Psychotherapy Research最新文献

Objective: It is unclear whether cognitive reactivity (CR), an indicator of depression vulnerability, is reduced after cognitive behavioral therapy (CBT), as theorized. It is also unclear whether baseline CR and dysfunctional attitudes (DA) are associated with treatment outcome in CBT for depression. This study aims to examine these questions and assess if these effects are specific to CBT for depression.

Method: Depressed adult outpatients (n = 159) randomized to 16 sessions CBT or short-term psychodynamic supportive therapy (SPSP) completed measures of depression severity and CR at baseline and post-treatment (week 22), DA at week 5, and depression severity at baseline, week 5 and 10, and post-treatment. Mixed-model analyses were applied to estimate CR change and the moderating effect of DA and CR on depression levels at post-treatment.

Results: CR decreased significantly with a medium effect size. CR was negatively associated with post-treatment depression levels. DA was inconsistently associated with treatment outcome. We found no indications that these findings were specific to CBT.

Conclusion: CR decreases in both CBT and SPSP, broadening treatment options. CR, and possibly DA, appear to be prognostic factors for treatment outcome, potentially indicating the need to consider additional or alternativetreatment.

Objective: Teletherapy via videoconferencing has become common practice but has unique challenges. We aimed to develop and validate the first performance-based observer-rated measure of teletherapy skills: The Teletherapy Facilitative Interpersonal Skills Performance Task (Tele-FIS). Methods: We developed a set of 12 Tele-FIS video stimulus clips as simulations of four research-informed common therapeutic challenges in teletherapy: technology, distraction, boundaries and privacy, and emotional disconnection. A total of 153 therapists recorded interventions to the clips which were later rated on interpersonal skills. Results: The Tele-FIS performance task demonstrated good interrater reliability, internal consistency, test-retest reliability, and convergent validity. The Tele-FIS was positively associated with self-reported facilitative interpersonal skills, self-efficacy, attitudes towards technology, and observer-rated skills on a version of the FIS task that simulates in-person therapy. Therapists performed similarly on teletherapy clips of emotional disconnection and privacy issues compared to clips of in-person therapy. Therapists performed worse on Tele-FIS clips of technology and distraction challenges than in-person therapy clips. Conclusions: The Tele-FIS has potential as an assessment tool in skills training for trainees and licensed clinicians as well as future research about therapeutic work via teletherapy. Results are discussed to consider therapist skill and the use of practice-relevant materials in training.

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.

Objective: We assessed a new methodological and analytical approach for examining how therapist moment-to-moment interpersonal flexibility and responsiveness influence subsequent client collaboration. Therapist interpersonal flexibility was conceptualized as one of the crucial components of interpersonal responsiveness and operationalized as adjustments in therapists' interpersonal behaviors between speaking turns. To uncover the context-dependent nature of the responsiveness, the study also explored how these turn-to-turn adjustments, in relation to previous client collaboration, influence subsequent client collaboration. Method: This study involved 1107 speaking turns nested in 12 sessions nested within three therapist-client dyads. Three raters assessed therapist interpersonal behaviors in dominance-submission and approach-avoidance dimensions for each therapist speaking turn and the level of client collaboration for each client speaking turn. Distance scores and Dynamic Structural Equation Modeling (DSEM) were used to explore the hypothesized effects at a within-session level. Results: We found when therapists adjusted their interpersonal styles to a moderately high degree, clients were more collaborative than usual. We also found therapist turn-to-turn adjustments had a significantly positive effect on subsequent client collaboration only when clients were not collaborative before such adjustments were made. Conclusion: Overall, this study offers a methodological advancement in the study of therapist responsiveness by demonstrating the nuanced clinical insights offered by use of sophisticated analyses (i.e., within-session moment-to-moments responsiveness, Euclidean distance scores, Dynamic Structural Equation Modeling [DSEM]). Findings suggest a moderate level of turn-to-turn interpersonal adjustment may benefit subsequent client collaboration. Findings also suggest that a therapist's turn-to-turn adjustment in response to previous low client collaboration may facilitate subsequent client collaboration. Strengths, methodological limitations, and clinical implications are discussed.

Objective: Dropout is a major factor undermining the effectiveness of psychotherapy, however, it remains poorly anticipated in clinical practice. Classification trees may offer simple, accessible, and practical solutions to identifying patients at-risk of dropout by synthesizing potentially complex patterns of relationships among intake measures. Method: Intake variables were collected from day-patients who attended a Cognitive Behavior Therapy (CBT) group program at a private psychiatric hospital between 2015 and 2019. Based on these variables, two classification trees were trained and tested to predict dropout in (1) a weekly group, and (2) an intensive daily program. Results: Dropout was lower in the intensive treatment (Weekly CBT = 21.9%, Daily CBT = 13.2%), however, in both programs, the number of comorbid diagnoses was the most important factor predicting dropout. Overall balanced accuracy was comparable for both tree models, with the Weekly CBT model identifying 63.18% of dropouts successfully, and the Daily CBT model identifying dropouts with 62.06% accuracy. Conclusion: Findings suggest that comorbidity may be the most important factor to consider when assessing dropout risk in CBT, and that dropout can be predicted with moderate accuracy early in therapy via simple models. Furthermore, findings suggest that condensed, intensive treatments may bolster patient retention.

Objective: This study examines if experiencing the sequence of primary maladaptive emotions followed by primary adaptive emotions in-session predicts therapeutic change and whether this sequence mediates the impact of therapist emotional reflections on outcomes at post-treatment and follow-up.

Method: Nineteen participants with high self-criticism underwent 10-12 sessions of emotion-focused therapy (EFT). Therapist responses focusing on emotions, thoughts, and actions were coded for two sessions (sessions 6-12) during the initial 10 minutes prior to chair work. Clients' emotional states were coded using the Classification of Affective Meaning States (CAMS) during the subsequent chair work. Self-criticism and depression were measured at pre-treatment, post-treatment, and 3-month follow-up.

Results: Primary maladaptive emotions and the transformational sequence (primary maladaptive followed by adaptive emotion) predicted reductions in self-criticism at post-treatment, with the transformational sequence also predicting improvements at follow-up. The impact of therapist focus on emotions on depression and self-criticism at post-treatment and follow-up was mediated by the transformational sequence.

Conclusion: The transformational sequence predicts therapeutic outcomes and mediates the impact of therapist responses focused on the client's emotion and therapeutic results. Implications for therapist training are discussed.

Objective.: There is a growing consensus that interpersonal processes are key to understanding psychotherapy. How might that be reflected in the brain? Recent research proposes that inter-brain synchrony is a crucial neural component of interpersonal interaction. The current proof-of-concept study examines, for the first time, therapist-patient inter-brain synchrony measurement during multiple sessions. To guide the design of future studies, we performed a precursory test in a small sample of the association between inter-brain synchrony and therapeutic change, hypothesizing that it would gradually increase over therapy, reflecting inter-brain plasticity.

Method.: We scanned 18 therapy sessions of participants (N = 8) who underwent a 6-session test anxiety treatment. We measured therapist and patient brain activity using functional near-infrared spectroscopy (fNIRS) and assessed perceived session quality, wellbeing, symptoms, and therapeutic alliance every session.

Results.: In this proof-of-concept sample inter-brain synchrony gradually increased over treatment, and was associated with reduced symptoms, improved wellbeing and perceived session quality, but not with a stronger therapeutic alliance. fNIRS imaging had no discernable adverse effects.

Conclusion.: Our findings demonstrate that fNIRS imaging during psychotherapy is a feasible and viable research method and that inter-brain plasticity should be a candidate for future research on biological mechanisms underlying therapeutic change.

Background: Emotion-Focused Therapy is one of the evidence-based psychotherapies for a range of psychological problems. While most evidence was gained from randomized controlled studies or process research at university settings, there is a need for more outcome research conducted within practitioner-researcher networks assessing the effectiveness of Emotion-Focused Therapy in private practice. Methods: A total of N = 70 clients with a variety of psychiatric disorders have been included in the bi-national practitioner researcher network for Emotion-focused Therapy Switzerland-Germany. Symptom change was assessed using CORE-OM, BDI-II, IIP and WSAS. Therapist adherence was assessed by the self-reported version of the PCEPS. Pre-post-follow-up analyses were conducted using paired sample t-tests and hierarchical linear modeling. Results: Pre-post-assessment shows small to medium effect sizes for all outcome measures (except for interpersonal problems which did not change). Symptom reduction is maintained for CORE, BDI and WSAS, and increased for IIP at 3 and 6 months follow-up. Therapist adherence is good to excellent in this sample. Conclusions: Emotion-Focused Therapy is effective in the real-world practice, as suggested by the small to moderate effect sizes. The smaller effects found in the current study as compared to randomized controlled trials are consistent with the literature and suggest that EFT remains moderately effective when applied in a naturalistic context.

Objectives: High levels of change are linked to the flexibility between immersion and distancing, as well as to higher levels of therapeutic alliance. This study aims to explore the evolution of flexibility between immersion and distancing throughout the entire therapeutic process and its relationship with therapeutic alliance and depressive symptoms in a clinical case.

Method: We analyzed five sessions of a good outcome case of depression undergoing cognitive-behavioral therapy. We assessed the distancing/immersion of these sessions using the Measure of Immersed and Distanced Speech, and therapeutic alliance with the Working Alliance Inventory-Short Form. The depressive symptoms were assessed from the Beck Depression Inventory-II.

Results: Flexibility and therapeutic alliance from both client's and therapist's perspectives increased throughout the therapeutic process. A strong negative correlation was found between flexibility and depressive symptoms.

Conclusions: The increase in flexibility can be an adaptive pattern associated with the decrease in depressive symptoms, the increase in therapeutic alliance (from both the client's and the therapist's perspective), and therapeutic success.

Objective: Routine Outcome Monitoring (ROM) in group psychotherapy has shown varied results, as personalizing therapy for multiple patients is challenging. This study explored the impact of ROM and individual Add-On Interventions (AOIs) for patients with depression who were not progressing during Group Cognitive Behavioral Therapy (GCBT). We followed the research question, "How can individual AOIs contribute to patients' therapy courses?".

Method: We interviewed patients and therapists involved in GCBT with ROM and individual AOIs prompted by Not-On-Track alerts. Thematic analysis was used to generate themes related to participants' experiences. Three cases were selected to illustrate the structure of the themes.

Results: The main theme, "AOIs: Potential for active engagement," was constituted by seven subthemes concerning the influence of ROM, therapeutic collaboration, shared decision-making, allowing for person-tailored interventions, and the dynamic between group and individual sessions. The potential for active engagement was nurtured through flexible awareness, as patients shifted between a first-person perspective and an external perspective on their therapy process.

Conclusion: Individual AOIs, prompted by patient feedback, could create opportunities for reflection and engagement. However, the impact was shaped by the therapeutic relationships, the shared decision-making process, and the extent to which the AOIs offered complementary approaches to group psychotherapy.