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Fiorentino F, Lo Buglio G, Morelli M, Chirumbolo A, Di Giuseppe M, Lingiardi V, Tanzilli A. Defensive functioning in individuals with depressive disorders: A systematic review and meta-analysis. J Affect Disord 2024; 357:42-50. [PMID: 38663554 DOI: 10.1016/j.jad.2024.04.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/04/2024]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to address the limited generalizability of studies on defense mechanisms in depression by comparing depressive individuals with non-clinical controls (aim a) and examining changes throughout psychological interventions (aim b) (PROSPERO CRD42023442620). METHODS We followed PRISMA 2020 guidelines, searching PubMed/Web of Science/(EBSCO)PsycINFO until 13/04/2023 for studies evaluating defense mechanisms with measures based on the hierarchical model in depressive patients versus non-clinical controls or throughout psychological intervention. We conducted random-effect meta-analyses for mature defenses/non-mature (neurotic/immature) defenses/overall defensive functioning (ODF), with standardized mean difference (SMD) as outcome measure metric. Meta-regression/sub-group/sensitivity analyses were conducted. Study quality was appraised using the Newcastle-Ottawa Scale (NOS), and certainty of evidence for aim b outcomes was evaluated using GRADE (Grading of Recommendations, Assessment, Development and Evaluations). RESULTS 18 studies were included (mean NOS score = 5.56). Depressive patients used significantly more non-mature defenses than non-clinical controls (SMD = 0.74; k = 13). Non-clinical controls did not significantly differ in use of mature defenses compared to depressive patients (SMD = 0.33; k = 14). Significant moderators were publication year/NOS score/geographical distribution/mean age for non-mature defenses and NOS score/geographical distribution for mature defenses. Throughout psychological interventions, only ODF significantly increased (SMD = 0.55; k = 2) (GRADE = very low). LIMITATIONS Quality of many studies was medium/sub-optimal, and longitudinal studies were scarce. CONCLUSION Individuals with depressive disorders show a high use of non-mature defenses that could be assessed and targeted in psychological interventions, especially in younger patients.
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Affiliation(s)
- Flavia Fiorentino
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
| | - Gabriele Lo Buglio
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Mara Morelli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | | | | | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Annalisa Tanzilli
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
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Deisenhofer AK, Hehlmann MI, Rubel JA, Lutz W, Schwartz B, Bräscher AK, Christiansen H, Fehm L, Glombiewski JA, Heider J, Helbig-Lang S, Hermann A, Hoyer J, In-Albon T, Lincoln T, Margraf J, Risch AK, Schöttke H, Schulze L, Stark R, Teismann T, Velten J, Willutzki U, Wilz G, Witthöft M, Odyniec P. Love yourself as a therapist, doubt yourself as an institution? Therapist and institution effects on outcome, treatment length, and dropout. Psychother Res 2024:1-14. [PMID: 38831579 DOI: 10.1080/10503307.2024.2352749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Research suggests that some therapists achieve better outcomes than others. However, an overlooked area of study is how institution differences impact patient outcomes independent of therapist variance. This study aimed to examine the role of institution and therapist differences in adult outpatient psychotherapy. METHOD The study included 1428 patients who were treated by 196 therapists at 10 clinics. Two- and three-level hierarchical linear regression models were employed to investigate the effects of therapists and institutions on three dependent patient variables: (1) symptom change, (2) treatment duration, and (3) dropout. Level three explanatory variables were tested. RESULTS The results showed that therapist effects (TE) were significant for all three types of treatment outcome (7.8%-18.2%). When a third level (institution) was added to the model, the differences between therapists decreased, and significant institution effects (IE) were found: 6.3% for symptom change, 10.6% for treatment duration, and 6.5% for dropout. The exploratory analyses found no predictors able to explain the systematic variation at the institution level. DISCUSSION TE on psychotherapy outcomes remain a relevant factor but may have been overestimated in previous studies due to not properly distinguishing them from differences at the institution level.
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Affiliation(s)
| | - Miriam I Hehlmann
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Julian A Rubel
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Wolfgang Lutz
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany
| | - Brian Schwartz
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Trier, Trier, Germany
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, University of Mainz, Mainz, Germany
| | - Hanna Christiansen
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
- Child and Adolescent Psychotherapy Clinic (KJ-PAM), Marburg, Germany
- German Center for Mental Health (DZPG), Bochum-Marburg, Germany
| | - Lydia Fehm
- Center for Psychotherapy at the Insitute of Psychology (ZPHU), Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia A Glombiewski
- Clinical Psychology and Psychotherapy of Adulthood, University of Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Jens Heider
- Clinical Psychology and Psychotherapy of Adulthood, University of Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Sylvia Helbig-Lang
- Psychotherapy Training Program (PTA Hamburg) at Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Science, Universität Hamburg, Hamburg, Germany
| | - Andrea Hermann
- Psychotherapy and Systems Neuroscience, Department of Psychology, Justus Liebig University of Giessen, Giessen, Germany
| | - Jürgen Hoyer
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, University of Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Tania Lincoln
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Movement Science, Universität Hamburg, Hamburg, Germany
| | - Jürgen Margraf
- Child and Adolescent Psychotherapy Clinic (KJ-PAM), Marburg, Germany
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Anne Katrin Risch
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Henning Schöttke
- Institute of Psychology, Clinical Psychology and Psychotherapy, University of Osnabrück, Osnabrück, Germany
| | - Lars Schulze
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Rudolf Stark
- Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
| | - Tobias Teismann
- Mental Health Treatment and Research Center, Ruhr-University Bochum, Bochum, Germany
| | - Julia Velten
- Faculty of Psychology, Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
| | - Ulrike Willutzki
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Michael Witthöft
- Department of Clinical Child and Adolescent Psychology, Philipps University Marburg, Marburg, Germany
| | - Patrizia Odyniec
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
- Department of Psychology, University of Kassel, Kassel, Germany
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Schoenenberg K, Martin A. Empathy, working alliance, treatment expectancy and credibility in video and face-to-face psychotherapeutic first contact. Psychother Res 2024; 34:626-637. [PMID: 37436800 DOI: 10.1080/10503307.2023.2233685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/01/2023] [Indexed: 07/13/2023] Open
Abstract
Objective Video-based therapy has been used increasingly since the onset of the COVID-19 pandemic. Yet, video-based initial psychotherapeutic contact can be problematic due to the limitations of computer-mediated communication. At present, little is known about the effects of video first contact on important psychotherapeutic processes. Method: Forty-three individuals (nvideo = 18, nface-to-face = 25) were recruited via an outpatient clinic waiting list and were randomly assigned to video or face-to-face initial psychotherapeutic sessions. Participants rated treatment expectancy before and after the session, and the therapist's empathy, working alliance, and credibility after the session and several days later. Results: Empathy and working alliance ratings of patients and therapists were high and did not differ between the two communication conditions after the appointment or at follow-up. Treatment expectancy increased to a similar extent for the video and face-to-face modalities from pre to post. Willingness to continue with video-based therapy increased in participants who had video contact, but not in those with face-to-face contact. Conclusion: This study indicates that crucial processes related to the therapeutic relationship can be initiated via video, without prior face-to-face contact. Given the limited nonverbal communication cues in video appointments, it remains unclear as to how such processes evolve.Trial registration: German Clinical Trials Register identifier: DRKS00031262..
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Affiliation(s)
- Katrin Schoenenberg
- Department for Clinical Psychology and Psychotherapy, University Wuppertal, Wuppertal, Germany
| | - Alexandra Martin
- Department for Clinical Psychology and Psychotherapy, University Wuppertal, Wuppertal, Germany
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Fischer R, Bailey Y, Shankar M, Safaeinili N, Karl JA, Daly A, Johnson FN, Winter T, Arahanga-Doyle H, Fox R, Abubakar A, Zulman DM. Cultural challenges for adapting behavioral intervention frameworks: A critical examination from a cultural psychology perspective. Clin Psychol Rev 2024; 110:102425. [PMID: 38614022 DOI: 10.1016/j.cpr.2024.102425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/14/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
We introduce the bias and equivalence framework to highlight how concepts, methods, and tools from cultural psychology can contribute to successful cultural adaptation and implementation of behavioral interventions. To situate our contribution, we provide a review of recent cultural adaptation research and existing frameworks. We identified 68 different frameworks that have been cited when reporting cultural adaptations and highlight three major adaptation dimensions that can be used to differentiate adaptations. Regarding effectiveness, we found an average effect size of zr = 0.24 (95%CI 0.20, 0.29) in 24 meta-analyses published since 2014, but also substantive differences across domains and unclear effects of the extent of cultural adaptations. To advance cultural adaptation efforts, we outline a framework that integrates key steps from previous cultural adaptation frameworks and highlight how cultural bias and equivalence considerations in conjunction with community engagement help a) in the diagnosis of behavioral or psychological problems, b) identification of possible interventions, c) the selection of specific mechanisms of behavior change, d) the specification and documentation of dose effects and thresholds for diagnosis, e) entry and exit points within intervention programs, and f) cost-benefit-sustainability discussions. We provide guiding questions that may help researchers when adapting interventions to novel cultural contexts.
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Affiliation(s)
- Ronald Fischer
- Institute D'Or for Research and Education, Sao Paulo, Brazil; School of Psychology, Victoria University of Wellington, New Zealand.
| | | | - Megha Shankar
- Division of General Internal Medicine, Department of Medicine, University of California San Diego, USA
| | - Nadia Safaeinili
- Division of Primary Care and Population Health, Stanford School of Medicine, USA
| | - Johannes A Karl
- School of Psychology, Dublin City University, Dublin, Ireland; School of Psychology, Victoria University of Wellington, New Zealand
| | - Adam Daly
- School of Psychology, Dublin City University, Dublin, Ireland
| | | | - Taylor Winter
- School of Mathematics and Statistics, University of Canterbury, New Zealand
| | | | - Ririwai Fox
- School of Psychology, University of Waikato, Tauranga, New Zealand
| | - Amina Abubakar
- Aga Khan University, Nairobi, Kenya & Kenya Medical Research Institute/Wellcome Trust Research Programme, Kilifi, Kenya
| | - Donna Michelle Zulman
- Division of Primary Care and Population Health at Stanford University & Center for Innovation to Implementation (Ci2i) at VA Palo Alto, USA
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Mac Dhonnagáin N, O'Reilly A, Shevlin M, Dooley B. Examining Predictors of Psychological Distress Among Youth Engaging with Jigsaw for a Brief Intervention. Child Psychiatry Hum Dev 2024; 55:731-743. [PMID: 36169770 PMCID: PMC11061019 DOI: 10.1007/s10578-022-01436-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2022] [Indexed: 11/29/2022]
Abstract
Risk factors for psychological distress among help-seeking youth are poorly understood. Addressing this gap is important for informing mental health service provision. This study aimed to identify risk factors among youth attending Jigsaw, a youth mental health service in Ireland. Routine data were collected from N = 9,673 youth who engaged with Jigsaw (Mean age = 16.9 years, SD = 3.14), including presenting issues, levels of psychological distress, age, and gender. Confirmatory Factor Analysis identified thirteen factors of clustering issues. Several factors, including Self-criticism and Negative Thoughts, were strongly associated with items clustering as psychological distress, however these factors were poorly predictive of distress as measured by the CORE (YP-CORE: R2 = 14.7%, CORE-10: R2 = 6.9%). The findings provide insight into associations between young people's identified presenting issues and self-identified distress. Implications include applying appropriate therapeutic modalities to focus on risk factors and informing routine outcome measurement in integrated youth mental health services.
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Affiliation(s)
| | - Aileen O'Reilly
- School of Psychology, University College Dublin, Dublin, Ireland
- Jigsaw-The National Centre for Youth Mental Health, Dublin, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
| | - Barbara Dooley
- School of Psychology, University College Dublin, Dublin, Ireland
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Aday JS, Horton D, Fernandes-Osterhold G, O'Donovan A, Bradley ER, Rosen RC, Woolley JD. Psychedelic-assisted psychotherapy: where is the psychotherapy research? Psychopharmacology (Berl) 2024:10.1007/s00213-024-06620-x. [PMID: 38782821 DOI: 10.1007/s00213-024-06620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
RATIONALE Psychedelic-assisted psychotherapy (PAP) has emerged as a potential treatment for a variety of mental health conditions, including substance use disorders and depression. Current models of PAP emphasize the importance of psychotherapeutic support before, during, and after ingestion of a psychedelic to maximize safety and clinical benefit. Despite this ubiquitous assumption, there has been surprisingly little empirical investigation of the "psychotherapy" in PAP, leaving critical questions about the necessary and sufficient components of PAP unanswered. OBJECTIVES As clinical trials for psychedelic compounds continue the transition from safety- and feasibility-testing to evaluating efficacy, the role of the accompanying psychotherapy must be better understood to enhance scientific understanding of the mechanisms underlying therapeutic change, optimize clinical outcomes, and inform cost-effectiveness. RESULTS The present paper first reviews the current status of psychotherapy in the PAP literature, starting with recent debates regarding "psychotherapy" versus "psychological support" and then overviewing published clinical trial psychotherapy models and putative models informed by theory. We then delineate lessons that PAP researchers can leverage from traditional psychotherapy research regarding standardizing treatments (e.g., publish treatment manuals, establish eligibility criteria for providers), identifying mechanisms of change (e.g., measure established mechanisms in psychotherapy), and optimizing clinical trial designs (e.g., consider dismantling studies, comparative efficacy trials, and cross-lagged panel designs). Throughout this review, the need for increased research into the psychotherapeutic components of treatment in PAP is underscored. CONCLUSIONS PAP is a distinct, integrative, and transdisciplinary intervention. Future research designs should consider transdisciplinary research methodologies to identify best practices and inform federal guidelines for PAP administration.
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Affiliation(s)
- Jacob S Aday
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
| | - David Horton
- Department of Family Medicine and Community Health, University of Wisconsin, Madison, Madison, WI, USA
| | | | - Aoife O'Donovan
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Ellen R Bradley
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
| | - Raymond C Rosen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Joshua D Woolley
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
- San Francisco VA Medical Center, San Francisco, CA, USA
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7
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Archer KR. Cognitive-Behavioral-Based Physical Therapy for Improving Recovery After a Traumatic Lower-Extremity Injury: The Results of a Randomized Controlled Trial. J Bone Joint Surg Am 2024:00004623-990000000-01113. [PMID: 38781313 DOI: 10.2106/jbjs.23.01234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Lower-extremity injuries can result in severe impairment and substantial years lived with a disability. Persistent pain and psychological distress are risk factors for poor long-term outcomes and negatively influence the recovery process following a traumatic injury. Cognitive-behavioral therapy (CBT) interventions have the potential to address these risk factors and subsequently improve outcomes. This study aimed to evaluate the effect of a telephone-delivered cognitive-behavioral-based physical therapy (CBPT) program on physical function, pain, and general health at 12 months after hospital discharge following lower-extremity trauma. The CBPT program was hypothesized to improve outcomes compared with an education program. METHODS A multicenter, randomized controlled trial was conducted involving 325 patients who were 18 to 60 years of age and had at least 1 acute orthopaedic injury to the lower extremity or to the pelvis or acetabulum requiring operative fixation. Patients were recruited from 6 Level-I trauma centers and were screened and randomized to the CBPT program or the education program early after hospital discharge. The primary outcome was the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) scale. The secondary outcomes were objective physical function tests (4-square step test, timed stair ascent test, sit-to-stand test, and self-selected walking speed test), PROMIS Pain Intensity and Pain Interference, and the Veterans RAND 12-Item Health Survey. Treatment effects were calculated using targeted maximum likelihood estimation, a robust analytical approach appropriate for causal inference with longitudinal data. RESULTS The mean treatment effect on the 12-month baseline change in PROMIS PF was 0.94 (95% confidence interval, -0.68 to 2.64; p = 0.23). There were also no observed differences in secondary outcomes between the intervention group and the control group. CONCLUSIONS The telephone-delivered CBPT did not appear to yield any benefits for patients with traumatic lower-extremity injuries in terms of physical function, pain intensity, pain interference, or general health. Improvements were observed in both groups, which questions the utility of telephone-delivered cognitive-behavioral strategies over educational programs. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Haber Y, Levkovich I, Hadar-Shoval D, Elyoseph Z. The Artificial Third: A Broad View of the Effects of Introducing Generative Artificial Intelligence on Psychotherapy. JMIR Ment Health 2024; 11:e54781. [PMID: 38787297 PMCID: PMC11137430 DOI: 10.2196/54781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/24/2024] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Unlabelled This paper explores a significant shift in the field of mental health in general and psychotherapy in particular following generative artificial intelligence's new capabilities in processing and generating humanlike language. Following Freud, this lingo-technological development is conceptualized as the "fourth narcissistic blow" that science inflicts on humanity. We argue that this narcissistic blow has a potentially dramatic influence on perceptions of human society, interrelationships, and the self. We should, accordingly, expect dramatic changes in perceptions of the therapeutic act following the emergence of what we term the artificial third in the field of psychotherapy. The introduction of an artificial third marks a critical juncture, prompting us to ask the following important core questions that address two basic elements of critical thinking, namely, transparency and autonomy: (1) What is this new artificial presence in therapy relationships? (2) How does it reshape our perception of ourselves and our interpersonal dynamics? and (3) What remains of the irreplaceable human elements at the core of therapy? Given the ethical implications that arise from these questions, this paper proposes that the artificial third can be a valuable asset when applied with insight and ethical consideration, enhancing but not replacing the human touch in therapy.
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Affiliation(s)
- Yuval Haber
- The PhD Program of Hermeneutics and Cultural Studies, Interdisciplinary Studies Unit, Bar-Ilan University, Ramat Gan, Israel
| | | | - Dorit Hadar-Shoval
- Department of Psychology and Educational Counseling, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Zohar Elyoseph
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- The Center for Psychobiological Research, Department of Psychology and Educational Counseling, The Max Stern Yezreel Valley College, Emek Yezreel, Israel
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Kleinbub JR, Esposito G, Cutolo AS, Palmieri A, Gonçalves MM. Physiological synchronization and innovative moments in psychotherapy: A single-case study of micro-process. Psychother Res 2024:1-16. [PMID: 38754031 DOI: 10.1080/10503307.2024.2352752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE Interpersonal synchronization is increasingly studied as a biomarker of empathy, therapeutic alliance, and treatment outcome. However, most studies average data over sessions, leaving associations between synchrony and actual interactions largely unexplored. We aim to showcase a novel approach examining synchronization during specific micro-processes: Innovative Moments (IM) as markers of exceptions to clients' problematic patterns of meaning. METHODS Electrodermal activity was recorded over 15 sessions of a psychodynamic psychotherapy single case. Moment-to-moment patient-therapist synchrony was calculated using the Adaptive Matching Interpolated Correlations (AMICo) algorithm. The Innovative Moments Coding System was utilized to identify IMs within session transcripts with precise timing. Monte-Carlo permutation tests were conducted to examine the association between physiological synchrony and IM Levels of increasing complexity (Levels 1-3). RESULTS Higher-than-random synchronization emerged during Level 3 IMs (p = 0.046; d = 0.21) but not in lower Levels. Post-hoc qualitative analyses linked high synchrony to sub-processes of Level 3 IMs, such as positive contrasts and attributions for change. CONCLUSION Our findings show it is possible to link moment-by-moment physiological co-regulation to theoretically identified meaning-making processes. While generalization of these observations is undue, this work demonstrates a robust and promising application of a multimodal approach to investigating psychotherapy, providing insights into both the clinical case and the theoretical model adopted.
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Affiliation(s)
- Johann R Kleinbub
- Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Padova, Italy
| | - Giovanna Esposito
- Department of Humanities, University of Napoli Federico II, Napoli, Italy
| | - Anna S Cutolo
- Department of Humanities, University of Napoli Federico II, Napoli, Italy
| | - Arianna Palmieri
- Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padova, Padova, Italy
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Schumacher L, Burger J, Echterhoff J, Kriston L. Methodological and Statistical Practices of Using Symptom Networks to Evaluate Mental Health Interventions: A Review and Reflections. MULTIVARIATE BEHAVIORAL RESEARCH 2024:1-14. [PMID: 38733300 DOI: 10.1080/00273171.2024.2335401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Abstract
The network approach to psychopathology, which assesses associations between individual symptoms, has recently been applied to evaluate treatments for mental disorders. While various options for conducting network analyses in intervention research exist, an overview and an evaluation of the various approaches are currently missing. Therefore, we conducted a review on network analyses in intervention research. Studies were included if they constructed a symptom network, analyzed data that were collected before, during or after treatment of a mental disorder, and yielded information about the treatment effect. The 56 included studies were reviewed regarding their methodological and analytic strategies. About half of the studies based on data from randomized trials conducted a network intervention analysis, while the other half compared networks between treatment groups. The majority of studies estimated cross-sectional networks, even when repeated measures were available. All but five studies investigated networks on the group level. This review highlights that current methodological practices limit the information that can be gained through network analyses in intervention research. We discuss the strength and limitations of certain methodological and analytic strategies and propose that further work is needed to use the full potential of the network approach in intervention research.
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Affiliation(s)
- Lea Schumacher
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf
| | - Julian Burger
- Department of Psychological Methods, University of Amsterdam
- University Medical Center Groningen, University of Groningen
- Centre for Urban Mental Health, University of Amsterdam
| | - Jette Echterhoff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf
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11
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Kramuschke M, Reinhardt J, Dölemeyer R, Kaiser J, Kersting A. The change of working alliance and the association to treatment outcome in an internet-based therapy after pregnancy loss. BMC Psychol 2024; 12:254. [PMID: 38715033 PMCID: PMC11077727 DOI: 10.1186/s40359-024-01751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Working alliance is a prominent non-specific factor for treatment outcomes in face-to-face and internet-based interventions. The association between working alliance and therapy outcome appears to be time- and disorder-specific, but less is known about the change of working alliance during the intervention and the impact of working alliance in grief-specific interventions. The present study examines the association between the change of working alliance and treatment outcomes in an internet-based intervention for parents who experienced pregnancy loss. METHODS 228 participants received a grief intervention based on cognitive behavioral therapy with asynchronous text-based therapist feedback. Prolonged grief and related symptoms of traumatic stress, depression, anxiety, and general psychopathology were assessed with validated instruments before and after the intervention. The change of working alliance was assessed using the short version of the Working Alliance Inventory at mid-treatment (session 4) and the end of the treatment (session 10). RESULTS Data for N = 146 persons was analyzed. Working alliance in total and all subscales increased significantly from sessions 4 to 10. This change in working alliance correlated significantly with a reduction in prolonged grief. Changes in subscales of working alliance also correlated with symptoms of depression and general psychopathology. Regression analysis showed that a change in working alliance predicted a reduction in prolonged grief but did not predict improvements in other grief-related symptoms. CONCLUSION The results examine the change of working alliance during an internet-based intervention and the association with treatment outcome. A small impact of change in working alliance on treatment outcome of prolonged grief was confirmed, but not on related symptoms. Further research is needed to assess moderators of the alliance-outcome association to improve internet-based interventions. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Martin Kramuschke
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Jana Reinhardt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Ruth Dölemeyer
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Julia Kaiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
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Peill J, Marguilho M, Erritzoe D, Barba T, Greenway KT, Rosas F, Timmermann C, Carhart-Harris R. Psychedelics and the 'inner healer': Myth or mechanism? J Psychopharmacol 2024; 38:417-424. [PMID: 38605658 PMCID: PMC11102647 DOI: 10.1177/02698811241239206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Reference to an intrinsic healing mechanism or an 'inner healer' is commonplace amongst psychedelic drug-using cultures. The 'inner healer' refers to the belief that psychedelic compounds, plants or concoctions have an intrinsically regenerative action on the mind and brain, analogous to intrinsic healing mechanisms within the physical body, for example, after sickness or injury. AIMS Here, we sought to test and critique this idea by devising a single subjective rating item pertaining to perceived 'inner healing' effects. METHODS The item was issued to 59 patients after a single high (25 mg, n = 30) or 'placebo' (1 mg, n = 29) dose of psilocybin in a double-blind randomised controlled trial of psilocybin for depression. RESULTS Inner healer scores were higher after the high versus placebo dose of psilocybin (t = 3.88, p < 0.001). Within the high-dose sub-sample only, inner healer scores predicted improved depressive symptomatology at 2 weeks post-dosing. CONCLUSIONS The principle of activating inner healing mechanisms via psychedelics is scientifically nascent; however, this study takes a positivist and pragmatic step forward, asking whether it warrants further examination.
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Affiliation(s)
- Joseph Peill
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, UK
| | - Miriam Marguilho
- Division of Psychiatry, Lisbon Psychiatric Hospital Centre, Lisbon, Portugal
| | - David Erritzoe
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, UK
| | - Tommaso Barba
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, UK
| | - Kyle T Greenway
- Division of Psychiatry, Lisbon Psychiatric Hospital Centre, Lisbon, Portugal
- Faculty of Medicine, Department of Psychiatry, McGill University, Ludmer Research and Training Building, Montréal, QC, Canada
- Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada
| | - Fernando Rosas
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, UK
- Centre for Complexity Science, Imperial College London, London, UK
- Department of Informatics, University of Sussex, Brighton, UK
- Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, UK
| | - Christopher Timmermann
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, UK
| | - Robin Carhart-Harris
- Division of Psychiatry, Department of Brain Sciences, Centre for Psychedelic Research, Imperial College London, London, UK
- Departments of Neurology and Psychiatry, Carhart-Harris Lab, University of California San Francisco, San Francisco, CA, USA
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13
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Wolff M, Evens R, Mertens LJ, Schmidt C, Beck J, Rutrecht H, Cherniak AD, Gründer G, Jungaberle H. Measuring psychotherapeutic processes in the context of psychedelic experiences: Validation of the General Change Mechanisms Questionnaire (GCMQ). J Psychopharmacol 2024; 38:432-457. [PMID: 38742761 PMCID: PMC11102652 DOI: 10.1177/02698811241249698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Therapeutic and salutogenic effects of psychedelic drugs have been attributed to psychotherapeutic or psychotherapy-like processes that can unfold during the acute psychedelic experience and beyond. Currently, there are no psychometric instruments available to comprehensively assess psychotherapeutic processes (as conceptualized by empirical psychotherapy research) in the context of psychedelic experiences. AIMS We report the initial validation of the General Change Mechanisms Questionnaire (GCMQ), a self-report instrument designed to measure five empirically established general change mechanisms (GCMs) of psychotherapy-(1) resource activation, (2) therapeutic relationship, (3) problem actuation, (4) clarification, and (5) mastery-in the context of psychedelic experiences. METHODS An online survey in a sample of 1153 English-speaking and 714 German-speaking psychedelic users was conducted to evaluate simultaneously developed English- and German-language versions of the GCMQ. RESULTS The theory-based factor structure was confirmed. The five GCMQ scales showed good internal consistency. Evidence for convergent validity with external measures was obtained. Significant associations with different settings and with therapeutic, hedonic, and escapist use motives confirmed the hypothesized context dependence of GCM-related psychedelic experiences. Indicating potential therapeutic effects, the association between cumulative stressful life events and well-being was significantly moderated by resource activation, clarification, and mastery. Factor mixture modeling revealed five distinct profiles of GCM-related psychedelic experiences. CONCLUSION Initial testing indicates that the GCMQ is a valid and reliable instrument that can be used in future clinical and nonclinical psychedelic research. The five identified profiles of GCM-related experiences may be relevant to clinical uses of psychedelics and psychedelic harm reduction.
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Affiliation(s)
- Max Wolff
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- MIND Foundation, Berlin, Germany
| | - Ricarda Evens
- Department of Psychiatry and Neurosciences, Charité—Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lea J Mertens
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Jessica Beck
- MIND Foundation, Berlin, Germany
- Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | | | - Aaron D Cherniak
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Psychology, Reichman University, Herzliya, Israel
| | - Gerhard Gründer
- Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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14
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Polak M, Tanzer NK. Internet-Based Cognitive Behavioural Treatments for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis. Clin Psychol Psychother 2024; 31:e2989. [PMID: 38769929 DOI: 10.1002/cpp.2989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 05/22/2024]
Abstract
Obsessive-compulsive disorder (OCD) is a common mental health condition characterized by distressing, intrusive thoughts (obsessions) and repetitive behaviours (compulsions) aimed at reducing anxiety. Internet-based cognitive behavioural therapy (ICBT) has emerged as an effective treatment modality for various mental health disorders. This meta-analysis evaluates the efficacy of guided self-help ICBT (GSH ICBT) and unguided self-help ICBT (SH ICBT) against active and passive control conditions in adults with OCD. A comprehensive systematic literature search yielded 12 randomized controlled trials (RCTs) comprising 15 comparison arms (N = 1416) that met the inclusion criteria. Results indicate that GSH ICBT significantly reduced OCD symptomatology posttreatment compared to active controls (g = 0.378, k = 9), with no significant effects maintained at follow-up (g = 0.153, k = 4). GSH ICBT was also found to be as effective as active CBT interventions in reducing comorbid anxiety and depression symptoms posttreatment (g = 0.278, k = 6) and at follow-up (g = 0.124, k = 4). However, improvements in quality of life were not significant posttreatment (g = 0.115, k = 4) nor at follow-up (g = 0.179, k = 3). Combined GSH and SH ICBT demonstrated large effects on reducing OCD symptoms (g = 0.754, k = 6), medium effects on comorbid symptoms (g = 0.547, k = 6) and small effects on quality of life (g = 0.227, k = 2) when compared to inactive controls. No significant differences were found between GSH and SH ICBT in all measured outcomes posttreatment (OCD: g = 0.098, k = 3; AD: g = 0.070, k = 3; QoL: g = -0.030, k = 1) and at follow-up (OCD: g = 0.265, k = 2; AD: g = 0.084, k = 2; QoL: g = 0.00, k = 1). Sample size was identified as a significant moderator of treatment effects. This paper further explores clinical significance, treatment adherence, therapist time investment and moderator influences of the ICBT. The limitations of the study and recommendations for future research are thoroughly discussed.
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Affiliation(s)
- Martin Polak
- Department of Psychology, University of Graz, Graz, Austria
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15
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Dimaggio G, Weinberg I. What do we need in order to successfully treat persons with pathological narcissism? How does change happen? Treatment principles and mechanisms of change emerging from single cases treated by experts: A commentary. J Clin Psychol 2024; 80:1079-1097. [PMID: 38308855 DOI: 10.1002/jclp.23652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/21/2024] [Indexed: 02/05/2024]
Abstract
Persons with pathological narcissism (PN) or narcissistic personality disorder present with a wide array of symptoms and social problems. They need effective psychotherapies but empirical evidence for what works with them is mostly lacking. In this issue of the Journal and Clinical Psychology: In Session four authors from different orientations described single cases of patients suffering from different manifestations of PN. In this commentary we reviewed in detail the four cases and tried to distill (a) the treatment principles adopted; (b) the actual mechanisms of therapeutic change. We hope that the list of principles and mechanisms and change we identified here can help both clinicians and researchers develop and test effective options for persons with PN who are difficult to treat but do have chances to change in a meaningful way in treatment.
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Marciniak MA, Shanahan L, Myin-Germeys I, Veer IM, Yuen KSL, Binder H, Walter H, Hermans EJ, Kalisch R, Kleim B. Imager-A mobile health mental imagery-based ecological momentary intervention targeting reward sensitivity: A randomized controlled trial. Appl Psychol Health Well Being 2024; 16:576-596. [PMID: 37942875 DOI: 10.1111/aphw.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
Robust reward sensitivity may help preserve mental well-being in the face of adversity and has been proposed as a key stress resilience factor. Here, we present a mobile health application, "Imager," which targets reward sensitivity by training individuals to create mental images of future rewarding experiences. We conducted a two-arm randomized controlled trial with 95 participants screened for reward sensitivity. Participants in the intervention group received an ecological momentary intervention-Imager, which encouraged participants to create mental images of rewarding events for 1 week. The control group participants received only ecological momentary assessment, without the instruction to generate mental images. Adherence to Imager was high; participants in the intervention group engaged in 88% of the planned activities. In the follow-up assessment, the intervention group reported less mental health symptoms, mainly in depression (β = -0.34, df = 93, p = .004) and less perceived stress (β = -0.18, df = 93, p = .035), than control group participants and compared with the baseline assessment. Our results show the positive effects of Imager on mental health symptoms. The encouraging effects of the app on mental health outcomes may lead to greater use of ecological momentary interventions in the clinical preventive practice of affective disorders.
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Affiliation(s)
- Marta Anna Marciniak
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
| | - Lilly Shanahan
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Ilya Milos Veer
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Kenneth S L Yuen
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - Henrik Walter
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Erno J Hermans
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
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Haakana R, Rosenström T, Parkkinen L, Tuomisto MT, Isometsä E. Effectiveness of an add-on brief group behavioral activation treatment for depression in psychiatric care: a randomized clinical trial. Front Psychiatry 2024; 15:1284363. [PMID: 38745781 PMCID: PMC11091724 DOI: 10.3389/fpsyt.2024.1284363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 04/09/2024] [Indexed: 05/16/2024] Open
Abstract
Objective Behavioral activation (BA) is an effective treatment for depression. We investigated the effectiveness of add-on group-format BA and peer support (PS) with treatment as usual (TAU) in a registered randomized clinical trial in psychiatric outpatient settings (ISRCTN10647845). Methods Adult outpatients (N = 140) with major depressive disorder (MDD) and Patient Health Questionnaire (PHQ-9) score ≥10 were randomized into a) group BA, consisting of eight 90-minute weekly group sessions plus TAU; b) group PS, including eight 90-minute weekly group sessions plus TAU; or c) TAU alone. The primary outcome was a within-individual change in PHQ-9 score between baseline and 8 weeks. Secondary outcomes were 1) response, 2) remission, and 3) functional impairment at 8 weeks, plus 4) change in PHQ-9 at 6 months. Results Of the randomized patients, 100 (71.4%) completed treatments, including 29/45 (64.4%) patients in the BA group, 39/49 (79.6%) in the PS group, and 32/46 (69.6%) in the TAU group. By 8 weeks, PHQ-9 scores declined most in the TAU group [BA -0.28 (95% CI -2.48, 1.92), PS -0.58 (-2.09, 0.94) vs. TAU -3.32 (-5.21, -1.44); group-difference test, p = 0.034]. The secondary outcomes in the BA or PS arms did not significantly differ from those in TAU. Videotaped sessions revealed marked variation in briefly trained therapists' adherence to the treatment manual. Conclusions In this randomized trial, the effectiveness of treatments with the added BA and PS groups did not exceed that of TAU alone. The preconditions in which brief BA or PS group interventions benefit outpatients with depression in psychiatric settings warrant critical investigation.
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Affiliation(s)
- Riikka Haakana
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Lauri Parkkinen
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Martti T. Tuomisto
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Erkki Isometsä
- Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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18
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Laurila M, Lindfors O, Knekt P, Heinonen E. The effect of individual short- and long-term psychotherapy on perceived social support: analysis of secondary outcomes of a randomized clinical trial. Nord J Psychiatry 2024; 78:230-237. [PMID: 38323800 DOI: 10.1080/08039488.2024.2306229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/11/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Social support is important for maintaining and restoring psychological well-being but the effects of individual psychotherapies on perceived social support are not well known. In this analysis of secondary outcomes from a randomized clinical study, we compared the effects of long-term psychotherapy and two short-term psychotherapies on social support during a 5-year follow-up. MATERIALS AND METHODS Altogether 326 adult outpatients suffering from depressive and/or anxiety disorders were randomly assigned to long-term psychodynamic psychotherapy (LPP, n = 126), short-term psychodynamic psychotherapy (SPP, n = 101) and solution-focused therapy (SFT, n = 97). Outcome was measured by the global index and six subscores of the self-reported Brief Inventory of Social Support and Integration scale (BISSI) at baseline and at 1, 2, 3, 4 and 5 years after the beginning of the therapy. RESULTS Social support improved in all therapy groups and the improvement was relatively stable, lasting several years after the end of therapy. Little difference in improvement was observed either between therapy orientations or durations. CONCLUSIONS While no major differences were observed between treatment groups, the slight differences call for further research to verify these findings and to better understand how different therapies may improve perceived social support.
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Affiliation(s)
- Matias Laurila
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Olavi Lindfors
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Paul Knekt
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Erkki Heinonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- University of Oslo, Oslo, Norway
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19
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Pontén M, Jonsjö M, Vadenmark V, Moberg E, Grannas D, Andersson G, Boersma K, Hedman-Lagerlöf E, Kleinstaeuber M, Weise C, Kaldo V, Ljótsson B, Andersson E, Axelsson E, Jensen K. Association between expectations and clinical outcomes in online v. face-to-face therapy - an individual participant data meta-analysis. Psychol Med 2024; 54:1207-1214. [PMID: 37905404 DOI: 10.1017/s0033291723003033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Online treatments are increasing in number and are currently available for a wide range of clinical problems. To date little is known about the role of treatment expectations and other placebo-like mechanisms in online settings compared to traditional face-to-face treatment. To address this knowledge gap, we analyzed individual participant data from randomized clinical trials that compared online and face-to-face psychological interventions. METHODS MEDLINE (Ovid) and PsycINFO (Ovid) were last searched on 2 February 2021. Randomized clinical trials of therapist guided online v. face-to-face psychological interventions for psychiatric or somatic conditions using a randomized controlled design were included. Titles, abstracts, and full texts of studies were independently screened by multiple observers. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Authors of the matching trials were contacted for individual participant data. Ratings from the Credibility and Expectancy Questionnaire and the primary outcome measure from each trial were used to estimate the association between expectation ratings and treatment outcomes in online v. face-to-face interventions, using a mixed-effects model. RESULTS Of 7045 screened studies, 62 full-text articles were retrieved whereof six studies fulfilled the criteria and provided individual participant data (n = 491). Overall, CEQ ratings predicted clinical outcomes (β = 0.27) at end of treatment with no moderating effect of treatment modality (online v. face-to-face). CONCLUSIONS Online treatment appears to be equally susceptible to expectancy effects as face-to-face therapy. This furthers our understanding of the importance of placebo-like factors in online treatment and may aid the improvement of healthcare in online settings.
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Affiliation(s)
- Moa Pontén
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Martin Jonsjö
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Medical Unit Medical Psychology, Theme Women's Health and Allied Health Professionals, Karolinska University Hospital Solna, Solna, Sweden
| | - Viktor Vadenmark
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Erica Moberg
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - David Grannas
- Biostatistics Core Facility, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Katja Boersma
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | | | | | - Cornelia Weise
- Department of Psychology, Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Viktor Kaldo
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Erland Axelsson
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Solna, Sweden
| | - Karin Jensen
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
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Murphy ST, Bailey B, Strunk DR. Promoting skill use in skill enhanced cognitive behavioral therapy: A case example. J Clin Psychol 2024; 80:912-927. [PMID: 38111144 DOI: 10.1002/jclp.23634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/14/2023] [Accepted: 11/23/2023] [Indexed: 12/20/2023]
Abstract
Cognitive behavioral therapy (CBT) appears to achieve its effects at least in part by fostering the development of CBT skills. In an effort to leverage CBT skill development, our group developed and tested a skill-enhanced version of CBT (CBT-SE) in a recent trial. In this paper, we describe our work with a client who participated in a 12-week course of CBT-SE as part of that trial. Although homework is a critical aspect of CBT, the greater emphasis on skill development in CBT-SE means that homework is even more central. This client's course of treatment illustrates the potential benefits of a strong focus on skill development and the use of specific homework assignments to foster mastery and ongoing use of CBT skills. The client developed CBT skills at a rapid pace early in treatment and exhibited enduring symptom reductions. The experience of this client reinforces the value of a focus on CBT skills and highlights strategies for fostering skill development. Given the evidence in support of the therapeutic value of CBT skills and the well-established benefits of homework assignment, we encourage use of skill enhancing procedures, including in-session procedures and assignments that help clients develop and maintain ongoing skill use.
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Affiliation(s)
- Samuel T Murphy
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Brooklynn Bailey
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
| | - Daniel R Strunk
- Department of Psychology, The Ohio State University, Columbus, Ohio, USA
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21
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Bisby MA, Balakumar T, Scott AJ, Titov N, Dear BF. An online therapist-guided ultra-brief treatment for depression and anxiety: a randomized controlled trial. Psychol Med 2024; 54:902-913. [PMID: 37655527 DOI: 10.1017/s003329172300260x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND There are many barriers to engaging in current psychological treatments, including time, cost, and availability. Ultra-brief treatments overcome some of these barriers by delivering therapeutic information and skills using significantly less time than standard-length treatments. We developed a therapist-guided online ultra-brief treatment for depression and anxiety and compared it to an existing 8-week, 5-lesson therapist-guided standard-length treatment and a waitlist control. METHODS In a randomized controlled trial, adults with self-reported depression or anxiety were randomized (1:1:1) to the ultra-brief treatment, standard-length treatment, or waitlist control. The primary outcomes were depression symptoms and anxiety symptoms assessed at baseline, 5-weeks later, 9-weeks later (primary timepoint), and 3-months later. The trial was prospectively registered. RESULTS Between 7 February 2022, and 16 August 2022, 242 participants were enrolled in the ultra-brief treatment (n = 85), standard-length treatment (n = 80), and waitlist control (n = 77). Participants were mostly women with an average age of 48.56 years. At 9-weeks post-baseline, participants in the ultra-brief treatment group reported significantly lower depression (between groups d = 0.41) and anxiety (d = 0.53) than the waitlist control. The ultra-brief treatment was non-inferior for anxiety at both 9-weeks and 3-months follow-up. Non-inferiority for depression was observed at 9-weeks. CONCLUSIONS The online ultra-brief treatment resulted in significant reductions in depression and anxiety that were non-inferior to a longer treatment course after 9-weeks. Remotely delivered ultra-brief treatments have the potential to provide accessible and effective care for those who cannot, or would prefer not to, access longer psychological interventions.
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Affiliation(s)
- Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Tanya Balakumar
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Amelia J Scott
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- MindSpot Clinic, MQ Health, Macquarie University, Sydney, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
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22
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Gumz A, Daubmann A, Erices R, Berger J, Reuter L, Kästner D. Associations between therapists' verbal techniques and patient-rated therapeutic alliance, insight, and problem solving. Psychother Res 2024:1-12. [PMID: 38527181 DOI: 10.1080/10503307.2024.2327443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/04/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To investigate associations between common factors (alliance, insight, problem solving) and therapists' techniques. We expected a positive association between (1) supportive techniques and the alliance, (2) interpretative techniques and insight, and (3) a stronger association between interpretative techniques and insight for patients with more severe baseline symptoms. Other associations were analyzed in an exploratory way. METHOD Sixty sessions from 15 adult female patients diagnosed with personality disorder were analyzed using the Psychodynamic Interventions List (verbal techniques, observer-rated transcripts), and the Session Questionnaire for General and Differential Individual Psychotherapy (common factors, patient-rated after each session). Multilevel modeling was applied. RESULTS A greater use of supportive techniques was related to a higher therapeutic alliance (b = .28, 95% CI: .01-.55, p = .042). Neither the positive association between interpretative techniques and insight nor the moderating effect of baseline symptom severity could be confirmed. Exploratory analyses revealed associations between problem-solving and different verbal techniques. CONCLUSION Therapists' use of supportive techniques seems to influence the therapeutic alliance positively in patients with personality disorders. The effect of interpretative techniques might depend on other factors like patient characteristics. In general, there seem to be differential and specific associations between different therapists' verbal techniques and common factors.
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Affiliation(s)
- Antje Gumz
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Erices
- Institute for History of Medicine and Medical Ethics, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen, Germany
| | - Jelka Berger
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Laurence Reuter
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Denise Kästner
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
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Aujoulat C, Vancappel A, Tapia G. [Effectiveness of psychotherapy on dissociative symptoms in adult populations: A PRISMA systematic review]. L'ENCEPHALE 2024:S0013-7006(24)00044-7. [PMID: 38523025 DOI: 10.1016/j.encep.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Dissociation is a psychological process in reaction to threat which can be found in many psychiatric conditions. Dissociative symptoms can become very disabling, whether in daily life or in care. Nevertheless, few studies seem to have examined the efficacy of psychotherapy on the latter and its relevance as a therapeutic target. METHOD A systematic review of the literature (PRISMA) on the efficacy of psychotherapy on dissociative symptoms in adults with mental disorders was conducted. Effectiveness was considered in terms of reduction in dissociative symptomatology. The search was conducted on Scopus, PubMed and PsycInfo. Overall, 50 full-text articles were evaluated. RESULTS Fourteen studies were included in the review. In all, 711 adult subjects with post-traumatic stress disorder, borderline personality disorder or dissociative disorder were included. Overall, this systematic review reports a reduction in dissociative symptoms associated with a variety of psychotherapeutic interventions, without allowing any conclusions to be drawn on the superiority of one psychotherapy over another. DISCUSSION The conclusions of this work highlight three possible therapeutic orientations for reducing dissociative symptoms: (i) by reintegrating the dynamic subsystems, (ii) by treating the cognitive processes underlying dissociation, and (iii) by acting on the processes identified as common to the effectiveness of psychotherapy.
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Affiliation(s)
| | - Alexis Vancappel
- Laboratoire QualiPsy, EE 1901, université de Tours, Tours, France; Pôle Psychiatrie-addictologie, clinique psychiatrique universitaire - centre régional de psychotraumatologie-CVL, CHRU de Tours, Tours, France
| | - Géraldine Tapia
- Université de Bordeaux, Bordeaux, France; Université de Bordeaux, LabPsy, UR 4139, 33000 Bordeaux, France.
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Elyoseph Z, Levkovich I. Comparing the Perspectives of Generative AI, Mental Health Experts, and the General Public on Schizophrenia Recovery: Case Vignette Study. JMIR Ment Health 2024; 11:e53043. [PMID: 38533615 PMCID: PMC11004608 DOI: 10.2196/53043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/24/2024] [Accepted: 02/11/2024] [Indexed: 03/28/2024] Open
Abstract
Background The current paradigm in mental health care focuses on clinical recovery and symptom remission. This model's efficacy is influenced by therapist trust in patient recovery potential and the depth of the therapeutic relationship. Schizophrenia is a chronic illness with severe symptoms where the possibility of recovery is a matter of debate. As artificial intelligence (AI) becomes integrated into the health care field, it is important to examine its ability to assess recovery potential in major psychiatric disorders such as schizophrenia. Objective This study aimed to evaluate the ability of large language models (LLMs) in comparison to mental health professionals to assess the prognosis of schizophrenia with and without professional treatment and the long-term positive and negative outcomes. Methods Vignettes were inputted into LLMs interfaces and assessed 10 times by 4 AI platforms: ChatGPT-3.5, ChatGPT-4, Google Bard, and Claude. A total of 80 evaluations were collected and benchmarked against existing norms to analyze what mental health professionals (general practitioners, psychiatrists, clinical psychologists, and mental health nurses) and the general public think about schizophrenia prognosis with and without professional treatment and the positive and negative long-term outcomes of schizophrenia interventions. Results For the prognosis of schizophrenia with professional treatment, ChatGPT-3.5 was notably pessimistic, whereas ChatGPT-4, Claude, and Bard aligned with professional views but differed from the general public. All LLMs believed untreated schizophrenia would remain static or worsen without professional treatment. For long-term outcomes, ChatGPT-4 and Claude predicted more negative outcomes than Bard and ChatGPT-3.5. For positive outcomes, ChatGPT-3.5 and Claude were more pessimistic than Bard and ChatGPT-4. Conclusions The finding that 3 out of the 4 LLMs aligned closely with the predictions of mental health professionals when considering the "with treatment" condition is a demonstration of the potential of this technology in providing professional clinical prognosis. The pessimistic assessment of ChatGPT-3.5 is a disturbing finding since it may reduce the motivation of patients to start or persist with treatment for schizophrenia. Overall, although LLMs hold promise in augmenting health care, their application necessitates rigorous validation and a harmonious blend with human expertise.
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Affiliation(s)
- Zohar Elyoseph
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- The Center for Psychobiological Research, Department of Psychology and Educational Counseling, Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College, Kiryat Tiv'on, Israel
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25
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Feingold D, Tzur Bitan D, Ferri M, Hoch E. Predictors of effective therapy among individuals with Cannabis Use Disorder: a review of the literature. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01781-4. [PMID: 38493284 DOI: 10.1007/s00406-024-01781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024]
Abstract
Treatment demand for Cannabis Use Disorder (CUD) has increased in the past decade in almost all European countries, and CUD is currently the most common reason for first-time drug-related treatment admission in the European Union. Even though several therapeutic approaches have been shown to benefit individuals with CUD, there is a lack of knowledge regarding factors associated with effective therapy and the underlying mechanisms of change among individuals with CUD presenting for treatment. The aim of the present paper was to review current knowledge on factors that have been shown to contribute to positive outcomes in CUD treatment. A scoping methodology was used, focusing on empirically evaluated studies that used defined, cannabis-related outcome measures. In eligible studies, factors of investigation were categorized as either 'mediators', i.e., treatment-related factors associated with the processes or mechanisms through which patients benefit from therapy, or 'moderators' which are patient-related characteristics that predict his/her odds to benefit from treatment or patient-related (i.e., moderators). Factors categorized as mediators were then classified 'specific factors' if they were related to a certain technique or treatment modality or 'common factors' if they were assessed beyond treatment modalities. Findings suggest that in CUD treatment, specific mediators include treatment duration, addressing motivation to change, acquiring coping skills, enhancing self-efficacy, and integrating several therapeutic components. Common mediators include therapeutic alliance, empathy, expectations and cultural adaptation. Moderators in CUD treatment include sex, ethnicity, age-related factors and comorbid disorders.
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Affiliation(s)
- Daniel Feingold
- Psychology Department, Achva Academic College, Achva, Israel.
| | - Dana Tzur Bitan
- Department of Community Mental Health, University of Haifa, Haifa, Israel
- Shalvata Mental Health Center, Hod Hasharon, Israel
| | | | - Eva Hoch
- Department of Psychiatry, Ludwig-Maximilians-University, Munich, Germany
- IFT Institut für Therapieforschung, Centre of Health and Addiction Research, Munich, Germany
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Cuijpers P, Miguel C, Ciharova M, Harrer M, Karyotaki E. Non-directive supportive therapy for depression: A meta-analytic review. J Affect Disord 2024; 349:452-461. [PMID: 38211757 DOI: 10.1016/j.jad.2024.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Non-directive supportive therapy (NDST) is an important treatment of adult depression, but no recent meta-analysis has integrated the randomized trials examining its effects. METHODS We conducted a meta-analysis comparing NDST to control conditions and to other therapies, by using an existing database of randomized trials of psychological treatments of depression in adults. This database was built through searches in PubMed, PsycINFO, Embase and the Cochrane Library. RESULTS 48 randomized controlled trials (5075 participants), with 20 comparisons between NDST and a control group and 49 comparisons between NDST and another psychotherapy were included. Random effects meta-analyses found an effect size of NDST compared with control conditions of g = 0.53 (95 % CI, 0.34; 0.72) with moderate heterogeneity (I2 = 51; 95 % CI: 18; 71; PI = -0.02 to 1.09). NDST was less effective than other therapies (g = -0.21; 95 % CI: -0.31; -0.11). The difference with other therapies was significantly larger in studies in which NDST was used as a control group (p = .003). There was no significant difference between NDST and other therapies in which NDST was not used as a control group (k = 14; g = -0.05; 95 % CI: -0.17; 0.07). CONCLUSIONS NDST probably is an effective treatment of depression. The effects may be somewhat smaller than those of other therapies, but that may also be an artefact, because NDST is often used as a control group and may be designed as an "intent-to-fail" intervention in some studies.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands; Babeș-Bolyai University, International Institute for Psychotherapy, Cluj-Napoca, Romania.
| | - Clara Miguel
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Marketa Ciharova
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Mathias Harrer
- Psychology & Digital Mental Health Care, Department of Health Sciences, Technical University of Munich, Munich, Germany
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, the Netherlands
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Malkomsen A, Røssberg JI, Dammen T, Wilberg T, Løvgren A, Ulberg R, Evensen J. "It takes time to see the whole picture": patients' views on improvement in cognitive behavioral therapy and psychodynamic therapy after three years. Front Psychiatry 2024; 15:1342950. [PMID: 38559399 PMCID: PMC10978640 DOI: 10.3389/fpsyt.2024.1342950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction There is a lack of qualitative research that retrospectively explores how patients with major depressive disorder view their improvement in psychotherapy. Methods Fifteen patients who received short-term cognitive behavioral therapy and psychodynamic therapy were individually interviewed approximately three years after completing therapy. Results Some patients had altered their views on therapy, especially those who initially were uncertain of how helpful therapy had been. They said they did not realize the extent and importance of their improvement in therapy before some time had passed, which can be explained by the surprising cumulative effects of seemingly small changes. Discussion This should make retrospective qualitative research an important part of future psychotherapy research.
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Affiliation(s)
- Anders Malkomsen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jan Ivar Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Toril Dammen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Theresa Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - André Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Randi Ulberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Julie Evensen
- Nydalen Outpatient Clinic, Oslo University Hospital, Oslo, Norway
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Schaffler Y, Jesser A, Humer E, Haider K, Pieh C, Probst T, Schigl B. Process and outcome of outpatient psychotherapies under clinically representative conditions in Austria: protocol and feasibility of an ongoing study. Front Psychiatry 2024; 15:1264039. [PMID: 38510799 PMCID: PMC10951102 DOI: 10.3389/fpsyt.2024.1264039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 02/16/2024] [Indexed: 03/22/2024] Open
Abstract
Background While most studies assessing psychotherapy efficacy are randomized-controlled trials conducted in research institutions or short clinical treatments, the understanding of psychotherapy effectiveness under regular, clinically representative conditions, particularly in outpatient practice, remains limited. Representative data examining the effectiveness of psychotherapy under real-world conditions in Austria is lacking. Aims and Methods This paper introduces a naturalistic observational combined process- and outcome study, implementing a dual-perspective approach through standardised pre- and post-treatment questionnaires and evaluating changes in the therapeutic alliance after each session. Further, semi-structured qualitative interviews aim to illuminate the personal experiences of patients and therapists. The primary objective of the presented study is to discern whether symptoms markedly decrease following therapy. A significant secondary goal is to trace the therapeutic alliance's evolution from both patient and therapist viewpoints, emphasising the alliance-outcome association and gender dynamics within the pairs. This paper discusses the project's feasibility after three years and shares key insights. Discussion Recruitment for this study has posed substantial challenges due to psychotherapists' concerns regarding data protection, extensive documentation, and philosophical reservations about the study design. Consequently, we recruited fewer participants than initially planned. Despite these hurdles, qualitative data collection has shown notable success. Given psychotherapists' busy schedules and reluctance to participate, more potent external incentives or a legal obligation may be necessary to encourage participation in future studies.
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Affiliation(s)
- Yvonne Schaffler
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
| | - Andrea Jesser
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Vienna, Austria
| | - Elke Humer
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Vienna, Austria
| | - Katja Haider
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
| | - Christoph Pieh
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
| | - Thomas Probst
- Division of Psychotherapy, Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Brigitte Schigl
- Department Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Krems, Austria
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29
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Echterhoff J, Kriston L, Klein JP, Härter M, Schramm E, Schumacher L. Symptom-specific improvement across therapies and their putative mediators: A mediation network intervention analysis. Psychother Res 2024:1-12. [PMID: 38431848 DOI: 10.1080/10503307.2024.2320349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE We evaluated differential treatment effects on specific symptoms and their mediators for Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy (SP) in persistently depressed patients. METHOD We conducted a Bayesian mediation network intervention analysis with data from a randomized controlled trial comparing CBASP and SP. Three networks were calculated to investigate (1) differential treatment effects on specific symptoms, (2) differential treatment effects on the potential mediators interpersonal problems and social functioning, and (3) associations between change in symptoms and change in the potential mediators. RESULTS First, we found no evidence that CBASP more strongly improves most depressive symptoms specifically, except minimal evidence of symptom-specific effects on sleeping problems and self-esteem. Second, no and minimal evidence for differential treatment effects on interpersonal problems and social functioning was shown, respectively. Third, interpersonal problems and social functioning were strongly related to depressive symptoms. CONCLUSION While CBASP showed superior treatment effects for overall symptom severity, this treatment might not be superior in improving specific symptoms and the potential mediators interpersonal problems and social functioning. Still, interpersonal problems and social functioning seem to play an important role for depression symptoms. Future research needs to further investigate potential working mechanisms of CBASP.Trial registration: ClinicalTrials.gov identifier: NCT00970437.
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Affiliation(s)
- Jette Echterhoff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Philipp Klein
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lea Schumacher
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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30
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Wucherpfennig F, Schwartz B, Rubel J. Towards a taxonomy of mechanisms of change? Findings from an expert survey on the association between common factors and specific techniques in psychotherapy. Psychother Res 2024; 34:398-411. [PMID: 37127943 DOI: 10.1080/10503307.2023.2206051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE In the present study, we used structural equation modeling (SEM) to investigate the complex relationship between common factors, i.e., mechanisms of change, and specific factors, i.e., therapeutic techniques. METHOD N = 256 psychotherapy experts were asked to rate the appropriateness of 14 techniques commonly used in psychotherapy to facilitate five different common factors - resource activation, motivational clarification, self-management & emotion regulation, social competence, and therapeutic relationship. Using SEM, we defined techniques as indicators and common factors as latent variables. Data were split randomly into two subsets. Indicators were selected if three a priori defined criteria were met based on training data (n = 128). Subsequently, the goodness of model fit was assessed in the test data (n = 128). RESULTS The proposed model revealed adequate fit. All factor loadings were theoretically sound and significant in magnitude. Findings suggest that psychotherapy experts discriminate between common factors by their various associations with therapeutic techniques. CONCLUSION Suggestions are made, how therapeutic techniques are to be used to facilitate desirable change in the patient. Our model is a step towards a taxonomy of mechanisms of change that may help to improve research-informed decision-making.
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Affiliation(s)
| | - Brian Schwartz
- Department of Psychology, University of Trier, Trier, Germany
| | - Julian Rubel
- Department of Psychology, University of Giessen, Giessen, Germany
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31
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Behr S, Fenski F, Boettcher J, Knaevelsrud C, Hammelrath L, Kovacs G, Schirmer W, Petrick H, Becker P, Schaeuffele C. TONI - One for all? Participatory development of a transtheoretic and transdiagnostic online intervention for blended care. Internet Interv 2024; 35:100723. [PMID: 38370289 PMCID: PMC10874715 DOI: 10.1016/j.invent.2024.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/13/2023] [Accepted: 02/02/2024] [Indexed: 02/20/2024] Open
Abstract
Background Internet-based interventions offer a way to meet the high demand for psychological support. However, this setting also has disadvantages, such as the lack of personal contact and the limited ability to respond to crises. Blended care combines Internet-based interventions with face-to-face psychotherapy and merges the benefits of both settings. To ensure the uptake of blended care in routine care, Internet-based interventions need to be suitable for different therapeutic approaches and mental disorders. Objective This paper describes the participatory development process of the Internet-based intervention "TONI" using a common therapeutic language and content on various transdiagnostic topics to be integrated into routine outpatient psychotherapy. Methods To develop this intervention in a participatory manner, we followed the Integrate, Design, Assess, and Share (IDEAS) framework. In a multilevel development process, we used a combination of interviews, focus groups, and proofreading to optimally tailor online modules to routine outpatient psychotherapy. Building on well-established cognitive-behavioral online content, we included expert interviews with psychodynamic (n = 20) and systemic psychotherapists (n = 9) as well as focus groups with psychotherapists of different approaches (n = 10) and persons with lived experience of mental illness (PWLE; n = 10). Results We describe the development process of TONI step-by-step, outlining the specific requirements that therapists from different therapeutic approaches as well as PWLE have and how we implemented them in our intervention. This includes the content and specific exercises in the online modules, aspects of data protection, language, design, and usability. Conclusion Internet-based interventions that use a common therapeutic language and address therapeutic principles across different approaches have the potential to advance digitalization in psychotherapy. Involving psychotherapists and PWLE in intervention development may positively impact acceptance and usage in practice. This study shows how participatory intervention development involving both psychotherapists and PWLE can be carried out.
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Affiliation(s)
- S. Behr
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - F. Fenski
- Department of Psychology and Psychotherapy, Psychologische Hochschule Berlin, Am Köllnischen Park 2, 10179 Berlin, Germany
| | - J. Boettcher
- Department of Psychology and Psychotherapy, Psychologische Hochschule Berlin, Am Köllnischen Park 2, 10179 Berlin, Germany
| | - C. Knaevelsrud
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - L. Hammelrath
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - G. Kovacs
- Berlin School of Design and Communications, SRH Berlin University of Applied Sciences, Prinzenstraße 84.1, 10969 Berlin, Germany
| | - W. Schirmer
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - H. Petrick
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - P. Becker
- Department of Psychology and Psychotherapy, Psychologische Hochschule Berlin, Am Köllnischen Park 2, 10179 Berlin, Germany
| | - C. Schaeuffele
- Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
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Luyten P, Campbell C, Moser M, Fonagy P. The role of mentalizing in psychological interventions in adults: Systematic review and recommendations for future research. Clin Psychol Rev 2024; 108:102380. [PMID: 38262188 DOI: 10.1016/j.cpr.2024.102380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 12/20/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
Mentalizing is the human capacity to understand actions of others and one's own behavior in terms of intentional mental states, such as feelings, wishes, goals and desires. Mentalizing is a transtheoretical and transdiagnostic concept that has been applied to understanding vulnerability to psychopathology and has attracted considerable research attention over the past decades. This paper reports on a pre-registered systematic review of evidence concerning the role of mentalizing as a moderator and mediator in psychological interventions in adults. Studies in adults were reviewed that address the following questions: (a) does pre-treatment mentalizing predict treatment outcome; (b) do changes in mentalizing across treatment predict outcome; (c) does adherence to the principles or protocol of mentalization-based treatment predict outcome; and (d) does strengthening in-session mentalizing impact the therapeutic process via improved alliance, alleviated symptoms, or improved interpersonal functioning? Results suggest that mentalizing might be a mediator of change in psychotherapy and may moderate treatment outcome. However, the relatively small number of studies (n = 33 papers based on 29 studies, totaling 3124 participants) that could be included in this review, and the heterogeneity of studies in terms of design, measures used, disorders included, and treatment modalities, precluded a formal meta-analysis and limited the ability to draw strong conclusions. Therefore, theoretical and methodological recommendations for future research to improve the quality of existing research in this area are formulated.
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Affiliation(s)
- Patrick Luyten
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, Pobox 3722, Leuven 3000, Belgium; Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK.
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Max Moser
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
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Hertenstein E, Trinca E, Schneider CL, Fehér KD, Johann AF, Nissen C. Acceptance and Commitment Therapy, Combined with Bedtime Restriction, versus Cognitive Behavioral Therapy for Insomnia: A Randomized Controlled Pilot Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:114-128. [PMID: 38417415 DOI: 10.1159/000535834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/08/2023] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Cognitive behavioral therapy for insomnia (CBT-I) is the current first-line treatment for insomnia. However, rates of nonresponse and nonremission are high and effects on quality of life are only small to moderate, indicating a need for novel treatment developments. We propose that Acceptance and Commitment Therapy (ACT) addresses core pathophysiological pathways of insomnia. ACT therefore has the potential to improve treatment efficacy when combined with bedtime restriction, the most effective component of CBT-I. The aim of this study was to compare the efficacy of ACT for insomnia combined with bedtime restriction (ACT-I) and CBT-I in improving insomnia severity and sleep-related quality of life. METHODS Sixty-three patients with insomnia disorder (mean age 52 years, 65% female, 35% male) were randomly assigned to receive either ACT-I or CBT-I in a group format. The primary outcomes were insomnia severity (Insomnia Severity Index) and sleep-related quality of life (Glasgow Sleep Impact Index). Outcomes were assessed before randomization (T0), directly after treatment (T1), and at 6-month follow-up (T2). RESULTS The results indicated significant, large pre-to-post improvements in both groups, for both primary and secondary outcomes. Improvements were maintained at the 6-month follow-up. However, there was no significant group by time interactions in linear mixed models, indicating an absence of differential efficacy. On a subjective treatment satisfaction scale, patients in the ACT-I group indicated significantly greater satisfaction with their improvement of several aspects of health including their energy level and work productivity. CONCLUSIONS The results suggest that ACT-I is feasible and effective, but not more effective than CBT-I for the improvement of insomnia severity and sleep-related quality of life. Future studies are needed to assess whether ACT-I is noninferior to CBT-I and to shed light on mechanisms of change in both treatments.
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Affiliation(s)
- Elisabeth Hertenstein
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ersilia Trinca
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Carlotta L Schneider
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Kristoffer D Fehér
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anna F Johann
- Clinic for Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Nissen
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Division of Psychiatric Specialties, Department of Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
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Zilcha-Mano S. Individual-Specific Animated Profiles of Mental Health. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2024:17456916231226308. [PMID: 38377015 DOI: 10.1177/17456916231226308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
How important is the timing of the pretreatment evaluation? If we consider mental health to be a relatively fixed condition, the specific timing (e.g., day, hour) of the evaluation is immaterial and often determined on the basis of technical considerations. Indeed, the fundamental assumption underlying the vast majority of psychotherapy research and practice is that mental health is a state that can be captured in a one-dimensional snapshot. If this fundamental assumption, underlying 80 years of empirical research and practice, is incorrect, it may help explain why for decades psychotherapy failed to rise above the 50% efficacy rate in the treatment of mental-health disorders, especially depression, a heterogeneous disorder and the leading cause of disability worldwide. Based on recent studies suggesting within-individual dynamics, this article proposes that mental health and its underlying therapeutic mechanisms have underlying intrinsic dynamics that manifest across dimensions. Computational psychotherapy is needed to develop individual-specific pretreatment animated profiles of mental health. Such individual-specific animated profiles are expected to improve the ability to select the optimal treatment for each patient, devise adequate treatment plans, and adjust them on the basis of ongoing evaluations of mental-health dynamics, creating a new understanding of therapeutic change as a transition toward a more adaptive animated profile.
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Pettersson K, Liedgren P, Lyon AR, Hasson H, von Thiele Schwarz U. Fidelity-consistency and deliberateness of modifications in parenting programs. Implement Sci Commun 2024; 5:13. [PMID: 38351018 PMCID: PMC10865709 DOI: 10.1186/s43058-024-00545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Evidence-based interventions (EBIs) are frequently modified in practice. It is recommended that decisions to modify EBIs should be made deliberately to ensure fidelity-consistency, yet the relationship between fidelity-consistency and deliberateness is not well understood. This study aims to explore modifications in a sample of practitioners delivering evidence-based parenting programs (i.e., interventions to strengthen parent-child relationships, reduce harmful interactions, and improve child health and well-being). The study investigated three research questions: (1) What kind of modifications are made during the delivery of parenting programs? (2) To what degree are the identified modifications consistent with the core functions of each program? and (3) Is deliberateness associated with the fidelity-consistency of the identified modifications? METHODS In total, 28 group leaders of five widely disseminated parenting programs in Sweden participated in five focus groups, and two participants from each group also participated in individual interviews (n = 10). A content analysis approach was used where the identification of modifications was directed by the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) and then assessed for fidelity-consistency and four levels of deliberateness (universal, situational, conditional, and unintentional). Chi-square tests were performed to compare consistent and inconsistent modifications, and logistic regression was performed to explore whether deliberateness predicted consistency. RESULTS A total of 137 content modifications were identified, covering most of the content modification categories in FRAME. The most common were tailoring/tweaking/refining, adding elements, shortening/condensing, lengthening/extending, and integrating another treatment. Modifications were mostly fidelity-consistent but consistency varied greatly among categories. Furthermore, modifications made unintentionally or situationally were more likely to be fidelity-inconsistent. CONCLUSIONS These results indicate that explicit consideration of modifications and their impact could be essential for sustaining the fidelity-consistent use of EBIs, even as such interventions are continuously modified.
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Affiliation(s)
| | - Pernilla Liedgren
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Henna Hasson
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77, Stockholm, SE, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm County Council, 171 29, Stockholm, SE, Sweden
| | - Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77, Stockholm, SE, Sweden
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De Smet MM, Acke E, Cornelis S, Truijens F, Notaerts L, Meganck R, Desmet M. Understanding "patient deterioration" in psychotherapy from depressed patients' perspectives: A mixed methods multiple case study. Psychother Res 2024:1-15. [PMID: 38319980 DOI: 10.1080/10503307.2024.2309286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/12/2024] [Indexed: 02/08/2024] Open
Abstract
OBJECTIVE This study scrutinizes the meaning of deterioration in psychotherapy beyond the widely used statistical definition of reliable symptom increase pre-to-post treatment. METHOD An explanatory sequential mixed-methods multiple case study was conducted, combining quantitative pre-post outcome evaluation of self-reported depression symptoms and qualitative analysis of patients' interviews. In a Randomized Controlled Study on the treatment of Major Depression, three patients showing reliable increase in symptom severity on the BDI-II pre-to-post therapy were selected. An interpretative phenomenological analysis (IPA) was performed on individual interviews conducted pre-, peri- and post-treatment. RESULTS Cross-case outcome experiences were: (1) uncontrollable complaints; (2) remaining questions and uninternalized insights and (3) persisting interpersonal difficulties. Within-case idiosyncratic differences revealed that the statistical classification of "deterioration" not necessarily corresponds to a "deteriorated experience," nor univocally indicates unwanted therapy effects. Our findings point at the influences of the patient's (lack of) agency in the process, a discrepancy between patients' expectations and the therapy offer, the therapeutic relationship, interpersonal difficulties, and contextual influences. CONCLUSION The meaning of symptomatic deterioration should be interpreted within a patient's idiosyncratic context. The multi-faceted nature of deterioration requires further research to rely on multiple perspectives and mixed methods.
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Affiliation(s)
- Melissa Miléna De Smet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
- Research Foundation Flanders, FWO, Brussels, Belgium
| | - Emma Acke
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Shana Cornelis
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Femke Truijens
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Liza Notaerts
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Reitske Meganck
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Mattias Desmet
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
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Melicherova U, Schott T, Brucker M, Hoyer J, Köllner V. Originalbeiträge (Originals). Psychotherapeutic inpatient depression treatment in open versus closed group format. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2024; 70:6-23. [PMID: 37830880 DOI: 10.13109/zptm.2023.69.oa6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Controversy exists about the comparative efficacy of different group formats, e. g., open versus closed. Most of the findings come from outpatient, closed group research. In practice, the open format is more widely used. This monocentric study aims to compare the efficacy as well as group cohesion during inpatient group psychotherapy for depression delivered in an open versus closed format. METHODS 291 depressed inpatients (ageM= 55.7, SD = 11) of a psychosomatic-rehabilitation clinic were consecutively assigned to either open (n = 117) or closed (n = 174) cognitive-behavioral groups, further subdivided into groups based on length of the stay. Using multilevel models, we examined depression and group cohesion concerning changes in patients' random effects over time. RESULTS Both group formats showed a reduction in symptomatology (d = 1.8). A significant group format x time interaction in favor of the closed format was found regarding group cohesion. CONCLUSION While group cohesion improved in the closed format only, we did not find any significant difference between group formats regarding their efficacy. Further research should focus on randomized controlled trials comparing both formats directly.
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Andersson J, Hallin J, Tingström A, Knutsson J. Virtual reality exposure therapy for fear of spiders: an open trial and feasibility study of a new treatment for arachnophobia. Nord J Psychiatry 2024; 78:128-136. [PMID: 38295831 DOI: 10.1080/08039488.2023.2279643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/11/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE This analogue pilot study examined the feasibility (i.e. preliminary results, safety, acceptability) of a new single-session treatment for adults with a fear of spiders. MATERIALS It used state-of-the-art consumer available VR-hardware for therapist-assisted exposure (VRET-AP). The VRET-AP is largely adapted from Öst's one-session treatment for arachnophobia (Öst, 1987), with the aim of addressing shortcomings of previous VRET treatments, such as marked differences in procedures compared to available and evidence based in-vivo treatments. METHOD Participants (N = 12) were screened for fear of spiders using the Spider Phobia Questionnaire (SPQ), Fear Questionnaire (FQ) and the Behavioral Approach Test (BAT), prior to and directly after treatment in a repeated measures quasi-experimental design. In addition, acceptance and completion rates were measured and participants were interviewed about their experience of the treatment. Mean ratings as well as Reliable Change Index (RCI) for individual trajectories were analyzed. RESULTS The results from the preliminary data indicates potential for improvements with large effect sizes (d = 0.90-1,384) in all measurements of spider fear at post-treatment. Reliable Change Index (RCI) analysis showed that spider fear diminished in all twelve participants although the change was certain in only two. None deteriorated. All that responded accepted the treatment and all 11 participants completed all levels in the treatment. No concerns or adverse effects were reported in the interviews which largely confirm the quantitative results. CONCLUSION VRET-AP is a feasible alternative for delivering effective treatment for fear of spiders and the results motivate larger, randomized trials of VRET-AP involving participants diagnosed with arachnophobia.
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Affiliation(s)
| | - Joel Hallin
- Department of Psychiatry, Lund University, Lund, Sweden
| | | | - Jens Knutsson
- Department of Psychology, Lund University, Lund, Sweden
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Meisel SN, Boness CL, Miranda R, Witkiewitz K. Beyond mediators: A critical review and methodological path forward for studying mechanisms in alcohol use treatment research. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:215-229. [PMID: 38099412 PMCID: PMC10922633 DOI: 10.1111/acer.15242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 12/29/2023]
Abstract
Understanding how treatments for alcohol use disorder (AUD) facilitate behavior change has long been recognized as an important area of research for advancing clinical care. However, despite decades of research, the specific mechanisms of change for most AUD treatments remain largely unknown because most prior work in the field has focused only on statistical mediation. Statistical mediation is a necessary but not sufficient condition to establish evidence for a mechanism of change. Mediators are intermediate variables that account statistically for the relationship between independent and dependent variables, whereas mechanisms provide more detailed explanations of how an intervention leads to a desired outcome. Thus, mediators and mechanisms are not equivalent. To advance mechanisms of behavior change research, in this critical review we provide an overview of methodological shortfalls of existing AUD treatment mechanism research and introduce an etiologically informed precision medicine approach that facilitates the testing of mechanisms of behavior change rather than treatment mediators. We propose a framework for studying mechanisms in alcohol treatment research that promises to facilitate our understanding of behavior change and precision medicine (i.e., for whom a given mechanism of behavior change operates and under what conditions). The framework presented in this review has several overarching goals, one of which is to provide a methodological roadmap for testing AUD recovery mechanisms. We provide two examples of our framework, one pharmacological and one behavioral, to facilitate future efforts to implement this methodological approach to mechanism research. The framework proposed in this critical review facilitates the alignment of AUD treatment mechanism research with current theories of etiologic mechanisms, precision medicine efforts, and cross-disciplinary approaches to testing mechanisms. Although no framework can address all the challenges related to mechanisms research, our goal is to help facilitate a shift toward more rigorous and falsifiable behavior change research.
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Affiliation(s)
| | | | - Robert Miranda
- E. P. Bradley Hospital, Riverside, RI USA
- Department of Psychiatry & Human Behavior, Brown University, Providence, RI USA
| | - Katie Witkiewitz
- Center on Alcohol, Substance use, And Addictions, University of New Mexico
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Lund C. Addressing social determinants of mental health: a new era for prevention interventions. World Psychiatry 2024; 23:91-92. [PMID: 38214613 PMCID: PMC10786004 DOI: 10.1002/wps.21161] [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: 01/13/2024] Open
Affiliation(s)
- Crick Lund
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, London, UK
- A.J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Baudinet J, Eisler I, Konstantellou A, Simic M, Schmidt U. How young people perceive change to occur in family therapy for anorexia nervosa: a qualitative study. J Eat Disord 2024; 12:11. [PMID: 38254187 PMCID: PMC10804743 DOI: 10.1186/s40337-024-00971-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Family therapy for anorexia nervosa (FT-AN) is the first line recommended treatment for child and adolescent anorexia nervosa. Despite evidence of its efficacy, little is understood about the treatment mechanisms. This study aimed to understand how young people who have received FT-AN perceive change to occur across treatment. METHOD Fifteen adolescents (age 12-18 years) completed individual semi-structured interviews online. Recordings were transcribed verbatim and analysed using reflexive thematic analysis. RESULTS Four inter-connected themes describing the process of change during treatment were generated; (1) relationships as the vehicle for change, (2) an awakening, (3) through, not around - no way out, (4) the life beyond. CONCLUSIONS Current data match relatively closely with theoretical models of FT-AN and emphasise the importance of building trust with all family members, including the young person. Additionally, supporting the family to create a trusting context in which there is a sense that the only way out of the illness is by going through it (rather than avoiding it) is critical. Empirical investigation of each of the described mechanisms is needed.
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Affiliation(s)
- Julian Baudinet
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AZ, UK.
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
| | - Ivan Eisler
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AZ, UK
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Ulrike Schmidt
- Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AZ, UK
- Adult Eating Disorders Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
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Markowitz JC, Milrod BL. Affect-Focused and Exposure-Focused Psychotherapies. Am J Psychother 2024:appipsychotherapy20230012. [PMID: 38247343 DOI: 10.1176/appi.psychotherapy.20230012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The authors discuss the two broad domains of affect-focused and exposure-focused psychotherapies, defining the characteristics and potential advantages and disadvantages of each. The two domains differ in their theoretical approaches, structures, and techniques. Exposure-focused therapies have come to dominate research and practice, leading to the relative neglect of affect-focused therapies. When the two approaches have been examined in well-conducted clinical trials, they generally appear to be equally beneficial for treating common mood, anxiety, and trauma disorders, although further research may better define differential therapeutics. The authors argue for better training in affect awareness and tolerance across psychotherapies and use a brief case vignette to illustrate several aspects of these different approaches.
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Affiliation(s)
- John C Markowitz
- Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York City (Markowitz); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Milrod)
| | - Barbara L Milrod
- Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, New York City (Markowitz); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Milrod)
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Farrand P, Raue PJ, Ward E, Repper D, Areán P. Use and Engagement With Low-Intensity Cognitive Behavioral Therapy Techniques Used Within an App to Support Worry Management: Content Analysis of Log Data. JMIR Mhealth Uhealth 2024; 12:e47321. [PMID: 38029300 PMCID: PMC10809068 DOI: 10.2196/47321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/19/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Low-intensity cognitive behavioral therapy (LICBT) has been implemented by the Improving Access to Psychological Therapies services across England to manage excessive worry associated with generalized anxiety disorder and support emotional well-being. However, barriers to access limit scalability. A solution has been to incorporate LICBT techniques derived from an evidence-based protocol within the Iona Mind Well-being app for Worry management (IMWW) with support provided through an algorithmically driven conversational agent. OBJECTIVE This study aims to examine engagement with a mobile phone app to support worry management with specific attention directed toward interaction with specific LICBT techniques and examine the potential to reduce symptoms of anxiety. METHODS Log data were examined with respect to a sample of "engaged" users who had completed at least 1 lesson related to the Worry Time and Problem Solving in-app modules that represented the "minimum dose." Paired sample 2-tailed t tests were undertaken to examine the potential for IMWW to reduce worry and anxiety, with multivariate linear regressions examining the extent to which completion of each of the techniques led to reductions in worry and anxiety. RESULTS There was good engagement with the range of specific LICBT techniques included within IMWW. The vast majority of engaged users were able to interact with the cognitive behavioral therapy model and successfully record types of worry. When working through Problem Solving, the conversational agent was successfully used to support the user with lower levels of engagement. Several users engaged with Worry Time outside of the app. Forgetting to use the app was the most common reason for lack of engagement, with features of the app such as completion of routine outcome measures and weekly reflections having lower levels of engagement. Despite difficulties in the collection of end point data, there was a significant reduction in severity for both anxiety (t53=5.5; P<.001; 95% CI 2.4-5.2) and low mood (t53=2.3; P=.03; 95% CI 0.2-3.3). A statistically significant linear model was also fitted to the Generalized Anxiety Disorder-7 (F2,51=6.73; P<.001), while the model predicting changes in the Patient Health Questionnaire-8 did not reach significance (F2,51=2.33; P=.11). This indicates that the reduction in these measures was affected by in-app engagement with Worry Time and Problem Solving. CONCLUSIONS Engaged users were able to successfully interact with the LICBT-specific techniques informed by an evidence-based protocol although there were lower completion rates of routine outcome measures and weekly reflections. Successful interaction with the specific techniques potentially contributes to promising data, indicating that IMWW may be effective in the management of excessive worry. A relationship between dose and improvement justifies the use of log data to inform future developments. However, attention needs to be directed toward enhancing interaction with wider features of the app given that larger improvements were associated with greater engagement.
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Affiliation(s)
- Paul Farrand
- Clinical Education, Development and Research, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- Department of Psychology, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
| | - Patrick J Raue
- AIMS CENTER, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Earlise Ward
- School of Medicine and Public Health, Carbone Comprehensive Cancer Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Dean Repper
- Trent PTS, Improving Access to Psychological Therapies, Derby, United Kingdom
| | - Patricia Areán
- AIMS CENTER, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
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Elyoseph Z, Levkovich I, Shinan-Altman S. Assessing prognosis in depression: comparing perspectives of AI models, mental health professionals and the general public. Fam Med Community Health 2024; 12:e002583. [PMID: 38199604 PMCID: PMC10806564 DOI: 10.1136/fmch-2023-002583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) has rapidly permeated various sectors, including healthcare, highlighting its potential to facilitate mental health assessments. This study explores the underexplored domain of AI's role in evaluating prognosis and long-term outcomes in depressive disorders, offering insights into how AI large language models (LLMs) compare with human perspectives. METHODS Using case vignettes, we conducted a comparative analysis involving different LLMs (ChatGPT-3.5, ChatGPT-4, Claude and Bard), mental health professionals (general practitioners, psychiatrists, clinical psychologists and mental health nurses), and the general public that reported previously. We evaluate the LLMs ability to generate prognosis, anticipated outcomes with and without professional intervention, and envisioned long-term positive and negative consequences for individuals with depression. RESULTS In most of the examined cases, the four LLMs consistently identified depression as the primary diagnosis and recommended a combined treatment of psychotherapy and antidepressant medication. ChatGPT-3.5 exhibited a significantly pessimistic prognosis distinct from other LLMs, professionals and the public. ChatGPT-4, Claude and Bard aligned closely with mental health professionals and the general public perspectives, all of whom anticipated no improvement or worsening without professional help. Regarding long-term outcomes, ChatGPT 3.5, Claude and Bard consistently projected significantly fewer negative long-term consequences of treatment than ChatGPT-4. CONCLUSIONS This study underscores the potential of AI to complement the expertise of mental health professionals and promote a collaborative paradigm in mental healthcare. The observation that three of the four LLMs closely mirrored the anticipations of mental health experts in scenarios involving treatment underscores the technology's prospective value in offering professional clinical forecasts. The pessimistic outlook presented by ChatGPT 3.5 is concerning, as it could potentially diminish patients' drive to initiate or continue depression therapy. In summary, although LLMs show potential in enhancing healthcare services, their utilisation requires thorough verification and a seamless integration with human judgement and skills.
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Affiliation(s)
- Zohar Elyoseph
- Department of Psychology and Educational Counseling, The Center for Psychobiological Research, Max Stern Yezreel Valley College, Yezreel Valley, Israel
- Department of Brain Sciences, Imperial College London, London, UK
| | - Inbar Levkovich
- Faculty of Graduate Studies, Oranim Academic College, Tivon, Israel
| | - Shiri Shinan-Altman
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University, Ramat Gan, Tel Aviv, Israel
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Kumpasoğlu GB, Campbell C, Saunders R, Fonagy P. Therapist and treatment credibility in treatment outcomes: A systematic review and meta-analysis of clients' perceptions in individual and face-to-face psychotherapies. Psychother Res 2024:1-16. [PMID: 38176020 DOI: 10.1080/10503307.2023.2298000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE No systematic review was identified investigating the influence of perceived therapist credibility on treatment outcomes. Extant treatment credibility reviews have focused on early perceptions without considering influence of various therapy phases. This study aimed to examine the relationship between perceived treatment and therapist credibility and treatment outcomes, while considering the timing of the credibility assessment as a potential moderator. METHOD Articles published in English peer-reviewed journals containing at least one quantitative measure of credibility and treatment outcome regarding face-to-face therapist-delivered interventions were eligible. PsycINFO, MEDLINE and Embase online databases were last searched on April 5th, 2023, and the Effective Public Health Practice Project tool was used to assess the study quality. Correlations between treatment credibility and outcomes, and therapist credibility were calculated separately. RESULTS Analysis of 27 studies revealed a positive association between perceived treatment credibility and treatment outcome (r = 0.15,95%CI = 0.09,0.21,p < 0.001,n = 2061). Nine studies showed a strong association between perceived therapist credibility and outcome (r = 0.35,95%CI = 0.18,0.51;p < .001,n = 1161). No significant moderator found in both meta-analyses. CONCLUSION Findings suggest that clients' perceptions of higher credibility - whether concerning the treatment or the therapist - are associated with better therapeutic outcomes. Constraints in inclusion criteria and the small sample size in eligible studies were notable limitations.
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Affiliation(s)
- Güler Beril Kumpasoğlu
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
- Department of Psychology, Ankara University, Ankara, Turkey
| | - Chloe Campbell
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Rob Saunders
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Anna Freud National Centre for Children and Families, London, UK
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Høgenhaug SS, Kongerslev MT, Kjaersdam Telléus G. The role of interpersonal coordination dynamics in alliance rupture and repair processes in psychotherapy-A systematic review. Front Psychol 2024; 14:1291155. [PMID: 38239459 PMCID: PMC10794593 DOI: 10.3389/fpsyg.2023.1291155] [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: 09/08/2023] [Accepted: 11/27/2023] [Indexed: 01/22/2024] Open
Abstract
Introduction The purpose of this systematic review is to expand our knowledge of the underlying mechanisms of the alliance in psychotherapy. This is done by examining the association between alliance rupture and repair processes and interpersonal coordination dynamics. Method A systematic review based on PRISMA guidelines was conducted, aimed at papers investigating the association between alliance rupture and repair episodes and different behavioral modalities (i.e., physiology, movement) in the psychotherapeutic interaction. Seventeen studies were included for full text-analysis. Results The results indicate that rupture and repair episodes were associated with interpersonal coordination dynamics. Different modalities (movement, heart rate, and vocalization) were found to serve as markers for alliance rupture and repair events. Facial expressions, physiological arousal, vocalization, and behavior were found to play important roles in the therapeutic interaction in relation to mutual emotion regulation, empathic response, safety, trust, and meaning-making. Discussion Limitations of this review are discussed, including the great methodological variation and selection bias observed in the reviewed studies. Recommendations for future research in this area are presented. Overall, interpersonal coordination dynamics was found to have the potential to help identify and manage alliance ruptures and foster repairs in the therapeutic interaction, which has high potential for future clinical work and training.
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Affiliation(s)
- S. S. Høgenhaug
- Clinic North, Psychiatric Hospital, Bronderslev, Denmark
- Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - M. T. Kongerslev
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Mental Health Services West, Region Zealand, Slagelse, Denmark
| | - G. Kjaersdam Telléus
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Psychology, Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
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Liu W, Yuan J, Wu Y, Xu L, Wang X, Meng J, Wei Y, Zhang Y, Kang CY, Yang JZ. A randomized controlled trial of mindfulness-based cognitive therapy for major depressive disorder in undergraduate students: Dose- response effect, inflammatory markers and BDNF. Psychiatry Res 2024; 331:115671. [PMID: 38101069 DOI: 10.1016/j.psychres.2023.115671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/28/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Abstract
To examine the dose-response effect of mindfulness-based cognitive therapy (MBCT) for college students with major depressive disorder (MDD), a randomized control trial with MBCT and a wait-list (WL) group was performed. All participants were invited to self-administer a set of questionnaires at baseline, mid-intervention (4th week), and post-intervention (8th week) by the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder scale (GAD-7), the Pittsburgh Sleep Quality Index (PSQI), the Five Facet Mindfulness Questionnaire (FFMQ), the Self-Compassion Scale (SCS). The serum levels of IL-1β, IL-6, IL-8, TNF-α, BDNF were detected at baseline and post-intervention. After intervention, the scores of PHQ-9, GAD-7, PSQI, and the levels of IL-1β, IL-6, IL-8 and TNF-α in the MBCT were significantly lower than those in WL group, and total scores of FFMQ, SCS, and the level of BDNF were significantly higher than those in WL group. In MBCT group, daily practice time and session numbers positively related to reduction rates of PHQ-9, GAD-7 and PSQI at post-intervention. The reduction rate of PHQ-9, GAD-7 and PSQI at post-intervention in the completers were higher significantly than those in the partial attendees. These findings suggested MBCT is effective for MDD, and the intervention has a dose-response effect. TRIAL REGISTRATION: Registration number is [ChiCTR2100044309].
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Affiliation(s)
- Wei Liu
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jing Yuan
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yun Wu
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Li Xu
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xin Wang
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Junyu Meng
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yujun Wei
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Yan Zhang
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chuan-Yuan Kang
- Department of Psychosomatic Medicine, Tongji University School of Medicine, Shanghai East Hospital, Shanghai, 200120, China.
| | - Jian-Zhong Yang
- Department of Psychiatry, the Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China; Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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Miller KE, Rasmussen A, Jordans MJD. Strategies to improve the quality and usefulness of mental health trials in humanitarian settings. Lancet Psychiatry 2023; 10:974-980. [PMID: 37879349 DOI: 10.1016/s2215-0366(23)00273-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 10/27/2023]
Abstract
A striking rise in the number of people affected by humanitarian crises has led to an increase in mental health and psychosocial support interventions to reduce the psychological effects of such crises. In a parallel trend, researchers have brought increased methodological rigour to their evaluation of these interventions. However, several methodological issues still constrain the quality and real-world relevance of the existing evidence base. We examine five core challenges in randomised controlled trials of mental health and psychosocial support interventions with conflict-affected and disaster-affected populations. These challenges are: translating intervention effects into metrics of real-world significance; giving adequate consideration to the selection and monitoring of control conditions; following rigorous processes to ensure outcome measures are culturally appropriate and psychometrically sound; ensuring and monitoring implementation variables, including fidelity, exposure, participant engagement, and the competence of implementation staff; and assessing mechanisms of change.
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Affiliation(s)
- Kenneth E Miller
- Department of Educational and Counselling Psychology, and Special Education, Faculty of Education, University of British Columbia, Vancouver, BC, Canada.
| | - Andrew Rasmussen
- Department of Psychology, Fordham University, New York City, NY, USA
| | - Mark J D Jordans
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, Netherlands
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Conklin DY, Karakurt G. Women with mood disorders and couples conflict: menopause symptom improvement, after group therapy. Climacteric 2023; 26:565-570. [PMID: 37387363 DOI: 10.1080/13697137.2023.2223922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/17/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Although a public health crisis, intimate partner violence (IPV) has been understudied for middle-aged women with mood disorders during their perimenopausal and postmenopausal years. The aims of this study were to examine the relationship between IPV and hot flashes/night sweats (HF/NS) frequency and severity among women with mood disorders and to test whether the effect of cognitive behavioral group therapy on menopausal symptoms differs between those with and without IPV at baseline and post-test. METHODS Of 59 participants from a mood disorders outpatient clinic enrolled in the parent study, 24 experienced IPV. This study analyzed pretreatment and post-treatment data from the Revised Conflict Tactic Scale - Short Form-2, and HF/NS frequency and severity ratings on the Hot Flash Daily Diary using the McNemar chi-square test. RESULTS The presence of any type of violence at pretreatment was significantly (p < 0.01) linked to improvements in HF/NS frequency and severity. Women who showed improvements in negotiation skills had better outcomes in menopausal symptoms. Sexual coercion increased from one to three women. CONCLUSIONS Negotiation skills may help women with mood disorders to reduce HF/NS frequency and severity. More studies need to be conducted with a special focus on helping women in this population.
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Affiliation(s)
- D Y Conklin
- Department of Psychiatry, Case Western Reserve University, School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - G Karakurt
- Department of Psychiatry, Case Western Reserve University, School of Medicine, Cleveland, OH, USA
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Salkovskis PM, Sighvatsson MB, Sigurdsson JF. How effective psychological treatments work: mechanisms of change in cognitive behavioural therapy and beyond. Behav Cogn Psychother 2023; 51:595-615. [PMID: 38180111 DOI: 10.1017/s1352465823000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) has, in the space of 50 years, evolved into the dominant modality in psychological therapy. Mechanism/s of change remain unclear, however. AIMS In this paper, we will describe key features of CBT that account for the pace of past and future developments, with a view to identifying candidates for mechanism of change. We also highlight the distinction between 'common elements' and 'mechanisms of change' in psychological treatment. METHOD The history of how behaviour therapy and cognitive therapy developed are considered, culminating in the wide range of strategies which now fall under the heading of cognitive behavioural therapy (CBT). We consider how the empirical grounding of CBT has led to the massive proliferation of effective treatment strategies. We then consider the relationship between 'common factors' and 'mechanisms of change', and propose that a particular type of psychological flexibility is the mechanism of change not only in CBT but also effective psychological therapies in general. CONCLUSION Good psychological therapies should ultimately involve supporting people experiencing psychological difficulties to understand where and how they have become 'stuck' in terms of factors involved in maintaining distress and impairment. A shared understanding is then evaluated and tested with the intention of empowering and enabling them to respond more flexibly and thereby reclaim their life.
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Affiliation(s)
- Paul M Salkovskis
- University of Oxford Department of Experimental Psychology and Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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