Psychotherapy Research最新文献

ABSTRACTBackground: With the rising prevalence of major depressive disorder in the general population, understanding the mechanisms through which therapeutic interventions affect treatment outcomes is crucial. This study investigates the roles of mastery and motivational clarification as mediators of the treatment effectiveness of cognitive therapy for depression. Methods: This secondary analysis used data from a randomized controlled effectiveness trial involving 149 participants (M age = 40.7 years, SD = 11.6; 59.6% females, 40.4% males), who received a maximum of 22 sessions of either cognitive behavioral therapy (CBT) or exposure-based cognitive behavioral therapy (EBCT-R). Cross-lagged panel models were used to examine how mastery and motivational clarification mediated changes in depression severity over time. Results: The mediation paths showed a significant positive effect of therapy condition on mastery, with a larger increase for participants in the CBT condition. Mastery had a positive effect on WHO-5 well-being ratings and significantly mediated the treatment effect on well-being. Motivational clarification also had a significant positive effect on WHO-5 ratings, but did not mediate the overall treatment effect. Conclusion: Results suggest that fostering both mastery and motivational clarification within therapeutic interventions can enhance patients' well-being, with mastery specifically mediating the effects of CBT on treatment outcomes.

Objective: Young adult vulnerability is thought to elicit parental responsiveness, and parental responsiveness is thought to facilitate young adult vulnerability. These moment-by-moment in-session processes are purported core change mechanisms in attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents (ABFT-SGM). This study examined whether young adult vulnerability predicted immediately subsequent parental responsiveness, and parental responsiveness predicted immediately subsequent young adult vulnerability, and whether the frequency of such sequences predicted treatment outcome. Method: Analyses were conducted on all conjoint attachment sessions (N = 146) from 26 cases treated in an open trial of ABFT-SGM. Over 16,000 young adult speech-turns were coded for vulnerability and over 27,000 parental speech-turns were coded for responsiveness. Results: Hierarchical linear modeling revealed that young adult vulnerability predicted immediately subsequent parental responsiveness, and that parental responsiveness predicted immediately subsequent young adult vulnerability. Frequency of vulnerability-responsiveness sequences, for the most part, did not predict changes in young adults' perceived parental acceptance or rejection. Conclusions: Results support the bidirectional moment-by-moment effects of young adult vulnerability and parental responsiveness during conjoint ABFT-SGM sessions. The link between the simple frequency of vulnerability-responsiveness sequences and treatment outcome is tenuous.

This study examines fathers' experiences of participating in Emotion-Focused Skills Training (EFST). Method: The study is based on transcribed interviews with five men (M = 48 years) who participated in EFST. We analyzed the data using reflexive Thematic Analysis.

We identified five main themes: (1) Breach of expectations in the face of the program; (2) The group created a sense of community and normalization; (3) The program strengthened cohesion with partner; (4) Gaining better understanding of own emotional and behavioral patterns; and (5) Accessing concrete skills made it possible to be a father in new ways.

The findings show how the men experienced participation in EFST as both demanding and rewarding, with therapy-initiated processes expanding the perception of who they could be and what the role as a father and partner could entail.

Objective: The Working Alliance Inventory-Short Revised (WAI-SR) is a self-report measure of therapeutic alliance from the patient's perspective. This study aimed to examine the factor structure of the WAI-SR and evaluate its measurement invariance across in-person and videoconferencing psychotherapy sessions.

Method: The study sample consisted of 1043 adult patients. Exploratory and confirmatory factor analyses were conducted to evaluate the WAI-SR dimensions and structure. Measurement invariance was tested using multi-group confirmatory factor analysis, multiple indicator multiple causes model analysis, and item bias analysis.

Results: The findings supported a three-factor structure of the WAI-SR, encompassing goal, task, and bond dimensions. Results demonstrated configural, metric, scalar, and residual invariance across in-person and videoconferencing formats. The factor structure remained consistent after accounting for patient age and gender. Additionally, no differential item functioning or bias was observed between groups. The WAI-SR exhibited excellent internal consistency and composite reliability.

Conclusions: The WAI-SR is a reliable and valid tool for assessing therapeutic alliance across both in-person and videoconferencing sessions. The equivalence in measurement properties and mean scores across modalities highlights the adaptability of therapeutic alliance to virtual environments, supporting the broader use of telehealth in psychotherapy.

Introduction: Although personality functioning has a long psychodynamic tradition and has received renewed interest in psychotherapy research with the DSM-5 and ICD-11, little is known about its course and influencing factors following psychotherapy.

Methods: In a sample of 1208 completed outpatient psychodynamic psychotherapies, we examined changes in personality functioning in the 1-year follow-up. Machine learning was used to filter out potential predictors from all 227 possible predictors for changes in personality functioning following psychotherapy.

Results: For most patients, improvement in personality functioning remained stable following psychotherapy. Fourteen potential predictors were identified, including the length of psychotherapy, adverse childhood experiences, diagnosis of PTSD or recurrent depressive disorder, the improvement in interpersonal problems and symptoms as well as the stability of the bond between psychotherapist and patient. Furthermore, it was found that strong improvements can be considered a potential indicator for subsequent loss of personality functioning following psychotherapy.

Discussion: Our results suggest that in most cases improvement in personality functioning achieved during psychotherapy remains stable. In addition, the change in personality functioning following psychotherapy appears to be influenced by a multitude of small effects. It is then discussed that most of the identified predictors are associated with interpersonal relationships and experiences.

Objective: To evaluate the feasibility, acceptability, and religious congruence of integrating the 4T religious psychoeducation model into CBT group therapy for religious OCD, with exploratory analyses of clinical change.

Method: Twenty-three adults with religious OCD were randomly assigned to standard CBGT or a 4T-integrated group. Assessments were conducted at pre-test, post-test, and 1-, 3-, and 12-month follow-ups using the Y-BOCS, OBQ-44, TAFS, PIOS, BDI, and BAI. Linear mixed-effects and nonparametric analyses explored within-group change. Feasibility indicators included recruitment, retention, adherence, and participant feedback. Semi-structured interviews were thematically analyzed to examine acceptability and cultural fit.

Results: Both interventions were feasible and well-tolerated, with adequate recruitment and retention. Participants in both groups showed within-group improvements across symptom and cognitive measures. Exploratory trends suggested greater reductions in thought-action fusion (likelihood) and additional late-phase cognitive shifts in the 4T group. Qualitative findings highlighted positive perceptions of the 4T model's religious congruence, clearer understanding of intrusive thoughts, and enhanced motivation.

Conclusion: This randomized pilot feasibility trial supports the practicality and acceptability of integrating religiously grounded psychoeducation into CBGT for religious OCD. Preliminary trends suggest the need for a larger definitive trial, and qualitative data highlight the contextual relevance of religiously integrated psychoeducation for treatment engagement.

Objective: Few studies have examined whether changes in emotion regulation strategies-cognitive reappraisal (CR) and expressive suppression (ES)-serve as change mechanisms across different psychological treatments. Therefore, we tested whether increases in CR and decreases in ES predict subsequent reductions in client distress and whether these processes are specific to Cognitive Behavioral treatments or represent non-specific mechanisms of change.

Method: Participants were 1,116 adult outpatients (76.8% female; M = 34.2, SD = 10.8) treated by 947 licensed psychotherapists in the Italian PsyCARE study. Clients completed the Emotion Regulation Questionnaire (Gross & John, 2003), the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 at baseline, session 12, and 6-month follow-up. Polynomial regression and response surface analysis examined whether changes in CR and ES predicted later changes in distress, adjusting for therapist clustering.

Results: Increases in CR and decreases in ES significantly predicted subsequent reductions in client distress. Response surface analysis showed that clients who increased CR and decreased ES by an equal amount exhibited the greatest decreases in distress. These effects were not moderated by treatment type, suggesting that CR and ES are non-specific mechanisms of change.

Conclusion: The findings suggest that improving CR while reducing ES predicts improved outcomes across treatment approach, supporting emotional regulation as a general transdiagnostic mechanism of change.

Objective: The therapeutic alliance is a strong predictor of treatment outcome. Recent research emphasizes distinguishing between trait-like and state-like alliance. This study used the Social Relations Model (SRM) to analyze the variance attributable to the different trait and state components. Specifically, we focused on the bond component of the alliance and examined the extent to which SRM elements - Perceiver effect (evaluating relationships consistently), Target effect (being consistently perceived by others), and Relationship effect (influences specific to the dyad) contribute to the bond variance, and their associations with treatment outcome.

Method: Bond ratings of 118 patients with major depressive disorder receiving psychodynamic psychotherapy, and three treatment-agents (therapists, case managers and interviewers) were analyzed, using the Working Alliance Inventory. Outcomes were assessed using the Hamilton Rating Scale for Depression.

Results: Variance partitioning of the elements showed that the perceiver effect accounted for the largest proportion of bond rating variance for patients and treatment-agents. The relationship effect (of patients and treatment-agents) emerged as a significant predictor of treatment outcome.

Conclusion: Applying SRM across psychotherapy advances understanding of trait/state-like bond contributions to outcomes. Our findings underscore the potential of the unique relationship to capture processes of change, beyond stable patients' and therapists' characteristics.

Objective: Written Exposure Therapy (WET) is a brief cognitive behavioral intervention that appears clinically useful for the individuals dually diagnosed with PTSD and substance use disorders. However, the factors that are associated with its effectiveness for this population are unclear. A promising direction for investigating correlates of WET treatment outcomes is to study the written narratives generated during exposure sessions.

Method: This study analyzed the WET narratives of dually diagnosed Veterans (n = 19) as part of a larger feasibility study implementing this intervention in a residential substance use disorder treatment setting. Participants' narratives were analyzed with a structural topic modeling approach to explore latent topics that characterize the writings and examine their associations with study outcomes.

Results: Latent topics were found to characterize WET narratives, with one appearing to comprise a dimension of negative cognitions. Change in negative cognitions in Veterans' writings over the course of treatment associated with change in PTSD symptom severity, as measured by the CAPS-5 (p = 0.045). Increasingly writing of the negative impact of the traumatic event was associated with reduced treatment response.

Conclusion: The results may indicate that negative cognitions common among dually diagnosed individuals may interfere with the effectiveness of WET.