Psychotherapy Research最新文献

Objective: Our primary aim was to assess the associations between outcomes and therapist interpersonal skills (TIS) of empathy, congruence, regard, and unconditionality, as rated by young people. We also aimed to compare these associations against outcome-alliance associations, and to assess whether these associations were specific to a TIS-prioritizing therapeutic practice.

Methods: Our primary sample was 167 13-16-year-olds who exhibited emotional symptoms and received up to 10 weeks of school-based humanistic counseling plus pastoral care as usual (SBHC + PCAU). Young people were predominantly female (76%), with 45% Black or other minoritized identity. We measured TIS with the Barrett Lennard Relationship Inventory; and used linear regression modeling to assess TIS associations with outcomes on psychological distress, wellbeing, and satisfaction.

Results: TIS, most markedly congruence, were significantly associated with outcomes, contributing approximately 3% of change. TIS and alliance explained similar proportions of outcomes, with a model including only congruence showing the best fit on psychological distress and wellbeing. We did not find consistent evidence that the TIS-outcome association was specific to humanistic counseling.

Conclusion: Therapists and lay professionals working with young people should strive to develop their interpersonal skills-particularly congruence-within the context of other relationship skills, qualities, and characteristics.

Background: The Clinical Outcomes in Routine Evaluation (CORE) system was launched in 1998 intended to support the development of practice-based evidence and to reduce the research/practice gap. Since then, CORE instruments have been widely used.

Aims: To map the utilization of the CORE system as reflected in peer-reviewed literature.

Methods: We followed the guidelines for conducting a scoping review.

Results: We identified 721 papers from 1998 to 2021 citing the CORE system, with 636 of them referencing its use in clinical settings. There has been a marked increase in use of the system over that period. All CORE instruments were used at least once, spanning 39 countries and 24 languages. Papers had a broad spectrum of objectives and populations across diagnoses and settings, aligning with the authors' planned versatility for the CORE system.

Conclusions: In the light of the findings, we present a guide to enhance the reporting of work utilizing the CORE system. This could be applied to all practice-based evidence data collection, CORE or otherwise.

Objective: The objective was to test the hypothesis that externalizing and internalizing helpfulness beliefs and learning styles at baseline moderate panic severity and overall mental illness as short-term and long-term outcomes of two panic-focused psychotherapies, Panic Control Treatment (PCT) and Panic-Focused Psychodynamic Psychotherapy (PFPP).

Method: Participants were 108 adults with DSM-IV Panic Disorder with or without Agoraphobia (PD/A) who were randomized to treatment in a trial of PCT and PFPP. Piece-wise/segmented multilevel modeling was used to test three-way interactions (Treatments × Moderator × Time), with participants and therapists as random factors. Outcome variables were clinician-rated panic severity and self-rated mental illness post-treatment and during follow-up.

Results: Patients' externalizing (but not internalizing) helpfulness beliefs moderated mental illness outcomes during follow-up (but not during treatment); low levels of Externalization were facilitative for PFPP but not PCT. Internalizing and externalizing helpfulness beliefs and learning style did not moderate clinician-rated panic severity, whether short- or long-term.

Conclusions: These results suggest that helpfulness beliefs and learning style have limited use in assignment to either PCT or PFPP for PD/A. Although further research is needed, low levels of helpfulness beliefs about externalizing coping may play a role in mental illness outcomes for PFPP.

Objective: This exploratory study investigated the association between interpersonal movement and physiological synchronies, emotional processing, and the conversational structure of a couple therapy session using a multimodal, mixed-method approach.

Method: The video recordings of a couple therapy session, in which the participants' electrodermal activity was recorded, were analyzed. The session was divided into topical episodes, a qualitative analysis was conducted on each topical episode's emotional aspects, conversational structure and content. In addition, movement and physiological synchrony were calculated in each topical episode. Regression models were used to discover the associations between qualitative variables and synchronies.

Results: Physiological synchrony was associated with the emotional aspects of the session and to episodes in which the spouses' relationship was addressed, while movement synchrony was only related to emotional valence. No association between synchrony and conversational structure was found.

Conclusion: The findings suggest that physiological and movement synchrony play distinct roles in psychotherapy. The exploratory study sheds light on the association between momentary synchrony, emotions, and conversational structure in a couple therapy session.

Objective: Theories assert that avoidance maintains maladaptive anxiety over time, yet a clear prospective test of this effect in the day-by-day lives of people with social anxiety disorder (SAD) is lacking.

Method: We used intensive longitudinal data to test prospective relationships between social fear and social avoidance in 32 participants with SAD who reported on a total of 4256 time points.

Results: Results suggested that avoidance strongly predicted future anxiety, but only in a minority of people with SAD. Relationships between anxiety and avoidance varied considerably across individuals. Pre-registered tests found that the strength of autocorrelation for social fear is a good target for future testing of prediction of exposure response. Participants with lower autocorrelations were less likely to show between-session habituation.

Conclusions: Overall, results suggest avoidance maintains fear in SAD for at least some individuals, but also indicates considerable variability. Further intensive longitudinal data is needed to examine individuals with SAD across varying time courses.

Objective: Interpersonal synchronization is increasingly studied as a biomarker of empathy, therapeutic alliance, and treatment outcome. However, most studies average data over sessions, leaving associations between synchrony and actual interactions largely unexplored. We aim to showcase a novel approach examining synchronization during specific micro-processes: Innovative Moments (IM) as markers of exceptions to clients' problematic patterns of meaning.

Methods: Electrodermal activity was recorded over 15 sessions of a psychodynamic psychotherapy single case. Moment-to-moment patient-therapist synchrony was calculated using the Adaptive Matching Interpolated Correlations (AMICo) algorithm. The Innovative Moments Coding System was utilized to identify IMs within session transcripts with precise timing. Monte-Carlo permutation tests were conducted to examine the association between physiological synchrony and IM Levels of increasing complexity (Levels 1-3).

Results: Higher-than-random synchronization emerged during Level 3 IMs (p = 0.046; d = 0.21) but not in lower Levels. Post-hoc qualitative analyses linked high synchrony to sub-processes of Level 3 IMs, such as positive contrasts and attributions for change.

Conclusion: Our findings show it is possible to link moment-by-moment physiological co-regulation to theoretically identified meaning-making processes. While generalization of these observations is undue, this work demonstrates a robust and promising application of a multimodal approach to investigating psychotherapy, providing insights into both the clinical case and the theoretical model adopted.

Objective: Session-by-session tracking of the working alliance enables clinicians to detect alliance deterioration and intervene accordingly, which has shown to improve treatment outcome, and reduce dropout. Despite this, regular use of alliance self-report measures has failed to gain widespread implementation. We aimed to develop an automated alliance prediction using behavioral features obtained from video-recorded therapy sessions.

Method: A naturalistic dataset of session recordings with patient-ratings of working alliance was available for 252 in-person and teletherapy sessions from 47 patients treated by 10 clinicians. Text and audio-based features were extracted from all 252 sessions. Additional video-based feature extraction was possible for a subsample of 80 sessions. We developed a modeling pipeline for audio and text and for audio, text and video to train machine learning regression models that fuse multimodal features.

Results: Best results were achieved with a Gradient Boosting architecture, when using audio, text, and video features extracted from the patient (ICC = 0.66, Pearson r = 0.70, MAE = 0.33).

Conclusion: Automated alliance prediction from video-recorded therapy sessions is feasible with high accuracy. A data-driven multimodal approach to feature extraction and selection enables powerful models, outperforming previous work.

Objective: This randomized controlled trial investigated the efficacy of dynamic relational group therapy (DRT) relative to group psychodynamic supportive therapy (PST) in improving perfectionism-related attitudes and components of the perfectionistic self-relationship. Method: Based on a comprehensive conceptualization of perfectionism, 80 community-recruited, highly perfectionistic individuals were randomly allocated to 12 sessions of group DRT (n = 41; 5 groups) or group PST (n = 39; 5 groups). Patients completed measures of dysfunctional attitudes, self-criticism, self-esteem, and self-reassurance at pre-, mid-, and post-treatment, and six months post-treatment. Results: Multigroup latent growth curve modeling revealed significant (p < .05) decreases in dysfunctional attitudes, concern over mistakes, two types of self-criticism, and self-esteem problems, along with a significant increase in self-reassurance, from pre-treatment to six-month follow-up in both DRT and PST. Moderate-to-large between-group differences favoring DRT over PST were found for dysfunctional attitudes and self-reassurance. A majority of patients in both conditions maintained reliable improvement at six-month follow-up in dysfunctional attitudes, concern over mistakes, and self-criticism focused on inadequacy. Conclusion: Findings provide evidence for the use of psychodynamic group therapy approaches in treating perfectionism-related attitudes and self-relational elements of perfectionism, and support the relative efficacy of DRT for dysfunctional attitudes and self-reassurance.

Introduction: Flexibility, the ability of an individual to adapt to environmental changes in ways that facilitate goal attainment, has been proposed as a potential mechanism underlying psychopathology and psychotherapy. In psychotherapy, most findings are based on self-report measures that have important limitations. We propose a multimodal, multi-dyad approach based on a nonlinear dynamical systems framework to capture the complexity of this concept.

Method: A new research paradigm was designed to explore the validity of the proposed conceptual model. The paradigm includes a psychotherapy-like social interaction, during which body movement and facial expressiveness data were collected. We analyzed the data using Hankel Alternative View of Koopmann analysis to reconstruct attractors of the observed behaviors and compare them.

Results: The patterns of behavior in the two cases differ, and differences in the reconstructed attractors correspond with differences in self-report measures and behavior in the interactions.

Conclusions: The case studies show that information provided by a single modality is not enough to provide the full picture, and multiple modalities are needed. These observations can serve as an initial support for our claims that a multi-modal and multi-dyad approach to flexibility can address some of the issues of measurement in the field.

Objective: We evaluated whether respiratory sinus arrhythmia (RSA) reactivity and resting RSA-physiological markers reflecting the increase in heart rate with inspiration and decrease during expiration related to parasympathetic influence on the heart-are modifiable and predict symptom change during youth psychotherapy. Methods: Diverse youth (N = 158; ages 7-15; 48.1% female) received the Modular Approach to Therapy for Children and completed pre-treatment (pre), post-treatment (post), and 18-months postbaseline (18Mo) assessments. We measured resting RSA, RSA reactivity during stress induction, and psychopathology symptoms. Results: Pre-to-post and pre-to-18Mo, reactivity decreased, and resting RSA increased. Changes in reactivity and resting RSA, separately, did not predict reduced psychopathology. Yet, decreased reactivity combined with increased resting RSA predicted reduced psychopathology over time, suggesting that observed RSA changes were beneficial for some. Higher dosage of a module utilizing slow-breathing, muscle-relaxation, and imagery predicted greater pre-to-18Mo changes in reactivity and resting RSA, whereas a similar module with less emphasis on slow-breathing did not. Conclusions: Findings raise the possibility that youth reactivity and resting RSA could be modifiable during cognitive behavioral therapy and contribute to the amelioration of psychopathology. More studies are needed to determine whether resting RSA and RSA reactivity are modifiable indices of symptom change in slow-breathing practices and psychotherapy.

Clinicaltrials.gov identifier: NCT03153904, registered May 15, 2017.