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Engelhardt CL, Meier M, Keller S, Laireiter AR. Positive psychotherapy and cognitive behavioral therapy in anxiety patients - A study protocol for a randomized control trial in an online group setting. PLoS One 2024; 19:e0299803. [PMID: 38625877 PMCID: PMC11020599 DOI: 10.1371/journal.pone.0299803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/16/2024] [Indexed: 04/18/2024] Open
Abstract
BACKGROUND Anxiety disorders are common and debilitating which is why treatment is so important. According to the guidelines, Cognitive Behavioral Therapy (CBT) has the highest level of effectiveness among psychotherapeutic treatments and is the recommended procedure. However, not everyone responds well or at all to CBT which makes a wider range of therapy options valuable. Positive Psychotherapy (PPT) comes to mind as an alternative with its strength-based approach focusing on enhancing well-being and life satisfaction. Additionally, it has not yet been extensively studied how the processes that occur during treatment sessions and between treatment sessions effect treatment outcome. Thus, to lessen the lack of evidence regarding the efficacy of PPT as an anxiety treatment the planned study examines and compares the effectiveness of CBT and PPT as well as the effect of intrasession and intersession processes of the two therapy approaches. METHOD The study is in the planning stage and consists of an efficacy and a process study. The efficacy study is a randomized controlled comparative study of patients with anxiety disorders (generalized anxiety disorder and/or panic disorder with or without agoraphobia) with two active treatment conditions (PPT and CBT) and a control group (CG; positive psychotherapy with minimal therapeutic supervision) in an online group setting. There are three measurement time points: before treatment begins (T0), at the end of the ten-week treatment (T1), and a follow-up after three months (T2). The aim of the study is to evaluate the efficacy of PPT and CBT in the treatment of anxiety disorders, and to compare the efficacy of online-based PPT with minimal therapeutic supervision and online-based PPT with intensive therapeutic supervision in the treatment of anxiety disorders. The process study will be used to evaluate both the intrasession processes and the intersession processes of the therapy in the two intervention groups. In addition, the process variables that predict the success of the therapy and the extent to which PPT and CBT differ in the therapy processes will be tested. The study is registered at the German Clinical Trial Register (№ DRKS00027521). DISCUSSION To our knowledge, this is the first randomized controlled comparative study to examine the effectiveness of CBT and PPT for anxiety disorders in an online group setting.
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Affiliation(s)
| | - Marina Meier
- Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Sabrina Keller
- Department of Psychology, Paris Lodron University of Salzburg, Salzburg, Austria
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Gablonski TC, Herrmann PL, Lüdemann J, Andreas S. Intersession experiences and internalized representations of psychotherapy: A scoping review. J Clin Psychol 2023. [PMID: 36916742 DOI: 10.1002/jclp.23502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/30/2022] [Accepted: 02/25/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Between-session processes outside the therapy room and beyond the direct interaction between a therapist and client can play an important role in the psychotherapeutic process and outcome. These processes are called intersession experiences and can be seen as internalized mental representations of therapy and/or therapists. Due to the COVID-19 pandemic, different digital forms of treatment have successfully been implemented and could be relevant even after the end of the COVID-19 pandemic. Therefore, patients' internalized mental representations may become highly relevant in the future. RATIONALE The aim of this study was to conceptually delineate the current state of research on internalized mental representations of therapy or therapists in the period between sessions and to provide an overview of the evidence. In addition, we aimed to identify research gaps to provide a baseline for further research. METHODS For this purpose, we conducted a scoping review to obtain a comprehensive overview of the evidence and to identify the relevant research gaps. We searched PsycArticles, Medline, PsycINFO, and PSYNDEX for publications on internalized mental representations. RESULTS The final sample comprised 30 publications published from 1989 to 2021. Based on the individual study results, it can be assumed that intersession experiences are of central importance for psychotherapeutic treatment. However, the scoping review showed that there was a large gap in knowledge in the research of intersession experiences. All previous research was barely comparable, and therefore, a generalized statement is not possible. CONCLUSION Future research should provide sufficient information about relevant aspects, such as the setting, therapists, and patients, as these factors are likely to have a significant impact on the outcome. Furthermore, better measurements for the assessment of these processes should be developed.
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Affiliation(s)
| | | | - Jonas Lüdemann
- Institute of Psychology, University of Klagenfurt, Klagenfurt, Austria
| | - Sylke Andreas
- Institute of Psychology, University of Klagenfurt, Klagenfurt, Austria
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Andreas S, Gablonski TC, Tschacher W, Gebhardt A, Rabung S, Schulz H, Kadur J. Long-term psychodynamic psychotherapy in a face-to-face versus videoconferencing setting: A single case study. J Clin Psychol 2023; 79:277-295. [PMID: 35819447 PMCID: PMC10084227 DOI: 10.1002/jclp.23411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 06/07/2022] [Accepted: 06/26/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Due to the coronavirus pandemic and crisis, psychotherapists around the world were forced to switch to video- or tele-based treatments overnight. To date, only a few studies on the effectiveness of video-based psychodynamic psychotherapy via the Internet exist. Therefore, the goal of the present study was to examine symptom improvement, therapeutic relationship, nonverbal synchrony processes, and intersession processes within a systematic single case design and compare face-to-face to video-based approaches in long-term psychodynamic-oriented psychotherapy. METHODS We examined 85 sessions of a client with major depression whose psychodynamic psychotherapy changed from a face-to-face setting to a video-based setting. Video recordings were analyzed using motion energy analysis, and nonverbal synchrony was computed using a surrogate synchrony approach. Time series analyses were performed to analyze changes in symptom severity, therapeutic relationship, and intersession processes. RESULTS The results showed that symptom severity improved descriptively, but not significantly, across the entire course of psychotherapy. There were significant differences, however, in the therapeutic relationship, intersession experiences, and synchronous behavior between the face-to-face and video-based settings. CONCLUSION The results indicate that the presented methodology is well situated to investigate the question whether psychodynamic psychotherapy in video-based setting works in the sameway as in a face-to-face setting.
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Affiliation(s)
- Sylke Andreas
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Thorsten-Christian Gablonski
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Wolfgang Tschacher
- University Hospital of Psychiatry and Psychotherapy, Experimental Psychology Division, University of Bern, Bern, Switzerland
| | - Albrecht Gebhardt
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Sven Rabung
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jennifer Kadur
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria
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Georg AK, Hauschild S, Schröder-Pfeifer P, Kasper LA, Taubner S. Improving working relationships with families in German early childhood interventions home visitors: a quasi-experimental training study. BMC Psychol 2022; 10:302. [PMID: 36510291 PMCID: PMC9745960 DOI: 10.1186/s40359-022-01009-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Home visitation services within German Early Childhood Interventions (ECI) for families with a child aged 0-3 are mainly provided by frontline pediatric nurses and family midwifes. Home visitors are often challenged by difficult interactions with families. Mentalizing, the ability to understand mental states of oneself and others, is a key skill for building effective working relationships, which in turn positively affect intervention outcomes. The aim of this study was to investigate if a mentalizing skills training offered to home visitors active in German ECI contributes to continued professional development. We investigated, whether the training positively affected the quality of the working relationships with families as well as home visitors' empathy, self-efficacy, and mentalizing. METHODS To test the effects of a single day mentalizing skills training on the working relationship in N = 73 ECI home visitors, we used a quasi-experimental design with repeated measures (T0, T1, T2, T3) across seven weeks in order to assess immediate change from baseline (T0) after the training (T2) and stability of changes at follow up (T3). A literature-based intervention was implemented before the training to estimate possible repeated measurement and expectational effects (T1). Primary outcome was the quality of the working relationship experienced by the home visitors. Secondary outcome criteria were empathy, work-related self-efficacy, self-reported and observer-rated mentalizing. RESULTS Significant positive change in the working relationship quality was observed at T2 and at T3. Results on the secondary outcomes were less consistent, with data indicating improvement in empathy and increase on some but not all components of mentalizing. CONCLUSIONS This study provides preliminary evidence that brief mentalizing skills trainings may be an effective method for continuous professional qualification in frontline ECI home visitors who afterwards, experience better working relationships with families. Thus, training participation may positively impact efficacy and implementation of home visitations in ECI.
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Affiliation(s)
- Anna K. Georg
- grid.5253.10000 0001 0328 4908Institute for Psychosocial Prevention, University Hospital Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany
| | - Sophie Hauschild
- grid.5253.10000 0001 0328 4908Institute for Psychosocial Prevention, University Hospital Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Psychological Institute, University Heidelberg, Hauptstraße 47-51, 69117 Heidelberg, Germany
| | - Paul Schröder-Pfeifer
- grid.5253.10000 0001 0328 4908Institute for Psychosocial Prevention, University Hospital Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany
| | - Lea A. Kasper
- grid.5253.10000 0001 0328 4908Institute for Psychosocial Prevention, University Hospital Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Psychological Institute, University Heidelberg, Hauptstraße 47-51, 69117 Heidelberg, Germany
| | - Svenja Taubner
- grid.5253.10000 0001 0328 4908Institute for Psychosocial Prevention, University Hospital Heidelberg, Bergheimer Str. 54, 69115 Heidelberg, Germany
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Gablonski TC, Senft B, Andreas S. Level of Structural Integration and Its Association with Intersession Experiences and Outcomes: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159254. [PMID: 35954610 PMCID: PMC9367804 DOI: 10.3390/ijerph19159254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 02/04/2023]
Abstract
The level of structural integration (LSI), a psychodynamic/psychoanalytic concept originally developed by the Operationalized Psychodynamic Diagnosis (OPD), provides a promising empirical approach that is recognized beyond the boundaries of psychoanalysis and is highly relevant for therapy and research. The aim of our study was to investigate the intersession experiences of patients in psychotherapy with different levels of structural integration. The sample consisted of 69 inpatients who were undergoing psychotherapeutic treatment. The patients were asked to complete the German version of the Intersession Experience Questionnaire (IEQ), the short version of the OPD Structure Questionnaire (OPD-SQS) and the Brief-Symptom Inventory (BSI). LSI is associated with the situations, contents and negative emotions in the intersession experiences of patients, as well as their symptom distress over the course of therapy. Furthermore, the level of structural integration is a significant predictor of outcomes. Patients with different LSI had different intersession experiences.
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Affiliation(s)
| | - Birgit Senft
- Reha-Klinik für Seelische Gesundheit Klagenfurt, 9020 Klagenfurt am Wörthersee, Austria;
| | - Sylke Andreas
- Institute for Psychology, University of Klagenfurt, 9020 Klagenfurt am Wörthersee, Austria;
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Beatty C, Malik T, Meheli S, Sinha C. Evaluating the Therapeutic Alliance With a Free-Text CBT Conversational Agent (Wysa): A Mixed-Methods Study. Front Digit Health 2022; 4:847991. [PMID: 35480848 PMCID: PMC9035685 DOI: 10.3389/fdgth.2022.847991] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
The present study aims to examine whether users perceive a therapeutic alliance with an AI conversational agent (Wysa) and observe changes in the t‘herapeutic alliance over a brief time period. A sample of users who screened positively on the PHQ-4 for anxiety or depression symptoms (N = 1,205) of the digital mental health application (app) Wysa were administered the WAI-SR within 5 days of installing the app and gave a second assessment on the same measure after 3 days (N = 226). The anonymised transcripts of user's conversations with Wysa were also examined through content analysis for unprompted elements of bonding between the user and Wysa (N = 950). Within 5 days of initial app use, the mean WAI-SR score was 3.64 (SD 0.81) and the mean bond subscale score was 3.98 (SD 0.94). Three days later, the mean WAI-SR score increased to 3.75 (SD 0.80) and the mean bond subscale score increased to 4.05 (SD 0.91). There was no significant difference in the alliance scores between Assessment 1 and Assessment 2.These mean bond subscale scores were found to be comparable to the scores obtained in recent literature on traditional, outpatient-individual CBT, internet CBT and group CBT. Content analysis of the transcripts of user conversations with the CA (Wysa) also revealed elements of bonding such as gratitude, self-disclosed impact, and personification. The user's therapeutic alliance scores improved over time and were comparable to ratings from previous studies on alliance in human-delivered face-to-face psychotherapy with clinical populations. This study provides critical support for the utilization of digital mental health services, based on the evidence of the establishment of an alliance.
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Affiliation(s)
- Clare Beatty
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | | | - Saha Meheli
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Chaitali Sinha
- Wysa Inc., Boston, MA, United States
- *Correspondence: Chaitali Sinha
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Galasiński D, Ziółkowska J, Witkowicz M. Experience of the Absence of the Journey to Sessions in Clients' Narratives About Online Psychotherapy. Front Psychol 2022; 13:798960. [PMID: 35250734 PMCID: PMC8888532 DOI: 10.3389/fpsyg.2022.798960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022] Open
Abstract
Background Remotely provided psychotherapy due to the COVID-19 pandemic became common. One of the most significant changes related to providing online psychotherapy services is that clients no longer travel to their sessions. Aims In the article we are interested in the narrated experience of the absence of journey to psychotherapy sessions. We study clients' stories of past journeys and how their absence, resulting from the change of the mode of therapy provision, is coped with and replaced by other activities in their narratives. Methods The study takes a constructionist approach to discourse and focuses on the lexico-grammatical form of the notes. The data come from 12 semi-structured interviews with people who declared attending remote psychotherapy sessions after the national lockdown had been introduced. Results In the collected data, the physical journey is constructed not only as travel time, solitude which can be used for reflection, but, importantly, as an active process which ends with a resolution. In contrast, in narratives of the time before an online session, constructions of unfettered agents are replaced with those of people whose actions are hedged and qualified. Conclusion We argue that in the informants' narratives the journey to psychotherapy is meaningful and is part of the therapeutic process. We propose that it is a time of passing between two states—one before therapy and one in session. The journey therefore is experienced as a process of change, and not only a process of traveling.
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Affiliation(s)
- Dariusz Galasiński
- Centre for Interdisciplinary Research into Health and Illness, University of Wroclaw, Wrocław, Poland
| | - Justyna Ziółkowska
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Wrocław, Poland
| | - Magdalena Witkowicz
- Centre for Interdisciplinary Research into Health and Illness, University of Wroclaw, Wrocław, Poland
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Kivity Y, Strauss AY, Elizur J, Weiss M, Cohen L, Huppert JD. Patterns of alliance development in cognitive behavioral therapy versus attention bias modification for social anxiety disorder: Sawtooth patterns and sudden gains. J Clin Psychol 2021; 78:122-136. [PMID: 34297850 DOI: 10.1002/jclp.23219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/17/2021] [Accepted: 06/30/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES We examined patterns in alliance development in cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) compared to attention bias modification (ABM). We focused on the occurrence of sawtooth patterns (increases within- and decreases between-sessions) and sudden gains and their association with outcome. METHODS Clients received CBT (n = 33) or ABM (n = 17). Client-rated alliance was measured before and after each session. Self-reported and clinician-rated anxiety were measured weekly and monthly, respectively. RESULTS The alliance increased in CBT in a sawtooth pattern and did not change in ABM. When examining individual clients, sawtooths were more common in CBT (61% clients) than in ABM (6%) and predicted worse outcome in CBT. Sudden gains were equally frequent (CBT, 18%; ABM, 18%) and did not predict outcome. CONCLUSION The alliance in CBT is dynamic and important for outcome. Sawtooths are common in CBT and may mark worse outcome.
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Affiliation(s)
- Yogev Kivity
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Asher Y Strauss
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jonathan Elizur
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michal Weiss
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lior Cohen
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
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Richards P, Simpson S, Bastiampillai T, Pietrabissa G, Castelnuovo G. The impact of technology on therapeutic alliance and engagement in psychotherapy: The therapist's perspective. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12102] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Penelope Richards
- Psychology Clinic, School of Psychology, Social Work & Social Policy, University of South Australia, Adelaide, South Australia, Australia,
| | - Susan Simpson
- Psychology Clinic, School of Psychology, Social Work & Social Policy, University of South Australia, Adelaide, South Australia, Australia,
| | - Tarun Bastiampillai
- Department of Psychiatry, University of Adelaide School of Medical Sciences, Adelaide, South Australia, Australia,
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy,
- Ospedale San Giuseppe, Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Verbania, Italy,
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, Milan, Italy,
- Ospedale San Giuseppe, Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Verbania, Italy,
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Kivity Y, Strauss AY, Elizur J, Weiss M, Cohen L, Huppert JD. The alliance mediates outcome in cognitive-behavioral therapy for social anxiety disorder, but not in attention bias modification. Psychother Res 2020; 31:589-603. [PMID: 33112720 DOI: 10.1080/10503307.2020.1836423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: The aim of the current study was to examine changes in the therapeutic alliance and its role as a mediator of treatment outcome in cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) compared to attention bias modification (ABM). Method: Patients were randomized to 16-20 sessions of CBT (n = 33) or 8 sessions of ABM (n = 17). Patient-rated alliance and self-reported social anxiety were measured weekly and evaluator-rated social anxiety was measured monthly. Results: Early alliance predicted greater subsequent anxiety reduction in CBT but not in ABM. The alliance increased and weekly improvements in alliance predicted weekly contemporaneous and subsequent decreases in anxiety only in CBT. Decreases in anxiety did not predict subsequent improvements in alliance. Both treatments were effective in reducing anxiety, but treatment effects were mediated by stronger early alliance and stronger cross-lagged effects of alliance on outcome in CBT compared to ABM. Conclusions: The results highlight the importance of the alliance in CBT for SAD. Further studies should examine the role of alliance alongside additional mediators to better understand differential mechanisms in CBT and ABM.
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Affiliation(s)
| | - Asher Y Strauss
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | - Jonathan Elizur
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | - Michal Weiss
- Department of Psychology, The Hebrew University of Jerusalem, Israel
| | - Lior Cohen
- Department of Psychology, The Hebrew University of Jerusalem, Israel
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Intersession-Online: A Smartphone Application for Systematic Recording and Controlling of Intersession Experiences in Psychotherapy. J 2019. [DOI: 10.3390/j2040031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mobile health technologies have become more and more important in psychotherapy research and practice. The market is being flooded by several psychotherapeutic online services for different purposes. However, mobile health technologies are particularly suitable for data collection and monitoring, as data can be recorded economically in real time. Currently, there is no appropriate method to assess intersession experiences systematically in psychotherapeutic practice. The aim of our project was the development of a smartphone application framework for systematic recording and controlling of intersession experiences. Intersession-Online, an iOS- and Android-App, offers the possibility to collect data on intersession experiences easily, to provide the results to therapists in an evaluated form and, if necessary, to induce or interrupt intersession experiences with the primary aim to improve outcome of psychotherapy. In general, the smartphone application could be a helpful, evidence-based tool for research and practice. Overall speaking, further research to investigate the efficacy of Intersession-Online is necessary.
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Kaiser T, Laireiter AR. Process-symptom-bridges in psychotherapy: An idiographic network approach. J Pers Oriented Res 2018; 4:49-62. [PMID: 33569133 PMCID: PMC7842641 DOI: 10.17505/jpor.2018.06] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
AIM real-time monitoring of psychotherapeutic processes was recently described as a promising, new way of tracking periods of change in ongoing treatments. This approach generates complex, multivariate datasets that have to be presented in an intuitive way for clinicians to aid their clinical decision-making. Using network modeling and new approaches in centrality analyses, we examine "bridge nodes" between symptom stress and aspects of the psychotherapeutic process between therapy session (intersession processes, ISP). Method:we recorded intersession processes as well as depressive and anxiety symptoms using daily questionnaires in ten cases. Regularized, thresholded intraindividual dynamic networks were estimated. We applied bridge centrality analysis to identify individual bridges between psychotherapeutic processes and symptoms in the resulting models. Case-wise interpretations of bridge centrality values are offered. RESULTS bridge centrality analysis revealed individual bridge nodes between intersession processes and symptom severity. Strength and direction of bridges varied substantially across individuals. CONCLUSION given current methodological challenges, idiographic network studies are feasible and offer important insights for psychotherapy process research. In this case, we demonstrated how patients deal with periods of increased symptom stress. In this case we have described how patients deal with their therapy under increased symptom load. Bridges between psychotherapeutic processes and symptom stress are a promising target for monitoring systems based on ISP. Future studies should examine the clinical utility of network-based monitoring and feedback in ongoing therapies. In the near future, process feedback systems based on idiographic models could serve clinicians to improve treatments.
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Affiliation(s)
- Tim Kaiser
- University of Salzburg, Psychotherapy Research Group, Hellbrunnerstrasse 34, 5020 Salzburg, Austria
| | - Anton-Rupert Laireiter
- University of Salzburg, Psychotherapy Research Group, Hellbrunnerstrasse 34, 5020 Salzburg, Austria
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Kaiser T, Laireiter AR. Daily dynamic assessment and modelling of intersession processes in ambulatory psychotherapy: A proof of concept study. Psychother Res 2018; 29:1062-1073. [PMID: 30012060 DOI: 10.1080/10503307.2018.1497213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: the typical mode of assessment in studies on intersession processes (ISP) in psychotherapy is using cross-sectional or weekly measurements. Daily dynamics of intersession processes have not yet been studied. Method: intersession process data from 22 ambulatory psychotherapy cases were collected in a naturalistic study with high temporal resolution, resulting in a total of 1026 daily measurements. Multilevel vector autoregressive (VAR) modelling was applied to discover the temporal course and causal influences among intersession processes. Centrality analysis was applied to discover unique functions of various intersession process variables. Results: a group-level network structure was discovered, offering first insights on the role of different intersession processes during psychotherapy. Centrality analysis revealed unique roles for various aspects of the intersession process. Temporal distance from the last session had only weak influence on the ISP. Conclusions: using short, daily measures, the unique role of various aspects of the ISP were uncovered. Some aspects of the ISP, like recalling session contents or reflection on future session contents, are facilitators of overall ISP intensity. Other aspects like thoughts on payment or appointments or negative treatment-related emotions are likely to suppress ISP.
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Affiliation(s)
- Tim Kaiser
- Department of Psychology, University of Salzburg , Salzburg , Austria
| | - Anton-Rupert Laireiter
- Department of Psychology, University of Salzburg , Salzburg , Austria.,Department of Psychology, University of Vienna , Vienna , Austria
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Kaiser T, Laireiter AR. DynAMo: A Modular Platform for Monitoring Process, Outcome, and Algorithm-Based Treatment Planning in Psychotherapy. JMIR Med Inform 2017; 5:e20. [PMID: 28729233 PMCID: PMC5544897 DOI: 10.2196/medinform.6808] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/24/2017] [Accepted: 04/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In recent years, the assessment of mental disorders has become more and more personalized. Modern advancements such as Internet-enabled mobile phones and increased computing capacity make it possible to tap sources of information that have long been unavailable to mental health practitioners. OBJECTIVE Software packages that combine algorithm-based treatment planning, process monitoring, and outcome monitoring are scarce. The objective of this study was to assess whether the DynAMo Web application can fill this gap by providing a software solution that can be used by both researchers to conduct state-of-the-art psychotherapy process research and clinicians to plan treatments and monitor psychotherapeutic processes. METHODS In this paper, we report on the current state of a Web application that can be used for assessing the temporal structure of mental disorders using information on their temporal and synchronous associations. A treatment planning algorithm automatically interprets the data and delivers priority scores of symptoms to practitioners. The application is also capable of monitoring psychotherapeutic processes during therapy and of monitoring treatment outcomes. This application was developed using the R programming language (R Core Team, Vienna) and the Shiny Web application framework (RStudio, Inc, Boston). It is made entirely from open-source software packages and thus is easily extensible. RESULTS The capabilities of the proposed application are demonstrated. Case illustrations are provided to exemplify its usefulness in clinical practice. CONCLUSIONS With the broad availability of Internet-enabled mobile phones and similar devices, collecting data on psychopathology and psychotherapeutic processes has become easier than ever. The proposed application is a valuable tool for capturing, processing, and visualizing these data. The combination of dynamic assessment and process- and outcome monitoring has the potential to improve the efficacy and effectiveness of psychotherapy.
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Affiliation(s)
- Tim Kaiser
- Psychotherapy Research Group, Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Anton Rupert Laireiter
- Psychotherapy Research Group, Department of Psychology, University of Salzburg, Salzburg, Austria
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15
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Bimont D, Werbart A. “I’ve got you under my skin”: Relational therapists’ experiences of patients who occupy their inner world. COUNSELLING PSYCHOLOGY QUARTERLY 2017. [DOI: 10.1080/09515070.2017.1300135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Diane Bimont
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Andrzej Werbart
- Department of Psychology, Stockholm University, Stockholm, Sweden
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16
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Zeeck A, Hartmann A, Wild B, De Zwaan M, Herpertz S, Burgmer M, von Wietersheim J, Resmark G, Friederich HC, Tagay S, Dinkel A, Loewe B, Teufel M, Orlinsky D, Herzog W, Zipfel S. How do patients with anorexia nervosa "process" psychotherapy between sessions? A comparison of cognitive-behavioral and psychodynamic interventions. Psychother Res 2016; 28:873-886. [PMID: 27808005 DOI: 10.1080/10503307.2016.1252866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Patients' processing of psychotherapy between sessions ("inter-session process" (ISP)) has been repeatedly shown to be related to outcome. The aim of this study was to compare ISP characteristics of cognitive-behavioral vs. psychodynamic psychotherapy in the treatment of anorexia nervosa (AN) and their relation to outcome. METHODS Data of 106 patients participating in a randomized-controlled trial who received either 40 sessions of enhanced cognitive-behavioral therapy (CBT-E) or focal psychodynamic therapy (FPT) were analyzed. The ISP was measured with the Inter-session Experience Questionnaire (IEQ). Three outcome classes were distinguished: full recovery, partial recovery, and still fulfilling all AN criteria. RESULTS Patients receiving CBT-E reported more on "applying therapy" in the initial and the final treatment phase compared to FPT patients. In terms of process-outcome relations, higher levels of "recreating the therapeutic dialogue between sessions," "recreating the therapeutic dialogue with negative emotions" as well as "applying therapy with negative emotions" in the final phase of treatment predicted negative outcome in FPT, whereas overall higher levels of negative emotions predicted negative outcome in CBT-E. CONCLUSIONS In outpatient treatment in AN, the processing of therapy as measured by the IEQ showed surprisingly few differences between CBT-E and FPT. However, different ISP patterns were predictive of outcome, pointing to different mechanisms of change.
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Affiliation(s)
- A Zeeck
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Freiburg , Freiburg , Germany
| | - A Hartmann
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Freiburg , Freiburg , Germany
| | - B Wild
- b Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics , Heidelberg University Hospital , Heidelberg , Germany
| | - M De Zwaan
- c Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Hannover , Hannover , Germany
| | - S Herpertz
- d Department of Psychosomatic Medicine and Psychotherapy , LWL-University Medical Center of the Ruhr-University Bochum , Bochum , Germany
| | - M Burgmer
- e Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Münster , Münster , Germany
| | - J von Wietersheim
- f Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Ulm , Ulm , Germany
| | - G Resmark
- g Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Tübingen , Tübingen , Germany
| | - H-C Friederich
- h Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Düsseldorf , Düsseldorf , Germany
| | - S Tagay
- i Department of Psychosomatic Medicine and Psychotherapy , University Duisburg-Essen , Duisburg , Germany
| | - A Dinkel
- j Department of Psychosomatic Medicine and Psychotherapy , University of Technology München , München , Germany
| | - B Loewe
- k Institute and Outpatient Clinic for Psychosomatic Medicine and Psychotherapy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - M Teufel
- g Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Tübingen , Tübingen , Germany
| | - D Orlinsky
- l Department of Comparative Human Development , University of Chicago , Chicago , IL , USA
| | - W Herzog
- b Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics , Heidelberg University Hospital , Heidelberg , Germany
| | - S Zipfel
- g Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Tübingen , Tübingen , Germany
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- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Freiburg , Freiburg , Germany
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Irwin R, Pullen C. Brief psychosexual therapy: reflections on the provision of a time-limited therapy service in a sexual health clinic. SEXUAL AND RELATIONSHIP THERAPY 2016. [DOI: 10.1080/14681994.2016.1237772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Robert Irwin
- College of Liberal Arts, Bath Spa University, Bath, United Kingdom of Great Britain and Northern Ireland
| | - Caroline Pullen
- Bristol Sexual Health Centre, Central Health Clinic, Bristol, United Kingdom of Great Britain and Northern Ireland
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18
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Hartmann A, Zeeck A, Herzog W, Wild B, de Zwaan M, Herpertz S, Burgmer M, von Wietersheim J, Tagay S, Dinkel A, Löwe B, Resmark G, Orlinsky D, Zipfel S. The Intersession Process in Psychotherapy for Anorexia Nervosa: Characteristics and Relation to Outcome. J Clin Psychol 2016; 72:861-79. [DOI: 10.1002/jclp.22293] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 11/12/2015] [Accepted: 02/01/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Armin Hartmann
- Department of Psychosomatic Medicine and Psychotherapy; Medical Center, University Freiburg; Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy; Medical Center, University Freiburg; Germany
| | - Wolfgang Herzog
- Center for Psychosocial Medicine; Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital; Germany
| | - Beate Wild
- Center for Psychosocial Medicine; Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital; Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy; University Medical Center, Hannover; Germany
| | - Stephan Herpertz
- Clinic for Psychosomatic Medicine and Psychotherapy; LWL University Hospital of the Ruhr, University of Bochum; Germany
| | - Markus Burgmer
- Clinic for Psychosomatic Medicine and Psychotherapy; University Hospital Münster; Germany
| | - Joern von Wietersheim
- Department of Psychosomatic Medicine and Psychotherapy; University Hospital of Ulm; Germany
| | - Sefik Tagay
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR Hospital Essen; University of Duisburg-Essen; Germany
| | - Andreas Dinkel
- Clinic for Psychosomatic Medicine and Psychotherapy; University of Technology Munich; Germany
| | - Bernd Löwe
- Institute and Outpatient Clinic for Psychosomatic Medicine and Psychotherapy; University Hospital Hamburg-Eppendorf; Germany
| | - Gaby Resmark
- Department of Psychosomatic Medicine and Psychotherapy; University Hospital Tübingen; Germany
| | - David Orlinsky
- Department of Comparative Human Development; University of Chicago; IL USA
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy; University Hospital Tübingen; Germany
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Orlinsky DE, Rønnestad MH. Psychotherapists Growing Older: A Study of Senior Practitioners. J Clin Psychol 2015; 71:1128-38. [PMID: 26401632 DOI: 10.1002/jclp.22223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A sample of 1,102 psychotherapists aged 60 years and older was selected from the multinational database of the Society for Psychotherapy Research Collaborative Research Network. These older therapists were first described in terms of gender, generation, years in practice, civil status, professional background, and theoretical orientation. To compare them on practice-related characteristics with cohorts of younger therapists, the following age-based taxonomy was developed: young adult (21 < 30); prime adult (30 < 45); mature adult (45 < 60); senior adult (60 to 90). Senior adults were further differentiated into young old (60 to 66), mid old (67 to 74), and long old (75 to 90). Comparisons between therapist age groups were made regarding practice setting, quality of therapeutic involvement, current use of supervision and personal therapy, currently experienced professional growth, personal life quality, and perceived aspects of self in close personal relationships. Given a series of positive results favoring senior adults as a group, and even long old compared to young old, it is suggested that these hardy "surviving" therapists typically have succeeded in mastering the developmental tasks of previous phases of professional development.
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Gelo OCG, Manzo S. Quantitative Approaches to Treatment Process, Change Process, and Process-Outcome Research. Psychother Res 2015. [DOI: 10.1007/978-3-7091-1382-0_13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Schröder T, Orlinsky D, Rønnestad MH, Willutzki U. Psychotherapeutic Process from the Psychotherapist’s Perspective. Psychother Res 2015. [DOI: 10.1007/978-3-7091-1382-0_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Richards P, Simpson S. Beyond the therapeutic hour: an exploratory pilot study of using technology to enhance alliance and engagement within face-to-face psychotherapy. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2014. [DOI: 10.1080/03069885.2014.936824] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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23
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Hartmann A, Joos A, Orlinsky DE, Zeeck A. Accuracy of therapist perceptions of patients' alliance: Exploring the divergence. Psychother Res 2014; 25:408-19. [DOI: 10.1080/10503307.2014.927601] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Weiss M, Kivity Y, Huppert JD. How does the therapeutic alliance develop throughout cognitive behavioral therapy for panic disorder? Sawtooth patterns, sudden gains, and stabilization. Psychother Res 2013; 24:407-18. [DOI: 10.1080/10503307.2013.868947] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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25
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Zeeck A, Orlinsky DE, Hermann S, Joos A, Wirsching M, Weidmann W, Hartmann A. Stressful involvement in psychotherapeutic work: Therapist, client and process correlates. Psychother Res 2012; 22:543-55. [DOI: 10.1080/10503307.2012.683345] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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