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Barr BL, McIntosh VVW, Britt EF, Jordan J, Carter JD. Clinical factors and early life experiences associated with therapeutic alliance development in treatment for depression or binge eating. Psychother Res 2024; 34:4-16. [PMID: 37079925 DOI: 10.1080/10503307.2023.2191800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 03/10/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE This study examines childhood and clinical factors theorized to impact therapeutic alliance development over the course of psychotherapy. METHOD Raters assessed the therapeutic alliance of 212 client-therapist dyads, participating in two randomized controlled trials of schema therapy and cognitive behavioural therapy for binge eating or major depression, at three time points. Linear mixed models were used to characterize therapeutic alliance development over time and assess the influence of childhood trauma, perceived parental bonding, diagnosis and therapy type on scores. RESULTS Participants differed in initial alliance ratings for all subscales but had similar growth trajectories in all but the patient hostility subscale. A diagnosis of bulimia nervosa or binge eating disorder predicted greater initial levels of client distress, client dependency and overall client contribution to a strong therapeutic alliance, compared with a diagnosis of depression. Therapy type, childhood trauma and perceived parental bonds did not predict alliance scores. CONCLUSION Findings highlight the potential influence of clinical and personal characteristics on alliance strength and development, with implications for maximizing treatment outcomes through anticipating and responding to these challenges.
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Affiliation(s)
- Brogan L Barr
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Virginia V W McIntosh
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Eileen F Britt
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Te Whatu Ora Health New Zealand - Waitaha, Canterbury, New Zealand
| | - Janet D Carter
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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Kashyap H, Mehta UM, Reddy RP, Bharath RD. Role of Cognitive Control in Psychotherapy: An Integrated Review. Indian J Psychol Med 2023; 45:462-470. [PMID: 37772131 PMCID: PMC10523513 DOI: 10.1177/02537176221128611] [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] [Indexed: 09/30/2023] Open
Abstract
Background Cognitive control (CC), including shifting, updating, and inhibiting functions, may play an integral role in various aspects of psychotherapy; however, research on this is limited. This review aims to link the disparate lines of evidence on CC as they relate to psychotherapy processes, techniques, and outcomes. Methods A systematic search of the literature on neuropsychological domains relating to psychotherapy in adults with anxiety/depression yielded 18 eligible studies. The review also uses a narrative format to explore other potential links between CC and psychotherapy that are underinvestigated, and highlights the need for research and application to evidence-based practice of psychotherapy. Results and conclusions Findings suggest that CC may predict psychotherapy outcomes and also improve as a function of psychotherapy. Analog sample studies suggest a possible link between CC and techniques for regulation of cognition and emotion, such as reappraisal, mindfulness, and cognitive restructuring. CC may also play an integral role in the regulation of behavior. Study of CC in the context of psychotherapy may potentially explain individual differences in psychotherapy outcomes and mechanisms of action of various psychotherapy techniques and processes. Such an understanding may have possible implications for "best fit" matching clients to therapies and modifying psychological interventions to account for poorer CC abilities. CC may be enhanced through training and further research is warranted on the impact of such training in facilitating better long-term psychotherapy outcomes.
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Affiliation(s)
- Himani Kashyap
- Dept. of Clinical Psychology & Cognite
Clinic, National Institute of Mental Health And Neuro Sciences, Bengaluru, Karnataka,
India
| | - Urvakhsh Meherwan Mehta
- Dept. of Psychiatry, National Institute of
Mental Health And Neuro Sciences, Bengaluru, Karnataka, India
| | - Rajakumari P. Reddy
- Dept. of Clinical Psychology & Cognite
Clinic, National Institute of Mental Health And Neuro Sciences, Bengaluru, Karnataka,
India
| | - Rose Dawn Bharath
- Dept. of Neuroimaging and Interventional
Radiology, National Institute of Mental Health And Neuro Sciences, Bengaluru, Karnataka,
India
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Bernhardt M, Schwert C, Aschenbrenner S, Weisbrod M, Schröder A. Longitudinal Changes of Cognitive Deficits and Treatment Outcome of Cognitive Behavioral Therapy for Major Depression. J Nerv Ment Dis 2021; 209:336-342. [PMID: 33555821 DOI: 10.1097/nmd.0000000000001301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT The current study examined neuropsychological changes over the course of cognitive behavioral therapy (CBT) in outpatients with major depressive disorder and the influence of cognitive deficits as predictors of clinical outcome in depression. A neuropsychological test battery was carried out on depressed outpatients (N = 54) at the beginning and at the end of CBT. Small improvements were found in divided attention, figural memory, and processing speed from pre- to posttreatment. Cognitive deficits in executive functions before treatment predicted the clinical outcome at the end of CBT. The present study reveals that attention and memory deficits are most likely to improve over the course of treatment, whereas executive functions remain stable in the long term. Depressed patients with worse executive functions at the beginning of treatment seem to benefit more from long-term CBT therapy.
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Affiliation(s)
- Maren Bernhardt
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau
| | - Christine Schwert
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau
| | - Steffen Aschenbrenner
- Department of Psychiatry and Psychotherapy, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad
| | | | - Annette Schröder
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau
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Kopf-Beck J, Zimmermann P, Egli S, Rein M, Kappelmann N, Fietz J, Tamm J, Rek K, Lucae S, Brem AK, Sämann P, Schilbach L, Keck ME. Schema therapy versus cognitive behavioral therapy versus individual supportive therapy for depression in an inpatient and day clinic setting: study protocol of the OPTIMA-RCT. BMC Psychiatry 2020; 20:506. [PMID: 33054737 PMCID: PMC7557007 DOI: 10.1186/s12888-020-02880-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Major depressive disorder represents (MDD) a major cause of disability and disease burden. Beside antidepressant medication, psychotherapy is a key approach of treatment. Schema therapy has been shown to be effective in the treatment of psychiatric disorders, especially personality disorders, in a variety of settings and patient groups. Nevertheless, there is no evidence on its effectiveness for MDD in an inpatient nor day clinic setting and little is known about the factors that drive treatment response in such a target group. METHODS In the current protocol, we outline OPTIMA (OPtimized Treatment Identification at the MAx Planck Institute): a single-center randomized controlled trial of schema therapy as a treatment approach for MDD in an inpatient and day clinic setting. Over the course of 7 weeks, we compare schema therapy with cognitive behavioral therapy and individual supportive therapy, conducted in individual and group sessions and with no restrictions regarding concurrent antidepressant medication, thus approximating real-life treatment conditions. N = 300 depressed patients are included. All study therapists undergo a specific training and supervision and therapy adherence is assessed. Primary outcome is depressive symptom severity as self-assessment (Beck Depression Inventory-II) and secondary outcomes are clinical ratings of MDD (Montgomery-Asberg Depression Rating Scale), recovery rates after 7 weeks according to the Munich-Composite International Diagnostic Interview, general psychopathology (Brief Symptom Inventory), global functioning (World Health Organization Disability Assessment Schedule), and clinical parameters such as dropout rates. Further parameters on a behavioral, cognitive, psychophysiological, and biological level are measured before, during and after treatment and in 2 follow-up assessments after 6 and 24 months after end of treatment. DISCUSSION To our knowledge, the OPTIMA-Trial is the first to investigate the effectiveness of schema therapy as a treatment approach of MDD, to investigate mechanisms of change, and explore predictors of treatment response in an inpatient and day clinic setting by using such a wide range of parameters. Insights from OPTIMA will allow more integrative approaches of psychotherapy of MDD. Especially, the identification of intervention-specific markers of treatment response can improve evidence-based clinical decision for individualizing treatment. TRIAL REGISTRATION Identifier on clinicaltrials.gov : NCT03287362 ; September, 12, 2017.
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Affiliation(s)
- Johannes Kopf-Beck
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany.
| | - Petra Zimmermann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Samy Egli
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Martin Rein
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Nils Kappelmann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Julia Fietz
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Munich, Germany
| | - Jeanette Tamm
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Katharina Rek
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- University of Kassel, Kassel, Germany
| | - Susanne Lucae
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Anna-Katharine Brem
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Berenson-Allen Center for Noninvasive Brain Stimulation, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland
- Department of Neuropsychology, Lucerne Psychiatry, Lucerne, Switzerland
| | - Philipp Sämann
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
| | - Leonhard Schilbach
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Independent Max Planck Research Group for Social Neuroscience, München, Germany
- Ludwig-Maximilians-Universität, Munich, Germany
| | - Martin E Keck
- Max Planck Institute of Psychiatry, Kraepelinstraße 2-10, 80804, Munich, Germany
- Schmieder Hospital in Gailingen, Gailingen, Germany
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Bruijniks SJE, Sijbrandij M, Huibers MJH. The effects of retrieval versus rehearsal of online problem-solving therapy sessions on recall, problem-solving skills and distress in distressed individuals: An experimental study. J Behav Ther Exp Psychiatry 2020; 66:101485. [PMID: 31491535 DOI: 10.1016/j.jbtep.2019.101485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/29/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Improving memory for the content of therapy sessions might increase the effects of psychological interventions. Previous studies showed that healthy individuals who took a memory test (retrieval) of studied material showed better long-term memory retention than individuals who restudied (rehearsal) the material. The aim of the current study was to find out whether we can translate these findings to a subclinical setting. METHODS Individuals with moderate levels of distress were randomized into retrieving (n = 46) or rehearsing (n = 49) four weekly sessions of online Problem-Solving Therapy (PST). Session recall, problem-solving skills and distress were measured at baseline, three days after each session and at one-week follow-up. RESULTS Retrieval led to overall higher recall, but this difference disappeared when controlling for the time spent on retrieval versus rehearsal. Retrieval did not lead to better problem-solving skills or less distress, compared to rehearsal. Baseline working memory performance moderated the effect of condition on recall after controlling for the time spent on retrieval versus rehearsal: the effect of retrieval compared to rehearsal on recall was larger for individuals with lower working memory performance. LIMITATIONS The sample mostly consisted of university students with overall high working memory scores. CONCLUSIONS This study provided the first evidence that retrieval of the content of PST sessions may lead to better session recall compared to rehearsal of the PST sessions in individuals with a low working memory score. Implications for the use of cognitive support strategies within a therapeutic setting are discussed.
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Affiliation(s)
- Sanne J E Bruijniks
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands.
| | - Marit Sijbrandij
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands
| | - Marcus J H Huibers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, the Netherlands; Department of Psychology, University of Pennsylvania, Philadelphia, United States
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