Pub Date : 2024-11-01Epub Date: 2023-11-03DOI: 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.
{"title":"Enhancing the effectiveness of CBT for patients with unipolar depression by integrating digital interventions into treatment: A pilot randomized controlled trial.","authors":"Jan Kalde, Ece Atik, Johannes Stricker, Magnus Schückes, Peter Neudeck, Andre Pittig, Reinhard Pietrowsky","doi":"10.1080/10503307.2023.2277866","DOIUrl":"10.1080/10503307.2023.2277866","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Methods: </strong>Patients (<i>N</i> = 82) were randomly assigned to bCBT (<i>n</i> = 42) or CBT (<i>n</i> = 40) over 12 weeks. bCBT consisted of weekly CBT sessions accompanied by the <i>elona therapy</i> 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.</p><p><strong>Results: </strong>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 (<i>d</i> = .50) and generalized anxiety symptoms (<i>d</i> = -.45). In other secondary outcomes (BAI, PSWQ, GSE, WHOQOL-BREF), improvements were descriptively larger for bCBT compared to CBT.</p><p><strong>Conclusion: </strong>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.</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":"71434779","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}
Pub Date : 2024-11-01Epub Date: 2023-11-06DOI: 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.
{"title":"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.","authors":"Shannon Maloney, Jesus Montero-Marin, Willem Kuyken","doi":"10.1080/10503307.2023.2269299","DOIUrl":"10.1080/10503307.2023.2269299","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>Compared to OMP, MBCT-TiF experienced significant improvements in mental well-being through changes in all three mediators (mindfulness: <i>ab </i>= 0.11 [0.03, 0.25]; decentering: <i>ab </i>= 0.16 [0.05, 0.33]; self-compassion: <i>ab </i>= 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.</p><p><strong>Conclusion: </strong>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.<b>Trial registration:</b> ClinicalTrials.gov identifier: NCT05154266.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537299/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71487550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"心理学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01Epub Date: 2023-10-17DOI: 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)。
{"title":"Comparing counseling outcome for college students: Metaverse and in-person approaches.","authors":"Soohyun Cho, Jieun Kang, Woo Hyun Baek, Yeon Bin Jeong, Seongchan Lee, Sang Min Lee","doi":"10.1080/10503307.2023.2270139","DOIUrl":"10.1080/10503307.2023.2270139","url":null,"abstract":"<p><p><b>ABSTRACT</b><i>Objective</i> 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. <b>Method:</b> 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. <b>Results and Conclusion:</b> 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 <i>d</i> = 1.04, In-person counseling Cohen's <i>d</i> = .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).</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":"41239931","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}
Pub Date : 2024-11-01Epub Date: 2023-10-19DOI: 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.
{"title":"The effect of Oxytocin administration on patient-therapist alliance congruence: Results from a randomized controlled trial.","authors":"Ariella Grossman-Giron, Hadar Fisher, Dana Atzil-Slonim, Hagai Maoz, Uri Nitzan, Dana Tzur Bitan","doi":"10.1080/10503307.2023.2269300","DOIUrl":"10.1080/10503307.2023.2269300","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Method: </strong>Inpatients with mental disorders (<i>N </i>= 87) participating in a randomized controlled trial received OT (<i>n </i>= 44) or placebo (<i>n </i>= 43) intranasally twice a day, for four weeks. Patients and therapists rated the alliance after each session.</p><p><strong>Results: </strong>Oxytocin significantly moderated the level of agreement (<i>b</i> = -0.56, <i>SE</i> = 0.25, <i>t</i> = -2.30, <i>p</i> = 0.02), such that patients receiving OT demonstrated lower discrepancy (<i>b</i> = -0.73, <i>p </i>< 0.001) than did those receiving placebo (<i>b</i> = -1.30, <i>p </i>< 0.001). On the other hand, the mutual covariance of patient-therapist ratings across sessions was positive and significant for patients receiving placebo (<i>b </i>= 0.26, <i>p</i> = 0.01) but not for patients in the OT group (<i>b </i>= -0.06, <i>p</i> = .56).</p><p><strong>Conclusion: </strong>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.</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":"49683650","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}
Pub Date : 2024-11-01Epub Date: 2023-08-29DOI: 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.
{"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}
Pub Date : 2024-10-29DOI: 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.
{"title":"Client characteristics and early working alliance development: A person-centered research approach.","authors":"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","doi":"10.1080/10503307.2024.2418868","DOIUrl":"https://doi.org/10.1080/10503307.2024.2418868","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Method: </strong>Individual psychotherapy clients (<i>N </i>= 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.</p><p><strong>Results: </strong>Latent profile analysis revealed three profiles of working alliance development: <i>high and stable</i>, <i>moderate and increasing</i>, and <i>low and stable</i>. 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 <i>low and stable</i> alliance profile.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548341","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}
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.
{"title":"Using machine learning methods to identify trajectories of change and predict responders and non-responders to short-term dynamic therapy.","authors":"Refael Yonatan-Leus, Gershom Gwertzman, Orya Tishby","doi":"10.1080/10503307.2024.2420725","DOIUrl":"https://doi.org/10.1080/10503307.2024.2420725","url":null,"abstract":"<p><strong>Objectives: </strong>Predicting therapy responders can significantly improve clinical outcomes. This study aims to identify predictors of response to short-term dynamic therapy.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510551","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}
Pub Date : 2024-10-22DOI: 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.
{"title":"Assessing the implementation of suicide-focused treatments delivered in hybrid telemental health format in a real-world setting.","authors":"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","doi":"10.1080/10503307.2024.2415104","DOIUrl":"https://doi.org/10.1080/10503307.2024.2415104","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Method: </strong>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).</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.<b>Trial registration:</b> ClinicalTrials.gov identifier: NCT04728815.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510550","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}
Pub Date : 2024-10-09DOI: 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.
{"title":"First impressions count: Therapists' impression on patients' motivation and helping alliance predicts psychotherapy dropout.","authors":"Kristin Jankowsky, Johannes Zimmermann, Ulrich Jaeger, Robert Mestel, Ulrich Schroeders","doi":"10.1080/10503307.2024.2411985","DOIUrl":"https://doi.org/10.1080/10503307.2024.2411985","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Method: </strong>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 (<i>N</i> = 1,691 and <i>N</i> = 12,473) using baseline and initial process variables reported by patients and therapists.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394317","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}
Pub Date : 2024-10-07DOI: 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.
{"title":"Change in emotion-based narrative as a potential mechanism of change in a brief treatment for borderline personality disorder.","authors":"Ueli Kramer, Alessio Simonini, Ere Rrustemi, Romane Fellrath, Kim Stucchi, Eleonora Noseda, Chantal Martin Soelch, Stéphane Kolly, José Blanco-Machinea, Tali Boritz, Lynne Angus","doi":"10.1080/10503307.2024.2406543","DOIUrl":"https://doi.org/10.1080/10503307.2024.2406543","url":null,"abstract":"<p><p><b>Background:</b> 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. <b>Methods:</b> A total of <i>N</i> = 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. <b>Results:</b> 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. <b>Conclusions:</b> 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.</p>","PeriodicalId":48159,"journal":{"name":"Psychotherapy Research","volume":null,"pages":null},"PeriodicalIF":2.6,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394316","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}