Showing papers in "Psychotherapy Research in 2019"
TL;DR: The currently available component studies do not have the statistical power nor the quality to draw any meaningful conclusion about key ingredients of psychotherapies for adult depression.
Abstract: Objectives: A recent report from the US Institute of Medicine indicated that identifying core elements of psychosocial interventions is a key step in successfully bringing evidence-based psychosoci...
88 citations
TL;DR: Substantial evidence exists to recommend group therapy (particularly exposure-based group CBT) for those who might not be able to access alternative treatments, and the evidence base of recommendations for group therapy in current international treatment guidelines needs to be updated.
Abstract: Objective: The present meta-analysis evaluates the efficacy of group psychotherapy for post-traumatic stress disorder (PTSD) in adults directly compared to no treatment or active treatments examine...
78 citations
TL;DR: Qualitative developments made it possible to combine these two questions so as to better capture the richness and complexity of therapeutic work, and the paper reviews the progress from a single snapshot of a process variable to approaching causality.
Abstract: Significant progress has been achieved in the last decades in studying two central questions in psychotherapy research: what treatment works for which patient and why does treatment work. This paper delineates central developments in the methods used to study each of these questions. Through targeted examples, the paper discusses several phenomena and trends in psychotherapy research. Regarding the question of what works for whom, the discussion focuses on the progress from the search for one moderator to guide clinical decision-making to the search for a set of such moderators and their interactive effects, to best answer this question. To answer the question why treatment is effective, the paper reviews the progress from a single snapshot of a process variable to approaching causality, that is, temporal relationships, higher dependability, and closer attention to the dynamics of change in process variables. Finally, methodological developments made it possible to combine these two questions so as to better capture the richness and complexity of therapeutic work. Two central products of this integration are discussed and demonstrated through the case of the working alliance.
59 citations
TL;DR: Evidence is provided that the 3RS is a reliable and useful tool for examining psychotherapy process and predicting dropout, and can be used to identify problems in the therapeutic relationship that are associated with premature dropout from therapy.
Abstract: Objective: Our aim was to examine the reliability and validity of the Rupture Resolution Rating System (3RS), an observer-based measure of alliance ruptures and resolution processes. Method: We use...
55 citations
TL;DR: A critical review of research on a possible risk factor and potential change process in psychotherapy, including related training strategies, that has important implications for treatment outcome and professional development is provided.
Abstract: Objective: The study of alliance rupture has become quite prevalent since 1990 and especially in the past 10 years where we have seen a noticeable surge in empirical publications on the subject. Th...
52 citations
TL;DR: Preliminary pilot data support the feasibility of implementing transdiagnostic common elements therapy in residential ED treatment, and suggest that implementation may benefit trans Diagnostic outcomes for patients.
Abstract: Objective: Data are lacking from empirically supported therapies implemented in residential programs for eating disorders (EDs). Common elements treatments may be well-suited to address the complex...
50 citations
TL;DR: This article provides useful and actionable knowledge about the patient perspective on ROM/CF, an important discussion on the current state of research in this area, and useful and concrete suggestions for further avenues of research.
Abstract: Routine outcome monitoring (ROM) and clinical feedback (CF) systems have become important tools for psychological therapies, but there are challenges for their successful implementation Objective: To overcome these challenges, a greater understanding is needed about how patients experience the use of ROM/CF Method: We conducted a systematic literature search of qualitative studies on patient experiences with the use of ROM/CF in mental health services Results: The findings from 16 studies were synthesized, resulting in four meta-themes: (1) Suspicion towards service providers, (2) Flexibility and support to capture complexity, (3) Empowering patients, and (4) Developing collaborative practice Conclusions: We discuss the implications of these meta-themes for further development and implementation of ROM/CF into clinical practice, acknowledging the limitations of our review and suggesting avenues for further researchClinical or methodological significance of this article: This article provides
47 citations
TL;DR: The findings show that, across several different problem areas, routine psychotherapy provided substantial benefit, particularly to clients in the most distress, however, there is room to improve, especially by increasing the number of clients who return to normal functioning by the end of treatment.
Abstract: Objective: Though many studies have shown that psychotherapy can be effective, psychotherapy available in routine practice may not be adequate. Several methods have been proposed to evaluate routin...
38 citations
TL;DR: The findings of this study indicate the importance of providing patients with a supportive service structure that offers clear information, choice, involvement in decision-making, explicit contracting and clarity about sessions and progress.
Abstract: BACKGROUND: It is estimated that between 3% and 15% of patients have a negative experience of psychotherapy, but little is understood about this. AIMS: The aim of this study was to investigate the factors associated with patients' negative therapy experiences. METHOD: The data comprised 185 patient and 304 therapist questionnaires, 20 patient and 20 therapist interviews. Patients reported on an unhelpful or harmful experience of therapy, and therapists on a therapy where they thought the patient they were working with had a poor or harmful experience. These were transcribed and analysed using thematic analysis. RESULTS: There was a Lack of fit between Patient needs, Therapist skills, and Service structures. This could result in Fault Lines, a tension between Safety and containment and Power and control. This tension led to Strain and Poor Engagement, which led to Consequences following the negative therapy experience. CONCLUSIONS: Patients require clear information, choice, involvement in decision-making, explicit contracting and clarity about sessions and progress. Opportunities for patient feedback should be the norm, where the therapist and service are vigilant for signs of deterioration and solutions considered. Clinical and methodological significance of this article: Estimates of "unwanted effects," including long-lasting effects, of psychotherapy have ranged from 3% to 15%. Few empirical studies have been conducted in this area. This study aimed to address this gap and provide clinicians with a model of risk factors for negative therapy effects. The findings of this study indicate the importance of providing patients with a supportive service structure that offers clear information, choice and involvement in decision-making. Explicit contracting at the beginning of therapy and clarity about sessions and progress are also important in managing patient expectations throughout. Opportunities for patient feedback should be provided.
33 citations
TL;DR: The paper illustrates how coping capacities influence the process of psychotherapy and outcome in personality disorders and demonstrates the relevance of individualizing treatments for personality disorders.
Abstract: Objective: The present paper elaborates a process perspective of change in psychotherapy for personality disorders (PDs) Firstly, the paper reviews the literature of mechanisms of change in treatments of PD, with the main focus on emotional processing and socio-cognitive processing Secondly, it proposes an illustrative case-series analysis of eight cases, drawn from a mediation analysis conducted within the context of a randomized controlled trial for borderline personality disorder (BPD) Method: As such, cases with good and poor outcomes are compared, as are cases with poor and good intake features and cases with poor and good process markers across treatment Results: The results illustrate possible pathways to healthy change over the course of four months of treatment, and possible pathways of the absence of change Conclusions: These results are discussed with regard to three main research perspectives: the combination of qualitative and quantitative methodology in psychotherapy research ma
30 citations
TL;DR: Support is shown for the association between adherence to mentalization and growth of affect regulation and symbolic play in psychodynamic therapy.
Abstract: Objective: Children with behavioral problems often have problems with symbolic play organization, specifically with the regulation of negative affect and its representation. One of the aims of psychodynamic therapy with these children is enhancing their symbolic and mentalizing capacities in play. This study investigated the associations between promoting mentalization, and the growth of symbolic play and affect regulation. Method: The sample included 48 children with behavioral problems, who underwent long-term psychodynamic treatment informed with mentalization principles, with good outcome. Three hundred twenty-nine sessions were coded for children's symbolic play and affect regulation strategies, and each treatment was rated for adherence to mentalizing principles. Results: Hierarchical linear modeling showed quadratic growth of variables, wherein symbolic play initially increased followed by a deceleration in change, whereas affect regulation initially decreased followed by an increase. Adherence to mentalizing principles was associated with both symbolic play and affect regulation. A two-way interaction between time in treatment and adherence to mentalization showed that in high adherent treatments, affect regulation increased towards the end of treatment, whereas in low adherent treatments, there was no change. Conclusion: Results show support for the association between adherence to mentalization and growth of affect regulation and symbolic play in psychodynamic therapy.
TL;DR: Generally, the results indicate that any bona fide psychotherapy will be equally effective, with the exception of bona fide CBT resulting in greater reductions in ED psychopathology assessed by the ED Examination, which primarily assesses maintenance factors according to the CBT model.
Abstract: Objective: We conducted a meta-analysis of randomized controlled trials (RCTs) of bona fide psychotherapy for adults with eating disorders (EDs). Method: Thirty-five RCTs with 54 direct comparisons were included. The majority of RCTs included participants with bulimia nervosa and/or binge-ED, while only two RCTs included participants with anorexia nervosa, and three RCTs included participants with an ED not otherwise specified. Results: There was a clear advantage of bona fide psychotherapy over wait-list controls. Bona fide psychotherapy was superior to non-bona fide treatment; however, the majority of results were not stable. There were no significant differences between bona fide cognitive-behavioral therapy (CBT) and bona fide non-CBT, with the exception of bona fide CBT resulting in greater reductions in ED psychopathology assessed by the ED Examination, which primarily assesses maintenance factors according to the CBT model. Conclusions: Generally, the results indicate that any bona fide psychotherapy will be equally effective. While the number of trials remains modest, we hope that as more research becomes available, treatment guidelines can be updated, and more evidence-based treatment options will be available for treating EDs.
TL;DR: Benefits and disadvantages of bCBT should be taken into account in the further implementation of this new treatment format, which seems to balance missing aspects of stand-alone internet-based and face-to-face treatment for depression.
Abstract: Background: Blended cognitive behavioural therapy (bCBT), which combines face-to-face (FtF), and internet-based cognitive behavioural therapy (iCBT), may be a particularly promising approach, but little is known about the effectiveness and patients' subjective evaluations of the bCBT format. The aim of this qualitative study is to explore perceived advantages and disadvantages of bCBT from the patients' perspective in specialized mental health care. Methods: Semi-structured interviews were conducted with 15 patients suffering from major depression who underwent treatment in a bCBT format. The interview data were processed by means of a qualitative content analysis. Results: The content analysis generated 18 advantages and 15 disadvantages which were grouped into 6 main topics. In general, bCBT was perceived as purposive and effective for treating depression. The patients perceived the combined treatment as complementary and emphasized the advantage of the constant availability of the online programme. Furthermore, a segment analysis revealed that patients reported different advantages and disadvantages of bCBT as a function of the severity of their depressive episode. Conclusion: The findings of the present study reveal advantages and disadvantages of bCBT, which should be taken into account in the further implementation of this new treatment format. Clinical or methodological significance of this article: Blended treatment seems to balance missing aspects of stand-alone internet-based and face-to-face treatment for depression. Patients suffering from major depression perceived the blended format as purposive and effective after 18 weeks. Patients with different levels of depression severity may perceive different advantages and disadvantages of blended treatment for depression.
TL;DR: The findings of this study provide support for the integration of the interpersonal theory of suicide and psychological flexibility model to improve the conceptualization of suicide risk among psychiatric inpatients.
Abstract: Objective: The interpersonal theory of suicide posits the simultaneous presence of thwarted belongingness and perceived burdensomeness (i.e., thwarted interpersonal needs) leads to active suicide i...
TL;DR: Results suggest that both treatments produced significant short- and long-term improvement in depression symptoms, but the integration of emotion-focused techniques within an exposure framework did not have added benefit.
Abstract: Background: Emotional processing (EP) is hypothesized to be a key mechanism of change in psychotherapy that may enhance its long-term efficacy. To study the effects of fostering EP in psychotherapy...
TL;DR: It is suggested that the PACS Exploring scale might be a practical method for assessing RF in psychotherapy research and a way for researchers and clinicians to track patients’ RF on an ongoing basis.
Abstract: Objective: In this paper, we test the reliability and validity of two novel ways of assessing mentalizing in the therapy context: the Reflective Functioning scale (RF) applied to code psychotherapy transcripts (In-session RF), and the Exploring scale of the Patient Attachment Coding System (PACS), which measures in-session autonomy and is linked with secure attachment in psychotherapy. Method: Before treatment, 160 patients in different types of psychotherapy and from three different countries were administered the Adult Attachment Interview (AAI), which was rated with the RF scale. One early psychotherapy session for each patient was independently rated with the In-session RF scale and with the PACS Exploring scale. Results: Both scales were found to be reliable and to have concurrent validity with the RF scale rated on the AAI, with the PACS Exploring scale found to be a better predictor of RF on the AAI. Conclusions: These results suggest that the PACS Exploring scale might be a practical method for assessing RF in psychotherapy research and a way for researchers and clinicians to track patients' RF on an ongoing basis. These results also provide information regarding the ways in which differences in RF manifest during psychotherapy sessions. Clinical or methodological significance of this article Researchers and clinicians can assess patients' mentalizing based on any single psychotherapy transcript, in many therapeutic modalities The Exploring scale of the Patient Attachment Coding System can yield a reliable measure of reflective functioning based on any single psychotherapy transcript, in many therapeutic modalities Client differences in mentalizing manifest in part independently of the therapist's contributions.
TL;DR: Patients’ progress is associated with therapists’ experiences of difficulties, yet, trait- and state-based difficulties lead to different results.
Abstract: Objective: This study examined psychotherapist trainees’ experiences of “professional self-doubt” (PSD) and “negative personal reaction” (NPR) during cognitive behavioral therapy (CBT) and their as...
TL;DR: Various depressed patients’ characteristics predict initial outcome expectation level and change, with significant between-therapists’ differences related to outcome expectation change.
Abstract: Objective: Although there is an established link between patients’ early positive outcome expectation for and their actual improvement from therapy, there is little research on patients’ change in ...
TL;DR: The revised CIS-R is a reliable rating system that is suitable for both empirical research and clinical assessment and is useful for recognizing rupture and resolution processes, both in clinical everyday practice and in psychotherapists' training.
Abstract: Objective: This study presents the revised version of the Collaborative Interactions Scale (CIS) [Colli, A., & Lingiardi, V. (2009). The Collaborative Interactions Scale: A new transcript-based method for the assessment of therapeutic alliance ruptures and resolutions in psychotherapy. Psychotherapy Research, 19(6), 718–734.], an observer-rated measure for the assessment of therapeutic-alliance ruptures and resolutions. Intensive use of the previous scale resulted in three criticisms: (i) excessive time required to perform evaluations, (ii) the low occurrence of some items, and (iii) the scale’s low capacity to capture some patient–therapist interactions in fine detail. In this study, we aimed to describe the scale revision process and evaluate interrater reliability and scale validity by comparing sessions of patients with and without personality disorders (PDs). Method: Three raters conducted a blind evaluation of a sample of 60 sessions (180 segments; 3607 narrative units) with 30 patients (15 ...
TL;DR: This study further supports the long-term clinical benefit of integrating MI into CBT when treating the highly prevalent and historically difficult-to-treat condition of GAD and points to the theory-specific mechanism of MI as accounting for the integrative treatment’s additive effect on worry reduction across a follow-up period.
Abstract: Objective: A trial of psychotherapy for generalized anxiety disorder (GAD) demonstrated that motivational interviewing (MI) integrated with cognitive-behavioral therapy (CBT) outperformed CBT alone on clients’ worry reduction across a 12-month follow-up. In the present study, we hypothesized and tested that less client resistance and greater client-perceived therapist empathy (specific foci of MI) would account for MI’s additive effect. Exploratory analyses assessed whether the common processes of homework completion and therapeutic alliance quality mediated the treatment effect. Method: Clients with GAD were randomized to 15 sessions of MI-CBT (n = 42) or CBT alone (n = 43). Worry was assessed throughout treatment and follow-up. Observers rated resistance at midtreatment, and clients reported on perceived therapist empathy, alliance, and homework completion throughout treatment. Mediation was tested with bootstrapping methods. Results: Expectedly, MI-CBT clients evidenced less resistance and perc...
TL;DR: Findings provide preliminary evidence to suggest that IPT may be an accepted and tolerated treatment option for patients with common mental health disorders and highlights the need for future trials to rigorously report detail pertaining to patient dropout.
Abstract: Objective: Dropout is one factor that might limit the effectiveness of interpersonal psychotherapy (IPT) Improved understanding of IPT dropout is an important research priority This meta-analysis
TL;DR: Evidence is provided to support a fast (5 hours or fewer) robust intervention for PTSD characterized by intrusive symptoms including current-month flashbacks, nightmares, and accompanied by sympathetic arousal in response to trauma narratives.
Abstract: Design: A randomized waitlist-controlled design (n = 74) examined the efficacy of Reconsolidation of Traumatic Memories (RTM) among male veterans with current-month flashbacks and nightmares. Volun...
TL;DR: A three-item version of the Brief Assessment of Family Functioning Scale (BAFFS), designed to be used when brevity is especially important, appears to serve as a good proxy for the GF-FAD when an ultra-brief family assessment measure is needed.
Abstract: The purpose of the present study is to compare results from the 12-item General Functioning Scale (GF-FAD) of the Family Assessment Device (FAD) to a three-item version, the Brief Assessment of Family Functioning Scale (BAFFS), designed to be used when brevity is especially important. We used principal components analysis of the GF-FAD, followed by multiple sample confirmatory factor analyses to test the robustness of the BAFFS in different samples. The BAFFS correlated highly with the GF-FAD, and demonstrated good concurrent validity with another measure of global marital functioning, the Dyadic Adjustment Scale-4 in a help-seeking sample. Like the 12-item version, the BAFFS moderately correlated with an objective, interview-based rating of family functioning, the McMaster Clinical Rating Scale. The BAFFS appears to serve as a good proxy for the GF-FAD when an ultra-brief family assessment measure is needed.Clinical or methodological significance of this article: This article introduces an ultra-...
TL;DR: The MULTI-30, developed and validated in this study, is a valid, reliable, and cost-effective brief measure which could be used to assess patients, therapists, and observers’ perceptions of use of interventions from eight major therapeutic approaches.
Abstract: Objective: To develop a brief version of the Multitheoretical List of Therapeutic Interventions (MULTI-60) in order to decrease completion time burden by approximately half, while maintaining conte...
TL;DR: Evidence of the contribution of emotional processes to the emergence, maintenance, and experience of medically unexplained symptoms (MUS) suggests that clinical approaches which target these processes could be beneficial and provide new insights around obstacles to engagement alongside potential solutions when addressing the psychological needs of clients with MUS.
Abstract: Objectives: Evidence of the contribution of emotional processes to the emergence, maintenance, and experience of medically unexplained symptoms (MUS) suggests that clinical approaches which target ...
TL;DR: It appears that therapist experience may matter for internalizing clients under certain circumstances, but this relationship is modest.
Abstract: Objective: This meta-analysis synthesized the literature regarding the effect of therapist experience on internalizing client outcomes to evaluate the utility of lay providers in delivering treatment and to inform therapist training. Method: The analysis included 22 studies, contributing 208 effect sizes. Study and client characteristics were coded to examine moderators. We conducted subgroup meta-analyses examining the relationship of therapist experience across a diverse set of internalizing client outcomes. Results: Results demonstrated a small, but significant relationship between therapist experience and internalizing client outcomes. There was no relationship between therapist experience and outcomes in clients with primary anxiety disorders. In samples of clients with primary depressive disorders and in samples of clients with mixed internalizing disorders, there was a significant relationship between experience and outcomes. The relationship between therapist experience and outcomes was stronger when clients were randomized to therapists, treatment was not manualized, and for measures of client satisfaction and "other" outcomes (e.g., dropout). Conclusions: It appears that therapist experience may matter for internalizing clients under certain circumstances, but this relationship is modest. Continuing methodological concerns in the literature are noted, as well as recommendations to address these concerns.
TL;DR: By focusing on improving the therapeutic alliance with high-conflict coparenting cases as well as clients with higher levels of distress, therapists may be able to increase client retention.
Abstract: Objective: The objective of this study was to test whether the therapeutic alliance mediated the relationship between previously identified predictors of premature termination and dropout during th...
TL;DR: The role and impact of adherence and competence on therapeutic outcomes remains unclear within individual CBT in a child population, comparable with the current adult literature, where findings also remain inconclusive.
Abstract: Objective: Whilst the evidence base for cognitive behavioural therapy (CBT) with children and young people is growing, the mechanisms through which these beneficial effects occur are still unclear....
TL;DR: Findings suggest that a specific interdependence exists among the therapeutic alliance, technical intervention, and metacognitive functioning among patients and therapists in the earliest phase of the therapeutic process.
Abstract: Objective: Several authors have identified a bidirectional link between patient metacognitive functioning and the therapeutic alliance. Specifically, metacognition might be enhanced by a positive a...
TL;DR: This qualitative, descriptive-interpretative study uses a theoretical framework drawn from emotion-focused therapy (EFT) as the basis of the interpretation of GAD clients’ presentation of their difficulties, which should contribute to clinical understanding of the presentation of the clients with GAD.
Abstract: Objective: The classification of generalized anxiety disorder (GAD) is influenced by the tradition of conceptualizing disorders in the context of their clinical presentation and subsequent professi...