Psychotherapy Research最新文献

Objective: Few reliable patient characteristics have emerged as significant predictors of outcomes for Social Anxiety Disorder (SAD). This study aimed to explore whether affect integration, metacognitions, and maladaptive schemas could serve as predictors of therapeutic outcomes for patients with SAD. Relationships between these psychological constructs and baseline SAD symptomatology were also examined.

Methods: Eighty-eight patients across three sites participated in Cognitive Behavioral Therapy (CBT) or Metacognitive Therapy (MCT) for SAD in inpatient or outpatient clinics. Measures of predictors and SAD symptomatology were repeatedly assessed. Statistical analyses included longitudinal, multilevel modeling.

Results: Difficulties with affect integration, metacognitions and early maladaptive schemas clearly related to higher levels of SAD symptoms at baseline but were not generally predictive of changes in SAD symptoms during therapy. However, examining sub-domains revealed that difficulties with the integration of jealousy and tenderness, and the maladaptive schema of defectiveness/shame, predicted poorer outcomes. In contrast, initial difficulties with the integration of sadness, a greater lack of cognitive confidence, and the maladaptive schema of dependence/incompetence were associated with greater symptom improvement.

Conclusion: Identifying issues of affect integration and core self-other beliefs prior to therapy may enhance patient selection and allow for a more individualized treatment.

Objective: Develop a Psychotherapy Change Motivation Scale (PCMS) with robust psychometric properties.

Method: A literature review, semi-structured interviews, and expert evaluation were used to draft the scale. The scale was administered to participants receiving psychological counseling or therapy at specialized hospital psychological intervention centers, university mental health education centers, and social psychological counseling agencies using convenience sampling. The initial sample (n = 178) was subjected to item analysis and exploratory factor analysis, and the formal sample (n = 180) was then subjected to confirmatory factor analysis and reliability and validity testing. Criterion validity was tested using the Outcome Questionnaire-45(OQ-45) and the revised Chinese version of the University of Rhode Island Change Assessment (URICA).

Results: The final scale comprised 19 items across four dimensions: Activation, Expected benefits, Agency, and Maintenance and Orientation. The Cronbach's α coefficients ranged from 0.608 to 0.897 for the total scale and subscales; split-half reliability was 0.796; cumulative explained variance was 58.363%, with good structural validity (X²/df = 1.69, RMSEA = 0.062, GFI = 0.875, CFI = 0.915, IFI = 0.917, TLI = 0.901). PCMS scores and its four factors were negatively correlated with OQ-45 (r = -0.234 to -0.375, p<0.01) and positively correlated with the Chinese URICA (r = 0.386-0.694, p<0.01).

Conclusion: The developed PCMS demonstrates good reliability and validity, meeting psychometric standards.

Objective: Early improvement predicts good outcome in psychotherapy for eating disorders. Prior studies have examined change in body mass index (BMI) or Eating Disorder Examination Questionnaire scores (EDE-Q) as indicators of early response, but not both simultaneously. Little research has examined early change among Anorexia Nervosa (AN) samples treated with eating disorder-focussed cognitive behavioural therapy (CBT-ED). We studied the process of early change in a fine-grained way to better understand whether early response predicts later response and post-treatment outcomes in CBT-ED for AN, and how the changes in EDE-Q and BMI are related.

Method: Adults (N = 193) diagnosed with AN were treated with outpatient CBT-ED. We used bivariate Latent Change Score models to examine change in BMI and EDE-Q and relations between them.

Results: Early change in BMI was independent of early change in EDE-Q. Larger changes in EDE-Q over the first five weeks of therapy followed smaller ones over the next five weeks, meanwhile smaller changes followed larger ones. Early change was predictive of post-treatment scores.

Conclusion: Early change in BMI and EDE-Q during CBT-ED appear to be unrelated and follow different trajectories. Therefore, individuals declared as early responders may differ depending on which variable is used for the decision.

Objective: The tendency to linguistically synchronize is an adaptive and prosocial process observed in verbal and written communication. Research in therapeutic contexts has primarily conceptualized reciprocal language style matching (rLSM; i.e., similarity of function words) as indicating the therapeutic relationship. However, in non-therapeutic contexts, rLSM has been conceptualized as facilitating relationship formation and maintenance. The aim of the present study was to examine if an indication model or facilitation model provided a better explanation for the association between rLSM and the therapeutic bond.

Methods: Online text-based crisis-counseling sessions (N = 350) with clients in suicidal crisis were coded for rLSM and therapeutic bond. To examine and compare the indication and facilitation models, we used random intercept cross-lagged panel models.

Results: The association between rLSM and therapeutic bond was better explained by the facilitation model (i.e., rLSM predicting bond) than the indication model (i.e., rLSM co-occurring with bond). However, a model that included (a) rLSM predicting therapeutic bond and (b) the cross-sectional association between therapeutic bond and rLSM was the best fit.

Conclusions: Our findings indicate that rLSM may play a role in establishing the therapeutic relationship and be reflective of the client-counselor relationship. Implications for counseling practice are discussed.

Objective: Psychotherapy does not work equally well for all clients. For research to support clinicians in helping more clients, we need to better understand the process of when therapy become particularly challenging. In this study, we investigated challenging change processes from the therapists' perspective when applying Emotion-Focused Therapy (EFT). Method: We interviewed 14 therapists trained in EFT about their experiences of difficulties with applying EFT to clients with varying severity of mental health difficulties. Interviews were analyzed using reflexive thematic analysis. Results: Five themes were constructed. Three describing what EFT therapist find challenging; (1) Challenges in the therapeutic relationship, (2) When feelings are too big, too small or difficult to experience, (3) Matching EFT with the client's challenges, and two describing therapist responses to the challenges: (4) Do I know EFT, and what would I have needed to know more? (5) What do I do when it becomes difficult? A total of 20 subthemes were identified. Conclusion: Reported experiences of applying EFT to a diverse population suggests a need for either model refinement or strengthening of the dissemination process to better enable EFT-therapists to help clients with more severe mental health difficulties.

Objective: Research on nonverbal synchrony (NVS) as a core element in the therapeutic relationship has substantially increased and suggests that NVS influences therapeutic alliance and outcomes.

Method: Studies on NVS regarding body movements, vocal pitch, peripheral physiological measures, and hormonal states were included. A random-effects multilevel meta-analysis was performed on 23 publications from 13 trials.

Results: There was no significant overall association between NVS and alliance/outcome (r = .03, p = .644). Across modalities, there was a marginally significant association between higher NVS and smaller interpersonal problems (r = .10, p = .084) and a nonsignificant effect for the association between NVS and alliance (r = .06, p = .316), symptomatic outcome (r = -.06, p = .320), and other outcomes (r = .07, p = .255). There was significant heterogeneity between studies (I² = 56.47). Moderator analyses revealed that vocal pitch synchrony was negatively associated with alliance/outcome (r = -.20, p = .011), while NVS of peripheral physiological parameters was positively correlated with alliance/outcome (r = .32, p = .006).

Conclusion: Findings suggest that specific modalities of NVS show specific associations with outcomes. More research is needed to investigate whether NVS across modalities reflects a unified underlying construct.

Objective: To observe ruptures through clients' and therapists' experiences of closeness and distance in therapy. Method: Sixty-six clients and their 29 therapists underwent RAP interviews that were rated with the Therapeutic-Distance-Scale- observer version (TDS-O) and completed the Post-Session-Questionnaire (PSQ) three times along therapy (early, mid and late therapy). Using a dyadic model, we associated client and therapist self-report of ruptures with TDS-O observer ratings. Results: Clients' report of ruptures positively associated with clients' observed scores that the therapist was too distant, while therapists' report of ruptures related to their observed scores that the client was too close. Clients report that the rupture addressed related to their higher observed autonomy, but therapists report that the rupture addressed related to less client's autonomy. Resolution related to lower observed distance and higher observed engagement of both partners. In dyads in which the therapist was rated as experiencing distance, there was a higher level of resolution than in dyads in which the client observed as experiencing distance and the therapist did not. Clinical examples demonstrate how ruptures were manifested and understood through the therapeutic-distance prism. Conclusions: Observing the therapeutic-distance potentially improves therapists' ability to identify, negotiate, and resolve ruptures.

Objective: There is a pervasive underrepresentation of researchers and clinicians from diverse backgrounds in psychology. This is the first study to focus on diversity gaps in Psychotherapy Research. We examine a gap in the representation of research from low-income countries and summarize barriers and solutions to increase diversity in the field.

Method: We examined trends in submission, acceptance, and rejection rates of all submissions (n = 7183) from 75 countries, representing eight geographical regions to Psychotherapy Research, between 28 April 2005 and 22 June 2023.

Results: Most submissions were from Europe and North America, with the fewest from Africa and Asia/Northeast Asia. High-income countries had significantly more submissions than low-income countries, with gaps increasing over time. North America and Europe had the highest acceptance rates and Africa and Asia/Southeast Asia had the lowest rates.

Conclusion: Psychotherapy Research is one of the most internationally representative journals in the field. Yet, we found underrepresentation of non-western countries. There is a need to increase the representation of research participants and researchers from non-western countries through direct initiatives and investments in research and researchers from underrepresented backgrounds.

Objective: Remote forms of psychotherapy became more common during the COVID-19 pandemic, increasing the importance of understanding how technological factors might affect remote treatment. Past research on other modes of communication suggests that perceptions can be influenced when the audiovisual quality of online communication is distorted. The aim of the current research was to examine the potential influence of visual or audio distortions during online therapy.

Method: 263 participants judged the interpersonal characteristics and skill of a psychotherapist after viewing segments of treatment sessions in either a video or audio-only format and where the presentation was either clear or distorted.

Results: Contrary to expectations, participants who viewed a poorer quality version of a therapy segment perceived the therapist to have more positive interpersonal characteristics than those who saw a segment of higher quality. There was no reliable difference in perception of the therapist's skill as a function of segment quality.

Conclusion: The findings from the study suggest that perceptions of a therapist are not adversely affected if the video or audio quality of a remote therapy session is less than ideal. Therefore, these technical aspects of online treatment may not need to be a top concern.