Talking treatment in general.
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1201 to 1225 of 1,623Ethnoracial status, intersectionality with gender, and psychotherapy utilization, retention, and outcomes.
Objective: Psychotherapy access, utilization, retention, and effectiveness require continued improvement, especially for groups for whom availability and outcomes may be currently suboptimal, including ethnoracial minorities. Further, ethnoracial status' intersectionality with other identity variables (e.g., gender) may relate to structural barriers to care and effectiveness of care, an area in need of further research.
Method: The Florida State University Psychology Clinic, a low-cost population-facing treatment center, has routinely collected clinically relevant information on all consenting clients, including severity of clinical presentation at intake and over time, number of therapy sessions attended and of no-shows, premature termination, demographics, etc. A large sample of clients (N = 2,076; 57% women; 67.9% non-Hispanic White) on whom we collected and entered at least some data…
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The long-term outcome of accelerated experiential dynamic psychotherapy: 6- and 12-month follow-up results.
Accelerated experiential dynamic psychotherapy (AEDP; Fosha, 2000, 2021b) is an integrative, healing-oriented, mind-body, affect-focused therapy. A posttreatment outcome study demonstrated AEDP's effectiveness (Iwakabe et al., 2020) on a variety of measures of psychological functioning. This study sought to address AEDP's long-term effectiveness. As previously reported, 63 adult patients completed a 16-session AEDP treatment with qualified therapists in private practice in the United States, Canada, Israel, Japan, and Sweden. Forty patients responded to 6-month follow-up and 52 responded to 12-month follow-up. Results indicate that patients maintained their posttreatment therapeutic gains, both 6 and 12 months later. Large effect sizes (d = 0.74 to d = 1.60) both for reductions on measures of psychopathology (e.g., depression, negative automatic thoughts, experiential avoidance) and impr…
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The Effectiveness of Family Constellation Therapy in Reducing Psychopathological Symptoms in a Naturalistic Setting.
Background: The aim of this study (ClinicalTrials.gov identifier: NCT03233958) was to provide further evidence on the effectiveness and safety of family/systemic constellation therapy, a widely used but rarely investigated form of brief group psychotherapy.
Subjects and methods: Altogether, 102 individuals from the general population were followed up 1- and 6 months after their participation in the 2-day intervention. Indicators of general and problem-area-specific psychopathology, interpersonal quality of life, meaning in life, and general wellbeing were assessed. Both statistical and clinical significance were considered, and active surveillance of potential iatrogenic effects was also conducted.
Results: The data showed significant improvement post-intervention in the case of the vast majority of the 17 outcome variables. At 1-month follow-up, the magnitude of improvements was typical…
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Gender differences in the treatment of patients with borderline personality disorder.
It is debated whether men with borderline personality disorder (BPD) are less often treated for their disorder, compared to women, even when they have sought care. Here, the aim was to examine gender differences in the treatment of patients with BPD. Through linkage to Swedish health and administrative registers, we identified all patients diagnosed with BPD (n = 5530) in Stockholm County from 2012 to 2016. We ascertained information on sociodemographic characteristics, comorbid psychiatric diagnoses, and all mental health care utilization within inpatient and outpatient mental health care, including receipt of psychiatric medication and various psychological therapies. We identified 802 men and 4,728 women with BPD during the study period. Men with BPD were less likely than their female counterparts to be treated with psychotherapy as well as psychiatric medication. Most of the differen…
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The process and outcome of spiritually integrated psychotherapies: A cross-cultural study in Asia, Africa, Europe, and Latin America.
We investigated the process and outcome of spiritually integrated psychotherapies (SIPs) with 34 Catholic therapists and 359 clients in Asia, Africa, Europe, and Latin America using a practice-based evidence design. The three most frequently used spiritual interventions across all therapists were: "encouraging personal prayer," "affirming trusting God," and "encouraging listening to the heart," but "discussing hope" was also one of the top three in Asia and Africa, "self-control" in Asia, "spiritual confrontation" and "self-disclosure" in Latin America, and "listening to spiritual issues" in Europe. In addition, using growth curve analyses, we found a significant decrease in both spiritual and nonspiritual distress over the course of SIPs; the levels of spiritual and nonspiritual concerns were highly correlated (but distinct) at any given time point. Also, the nonspiritual outcomes at on…
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Bridging religion and spirituality with gestalt psychotherapy to improve clinical symptoms: Preliminary findings using gestalt pastoral care.
An inherent tension between religion and psychotherapy has inhibited the conversation between the two paradigms in determining the most effective approaches to improving mental health outcomes for people of faith. Preliminary research has suggested that the intersection between the two may prove fruitful in providing mental health interventions. As a part of a broader big-data study sponsored by the Bridges Consortium of Brigham Young University and underwritten by the John Templeton Foundation, the present study evaluated the effectiveness of the spiritually integrated strategies of the modality Gestalt Pastoral Care (GPC) focusing on two goals: (a) determining the overall clinical effectiveness of GPC, not previously scientifically validated, and (b) evaluating the effectiveness of GPC in the reduction of symptoms most commonly seen in clients using empirically validated clinical measu…
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Abel MR, Bianco A, Gilbert R, Schleider JL (2022)MEDLINE-indexed journal, not yet read by usJournal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 5312 citations When is Psychotherapy Brief? Considering Sociodemographic Factors, Problem Complexity, and Problem Type in U.S. Adolescents.
Objective: When psychotherapy is brief (1-2 sessions), "early dropout" - defined as premature treatment discontinuation due to financial or structural barriers - is a commonly assumed cause. However, there are several possible reasons why treatment may be brief, including youth-level factors such as psychopathology complexity or problem type. Better characterizing whether factors beyond financial and structural barriers predict adolescents' receipt of briefer (versus longer-term) treatment may guide efforts to retain specific youth in longer-term services - and disseminate intentionally brief interventions to youth potentially positioned to benefit. Method: Using data from the 2017 SAMHSA National Survey on Drug Use and Health, we examined whether sociodemographic disadvantage (minority race, low-income, government assistance), perceived problem type, and psychopathology complexity (1 ve…
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Cultural adaptation of meaning-centered psychotherapy for latino families: a protocol.
Introduction: Literature suggests couple-based interventions that target quality of life and communication can lead to positive outcomes for patients with cancer and their partners. Nevertheless, to date, an intervention to address the needs of Latino families coping with advanced cancer has not been developed. Meta-analytic evidence suggests that culturally adapted evidenced-based intervention targeting a specific cultural group is four times more effective. Our goal is to culturally adapt a novel psychosocial intervention protocol entitled 'Caregivers-Patients Support to Latinx coping advanced-cancer' (CASA). We hypothesised that combine two evidence-based interventions and adapting them, we will sustain a sense of meaning and improving communication as patients approach the end of life among the patient-caregiver dyad.
Methods and analysis: To culturally adapt CASA, we will follow an …
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Kleinbub JR, Ramseyer FT (2021)MEDLINE-indexed journal, not yet read by usPsychotherapy research : journal of the Society for Psychotherapy Research40 citations rMEA: An R package to assess nonverbal synchronization in motion energy analysis time-series.
Introduction. Motion Energy Analysis (MEA) is a procedure that allows to automatically assess the amount of persons' movement from video recordings. Recent studies used MEA to investigate nonverbal synchrony, i.e., the occurrence of simultaneous movement, suggesting the existence of an association with relationship quality. In patient-therapist dyads, synchrony predicted therapeutic alliance, empathy, as well as treatment outcome. Package description. The article presents rMEA, an open-source R package that allows to import, filter, and visualize dyadic time-series of nonverbal behaviour generated by other MEA software. The package includes a fast, state-of-the-art, moving window cross-correlation algorithm with lag analysis, which provides a user-friendly interface for the assessment of nonverbal synchrony. Through the analysis of a motivating example (40 psychotherapy intake interviews…
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Borderline Personality Disorder: A Case for the Right Treatment, at the Right Dose, at the Right Time.
There is now compelling evidence that a range of psychotherapeutic treatments are effective in the treatment of borderline personality disorder (BPD). Such treatments are often lengthy, expensive, subject to high rates of incompletion and are rarely available to people with sub-threshold symptoms. There is broad agreement that some combination of vulnerability, invalidating environment, childhood adversity, disrupted attachment in childhood or trauma play a role in the aetiology of the syndrome of BPD. These factors also contribute to problems with the capacity to mentalise, regulate emotions, tolerate distress and impact on psychosocial development with or without self-damaging and suicidal behaviour. This column takes as a given that people with BPD should receive evidence-based psychological treatments such as dialectical behaviour therapy (DBT), interpersonal therapy and cognitive be…
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Infertility-related distress and clinical targets for psychotherapy: a qualitative study.
Objectives: An estimated 30%-40% of women attending infertility tertiary care facilities experience clinically significant depression and anxiety. However, current psychological interventions for infertility are only modestly effective in this population. In this study, we aimed to identify the specific psychological components of infertility-related distress to assist in the development of a more targeted and effective therapeutic intervention. To our knowledge, this study is the first of its kind to include the views and opinions of mental health professionals who specialise in the field of infertility and the first to explore therapies currently used by mental health professionals.
Design: A qualitative approach using semistructured individual interviews and focus group interviews with women who have experience with infertility and also mental health professionals specialising in the …
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Selecting the optimal treatment for a depressed individual: Clinical judgment or statistical prediction?
Background: Optimizing treatment selection is a way to enhance treatment success in major depressive disorder (MDD). In clinical practice, treatment selection heavily depends on clinical judgment. However, research has consistently shown that statistical prediction is as accurate - or more accurate - than predictions based on clinical judgment. In the context of new technological developments, the current aim was to compare the accuracy of clinical judgment versus statistical predictions in selecting cognitive therapy (CT) or interpersonal psychotherapy (IPT) for MDD.
Methods: Data came from a randomized trial comparing CT (n=76) with IPT (n=75) for MDD. Prior to randomization, therapists' recommendations were formulated during multidisciplinary staff meetings. Statistical predictions were based on Personalized Advantage Index models. Primary outcomes were post-treatment and 17-month fol…
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Fairley M, Humphreys K, Joyce VR, Bounthavong M, Trafton J, Combs A, Oliva EM, Goldhaber-Fiebert JD, Asch SM, Brandeau ML, Owens DK (2021)MEDLINE-indexed journal, not yet read by usJAMA psychiatry85 citations Cost-effectiveness of Treatments for Opioid Use Disorder.
Importance: Opioid use disorder (OUD) is a significant cause of morbidity and mortality in the US, yet many individuals with OUD do not receive treatment.
Objective: To assess the cost-effectiveness of OUD treatments and association of these treatments with outcomes in the US.
Design and setting: This model-based cost-effectiveness analysis included a US population with OUD.
Interventions: Medication-assisted treatment (MAT) with buprenorphine, methadone, or injectable extended-release naltrexone; psychotherapy (beyond standard counseling); overdose education and naloxone distribution (OEND); and contingency management (CM).
Main outcomes and measures: Fatal and nonfatal overdoses and deaths throughout 5 years, discounted lifetime quality-adjusted life-years (QALYs), and costs.
Results: In the base case, in the absence of treatment, 42 717 overdoses (4132 fatal, 38 585 nonfatal) and 12 6…
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Psychotherapy in a resource-constrained setting: Understanding context for adapting and integrating a brief psychological intervention into primary care.
Low- and middle-income countries have few mental health professionals, and efforts to increase access to treatment are a global priority. A key gap is the lack of integration of psychotherapy interventions as a part of accessible evidence-based care. Current recommendations suggest that the integration of mental health treatments, including psychotherapy, into existing primary care pathways may serve as a means to address this disparity. Understanding the cultural and contextual factors that affect this process is a critical step in identifying necessary adaptations. The aim of this qualitative study was to identify contextual factors associated with integrating psychotherapy in primary care in a predominantly rural district in south-central Ethiopia. Purposive sampling was used to recruit 48 mental health service users, caregivers, health care providers, and community leaders. Semistruc…
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Alliance predicting progress in couple therapy.
The therapeutic alliance has gained status as a common factor in psychotherapy due to its robust predictive relationship with outcome. The current challenge in our field is to gain a more nuanced understanding of alliance's impact on the progress of treatment over the course of therapy. In the current study, alliance was measured on 3 dimensions: (a) the individual's as well as the couple's joint perception of alliance with the therapist ("self/group-therapist"), (b) each partner's perception of the alliance between the spouse and the therapist ("other-therapist"), and (c) the couple's assessment of alliance with each other ("within-system"). Based on self-reported data from 165 adult clients, we analyzed whether scores on these alliance dimensions at the beginning of therapy predicted the frequently measured outcomes on individual symptoms and relationship distress during treatment. We …
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Predictors of Patients' Responses to Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT).
Objective: Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT) is a flexible clinical protocol for delivering spiritually integrated group psychotherapy within acute psychiatric settings. The authors evaluated SPIRIT's feasibility by examining patients' perceptions of its benefits and clinical and spiritual predictors of observed effects associated with this intervention.
Methods: Over a 1-year period, 22 clinicians stationed on 10 clinical units provided SPIRIT to 1,443 self-referred patients with a broad range of demographic, clinical, and spiritual and religious characteristics.
Results: Overall, patients' perceptions of benefit from SPIRIT were not associated with demographic factors. Clinical factors similarly did not predict treatment responses, suggesting that SPIRIT is equally suitable for patients with mood, anxiety, traumatic, substance use, psy…
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Group counseling change process: An adaptive spiral among positive emotions, positive relations, and emotional cultivation/regulation.
Research has provided empirical support for the effectiveness of group psychotherapy. However, we have little understanding of mechanisms that account for the effectiveness. Thus, there is a need for complex theory-driven hypotheses and analytical models to understand the complexities of change in group counseling. We used Fredrickson's broaden-and-build theory as well as Yalom and Leszcz's proposition about adaptive spirals as guiding frameworks. We then examined the process of how positive emotions or positive relations and emotional cultivation (regulation) reciprocally influence one another to create an upward or adaptive spiral toward greater well-being over the course of group interventions. A total of 196 Taiwanese children and adolescent clients across 33 groups participated in an 8-session emotional cultivation/regulation group intervention. The random intercepts cross-lagged pa…
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Pugh M, Bell T, Dixon A (2021)MEDLINE-indexed journal, not yet read by usPsychotherapy research : journal of the Society for Psychotherapy Research13 citations Delivering tele-chairwork: A qualitative survey of expert therapists.
Objective: Recent years have seen a significant and rapid increase in the provision of tele-therapies. Chairwork methods such as empty-chair dialogues and role-play represent a "common" category of therapeutic interventions which are utilized in many psychotherapeutic approaches. However, guidelines for facilitating chairwork in tele-therapy are currently lacking. The aim of this study was to survey expert providers regarding how chairwork is best provided in internet-delivered psychotherapy. Method: Forty one experts were recruited from a range of therapeutic backgrounds including cognitive behaviour therapy, compassion focused therapy, emotion focused therapy, psychodrama, schema therapy, and voice dialogue. Participants completed a brief questionnaire survey exploring the delivery of tele-chairwork. Responses were analysed using thematic analysis. Results: Five themes were identified:…
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Veterans' perspectives on discussing moral injury in the context of evidence-based psychotherapies for PTSD and other VA treatment.
Objective: We examined Veterans' perspectives on discussing moral injury in veterans affairs (VA) evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) and other VA treatment.
Methods: Fourteen male warzone veterans (ages 25-74) who completed an EBP for PTSD within the past year participated in semistructured interviews related to discussing moral injury in VA treatment (e.g., EBPs for PTSD, chaplaincy). Qualitative interviews were evaluated using a thematic analysis.
Results: Four themes were identified; moral injury is often not identified or discussed during therapy, therapeutic relationships can promote or inhibit discussion of moral injury, treatment has limited impact on moral injury, and it is difficult to cope with moral injury even after treatment.
Conclusion: The majority of Veterans interviewed identified moral injury persisting within a year of comple…
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Understanding Preferences for Addressing Spirituality Among Adults Seeking Outpatient Mental Health Care.
Focusing on 472 religiously heterogenous adult patients seeking psychotherapy at a university-based outpatient clinic, this brief report examined (1) these patients' preferences about clinicians appreciating their religion and/or spirituality (R/S) backgrounds (spiritually affirming) and addressing spiritual concerns in treatment (spiritually integrated) and (2) role of demographic factors and psychological functioning in predicting preferences for R/S integration. Analyses revealed that more than half of patients reported moderate or greater importance for spiritually affirming care and one-third hoped to address spiritual issues. Furthermore, these factors emerged as indicators of stronger preferences for R/S integration: female sex, racial minority status (African American, Native American), history of marriage (past and present), affiliation to organized religion (Christianity, Islam…
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Kam C (2020)MEDLINE-indexed journal, not yet read by usThe journal of pastoral care & counseling : JPCC Growth in Adult Ego Development and Mentalizing Emotions for an Increasingly Multidimensional God Image.
Growth in cognitive complexity in the framework of adult ego development has shown to enable sophistication in mentalizing interpersonal emotions. This has implications for cultivating a more multidimensional God Image for spirituality in the Judeo-Christian tradition. The construct of mentalization will be used to understand the integration of these concepts. Empirical findings that support this conceptual integration will be explored. Clinical applications for spiritually integrated psychotherapy will follow.
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Bridging the gap between complexity science and clinical practice by formalizing idiographic theories: a computational model of functional analysis.
Background: The past decades of research have seen an increase in statistical tools to explore the complex dynamics of mental health from patient data, yet the application of these tools in clinical practice remains uncommon. This is surprising, given that clinical reasoning, e.g., case conceptualizations, largely coincides with the dynamical system approach. We argue that the gap between statistical tools and clinical practice can partly be explained by the fact that current estimation techniques disregard theoretical and practical considerations relevant to psychotherapy. To address this issue, we propose that case conceptualizations should be formalized. We illustrate this approach by introducing a computational model of functional analysis, a framework commonly used by practitioners to formulate case conceptualizations and design patient-tailored treatment.
Methods: We outline the ge…
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Agin-Liebes GI, Malone T, Yalch MM, Mennenga SE, Ponté KL, Guss J, Bossis AP, Grigsby J, Fischer S, Ross S (2020)MEDLINE-indexed journal, not yet read by usJournal of psychopharmacology (Oxford, England)218 citations Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer.
Background: A recently published randomized controlled trial compared single-dose psilocybin with single-dose niacin in conjunction with psychotherapy in participants with cancer-related psychiatric distress. Results suggested that psilocybin-assisted psychotherapy facilitated improvements in psychiatric and existential distress, quality of life, and spiritual well-being up to seven weeks prior to the crossover. At the 6.5-month follow-up, after the crossover, 60-80% of participants continued to meet criteria for clinically significant antidepressant or anxiolytic responses.
Methods: The present study is a long-term within-subjects follow-up analysis of self-reported symptomatology involving a subset of participants that completed the parent trial. All 16 participants who were still alive were contacted, and 15 participants agreed to participate at an average of 3.2 and 4.5 years followi…
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Worldwide implementation of clinical services for the prevention of psychosis: The IEPA early intervention in mental health survey.
Background: Clinical research into the Clinical High Risk state for Psychosis (CHR-P) has allowed primary indicated prevention in psychiatry to improve outcomes of psychotic disorders. The strategic component of this approach is the implementation of clinical services to detect and take care of CHR-P individuals, which are recommended by several guidelines. The actual level of implementation of CHR-P services worldwide is not completely clear.
Aim: To assess the global geographical distribution, core characteristics relating to the level of implementation of CHR-P services; to overview of the main barriers that limit their implementation at scale.
Methods: CHR-P services worldwide were invited to complete an online survey. The survey addressed the geographical distribution, general implementation characteristics and implementation barriers.
Results: The survey was completed by 47 CHR-P s…
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The Findings of a Cochrane Meta-Analysis of Couple Therapy in Adult Depression: Implications for Research and Clinical Practice.
The association between depressive symptoms and distressed intimate relationships supported the assumption that couple therapy, by focusing on the interpersonal context of depression, might be more effective as a treatment for depression than individual psychotherapy or drug therapy. This issue was addressed by a Cochrane meta-analysis assessing the evidence from clinical trials of couple therapy for depression in comparison with individual psychotherapy, drug therapy, and no/minimal intervention, including fourteen studies with 651 participants. No study was found free of bias and the quality of the evidence was low, with major problems of small sample sizes, missing outcome data, selective reporting, lack of information on random sequence generation and allocation concealment, recruitment of people not representative of clinical practice, and allegiance bias. The meta-analysis showed t…
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