can capture affective regulation dynamics during therapy sessions.

Objective: This study examined (a) the effectiveness of emotional cultivation counseling groups (i.e., BEAR groups) for Taiwanese youth with emotion regulation difficulties and (b) whether group composition (i.e., heterogeneity of friendship approach and avoidance goals) is associated with intervention outcomes.

Method: Conducted in real-world school settings, 232 students referred by teachers or counselors were randomized to either 20 BEAR groups or a waitlist control condition. BEAR groups, delivered in a semi-structured group format, integrated Eastern and Western perspectives on emotional cultivation and regulation to support relational development. Latent variables representing Relational Problem-Solving and Closeness to Others were assessed at pretest and at a three-month follow-up. Intervention effects were analyzed using the complex survey module in Mplus 8 (Muthén & Muthén, 2017), accounting for partial nesting.

Results: Compared to controls, BEAR participants showed significantly greater improvements in Relational Problem-Solving but not in Closeness to Others. Moreover, among BEAR participants, greater heterogeneity in pretest Friendship-Approach goals was associated with greater change in Relational Problem-Solving.

Conclusion: These findings suggest that BEAR groups may represent a promising, culturally grounded intervention for addressing emotional difficulties among Taiwanese youth, and that groups heterogeneous in friendship approach goals may enhance relational outcomes.

Objective: Compassion-Focused Therapy (CFT) is an emerging treatment approach that aims at cultivating compassion toward oneself and others. Self-compassion is associated with greater emotional resilience and reduced anxiety, depression, and stress. While CFT has shown promising results for young people, further research is needed. This study explores young people's (aged 15-21 years) experiences of participating in a group-based CFT program online.

Methods: Semi-structured group interviews were conducted post-treatment. Twelve group interviews, comprising 34 participants in total (85% female), were analyzed using reflexive thematic analysis.

Results: Two overarching themes were developed through the analysis. The first theme captured participants' experiences of having increased their ability to handle difficult emotions and to engage with compassion within the CFT program. The second theme illustrated the power of feeling connected in a group.

Conclusion: This analysis suggests that compassion-focused group therapy can be a valuable treatment for young people.