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Enhancing the effectiveness of CBT for patients with unipolar depression by integrating digital interventions into treatment: A pilot randomized controlled trial. 通过将数字干预纳入治疗来增强CBT对单极性抑郁症患者的有效性:一项试点随机对照试验。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-01 Epub Date: 2023-11-03 DOI: 10.1080/10503307.2023.2277866
Jan Kalde, Ece Atik, Johannes Stricker, Magnus Schückes, Peter Neudeck, Andre Pittig, Reinhard Pietrowsky

Objective: Blended cognitive behavioral therapy (bCBT) combines face-to-face therapy with digital elements, such as digital health apps. This pilot study aimed to explore the effectiveness and safety of a novel bCBT application for treating unipolar depression in adults combined with cognitive behavioral therapy (CBT) compared to CBT alone in routine care.

Methods: Patients (N = 82) were randomly assigned to bCBT (n = 42) or CBT (n = 40) over 12 weeks. bCBT consisted of weekly CBT sessions accompanied by the elona therapy depression module (a bCBT application for unipolar depression) for use between sessions. Standard CBT consisted of weekly CBT sessions. Outcomes (6,12 weeks) were analyzed with linear mixed models.

Results: Improvements in depressive symptoms (BDI-II, PHQ-9) were descriptively larger for the bCBT group. Yet, this difference did not reach statistical significance. bCBT was superior to standard CBT in secondary outcome measures of psychological health (d = .50) and generalized anxiety symptoms (d = -.45). In other secondary outcomes (BAI, PSWQ, GSE, WHOQOL-BREF), improvements were descriptively larger for bCBT compared to CBT.

Conclusion: This pilot study provided preliminary evidence that bCBT might be advantageous in comparison to CBT alone in the treatment of depression, but larger RCTs of the bCBT application are needed.

目的:混合认知行为疗法(bCBT)将面对面治疗与数字元素相结合,如数字健康应用程序。这项试点研究旨在探索一种新型bCBT应用程序在常规护理中联合认知行为疗法(CBT)治疗成人单极性抑郁症的有效性和安全性,与单独使用CBT相比。方法:患者(N = 82)被随机分配到bCBT(n = 42)或CBT(n = 40)在12周内。bCBT由每周CBT疗程组成,并在疗程之间使用elona治疗抑郁症模块(用于单极性抑郁症的bCBT应用程序)。标准CBT包括每周CBT会议。结果(6,12周)采用线性混合模型进行分析。结果:bCBT组抑郁症状(BDI-II、PHQ-9)的改善明显更大。然而,这种差异并没有达到统计学意义。bCBT在心理健康的次要结果测量方面优于标准CBT(d = .50)和广泛性焦虑症状(d = -.45)。在其他次要结果(BAI、PSWQ、GSE、WHOQOL-BREF)中,与CBT相比,bCBT的改善幅度更大。结论:这项试点研究提供了初步证据,表明在治疗抑郁症方面,与单独CBT相比bCBT可能更有利,但需要对bCBT应用进行更大规模的随机对照试验。
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引用次数: 0
Pathways to mental well-being for graduates of mindfulness-based cognitive therapy (MBCT) and mindfulness-based stress reduction (MBSR): A mediation analysis of an RCT. 正念认知治疗(MBCT)和正念减压(MBSR)毕业生的心理健康途径:随机对照试验的中介分析。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-01 Epub Date: 2023-11-06 DOI: 10.1080/10503307.2023.2269299
Shannon Maloney, Jesus Montero-Marin, Willem Kuyken

Objective: To explore mediated effects of Mindfulness-Based Cognitive Therapy-"Taking it Further" (MBCT-TiF) on mental well-being through changes in mindfulness, self-compassion, and decentering.

Method: A secondary analysis of an RCT using simple mediation, with 164 graduates of MBCT and mindfulness-based stress reduction (MBSR), was implemented whereby MBCT-TiF (vs ongoing mindfulness practice; OMP) was the independent variable; changes in mindfulness, self-compassion, and decentering during the intervention were the mediators; and mental well-being at post-intervention, whilst controlling for baseline, was the dependent variable. Secondary outcomes included psychological quality of life, depression, and anxiety.

Results: Compared to OMP, MBCT-TiF experienced significant improvements in mental well-being through changes in all three mediators (mindfulness: ab = 0.11 [0.03, 0.25]; decentering: ab = 0.16 [0.05, 0.33]; self-compassion: ab = 0.07 [0.01, 0.18]). A similar pattern was demonstrated for depression, but only mindfulness and decentering mediated effects on psychological quality of life and anxiety.

Conclusion: The findings provide preliminary support for all three mediators in driving change in mental well-being in a sample of MBCT/MBSR graduates. Future work must be theory-driven and powered to test all mediators in parallel and alongside other potential mediators (e.g., equanimity) to further understand independent contributions and interacting effects.Trial registration: ClinicalTrials.gov identifier: NCT05154266.

目的:探讨基于正念的认知疗法“更进一步”(MBCT TiF)通过正念、自我同情和分散注意力的变化对心理健康的中介作用。方法:采用简单中介对164名MBCT和基于正念的减压(MBSR)毕业生的随机对照试验进行二次分析,其中MBCT TiF(与正在进行的正念练习;OMP)是自变量;干预期间正念、自我同情和体面的变化是中介因素;干预后的心理健康,同时控制基线,是因变量。次要结果包括心理生活质量、抑郁和焦虑。结果:与OMP相比,MBCT TiF通过改变所有三种介质(正念:ab = 0.11[0.03,0.25];偏心:ab = 0.16[0.05,0.33];自我同情:ab = 0.07[0.01,0.18])。抑郁症也有类似的模式,但只有正念和分散注意力对心理生活质量和焦虑有中介作用。结论:研究结果为MBCT/MBSR毕业生样本中所有三种介质在推动心理健康变化方面提供了初步支持。未来的工作必须以理论为驱动,以并行测试所有中介,并与其他潜在中介(如平静)一起测试,以进一步了解独立贡献和相互作用的效果。试验注册:ClinicalTrials.gov标识符:NCT05154266。
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引用次数: 0
Comparing counseling outcome for college students: Metaverse and in-person approaches. 比较大学生的咨询结果:元宇宙和面对面的方法。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-01 Epub Date: 2023-10-17 DOI: 10.1080/10503307.2023.2270139
Soohyun Cho, Jieun Kang, Woo Hyun Baek, Yeon Bin Jeong, Seongchan Lee, Sang Min Lee

ABSTRACTObjective This study compared metaverse counseling with in-person counseling, using in-person counseling as a comparison group. To achieve this, we assessed whether metaverse counseling, a novel treatment approach, is comparable to traditional in-person counseling. Method: A total of 60 participants voluntarily participated in the study. Among the participants, 28 preferred in-person counseling, whereas 32 selected metaverse counseling as their preferred treatment option. Results and Conclusion: The findings indicated no statistically significant differences in the psychological symptom change patterns between the two counseling modalities. Both metaverse and in-person counseling demonstrated a common pattern of reduced symptom levels from pre-to post-session (Metaverse counseling Cohen's d = 1.04, In-person counseling Cohen's d = .62), which remained stable from post-session to follow-up regardless of the chosen counseling modality. Furthermore, the study revealed that the metaverse counseling group exhibited a higher level of working alliances than the in-person counseling group. Additionally, there was a slight tendency toward higher levels of counseling satisfaction in the metaverse counseling group than in the in-person counseling group. The results of this study support the use of synchronous metaverse programs to treat college students. The implications and limitations of this study are discussed. (195 words).

摘要目的本研究将元宇宙咨询与面对面咨询进行比较,并以面对面咨询为对照组。为了实现这一点,我们评估了元宇宙咨询这一新的治疗方法是否与传统的面对面咨询相媲美。方法:共有60名参与者自愿参与研究。在参与者中,28人更喜欢面对面咨询,而32人选择元宇宙咨询作为他们的首选治疗方案。结果与结论:两种咨询方式的心理症状变化模式无统计学差异。元宇宙和面对面咨询都显示出从治疗前到治疗后症状水平降低的共同模式(元宇宙咨询Cohen’s d = 1.04,当面咨询Cohen’s d = .62),无论所选择的咨询方式如何,从治疗后到随访都保持稳定。此外,研究表明,元宇宙咨询小组比面对面咨询小组表现出更高水平的工作联盟。此外,元宇宙咨询组的咨询满意度略高于面对面咨询组。这项研究的结果支持使用同步元宇宙程序来治疗大学生。讨论了本研究的意义和局限性。(195字)。
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引用次数: 0
The effect of Oxytocin administration on patient-therapist alliance congruence: Results from a randomized controlled trial. 催产素给药对患者-治疗师联盟一致性的影响:一项随机对照试验的结果。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-01 Epub Date: 2023-10-19 DOI: 10.1080/10503307.2023.2269300
Ariella Grossman-Giron, Hadar Fisher, Dana Atzil-Slonim, Hagai Maoz, Uri Nitzan, Dana Tzur Bitan

Objectives: The effects of oxytocin (OT) administration on psychotherapeutic processes have thus far been elusive. This study explored the effect of OT administration on patient-therapist congruence of the working alliance.

Method: Inpatients with mental disorders (N = 87) participating in a randomized controlled trial received OT (n = 44) or placebo (n = 43) intranasally twice a day, for four weeks. Patients and therapists rated the alliance after each session.

Results: Oxytocin significantly moderated the level of agreement (b = -0.56, SE = 0.25, t = -2.30, p = 0.02), such that patients receiving OT demonstrated lower discrepancy (b = -0.73, p < 0.001) than did those receiving placebo (b = -1.30, p < 0.001). On the other hand, the mutual covariance of patient-therapist ratings across sessions was positive and significant for patients receiving placebo (b = 0.26, p = 0.01) but not for patients in the OT group (b = -0.06, p = .56).

Conclusion: Oxytocin can reduce discrepancies of patient-therapist perceptions of the alliance, although additional studies are needed to explore OT's effect on alliance development over time. As alliance congruence is associated with therapy outcomes, such intervention may lead to enhancement of therapeutic gains.

目的:到目前为止,催产素(OT)给药对心理治疗过程的影响尚不明确。本研究探讨了OT管理对工作联盟患者-治疗师一致性的影响。方法:住院精神障碍患者(N = 87)接受OT(n = 44)或安慰剂(n = 43)鼻内给药,每天两次,持续四周。患者和治疗师在每次治疗后对联盟进行评分。结果:催产素显著降低了一致性水平(b = -0.56,SE = 0.25,吨 = -2.30,第页 = 0.02),使得接受OT的患者表现出较低的差异(b = -0.73,p b = -1.30,p b = 0.26,p = 0.01),但对于OT组的患者没有(b = -0.06,p = .56)。结论:催产素可以减少患者-治疗师对联盟的认知差异,尽管还需要更多的研究来探索OT对联盟发展的影响。由于联盟一致性与治疗结果有关,这种干预可能会提高治疗效果。
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引用次数: 0
Client-counselor behavioral and inter-brain synchronization among dismissing and secure clients and its association with alliance quality and outcome. 解雇型和安全型客户与咨询师之间的行为和大脑间同步性及其与联盟质量和结果的关系。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-11-01 Epub Date: 2023-08-29 DOI: 10.1080/10503307.2023.2249587
Xiaoyan Dai, Xueying Li, Na Xia, Juzhe Xi, Ya Zhang

Objective This study aimed to explore whether behavioral synchrony (BS) and inter-brain synchrony (IBS) could serve as potential biomarkers for alliance quality or outcomes among clients with different adult attachment styles. Method: We assessed the clients' self-report working alliance and clinical outcomes as well as simultaneously measured BS using motion energy analysis (MEA) and IBS with functional near-infrared spectroscopy (fNIRS) among 37 secure (N = 21) or dismissing (N = 16) clients with their counselors during the first psychological counseling meeting. Results: Dismissing dyads manifested significantly higher late-stage counselor-led and client-led IBS (p = .018) than secure dyads. Adult attachment style served as the moderators in the correlation of both whole-stage client-led BS with bond dimension of alliance (p = .015) as well as in the correlation of both whole-stage no-lag IBS with CORE-10 score changes (p = .022). Moreover, increases in the whole-stage client-led BS were significantly associated with decreases in early-stage, late-stage and whole-stage no-lag IBS (all ps ≤ 0.01). Conclusion: These findings revealed the potentially impeding role of interpersonal synchrony in alliance quality for dismissing clients, at least during the first psychological counseling meetings. They also might partially validate the relationship between different modalities of interpersonal synchrony.

目的 本研究旨在探讨行为同步性(BS)和脑间同步性(IBS)是否可以作为不同成人依恋风格客户之间联盟质量或结果的潜在生物标志物。研究方法我们评估了客户自我报告的工作联盟和临床结果,并同时使用运动能量分析法(MEA)和功能性近红外光谱法(fNIRS)测量了37名安全型(21人)或解雇型(16人)客户与咨询师在第一次心理咨询会议期间的行为同步性(BS)和脑间同步性(IBS)。结果显示与安全型二人组相比,解雇型二人组在后期阶段由咨询师主导和由求助者主导的 IBS(p = .018)明显更高。在整个阶段由客户主导的 BS 与联盟关系维度的相关性(p = .015)以及整个阶段无滞后 IBS 与 CORE-10 分数变化的相关性(p = .022)中,成人依恋风格起到了调节作用。此外,整个阶段客户主导 BS 的增加与早期、晚期和整个无滞后 IBS 的减少均有显著相关性(所有 ps 均小于 0.01)。结论这些研究结果揭示了人际同步性在解除求助者联盟质量中的潜在阻碍作用,至少在第一次心理咨询会议期间是如此。这些发现还可能部分验证了不同人际同步模式之间的关系。
{"title":"Client-counselor behavioral and inter-brain synchronization among dismissing and secure clients and its association with alliance quality and outcome.","authors":"Xiaoyan Dai, Xueying Li, Na Xia, Juzhe Xi, Ya Zhang","doi":"10.1080/10503307.2023.2249587","DOIUrl":"10.1080/10503307.2023.2249587","url":null,"abstract":"<p><p><i>Objective</i> This study aimed to explore whether behavioral synchrony (BS) and inter-brain synchrony (IBS) could serve as potential biomarkers for alliance quality or outcomes among clients with different adult attachment styles. <b>Method:</b> We assessed the clients' self-report working alliance and clinical outcomes as well as simultaneously measured BS using motion energy analysis (MEA) and IBS with functional near-infrared spectroscopy (fNIRS) among 37 secure (<i>N </i>= 21) or dismissing (<i>N </i>= 16) clients with their counselors during the first psychological counseling meeting. <b>Results:</b> Dismissing dyads manifested significantly higher late-stage counselor-led and client-led IBS (<i>p </i>= .018) than secure dyads. Adult attachment style served as the moderators in the correlation of both whole-stage client-led BS with bond dimension of alliance (<i>p</i> = .015) as well as in the correlation of both whole-stage no-lag IBS with CORE-10 score changes (<i>p</i> = .022). Moreover, increases in the whole-stage client-led BS were significantly associated with decreases in early-stage, late-stage and whole-stage no-lag IBS (all <i>p</i>s ≤ 0.01). <b>Conclusion:</b> These findings revealed the potentially impeding role of interpersonal synchrony in alliance quality for dismissing clients, at least during the first psychological counseling meetings. They also might partially validate the relationship between different modalities of interpersonal synchrony.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10114784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Client characteristics and early working alliance development: A person-centered research approach. 客户特征与早期工作联盟的发展:以人为本的研究方法。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-29 DOI: 10.1080/10503307.2024.2418868
Wilson T Trusty, Louis G Castonguay, Caitlin L Chun-Kennedy, Sultan A N Magruder, Rebecca A Janis, Katherine A Davis, Dominic C Augustin, Brett E Scofield

Objective: Certain client characteristics are associated with early working alliance difficulties in psychotherapy. However, there is limited quantitative evidence on whether combinations of these characteristics (e.g., intersectional identities, prior treatment experiences) are related to alliance development. The present study leveraged a person-centered research approach to examine profiles of early alliance development and differences in the latent class structure of client characteristics among alliance development profiles.

Method: Individual psychotherapy clients (N = 2,579) rated the working alliance for their first four sessions and self-reported demographics, treatment history, and psychological distress. Therapists provided their assessment of clients' primary presenting concerns at baseline.

Results: Latent profile analysis revealed three profiles of working alliance development: high and stable, moderate and increasing, and low and stable. Follow-up person-centered analyses (multigroup confirmatory latent class analysis) indicated that clients in the alliance profiles differed in their combinations of clinical and demographic characteristics. For example, women of color with high baseline distress and a history of prior psychotherapy were over-represented in the low and stable alliance profile.

Conclusion: These results are consistent with recommendations to holistically consider how clients' characteristics and experiences shape psychotherapy processes. Results also highlight the utility of person-centered quantitative methods in psychotherapy research.

目的:某些客户特征与心理治疗中的早期工作联盟困难有关。然而,关于这些特征的组合(如交叉身份、先前的治疗经历)是否与联盟发展有关,目前的定量证据还很有限。本研究采用以人为本的研究方法,对早期联盟发展的特征以及联盟发展特征中客户特征的潜类结构差异进行了研究:方法:个人心理治疗客户(N = 2,579)对其前四次治疗的工作联盟进行评分,并自我报告人口统计学、治疗史和心理困扰。治疗师提供了他们对客户在基线期主要关注问题的评估:潜在特征分析显示了工作联盟发展的三个特征:高度稳定、中度增加和低度稳定。后续的以人为中心的分析(多组确认潜类分析)表明,联盟特征中的客户在临床和人口特征组合方面存在差异。例如,基线痛苦程度高且曾接受过心理治疗的有色人种女性在低度和稳定联盟特征中的比例较高:这些结果与全面考虑客户的特征和经历如何影响心理治疗过程的建议是一致的。这些结果也凸显了以人为中心的定量方法在心理治疗研究中的实用性。
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引用次数: 0
Using machine learning methods to identify trajectories of change and predict responders and non-responders to short-term dynamic therapy. 使用机器学习方法识别变化轨迹,预测短期动态疗法的应答者和非应答者。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-26 DOI: 10.1080/10503307.2024.2420725
Refael Yonatan-Leus, Gershom Gwertzman, Orya Tishby

Objectives: Predicting therapy responders can significantly improve clinical outcomes. This study aims to identify predictors of response to short-term dynamic therapy.

Methods: Data from 95 patients who underwent 16-session therapy were analyzed using machine learning. Weekly progress was monitored with the Outcome Questionnaire (OQ45) and Target Complaints (TC). A machine learning model identified change trajectories for responders and non-responders, with a random forest algorithm and elastic net modeling predicting trajectory group membership using pre-treatment data.

Results: A weak positive relationship was found between the trajectories of the two outcome variables. The results of the different analysis methods were compared and discussed. Important predictors of OQ45 trajectories, based on random forest modeling, included initial symptom severity, difficulties in emotion regulation, coldness, avoidant attachment, conscientiousness, interpersonal problems, non-acceptance of negative emotion, neuroticism, emotional clarity, impulsivity, and emotion awareness (72.8% accuracy). Initial problem severity, self-scarifying extraversion, and non-assertiveness were the most dominant predictors for TC trajectories (62.8% accuracy).

Conclusions: These findings offer data-driven insights for selecting short-term dynamic therapy. Predicting response for the OQ45, a nomothetic measure, does not extend to the TC, an idiographic measure, and vice versa, highlighting the importance of multidimensional outcome evaluations for personalized treatment.

目的:预测治疗反应者可显著改善临床疗效。本研究旨在确定短期动态疗法反应的预测因素:方法:使用机器学习对 95 名接受了 16 个疗程治疗的患者的数据进行分析。通过结果问卷(OQ45)和目标投诉(TC)监测每周的进展情况。机器学习模型确定了应答者和非应答者的变化轨迹,通过随机森林算法和弹性网建模,利用治疗前数据预测轨迹组的成员:结果:两个结果变量的变化轨迹之间存在微弱的正相关关系。对不同分析方法的结果进行了比较和讨论。根据随机森林建模,OQ45轨迹的重要预测因子包括初始症状严重程度、情绪调节困难、冷漠、回避型依恋、自觉性、人际关系问题、不接受负面情绪、神经质、情绪清晰度、冲动性和情绪意识(准确率为72.8%)。最初的问题严重性、自我批评型外向性和非自负性是预测自闭症轨迹的最主要因素(准确率为 62.8%):这些发现为选择短期动态疗法提供了数据驱动的见解。这些研究结果为选择短期动态疗法提供了数据驱动的见解。对OQ45(一种提名测量)的反应预测并不能延伸到TC(一种特异测量),反之亦然,这凸显了多维结果评估对个性化治疗的重要性。
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引用次数: 0
Assessing the implementation of suicide-focused treatments delivered in hybrid telemental health format in a real-world setting. 评估在真实世界环境中以混合远程医疗形式提供的自杀焦点治疗的实施情况。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-22 DOI: 10.1080/10503307.2024.2415104
Francesca Kassing, John R Seeley, Shireen L Rizvi, Scott N Compton, James Sinclair, Linda A Oshin, Kyla Blalock, David A Jobes, Jennifer Crumlish, Susan Stadelman, Filiz Gözenman-Sapin, Ted Snyderman, Allison K Ruork, Cassidy M Fry, Robert J Gallop, James Goodrich, Jacqueline Pistorello

Objective: The purpose of this study was to assess the implementation of suicide-focused treatments delivered via a hybrid telemental health (TMH) and in-person format.

Method: This study was conducted at four university counseling centers (UCCs) across the United States. Treatment-seeking clients were recruited from their local UCCs and participated in adaptive treatment strategies (ATSs) involving Treatment as Usual (TAU), Collaborative Assessment and Management of Suicidality (CAMS), and Dialectical Behavior Therapy (DBT). Implementation outcomes, including appropriateness, acceptability, feasibility, fidelity, safety, and client satisfaction, were assessed. UCC clinicians participated in qualitative interviews focused on implementation of TMH for clients presenting with suicidal ideation (SI).

Results: Overall, treatments delivered via hybrid format were reported to be appropriate, acceptable, feasible, and satisfactory by clinicians and clients. Implementation of TMH was reported to be equivalent to in-person treatment across multiple measurement methods.

Conclusion: Results from this study demonstrate that TMH is an implementable treatment modality for addressing suicidality, particularly for college students presenting to UCCs with SI. This study has implications for real-world clinical settings planning to offer hybrid treatment modalities to address SI.Trial registration: ClinicalTrials.gov identifier: NCT04728815.

研究目的本研究旨在评估通过远程医疗(TMH)和面对面混合形式提供的自杀焦点治疗的实施情况:本研究在美国四所大学的咨询中心(UCC)进行。从当地的大学咨询中心招募了寻求治疗的客户,他们参与了适应性治疗策略(ATS),包括常规治疗(TAU)、自杀性合作评估与管理(CAMS)和辩证行为疗法(DBT)。对实施结果进行了评估,包括适当性、可接受性、可行性、忠实性、安全性和客户满意度。UCC 临床医生参与了定性访谈,重点讨论了针对有自杀意念(SI)的客户实施 TMH 的情况:总体而言,临床医生和客户都认为通过混合形式提供的治疗是适当的、可接受的、可行的和令人满意的。在多种测量方法中,TMH 的实施效果与面对面治疗的效果相当:本研究的结果表明,TMH 是一种可实施的治疗模式,可用于解决自杀问题,尤其是对于因 SI 而前往 UCC 的大学生。这项研究对现实世界中计划提供混合治疗模式以解决SI问题的临床环境具有借鉴意义:试验注册:ClinicalTrials.gov identifier:NCT04728815.
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引用次数: 0
First impressions count: Therapists' impression on patients' motivation and helping alliance predicts psychotherapy dropout. 第一印象很重要:治疗师对患者动机和帮助联盟的印象可预测心理治疗的放弃。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-09 DOI: 10.1080/10503307.2024.2411985
Kristin Jankowsky, Johannes Zimmermann, Ulrich Jaeger, Robert Mestel, Ulrich Schroeders

Objective: With meta-analytically estimated rates of about 25%, dropout in psychotherapies is a major concern for individuals, clinicians, and the healthcare system at large. To be able to counteract dropout in psychotherapy, accurate insights about its predictors are needed.

Method: We compared logistic regression models with two machine learning algorithms (elastic net regressions and gradient boosting machines) in the prediction of therapy dropout in two large inpatient samples (N = 1,691 and N = 12,473) using baseline and initial process variables reported by patients and therapists.

Results: Predictive accuracies of the two machine learning algorithms were similar and higher than for logistic regressions: Therapy dropout could be predicted with an AUC of .73 and .83 for Sample 1 and 2, respectively. The initial evaluation of patients' motivation and the therapeutic alliance rated by the respective therapist were the most important predictors of dropout.

Conclusions: Therapy dropout in naturalistic inpatient settings can be predicted to a considerable degree by using baseline indicators and therapists' first impressions. Feature selection via regularization leads to higher predictive performances whereas non-linear or interaction effects are dispensable. The most promising point of intervention to reduce therapy dropouts seems to be patients' motivation and the therapeutic alliance.

目的:根据荟萃分析估计,心理疗法的辍学率约为 25%,这是个人、临床医生和整个医疗保健系统都十分关注的问题。为了应对心理治疗中的辍学问题,我们需要准确了解其预测因素:方法:我们比较了逻辑回归模型和两种机器学习算法(弹性网回归和梯度提升机)在两个大型住院病人样本(N = 1,691 和 N = 12,473)中对治疗辍学的预测,并使用了病人和治疗师报告的基线和初始过程变量:结果:两种机器学习算法的预测准确率相似,且高于逻辑回归:样本 1 和样本 2 预测治疗退出的 AUC 分别为 0.73 和 0.83。对患者治疗动机的初步评估和由相关治疗师评定的治疗联盟是最重要的辍治预测因素:结论:利用基线指标和治疗师的第一印象可以在很大程度上预测自然住院环境中的治疗退出。通过正则化进行特征选择可获得更高的预测性能,而非线性效应或交互效应则是可有可无的。减少治疗辍学最有希望的干预点似乎是病人的动机和治疗联盟。
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引用次数: 0
Change in emotion-based narrative as a potential mechanism of change in a brief treatment for borderline personality disorder. 情感叙事的变化是边缘型人格障碍简短治疗的潜在变化机制。
IF 2.6 1区 心理学 Q2 PSYCHOLOGY, CLINICAL Pub Date : 2024-10-07 DOI: 10.1080/10503307.2024.2406543
Ueli Kramer, Alessio Simonini, Ere Rrustemi, Romane Fellrath, Kim Stucchi, Eleonora Noseda, Chantal Martin Soelch, Stéphane Kolly, José Blanco-Machinea, Tali Boritz, Lynne Angus

Background: The move from inconsistent and problematic autobiographical narrative to a more coherent and reality-based narrative construction of the Self has been discussed as potential mechanism of change in psychotherapies for personality disorders. So far, little empirical evidence exists that demonstrates in a time-dependent design the role of narrative construction in the treatment of borderline personality disorder, in particular when it comes to understanding the integration of body-related information from the affective system with the autobiographical narrative. The present study aims at demonstrating change in emotion-based narrative markers over brief psychiatric treatment and to assess the impact of these changes on subsequent symptom change. Methods: A total of N = 57 clients with borderline personality disorder were assessed at three timepoint over the course of four months of brief psychiatric treatment, within the context of a secondary process-outcome analysis of a randomized controlled trial. Symptom change was assessed using the OQ-45.2 and emotion-narrative change was assessed using the Narrative-Emotion Process Coding System to code client's in-session speech in terms of problem, transition and change markers. Results: All three emotion-based marker categories evidenced significant changes in the assumed direction. The reduction in problem emotion-based narrative markers (e.g., empty story telling) between session 1 and 5 into the treatment predicted the symptom reduction assessed between session 5 and 10. Conclusions: Emotion-based narrative construction may be a suitable method to study the pathway of change toward a more coherent and reality-based narrative construction of the Self-in-interaction-with-the-Other. Reduction of emotion-based problem-marker may be a promising candidate for a mechanism of change in treatments for personality disorders which should be tested in a time-dependent controlled design.

背景:在人格障碍的心理治疗中,从不连贯和有问题的自传体叙事到更加连贯和基于现实的自我叙事建构,一直被认为是潜在的改变机制。迄今为止,很少有经验证据能证明叙事建构在边缘型人格障碍治疗中的作用,尤其是在理解情感系统与身体相关信息与自传体叙事的整合方面。本研究旨在证明在短暂的精神治疗过程中,以情感为基础的叙事标记发生了变化,并评估这些变化对后续症状变化的影响。研究方法在一项随机对照试验的二次过程-结果分析中,对总共 N = 57 名边缘型人格障碍患者在四个月的简短精神治疗过程中的三个时间点进行了评估。症状变化采用 OQ-45.2 进行评估,情感-叙述变化采用叙述-情感过程编码系统进行评估,该系统根据问题、过渡和变化标记对客户的会话进行编码。结果:所有三个基于情绪的标记类别都在假设的方向上发生了显著变化。在治疗的第 1 次和第 5 次疗程之间,以问题情绪为基础的叙事标记(如空洞地讲故事)的减少预示着第 5 次和第 10 次疗程之间症状的减轻。结论以情绪为基础的叙事建构可能是一种合适的方法,可用于研究 "自我-与他人的互动 "中更连贯、更基于现实的叙事建构的变化路径。基于情绪的问题标记的减少可能是人格障碍治疗中一种有希望的候选变化机制,应在时间依赖性对照设计中进行测试。
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Psychotherapy Research
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