Psychotherapy Research最新文献

Objectives: This study aimed to investigate clients' perspectives on the integration of religion/spirituality (R/S) with psychotherapy in Singapore, a religiously diverse nation. It was hypothesized that clients would report R/S integration to have a positive impact (H1), initiate R/S discussions (H2), and their R/S and perception of the religious context would be associated with their attitudes towards R/S integrated psychotherapy (H3). A cross-sectional mixed-methods design was employed. Methods: Participants were 275 Singapore psychotherapy clients (52.3% male, 46.9% female, 8% non-binary/third gender). Mean age was 34.93 years (SD = 9.95). Participants completed a questionnaire comprised of demographical items, psychotherapy experiences, various R/S-related measures and qualitative questions on considerations and opinions on R/S integrated psychotherapy. Results: Clients reported that R/S integrated psychotherapy (RSIP) had a positive impact and that they were the main initiator. Considering R/S as supportive during adversity and perceptions of the religious context were associated with attitudes towards integration. Unexpectedly, R/S diversity appeared to have a facilitatory effect on RSIP. Qualitative findings revealed client's experiences and perspectives, including their expectations towards therapists. Conclusions: These findings highlight the importance of therapists' R/S competency. In R/S diverse contexts, therapists may require greater sensitivity, openness, and the ability to work with clients holding diverse R/S beliefs.

Objective: Low-intensity interventions based on cognitive behavioral therapy are often used to scale up treatment volumes for common mental health problems. However, mode of delivery could have implications for outcomes. Methods: This was an observational study of adults seeking treatment in a naturalistic setting of outpatient community mental health services (N = 897). Depending on their problem description, patients were allocated to four different low-intensity interventions: group psychoeducation, group therapies, guided self-help, and one-to-one consultations. Pre-to posttreatment changes on the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Work- and Social Adjustment Scale (WSAS) were estimated using linear mixed-effects models and propensity score weighted analyses. Results: The proportion of patients achieving clinically significant change (CSC), and time used to achieve CSC varied between interventions, with guided self-help showing the highest rates of CSC (53-66%, d = 0.62-1.04) and group psychoeducation being most time-effective intervention. For subclinical patients, guided self-help had the lowest rates of reliable deterioration (0-8%). Conclusion: Low-intensity interventions within routine community mental health care have acceptable outcomes. Mode of delivery appears to be important for rates of CSC, therapist time investment, and prevention of deterioration. Future studies should investigate which low-intensity interventions work for whom.

Objective: The Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is a pantheoretical mental health assessment instrument that has been translated into over 50 languages. Despite its widespread international use in clinical practice and research, the psychometric properties of CORE-OM require further investigation.

Method: We explored and tested the factorial validity of the German version of CORE-OM in a large adult clinical outpatient sample (N = 4355) using exploratory and confirmatory factor analysis. Internal consistency and correlations of the four CORE-OM domains (Well-being, Problems, Functioning, and Risk) across gender identities are presented.

Results: While no model satisfied all fit criteria in confirmatory analyses, the three-factor structure derived from exploratory factor analysis outperformed the theoretically favored four-domain solution. Internal consistency was overall acceptable with Well-being scoring slightly lower than the other scales. Non-binary respondents had statistically significantly higher average Risk scores then men and women.

Conclusion: Our findings support the reliability of CORE-OM and lend limited support to its factorial structure in a large German-speaking sample, and emphasize the importance of considering diverse gender identities in mental health assessment. The analyses further indicate a need for refinement in the scoring of CORE-OM in various cultural contexts.

Objective: Despite growing interest in personalized psychotherapy research, little is known about therapists' current practice of personalizing psychotherapy. This study aimed to examine the extent to which psychotherapists engage in personalized treatment selection (PTS), i.e., recommending the presumably best-fitting treatment package to a patient, as one way of personalizing psychotherapy. Method: This is a pre-registered study using open- and closed-ended questions in an online survey among German psychotherapists (N = 557 started, N = 392 (70.4%) completed). We applied logistic regression analyses to investigate predictors of PTS and qualitative analyses to investigate therapists' subjective reasoning for and against PTS. Results: 78.7% (N = 437) of the therapists stated that they had practiced PTS in the past. Therapists trained in psychodynamic approaches were more likely to engage in PTS than cognitive-behavioral therapists. Therapists named a variety of patient characteristics that can lead to the recommendation of specific treatment approaches, most notably diagnostic factors and patient preferences. Therapists not engaging in PTS most often referred to the effectiveness of their own approach as explanation. Conclusion: The majority of psychotherapists provide personalized treatment recommendations to their patients. In light of our findings, we discuss challenges for the implementation of data-driven clinical support tools for PTS.

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

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

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

Objective: To develop and validate a video rating instrument designed to assess transtheoretical clinical micro-skills within deliberate practice (DP) exercises.

Method: The Clinical Micro-Skill Training (CMST) Scale was developed based on three established therapeutic competence measures and refined by expert clinician input. The instrument was then applied by trainee psychotherapists to rate N = 433 videos from N = 59 training candidates, who responded to simulated patient statements as if they were the therapist in that situation. Descriptive results, internal consistency, inter-rater reliability, item structure, convergent and discriminant validity were examined.

Results: The CMST demonstrated good reliability, with an internal consistency of ω = .82 and inter-rater reliability of ICC = .73 for the total score. Exploratory factor analysis revealed three factors-Interpersonal Competence, Communication Competence, and Process and Time Management. The CMST also exhibited satisfactory convergent and discriminant validity.

Conclusion: The CMST demonstrates feasibility, reliability, validity, and efficiency in the assessment of therapeutic micro-skills. Its multidimensional structure allows for a nuanced approach, moving beyond mean scores to evaluate and target specific competence facets for improvement. However, its predictive validity for treatment outcomes remains to be explored in future studies.