Psychotherapy Research最新文献

Objective: Suicidal ideation is a central clinical risk in psychotherapy. Patients' engagement with therapy between sessions, captured by intersession processes (ISP), may be particularly informative for understanding risk and resilience. This study examined associations between ISP and suicidal ideation, distinguishing between-person vulnerabilities from within-person crisis dynamics.

Method: We analyzed routine outpatient data (N = 73, 2,586 total sessions), including an eight-item short version of the Intersession Experiences Questionnaire (IEQ-S) and the PHQ-9 suicidal ideation item. Multilevel logistic mixed-effects models treated suicidal ideation as a binary outcome, disaggregated between- and within-person effects, and included linear, quadratic, and cubic terms.

Results: At the between-person level, more frequent problem-focused application of therapeutic insights was associated with a lower likelihood, whereas higher levels of negative emotional ISP were linked to a higher likelihood of reporting suicidal ideation, following nonlinear trajectories. At the within-person level, increases in positive emotional engagement and problem-focused application co-occurred with a lower likelihood, whereas increases in imagining therapeutic dialogue and negative emotions were related to a higher likelihood of reporting suicidal ideation.

Conclusion: ISP reflect the internalized therapeutic alliance and clinically meaningful cognitive-affective processes, signaling crisis escalation, but also pointing to mechanisms of change. ISP may be valuable monitoring targets.

Objective: Enhancing affective regulation is a key focus in psychotherapy for depression, yet within-session markers that capture the dynamics of regulation remain limited. Respiratory Sinus Arrhythmia (RSA), a biomarker of vagal mediation of the parasympathetic nervous system, is well-known for its role in affective regulation. This nonrandomized observational psychotherapy process study examined (1) whether resting RSA can serve as a biomarker for depression severity, and (2) whether RSA reactivity and its interaction with resting RSA can serve as a within-session therapeutic biomarker linked to session quality. Method: Twenty-eight clients with MDD underwent Supportive-Expressive short-term psychodynamic therapy. Resting RSA and RSA reactivity were measured during five pre-scheduled sessions throughout treatment. Session quality was assessed using the self-report Session Evaluation Scale questionnaire. The data were analyzed using multi-level modeling. Results: Higher resting RSA was associated with lower pre-session depression and was only significant at the within-client level. The interaction between resting RSA and RSA reactivity was linked to session quality, with higher resting RSA predicting a positive association between RSA reactivity and session evaluation. Conclusion: The findings underscore the value of physiological measures such as RSA as a biomarker for assessing depression severity that can capture affective regulation dynamics during therapy sessions.

Objective: This study examined (a) the effectiveness of emotional cultivation counseling groups (i.e., BEAR groups) for Taiwanese youth with emotion regulation difficulties and (b) whether group composition (i.e., heterogeneity of friendship approach and avoidance goals) is associated with intervention outcomes.

Method: Conducted in real-world school settings, 232 students referred by teachers or counselors were randomized to either 20 BEAR groups or a waitlist control condition. BEAR groups, delivered in a semi-structured group format, integrated Eastern and Western perspectives on emotional cultivation and regulation to support relational development. Latent variables representing Relational Problem-Solving and Closeness to Others were assessed at pretest and at a three-month follow-up. Intervention effects were analyzed using the complex survey module in Mplus 8 (Muthén & Muthén, 2017), accounting for partial nesting.

Results: Compared to controls, BEAR participants showed significantly greater improvements in Relational Problem-Solving but not in Closeness to Others. Moreover, among BEAR participants, greater heterogeneity in pretest Friendship-Approach goals was associated with greater change in Relational Problem-Solving.

Conclusion: These findings suggest that BEAR groups may represent a promising, culturally grounded intervention for addressing emotional difficulties among Taiwanese youth, and that groups heterogeneous in friendship approach goals may enhance relational outcomes.

Objective: Compassion-Focused Therapy (CFT) is an emerging treatment approach that aims at cultivating compassion toward oneself and others. Self-compassion is associated with greater emotional resilience and reduced anxiety, depression, and stress. While CFT has shown promising results for young people, further research is needed. This study explores young people's (aged 15-21 years) experiences of participating in a group-based CFT program online.

Methods: Semi-structured group interviews were conducted post-treatment. Twelve group interviews, comprising 34 participants in total (85% female), were analyzed using reflexive thematic analysis.

Results: Two overarching themes were developed through the analysis. The first theme captured participants' experiences of having increased their ability to handle difficult emotions and to engage with compassion within the CFT program. The second theme illustrated the power of feeling connected in a group.

Conclusion: This analysis suggests that compassion-focused group therapy can be a valuable treatment for young people.

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.