Psychotherapy Research最新文献

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.

Objective: Maintaining relevance in a psychodynamic dialogue is a nuanced task, requiring therapists to balance between following patients' free associations while avoiding less effective interventions. Identifying less effective sequences of talk is especially challenging given the diversity of psychodynamic approaches and methodological barriers to analyzing session discourse. This study introduces a novel approach using the MATRIX coding system, an evidence-based tool, to differentiate content correlated with better session outcomes.

Method: Transcripts of 367 sessions were coded using the MATRIX. Therapist Out-of-MATRIX utterances, indicating a deviation from core therapeutic focus, were examined for their predictive value. Outcome measures included the next-session alliance and patient functioning scores. Two machine-learning-based models, using the Random Forest algorithm, predicted session-by-session changes in clinical outcomes based on MATRIX codes, and interpreted using the SHapley Additive exPlanations.

Results: Therapist Out-of-MATRIX utterances accurately predicted next-session changes in alliance and patient functioning scores. Our model also identified an optimal dose-effect relationship for the number of Out-of-MATRIX interventions needed for effective therapy session.

Conclusion: This study demonstrates the potential of using contemporary research tools to analyze therapeutic discourse, revealing how psychotherapy produces its benefits. Its scope extends beyond prediction, providing practical recommendations on how to enhance therapists' performance and outcomes.

Objective: Previous research has identified a complex relationship between client-therapist synchrony and therapy outcomes. We investigated the ways in which depression severity influences this relationship.

Method: The sample was comprised of 30 clients undergoing a 16-session supportive-expressive dynamic therapy for depression. Client-therapist interpersonal synchrony was assessed using the Client-Therapist interpersonal Synchrony (CIB) coding system during five pre-selected sessions. After each session, the clients evaluated their satisfaction with the session. We employed multi-level modeling (MLM) to analyze the data.

Results: Sessions characterized by higher levels of interpersonal synchrony were associated with better session quality, both within and between dyads. Depression severity moderated this association, such that the correlation between interpersonal synchrony and session outcome was weaker in dyads where clients reported greater depression severity.

Conclusions: These findings suggest that to facilitate effective synchrony it is important to consider the clients' level of depression.

Objective: Patients with Major depressive disorder (MDD) and a comorbid Borderline personality disorder (BPD) show a poorer prognosis for MDD compared to patients without BPD. Little is known about the therapeutic processes underlying this prognosis. The goal of the present study was to investigate whether patients with more severe BPD symptoms experience less strengthening in patient-therapist movement synchrony (MS) throughout treatment, and whether less strengthening in MS is associated with less effective sessions. Method: Ninety-five patients participating in a randomized control trial were assessed for BPD (N = 9) using the Structured Interview for DSM-IV Personality. 1367 video-taped sessions were analyzed for MS using Motion Energy Analysis. Session effectiveness was evaluated following each session using a one-item scale taken from the Helping Skills Measure. Multilevel models were used to assess whether BPD severity predicted MS throughout treatment, and whether MS predicted session effectiveness. Results: Patients with more severe BPD symptoms experienced greater strengthening in MS throughout treatment. Less MS strengthening was associated with less session effectiveness. Conclusion: These findings indicate unique therapeutic processes that characterize individuals with more severe BPD symptoms. Shedding light on these unique processes has the potential to contribute to the personalization of MDD treatment for patients with BPD.

Objective: Countertransference (CT) has been shown to interfere with therapy goals, and its management is crucial to desired treatment outcomes. As a first step, a clinician's awareness of their covert and overt CT reactions is critical to successfully managing CT. Research on CT awareness is scarce, however, mainly because of difficulties in empirically investigating and measuring this construct. In this study, we sought to develop and validate two instruments: one to measure CT feelings and one to measure CT behaviors.

Method: We developed the Countertransference Feelings Awareness Measure and the Countertransference Behavior Awareness Measure, both composed of 12 items comprising 3 dimensions: dominant, hostile and distant. A sample of 245 Italian and 110 American clinicians participated in the research. Confirmatory factor analysis was conducted to verify the factor structure of the measures. Reliability and invariance analyses were conducted for both measures and both samples.

Results: Factorial structure, reliability, and configural invariance across nationalities of both measures were confirmed.

Conclusion: These tools should prove useful for future research, supervision, theoretical advances, and clinical application, allowing a deeper understanding of how clinicians' awareness of different elements of their CT experience impacts the outcome of therapy.