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Herzog P, Kaiser T, Rief W, Brakemeier EL, Kube T. Assessing Dysfunctional Expectations in Posttraumatic Stress Disorder: Development and Validation of the Posttraumatic Expectations Scale (PTES). Assessment 2023; 30:1285-1301. [PMID: 35549727 DOI: 10.1177/10731911221089038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dysfunctional expectations are a particularly important subset of cognitions that influence the development and maintenance of various mental disorders. This study aimed to develop and validate a scale to assess dysfunctional expectations in posttraumatic stress disorder (PTSD), the "Posttraumatic Expectations Scale" (PTES). In a cross-sectional study, 70 PTSD patients completed the PTES, the Posttraumatic Cognitions Inventory (PTCI), as well as measures of the severity of symptoms of PTSD and depression. The results show that the PTES has excellent internal consistency and correlates significantly with the PTCI and PTSD symptom severity. A regression analysis revealed that the PTES explained variance of PTSD symptom severity above the PTCI, supporting the incremental validity of the PTES. While the original version of the PTES comprises 81 items, short scales were constructed using the BISCUIT (best items scales that are cross-validated, unit-weighted, informative and transparent) method. The current findings provide preliminary psychometric evidence suggesting that the PTES is an internally consistent and valid novel self-report measure in patients with PTSD. However, conclusions about the psychometric properties of the PTES are limited because of the absence of criterion-related validity, factor structure evidence, variability over time/response to intervention, and test-retest reliability. Future research should use the PTES in large-scale longitudinal studies to address these aspects to further validate the scale.
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Affiliation(s)
- Philipp Herzog
- Philipps-University Marburg, Germany
- University of Greifswald, Germany
- University of Koblenz-Landau, Germany
| | | | | | | | - Tobias Kube
- Philipps-University Marburg, Germany
- University of Koblenz-Landau, Germany
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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Coyne AE, Constantino MJ, Muir HJ, Gaines AN, Vîslă A. Participant factors as correlates of patients' psychotherapy outcome expectation: A meta-analytic and box-count review. Psychother Res 2023:1-15. [PMID: 37079855 DOI: 10.1080/10503307.2023.2197629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE More positive pre- or early therapy patient outcome expectation (OE) has consistently correlated with better treatment outcomes. Thus, it is important to identify factors that contribute to patients' OE, which can inform therapist responsivity to such risk or facilitative markers. With growing research on OE correlates-centered primarily on patient characteristics/treatment factors and, to a lesser extent, therapist factors-a comprehensive synthesis is warranted to elucidate replicated and mixed associations and stimulate further research. Accordingly, we set a pragmatic cutoff of k ≥ 5 for meaningful empirical aggregation of participant factor-OE associations; otherwise, we conducted box counts. METHOD We searched for articles published through March 2022 that included a clinical sample, a measure of patient's pre- or early treatment OE, and an explicit test of the factor-OE association. RESULTS Patient problem severity, problem chronicity, education, age, and quality of life were meta-analyzed. Greater severity correlated with lower/less optimistic OE (r = -0.13, p < .001) and higher QOL correlated with higher/more optimistic OE (r = 0.18, p < .001). Box counts revealed that few variables had consistent associations with OE. CONCLUSIONS Some factors can help forecast patient OE, though additional research is needed to enhance confidence and clinical meaning.
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Affiliation(s)
- Alice E Coyne
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Heather J Muir
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Averi N Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Andreea Vîslă
- Department of Psychology, University of Zurich, Zurich, Switzerland
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3
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Wiebe A, Kannen K, Selaskowski B, Mehren A, Thöne AK, Pramme L, Blumenthal N, Li M, Asché L, Jonas S, Bey K, Schulze M, Steffens M, Pensel MC, Guth M, Rohlfsen F, Ekhlas M, Lügering H, Fileccia H, Pakos J, Lux S, Philipsen A, Braun N. Virtual reality in the diagnostic and therapy for mental disorders: A systematic review. Clin Psychol Rev 2022; 98:102213. [PMID: 36356351 DOI: 10.1016/j.cpr.2022.102213] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/21/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders. OBJECTIVE To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders. DATA SOURCE Systematic literature searches via PubMed (last literature update: 9th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders. ELIGIBILITY CRITERIA To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology. STUDY EVALUATION For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria. RESULTS Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder. CONCLUSION While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application. REVIEW REGISTRATION PROSPERO register CRD42020188436. FUNDING The review was funded by budgets from the University of Bonn. No third party funding was involved.
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Affiliation(s)
- Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Aylin Mehren
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Ann-Kathrin Thöne
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Pramme
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Nike Blumenthal
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mengtong Li
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephan Jonas
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Maria Steffens
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Max Christian Pensel
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Matthias Guth
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Felicia Rohlfsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mogda Ekhlas
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Lügering
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Fileccia
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Julian Pakos
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
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Yeager CM, Benight CC. Engagement, Predictors, and Outcomes of a Trauma Recovery Digital Mental Health Intervention: Longitudinal Study. JMIR Ment Health 2022; 9:e35048. [PMID: 35499857 PMCID: PMC9112079 DOI: 10.2196/35048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/28/2022] [Accepted: 03/05/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Worldwide, exposure to potentially traumatic events is extremely common, and many individuals develop posttraumatic stress disorder (PTSD) along with other disorders. Unfortunately, considerable barriers to treatment exist. A promising approach to overcoming treatment barriers is a digital mental health intervention (DMHI). However, engagement with DMHIs is a concern, and theoretically based research in this area is sparse and often inconclusive. OBJECTIVE The focus of this study is on the complex issue of DMHI engagement. On the basis of the social cognitive theory framework, the conceptualization of engagement and a theoretically based model of predictors and outcomes were investigated using a DMHI for trauma recovery. METHODS A 6-week longitudinal study with a national sample of survivors of trauma was conducted to measure engagement, predictors of engagement, and mediational pathways to symptom reduction while using a trauma recovery DMHI (time 1: N=915; time 2: N=350; time 3: N=168; and time 4: N=101). RESULTS Confirmatory factor analysis of the engagement latent constructs of duration, frequency, interest, attention, and affect produced an acceptable model fit (χ22=8.3; P=.02; comparative fit index 0.973; root mean square error of approximation 0.059; 90% CI 0.022-0.103). Using the latent construct, the longitudinal theoretical model demonstrated adequate model fit (comparative fit index 0.929; root mean square error of approximation 0.052; 90% CI 0.040-0.064), indicating that engagement self-efficacy (β=.35; P<.001) and outcome expectations (β=.37; P<.001) were significant predictors of engagement (R2=39%). The overall indirect effect between engagement and PTSD symptom reduction was significant (β=-.065; P<.001; 90% CI -0.071 to -0.058). This relationship was serially mediated by both skill activation self-efficacy (β=.80; P<.001) and trauma coping self-efficacy (β=.40; P<.001), which predicted a reduction in PTSD symptoms (β=-.20; P=.02). CONCLUSIONS The results of this study may provide a solid foundation for formalizing the nascent science of engagement. Engagement conceptualization comprised general measures of attention, interest, affect, and use that could be applied to other applications. The longitudinal research model supported 2 theoretically based predictors of engagement: engagement self-efficacy and outcome expectancies. A total of 2 task-specific self-efficacies-skill activation and trauma coping-proved to be significant mediators between engagement and symptom reduction. Taken together, this model can be applied to other DMHIs to understand engagement, as well as predictors and mechanisms of action. Ultimately, this could help improve the design and development of engaging and effective trauma recovery DMHIs.
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Affiliation(s)
- Carolyn M Yeager
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
| | - Charles C Benight
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, United States
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Matthews SR, Elizabeth M, Roberts LN, Nixon RDV. Client Versus Clinicians' Standards of Clinically Meaningful Change and the Effects of Treatment Expectations on Therapeutic Outcomes in Individuals With Posttraumatic Stress Disorder. Behav Ther 2022; 53:560-570. [PMID: 35473657 DOI: 10.1016/j.beth.2021.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/19/2021] [Accepted: 12/20/2021] [Indexed: 11/02/2022]
Abstract
There is limited research on the concordance between client perceptions and clinician standards of the degree of symptom change required to achieve meaningful therapeutic improvement. This was investigated in an adult sample (N = 147) who received trauma-focused cognitive-behavioral therapies for posttraumatic stress disorder (PTSD). We examined whether clients' benchmarks of change were related to actual outcomes and the relationship between client expectations and their treatment outcomes. Clients completed measures indexing the level of symptom reduction required (in their view) to reflect a benefit or recovery from treatment and treatment expectations. Actual PTSD severity was indexed pre- and posttreatment via self-report and clinician-administered interview. Results demonstrated that the amount of change clients said they required to experience a benefit or recovery was significantly larger than typical clinical research standards. Nonetheless, the majority of client benchmarks of change (79.7-81.8%) were consistent with clinical research standards of what constitutes benefit or recovery. Client benchmarks were generally positively correlated with their actual outcomes. Clients' belief that treatment would be successful was associated with greater reductions in PTSD symptoms. These findings provide preliminary evidence that the standards used to determine clinically significant change are somewhat consistent with clients' own perceptions of required symptom change.
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Affiliation(s)
| | - Marja Elizabeth
- College of Education, Psychology and Social Work, Flinders University
| | - Larissa N Roberts
- College of Education, Psychology and Social Work, Flinders University
| | - Reginald D V Nixon
- Órama Institute for Mental Health and Wellbeing; College of Education, Psychology and Social Work, Flinders University.
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6
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Maglione MA, Chen C, Franco M, Gizaw M, Shahidinia N, Baxi S, Hempel S. Effect of patient characteristics on posttraumatic stress disorder treatment retention among veterans: A systematic review. J Trauma Stress 2022; 35:718-728. [PMID: 34800059 DOI: 10.1002/jts.22757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/08/2022]
Abstract
To identify baseline patient characteristics (i.e., demographic and psychological factors, military background) associated with better posttraumatic stress disorder (PTSD) treatment retention among veterans, we conducted a systematic review. After an electronic database search for studies of PTSD treatment in veterans, two reviewers independently screened the literature for eligibility, abstracted study-level information, and assessed risk of bias. As most studies used multivariate models to assess multiple potential predictors of retention simultaneously, the results were described narratively. The GRADE approach, adapted for prognostic literature, was used to assess the overall quality of evidence (QoE). In total, 19 studies reported in 25 publications met the inclusion criteria (n = 6 good quality, n = 9 fair quality, n = 4 poor quality). Definitions of treatment completion and dropout varied, and some studies lumped different therapy approaches together. Older age and higher treatment expectations were associated with better retention (moderate QoE). In 5 of 6 studies, baseline PTSD severity was not associated with retention, and the remaining study reported an association between better retention and more severe PTSD symptoms; the presence of more co-occurring psychiatric disorders was associated with better retention (moderate QoE). QoE was low or insufficient to support conclusions for any other characteristics due to inconsistent results, imprecision, potential publication bias, possible study population overlap, study limitations, or lack of studies. More research is needed regarding the associations between modifiable factors (e.g., motivation, barriers, expectations) and retention, and consistent definitions of treatment completion and minimally adequate treatment should be adopted throughout the field.
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Affiliation(s)
- Margaret A Maglione
- RAND Corporation, Santa Monica, California, USA.,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | | | | | | | | | - Susanne Hempel
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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7
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Nieforth LO, Rodriguez KE, O’Haire ME. Expectations versus experiences of veterans with posttraumatic stress disorder (PTSD) service dogs: An inductive conventional content analysis. Psychol Trauma 2022; 14:347-356. [PMID: 33630635 PMCID: PMC8483598 DOI: 10.1037/tra0001021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
[Correction Notice: An Erratum for this article was reported in Vol 14(3) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2022-33825-001). In this article, the length of time in which service dogs had been paired with Veterans was reported incorrectly in the third paragraph under the "Participants" heading of the "Methods" section whereby the sentence "Participants with a service dog had received their PTSD service dog an average of 51.5 months prior to participating in the study (range = 3-121.7 months, SD = 33.3)." should have read "Participants with a service dog had received their PTSD service dog an average of 20.9 months prior to participating in the study (range = 1.2-46.23 months, SD = 13.18)." All versions of this article have been corrected.] Objective: The objective of this study was twofold: to describe the benefits and drawbacks of a posttraumatic stress disorder (PTSD) service dog from the perspective of Veterans with service dogs and to compare these reports to the expectations of Veterans who were on a waitlist for a PTSD service dog. Method: A total of 128 U.S. post-9/11 Veterans with PTSD were recruited from a nonprofit service dog provider (K9s for Warriors), including n = 69 with a PTSD service dog and n = 59 on the waitlist. Participant responses to open-ended survey questions were analyzed with conventional content analysis and classified into 214 codes across six subthemes, creating three larger themes. A subset (20%) of the data was independently coded to establish interrater reliability (Cohen's κ = .804). Frequency data were used to compare theme and subtheme prevalence between groups. Results: Veterans' experiences and expectations were centered on the effects the service dogs had on Veteran mental health, human-dog interaction, and the associated drawbacks. Although the majority of Veterans reported benefits from their service dogs, the findings revealed that Veterans on the waitlist more frequently mentioned benefits than those with a service dog. Study findings suggest that the drawbacks expected from service dogs differ from the drawbacks experienced. Conclusion: Understanding expectations versus experiences provides critical information for mental health professionals who are informing Veterans on individualized interventions for PTSD. This knowledge will enable professionals to temper expectations and educate Veterans on specific benefits and drawbacks so that they have a more rounded view of PTSD service dogs. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Beck JG, Clapp JD, Unger W, Wattenberg M, Sloan DM. Moderators of PTSD symptom change in group cognitive behavioral therapy and group present centered therapy. J Anxiety Disord 2021; 80:102386. [PMID: 33799175 PMCID: PMC8487250 DOI: 10.1016/j.janxdis.2021.102386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 01/13/2021] [Accepted: 03/18/2021] [Indexed: 11/17/2022]
Abstract
To examine moderators of change during group-based intervention for Posttraumatic Stress Disorder (PTSD), multilevel models were used to assess trajectories of symptom clusters in male veterans receiving trauma focused Group Cognitive Behavioral Treatment (gCBT; N = 84) or non-trauma focused Group Present Centered Therapy (gPCT; N = 91; Sloan et al., 2018). Separate models were conducted for symptom clusters in each intervention, examining pre-treatment PTSD symptoms, pre-treatment depression severity, age, index trauma, and outcome expectancies as potential moderators. Unconditioned growth models for both gCBT and gPCT showed reductions in intrusions, avoidance, negative cognitions/mood, and arousal/reactivity (all p < .001). Distinct moderators of recovery emerged for each treatment. Reductions in avoidance during gCBT were strongest at high levels of pre-treatment PTSD symptoms (low PTSD: p = .964, d = .05; high PTSD: p < .001, d = 1.31) whereas positive outcome expectancies enhanced reductions in cognitions/mood (low Expectancy: p = .120, d = .50; high Expectancy: p < .001, d = 1.13). For gPCT, high levels of pre-treatment depression symptoms negatively impacted change in both intrusion (low depression: p < .001, d = .96; high depression: p = .376, d = .22) and arousal/reactivity (low depression: p < .001, d = .95; high depression: p = .092, d = .39) symptoms. Results support the importance of examining trajectories of change and their moderators for specific treatments, particularly when contrasting trauma focused and non-trauma focused treatments.
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Affiliation(s)
- J Gayle Beck
- University of Memphis, Department of Psychology, Memphis, TN, USA.
| | - Joshua D Clapp
- University of Wyoming, Department of Psychology, Laramie, WY, USA
| | | | | | - Denise M Sloan
- VA Boston Healthcare System, Boston, MA, USA; Boston University School of Medicine, Department of Psychiatry, Boston, MA, USA
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Luong HK, Drummond SPA, Norton PJ. Elements of the therapeutic relationship in CBT for anxiety disorders: A systematic review. J Anxiety Disord 2020; 76:102322. [PMID: 33035773 DOI: 10.1016/j.janxdis.2020.102322] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/15/2020] [Accepted: 09/27/2020] [Indexed: 12/21/2022]
Abstract
To optimise the effects of cognitive behaviour therapy (CBT) for anxiety disorders, research has increasingly focussed on understanding mechanisms of change. Specifically, the therapeutic relationship has been identified as a potential "active ingredient" of therapy. The evidence for the effects of eleven elements of the therapeutic relationship (alliance, collaboration, goal consensus, group cohesion, empathy, positive regard, feedback, emotional expression, outcome expectations, treatment credibility, alliance rupture-repair) on treatment outcomes in CBT for anxiety disorders was systematically reviewed. Fifty unique studies were included, and findings were qualitatively reviewed and summarised. Results revealed consistent and sizeable evidence for the cohesion-outcome and expectation-outcome relationships. There was emerging evidence for the effects of collaboration, empathy, and alliance rupture-repair on outcomes. However, the evidence for goal consensus and credibility on outcomes was limited. Notably, review of the alliance literature revealed substantial inconsistencies across studies. No studies were identified for positive regard, feedback, and emotional expression. Overall, further research is needed to clarify the role of the therapeutic relationship in CBT for anxiety disorders. These findings will contribute to the conceptual integration of therapeutic relationship constructs in cognitive behavioural models, and help to improve treatments and outcomes for individuals.
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Affiliation(s)
- Hoang K Luong
- School of Psychological Sciences, Monash University, Victoria, Australia
| | - Sean P A Drummond
- School of Psychological Sciences, Monash University, Victoria, Australia
| | - Peter J Norton
- The Cairnmillar Institute, Hawthorn East, Victoria, Australia.
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Abstract
The principal aim to this chapter is to present the latest ideas in virtual reality (VR), some of which have already been applied to the field of anxiety disorders, and others are still pending to be materialized. More than 20 years ago, VR emerged as an exposure tool in order to provide patients and therapists with more appealing ways of delivering a technique that was undoubtedly effective but also rejected and thus underused. Throughout these years, many improvements were achieved. The first section of the chapter describes those improvements, both considering the research progresses and the applications in the real world. In a second part, our main interest is to expand the discussion of the new applications of VR beyond its already known role as an exposure tool. In particular, VR is enabling the materialization of numerous ideas that were previously confined to a merely philosophical discussion in the field of cognitive sciences. That is, VR has the enormous potential of providing feasible ways to explore nonclassical ways of cognition, such as embodied and situated information processing. Despite the fact that many of these developments are not fully developed, and not specifically designed for anxiety disorders, we want to introduce these new ideas in a context in which VR is experiencing an enormous transformation.
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Affiliation(s)
| | | | - Giuseppe Riva
- Universita Cattolica del Sacro Cuore, Milan, Italy. .,ATN-P Lab, Istituto Auxologico Italiano, Milan, Italy.
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11
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Berke DS, Kline NK, Wachen JS, Mclean CP, Yarvis JS, Mintz J, Young-mccaughan S, Peterson AL, Foa E, Resick PA, Litz BT. Predictors of attendance and dropout in three randomized controlled trials of PTSD treatment for active duty service members. Behav Res Ther 2019; 118:7-17. [DOI: 10.1016/j.brat.2019.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/12/2019] [Accepted: 03/04/2019] [Indexed: 11/18/2022]
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Abstract
The processing and regulation of fear is one of the key components of posttraumatic stress disorder (PTSD). Fear can involve both acute and potential threats that can manifest in different behaviors and result from activity within different neural nodes and networks. Fear circuits have been studied extensively in animal models for several decades and in human neuroimaging research for almost 20 years. Therefore, the centrality of fear processing to PTSD lends the disorder to be more tractable to investigation at the level of brain and behavior, and provides several observable phenotypes that can be linked to PTSD symptoms. Moreover, psychophysiological metrics of fear conditioning offer tools that can be used to shift diagnostic paradigms in psychiatry toward neurobiology-consistent with a Research Domain Criteria approach to PTSD. In general, mammalian fear processing can be divided into fear learning (or acquisition), during which an association develops between previously neutral stimuli and aversive outcomes, and fear extinction, in which the latter associations are suppressed by a new form of learning. This review describes translational research in both fear acquisition and extinction, along with their relevance to PTSD and PTSD treatment, focusing specifically on the empirical value and potential clinical utility of psychophysiological methods.
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Lenz AS, Luo Y. Differential Estimation of Treatment Effect Between Clinician-Administered and Self-Reported PTSD Assessments. Journal of Counseling & Development 2019. [DOI: 10.1002/jcad.12230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- A. Stephen Lenz
- Department of Counseling and Educational Psychology, Texas A&M University-Corpus Christi
| | - Ye Luo
- Department of Counseling and Educational Psychology, Texas A&M University-Corpus Christi
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14
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Schumacher S, Niemeyer H, Engel S, Cwik JC, Knaevelsrud C. Psychotherapeutic treatment and HPA axis regulation in posttraumatic stress disorder: A systematic review and meta-analysis. Psychoneuroendocrinology 2018; 98:186-201. [PMID: 30193225 DOI: 10.1016/j.psyneuen.2018.08.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/29/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022]
Abstract
Posttraumatic stress disorder (PTSD) has been associated with dysregulation of the hypothalamic-pituitary- adrenal (HPA) axis. Research over the past years has investigated potential changes of these alterations in the context of psychotherapy. Yet, no systematic review has been conducted. To summarize the current state of research on psychotherapy and HPA hormones, namely cortisol, dehydroepiandrosterone and its sulfate form (DHEA(S)), we searched for studies investigating predictions or changes in hormones over treatment course within the databases PubMed, Scopus, Medline, PsychINFO, Pilots/ProQuest, and Web of Science, and in the grey literature up to May 2018. Controlled and uncontrolled trials investigating adult samples with a clinical status of PTSD were eligible for inclusion. Twelve studies (428 participants) were included. Study quality was overall sufficient. Hormone assessment designs differed considerably. Treatment efficacy on PTSD symptom reduction was mostly high, but predictions of pre-treatment hormone concentrations on treatment efficacy were largely non-significant. Changes from pre- to post-test in basal cortisol (g = -0.07, 95% CI = -0.36; 0.21) and in the cortisol awakening response (g = -0.07, 95% CI = -0.48; 0.35) were also non-significant. Future studies require comparable designs and need to be sufficiently powered to be able to detect potential associations with HPA regulation.
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15
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Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) results from exposure to traumatic events. Social support is negatively related to PTSD symptoms in cross-sectional and longitudinal studies. It is unclear, however, if social support is associated with treatment response for PTSD. The current study evaluated the extent to which social support was associated with PTSD treatment response among treatment-seeking veterans receiving prolonged exposure (PE). It was hypothesized that social support would improve PTSD treatment response and that PTSD symptom reduction would improve social support. METHOD A total of 123 veterans were recruited from a Veterans Affairs Medical Center and evaluated for PTSD, diagnostic-related symptoms, and social support. All participants received PE. Data were analyzed using mixed-effects models. RESULTS Findings suggested that elevated social support during treatment was associated with greater reductions in PTSD symptoms during treatment. Social support also increased during treatment. Increases in social support were not moderated by PTSD symptoms during treatment. CONCLUSIONS These findings suggest that social support and PTSD symptoms are related throughout treatment. Social support moderated the change in PTSD symptoms, whereas PTSD symptoms did not moderate changes in social support.
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Affiliation(s)
- Matthew Price
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Cynthia Luethcke Lancaster
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel F. Gros
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Alison C. Legrand
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Katherine van Stolk-Cooke
- Center for Research on Emotion, Stress, and Technology, Department of Psychological Science, University of Vermont, Burlington, VT, USA
| | - Ron Acierno
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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16
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Jerdan SW, Grindle M, van Woerden HC, Kamel Boulos MN. Head-Mounted Virtual Reality and Mental Health: Critical Review of Current Research. JMIR Serious Games 2018; 6:e14. [PMID: 29980500 PMCID: PMC6054705 DOI: 10.2196/games.9226] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 02/11/2018] [Accepted: 04/03/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND eHealth interventions are becoming increasingly used in public health, with virtual reality (VR) being one of the most exciting recent developments. VR consists of a three-dimensional, computer-generated environment viewed through a head-mounted display. This medium has provided new possibilities to adapt problematic behaviors that affect mental health. VR is no longer unaffordable for individuals, and with mobile phone technology being able to track movements and project images through mobile head-mounted devices, VR is now a mobile tool that can be used at work, home, or on the move. OBJECTIVE In line with recent advances in technology, in this review, we aimed to critically assess the current state of research surrounding mental health. METHODS We compiled a table of 82 studies that made use of head-mounted devices in their interventions. RESULTS Our review demonstrated that VR is effective in provoking realistic reactions to feared stimuli, particularly for anxiety; moreover, it proved that the immersive nature of VR is an ideal fit for the management of pain. However, the lack of studies surrounding depression and stress highlight the literature gaps that still exist. CONCLUSIONS Virtual environments that promote positive stimuli combined with health knowledge could prove to be a valuable tool for public health and mental health. The current state of research highlights the importance of the nature and content of VR interventions for improved mental health. While future research should look to incorporate more mobile forms of VR, a more rigorous reporting of VR and computer hardware and software may help us understand the relationship (if any) between increased specifications and the efficacy of treatment.
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Affiliation(s)
- Shaun W Jerdan
- Department of Digital Health, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Mark Grindle
- Department of Digital Health, Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Hugo C van Woerden
- Public Health Directorate, NHS Highland, Inverness, United Kingdom.,Centre for Health Science, University of the Highlands and Islands, Inverness, United Kingdom
| | - Maged N Kamel Boulos
- The Alexander Graham Bell Centre for Digital Health, Moray College UHI, University of the Highlands and Islands, Elgin, United Kingdom
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17
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Blais RK, Renshaw K, Christensen D. Biological attributions for postdeployment distress relate to higher likelihood of seeking mental health treatment in Iraq/Afghanistan service members/veterans. Military Psychology 2018. [DOI: 10.1080/08995605.2017.1420978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Rebecca K. Blais
- Department of Psychology, Utah State University, Logan, Utah
- Department of Psychology, University of Utah, Salt Lake City, Utah
| | - Keith Renshaw
- Department of Psychology, George Mason University, Fairfax, Virginia
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18
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Abstract
Psychological mechanisms can be defined as processes or events that are responsible for specific changes in psychological outcomes. In psychotherapy research, mechanisms are the factors through which interventions produce change. In this article, we explain the importance of identifying psychological mechanisms, describe methods for identifying them, and analyze recent literature on the psychological mechanisms underlying the development and treatment of posttraumatic stress disorder (PTSD). Based on the findings of recent investigations (from 2013 to present), we focus on four putative mechanisms: emotional engagement, extinction and contextualization, distress tolerance, and negative posttraumatic cognitions. Future directions for psychological mechanism research are also outlined, including possible opportunities for capitalizing on the most promising mechanisms identified to date.
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Affiliation(s)
- Rebecca K Sripada
- VA Center for Clinical Management Research, Health Services Research and Development, 2800 Plymouth Road, 48109, Ann Arbor, MI, USA. .,VA Ann Arbor Health Care System, 2215 Fuller Road, Ann Arbor, 48105, MI, USA. .,Department of Psychiatry, University of Michigan, 2450 Plymouth Road, 48109, Ann Arbor, MI, USA.
| | - Sheila A M Rauch
- Department of Psychiatry and Behavioral Sciences, Emory University, 12 Executive Park Drive NE #200, 30329, Atlanta, GA, USA.,Atlanta VA Medical Center, 1670 Clairmont Road, 30033, Decatur, GA, USA
| | - Israel Liberzon
- VA Ann Arbor Health Care System, 2215 Fuller Road, Ann Arbor, 48105, MI, USA.,Department of Psychiatry, University of Michigan, 2450 Plymouth Road, 48109, Ann Arbor, MI, USA
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Norrholm SD, Jovanovic T, Gerardi M, Breazeale KG, Price M, Davis M, Duncan E, Ressler KJ, Bradley B, Rizzo A, Tuerk PW, Rothbaum BO. Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy. Behav Res Ther 2016; 82:28-37. [PMID: 27183343 DOI: 10.1016/j.brat.2016.05.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 12/14/2022]
Abstract
Baseline cue-dependent physiological reactivity may serve as an objective measure of posttraumatic stress disorder (PTSD) symptoms. Additionally, prior animal model and psychological studies would suggest that subjects with greatest symptoms at baseline may have the greatest violation of expectancy to danger when undergoing exposure based psychotherapy; thus treatment approaches which enhanced the learning under these conditions would be optimal for those with maximal baseline cue-dependent reactivity. However methods to study this hypothesis objectively are lacking. Virtual reality (VR) methodologies have been successfully employed as an enhanced form of imaginal prolonged exposure therapy for the treatment of PTSD. Our goal was to examine the predictive nature of initial psychophysiological (e.g., startle, skin conductance, heart rate) and stress hormone responses (e.g., cortisol) during presentation of VR-based combat-related stimuli on PTSD treatment outcome. Combat veterans with PTSD underwent 6 weeks of VR exposure therapy combined with either d-cycloserine (DCS), alprazolam (ALP), or placebo (PBO). In the DCS group, startle response to VR scenes prior to initiation of treatment accounted for 76% of the variance in CAPS change scores, p < 0.001, in that higher responses predicted greater changes in symptom severity over time. Additionally, baseline cortisol reactivity was inversely associated with treatment response in the ALP group, p = 0.04. We propose that baseline cue-activated physiological measures will be sensitive to predicting patients' level of response to exposure therapy, in particular in the presence of enhancement (e.g., DCS).
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