Psychotherapy Research最新文献

Objective: Previous studies often fell short in identifying differences in treatment effects between psychotherapeutic frameworks. Instead of focusing on the overall treatment effects, we aimed to identify the effects of individually optimal treatment choice [cf. treatment personalization].

Method: We used a causal-inference machine learning (i.e., targeted learning) framework to estimate effects from observational data obtained from the Finnish Psychotherapy Quality Registry, which includes adult patients diagnosed with various mental disorders (n = 2255). Our objective was to estimate the difference in average treatment outcomes between the optimal individualized treatment and a randomly allocated treatment (i.e., the average of all treatment options). Outcomes were changes in self-assessed symptom scores and clinician-assessed functioning. In addition, we estimated counterfactual total-population outcomes for psychodynamic, solution-focused, cognitive-behavioral, and integrative or cognitive-analytic therapies.

Results: Compared to the average treatment effects, the counterfactual optimal treatment produced 0.28-0.29 standard deviations larger benefits for all the outcomes (confidence intervals between 0.20-0.39). Assuming all patients underwent psychotherapy within a single framework, treatment effects on symptom scores were similar across frameworks, but some differences emerged for change in therapist-assessed functioning.

Conclusion: Identifying optimal treatment rules for psychotherapy frameworks is feasible and may significantly improve outcomes.

Objective: Dynamic changes in patients' outcome expectancy have been increasingly recognized as important for psychotherapy success. However, whether expectancy change predicts treatment outcomes independently of baseline expectancy, particularly in major depressive disorder (MDD), remains underexplored. This study investigated the role of expectancy change throughout treatment as an independent predictor of psychotherapy outcomes in MDD.

Methods: Seventy-five patients with MDD underwent a 16-session psychotherapy treatment, during which expectancy was measured six times. Expectancy change was operationalized as the within-person slope of expectancy across sessions, while baseline expectancy was assessed prior to treatment onset. Linear regressions examined the contribution of baseline expectancy, expectancy change and their interaction to overall symptom improvement, from pre- to post-treatment.

Results: A greater increase in expectancy throughout treatment predicted faster and more substantial recovery. Notably, both higher baseline expectancy and greater expectancy change independently predicted better treatment outcomes.

Conclusions: These findings highlight that dynamic changes in patients' outcome expectancy predict overall symptom improvement, independently of baseline expectancy. Integrating these findings within a broader framework of belief-updating in depression, we propose that expectancy change may inform treatment progression and serve as a therapeutic target. Implications for clinical practice and future work are discussed.

Objective: Research on clinical skills and therapy outcomes is inconsistent. This study identifies skills profiles in patient-therapist dyads and their links to outcomes.

Method: Clinical microskills were assessed using the Inventory of Therapeutic Interventions and Skills (ITIS) in video-recorded therapy sessions of 194 patients treated by 32 therapists at a CBT outpatient clinic. Outcome and process measures - including distress, anxiety, depression, and alliance - were assessed at session 15. Latent profile analysis identified distinct skills profiles, and multilevel regression models examined their ability to predict outcomes.

Results: Three latent skills profiles emerged: one high, one medium, and one low. Therapists shifted between profiles depending on the patient, averaging 2.4 profiles each. Higher skills profiles correlated with better alliance ratings and lower distress in session 15. Skills profiles were not linked to depressive symptoms, anxiety, or patient rated outcome.

Conclusion: Therapeutic skills show state-like variability and influence the therapeutic alliance. These findings highlight the importance of examining dyadic processes to enhance therapy effectiveness.

Objective: This study examined the temporal dynamics of supervisor- and supervisee-rated supervisory working alliance (SWA) and their relations to treatment process and outcome.

Method: The sample included 28 supervisory dyads participating in a total of 1709 weekly supervision sessions and rating SWA at each session. Meanwhile, 261 community clients attended psychotherapy with the supervisees, providing session evaluation and alliance ratings at each session and the Outcome Questionnaire-45 (OQ) every eighth session. We used a longitudinal actor partner interdependence model. Responsiveness was operationalized as the paths from one partner's SWA to the other partner's SWA in the following week. In-phase responsiveness is a positive path, where dyadic SWA perceptions change in the same direction. Anti-phase responsiveness is a negative path, indicating that dyadic SWA perceptions fluctuate around an equilibrium. SWA rupture and repair was operationalized as SWA variability.

Results: Clients had greater OQ improvement when the supervisory dyads exhibited greater anti-phase responsiveness. Clients had higher session evaluation and greater OQ improvement when the supervisory dyads had greater SWA variability.

Conclusion: Supervisors who maintain a dynamic equilibrium in response to their supervisees' SWA changes may help offer a constructive consultant perspective. SWA variability may reflect in-depth work.

Objective: This study aimed to test and refine the complete alliance rupture repair model (RRM), consisting of three pathways, in short-term psychodynamic psychotherapy.

Method: The validation phase of task analysis was applied in a multi-method case study design to compare therapeutic strategies in a successful repair case (SRC) and an unsuccessful repair case (URC). The Working Alliance Inventory - Short was utilized to select cases and sessions, while the revised Rupture Resolution Rating System (3RS) provided the framework for analyzing the six selected sessions.

Results: The study found that pathway 1 strategies (acceptance, validation, curiosity, and engagement) were more frequently utilized in the SRC. These strategies were also linked to repair segments in both cases. Conversely, pathway 2 strategies (renegotiating tasks and goals) were employed less frequently in both cases and did not lead to successful repair. Pathway 3 strategies (exploring the rupture experience) were particularly effective in repairing the rupture in the SRC. However, in the URC, these strategies appeared to exacerbate the rupture.

Conclusion: Pathway 1 strategies are crucial, serving both as an independent approach and as a foundational element for effectively implementing strategies in pathway 3, and likely in pathway 2 as well.

Objective: This pilot study aimed to assess the feasibility and informativeness of a mixed-method approach to investigate how the Self changes during psychotherapy within a Dynamic Systems Theory (DST) framework, addressing theoretical heterogeneity and the limits of conventional pre-post designs.

Method: Five participants undergoing psychotherapy were scheduled to complete weekly smartphone-based diary assessments over several months (≥30 scheduled prompts). Each assessment included 11 (nomothetic) ad hoc items and 2 person-specific (idiographic) items. Responses to the Narrative Assessment Interview (NAI) were analyzed using conventional qualitative content analysis to derive person-specific items and interpret quantitative trajectories (but were not analyzed as a separate qualitative outcome). Quantitative data were analyzed using time-series methods (i.e., trend analysis and ARIMA modeling).

Results: The Self exhibited various change patterns (e.g., linear, nonlinear, stationary, and non-stationary), characterized by the influence of past values (i.e., the autoregressive component) and innovations (the moving-average component). Moreover, participants exhibited different change dynamics. Therefore, the conditions required for ergodic generalization were often not met in these data.

Conclusion: The mixed-methods approach was informative, capturing the complexity of Self-change. The method was feasible in a real clinical setting, but compliance and the time required to perform the analyses were critical.

Objective: Randomised Control Trials play an important role in psychotherapy research and have a defining impact on mental health policy. However, relatively little research has been published investigating the experiences of therapists participating in such trials. The present paper reports on a study investigating the experiences of therapists trained to deliver both protocols within an RCT.

Method: Semi-structured interviews were conducted with 9 therapists who participated in an RCT comparing Emotion-Focused Therapy (EFT) and Cognitive Behaviour Therapy (CBT) as treatments for Generalized Anxiety Disorder (GAD). Transcribed interviews were qualitatively analysed using a descriptive and interpretative framework.

Results: Therapists described their experience in terms of the many positive aspects of participation, the enormous challenges of participation, and the sometimes agonizing moments of emotional difficulty. Thus, findings are reported within the domains: "The Good," "The Hard," and "The Emotionally Difficult." Two additional domains summarize findings related to therapist experience of having to simultaneously deliver "The Two Protocols" and therapist-reported phenomena deemed as "Helpful."

Discussion: For a majority, though not all, the positive aspects of participation mitigated the challenges. Similarly, a majority, though not all, reported that having to deliver two protocols posed additional challenges but was not in and of itself a problem.

Objective: Blended Care (BC) has emerged as a promising approach to address the growing demand for mental health treatment, but little is known about its change mechanisms and how they compare to traditional psychotherapy (PT). This study investigates therapeutic alliance, general and mental health self-efficacy, and therapeutic agency function as mechanisms of change.

Methods: We conducted a secondary analysis of a randomized controlled trial (N = 1,159 patients) comparing BC to PT in routine outpatient care. Mechanism and outcome variables (mental distress, satisfaction with life) were assessed at four time points over six months. We used random-intercept cross-lagged panel models (RI-CLPM) to differentiate between- from within-person effects.

Results: All constructs were associated with better outcomes. Temporal effects showed that mental health self-efficacy predicted subsequent increases in satisfaction with life, and therapeutic alliance predicted lower mental distress at specific time points. General self-efficacy showed inconsistent effects, with counterintuitive findings in the BC group, where higher self-efficacy predicted increased mental distress. Agency was mainly related to satisfaction with life. Outcomes also predicted changes in mechanisms. Differences between BC and PT were only significant for general self-efficacy.

Conclusion: Our findings suggest that therapeutic change is dynamic and reciprocal. The unexpected associations in the BC group need replication.

Objective: This study explores how men with co-occurring personality disorder (PD) and substance use disorder (SUD) experience change following mentalization-based treatment (MBT), addressing a gap in research that has primarily focused on women.

Method: Semi-structured interviews were conducted with 10 men who had participated in MBT-SUD. Transcripts were analysed using reflexive thematic analysis within a hermeneutic-phenomenological framework.

Results: Five interconnected themes captured participants' change experiences: (1) I could be wrong-developing cognitive flexibility and self-reflection; (2) I know what it takes-acquiring emotion regulation skills and confidence; (3) It doesn't have to be anything more-reduced interpersonal hypersensitivity; (4) I understand what others need-enhanced interpersonal awareness; and (5) Something's happened, and I don't know what-varied and sometimes ambiguous transformation. Two distinct change pathways emerged: a stepwise developmental process and a more global transformation.

Conclusion: Men in MBT-SUD reported improved capacity to reflect on and differentiate between their own and others' mental states. However, change pathways varied, and not all participants experienced therapeutic benefits.

Objective: While the knowledge about developing an effective therapeutic alliance (TA) with patients diagnosed with an antisocial personality disorder (ASPD) is growing, little is known from patients' perspective. Given the important role of TA in therapy outcomes, a deeper understanding of the factors contributing to a strong TA is essential. This study aims to expand current knowledge by exploring the experiences and preferences of patients with ASPD regarding TA development.

Method: A qualitative research design was employed using reflective thematic analysis. Fifteen in-depth interviews were conducted with patients diagnosed with ASPD and analyzed for recurring themes.

Results: Seven themes were identified and grouped into two categories. The first category, "Facilitators" reflects therapeutic attitudes that align with the needs of patients with ASPD. The second category, "Barriers to engage" describes the difficulties patients experience in forming a TA.

Conclusions: Although patients with ASPD often experience establishing a TA as challenging, TA development can be achieved when therapists adapt their approach to patients' needs. Patients want a genuine, authentic therapist who can provide a pleasant, collaborative atmosphere. By maintaining a non-judgmental and calm attitude, while adopting a firm and clear style, therapists support patients' engagement and promote TA development.